2022-familyplanning-SF.pdf

Nursing Care for the Family in Need of Reproductive Life Planning Rev Oct 2022 Within 2 hours of SLA, students should be able to:  Define reproductive life planning Describe common methods of reproductive life planning and the advantages, disadvantages, and risk factors associat...

Nursing Care for the Family in Need of Reproductive Life Planning Rev Oct 2022 Within 2 hours of SLA, students should be able to:  Define reproductive life planning Describe common methods of reproductive life planning and the advantages, disadvantages, and risk factors associated with each. Formulate nursing diagnoses related to reproductive life planning concerns. Using the nursing process, plan nursing care that includes the six competencies of Quality & Safety Education for Nurses (QSEN).  Reproductive Life Planning Includes all decisions an individual or a couple make about having children, including – If and when to have children – How many children to have – The length of time between having children Counseling may include the topics of avoiding conception, increasing fertility, and/or what to do if contraception has failed.  Contraceptive Any device used to prevent fertilization of an egg An ideal contraception is.. 104 Safe Effective Compatible with spiritual and cultural beliefs and personal preferences Free of bothersome side effects Convenient to use/ easily obtainable Affordable Needs few instructions Free of effects after discontinuation Areas to Assess in Making Choices About Contraceptive Methods Personal values Ability to use method correctly Impact on sexual enjoyment Financial factors Length of projected relationship (short term versus long term) Past experience with contraception Future plans regarding pregnancy  Areas to Assess in Making Choices.. Vital signs, Pap smear, gonococcal and chlamydial screening Obstetric history, including STIs, past pregnancies, previous elective abortions, failure of previously used methods, and compliance history with past methods Patients’ beliefs, needs, feelings, and understanding of conception Current and anticipated sexual practices, number of partners, feelings, and body image Categories of Commonly Used Birth Control Methods Natural family planning Barrier methods Hormonal contraceptives Intrauterine devices (IUDs) Surgical methods NATURAL FAMILY PLANNING 1. Periodic abstinence methods – No chemical or foreign material into body – Failure rate ranges from 2% to 25% – Need for couple to be conscious of time period when woman is most likely to be fertile Abstinence – 0% failure rate – Most effective method to prevent sexually transmitted infections (STIs)  Natural … 2. Lactation amenorrhea method Failure rate - 1 to 5% Under six months of age – Breastfeeding with no supplements – Menses has not returned Totally breastfed at least daytime -q 4hours night- q 6 hours no supplementary feedings Not dependable- woman may be fertile even if she has not had a period since childbirth After 6 months, she should use another method of contraception **  Natural …. 3. Coitus interruptus (Withdrawal) Oldest method Couple proceeds with coitus until the moment of ejaculation, then the man withdraws and spermatozoa are emitted outside the vagina Offers little protection because ejaculation may occur before withdrawal is complete and despite the care used, spermatozoa may be deposited in the vagina Effective – 82% does not prevent STIs  Side effects of NFP None Not choice of adolescents Issues on -perimenopausal women - postpartal woman  Natural.. 4. FERTILITY AWARENESS METHODS Detecting when the woman will be capable of impregnation so abstinence can be used. sperm survival – 3 to more than 5 days Ova- 1 day (last up to 48 hours) Fertile period- 5 days before ovulation to 1 day after. Fertility Awareness Methods Calendar (rhythm) method Basal body temperature Cervical mucus (Billings) method Symptothermal method Ovulation awareness/detection Standard days method: Use of Cycle beads 2 Day method Marquette model Calendar/ Rhythm (Natural Family Planning) Action – periodic abstinence from intercourse during fertile period; based on the regularity of ovulation; variable effectiveness  Calendar (rhythm) method Entails keeping a day-by-day record of your cycle for 6 consecutive months This 6 month record will show you your longest and shortest cycles- from which you can calculate your FERTILE days Calendar (rhythm) method The first day of menstrual bleeding (day 1 of your period) counts as the first day of the cycle. Approximately 14 days (or 12 to 16 days) before the start of the next period, an egg will be released by one of the ovaries. While the egg from the woman lives for only around 24 hours, sperm from the man can survive for up to 3 days, possibly longer.  Calendar (rhythm) method First unsafe day: subtract 18 from the number of days in your shortest cycle Last unsafe day: subtract 11 from the number of days in your longest cycle Ex: shortest: 26 – 18 = day 8 longest: 31 – 11 = day 20 UNSAFE PERIOD!! Days 8 -20 -Avoid coitus or use a contraceptive 1. Calendar (rhythm) method  2. Basal Body Temperature Involves taking the temperature every morning BEFORE the woman gets out of bed and recording it The temperature drops slightly 0.5 F 24 hours before ovulation, then rises to about half a degree higher than normal and remains thus for up to three days: UNSAFE period! Not a very efficient method unless combines with calendar and mucus methods 3 to 25% failure rate 3. Cervical Mucus (Billings) Method Involves becoming aware of the normal changes in the cervical secretions that occur throughout your cycle by inserting the forefinger into the vagina first thing in the morning  Cervical Mucus (Billings) Method A few days after menstrual bleeding: little secretion, vagina is dry Gradually, secretion increases and becomes thicker, cloudy white and sticky As ovulation approaches, this secretion or mucus becomes copious, clear, thin, less viscous, more liquid, slippery or stringy; as soon as this change begins and for 3 to 4 days later: UNSAFE PERIOD!! Cervical Changes Spinnbarkeit test = Cervical mucus is thin, watery and can be stretched into long strands high level of estrogen: ovulation is about to occur Cervical Changes 95 Ferning of cervical mucus At the height of estrogen stimulation just before ovulation Ferning- due to crystallization of sodium chloride on mucus fibers  4. 2-day Method Assessing vaginal secretions daily for 2 days Suggests fertility Avoids coitus 12 days per month  5. Symptothermal method Combines BBT and cervical mucus methods Observes for other signs of ovulation - cervical mucus -BBT - cervix position and softness **developed in 1990  6. Ovulation awareness Use of over-the-counter OTC ovulation test kit which detects the midcycle LH (luteinizing hormone) surge in the urine 12 to 24 hours before ovulation 98 to 100% accurate  7. Marquette Model is a fertility awareness method that teaches women to identify their fertile window and their periods of infertility by using an electronic hormonal fertility monitor and their cervical mucus. 98% effective https://www.youtube.com/watch?v=j8- mXoNUnA8  Post coital douching Ineffective  Barrier Methods Barrier methods are those that place a chemical or latex barrier between the cervix and advancing sperm. – Spermicides – Male and female condoms – Diaphragm – Cervical cap SPERMICIDES Goal: death of the sperm before the sperm enters the cervix - Changes the vaginal ph to strong acid level - No protection for STIs -Nonoxynol-9 -gel, creams, films, foams, suppositories - 1hour before coitus - CI: women with acute cervicitis MALE CONDOM - 2 to 15 % failure rate - Advantages: male responsibility - No prescription - for couples not engaged in monogamous relationship  FEMALE CONDOM Latex or polyurethane made - inserted before coitus One time use only No prescription needed Not use together with male condom 5 to 15% FR Protects from STIs Not popular – bulky, difficult to use Sensitivity or allergy to latex DIAPHRAGM -mechanically halt sperm from entering the cervix -soft latex dome supported by a metal rim - maybe added with spermicidals can be inserted 2 hours before intercourse; removed at least 6 hours after coitus or within 24 hours -size must fit the individual - initially fitted by a doctor -washable, may be used for 2 years - 6 to 18% FR CERVICAL CAP similar to diaphragm but smaller -thimble-shaped rubber cap held onto the cervix by suction can be left for 48 hours Failure rate- 23 to 35%  Contraindications/side effects Abnormal uterus and cervix High incidence of UTIs Other infection Allergies Chief method for adolescents  Hormonal Contraceptives Hormones that cause fluctuations in the normal menstrual cycle to prevent ovulation or normal transport – Oral contraceptive (combination of hormones) – Oral contraceptives (progestin only) – Transdermal patch – Intravaginal ( vaginal rings) – Intramuscular injections – Subdermal hormone implants Oral contraceptives (combination of hormones) Aka: OC, COC Composed of varying amounts of estrogen combined with small amount of progesterone Estrogen suppresses FSH and LH, thereby suppressing ovulation Progesterone decreases the permeability of cervical mucus 99.5% effective Oral contraceptives (combination of hormones) Types: Monophasic- - Fixed doses of estrogen and progesterone ; 21 day cycle Biphasic- - Constant amount of estrogen with varrying progesterone Triphasic & Tetraphasic- Varying levels of estrogen and progesterone Oral contraceptives (progestin only) Oral contraceptives (combination of hormones)  How to start 114 Sunday start Quick start 1st day start After childbirth Not effective for 1st 7 days- Provide back up contraceptive  Oral Contraceptives Benefits of OC’s: DECREASED incidences of: Dysmenorrhea Premenstrual dysphoric syndrome Iron deficiency anemia Acute PID with tubal scarring Endometrial and ovarian cancer and ovarian cysts Fibrocystic breast disease  Oral Contraceptives Side Effects Nausea Weight gain Headache Breast tenderness Breakthrough bleeding Monilial vaginal infections Mild hypertension Depression  Oral Contraceptives Absolute Contraindications to OC’s Breastfeeding Family history of CVA or CAD History of thromboembolic disease History of liver disease Undiagnosed vaginal bleeding Possible Contraindications to OC’s Age 40+ Breast or reproductive tract malignancy Diabetes Mellitus Elevated cholesterol or triglycerides High blood pressure Mental depression  Possible Contraindications to OC’s Migraine or other vascular type headaches Obesity Pregnancy Seizure disorders Sickle cell or other hemoglobinopathies Smoking Use of drug with interaction effect  Estrogen-progesterone transdermal patch Highly effective, weekly hormonal birth control patch that’s worn on the skin Combination of estrogen and progestin Absorbed on the skin and then transferred into the bloodstream Can be worn on the upper outer arm, buttocks, trunks or abdomen Worn for 1 week, replaced on the same day of the week for 3 consecutive weeks. No patch-4th week Less effective for obese women  Vaginal estrogen /progestin rings Inserted vaginally and left for 3 weeks and removed for 1 week for menstruation Absorb directly by mucus avoiding “ first pass” through the liver Not removed for intercourse As effective with COC If removed > 4 hours – replace with new  Subcutaneous implants e.g Norplant 6 non biodegradable Silastic implants with synthetic progesterone embedded under the skin on the inside of the upper arm Inserted within 7 days of menses Slowly release the hormone over the next 5 years Suppress ovulation, stimulating thick cervical mucus and changing the endometrium so implantation is difficult  Implant side effects Weight gain Irregular menstruation Depression Scarring Need for removal CI: desire for pregnancy within 1 year  Intramuscular Method DMPA - Depo Provera Every 12 week, inhibits ovulation, alters endometrium and thickens cervical mucus 100% effectiveness- popular Can be used during breastfeeding Advantages- reduce ectopic pregnancy, endometrial cancer, others Side effects: headache, weight gain , depression, Menstrual problem  Intrauterine Devices (IUDs) – Copper T380 – Levonorgestrel-releasing intrauterine system (Mirena or Liletta) – Levonorgestrel-releasing intrauterine system 13.5 mg (Skyla) – Levonorgestrel-releasing intrauterine system 19.5 mg (Kyleena)  INTRAUTERINE DEVICES A small plastic device inserted into the uterus to prevent fertilization and/or decrease sperm motility T-shaped plastic device with copper With progesterone Mechanism of action not fully understood Must be fitted by physician, nurse practitioner or midwife Insertion performed in ambulatory setting after pelvic examination and pap smear Maybe used with within 5 days of unprotected sex Device is contained within uterus – string protrudes into vagina Effective for 5 years (Mirena type) or 10 years (Copper T380) Almost 100% effective INTRAUTERINE DEVICE  INTRAUTERINE DEVICES Side Effects: Spotting or uterine cramping Increased risk for PID Heavier menstrual flow Dysmenorrhea Ectopic pregnancy Emergency Postcoital Contraceptives For use in emergency only (such as rape) “Morning-after pills” MAP High dose progestin based pills Insertion of copper IUD Ulipristal acetate ( Ella) Must be initiated within 72 hours of unprotected intercourse Surgical Methods Tubal Ligation -28% of all women in US -fallopian tubes are cut,/tied/ cauterized to block passage of ova and sperm - 99.5% effective  Laparoscopy for tubal sterilization Surgical Methods Vasectomy 11% of all men in US - incisions are made in the sides of scrotum; vas deferens is cut and tied, then plugged or cauterized - blocks passage of sperm - viable sperm for 6 months post op - 99.5% effective - reversible 95% - 2 (-) sperm report at 6 and 10 weeks  Elective Termination of Pregnancy (Induced Abortion) Procedure to deliberately end a pregnancy before fetal viability Induced (mifepristone-progesterone antagonist; misoprostol-prostaglandin analog - 97% effective during 1st 63 days of pregnancy Medically induced D&C, D&E, saline induction, Hysterotomy  Nursing Diagnosis pp102 Readiness for enhanced knowledge regarding contraception options Deficient knowledge RT to different methods of contraception Decisional conflict Powerlessness Altered sexuality pattern Risk for ineffective health maintenance Examples of Nursing Diagnoses and Outcomes Related to Reproductive Life Planning Nursing Diagnosis Outcome Readiness for enhanced knowledge Patient/partners will identify and use the regarding contraception options related contraception option most likely to fit to a desire to prevent pregnancy their belief system, needs, and resources. Deficient knowledge related to use of a Patient is able to demonstrate proper diaphragm diaphragm insertion. Altered sexuality pattern related to fear Couple will be able to identify specific of pregnancy factors related to fear of pregnancy that may contribute to the altering of their usual pattern of sexuality.  Interventions Related to Reproductive Life Planning Nursing Diagnosis Possible Nursing and Therapeutic Interventions Readiness for enhanced knowledge Help patient/partners choose the regarding contraception options contraceptive method that best related to a desire to prevent fits their beliefs, needs, and pregnancy resources. Teach patient/partners how to use their chosen contraceptive method. Deficient knowledge related to use Teach or review with the woman of a diaphragm the steps in proper diaphragm insertion. Altered sexuality pattern related to Explore with the couple their fear of pregnancy beliefs and feelings related to use of various types of contraception. Discuss failure rates of various contraceptive methods.  Evaluating Outcomes Related to Reproductive Life Planning Nursing Diagnosis Expected Outcomes Readiness for enhanced knowledge Patient/partners report that they are regarding contraception options related successfully using their chosen to a desire to prevent pregnancy contraception method. Patient/partners report that they are satisfied with their chosen contraception method. Deficient knowledge related to use of a diaphragm ? Altered sexuality pattern related to fear of pregnancy ? Thank you! Rev Oct 2022