Nursing Maternity and Women's Health Past Paper PDF

NURS 3450 Maternity and Women’s Health Nursing Infection Maternal effects Fetal effects Newborn effects newborn if the mother develops varicella between 5 days before and 2 days after birth because the infant’s immune system is immature and there has been insufficient time for transplacental transfe...

NURS 3450 Maternity and Women’s Health Nursing Infection Maternal effects Fetal effects Newborn effects newborn if the mother develops varicella between 5 days before and 2 days after birth because the infant’s immune system is immature and there has been insufficient time for transplacental transfer of maternal antibodies. The death rate is high among these infants. Infants born to mothers within this time frame of exposure should receive varicella zoster immune globulin as soon as possible after birth (AAP, 2021). Chapter 8 Contraception 1. What factors should be considered when helping a patient determine best method of contraception for her? In most cases, the woman herself seeks contraception through an appointment at a health care facility, although in some situations, her partner may accompany her. The assessment and evaluation involve inquiring about the partner or partners in terms of sexual practices, risk for STIs, and commitment to using contraception. Evaluation of the couple desiring contraception involves assessing the woman’s reproductive history (menstrual, obstetric, gynecologic, contraceptive), physical examination, and sometimes current laboratory tests. The nurse must determine the couple’s knowledge about reproduction, contraception, and STIs and their commitment to any particular method. Assessment of the client begins with the following appraisals:  Determining the woman’s knowledge about contraception and her sexual partner’s commitment to any particular method  Collecting data about the frequency of coitus, the number of sexual partners, the level of contraceptive involvement, and her or her partner’s objections to any methods  Assessing the woman’s level of comfort and willingness to touch her genitals and cervical mucus  Identifying any misconceptions as well as religious and cultural factors and paying close attention to the woman’s verbal and nonverbal responses to hearing about the various available methods NURS 3450 Maternity and Women’s Health Nursing   Considering the woman’s reproductive life plan Completing a history (including menstrual, contraceptive, and obstetric), physical examination (including pelvic examination), and laboratory tests (as needed for identifying the presence of STIs) NURS 3450 Maternity and Women’s Health Nursing 2. Use the table below to summarize the types of contraception available in the United States. Method How does it work? What are the advantages? What are the disadvantages? Patient teaching NURS 3450 Maternity and Women’s Health Nursing Fertility Awareness Fertility awarenessbased (FAB) methods of contraceptio n, also known as periodic abstinence or NFP, depend on identifying the beginning and end of the fertile period of the menstrual cycle. These methods provide contraceptio n by relying on avoidance of intercourse during fertile periods. NFP methods are the only contraceptiv e practices acceptable to the Roman Catholic Church. When women who want to use FABs are educated about the menstrual cycle, three phases are identified: Advantages of these methods include low to no cost, heightened awareness and understanding of personal fertility, increased selfreliance, absence of chemicals, instant availability, increased involvement and intimacy with partner, and the ability of the couple to follow religious/cultural traditions. Disadvantages of FABs include difficulty with adherence to strict recordkeeping, requirement of male partner support, lower typical effectiveness than other methods, decreased effectiveness in women with irregular cycles (particularly adolescents in whom regular ovulatory patterns have not been established), decreased spontaneity of coitus, and no protection from STIs, including HIV infection. The typical failure rate for most FAB methods is 15% during the first year of use (Loder & Villavicencio, 2020). FAB methods involve several techniques to identify fertile days. The following discussion includes the most common techniques and some promising techniques for the future. Various smartphone applications (apps) have been developed to assist with following FAB methods; these apps are currently being studied to understand their effectiveness (Jennings & Polis, 2018; Karasneh, AlAzzam, Alzoubi, et al., 2020). NURS 3450 Maternity and Women’s Health Nursing 1. Infertile phase: before ovulation 2. Fertile phase: approximate ly 5 to 7 days around the middle of the cycle, including several days before and during ovulation and the day afterward 3. Infertile phase: after ovulation NURS 3450 Maternity and Women’s Health Nursing Spermicides Spermicides such as nonoxynol-9 (N-9) work by reducing sperm mobility. The chemicals attack the sperm flagella and body, thereby preventing the sperm from reaching the cervical os. N-9, the most commonly used spermicidal chemical in the United States, is a surfactant that destroys the sperm cell membrane. Effective, Easy to use, Non hormonal, Immediate action, accessibility, Minimal Side Effects. Data suggest that frequent use (more than two times a day) of N-9 or the use of N9 as a lubricant during anal intercourse may increase the transmission of HIV and can cause lesions. Insert according to instructions. Wait few minutes after insertion before intercourse. Do not douche immediately after. NURS 3450 Maternity and Women’s Health Nursing Male Condoms Sheath is applied over the erect penis before insertion or loss of preejaculato ry drops of semen. Used correctly, condoms prevent sperm from entering the cervix. Spermicidecoated condoms cause ejaculated sperm to be immobilized rapidly, thus increasing contraceptiv e effectivenes s. Safe No side effects Readily available Premalignant changes in cervix can be prevented or reduced in women whose partners use condoms. Method of male nonsurgical contraception. Must interrupt sexual activity to apply sheath Sensation may be altered. If used improperly, spillage of sperm can result in pregnancy. Condoms occasionally may tear during intercourse. Teaching should include the following instructions: Use a new condom (check expiration date) for each act of sexual intercourse or other acts between partners that involve contact with the penis. Place condom after penis is erect and before intimate contact. Place condom on head of penis (Fig. A) and unroll it all the way to the base. Leave an empty space at the tip (see Fig. A); remove any air remaining in the tip by gently pressing air out toward the base of the penis. If a lubricant is desired, use water-based products. Do not use petroleumbased products because they can cause the condom to break. NURS 3450 Maternity and Women’s Health Nursing After ejaculation, carefully withdraw the still-erect penis from the vagina, holding on to condom rim; remove and discard the condom. Store unused condoms in cool, dry place. Do not use condoms that are sticky, brittle, or obviously damaged. NURS 3450 Maternity and Women’s Health Nursing Female Condoms The female condom, which can be inserted 8 hours prior to intercourse, is a vaginal sheath made of nitrile, a nonlatex synthetic rubber, with flexible rings at both ends (Fig. 8.6A). Female condoms may protect against HIV, CMV, and other STIs, but they must be used properly and consistently. The closed end of the pouch is inserted into the vagina and anchored around the cervix; the open ring covers the labia. Women whose partner will not wear a male condom can use this device as a protective mechanical The female condom is available in one size, is intended for single use only, and is sold over the counter. Female condoms are more expensive than other contraceptives. Not as widely available. Difficult to insert. Noise during intercourse. Allergic reaction to materials used in female condom. Female condoms should not be reused. Easily accessible over the counter, Can be used with any type of lubricant. NURS 3450 Maternity and Women’s Health Nursing Diaphragms Non hormonal option, Reversible Contraception, protection Against STIs, Increased Control, No Systemic Side Effects, Immediate Effectiveness, Cost effective, Compatible with breast feeding. Disadvantages of diaphragm use include the reluctance of some women to insert and remove it. A diaphragm can be inserted up to 6 hours before intercourse; if insertion of the diaphragm occurs immediately before intercourse, a cold diaphragm and a cold gel temporarily reduce vaginal response to sexual stimulation. Some women or couples object to the messiness of the spermicide. These annoyances of diaphragm use, along with failure to insert the device once foreplay has begun, are the most common reasons for failures of this method. Side effects may include irritation of tissues related to contact with spermicides. The male could also have a reaction to the spermicide. The diaphragm is not a good option for women with poor vaginal muscle tone or recurrent urinary tract infections. Toxic shock syndrome (TSS), although reported in very small numbers, can occur in association with the use of the Use spermicide to the inside and around the rim before inserting the diaphragm. Pinch sides to insert, to remove hook one finger under the rim and pull out. Use every time for intercourse. Leave in place for at least 6 hours after intercourse to allow time for spermacide to work. NURS 3450 Maternity and Women’s Health Nursing contraceptive diaphragm. The nurse should instruct the woman about ways to reduce her risk for TSS. These measures include prompt removal 6 to 24 hours after intercourse, not using the diaphragm during menses, and learning and watching for danger signs of TSS (Bartz, 2022). NURS 3450 Maternity and Women’s Health Nursing Cervical Caps It comes in three sizes and is made of silicone rubber. The cap fits snugly around the base of the cervix, close to the junction of the cervix and vaginal fornices. It is recommend ed that the cap remain in place no less than 6 hours and not more than 48 hours at a time. It is left in place at least 6 hours after the last act of intercourse. The seal provides a physical barrier to sperm; spermicide inside the cap adds a chemical barrier. The extended period of wear may be an added convenience for women. Instructions for the actual insertion and use of the cervical cap closely resemble those for a contraceptive diaphragm. Some of the differences are that the cervical cap can be inserted hours before sexual intercourse, the cervical cap requires less spermicide than the diaphragm when initially inserted, and no additional spermicide is required for repeated acts of intercourse. The FemCap is less effective than the diaphragm (Bartz, 2022). The angle of the uterus, the vaginal muscle tone, and the shape of the cervix may interfere with ease of fitting and use of the cervical cap. The woman must check the position of the cap before and after each act of intercourse. Use of the cervical cap during menstruation is not advised. The cap should be refitted after any gynecologic surgery or birth and after major weight losses or gains. Otherwise, the size should be checked at least once a year. Some women are not good candidates for wearing the cervical cap. These include women with abnormal Papanicolaou (Pap) test results, women who cannot be fitted properly with the existing cap sizes, women who find insertion and removal of the device too difficult, women who have a history of TSS, women who have vaginal or cervical infections, and women who experience allergic reactions to the latex cap or spermicide. Failure rates vary according to parity: 13% to 16% for nulliparous women and 23% to 32% for multiparous woman (Bartz, 2022). Correct fitting does not require a trained clinician, but it is recommended to ensure proper fit and education on insertion and removal (Bartz, 2022). NURS 3450 Maternity and Women’s Health Nursing Combined Oral Contraceptives Because taking the pill does not relate directly to the sexual act, the acceptability of the pill may be increased. Improvement in sexual response may occur once the possibility of pregnancy is not an issue. For some women it is convenient to know when to expect the next menstrual flow. The noncontraceptive health benefits of COCs include reduction of menorrhagia and regulation of irregular cycles, treatment of endometriosis, and reduced incidence of dysmenorrhea and premenstrual syndrome (PMS). Oral contraceptives also offer protection against endometrial cancer and ovarian cancer, decrease hirsutism and acne, protect against the development of functional ovarian cysts, and increase bone mass (Roe, Bartz, & Douglas, 2021). Oral contraceptives are considered a safe option for nonsmoking women Women must be screened for conditions that present absolute or relative contraindications to oral contraceptive use. Contraindications to Combined Oral Contraceptive Use History of thromboembolic disorders Smoking ≥15 cigarettes/day at age ≥35 Cerebrovascular or cardiovascular disease Breast cancer (current and past with no evidence of disease within 5 years) Positive antiphospholipid antibodies Migraine with aura Multiple sclerosis with prolonged immobility Irritable bowel syndrome Malabsorptive bariatric procedures Medically treated and current gallbladder disease Acute or flare-up of viral hepatitis (initiation only) Pregnancy History of COCrelated cholestasis Severe cirrhosis Hepatocellular tumor Many different preparations of oral hormonal contraceptives are available. The nurse reviews prescribing information with the woman, individualizing this education and prescribing instructions based on the specific oral contraceptive that is prescribed for her. Because of the wide variations, each woman must be clear about the unique dosage regimen for the preparation prescribed for her. Directions for care after missing one or two pills also vary. It is important that the woman speak with her health care provider about the best way to manage missing any pills. Withdrawal bleeding tends to be short and scanty when some NURS 3450 Maternity and Women’s Health Nursing until menopause. Perimenopausal women can benefit from regular bleeding cycles, a regular hormonal pattern, and the noncontraceptive health benefits of oral contraceptives. A pelvic examination and Pap test are not necessary before initiating COCs. If STI screening is indicated in an asymptomatic woman, a urinebased or vaginal swab test can be used to screen for some infections (e.g., chlamydia, gonorrhea) (American College of Obstetricians and Gynecologists [ACOG], 2018/2020). Most health care providers assess the woman 3 months after beginning COCs to detect any complications. Use of oral hormonal contraception can be initiated at any time during the menstrual cycle without any restrictions, as long as the woman is not pregnant. This is known as the Quick Start method and offers faster, more reliable pregnancy protection, increased Malignant hepatoma Complicated solid organ transplantation Use of fosamprenavir, rifampin, or rifabutin Use of certain anticonvulsant medications and lamotrigine Lactation and nonlactation less than 6 weeks postpartum Hypertension (≥140/90 mm Hg, controlled or uncontrolled) Diabetes mellitus of >20 years’ duration or with vascular disease, nephropathy, neuropathy, or retinopathy. Certain side effects of COCs are attributable to estrogen, progestin, or both. Serious adverse effects documented with high doses of estrogen and progesterone include stroke, myocardial infarction, thromboembolism, hypertension, gallbladder disease, and liver tumors. Common side effects of estrogen excess include nausea, breast tenderness, fluid retention, and chloasma. Side effects of estrogen deficiency include early spotting combination pills are taken. A woman may see no fresh blood at all. A drop of blood or a brown smudge on a tampon or the underwear counts as a menstrual period. All women choosing to use oral contraceptives should be provided with a second method of birth control and be instructed in and comfortable with this backup method. Most women stop taking oral contraceptives for nonmedical reasons. The nurse also reviews the signs of potential complications associated with the use of oral contraceptives (see Signs of Potential Complications). Oral contraceptives NURS 3450 Maternity and Women’s Health Nursing continuation rates, and virtually no difference in breakthrough bleeding patterns compared with conventional start methods (wherein the pill must be started at the first day of the menstrual period). Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur; the overall effectiveness rate is almost 100%. Almost all failures (i.e., pregnancy occurs) are caused by omission of one or more pills during the cycle. The typical failure rate of COCs due to omission is 7% (CDC, 2022). (days 1 to 14), hypomenorrhea, nervousness, and atrophic vaginitis leading to painful intercourse (dyspareunia). Side effects of progestin excess include increased appetite, tiredness, depression, breast tenderness, vaginal yeast infection, oily skin and scalp, hirsutism, and postpill amenorrhea. Side effects of progestin deficiency include late spotting and breakthrough bleeding (days 15 to 21), heavy flow with clots, and decreased breast size. One of the most common side effects of combined COCs is bleeding irregularities (Roe et al., 2021). If a woman experiences unpleasant or unsafe side effects when taking a particular COC, the health care provider may prescribe an alternative COC that has a different mix of estrogen and progestin. The ideal COC for a woman contains the lowest dose of hormones that prevents ovulation and that has the fewest and least do not protect a woman against STIs or HIV. A barrier method such as condoms and spermicide must be used to provide this protection. NURS 3450 Maternity and Women’s Health Nursing harmful side effects. There is no way to predict the right dosage for any particular woman. Issues to consider in prescribing oral contraceptives include history of oral contraceptive use, side effects during past use, menstrual history, and drug interactions. There is no evidence of a relationship between use of oral contraceptives and the development of diabetes or glucose intolerance. The risks and benefits should be assessed before prescribing oral contraceptives for women who have diabetes with vascular problems. No strong pharmacokinetic evidence exists that shows a relationship between broadspectrum antibiotic use and altered hormonal levels among oral contraceptive users (Allen, 2022). After discontinuing oral contraception, return to fertility usually happens within several months (Roe et al., 2021). Many women ovulate the next month after stopping oral NURS 3450 Maternity and Women’s Health Nursing contraceptives; it may take longer for ovulation to resume in others. Women who discontinue oral contraception for a planned pregnancy commonly ask whether they should wait before attempting to conceive. There is a lack of evidence to support delaying attempts to achieve pregnancy after discontinuing oral contraceptive use. Little evidence suggests that oral contraceptives cause post-pill amenorrhea. SIGNS OF POTENTIAL COMPLICATIONS Oral Contraceptives When oral contraceptives are initially prescribed and at follow-up visits throughout hormone therapy, alert the woman to stop taking the pill and to report any of the following symptoms to the health care provider immediately. The mnemonic, ACHES, is useful to help clients remember this information: A—Abdominal pain may indicate a NURS 3450 Maternity and Women’s Health Nursing problem with the liver or gallbladder C—Chest pain or shortness of breath may indicate possible clot problem within the lungs or heart H—Headaches (sudden or persistent) may be caused by cardiovascular accident or hypertension E—Eye problems may indicate vascular accident or hypertension S—Severe leg pain may indicate a thromboembolic process 91-day Oral Contraceptive Some women prefer to take COCs in 3-month cycles and have fewer menstrual periods. A 91-day regimen may be prescribed for women who prefer to take COCs in 3-month cycles so that they have fewer menstrual periods. The FDA has approved a COC Seasonale (Seasonique) that combines levonorgestrel (progestin) and ethinyl estradiol (estrogen). It is taken in 3-month cycles of 12 weeks of active pills (pills that contain hormones) followed by 1 week of inactive pills (pills that do not contain hormones). Menstrual periods occur during the 13th week of the cycle. There is no protection from STIs, and risks are similar to COCs. Other monophasic COCs may be prescribed for extended cycle use and must be taken on a daily schedule, regardless of the frequency of intercourse (Kaunitz, 2022c). NURS 3450 Maternity and Women’s Health Nursing Transdermal Hormonal Available by prescription only, contraceptiv e transdermal patches deliver continuous levels of either ethinyl estradiol and norelgestro min (EE/N; Xulane, Zafemy) or ethinyl estradiol and levonorgestr el (EE/LNG; Twirla). The patch can be applied to intact skin of the upper outer arm, upper torso (front and back, excluding the breasts), lower abdomen, or buttocks. Application is on the same day once a week for 3 weeks, followed by a week without the patch. Withdrawal bleeding occurs during the nopatch week. Mechanism of action, efficacy, contraindicatio ns, skin reactions, and side effects are similar to those of COCs. The typical failure rate during the first year of use of the EE/N patch is 1.07%, consistent with oral contraception. For the EE/LNG patch, typical failure rate is 3.5%, 5.7%, and 8.6% in normal weight, overweight, and obese women; thus obesity is a contraindicatio n for this device (Burkman, 2021). NURS 3450 Maternity and Women’s Health Nursing Vaginal Contraceptive Ring Available only with a prescription, the vaginal contraceptiv e ring is a flexible ring (made of ethylene vinyl acetate copolymer) worn in the vagina to deliver continuous levels of either etonogestrel and ethinyl estradiol (ENG/EE; NuvaRing and EluRyng) or segesterone and ethinyl estradiol (SA/EE; Annovera). One vaginal ring remains in the vagina for 3 weeks, followed by a week without the ring. The ENG/EE ring is discarded, and a new ring is inserted to start the cycle over. The SA/EE ring is reusable for 1 year (13 cycles). Care involves washing with soap and water, drying, and storage in its case until the next cycle. The ring is inserted by the woman and does not have to be fitted. Some wearers may experience vaginitis, leukorrhea, and vaginal discomfort. Withdrawal bleeding occurs during the noring week. If the woman or partner notices discomfort during coitus, the ring can be removed from the vagina, but only up to 2 hours for the SA/EE ring and 3 hours for the ENG/EE ring to still be effective when reinserted. Mechanism of action, efficacy, contraindicatio ns, and side effects are similar to those of COCs. The typical failure rate of the ENG/EE ring is 9% and the SA/EE ring is 3% during the first year of use (Kerns & Darney, 2022). NURS 3450 Maternity and Women’s Health Nursing Progestin-only Oral Contraceptives Progestinonly methods impair fertility by inhibiting ovulation, thickening and decreasing the amount of cervical mucus, thinning the endometriu m, lowering midcycle peaks of FSH and LH, and altering cilia in the uterine tubes (Kaunitz, 2022d). The mechanism of action in progestinonly pills can vary among women and can also vary in one woman from cycle to cycle (Raymond & Grossman, 2018). Effectiveness is increased if minipills are taken correctly. Because the dose of progesterone is low, the minipill must be taken at the same time every day (Kaunitz, 2022d). Users often report irregular vaginal bleeding. NURS 3450 Maternity and Women’s Health Nursing Injectable Progestins Implantable Progestins Injectable progesteron e can be administere d as a longacting reversible contraceptiv e (LARC). There are two formulations of injectable progestins, referred to as depot medroxypro gesterone acetate (DMPA [DepoProvera]). There is a an intramuscula r injection given in the deltoid or gluteus maximus muscle and a subcutaneou s injection. DMPA can be given any time in the cycle Contraceptiv e implants consist of one or more nonbiodegra dable flexible tubes or rods that are inserted under the Advantages of DMPA include a contraceptive effectiveness comparable to that of perfect use of COCs, long-lasting effects, requirement of injections only four times a year, and the improbability of lactation being impaired. Side effects at the end of a year include possible decreased bone mineral density, weight gain, headaches, mood changes, and irregular vaginal spotting. Other disadvantages include no protection against STIs (including HIV). However, to avoid the need for backup or emergency contraception, it should be initiated during the first 7 days of the menstrual cycle and then administered every 11 to 13 weeks (Kaunitz, 2022b). Return to fertility may be delayed as long as up to 10 months after discontinuing DMPA. The typical failure rate is 6% in the first year of use (Kaunitz, 2022a). The newer implantable progestin, Nexplanon, is made of a single rod that releases etonogestrel. Research studies have indicated that not only is this an effective long-acting Irregular menstrual bleeding is the most common side effect. Less common side effects include headaches, nervousness, nausea, skin changes, and vertigo. No STI protection is provided with the implant Implants are understood to be as effective as, and perhaps even more effective than, sterilization and IUDs, so they are considered to be one of the most effective NURS 3450 Maternity and Women’s Health Nursing skin of a woman’s arm. These implants contain a progestin hormone and are effective for contraceptio n for at least 3 years. They must be removed at the end of the recommend ed time. The only FDAapproved implant in the United States is a single-rod etonogestrel implant (Nexplanon). Its predecessor, Implanon, was discontinued at the advent of Nexplanon use. Nexplanon is radiopaque, a feature that Implanon lacked. Three other devices used worldwide are unavailable in the contraceptive, but it also helps to decrease dysmenorrhea (Mendiratta & Lentz, 2022). Insertion and removal of the singlerod etonogestrel capsule are minor, inoffice surgical procedures that include a local anesthetic, a small incision, and no sutures. The capsule is injected subdermally in the inner aspect of the nondominant upper arm. Implants will prevent some, but not all, ovulatory cycles and will thicken cervical mucus. Other advantages include reversibility and longterm continuous contraception that is not related to frequency of coitus. Nexplanon can be inserted immediately following birth in breastfeeding women without affecting lactation. method, so condoms should be used for protection. contraceptive methods available (Darney, 2022). NURS 3450 Maternity and Women’s Health Nursing Emergency Contraception United States. One of these is Norplant, which was used frequently in the United States, but due to difficulties in insertion and removal (because it contains six rods) is no longer used. Emergency contraceptio n (EC) is available in more than 100 countries, and it is available without a prescription in approximate ly one-third of these countries. In the United States, oral levonorgestr el tablets are the only EC method available without a prescription, found on store shelves, and sold without age restriction. Ulipristal acetate, marketed as ella, ellaOne, and Fibristal, is available by prescription from a health care provider; it is available from a pharmacist without a prescription in only eight states. Other options that the FDA has determined to be safe for EC include high doses of COCs (Yuzpe method) and insertion of either the copper (TCu380A) or the levonorgestrel (LNG) 52 IUD (Turok, 2021). These options continue to be available by prescription only, but states differ in allowing pharmacists to dispense EC, and some states have inacted refusal legislation. In the wake of the June To minimize the side effect of nausea that occurs with high doses of estrogen and progestin, the woman can be advised to take an over-the-counter antiemetic 1 hour before each dose. Women with contraindications for estrogen use should use progestin-only EC. No medical contraindications for EC exist except current pregnancy. If the woman does not begin menstruation within 1week of the expected cycle start date, she should be evaluated for pregnancy. EC is ineffective if the woman is pregnant because the pills do not disturb an implanted pregnancy. Oral EC should be taken by a woman as soon as possible but within 5 days of unprotected intercourse or birth control mishap (e.g., broken condom, dislodged ring or cervical cap, missed oral contraceptives, late for injection) to prevent unintended pregnancy (Turok, 2021). Risk of pregnancy is reduced by as much as 97% if the woman takes oral EC within 5 days of intercourse (Turok). The NURS 3450 Maternity and Women’s Health Nursing This method carries names such as Plan B One-Step, Take Action, Aftera, Next Choice OneDose, and My Way and are located in the family planning aisle. With the new Supreme Court decision of June 2022, which overturned Roe vs. Wade (the 1973 decision that legalized abortion in the United States), we are facing uncertainty with the future access to emergency contraceptio n. If taken before ovulation, EC prevents ovulation by inhibiting follicular developmen t. If taken after 2022 Supreme Court decision that overturned Roe vs. Wade, President Biden signed an Executive Order to keep EC legal. With the changing legislative landscape, it is important that nurses are aware of any policy changes. oral ECP is commonly referred to as the “morningafter pill; however, it is effective up to 120 hours after intercourse, but the effectiveness is increased if taken close to when intercourse occurred (Rivlin & Davis, 2022). IUDs containing copper (see later discussion) provide another EC option. The IUD should be inserted within 5 days of unprotected intercourse. This method is suggested only for women who wish to have the benefit of long-term contraception. The risk of pregnancy is reduced by as much as 99% with emergency insertion of the copperreleasing IUD (Turok, 2021). Contraceptive counseling should be NURS 3450 Maternity and Women’s Health Nursing Intrauterine Devices ovulation occurs, there is little effect on ovarian hormone production or the endometriu m. Oral EC regimens consist of combined estrogen (ethinyl estradiol) and progestin (levonorgest rel) pills. An IUD is a small Tshaped device with bendable arms for insertion through the cervix (Fig. 8.7). Once the trained health care provider inserts the IUD against the uterine fundus, the arms open near the fallopian tubes to maintain the position of the device and to adversely affect sperm motility and provided to all women requesting EC, including a discussion of modification of risky sexual behaviors to prevent STIs and unwanted pregnancy. Advantages to choosing this method of contraception include long-term protection from pregnancy, although in rare cases an ectopic pregnancy can occur (Madden, 2022). The IUD is very effective; it is cost-effective; it can be inserted without time restrictions (although some providers prefer to insert the IUD during menstruation when the cervix is dilated and there is no chance of pregnancy); it is suitable for clients with estrogen contraindications; it reduces cervical, endometrial, and ovarian cancer risk; Uterine cramping and bleeding are usually decreased with these devices, although irregular spotting is common in the first few months following insertion. The typical failure rate in the first year of use is 0.1% (Madden, 2022). Disadvantages include unintentional expulsion of the device, increased risk of infection in the first month, increased bleeding (copper only), and unpredictable bleeding patterns (LNG only) (Bartz & Pocius, 2022). IUDs offer no protection against HIV or other STIs (Dean & Schwarz, 2018). The woman should be taught to check for the presence of the IUD strings after menstruation to rule out expulsion of the device. If pregnancy occurs with the IUD in place, an ultrasound is needed to rule out ectopic pregnancy. Early removal of the IUD helps to decrease the risk of spontaneous miscarriage or preterm labor. In some women who are allergic to copper, a rash develops, NURS 3450 Maternity and Women’s Health Nursing irritate the lining of the uterus. Two strings hang from the base of the stem through the cervix and protrude into the vagina for the woman to feel for assurance that the device has not been dislodged. The woman should have had a negative pregnancy test and signed a consent form before IUD insertion. STI testing can be performed at the time of IUD insertion (Bartz & Pocius, 2022). and there is immediate return to fertility when it is removed. Devicespecific advantages include avoidance of exogenous hormones (copper only); decrease in bleeding, anemia, and dysmenorrhea; and treatment of endometriosisrelated pelvic pain (LNG only) (Madden). necessitating the removal of the copperbearing IUD. Signs of potential complications include late menstrual period or abnormal spotting or bleeding; abdominal pain or pain with intercourse; abnormal vaginal discharge; fever or chills; IUD string shorter or missing (ACOG, 2016/2019). NURS 3450 Maternity and Women’s Health Nursing There are five FDA-approved IUDs: the copper ParaGard T 380 intrauterine systems Mirena, Liletta, Kyleena, and Skyla. The ParaGard T 380 polyethylene and fine solid copper and is approved and effective for 10 years of use, but it may be effective for longer than 10 years. The copper primarily serves to cause a cytotoxic inflammatory reaction in the endometrium; impairs sperm motility, viability, and acrosomal response; and impair implantation (Madden, 2022). Sterilization – female Mirena, Liletta, Kyleena, and Skyla release LNG from their vertical reservoirs. Mirena and Liletta are effective for up to 6 years, Kyleena is effective for up to 5 years, and Skyla is effective for up to 3 years. They impair sperm motility, thicken cervical mucus, decrease the lining of the uterus, and ha some anovulatory effects. Female Sterilization Any abdominal What to Expect sterilization procedures can be discomfort usually can After Tubal (bilateral safely done on an be controlled with a Ligation tubal outpatient basis. mild analgesic (e.g., ligation acetaminophen). You should [BTL]) may Tubal Occlusion Within days the scar is expect no be done A laparoscopic almost invisible (see change in immediately approach or a the Teaching for Selfhormones and after birth minilaparotomy can Management box: their influence. (within 24 to be used for tubal What to Expect After Your 48 hours), at ligation (Fig. 8.9), Tubal Ligation). As menstrual the same tubal with any surgery, period will be time as electrocoagulation, there is always a about the same induced or the application of possibility of as before the abortion, or bands or clips. complications of sterilization. as an Electrocoagulation anesthesia, infection, You may feel interval and ligation are hemorrhage, and pain at procedure considered to be trauma to other ovulation. (during any permanent methods. organs. The ovum phase of the Use of the bands or disintegrates menstrual clips has the within the cycle). If theoretic advantage abdominal sterilization of possible reversal cavity. is performed and return to fertility It is highly as an if the woman desires unlikely that interval to become pregnant you will procedure, in the future. become the health pregnant. care For the You should provider minilaparotomy, the not have a must be woman is admitted change in certain that the morning of sexual the woman surgery, having functioning; is not received nothing by you may enjoy pregnant. mouth since sexual relations Half of all midnight. more because NURS 3450 Maternity and Women’s Health Nursing female sterilization procedures are performed immediately after a pregnancy. Preoperative sedation is given. The procedure can be carried out with a local anesthetic; a regional or general anesthetic can also be used. A small incision is made in the abdominal wall below the umbilicus. The woman may experience sensations of tugging, but no pain, and the procedure is completed within 20 minutes. She may be discharged several hours later if she has recovered from anesthesia or the next day if done postpartum. you will not be concerned about becoming pregnant. Sterilization offers no protection against STIs; therefore you may need to use condoms. NURS 3450 Maternity and Women’s Health Nursing Sterilization – male Vasectomy is the surgical interruption of a man’s vas deferens, which is responsible for transporting mature sperm to the urethra (Viera, 2021). It is considered the easiest and most commonly used operation for male sterilization. Vasectomy can be performed with local anesthesia on an outpatient basis. It is considered a permanent method of sterilization unless a reversal procedure is attempted. Two methods are used for scrotal entry: conventional (scalpel Vasectomy has no effect on potency (ability to achieve and maintain erection) or volume of ejaculate. Endocrine production of testosterone continues, so secondary sex characteristics are not affected. Sperm production continues, but sperm are unable to leave the epididymis and are lysed by the immune system. Less common are painful granulomas from accumulation of sperm. Complications after bilateral vasectomy are uncommon and usually not serious. It is considered a safe and highly effective procedure (Hou & Roncari, 2018). The man is instructed in self-care to promote a safe return to routine activities. To reduce swelling and relieve discomfort, ice packs are applied to the scrotum intermittently for a few hours after surgery. A scrotal support may be applied to decrease discomfort. Moderate inactivity for approximately 2 days is advisable because of local scrotal tenderness. The skin suture can be removed 5 to 7 days after surgery. Sexual intercourse may be resumed as desired; however, sterility is not immediate. Some sperm will remain in the proximal portions of the sperm ducts after vasectomy. A period of 1 week to several NURS 3450 Maternity and Women’s Health Nursing incision) and no-scalpel (small puncture) vasectomy. The surgeon identifies and immobilizes the vas deferens through the scrotum. Then the vas is ligated or cauterized (see Fig. 8.8B). Surgeons vary in their techniques to occlude the vas deferens: ligation with sutures, division, cautery, application of clips, excision of a segment of the vas, fascial interposition , or some combination of these methods. months is required to clear the ducts of sperm; therefore some form of contraception is needed until the sperm count in the ejaculate on two consecutive tests is down to zero. NURS 3450 Maternity and Women’s Health Nursing 12. Complete the following:  Case study: 21st Century maternity and women's health nursing. (2023). In Sherpath for Maternal newborn (Lowdermilk version) (12th ed.). Elsevier. Mary is 26 years old and getting married in 2 months. She made an appointment for her annual physical examination with her nurse-midwife. Mary also wants to discuss her contraceptive plan. Because Mary and her fiancé are both Catholic, they want to use natural family planning methods for contraception. Mary is healthy with a normal BMI. She has no medical problems and is not taking any medication. Mary has had regular menstrual cycles every 28 days for the last 6 months. a. How does a fertility awareness method (FAM) or natural family planning prevent pregnancy? The Fertility Awareness Methods or Natural Family Planning prevents pregnancy by assisting individuals recognize the fertile days of a waman’s menstrual cycle. By identifying the fertile days, couples can sidestep intercourse that is unprotected to block a pregnancy. b. What are calendar-based methods? Documents the menstrual cycle to forecast days that the woman is ovulating. c. What would you teach Mary about monitoring her cervical secretions? This method requires that a woman check the quantity and character of mucus on the vulva or introitus with her fingers or tissue paper each day for several months. She then evaluates the mucus for cloudiness, tackiness, and slipperiness. This way she can learn how her cervical mucus responds to ovulation during her menstrual cycles. To ensure an accurate assessment of changes, the cervical mucus should be free from semen, contraceptive gels or foams, and blood or discharge from vaginal infections for at least one full cycle. d. What is the basal body temperature method? The BBT is the lowest body temperature of a healthy person, taken immediately after waking and before getting out of bed. The BBT usually varies from 36.2°C to 36.3°C (97.16 °F to 97.34 °F) during menses and for approximately 5 to 7 days afterward (Fig. 8.2). At about the time of ovulation a slight drop in temperature may occur in some women, but others may have no decrease at all. After ovulation the temperature averages between 36.5°C and 37°C (97.7 °F and 98.6 °F). The temperature remains on an elevated plateau until 2 to 4 days before menstruation. Then BBT decreases to the low levels recorded during the previous cycle unless pregnancy has occurred. In pregnant women the temperature remains elevated. If ovulation fails to occur, the pattern of lower body temperature continues throughout the cycle. Bottleneck or Difficult Concepts In your Elsevier Sherpath resource, there are case studies, further Sherpath lessons, and chapter PowerPoint sets for your review. Take notes as needed.