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76 Cards in this Set
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Sterilization
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Advantages: Ends concern about contraception. Tubal sterilization performed during or right after childbirth or between pregnancies. Vasectomy performed in physicians office with local anesthesia.
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Disadvantages: No protection against STDs. reversal is difficult, expensive, and may be unsuccessful. Potential complications as in any surgery. Vasectomy requires another contraceptive method until semen is free of sperm.
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Progestin Implant
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Advantages: unrelated to coitus. Provides 3 year protection. Safe during lactation.
body weight has no effect. |
Disadvantages: no protection against STD's Side effects similar to those of other progestin contraceptives, espicially irregular bleeding.
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Progestin injections (Depo-provera)
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Advantages: unrelated to coitus. Avoids need for daily use. May cause amenorrhea with continued use. requires use only every 12 weeks.
Disadvantages: no protection against STDS. Must remember to repeat every 12 weeks. Causes temporary decrease in bone density. Effect on peak bone mass and ostoporosis unknown. |
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Oral Contraceptives
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unrelated to coitus
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No protection against STDS
Must be taken daily at or near same time. May cause side effects and complications. |
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Emergency Contraception (EC)
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helps prevent pregnancy after unprotected coitus. Available without prescriptioin for patients older than 17 years old.
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no protection against STDS must be taken within 120 hours of unprotected intercourse. may cause nausea
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Transdermal contraceptive patch
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unrelated to coitus. Requires only weekly application. Regulates menstual cycles.
No protection against STDS> Must apply on right day. Less affective for women over 90 kg (198lb). may cause skin irritation other side effects simlar to those of OCs. Higher risk of clot formation. |
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Vaginal Contraceptive Ring
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unrelated to coitus
in place for 3 weeks at a time no fitting required |
no protection against stds
Must remember when to remove and when to insert. side effects include expulsion, vaginitis, vaginal discomfort or discharge, and others similar to those of OCs. |
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Intrauterine device or intrauterine system
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unrelated to coitus
In place at all times. Low long-term cost. Effective for 5 to 10 years. Copper IUD may also be used for EC |
No protection against STDS
high initial cost. can be expelled without womans knowledge; must check for strings. Potential side effects or complications: menorrhagia, infection, ectopic pregnancy, abortion, perforation. |
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Barrier
All methods |
avoid use of systemic hormones.
offer some protection against STDS. |
Most coitus-related (must be used just before coitus)
may interfere with sensation. contraindicated for allergies to components of spermicide or latex. |
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Chemical (Spermicides)
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quick and easy
no prescription needed. best protection available for STds low cost per single use Can be carried discreetly. Vaginal condoms increase womens control over contraceptive use and protection from STDS. |
must be checked for ex date and holes
can break or slip off can be used only once. Spermicide-coated condoms increase risk of urinary tract infection in women and vaginal irritation. Vaginal condom may seem unattractive. |
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Sponge
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AVailable over the counter
Can be inserted several hours before coitus. Effective for repeated intercourse. |
NO protection against STDS
Must remain in place for 6 hours but no more than 30 hours total. may cause irritation risk of toxic shock syndrome if used too long or during menstruation. |
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Diaphram
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can be inserted several hours before coitus.
provides some protection from STDS can remain in place for 24 hours |
Initially expensive
Requires health care provider to fit requires education on proper use difficult to insert or remove for some women added spermicide necessary to repeat coitus. Possibility of toxic shock with prolonged use or use during menses. bladder infection, remain in place after 6 hours checked for fit annually and after pregnancy or weight change of more than 20% |
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Cervical Cap
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small than diaphram and may fit women who cannot wear a diaphram.
no pressure against bladder less noticable than diaphram. provides some protection from STDS Can remain in place 48 hours. |
Initially expensive.
Requires health care provider to fit. Requires education on proper use. added spermicide needed for repeat coitus. possibility of toxic shock syndrome. Must remain in place at 6 hours after coitus |
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REPRODUCTIVE LIFE PLANNING
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CONCERNS:
CONCEIVING CHILD SPACING NEEDS GENETIC ABNORMALITIES |
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MISINFORMATION ON CONTRACEPTION
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MAGAZINES
FRIENDS TELEVISION INTRANET MOVIES |
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NURSE’S ROLE IN CONTRACEPTION
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EDUCATOR
COUNSELOR FOCUS MUST BE ON CLIENT’S NEEDS MUST NOT INTRODUCE PERSONAL BIASES |
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CONTRACEPTION COUNSELING
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TYPES OF CONTRACEPTIVES AVAILABLE
ADVANTAGES & DISADVANTAGES OF EACH METHOD HOW TO ENSURE PROPER USE OF EACH METHOD WHAT TO DO IF AN ERROR IS MADE EMERGENCY CONTRACEPTION BACKUP METHODS & WHEN THEY SHOULD BE USED WHAT TO DO IF THE WOMAN WANTS TO CHANGE METHODS QUESTIONS & CONCERNS |
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Cervical mucous (ovulation or Billings method) 3%
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Assess mucous at vaginal orific daily. AVoid intercourse during menses and from time mucus appears until 4 days after clear, sliippery, stretchy mucus ends.
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Intercourse is only allowed every other day. Semen interferes with assessment.
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Emergency contraception:
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can be taken up to 72 hours after intercourse
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CONSIDERATIONS-SAFETY
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PROTECTION FROM SEXUALLY TRANSMISSIBLE DISEASES
CARDIOVASCULAR DISEASE TOXIC SHOCK SYNDROME |
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EFFECTIVENESS
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IDEAL—PERFECT USE OF METHOD WITH EVERY
ACT OF INTERCOURSE. FAILURE FROM PROBLEM WITH METHOD |
TYPICAL-STUDIES OF PREGNANCY OCCURANCES.
FAILURE FROM INCONSISTENT OR INCORRECT USE OF THE TECHNIQUE |
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CONSIDERATIONS
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ACCEPTABILITY TO COUPLE---BARRIERS-MESSY ETC
CONVENIENCE EDUCATION NEEDED BENEFITS SIDE EFFECTS INTERFERENCE WITH SPONTANEITY AVAILABITY EXPENSE PREFERENCES RELIGIOUS & PERSONAL BELIEFS CULTURE |
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TEEN PREGNANCY
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1 IN 11 GIRLS
AGE 15-19 BECOMES PREGNANT EACH YEAR IN THE USA |
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TEENAGE CONTRACEPTION
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LITTLE KNOWLEDGE OF BODY PROCESSESS
MISINFORMATION RISK TAKING BEHAVIOR AMBIVALENT re pregnancy |
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TEENAGE CONTRACEPTIVE COUNSELING
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HAS TO ADMIT TO SEXUAL ACTIVITY
RN ASSURE CONFIDENTIALITY EDUCATE ENCOURAGE TEENAGER TO DISCUSS WITH PARENTS TEEN FAMILY PLANNING CLINICS |
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ADOLESCENT FAMILY PLANNING
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HIGHER RATE OF CONTRACEPTIVE FAILURE
BEST WHEN THEY CHOOSE METHOD—EASY TO USE AND UNRELATED TO COITUS REINFORCE CONDOMS FOR STD’S & EDUCATE-STD’S |
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CHANGE OF LIFE BABIES
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NEED BIRTH CONTROL UNTIL
MENOPAUSE LESS LIKELY TO RECEIVE CONTRACEPTIVE CARE IF NO RISK FACTORS-BCP’S OK REGULAR CHECK-UPS— NEED TO EVALUATE CONTRACEPTIVE NEEDS |
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STERILIZATION
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USUALLY IRREVERSIBLE
CAN HAVE SURGICAL COMPLICATIONS RARE PREGNANCY MAY RESULT IN ECTOPIC PREGNANCY |
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ESSURE-TUBAL STERILIZATION
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Essure micro insert is inserted. tissue grows into insert blocking fallopian tube
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VASECTOMY
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OFFICE PROCEDURE MAY TAKE UP TO 3 MONTHS TO REMOVE ALL OF SPERM FROM SYSTEM NEED ADDITIONAL BIRTH CONTROL SUBMIT SEMEN SAMPLE TO VERIFY
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HORMONAL CONTRACEPTIVES
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ALTERS NORMAL
HORMONAL FLUCTUATIONS OF THE MENSTRUAL CYCLE IE: pills, ring, patch |
Estrogen, progesterin, prevent pituitary from releasing hormones that prevent ovulation
PROGESTIN IMPLANT |
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IMPLANON IMPLANT
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RELEASES PROGESTIN
SUPPRESSES OVULATION THICKENS CERVICAL MUCUS LAST 3 YEARS |
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DEPO-PROVERA INJECTION
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PROGESTIN-LASTS 3 MONTHS
PREVENTS OVULATION DECREASED BONE DENSITY IN TEENAGERS & WITH PROLONGED USE |
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Oral Contraceptive
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Progestin in pill thickens cervical mucus to prevent sperm reaching uterus.
Lower levels of estrogen prevent pituitary from releasing LH, with no LH egg does not mature. No ovulation. |
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Biphasic and triphasic Birth control pills:
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contain varying amounts of hormone in different weeks of active pills
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monophasic birth control pills
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contain the same level of hormones
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COMBINATION PILLS ESTROGEN & PROGESTIN
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THICKENS CERVICAL MUCUS
INHIBITS OVULATION INHIBITS TUBAL MOTILITY ALTERS ENDOMETRIUM |
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PROGESTIN ONLY
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MINIPILLS—TAKEN DAILY
NO HORMONE FREE DAYS THICKEN CERVICAL MUCUS ALTER ENDOMETRIUM AVOIDS ESTROGEN SIDE EFFECTS NEED ADDITIONAL PROTECTION 1st CYCLE |
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Oral Contraceptives
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Benefits: Unrelated to coitus.
HIghly effective contraception Reduces ovarian and endometrial cancer Protection continues for years after use regulates menstrual cycle and reduces cramping, mentstrual blood loss and associated anemia return to fertility usually within 3 months when ended (6 months for some) Decreased Incidence of: Benign breast disease ovarian cysts pelvic inflammatory disease ectopic pregnancy sickle cell, asthma improves: acne, endometriosis, many premenstrual symptoms, dysmenorrhea, bleeding from fibroids (leiomyomas), bone mass (combined OCS only, polycystic ovary syndrome, hirsutism |
Disadvantages: must be taken every day near same time, espicially minipills
may not be covered by some insurance. Side effects:breakthru bleeding, nausea, headache, breast tenderness, weight gain, melasma, mood swings Risks: no pretection against STDS may increase incidence of deep superficial vein thrombosis pulmonary embolism myocardial infarction stroke Hypertension migraines chlamydial infection gallbladder women who smoke higher risk |
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ACHES
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A-abdominal pain severe---Mesenteric or pelvic vein thrombosis. Benign, liver tumor, gallbladder disease
C-Chest pain,dyspnea, hemoptysis, cough-----pulmonary emboli or myocardial infarction H-severe headache, weakness, or numbness of extremities, hypertension------stroke, migraine E-eye problems (complete or partial loss of vision), headache----retinal vein thrombosis, stroke, migraine S-severe leg pain or swelling (calf or thigh), swelling, heat, redness-----deep vein thrombosis |
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BENEFITS, RISKS, CAUTIONS of Oral Contraceptives
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BALANCE BETWEEN BENEFITS & RISKS
SMOKING CARDIOVASCULAR IE BLOOD CLOTS NOTIFY DR FOR LEG PAIN OR EDEMA |
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Teaching oral when to start:
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quick start-first pill on the day the pills are prescribed (if not pregnant) backup needed for first 7 days.
First day start: pill is taken on first day of next menstrual cycle. no backup needed. Sunday Start: pills are begun on first sunday after menses begin this way no cycle on weekends. (backup for first 7 days) |
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Transdermal Patch:
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cervical mucus thick, sperm unable to enter
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INTRAUTERINE DEVICES
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RISK OF
UTERINE PERFORATION ECTOPIC PREGNANCY TEACHING: SIDE EFFECTS STRING PRESENT INFECTION |
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IUD
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DO NOT USE
IF WOMAN HAS MULTIPLE SEX PARTNERS INCREASED RISK OF PELVIC INFAMMATORY DISEASE |
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BARRIER METHODS
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SPERMICIDES
OR DEVICES THAT PREVENT SPERM FROM ENTERING THE CERVIX |
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SPERMICIDES
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nonoxynal, menfogel, benzokonium chloride, (BZK)
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Delivery: foam, film, suppositories, foaming tablets
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DIAPHRAGM
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IF A CLIENT LOSES OR GAINS 10-20 POUNDS
SHE WILL NEED TO SEE HER HEALTH CARE PROVIDER TO CHECK TO SEE IF SHE NEEDS A NEW SIZE DIAPHRAGM |
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Lea's Shield
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Lea's Shield is a vaginal barrier contraceptive that is made of medical grade silicone. It is a cup-shaped device that is inserted into the vagina in order to prevent sperm from entering the cervix. Designed to be reusable, Lea's Shield is completely washable and lasts for a period of about six months. Lea's shield is available
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PERIODIC ABSTINENCE FERTILITY AWARENESS
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PHYSICAL CUES TO
PREDICT OVULATION & FERTILITY AVOID INTERCOURSE |
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NATURAL FAMILY PLANNING
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BASED ON PREMISE
OVUM MAY BE FERTILIZED FOR 24 HOURS SPERM HAS LIMITED SURVIVAL TIME IN WOMAN’S REPRODUCTIVE TRACT |
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Natural Methods of Birth Control
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Calendar 5%=subtract 18 days from shortest cycle and 11 days from longest cycle.
Standard days method-intercourse is allowed only on days 1-7 and day 20 to the end of the cycle. Use a barrier method or abstain on day 8-9 Basal body temp-BBT is lowest resting temp. During 1st half of cycle temp is lower than 2nd 1/2. BBt remains higher if conception occurs. Cervical mucus-Assess vaginal mucus daily fertility is determined by prescense of mucus no intercourse until 4 days after mucus ends. 2 day method-3.5%-check for mucus each day. fertility is determined by prescence of cervical mucus today or yesterday. Symptothermal-2%-3% combine all above methods and assess weight gain, libido, bloating, and mittelschmerz. |
CALENDAR-OVULATION
SAME TIME EACH CYCLE STANDARD DAYS—BEADS TO KEEP TRACK OF DAYS BASAL BODY-TEMP VARIATION BEFORE & AFTER OVULATION |
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SYMPTOTHERMAL METHOD
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CALENDAR
BASAL TEMP CERVICAL MUCUS SYMPTOMS |
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MARQUETTE MODEL
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MEASURES
ESTROGEN & LUTEINIZING HORMONES IN THE URINE TO DETERMINE FERTILE PHASE |
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NURSING PROCESS CHOOSING A CONTRACEPTIVE METHOD
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ASSESSMENT:
INTRODUCE SUBJECT DETERMINE WOMAN’S UNDERSTANDING ASSESSING WOMAN’S SATISFACTION |
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NURSING PROCESS
ANALYSIS: |
LACK OF KNOWLEDGE REGARDING FAMILY PLANNING
PLANNING: EXPECTED OUTCOMES |
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INTERVENTIONS: TEACH PROCESS OF REPRODUCTION
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TEACH CURRENT METHOD
TEACH OTHER METHODS TEACH PREVENTION OF STD’S INCLUDE WOMAN’S PARTNER ONGOING TEACHING….. ALLOW PATIENT TO MAKE HER OWN CHOICE |
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FERTILITY
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PRIMARY----NEVER HAD ANY CHILDREN
SECONDARY— HAS CONCEIVED AND HAD A CHILD IN THE PAST UNABLE TO CONCEIVE NOW |
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INFERTILITY TESTING
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STARTS WITH
SEMEN ANALYSIS LEAST INVASIVE |
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ABNORMAL ERECTIONS
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REDUCED ABILITY TO DEPOSIT SPERM PROPERLY
PHYSICAL & PSYCHOLOGICAL FACTORS NERVOUS SYSTEM DYSFUNCTIONS SURGERY VASCULAR DISEASES MEDICATIONS |
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ABNORMAL EJACULATION
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PREVENTS IDEAL SPERM PLACEMENT
MEDICATIONS, DRUGS, ETOH ANATOMICAL—HYPOSPADIAS, PARALYSIS RETROGRADE EJACULATION |
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ABNORMAL SEMINAL FLUID
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PROTECTS
TRANSPORTS NOURISHES SPERM IN THE VAGINA |
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FEMALE FACTOR INfertility
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OVUM PRODUCTION
PATENT REPRODUCTIVE TRACT ADEQUATE ENDOMETRIAL LINING |
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DISORDERS OF OVULATION
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DYSFUNCTION OF
HYPOTHALAMUS OR PITUITARY FAILURE OF OVARIES TO RESPOND TO FSH (FOLLICLE STIMULATING HORMONE) |
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Tubal Factor infertility
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OBSTRUCTIONS
INFECTIONS PELVIC INFLAMMATORY DISEASE SCARRING ENDOMETRIOSIS ADHESIONS ALTERED TUBAL MOTILITY |
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CERVICAL FACTORS
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SCARRING--POLYPS
PREVENTS DILATATION ALTERED ESTROGEN LEVELS INHIBIT CERVICAL MUCUS PRODUCTION |
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ADEQUATE ENDOMETRIUM
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PROPER HORMONAL
FUNCTIONING OF THE MENSTRUAL CYCLE AIDS IN PRODUCTION OF AN ADEQUATE ENDOMETRIAL LINING |
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REPEAT PREGNANCY LOSS
you may need: |
NEED A CHROMOSOMAL ANALYSIS FOR FETAL CHROMOSOMAL ABNORMALITIES
ENDOCRINE ABNORMALITIES IMMUNOLOGICAL FACTORS ENVIRONMENTAL AGENTS INFECTIONS ABNORMALITIES OF UTERUS OR CERVIX |
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Clomid
Serophene |
Action: stimulates pituitary gland to increase secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FS?H stimulate maturation of the ovarian follicle, ovulation, and development of the corpus luteum.
Indications: Female infertility in which estrogen levels are norma.. Dosage and Route: Female sterility: first course: 25 to 50mg PO daily for 5 days. Second course: same dose if ovulation occurred with first course. If ovulation did not occur, increase dose to 100mg daily for 5 days. Some women require up to 250 mg daily. A higher dose is not required if ovulation is triggered. Absorption: Readily absorbed from the gastrointestinal tract. Time to peak effect is 4 to 10 days after last day of treatment. Excreted in the feces: Contraindication and precautions: Pregnancy, liver disease, abnormal bleeding of undetermined origin, ovarian cysts. |
Adverse Reactions: Ovarian enlargement, symptoms similar to prementrual syndrome. Ovarian hyperstimulation syndrome Multiple gestation, if more than onve ovum is released. Visual disturbances. Abdominal distention, discomfort, nausea, vomiting. Abnormal uterine bleeding. Breast tenderness. Insomnia, nervousness, headache, depression, fatigue, lightheadedness, dizziness. Hot flashes, increased urination, allergic symptoms, weight gain, reversible alopecia. Dry cervical mucus.
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SURGICAL PROCEDURES
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LAPROSCOPY—ENDOMETRIOSIS, ADHESIONS,
TUBAL REVERSAL, MYOMECTOMY ETC ENDOSCOPIC AND LASER SURGERY |
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THERAPEUTIC INSEMINATION
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DONOR OR PARTNER IUI AIDS LOW SPERM COUNT BYPASSES CERVICAL MUCOUS
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GESTATIONAL SURROGATE
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UTERUS ONLY
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SURROGATE MOTHER-
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SUPPLIES OVUM & UTERUS
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IN VITRO FERTILIZATION
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USED WHEN THERE ARE BLOCKED OR ABSENT FALLOPIAN TUBES
MALE FACTOR INFERTILITY UNEXPLAINED INFERTILITY |
OVA REMOVED LAPAROSCOPICALLY
MIXED WITH SPERM EMBRYO OR EMBRYOS RETURNED TO UTERUS |
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SECONDARY INFERTILITY
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INABILITY TO
CONCEIVE AFTER BIRTH OF A PREVIOUS CHILD |
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NURSING IMPLICATIONS Infertility
teach |
TEACH PHYSIOLOGICAL AND PSYCHOLOGICAL
FACTORS OF INFERTILITY ASSIST COMMUNICATION i.e. male less likely to express feelings INCREASE THE COUPLE’S SENSE OF CONTROL REDUCE ISOLATION PROMOTE A POSITIVE SELF-IMAGE |
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