ATI Maternal Newborn latest complete study guide

ATI Maternal Newborn Chapter 1- contraception • Contraception refers to strategies or device used to reduce the risk of fertilization or implantation in an attempt to prevent pregnancy • Natural family planning: behavioral methods o Abstinence – no gentialia contact o Withdrawal (coitus interruptus) ▪ Choice for monogamous couple ▪ Least effective methods ▪ Risk for pregnancy o Calendar methods ▪ ovulation occurs about 14 days before the onset of her next menstrual cycle, and avoid intercourse during that period ▪ count at least 6 cycles o basal body temperature ▪ body temperature can drop slightly at the time of ovulation ▪ measure oral temperature prior to getting out of bed each morning to monitor ovulation ▪ inexpensive, convenient, and no adverse effects ▪ Basal body temperature and the symptothermal method are fertility awareness methods. o Lactational amenorrhea method • Barrier o Condoms ▪ Only water-soluble lubricants should be used with latex condoms to avoid condom breakage o Diaphragm ▪ Dome-shaped cup with a flexible rim made of silicon that fits snugly over the cervix with spermicidal cream or gel placed into the dome and around the rim ▪ Client should be properly fitted with a diaphragm by a provider ▪ Replaced every 2 years and refitted for a 20% weight fluctuation, after abdominal or pelvic surgery and after every pregnancy ▪ Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly or cream that is applied to the cervical side of the dome and around the rim ▪ The diaphragm can be inserted up to 6 hours before intercourse and must stay in place 6 hour after intercourse but for no more than 24 hrs. ▪ Spermicide must be reapplied with each act of coitus ▪ Patient should empty bladder before insertion ▪ Wash with soap and water after use o Cervical cap o Contraceptive sponge o Question ▪ Which method would the nurse identify as a barrier method of contraception? a. Basal body temperature b. Transdermal patch c. Diaphragm d. Symptothermal method • Hormonal o Oral contraceptives ▪ Adverse effect • Chest pain, shortness of breath, leg pain from a possible clot, headache, eye problems form a stroke, and hypertensive, breast tenderness, nausea, breakthrough bleeding (common adverse effects of estrogen component and progestin component) ▪ Can increase the risk of thromboembolism, stroke, heart attack, hypertension, gallbladder disease, liver tumor ▪ Effectiveness decrease when taking medications that affect liver enzymes, such as anticonvulsants and some antibiotics o Injectable contraceptives ▪ Medroxyprogesterone is an IM or SQ injection given to a female client every 11 to 13 weeks • First injection should be during the first 5 days of period • In postpartum, 5 days after delivery ▪ Maintain adequate intake of calcium and vitamin D ▪ Very effective and require only 4 injections per year ▪ Adverse effects • Decrease in bone mineral density, weight gain, increase depression and irregular vaginal spotting or bleeding ▪ Contraindicated for osteoporosis patient ▪ Return to fertility can be a long as 18 months after discontinuation o Transdermal patches o Vaginal rings o Implantable progestin ▪ Minor surgical procedure to subdermally implant and remove a single rod contain etonogestrel on the inner side of the upper arm ▪ Disadvantage • Etonogestrel can cause irregular menstrual bleeding ▪ Adverse effects • Irregular and unpredictable menstruation (most common) • Mood changes, headache, acne, depression, decreased bone density and weight gain o Intrauterine contraceptives (IUD) ▪ A chemically active T-shaped device that is inserted through the cervix and placed in the uterus by the provider ▪ Device must be monitored monthly by clients after menstruation to ensure the presence of small string that hangs form the device into the upper part of the vagina to rule out migration or expulsion of the device ▪ IUD can maintain effectiveness for 1 to 10 years ▪ Contraception can be reversed ▪ Can increase the risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy and can be expelled ▪ A client should report to the provider later or abnormal spotting or bleeding, abdominal pain or pain with intercourse, abnormal of foul-smelling vaginal discharge, fever, chills, a change in string length or if IUD cannot be located ▪ IUD can cause irregular menstrual bleeding ▪ Must be removed in the event of pregnancy o Emergency contraception ▪ Morning-after pill that prevents fertilization from taking place ▪ Pill is taken within 72 hr after unprotected coitus • Surgical methods o Tubal ligation ▪ Sterilization for women ▪ A laprascope is inserted; fallopian tubes are grasped and sealed o Vasectomy ▪ Sterilization for men ▪ Usually performed under local anesthesia ▪ Involves cutting the vas deferens, which carries the sperm .................................CONTINUED......................................