Gloria Nwagwu MSN, FNP-BC, RN
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Assessment
◦ Establishing trust
◦ Obtaining the sexual history
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Nursing diagnosis
Planning and implementation of care
Evaluation
Providing Contraception Care
Methods of Contraception
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Natural family planning
Fertility awareness
Coitus interruptus
Lactational amenorrhea method
(breastfeeding)
Abstinence—0% failure rate
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Inexpensive
Protect against STIs
Must be used prior to intercourse
Water-based lubricant
Few side effects
Key: consistent and correct use
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Diaphragm
Cervical cap
Condoms (male and female)
◦ Latex allergies
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Spermicides
Contraceptive sponge
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Oral contraceptives
◦ Monophasic, biphasic, triphasic
◦ Warning signs: ACHES
Low-dose progestin-only
Transdermal contraceptive patch
Vaginal contraceptive ring
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Initial examination
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3-month follow-up after beginning OCPs
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Yearly examination
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Regulate menstrual bleeding
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Mediate menopausal symptoms
◦ Hot flashes
◦ Vaginal dryness
Smoking and age greater than 35 years
Moderate/severe hypertension (BP 160/100)
Undiagnosed uterine bleeding
Diabetes of more than 20 years’ duration or with
vascular complications
◦ History of pulmonary embolism or deep venous
thrombosis
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Headaches
Breakthrough bleeding
Nausea
Breast tenderness
Cyclic weight gain
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Hormonal methods (two FDA-approved)
◦ Preven
◦ Plan B
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Copper-releasing intrauterine device
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Depo-Provera
◦ Injected every 3 months
◦ Reversible after 10 months
◦ Side effects: irregular bleeding, weight gain,
depression
◦ Safe for breastfeeding mothers
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Implanon
◦ Single rod
◦ Effective for 3 years
◦ Side effects: bleeding irregularities, emotional
lability, depression, weight gain
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Warning signs: PAINS
Benefits:
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No continued expense
No daily attention
No interference with intercourse
May decrease risk of endometrial cancer
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Side effects
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Contraindications
◦ Irregular bleeding
◦ Amenorrhea
◦ Pelvic infections
◦ Current STI
◦ Genital tract cancer
◦ Uterine anomalies, fibroids
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Female
◦ Bilateral tubal ligation
◦ Nonincisional hysteroscopic tubal ligation
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Male
◦ Vasectomy
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Ends pregnancy before fetus reaches age of
viability (20 to 24 weeks)
1973—Roe v. Wade
Elective abortion
Therapeutic abortion
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Guidance—pregnancy testing,
ultrasonography
Emotional support
Counseling—options, potential complications
Information about contraception
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Menstrual extraction, endometrial
aspiration
◦ 5 to 7 weeks gestation
◦ No anesthesia
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Vacuum aspiration
◦ Up to 12 weeks gestation
◦ Laminaria for cervical dilation
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Between 8 and 12 weeks of gestation
◦ Mechanical dilation of cervix
◦ Local anesthetic
◦ Complications: uterine perforation, cervical
lacerations, hemorrhage, infection, and adverse
reactions to the anesthetic agent
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Second trimester
◦ Cervical dilation and uterine evacuation
◦ Laminaria—24 hours preprocedure
◦ Possible long-term adverse effects from cervical
trauma
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Assessment
Emotional support
Observe for complications
◦ Excessive bleeding and cramping
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Schedule follow-up appointment
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Up to 63 days of gestation
Medications induce uterine contractions
Mifepristone (Mifeprex, RU-486)
Methotrexate
Misoprostol (Cytotec)
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Several days after medication—painless,
heavy bleeding, expulsion of tissue
Encourage friend/relative for emotional and
physical support
Follow-up visits
◦ Ultrasonography
◦ hCG levels
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Second trimester
◦ Vaginal or intrauterine prostaglandins
◦ Repeated doses
◦ Side effects: nausea, vomiting, diarrhea,
cramping
◦ Intrauterine hypertonic solutions (rare)
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Cramping, bleeding
Rare: infection, incomplete abortion,
hemorrhage, Asherman syndrome, postabortal syndrome
Nurse’s role
◦ Educate regarding signs of short-term
complications
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The nurse is planning an educational
session about contraception. What is the
most significant factor in choosing a
specific method of contraception in order to
avoid pregnancy?
Absolute reliability
Ease of use
Consistency of use
Cost
2. When teaching a woman about the use of
the diaphragm, it is important to instruct her
that the diaphragm should be rechecked for
correct size
a. Every five years
b. When weight gain or loss beyond five
pounds has occurred
c. After each term pregnancy
d. Only after significant weight loss
3. Which of the following is an absolute
contraindication to the use of OCP?
a. Smokes
b. Using antibiotics for UTI
c. History of miscarriages
d. Gestational diabetes
The Nurse’s Role in
Infertility Care
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Sterility
Infertility
Nurse’s role
◦ Educate—overview of infertility evaluation, basal
body temperature
◦ Counseling
◦ Assess understanding of fertile times
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Female
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Thyroid function test
Glucose tolerance test
Serum prolactin levels
Specific hormonal assays
Ultrasonography
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Female (cont’d)
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Male
◦ Endometrial biopsy
◦ Hysterosalpingography
◦ Laparoscopy
◦ Semen analysis
◦ Additional tests (endocrine, postcoital test,
ultrasonography)
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Medications to induce ovulation
Surgical options
Therapeutic insemination
Advanced reproductive technologies
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Factual information—advantages and
limitations
Financial implications
Donor confidentiality
Ongoing education and counseling
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Emotional stress
Feelings of disappointment and failure
Sense of loss and grief
Intercourse changes to goal-oriented
procedure
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Healthy lifestyle choices
◦ Physical activity, nutrition, stress management,
adequate rest
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Holistic/complementary alternatives
Herbal supplements
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Surrogacy—gestational carrier
◦ Ethical/legal implications
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Adoption
Child-free lifestyle
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Empowerment
Advocacy
Education
Appropriate care to encompass the cultural,
spiritual, and environmental domains
An infertile couple confides in the nurse at the
infertility clinic that they feel overwhelmed
with the decisions that face them. Which of
the following nursing strategies would be
most appropriate?
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b.
c.
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Refer them to a marriage counselor
Provide them with information throughout the
diagnostic process
Express concern and provide advise
Inquire about the names they have chosen for
their baby