Family Planning & Contraception

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Miriam Wahrman
MSN/Ed,RNC-MNN
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Included In This Lesson

Study Tools For Family Planning & Contraception

Intra Uterine Device – Potential Problems (Mnemonic)
Oral Birth Control Pills – Serious Complications (Mnemonic)
Oral Contraceptive (Image)
Contraceptive Patch (Image)
Family Planning (Cheatsheet)
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Outline

Overview

  1. Family planning consists of multiple ways  to plan or prevent pregnancy from occurring.

Nursing Points

General

  1. It is important to remember the patient’s preferences are most important and the below factors may influence choices of family planning
    1. Goal-oriented in selection of method
      1. Prevention versus planning
    2. Factors that may influence contraceptive selection:
      1. Religious, cultural, personal influences
      2. Age
      3. Smoker or nonsmoker
      4. Goals for family planning
      5. Level of compliance (for example, will she take an oral contraceptive every day?)
      6. Frequency of intercourse (for example, if someone is frequently having intercourse, will they use a condom every time or would an oral contraceptive or IUD be more appropriate?)
      7. Currently breastfeeding
  2. The only method that is 100% proven to prevent pregnancy or STI’s is abstinence

Assessment

  1. Assess their current lifestyle / habits
  2. Identify their family planning goals

Therapeutic Management

  1. Pregnancy prevention
    1. Oral contraceptives, intrauterine devices, cervical caps, diaphragm
  2. Pregnancy and STI prevention
    1. Condoms
  3. Trying to get pregnant
    1. Ovulation tracking
      1. Basal Body Temperature
      2. Ovulation Predictor Kits
      3. Calendar Method
    2. Infertility
      1. Meds
      2. Surgical procedures
        1. To fix whatever the problem is ie: blockage in the tubes carrying the sperm
      3. In vitro fertilization
      4. Intrauterine insemination
      5. Surrogacy
      6. Embryo hosts
      7. Adoption
  4. Finished having children and want to permanently prevent future pregnancy
    1. Tubal ligation (female)
    2. Vasectomy (male)

Nursing Concepts

  1. Reproduction
  2. Patient education

Patient Education

  1. Birth control pills should be taken at the same time every day
  2. Antibiotics and other meds may decrease the effectiveness of contraceptives – use other form of protection
  3. It is important to take a prenatal vitamin when trying to conceive – should include folic acid

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Transcript

So what does Family Planning actually mean? Well with this it just means that it could be a person is either trying to prevent a pregnancy from occurring or someone that’s trying to plan a pregnancy. So we are going to talk about several different considerations that need to be taken in and then also how to make them successful in what they have chosen for themselves.

So let’s first talk about the patient that wants contraception so this patient is not trying to get pregnant. What are the considerations that we need to take into account when trying to help her with this? So there are a few big things I’ll write out for you. We need to know if she has any religious or cultural preferences because that could affect our choice and decision with her. We need to know her age. Some medications or contraception such as the oral contraception pills are not going to be good for somebody that is older because of hormones and blood clot risk. Also we need to know if she’s a smoker, why? Same thing the oral contraception won’t be good for that type of patient because we worry with oral contraception about blood clots forming and so someone that smokes is going to be at an increased risk. We also need to know if she has risky sexual behavior and by this we mean someone that has multiple partners. Somebody that has risky sexual behaviors would not be the best patient have something like an intrauterine device(IUD) placed as birth control because we worry about pelvic infections with these patients and those that have multiple partners are more at risk for STI and pelvic infections so adding that to the fact that they have a foreign body implanted would put them more at risk. And the last consideration is is this patient breastfeeding? So maybe they’ve had a child already and they are breastfeeding them and they need birth control because they don’t want to have another baby quite yet. For them the best option is going to be something called the mini pill and this is just like a progesterone only pill that won’t to hinder their milk supply. When contraception is being discussed with a patient we need to find what is going to best work for them and for their situation but the one thing that always needs to be stressed to the patient is that the only way to be 100% effective in preventing pregnancy or from getting an STI would be abstinence.

Now you have a patient that actually wants to be pregnant and needs advice on how to do this. There’s a few different ways that women can track ovulation because if they know when they ovulate and have intercourse around that time then hopefully they’ll be more successful getting pregnant. The first way we’ll talk about is the basal body temperature tracking. This patient will track her temperature every day now it has to be at the same time everyday before rising out of bed okay so that’s the basal body temperature tracking. When she takes her temperature and it’s ovulation time her body temperature is going first drop and then rise about 0.4-1 degree higher than what it had been. This temperature rise means that ovulation has occurred. So let’s review what your basal body temperature needs to be taken everyday at the same time before rising out of bed you will notice that your temperature range is about the same and then you will have a drop in temperature right as the egg is being released from the ovary and then the temperature will rise and that means ovulation has occurred. There are also ovulation predictor kits that women can buy from a drugstore where they void on a stick and it lets them know whether or not they are ovulating. and the last method for women that are trying to track for pregnancy would be the calendar method. With the calendar method they’re going to track their menstrual cycles over several months to get an idea of when ovulation is occurring based on how long their cycles are and knowing that ovulation occurs around the 14th day of a cycle.

Let’s compare now some more permanent methods for contraception. First we have vasectomy so here the vas deferans is cut and cauterized so that the male become sterile. It is important to know that this is not an instant fix it’s about three months before they will say that the male is sterile. And he will need to undergo to sperm counts to verify that there are no more working sperm there. This is outpatient and he will just need to ice and take it easy for a few days. For the woman she can have a tubal ligation or sometimes also called tubes tied so with this the fallopian tubes are clamped and tied so this way no egg can travel through the tube and this will sterilize the woman. Female this is a little bit more of an intense procedure where she’s going to need a lot more rest time to some women will do this after they’ve had their last baby if they delivered by C-section since the doctors already in there but otherwise this will cause a lot more pain and recovery in comparison to a vasectomy being done.

There are a few key points to try to remember. It is important to always consider the patient’s lifestyle in any type of family planning to know what’s best going to work for them. What is the patient trying to do what is their ultimate goal? Do they want to plan a pregnancy or prevent pregnancy? Based on their ultimate goal there are many options for them so it is our job to find what is going to be best for them and that they can stick with.

Reproduction and patient education will be the nursing concepts for this. Obviously with family planning we are talking about reproduction either how to make it happen or how to prevent it. And there is a lot of patient education that goes into this. With family planning they have to be able to be compliant and use the right things to be preventative if that’s what they wish and then also education on becoming pregnant.

Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.

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OB

Concepts Covered:

  • Pregnancy Risks
  • Labor Complications
  • Newborn Complications
  • Fetal Development
  • Terminology
  • Prenatal Concepts
  • Newborn Care
  • Postpartum Care
  • Postpartum Complications
  • Medication Administration
  • Labor and Delivery
  • Studying
  • Communication

Study Plan Lessons

Abortion in Nursing: Spontaneous, Induced, and Missed
Abruptio Placentae (Placental abruption)
Acyclovir (Zovirax) Nursing Considerations
Addicted Newborn
Alpha-fetoprotein (AFP) Lab Values
Anemia in Pregnancy
Antepartum Testing
Antepartum Testing Case Study (45 min)
Babies by Term
Betamethasone and Dexamethasone
Betamethasone and Dexamethasone in Pregnancy
Breastfeeding
Butorphanol (Stadol) Nursing Considerations
Cardiac (Heart) Disease in Pregnancy
Causes of Chorioamnionitis Nursing Mnemonic (Pregnancies Are Very Interesting)
Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
Causes of Postpartum Hemorrhage Nursing Mnemonic (4 T’s)
Chorioamnionitis
Day in the Life of a Labor Nurse
Day in the Life of a Postpartum Nurse
Discomforts of Pregnancy
Disseminated Intravascular Coagulation (DIC)
Dystocia
Ectopic Pregnancy
Ectopic Pregnancy Case Study (30 min)
Emergent Delivery (OB) (30 min)
Epidural
Episiotomy – Evaluation of Healing Nursing Mnemonic (REEDA)
Erythroblastosis Fetalis
Eye Prophylaxis for Newborn
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Family Planning & Contraception
Fertilization and Implantation
Fetal Alcohol Syndrome (FAS)
Fetal Circulation
Fetal Development
Fetal Distress Interventions Nursing Mnemonic (Stop MOAN)
Fetal Heart Monitoring (FHM)
Fetal Environment
Fetal Wellbeing Assessment Tests Nursing Mnemonic (ALONE)
Fundal Height Assessment for Nurses
Gestation & Nägele’s Rule: Estimating Due Dates
Gestational Diabetes (GDM)
Gestational HTN (Hypertension)
Glucose Tolerance Test (GTT) Lab Values
Gravidity and Parity (G&Ps, GTPAL)
HELLP Syndrome
HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
Hemorrhage (Postpartum Bleeding) for Certified Emergency Nursing (CEN)
Hepatitis B Vaccine for Newborns
Homocysteine (HCY) Lab Values
Hydatidiform Mole (Molar pregnancy)
Hyperemesis Gravidarum
Hypovolemic Shock Case Study (OB sim) (60 min)
Incompetent Cervix
Infections in Pregnancy
Initial Care of the Newborn (APGAR)
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Labor Progression Case Study (45 min)
Leopold Maneuvers
Lung Surfactant for Newborns
Magnesium Sulfate (MgSO4) Nursing Considerations
Magnesium Sulfate in Pregnancy
Mastitis
Maternal Risk Factors
Mechanisms of Labor
Meconium Aspiration
Meds for Postpartum Hemorrhage (PPH)
Menstrual Cycle
Newborn of HIV+ Mother
Newborn Physical Exam
Newborn Reflexes
Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Chorioamnionitis
Nursing Care Plan (NCP) for Dystocia
Nursing Care Plan (NCP) for Ectopic Pregnancy
Nursing Care Plan (NCP) for Gestational Diabetes (GDM)
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for Hyperemesis Gravidarum
Nursing Care Plan (NCP) for Incompetent Cervix
Nursing Care Plan (NCP) for Mastitis
Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Meconium Aspiration
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Newborns
Nursing Care Plan (NCP) for Placenta Previa
Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH)
Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)
Nursing Care Plan (NCP) for Preterm Labor / Premature Labor
Nursing Care Plan (NCP) for Process of Labor
Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)
Nursing Care Plan (NCP) for Transient Tachypnea of Newborn
Nursing Case Study for Maternal Newborn
Nutrition in Pregnancy
OB (Labor) Nurse Report to OB (Postpartum) Nurses
OB Non-Stress Test Results Nursing Mnemonic (NNN)
Obstetric Trauma for Certified Emergency Nursing (CEN)
Obstetrical Procedures
Opioid Analgesics in Pregnancy
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Oxytocin (Pitocin) Nursing Considerations
Pediatric Vital Signs (VS)
Phytonadione (Vitamin K) for Newborn
Placenta Previa for Certified Emergency Nursing (CEN)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Discomforts
Postpartum Hematoma
Postpartum Interventions
Postpartum Physiological Maternal Changes
Preeclampsia (45 min)
Postpartum Thrombophlebitis
Precipitous Labor
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Labs
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Preterm Labor for Certified Emergency Nursing (CEN)
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Prolapsed Umbilical Cord
Prostaglandins in Pregnancy
Rh Immune Globulin in Pregnancy
Signs of Pregnancy (Presumptive, Probable, Positive)
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Tips & Advice for Newborns (Neonatal IV Insertion)
Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Tocolytics
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)