8 SURGICAL INTERVENTIONS Stoppage of the passage of spermVASECTOMYTUBAL LIGATION
9 VASECTOMYThe vas deferens are cut and ligated. The ends may be buried in the scrotal fascia. Sperm can no longer get from testes to penis. Semen no longer contains sperm.
10 VASECTOMY Has no effect on potency Male hormones are still produced, so male secondary sex characteristics are not affectedSperm production continues16. What is the main teaching both pre-op and post-op for the male undergoing a Vasectomy?
11 Vasectomy Patient Teaching: Apply ice to scrotum Moderate activity for two daysSterility is not immediate --some spermwill remain in the sperm ducts so, themale must have ejaculations to rid theducts of these spermAfter he has 2 negative sperm counts, he then can resume sexual activity without use of another contraceptive.
13 Tube is ligated and sperm and ovum can no longer meet. Tubal LigationThe fallopianTube is ligated and sperm and ovum can no longer meet.
14 Prevent passage of sperm or egg in the fallopian tubes by TUBAL LIGATIONPrevent passage of sperm or egg in the fallopian tubes byClips orRingsRemove part of tubeCautery
15 Tubal LigationMay be done immediately following delivery or at a later dateSide effects:Infection, Hemorrhage, Perforation ofintestinesReversal is only 15% success rateWhat information is included when teaching the woman about tubal ligation?
16 Tubal SterilizationUse of non-surgical method Insertion of small coil (Essure) into the fallopian tubes Tubes become blocked as tissue grows
17 Consents and Regulations All states have regulations for informed consent which include:Explanation of risksBenefitsAlternativesStatement regarding it as a permanent, irreversiblemethod of birth control** There is a 30 day waiting period between givingconsent and the sterilization.Many states permit sterilization withoutreference to her marital status or mates consent.If federal funds are used, the person must be 21 years old. Minors cannot be sterilized.18. What state or federal regulations govern sterilization regarding:Age of the womanMarital status19. What legal implications apply to the teenager seeking contraception? How may this differ from the nurse’s ethicalbeliefs, what ethical principals allow the nurse to assist the teen in meeting her needs?20. What are the ethical issues involved with assisting a couple select a method of contraception?
18 HORMONAL THERAPY SUPPRESSES OVULATION 11. How does hormonal therapy work?
20 Depo Provera --progestin injection that inhibits ovulation, alters endometrium.Effective for 3 months – so must teach patientimportance of getting re-injectionsCan be used during breast feedingNursing Implications:Do NOT massage site after injection. It can accelerate absorption, and shorten period of effectiveness.Increases risk for osteoporosis – teach about calciumand vitamin D intake and weight-bearing exercise
21 Contraceptive Skin Patch Ortho Evra is a hormonal birth control method whereby synthetic hormones are delivered directly through the skin and into the bloodstream via a thin patch.Women can wear the Ortho Evra contraceptive patch on the buttocks, abdomen, upper torso (front and back, excluding the breasts), or upper outer arm.
22 Contraceptive Skin Patch Ortho Evra is replaced on the same day of the week for three consecutive weeks, and the fourth week is "patch-free."The patch remains attached and effectivewhile exercising, bathing or in hot, humid conditions.It contains the same synthetic hormones as combined oral contraceptive pills (estrogen and progestin) and isthought to be about as effective as the Pill.
23 The NuvaRing vaginal contraceptive ring With NuvaRing®, estrogen and progestin release is activated once the ring comes into contact with the vagina.The hormones are then absorbed and distributed into the bloodstream.In a given 1-month period, NuvaRing® must be inserted into the vagina, removed after 3 weeks, and a new ring must be inserted no more than 7 days later.
24 Combined Oral Contraceptives Come in different formsSingle hormone -- Progestin onlyCombined hormone - progestin & estrogenWith Blanks or with lactose pills or ferrous sulfate so there are no blank daysPill should be taken the same time each dayExtended-cycle COC- a 91 day regimen in which the woman takes a pill for 84 days followed by 7 days of menses.What is the important teaching related to each of the following hormonal therapies? Include side effects, precautions,and plans for cessation:a. Combined Oral contraception- CEC – birth control pillsb. Contraceptive skin patchc. NuvaRing vaginal contraceptive ringd. Injectibles – Lunelle; Depo-Provera
25 Cautions in Use of Combined Oral Contraceptives Contraindicated in woman with history ofThrombophlebitis and thromboembolic disordersCerebrovascular or cardiovascular diseasesEstrogen-dependent cancer or breast cancerBenign or malignant liver tumorsHypertensionMigraines with focal auraDiabetes with vascular involvement
26 Cautions in Use of Combined Oral Contraceptives Contraindicated in woman withAny of the above conditionsImpaired liver functionSuspected or known pregnancyUndiagnosed vaginal bleedingHeavy cigarette smokingMajor surgery requiring prolonged immobilization
27 Emergency Contraception Used after unprotected intercourse (condom breaks, rape, contraceptive not used correctly or did not use contraceptive).
28 Emergency Postcoital Contraception Ovral Therapy - Two tablets taken 72 hours after unprotected intercourse and 2 tables taken 12 hours later.Action: High levels of estrogen interfere with production of progesterone. Progesterone levels fall and therefore the endometrium will slough.Preven (kit) available by prescription - estrogen and progestin.Plan B – progestin-only method. Available OTC to women over 18 years old.May insert IUD within 5 daysOvralWhen is the use of emergency contraception indicated?What patient teaching is appropriate for the woman?
30 Mechanical Barriers Intrauterine devices IUD Prevents implantationMost common is copper T-shapePatient must check placement after menses and before intercourseSide Effects:PID, increase in bleeding and spotting, cramping, uterine perforation. Report pelvic pain.How do the various forms of mechanical barriers differ? What are benefits and disadvantages of eachmechanical barrier?e. Intrauterine device
31 Intrauterine Device (IUD) The Mirena Intrauterine System, which releases levonorgestrel gradually, may be left in place for up to 5 years
32 Prevent the transport of sperm Condom Male and FemaleSheath to cover the penis in the maleSheath inserted into the vagina and anchored around the cervixPrevent the transport of spermto the ovumSome should be used with a sperimicideTeach how to apply and how to remove to be effective.10. How do the various forms of mechanical barriers differ? What are benefits anddisadvantages of each mechanical barrier?a. Condom (male & female)-
33 The Contraceptive Sponge 10. How do the various forms of mechanical barriers differ? What are benefits and disadvantages of eachmechanical barrier?d. contraceptive spongemoisten well with water and insert into the vagina with the concave portion positioned over the cervix.Should be left in place for 6 hours and may be worn for 24 hours
34 DiaphragmDome shaped rubber device with a flexible wire rim that covers the cervix.May be used with gel or foam10. How do the various forms of mechanical barriers differ? What are benefits and disadvantages of eachmechanical barrier?b. Diaphragm-
35 Patient Teaching Diaphragm Insertiona. Apply jelly to the rim and center of thediaphragm.b. insert the diaphragm, pushing the rim of thediaphragm under the symphysis pubis.c. Check placement of thediaphragm. Cervix shouldbe felt through the diaphragm.
36 Diaphragm **Main Patient teaching is: Be sure to be re-evaluated for fit following delivery, pelvic surgery, or a weight gain or loss of 10 pounds.
37 Similar to the diaphragm Cervical CapSimilar to the diaphragmbut smaller andmay stay in for upto 48 hours.10. How do the various forms of mechanical barriers differ? What are benefits and disadvantages of eachmechanical barrier?c. cervical cap
38 Think About This ! Most women can use the same diaphragm for years if proper care is maintained.Which of the following situations wouldwarrant re-measurement and refitting?a. weight gain or loss of 5 lbs.b. surgery involving general anesthesiac. pelvic infectiond. pelvic surgery or delivery
40 Spermicides Foams Jellies Suppositories Creams Gel CHEMICAL BARRIERS What is the mechanism of action with chemical barrier contraception?What are types of spermicides available and what teaching points must the nurse include whendiscussing with the woman/couple?SuppositoriesCreamsGel
41 Spermicides Patient Teaching 1. Place deeply in the vagina so it comes in contact withthe cervix before each intercourse2. Maximun effectiveness lasts about one hour. Must reapply.3. Suppositories take minutes to dissolve4. Don’t douche for six hours following use
42 Test Yourself ! The most effective spermicidal contraceptive agent generally is:a. spermicidal creamb. spermicidal foamc. spermicidal jellyd. spermicidal vaginal suppository
43 Review How do each of these act as a contraceptive? IUD Condom Birth Control PillsVasectomyFoams, jelliesTransdermal patchTubal ligation
45 Natural Family Planning Fertility Awareness / Periodic Abstinence Relies on the avoidanceof intercourse during thepresumed fertile days ofthe menstrual cycle.
46 Rhythm or Calendar Method Calculate the time at which ovulation is likely to occur based on the length of previous menstrual cycles.The woman must keep a diary of her menstrual cyclesAbstain on the fertile days
47 Basal Body Temperature Keep a chart of rectal temperatures taken at the same time every day.Note: Illness, if slept on a heated water bed, heating blanket, fatigue, less than 3 hours of sleep.3. How does the woman calculate her fertile days using the Rhythm or Calendar Method?4. How do changes in temperature indicate fertility? - look for the drop and then rise – where is the check mark.
48 Cervical Mucus Testing Used to assess for ovulation.Assess Cervical mucus throughout the menstrual cycle.Indications of ovulation, the cervical mucus will be:copioustransparentthin, wateryStretchable / SpinnbarkheitThis is the time to avoid intercoursehow does cervical mucus assist in prediction of ovulation?
49 Fertility Awareness Assess Mittelschmerz -pain at ovulation Test-Tape - assess for the time that it is the darkestPredictor Tests for Ovulation - detects the sudden surge of LH that occurs approximately 12 to 24 hours before ovulation.What other methods might a couple utilize for determining ovulation in natural familyplanning?
50 Least Reliable Methods of Contraception AbstinenceBreastfeedingCoitus interruptusWhat are least reliable forms of contraception?