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Presentation on theme: "CONTRACEPTION Chapter 10."— Presentation transcript:



What factors must the couple consider when choosing a contraceptive?

4 Considerations when Choosing a Contraceptive Method
Safety Protection from sexually transmissible diseases Effectiveness Acceptability Convenience Education needed Side Effects

5 Considerations cont. Benefits Interference with spontaneity
Availability Expense Preference Religious and personal beliefs Culture

6 Counseling Adolescents
Be sensitive to their feelings, concerns and needs Be accepting of teenager regardless of personal feelings Use understandable language when teaching

7 Methods of Contraception

Stoppage of the passage of sperm VASECTOMY TUBAL LIGATION

9 VASECTOMY The 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 affected Sperm production continues 16. 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 days Sterility is not immediate --some sperm will remain in the sperm ducts so, the male must have ejaculations to rid the ducts of these sperm After 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 Ligation The fallopian Tube is ligated and sperm and ovum can no longer meet.

14 Prevent passage of sperm or egg in the fallopian tubes by
TUBAL LIGATION Prevent passage of sperm or egg in the fallopian tubes by Clips or Rings Remove part of tube Cautery

15 Tubal Ligation May be done immediately following delivery or at a later date Side effects: Infection, Hemorrhage, Perforation of intestines Reversal is only 15% success rate What information is included when teaching the woman about tubal ligation?

16 Tubal Sterilization Use 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 risks Benefits Alternatives Statement regarding it as a permanent, irreversible method of birth control ** There is a 30 day waiting period between giving consent and the sterilization. Many states permit sterilization without reference 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 woman Marital status 19. What legal implications apply to the teenager seeking contraception? How may this differ from the nurse’s ethical beliefs, 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?

11. How does hormonal therapy work?

19 Hormonal Therapy HORMONAL THERAPY Vaginal Contraceptive Ring
Skin Patch HORMONAL THERAPY Progestin Injections Oral Contraception

20 Depo Provera --progestin injection that inhibits
ovulation, alters endometrium. Effective for 3 months – so must teach patient importance of getting re-injections Can be used during breast feeding Nursing Implications: Do NOT massage site after injection. It can accelerate absorption, and shorten period of effectiveness. Increases risk for osteoporosis – teach about calcium and 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 effective while exercising, bathing or in hot, humid conditions. It contains the same synthetic hormones as combined oral contraceptive pills (estrogen and progestin) and is thought 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 forms Single hormone -- Progestin only Combined hormone - progestin & estrogen With Blanks or with lactose pills or ferrous sulfate so there are no blank days Pill should be taken the same time each day Extended-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 pills b. Contraceptive skin patch c. NuvaRing vaginal contraceptive ring d. Injectibles – Lunelle; Depo-Provera

25 Cautions in Use of Combined Oral Contraceptives
Contraindicated in woman with history of Thrombophlebitis and thromboembolic disorders Cerebrovascular or cardiovascular diseases Estrogen-dependent cancer or breast cancer Benign or malignant liver tumors Hypertension Migraines with focal aura Diabetes with vascular involvement

26 Cautions in Use of Combined Oral Contraceptives
Contraindicated in woman with Any of the above conditions Impaired liver function Suspected or known pregnancy Undiagnosed vaginal bleeding Heavy cigarette smoking Major 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 days Ovral When is the use of emergency contraception indicated? What patient teaching is appropriate for the woman?

29 Mechanical Barriers

30 Mechanical Barriers Intrauterine devices IUD
Prevents implantation Most common is copper T-shape Patient must check placement after menses and before intercourse Side 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 each mechanical 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 Female Sheath to cover the penis in the male Sheath inserted into the vagina and anchored around the cervix Prevent the transport of sperm to the ovum Some should be used with a sperimicide Teach how to apply and how to remove to be effective. 10. How do the various forms of mechanical barriers differ? What are benefits and disadvantages 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 each mechanical barrier? d. contraceptive sponge moisten 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 Diaphragm Dome shaped rubber device with a flexible wire rim that covers the cervix. May be used with gel or foam 10. How do the various forms of mechanical barriers differ? What are benefits and disadvantages of each mechanical barrier? b. Diaphragm-

35 Patient Teaching Diaphragm
Insertion a. Apply jelly to the rim and center of the diaphragm. b. insert the diaphragm, pushing the rim of the diaphragm under the symphysis pubis. c. Check placement of the diaphragm. Cervix should be 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 Cap Similar to the diaphragm but smaller and may stay in for up to 48 hours. 10. How do the various forms of mechanical barriers differ? What are benefits and disadvantages of each mechanical 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 would warrant re-measurement and refitting? a. weight gain or loss of 5 lbs. b. surgery involving general anesthesia c. pelvic infection d. pelvic surgery or delivery

39 Chemical Barriers Act as spermicides

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 when discussing with the woman/couple? Suppositories Creams Gel

41 Spermicides Patient Teaching
1. Place deeply in the vagina so it comes in contact with the cervix before each intercourse 2. Maximun effectiveness lasts about one hour. Must reapply. 3. Suppositories take minutes to dissolve 4. Don’t douche for six hours following use

42 Test Yourself ! The most effective spermicidal
contraceptive agent generally is: a. spermicidal cream b. spermicidal foam c. spermicidal jelly d. spermicidal vaginal suppository

43 Review How do each of these act as a contraceptive? IUD Condom
Birth Control Pills Vasectomy Foams, jellies Transdermal patch Tubal ligation

44 Natural Family Planning Methods

45 Natural Family Planning Fertility Awareness / Periodic Abstinence
Relies on the avoidance of intercourse during the presumed fertile days of the 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 cycles Abstain 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: copious transparent thin, watery Stretchable / Spinnbarkheit This is the time to avoid intercourse how 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 darkest Predictor 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 family planning?

50 Least Reliable Methods of Contraception
Abstinence Breastfeeding Coitus interruptus What are least reliable forms of contraception?


52 The nurse would teach the breastfeeding woman it is
BEST to use use which of the following? A. Birth Control Pills B. Estrogen injections C. IUD D. Condom and spermicidal foam

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