Managment of Fertility and infertility Chapter 31

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Managment of Fertility and infertility Chapter 31
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2013-04-25 21:59:12
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Managment Fertility infertility Chapter 31
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Managment of Fertility and infertility Chapter 31 SPC nursing
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  1. THe nurse plays an important role in educating women about contraceptives techniques and their correct use.
  2. Important issues in choosing contraceptives include safety, protection from STD's effectivness, acceptibitity, convenienc education needed benefits side effects, effects on spontaneity.
  3. Written informed consent may be necessary for some contraceptives choices
  4. Adolescents feel more comfortable talking about contraception with a nurse who has an accepting attitude, provides extra time for education and uses understandable terms and audiovisual materials.
  5. Women older than 35 years old who smoke or have cardiac risk factors should not use combined oral contraceptives (OCs).
  6. A tubal sterilization can be performed soon after childbirth or at any time.  Vasectomy is less expensive and can be performed in a physiscians office under local anesthesia.  Although surgery to reverse sterilization is possible it is expensive and not always successful.
  7. intrauterine devices (IUDs) are very effective and safe.  Women must check for the devices strings and know when to seek medical treatment.
  8. Hormonal contraceptives include hormone implants injections, OCs, patches, or vaginal rings.  Hormonal contraceptives inhibit ovulation and make the cervical mucus unreceptive to sperm.  Side effects and complications make these unsuitable for some women.
  9. OCs, the patch, and the ring may be used on a monthly basis, for extended cycles, or indefinitely to decrease menstrual periods.
  10. Emergency contraceptive (EC) protects against pregnancy if taken within 3-5 days after unprotected intercourse.
  11. Barrier methods may be chemical or mechanical.  They kill sperm or prevent sperm from entering teh cervix and may provide some protection against STDs.
  12. Natural family planning methods involve avoidance of coitus when physiologic cues suggest that ovulation is likely.  THey involve extensive education and high motivation and have a high risk of pregnancy should error occur.
  13. Because of the many unknown factors in reproduction, identfication and correction of problems in one or both partners do not necessarily resolve their infertility.
  14. A variety of structural and fuctional abnormalities may contribute to a couple's infertility.  THe man may hav abnormalities of the sperm or of the seminal fluid or with ejaculation.  The woman may have ovulation disorders, anatomic problems such as fallopian tube occlusion, or physiologic disorders such as hormone imbalances.
  15. A systematic evaluation of both partners, proceeding from simple to complex, identifies therapy most likely to be sucessful and cost-effective.  The couple may decide to stop evaluation or therapy at any point.
  16. Infertile couples must make choices at many points before and during evaluation of therapy. Some major factors that enter into their decisions involve social, cultural, and religious values; difficultuy of treatment; probability of success financial resources; and age, particularly the woman's.
  17. infertility is a crisis for the couple and often for the extended family. Either or both partners may feel that the inability to conceive represents a personal failure.
  18. THe possible outcomes after infertility therapy may present new challanges to the partners and their families; unsuccessful therapy and the choice of whether to pursue adoption, pregnancy loss after infertility, and parenthood after infertility.  Stopping infertlity therapy and remaining childless are other options.
  19. THe body temperature at rest.
    Basal body temperature
  20. Presence of endometrial tissue outside the uterine cavity
    Endometriosis
  21. A woman carries the embryo of an infertile couple and relinquishes the child.
    Gestational surrogate
  22. Inability to conceive after 1 year
    Infertility
  23. Decreased number of sperm in semen
    Oligospermia
  24. A chemical that kills sperm
    Spermicide
  25. Cutting the fallopian tubes to prevent passage of ova and sperm.
    Tubal ligation
  26. Why is the typical, or actual, failure rate of contraceptive more usefull than the theoretical failure rate?
    The typical failure rate reflects the way real people use a contraceptive and includes mistakes or inconsistencies of use.  It is most meaningful when counseling patients.
  27. What are the major side effects of Depo-Provera?
    Menstral irregularities, weight gain, headaches, depression, hair loss, and decreased bone density
  28. When may a perimenopausal woman discontinue contraception
    Pregnancy is rare after age 50 or if menstruation has ceased for at least 1 year.
  29. Why should a man have his semen analyzed following vasectomy?
    Sperm may be in the ductal system, distal to the ligation of the vas deferens and able to impregnate a woman
  30. How do hormone injections prevent pregnancy?
    They cause thickening of the cervical mucus, which help prevent penetration by sperm and makes the endometrial lining unfavorable for implantation.  They prevent ovulation for 14 weeks.
  31. How do estrogen-progestin oral contraceptives prevent conception?
    They prevent secretion of follicle-stimulating and luteinizing hormones, thus preventing ovulation; they also make the cervical mucus too thick for sperm to penetrate and the endometrium less
  32. How do progestin-only oral contraceptives prevent conception
    THey thicken cervical mucus to inhibit sperm penetratoin and make the endometrium less hospitalbe.
  33. What teaching is appropriate in the area related to oral contracetive use?  Back-up contraception?
    Have a back-up methoud readily available for side effects with discontinuance or missed doses.
  34. What teaching is appropriate in the area related to oral contracetive use?  Time of day
    Take at the same time of day to maintain constant blood levels. maximize effectiveness, and reduce break-through bleeding
  35. What teaching is appropriate in the area related to oral contracetive use? Possible pregnancy
    Stop pills and use a back up if pregnancy is suspected; get a sensitive pregnancy test.
  36. What teaching is appropriate in the area related to oral contracetive use? Use of lactation
    Combinaition pills reduce milk production and small amounts are transferred to milk; use after lactation is well established
  37. What teaching is appropriate in the area related to oral contracetive use? Other medications
    Interactions may alter the effectivenss of each medication; inform health care provider of all medications.
  38. List some types of emergency contraception
    High doses of oral contraceptive within 72 hrs of unprotected intercourse, with a second dose of 12 hours later; high doses of progestin-only contraceptives; insertion of the copper T 380A intrauterine device within 5 days mifepristone.
  39. Why should women using an intauterine device (IUD) be in a mutually monogamous relationship.
    Pelvic infections associated with the IUD are usually caused by STDs, if the woman ahd her partener are mutually monogamous, the risk of STDs is low thus reducing the risk of IUD-associated infection
  40. What teaching is important related to IUD use?
    Check for the tail weekly for 4 weeks, then monthly after the menstrual period and if you have signs of expulsion (cramping or unexpected bleeding).  See your health care provider if strings are longer or shorter than before. Report signs of infection or pregnancy.
  41. What are teh two main advantages of barrier methods of contraception
    Avoidance of systmic hormones, protection from STDs
  42. Why is the use of spermicide with condoms advisiable
    The spermicide adds a chemical barrier to the mechanical barrier of the condom and lubricates the condom to reduce tearing
  43. What should the woman who uses spermicides be taught about douching?
    Avoid douching for at least 6 hours to avoid washing the protection away.
  44. Why is it essential to help the man or woman understand the difference between natural membrane condoms and latex condoms?
    Natural membrane condoms do not protect from STDs including HIV
  45. At what time should the woman who uses a diaphragm for contraception have the fit checked?
    She should have it checked yearly, after a weight gain or loss of more than 10 lbs, or after any pregnancy or abortion.
  46. What is the major problem in using natural family planning methods
    Any error in predicitng ovulation or safe times for intercourse may result in pregnancy
  47. List factors that may impair the ability of sperm to fertilize the ovum?
    Abnormal hormone stimulation, acute or chronic illness, infections of the gential tract, anatomic abnormalities, exposure to toxins, theraputic treatments for cancer or other illness, excessive alcohol intake, illicit drug ingestion, elevated scrotal temperature, antibodies produced by the man or the woman that alter function.
  48. List factors that may impair structure and function of the fallopian tubes
    infections, endometiosis or surgery that causes adhesions, congential anomalies
  49. Describe two complications associated with medications given to induce ovulation
    THe risk for multifetal pregnancies increases, because multiple ova may be released and thus fertilized

    Ovarian hyperstimulation syndrome may cause exudation of fluid into the womans peritoneal and pleural cavities.
  50. What are some reasons for choosing therapeutic insemination?
    A low sperm count, genetic defect carried by male, womans desire for a biological child without having a male partner
  51. What complications lessen the risk that a man will transmit infection or genetic disorders when he donates his sperm?
    a personal and family health history is taken; questions are asked about social habits and personality.  Other test include a physical examination and laboratory studies including those for genetic defects. Donar sperm is frozen and held for 6 month before use.

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