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Absolute contraindications for oral contraceptives
- **Liver issues...including benign or malignant tumors
- hx of thrombophlebitis
- Heart disease
- suspected or known pregnancy
- undiagnosed vaginal bleeding
- ** heavy cigarette smoking if over 35
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Relative contraindications for oral contraceptives
- headaches that began after starting use
- HTN...Diastolic >90
- Heart/Renal dysfunction
- Impaired glucose tolerance
- Depression
- Varicose Veins
- Hepatitis
- ASthma
- Breast Feeding
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Warning signs of Oral Contraceptive problems
- Abdominal pain
- Chest pain, dyspnea, hemoptysis, SOB
- Headache, weak or numb extremities
- Eye disturbances
- Severe leg pain
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How can using the rhythm method get messed up?
it is unreliable if the client is sick, pp, lactating or is older
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When do you take your basal temp?
Details
in the am before you get out of bed.
- must do for 3-4 successive months
- temperature will drop before ovulation, then rise
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What does mucus look like when you are ovulating?
clear, thin and elastic
Want it to be tacky and sticky to have sex....not ovulating
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Barrier methods of birth control that use spermicide
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What kind of a barrier is a vaginal spermicide?
physical barrier that is in a foam, cream, suppository or jelly that contains sperm killing chemicals
NO RX required
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When do you put the vaginal spermicide in?
can put in 15 to 8 hours before intercourse
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2 Barriers that require a RX
Cervical Cap and Diaphragm
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When can you put in the cervical cap? Remove?
6-8 hrs before sex
leave in for at least 6 hours....but not longer than 48-TSS
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Two problems commonly seen with Diaphragm and Cervical cap
bladder irritation...UTI's
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Teaching for the cervical cap and diaphragm
- s/s of TSS
- must be refitted if lose or gain 10-15 lbs
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Which barrier do we need to check for a latex allergy?
Diaphragm
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Which birth control is good for a woman pp who is nursing and doesn't want to be on bcp?
Diaphragm
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What helps to prevent STD transmission?
latex
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What kind of lubricant do you use with a condom?
water based only
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What do you teach teens about condoms?
- Don't store anywhere that it can get hot
- check expiration date
- don't use if package is broken
- roll condom OUT on an erect penis
- pinch tip of condom
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How do you remove a condom?
pull from the tip, keeping contents in
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It is recommended to take the pill....
at the same time every day and at night
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Advantages of the pill
- decreases risk of PID
- decreases dysmenorrhea
- prevents cyclic breast modularity
- decreases menses
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Disadvantages of the pill
- increases MI risk
- increases stroke risk....especially if over 35 and heavy smoker
- doesn't protect from STD's
- other meds can decrease it's effectiveness
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Rules for missing birth control pills
if miss three and get your period....start a new pack, throw out old pack
if miss 1 pill...take right away
if miss 2 pills....take 2 and 2 and use back up contraception
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Rule for Depo-Provera
if the shot is given within 5 days of start of period....no need for back up contraception
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How long does each depo provera injection last?
3 months
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Disadvantages of Depo Provera
- may spot every day for the 1st 6 months
- depression....if hx of don't take
- ovulation may not resume for 12-18 months after injection
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Who is likely to be given depo provera?
- people with sickle cell disease
- persons on rifampin
- persons on anti-convulsants
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If on Depo Provera teach....
may lose bone density...so need to take calcium and exercise
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How often do you change the cervical ring?
every 3 weeks
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2 problems with contraceptive patch
- lots of estrogen so increased risk for a blood clot
- not effective in an obese person
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Rules about the contraceptive patch
- replace weekly
- place in a dry area where you don't sweat alot
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How does the morning after pill work?
- inhibits ovulation
- prevents fertilization
- prevents fertilized egg from implanting
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When does the morning after pill have to be taken?
within 72 hours of intercourse
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Good part about IUD/Mirena
fertility returns immediately
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How often do you check placement of the IUD and how?
every month....find string....longer or shorter it has moved
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How does a vasectomy work?
vas deferens is tied off or part is removed....so sperm doesn't come out with semen
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Salpingectomy
removal or tying off of a portion or all of the uterine tubes
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Rules about sterilization
- may or may not require spouse permission
- must be 21 for government reimbursement
- *requires 30 day waiting period between consent and procedure
- *can be waived to 72 hours
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Who's at risk for testicular cancer?
white males 20-35 with undescended testes
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How do you check for testicular cancer?
palpate testes monthly looking for enlargement or irregularity of the testes
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What infectious disease can cause testicular cancer?
mumps
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S/S of testicular cancer
- small painless lump
- testes feeling heavy
- enlarged male breasts/breast tenderness
- enlarged teste
- pain
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How do you do a testicular self exam?
- 1 x a month
- during or after a shower/bath
- warm water is good to help scrotum relax and drop down
- support each testicle with one hand and examine it with the other
- roll between thumb and fingers
- testes should feel firm and smoothe...like a hard boiled egg without the shell
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What do normal testes look like?
- left hangs a little lower than the right
- common for 1 to be larger than the other
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Tumor markers for testicular cancer
HCG and AFT
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