COC, Contraception, Testicular Cancer, Culture Issues
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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
Relative contraindications for oral contraceptives
- headaches that began after starting use
- HTN...Diastolic >90
- Heart/Renal dysfunction
- Impaired glucose tolerance
- Varicose Veins
- Breast Feeding
Warning signs of Oral Contraceptive problems
- Abdominal pain
- Chest pain, dyspnea, hemoptysis, SOB
- Headache, weak or numb extremities
- Eye disturbances
- Severe leg pain
How can using the rhythm method get messed up?
it is unreliable if the client is sick, pp, lactating or is older
When do you take your basal temp?
in the am before you get out of bed.
- must do for 3-4 successive months
- temperature will drop before ovulation, then rise
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
Barrier methods of birth control that use spermicide
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
When do you put the vaginal spermicide in?
can put in 15 to 8 hours before intercourse
2 Barriers that require a RX
Cervical Cap and Diaphragm
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
Two problems commonly seen with Diaphragm and Cervical cap
Teaching for the cervical cap and diaphragm
- s/s of TSS
- must be refitted if lose or gain 10-15 lbs
Which barrier do we need to check for a latex allergy?
Which birth control is good for a woman pp who is nursing and doesn't want to be on bcp?
What helps to prevent STD transmission?
What kind of lubricant do you use with a condom?
water based only
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
How do you remove a condom?
pull from the tip, keeping contents in
It is recommended to take the pill....
at the same time every day and at night
Advantages of the pill
- decreases risk of PID
- decreases dysmenorrhea
- prevents cyclic breast modularity
- decreases menses
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
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
Rule for Depo-Provera
if the shot is given within 5 days of start of period....no need for back up contraception
How long does each depo provera injection last?
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
Who is likely to be given depo provera?
- people with sickle cell disease
- persons on rifampin
- persons on anti-convulsants
If on Depo Provera teach....
may lose bone density...so need to take calcium and exercise
How often do you change the cervical ring?
every 3 weeks
2 problems with contraceptive patch
- lots of estrogen so increased risk for a blood clot
- not effective in an obese person
Rules about the contraceptive patch
- replace weekly
- place in a dry area where you don't sweat alot
How does the morning after pill work?
- inhibits ovulation
- prevents fertilization
- prevents fertilized egg from implanting
When does the morning after pill have to be taken?
within 72 hours of intercourse
Good part about IUD/Mirena
fertility returns immediately
How often do you check placement of the IUD and how?
every month....find string....longer or shorter it has moved
How does a vasectomy work?
vas deferens is tied off or part is removed....so sperm doesn't come out with semen
removal or tying off of a portion or all of the uterine tubes
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
Who's at risk for testicular cancer?
white males 20-35 with undescended testes
How do you check for testicular cancer?
palpate testes monthly looking for enlargement or irregularity of the testes
What infectious disease can cause testicular cancer?
S/S of testicular cancer
- small painless lump
- testes feeling heavy
- enlarged male breasts/breast tenderness
- enlarged teste
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
What do normal testes look like?
- left hangs a little lower than the right
- common for 1 to be larger than the other
Tumor markers for testicular cancer
HCG and AFT
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