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Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
Responsible parenthood  ncm lec
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Responsible parenthood ncm lec

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  • 1. July 2, 2010<br />July 16, 2010<br />FAMILY PLANNING<br />The overall goal of family planning is to provide universal access to family planning information and services wherever and whenever these are needed. It aims to contribute in reducing infant deaths, neonatal deaths, under-five year old deaths and maternal deaths<br />RESPONSIBLE PARENTHOOD- it is anchored on the following basic principles:<br /><ul><li>Responsible parenthood
  • 2. Respect for Life. The 1987 Constitution states that the government protects the sanctity of life. Abortion is not a FB method.
  • 3. Birth Spacing refers o the interval between pregnancies, which is ideally 3 years and informed choice.
  • 4. includes all decisions by an individual or couple pertaining to having children
  • 5. which means that each family has the right and duty to determine the desired number of children they might have and when they might have them
  • 6. responsible parenting which is the proper upbringing and education of children so that they grow up to be upright, productive and civic-minded citizens
  • 7. it enables women to recover their health, improves women’s potential to be more productive and to realize their personal aspiration and allows more time to care for children and spouse/husband
  • 8. that is upholding and ensuring the right of couples to determine the number and spacing of their children according to their life’s aspirations and reminding couples that planning size of their families have a direct bearing on the quality of their children’s and their own lies
  • 9. Conception=fertilization (meeting of egg and sperm)
  • 10. Contraception- preventing fertilization</li></ul>Contraception<br /><ul><li>is a regimen of one or more actions, devices, or medications followed in order to deliberately prevent or reduce the likelihood of pregnancy or childbirth,
  • 11. Birth control
  • 12. Termination of pregnancy </li></ul>Nurses role on FP:<br /><ul><li>Health education</li></ul>Nursing process:<br /><ul><li>Personal values
  • 13. Status of couple’s relationship
  • 14. Ability to use method correctly
  • 15. Financial factors
  • 16. How methods affect sexual life
  • 17. Prior experiences
  • 18. Future plans
  • 19. Legal and ethical considerations
  • 20. Diagnoses:
  • 21. Health seeking behaviors regarding contraception ooptions R/T desire to prevent pregnancy
  • 22. Deficient knowledge RT use of
  • 23. Ineffective sexuality patterns
  • 24. Planning- realistic, sensitive, and appropriate goals
  • 25. Implementation:
  • 26. Health teachings on FP options
  • 27. Ideal contraception:
  • 28. Safe
  • 29. 100% effective
  • 30. Free from side effects
  • 31. Easily obtainable
  • 32. Affordable
  • 33. Acceptable
  • 34. Free from side effects on future pregnancies
  • 35. Evaluation- reassess within 1-3 weeks after counseling on method</li></ul>FP Methods:<br /><ul><li>Abstinence- abstain from sexual intercourse
  • 36. Advantage: Most effective way, 0% failure rate, most effective n preventing STDs
  • 37. Disadvantage: not realistic
  • 38. Natural family planning- involves no chemical or foreign material being introduced into the body
  • 39. Utilizes fertility awareness methods- detecting fertile days
  • 40. Natural, poses no risk for occurring or future pregnancies; cost effective; theoretical failure rate 1-2%
  • 41. actual failure rate- 10-20%</li></ul>FERTILITY AWARENESS METHODS:<br /><ul><li>Standard days SDM
  • 42. Gather diary of 6 consecutive menstrual cycles (if cycle is 28 days, ovulation is on the 14th, 30days, 16th) [rule: length of menstrual cycle- 14days= ovulation day)
  • 43. Fertile days (fertile window of days 8-19):
  • 44. Shortest documented, subtract 18 = first fertile day
  • 45. Longest, subtract 11= last fertile day
  • 46. “Cycle beads” or “vertical beads”:
  • 47. Red- first day of menstruation
  • 48. Green- fertile days
  • 49. Brown- infertile days
  • 50. Chocolate (dark) brown- if menstrual cycle is shortened/lengthened
  • 51. Important points:
  • 52. Menstrual cycle length is below 26, above 32- the first time this happens, ct. takes note and marks ct. card; 2nd time around, change to another family planning method
  • 53. If 42 days or more, ct. is advised to take a pregnancy test
  • 54. Return during 1st week of next menstrual period
  • 55. Who can use?
  • 56. Women with menstrual cycles between 26-32 days
  • 57. Couples who want to space childbirth at this time
  • 58. Couples who can avoid sexual intercourse during fertile days
  • 59. Couples at low risk of STDs (monogamous)
  • 60. Women who can count and remember the length of her cycle
  • 61. When was her last menstrual period LMP
  • 62. When will be the next NMP
  • 63. When was the previous PMP
  • 64. Assessing women with special/unusual situations (hormone is not stable yet ):
  • 65. Postpartum and breastfeeding women
  • 66. Recent user of pills (alters ovulation cycle), injectables (DMPA)
  • 67. For women who just had an IUD removed
  • 68. For woman who recently had a miscarriage or abortion (8-12weeks birth spacing)
  • 69. Basal Body temp BBT- is the temp at rest after at least three hours of continuous sleep or rest
  • 70. Based on woman’s menstrual cycle
  • 71. It entails the daily taking and recording of the woman’s temp after 3 hrs of continuous sleep
  • 72. 98% effective rate
  • 73. Materials: thermometer, basal body temp method chart
  • 74. Process:
  • 75. Shake the thermometer to 35C or below in the evening and place at bedside
  • 76. Starting on the first day of menstruation, take the temp upon waking up every morning
  • 77. Take temp under tongue or axilla for 5 mins
  • 78. Cover line- the point of reference for determining the thermal shift that occurs during ovulation
  • 79. Identify the temp reading of the first 10 days of cycle
  • 80. Disregard the temp of the first five days
  • 81. Find the highest temp from 6-10
  • 82. Draw a horizontal line from 6th to 10th day
  • 83. Thermal shift- watch for 3 consecutive temp recordings above the cover line
  • 84. Count these 3 consecutive temp above the cover line, and mark them as days 1,2,3
  • 85. Draw vertical line between 2 and 3
  • 86. Going to the right- infertile days, left- fertile
  • 87. Follow up: not later than 3rd week after menstrual period
  • 88. Billings Ovulation Method (BOM) or (CMM ) Cervical Mucus Method- (OM, MM) ovulation/mucus method
  • 89. Based on observation of the changes in the mucus secretions of the woman
  • 90. Has 98 % effectivity rate
  • 91. Daily observation of the mucus change, recording of BOM chart</li></ul>**INCOMPLETE DATA<br /><ul><li>OBSERVINGQUESTIONRECORDINGThe womanWho? CoupleSensation (wet, dry)What?Sensation (wet, dry)Appearance (mucus)Appearance (mucus)Vaginal areaWhere?Every day from the first day of menstruationWhen?in the evening before going to sleepThroughout the dayat the end of the dayBefore or after urinatingbefore or after urinating What do I feel?What do I see?Symbols</li></ul>Symbols:<br />R- regla or Menstruation, spotting<br />D- Dry with no mucus<br />X- Wet with slippery, stretchy, clear, or watery mucus fertile days<br />(X)- Peak day, last day of wetness or wet mucus<br />M- Dry with sticky, pasty, or crumbly mucus<br />1, 2, 3- post peak days<br /><3 love making day<br /><ul><li>Two day method TDM- natural way of family planning that allow couples to distinguish fertile and infertile days of the menstrual cycle by means of cervical mucus observation
  • 92. This named two-day because the
  • 93. Effectivity rate
  • 94. Who can use?
  • 95. Wives that can observer her mucus secretion
  • 96. Wives that has normal mucus secretions (mucus secretion must be at least 5 days and will not exceed 14 days)
  • 97. Wives that have ample time in observing mucus secretions
  • 98. Couples that can record mucus observations at the end of the day (all throughout the day)
  • 99. Couples who want to space childbirth at this time
  • 100. Couples who can avoid sexual intercourse during fertile days
  • 101. Couples at low risk of STDs
  • 102. Assessing women with special/unusual situations: same with standard methods
  • 103. After menstruations, there may be days without secretion after which, a little secretion may be noticed. At the start you need to pay a lot of attention to notice it.
  • 104. How does mucus look like?
  • 105. Mucus does not appear the same at all tines
  • 106. In the first phases of secretion only a little mucus will be observed, this demands a careful observation
  • 107. All the days with mucus secretion marks the fertile days
  • 108. How do I know if I have secretions??
  • 109. Mucus can be seen and felt by the wife
  • 110. You can check it when you go to the toilet:
  • 111. By wiping yourself with tissue before passing urine
  • 112. Looking at underwear
  • 113. Touching genital area with clean fingers
  • 114. You can feel it when there is dampness of the genitals?
  • 115. Without interrupting what you are doing, think if you feel some dampness or not. E conscious.
  • 116. What days can you get pregnant?
  • 117. If you had secretions today or yesterday, abstain from intercourse today
  • 118. For couples whose intention is to space childbirth, abstain from sexual intercourse during fertile days
  • 119. Symptothermal Method STM- temperature changes and cervical mucus changes (BBT-CMM)
  • 120. Combines the observations made of the cervical mucus, temperature records, and other signs of ovulation to determine the fertile and infertile phases
  • 121. Has 99% effectivity rate
  • 122. Using symbols
  • 123. Rules:
  • 124. The first fertile day is identified on the first onset of mucus following dry days after menstruation. Follow the early days rule (EDR)
  • 125. On dry days following menstruation, lovemaking will be on alternate evenings only
  • 126. If there are no dry days following menstruation, EDR cannot be applied
  • 127. The post ovulatory phase is determined to be following both BBT and MM rules. However, when there is a difference, follow what comes later, whether the peak day or thermal shift.
  • 128. Lactation Amenorrhea Method LAM- breastfeeding can be used as a family planning method by women who are fully or almost breastfeeding, have no menstruation yet during their first six months from delivery
  • 129. Temporary introductory method of a family planning based on the physiological
  • 130. Lactation
  • 131. Exclusive of fully breastfeeding
  • 132. Almost exclusive or almost fully bf
  • 133. Feeding interval should not exceed four hours during the day and six hours at night
  • 134. Amenorrhea
  • 135. women’s menstruation has not yet returned (this does not include the spotting that occurs 56 days postpartum [6weeks after birth])
  • 136. Method-
  • 137. LAM has proven to be more than 98% effective if woman meets the 3 criteria established for use of the method
  • 138. criteria:
  • 139. she is amenorrheic
  • 140. fully or nearly fully breastfeeding her infant
  • 141. Infant is less than 6 months old
  • 142. Uses symbols for chart
  • 143. Return visit- once the menstruation returns, no longer breastfeeding, infant is 6 months
  • 144. Coitus Interruptus- withdrawal
  • 145. One of the oldest known methods
  • 146. Coitus until moment of ejaculation
  • 147. Man withdraws and spermatozoa are emitted outside the vagina
  • 148. Disadvantage- ejaculation may occur before withdrawal is complete
  • 149. High failure rate</li></ul>ARTIFICIAL METHODS<br />Main categories:<br /><ul><li>Barrier methods (e.g., condoms, diaphragm, spermicides)
  • 150. Hormonal methods (e.g., birth control pills, injectables, patch)
  • 151. Serilixation (e.g., tubal ligation, vasectomy)</li></ul>Barrier methods- place a physical impediment to the movement of sperm into the female resproductive tract<br /><ul><li>Advantage- prevent spread of STDs, lack of hormonal side effects
  • 152. Disadvantage- inc. failure rates, decrease sexual enjoyment
  • 153. Male condoms- latex/rubber or synthetic sheath placed over an erect penis before coitus; removed after ejaculation
  • 154. Space at tip
  • 155. Not to reuse, even a pinpoint hole can allow thousands of sperm to escape
  • 156. Discard old stock
  • 157. Effectiveness: 98%
  • 158. Contraindicated: latex allergy
  • 159. Female condoms
  • 160. Latex sheaths made of polyurethane and lubricated with nonoxynol-9 (treat STDs)
  • 161. Inner (closed end covers the cervix) and outer ring (open end @vaginal opening)
  • 162. Be placed before coitus
  • 163. Failure rate- 15%
  • 164. IUD- small flexible plastic frame inserted into a woman’s vagina through her uterus
  • 165. Can be inserted immediately after childbirth
  • 166. Two types:
  • 167. ParaGard, a copper IUD- Spermicidal, lasts for 12yrs; 99.2% effective
  • 168. Mirena- contains a synthetic hormone called levonorgestrel- cervical mucus thickening; 99.l9% effectiveness rate; lasts 5yrs
  • 169. More convenient, decrease incidence of endometrial cancer
  • 170. Not effective at preventing STDs, just pregnancy
  • 171. S/E and contraindications:
  • 172. Unprotected intercourse in the first 2-3 weeks after insertion
  • 173. Use of tampons- staphylococcal infection
  • 174. Those who haven’t been pregnant
  • 175. Multiple sex partners: PID
  • 176. Distorted uterine shape
  • 177. Severe dysmenorrheal
  • 178. With history of ectopic pregnancy, valvular heart disease
  • 179. Anemia
  • 180. Diaphragm
  • 181. Circular rubber disk with r without coated rim with spermicide
  • 182. To be prescribed and fitted by medical practitioner
  • 183. Supine position, by fingers insert 2 hours prior to coitus, retained 6 hours or up to or 24 hours post ejaculation; lasts up to two years- reusable
  • 184. S/E and contraindications
  • 185. Easy losing or gaining weight
  • 186. UTIs
  • 187. Uterine: prolapsed, retroflexed, or anteflexed- cervix is displaced
  • 188. Presence of cystocele or rectocele (almuranas)
  • 189. Cervical cap
  • 190. Soft rubber, thimble0shaped, fit snugly in the cervix
  • 191. Unlike diaphragm, however, the cervical cap is much smaller and fits more tightly around the cervix when in place
  • 192. Placed not >24hrs
  • 193. Easily dislodged
  • 194. Failure rate
  • 195. CX
  • 196. Abnormally short/long cervix
  • 197. Previous papsmear
  • 198. A hx of toxic shock syndrome
  • 199. Allergy to latex or spermicide
  • 200. A hx of PD
  • 201. Vaginal spermicides
  • 202. Gels, creams, films, foams, suppositories
  • 203. Dec. pH
  • 204. Nonoxynol- 9( prevent STDs)
  • 205. Becoming not conducive for sperm survival
  • 206. Done 1 hour prior to coitus to last up until 6 hours post coitus
  • 207. Cx- cervicitis, discomfort on vaginal leak
  • 208. Failure rate- 20%
  • 209. Vaginal rings
  • 210. Thin flexible plastic ring about 2 inches across
  • 211. With very low content of estrogen and progestin
  • 212. Left in place for 21 days, removed for 7 days (for menstrual flow)</li></ul>HORMONAL METHODS<br /><ul><li>Oral contraception
  • 213. Subcutaneous implants
  • 214. Intramuscular injections
  • 215. Intracervical/intrauterine devices
  • 216. Estrogen is high- suppresses FSH, LH
  • 217. Progesterone is high- decreases permeability of cervical mucus, dec. sperm motility, dec. endometrial proliferation
  • 218. Non-contraceptive benefits
  • 219. Decreased incidence of dysmenorrheal
  • 220. Premenstrual dysphoric syndrome
  • 221. IDA (iron deficiency anemia)
  • 222. Acute PID (pelvic inflammatory disease ) with tubal scarring
  • 223. Endometrial and ovarian cancer, ovarian cysts
  • 224. Fibrocystic disease
  • 225. Combined pill or OCs
  • 226. Monophasic- Fixed dose of both e. and p. in 21 days
  • 227. Biphasic- Constant amt. of e. throughout the cycle but p. inc during the last 11 days
  • 228. Triphasic- vary both e. and p. content throughout the cycle; mimics the natural cycle
  • 229. Schedule:
  • 230. After childbirth: Sunday closest to the 2weeks postpartum
  • 231. If abortion: 1st Sunday after the procedure
  • 232. 1st 7 days not as effective- use other form
  • 233. Take pills at the same time of the day for 21 days
  • 234. Place at area of plain sight e.g. at bathroom counter
  • 235. S/E and Contraindication
  • 236. Nausea
  • 237. Weight gain
  • 238. Headache to stroke
  • 239. Breast tenderness
  • 240. Breakthrough bleeding
  • 241. Mild HPN
  • 242. Chest pain; SOB
  • 243. Depression
  • 244. Thrombophlebitis
  • 245. Breastfeeding
  • 246. Family hx of CVA or CAD
  • 247. Hx of liver disease
  • 248. Undiagnosed vaginal bleeding
  • 249. Age 40+
  • 250. DM
  • 251. Hypertension
  • 252. Migraine
  • 253. Smoking
  • 254. 1st 2yrs after menarche
  • 255. If ct. forgets to take 1 pill, take it as soon as possible, taking 2 pills in 1 day
  • 256. If ct. forgets to take 2 consecutive pills, take 2 pills as soon as remembered, then continue the following day
  • 257. If 3 or more consecutive pills, discard start anew, use alternative contra in the 1st 7 days
  • 258. When can the woman get pregnant after discontinuation?
  • 259. Recovery period- 1-2 months
  • 260. To induce ovulation- clomiphene citrate
  • 261. 99.5% effectivity rate</li></ul>Progestin- only pill<br /><ul><li>POPs or minipills
  • 262. Progestin- only oral contra</li></ul>Emergency post-coital pill<br /><ul><li>Plan A- prevent kit- 4 pills, pregnancy kit
  • 263. First 2 pills are given after 72 hours of unprotected sex (sexual assault), then 2 additional pills after 12 hours
  • 264. Very high estrogen- cause vomiting, if within two hours of administering, repeat
  • 265. 98% effective
  • 266. Plan B- progestin only, Levonogestrel
  • 267. Mifepristone- abortifacient, effective up to 49 days only</li></ul>Inejctables<br /><ul><li>Advantage- long term reliability
  • 268. Nearly 100% effective
  • 269. Can be used while breastfeeding
  • 270. s/e- almost similar with pills and an increase in the risk of for osteoporosis
  • 271. a single injection of medroxyprogesterone acetate given as an intramuscular injection every three months, or Lunelle injection
  • 272. Noristerat q8 weeks IM
  • 273. given to inhibit ovulation</li></ul>Subcutaneous implants<br /><ul><li>consists on non-biodegradable silastic implants about a width of a pencil lead-filled with levonogestrel (synthetic progesterone)
  • 274. embedded under the upper ant aspect of forearm
  • 275. can be inserted anytime after abortion or 6 weeks post partum
  • 276. 1-3% failure rate
  • 277. Reversible, good for 5 years
  • 278. Ad- long term, reversible, sexual enjoyment not inhibited
  • 279. Can be used during breastfeeding
  • 280. Can be use by adolescents
  • 281. Disad- cannot be pregnant w/in next 5 yrs, possibility of infection</li></ul>Contraceptive patch<br /><ul><li>Is a transdermal patch applied to the skin (upper outer arm, buttocks, abdomen) that releases synthetic estrogen and progestin hormone</li></ul>Sterilization<br /><ul><li>Tubal ligation for women
  • 282. The fallopian tubes may be tied, cut, cauterized, clamped, or blocked (silicone-gel, reversible)
  • 283. This serves to prevent sperm from joining the unfertilized egg
  • 284. Permanent
  • 285. Women should have no unprotected coitus few hours before the procedure
  • 286. Can be done as soon as 4-6 hours following birth of a baby or abortion
  • 287. 99.9% effective
  • 288. Vasectomy
  • 289. The vas deferens is surgically blocked by tying and cutting it, thus the sperm cannot escape from the testes
  • 290. Permanent, 99% effective
  • 291. Doesn’t interfere with the production of spermatozoa
  • 292. But the latter cannot pass through the severed vas deferens
  • 293. Take effect only after 10-20 ejaculations, when the 2 sperm reports are negative. Since sperms in the vas deferens remain viable for 6 months

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