Responsible parenthood ncm lec

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Responsible parenthood ncm lec

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