Week 8

 

Women's Health Part I:
Contraception

 

Link to Outline for lecture

 

 

I. DISORDERS

A. Conditions or disorders in which the FNP offers care, usually with no M.D. consultation:
1. contraception uncomplicated client
2. secondary amenorrhea
3. infertility uncomplicated female client
4. infertility uncomplicated male client

B. Disorders in which the FNP participates in care with M.D. consultation:
1. Primary amenorrhea
2. polycystic ovaries
3. infertility in clients with chronic disease
4. contraception complicated client
5. Assisted reproductive techniques
6. IUD insertion
7. Ovarian cyst

C. Disorders in which the FNP recognizes that consultation or referral is necessary.
1. Sterilization
2. Pregnacy with IUD
3. Tubal pregnancy
4. Endometriosis
5. Gonadal dysgenesis
6. Uterine disorders: anatomic and endometrial
7. Pregnancy termination
8. Assisted reproductive techniques

II. HISTORY: the student will be able to gather relevant history regarding:

1. menstrual and obstetric history
2. prior contraceptive use and tolerance
3. past medical history pertinent to contra-indications of contraceptive methods
4. past medical history pretinent to infertility work-up.
5. sexual history

II. PHYSICAL EXAM:

The student will be able to perform the following:

1. A thorough pelvic exam, which includes: determining uterine size, shape, position
2. Modify pelvic exam to meet needs of the pediatric patient or older women
3. Perform the following procedures utilizing adequate sampling techniques: Papanicolaou smear, wet mount, STD screening tests
4. Evaluation for sizing and fitting of a diaphragm (or cervical cap)

III. MANAGEMENT:

the student will be able to:

A. Evaluation Studies: state the indications for and cost effectiveness of the following tests:
1. Lab: cytology (PAP) specimens of the cervix; Hct; UA; laproscopy; appropriate endocrine testing; pregnancy tests; semen analysis

2. Radiology - Nuclear Medicine: sonography; hysterosalpingogram (HSG)B. Medications: understand the indications, contraindications, side effects and cost effectiveness of the following:
1. injectables: Depo-Provera
2. oral contraceptive medications: estrogen, progestins alone or in combinations.
3. Spermicides: gels, films, foams
4. implants (Norplant), IUD's with pharmocological agents
5. hormones to treat infertility: Provera, Pergonal, Profasil, Chlomiphene, Clomid, Bromocriptine.
6. post-coital treatments

C. Patient Education: counsel patients regarding the following topics:
1. Responsibility for contraception
2. Risks, contraindications, advantages, disadvantages, and proper use of the various alternatives in contraception including oral contraception, IUD, diaphragm, foams and jellies, condoms, rhythm method, vasectomy, abstinence
3. Management of common problems with OCP; amenorrhea, breakthrough bleeding, weight gain, mood changes

D. Evaluation and treatment: The student will be able to state the indications, effectiveness, contraindications, risks, possible complications and general cost of the following:
1. Oral contraceptives
2. I.U.D.
3. Diaphragm/cervical cap
4. Foam/jelly/sponge
5. Natural methods/fertiltiy awareness: BBT, Mucous
6. Condom: male and female
7. Implants (Norplant)
8. Vasectomy/tubal ligation
9. Injectable (DepoProvera)
10. Nuvoring

E. Consultation/Referral:
1. Discuss the purpose and risks of the following:
a. sonography
b. laparoscopy
c. endometrial/cervical biopsy
d. permanent sterilization methods

2. Identify and seek consultation for the following problems:
1. severe headache
2. severe leg pain
3. chest pain
4. visual changes
5. hypertension
6. abdominal pain

G. Community: provide information about community resources for:
1. low cost contraceptive counseling and management.
2. pregnancy termination, sterilization.
3. support in continuing pregnancy and/or for adoption.

REQUIRED READINGS

 

A. TEXTS:

1. Cash, Chapter13 page 326-335 and 705-707.

2. Review pharmacology text for medications use for contraception

3. Youngkin: Women's Health A Primary Care Guide, Chapter 12.

4. Guide to clinical preventive services, Go to website: Counseling to prevent unintended pregnancy

5. Papidakis. Current Diagnosis and Treatment (section on contraception, in the gynecologic disorder chapter)

6. Hatcher,Pocket Guide to Managing Contraception (familiarize yourself with what is in the book)

 

Articles

Hysterical! How Far will a condom Stretch
(if someone tells you condoms are "too small" for them to use, remember this video!)

Effectiveness Chart for Contraceptives

Diaphragm Fitting (pdf)

Implanon (pdf)

Initiating Oral Contraceptives (pdf)

Latex Allergey (something to think about with vaginal exams and recommending condoms)

Copper IUD vs. DepoProvera for Contraception

Preventing Gaps When Switching Contraceptives

Managing Adverse Effects of Hormonal Contraceptives

Contraception Choices in Women With Underlying Medical Conditions

B.Websites

Planned Parenthood: http://www.plannedparenthood.org/


Alan Guttmacher Institute: http://www.guttmacher.org/


Centers for Disease Control: http://www.cdc.gov  

Interactive Birth Control Tool to Help Patients Chose the Right Method for them