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Cleansweep RN
Family Planning is defined as "educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved (Wikipedia encyclopedia).

A. NATURAL METHODS (Fertility awareness method)

  • Calendar (rhythm method) - estimate date of ovulation based on length of cycle
  • Basal body temperature - identifies ovulation by drop and rise in temperature, identifies the days on which coitus is avoided to avoid conception.
  • Cervical mucus method- identifies ovulation by increase in mucus amount and stretchability; when affected by estrogen and most conductive to penetration by sperm, cervical mucus is clear, slippery and stretchy; when influenced by progesterone, cervical mucus is thick, cloudy and sticky and does not allow sperm passage; coitus is avoided during days of estrogen- influenced mucus.
  • Sympto-thermal – combination of basal body temperature and cervical mucus method to increase effectiveness.
  • Coitus interruptus – withdrawal of penis from the vagina before ejaculation, not very safe, pre ejaculatory fluids from Cowper’s gland may contain live and motile sperm.

B. CHEMICAL AGENTS

  • Creams, foams, jellies, or vaginal suppositories – barriers designed to destroy the sperm or limit their motility, they are available without prescriptions and widely used, need to be placed on vagina immediately before each intercourse.

C. MECHANICAL BARRIER METHODS

  • Diaphragm- shallow rubber dome fits over the cervix that covers the external os.
  1. Disadvantage: must be fitted, provides no protection against STD's and risk of TSS (toxic shock syndrome)
  2. Most effective when used with a chemical agent
  3. Woman needs to measured for the diaphragm and refitted after each childbirth or weight gain and loss of 10 lbs.
  4. Women should practice in the insertion and removal and to be taught how to check for holes in diaphragm
  5. Device should be left on place 6 – 8 hours after intercourse

  • Condom – thin stretchable rubber sheath worn over penis during intercourse.
  1. Disadvantage: decreases penile sensation and spontaneity
  2. Advantage: inexpensive, accessible, and reduces spread of STD's
  3. Widely used without available prescription and applied to erect penis before vaginal intercourse.
  4. Man is instructed to hold on the rim of the condom as he withdraws from the female vagina to prevent spilling of the semen.
  • Cervical cap – cup shaped device that is placed over cervical os and held in place by suction.
  1. It comes in four sizes; client needs to be fitted, and may be left in place up to 24 hours.
    Spermicides increase effectiveness

D. HORMONE THERAPY (Oral contraceptives)

  • Single-hormone therapy - Estrogen given two weeks to suppress LH and FSH. Progesterone given daily to make cervical mucus impervious to sperm.
  • Combined-hormone therapy - combination of estrogen and progesterone on a 25-day cycle.
  • Bleeding starts one to four days after the last pill.
  • Usually taken beginning on the 5th day of the menstrual cycle through the 25th day, then discontinued.
  • Contraindications: family history of stroke, migraines, hypertension, diabetes, chronic renal disease, thrombophlebitis, tobacco use- smoking, 35 years old and above.
  • Side effects: nausea and vomiting, edema and weight gain, breakthrough bleeding, thrombophlebitis, pulmonary embolism, stroke

E. INTRAUTERINE DEVICES

  • Placement of plastic or nonreactive device into uterine cavity.
  • It creates sterile endometrial inflammation that discourages implantation (Nidation).
  • Device is inserted during of just after menstruation, while cervix is slightly open.
  • Side effects: heavy menstrual bleeding, severe cramping, bleeding between periods
  • Complications: uterine perforation, infections, increased risk of Pelvic infection (PID)

F. LONG-ACTING METHODS (steroid implants)

  • Biodegradable rods containing sustained-release, low dose progesterone that inhibits LH (luteinizing hormone) to release that is necessary for ovulation.
  • Implantable progestin (Norplant) – effective for five years
  • Injectable progestin (Depo Provera) – last up to three months

G. SURGICAL STERILIZATION (Permanent contraception)

  • Male sterilization (vasectomy) – surgical removal of vas deferens that connects the testes to seminal vesicle and urethra. This does not affect the sexual desire or potency.
  • Female sterilization- tubal ligation, hysterectomy (removal of uterus)

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