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ATI Maternal Newborn Study Guide
Nursing Concepts (Arizona State University)
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ATI MATERNAL NEWBORN
Chapter 1- contraception
Contraception refers to strategies or devices used to reduce the risk of fertilization
orimplantation in an attempt to prevent pregnancy
Natural family planning: behavioral methods
o Abstinence – no gentialia contact
o Withdrawal (coitus interruptus)
The choice for the monogamous couple
Least effective methods
Risk for Pregnancy
o Calendar methods
ovulation occurs about 14 days before the onset of her next menstrual cycle,
and avoid intercourse during that period
count at least 6 cycles
o basal body temperature
body temperature can drop slightly at the time of ovulation
measure the oral temperature before getting out of bed each morning
tomonitor ovulation
inexpensive, convenient, and with no adverse effects
Basal body temperature and the symptothermal method are fertility
awareness methods.
o Lactational amenorrhea method
Barrier
o Condoms
Only water-soluble lubricants should be used with latex condoms to avoid
condom breakage
o Diaphragm
Dome-shaped cup with a flexible rim made of silicon that fits snugly over the
cervix with spermicidal cream or gel placed into the dome and around the
rim
The client should be properly fitted with a diaphragm by a provider
Replaced every 2 years and refitted for a 20% weight fluctuation, after
abdominal or pelvic surgery, and after every pregnancy
Before coitus, the diaphragm is inserted vaginally over the cervix with
spermicidal jelly or cream that is applied to the cervical side of the dome and
around the rim
The diaphragm can be inserted up to 6 hours before intercourse and must
stay in place 6 hours after intercourse but for no more than 24 hrs.
Spermicide must be reapplied with each act of coitus
The patient should empty the bladder before insertion
Wash with soap and water after use
o Cervical cap
o Contraceptive sponge
o Question
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Which method would the nurse identify as a barrier method of
contraception?
a. Basal body temperature
b. Transdermal patch
c. Diaphragm
d. Symptothermal method
Hormonal
o Oral contraceptives
Adverse effect
Chest pain, shortness of breath, leg pain from a possible clot,
headache, eye problems from a stroke, hypertension, breast
tenderness, nausea, breakthrough bleeding (common adverse effects
of estrogen component and progestin component)
Can increase the risk of thromboembolism, stroke, heart attack,
hypertension, gallbladder disease, liver tumor
Effectiveness decrease when taking medications that affect liver enzymes,
such as anticonvulsants and some antibiotics
o Injectable contraceptives
Medroxyprogesterone is an IM or SQ injection given to a female client every
11 to 13 weeks
The first injection should be during the first 5 days of period
In postpartum, 5 days after delivery
Maintain adequate intake of calcium and vitamin D
Very effective and require only 4 injections per year
Adverse effects
Decrease in bone mineral density, weight gain, increase depression,
and irregular vaginal spotting or bleeding
Contraindicated for osteoporosis patient
Return to fertility can be as long as 18 months after discontinuation
o Transdermal patches
o Vaginal rings
o Implantable progestin
A minor surgical procedure to subdermally implant and remove a single
rod containing etonogestrel on the inner side of the upper arm
Disadvantage
Etonogestrel can cause irregular menstrual bleeding
Adverse effects
Irregular and unpredictable menstruation (most common)
Mood changes, headache, acne, depression, decreased bone density,
and weight gain
o Intrauterine contraceptives (IUD)
A chemically active T-shaped device that is inserted through the cervix and
placed in the uterus by the provider
The device must be monitored monthly by clients after menstruation to
ensure the presence of a small string that hangs from the device into the
upper part ofthe vagina to rule out migration or expulsion of the device
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IUDs can maintain effectiveness for 1 to 10 years
Contraception can be reversed
Can increase the risk of pelvic inflammatory disease, uterine perforation, or
ectopic pregnancy and can be expelled
A client should report to the provider later abnormal spotting or bleeding,
abdominal pain or pain with intercourse, abnormal foul-smelling vaginal
discharge, fever, chills, a change in string length, or if the IUD cannot be
located
IUD can cause irregular menstrual bleeding
Must be removed in the event of pregnancy
o Emergency contraception
A morning-after pill that prevents fertilization from taking place
The pill is taken within 72 hr after unprotected coitus
Surgical methods
o Tubal ligation
Sterilization for women
A laparoscope is inserted; fallopian tubes are grasped and sealed
o Vasectomy
Sterilization for men
Usually performed under local anesthesia
Involves cutting the vas deferens, which carries the sperm
Chapter 3 – Expected physiological changes during pregnancy
Signs of Pregnancy
o Presumptive, probable, positive
Presumptive: those changes felt by the woman
o e.g., breast changes (darkened areolae, enlarged Montgomery’s glands), uterine
enlarged, quickening (slight fluttering movements of the fetus felt by a woman,
usually between 16 to 20 weeks of gestation)
o A skipping period is not a reliable sign of pregnancy by itself but if it is
accompanied bynausea, fatigue, breast tenderness, and urinary frequency,
pregnancy would see very likely
Probable: those changes observed by an examiner
o Hegar’s sign – softening and compressibility of lower uterine segment or isthmus
o Ballottement
examiner pushes against the woman's cervix during a pelvic exam and feels
a rebound from the floating fetus
a rebound of the unengaged fetus
o abdominal enlargement
o Chadwick’s sign – deepened the violet-bluish color of the cervix and vaginal mucosa
o Broxton Hicks contractions – falls contractions that are painless, irregular, and
usually relieved by walking
o Positive pregnancy test
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