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Advanced Practice Nursing Clinical Practicum

by: Domenico Schoen

Advanced Practice Nursing Clinical Practicum NURSING 439B

Domenico Schoen
GPA 3.95


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Class Notes
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This 40 page Class Notes was uploaded by Domenico Schoen on Friday September 4, 2015. The Class Notes belongs to NURSING 439B at University of California - Los Angeles taught by Staff in Fall. Since its upload, it has received 104 views. For similar materials see /class/177873/nursing-439b-university-of-california-los-angeles in Nursing and Health Sciences at University of California - Los Angeles.

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Date Created: 09/04/15
Intrauterine Devices IUDs WHO Decision Aid on Contraceptive Effectiveness fConlraceplive Methods Comparing Typical Effectiveness o Musiu echue wwltmmmm 11mm Mm 39m Mwummwm 2m Mm ummmzmywmmnu MW uwwmuu mum um my mm m m mm wnnmmmm u ukutvylmywmnkl Mmmnmmmm am much WW 4 mm M WM m Wm M mm mm m w mm m m u IUD Safety Research has proven lU D3 to be safe and effective Elements of high quality care appropriate screening informative counseling adequate infection prevention measures and careful insertion proper followup care Overview of IUDs I Types of IUDs Mechanisms of action Charameristics of IUDs Ways to reduce risk of complications Early IUDs Lippss me V Chinese Sminlass Steel Rings 1 Hormonal IUDs LNG IUD 20 pg Levonorgestrel daily 5year lifespan or more Mirena Intrauterine System Mechanism of Action Continuous release of low levels of levonorgestrel acting on endometrium Low plasma levels Probable local effects thickened cervical mucous inhibition of sperm survival and altered endometrium Reversible Side Effects of Mirena IUS Irregular Bleeding patterns and amenorrhea Slightly higher risk of ectopic pregnancy Possible effect on glucose tolerance monitor in diabetic patients Contraindications for Mirena IUS Pregnancy or suspected Acute PID postpartum endornetritis in past 3 months untreated vagintis Unknown source of genital bleeding Uterine or cervical neoplasia Acute liver disease HX breast cancer or ectopic pregnancy Distortions of uterine cavity I Mechanisms of Action of Copper IUDs I Prevents fertilization by impairing the viability of the sperm interfering with sperm movement Contraceptive Failure Rates Spermicides I I Periodic Absiinence I I Diaphragm I I Condom I I case I I IUD TCuGBOA Female sieriiizaiion I DepoFrovera Norpiams O 5 10 15 20 25 Fercem 01 Women Pregnant in First Year 1 Use sumce nussell i990 Junelenllesl I992 coc iypmai use naia us naia I Characteristics of Copper lUDs Highly effective and economical Does not interfere with intercourse Easy to use Longlasting Easily reversible Quick return of fertility No systemic effects Characteristics of Copper lUDs continued Possible side effects include pain and crampin heavier menstrual bleeding menstrual irregularities Possible complications include perforation pelvic inflammatory disease Low risk of method failure uterine or ectopic pregnancy Pelvic Inflammatory Disease PID PID is an infection of the woman s upper genital tract Risk of PID in IUD users Low overall Higher during first 20 days after insertion Due mostly to infection with gonorrhea and chlamydia Similar to risk of PID in women with gonorrhea and chlamydia who are not using IUD PID Incidence Rate by Time Since Insertion PID Hale per 1000 woman years a a a a A A 2 2 n n 1 2 Cl 4 5 a 7 a a 10 II I 2 Cl 4 5 s 7 5 Monlh5irs1 year Vets Time Snce Insertion Suulce Farley 1 al 1992 Reducing the Risk of PID Screen women for risk of STls generally can use if at risk of STls not recommended if at high individual risk of STls Screen out women with clinical symptoms and signs of an STI Counsel about risk of PID Follow infection prevention procedures during insertion Recommend onemonth followup visit to check for infection return immediately if any symptoms of PID develop Perforations Very rare 1 in 1000 insertions Flisk linked to skill and experience of provider reduced through supervised training greater for postpartum insertions performed between 48 hours and 6 weeks after delivery Estimated Ectopic Pregnancy Rates by Method Typical Eclopic Pregnancy Rate per man woman years n in No Diaphragm Condom Female mm M Method Sterilization rm 350 5 2 Adnplad lrnm 1991 Expulsions Partial or unnoticed expulsion may result in irregular bleeding and or pregnancy aaxuewmmummw 39 39 a glimmer a tmll wrmuam a 39 39 quot 39 at L WHO Ettgtbttity Criteria fer Contraceptive Use i f When CHIHCEIJ When CJJI caJ Category 39 quot jLJc gment J ElvzmabJe HmJEecJ 1 No restriction for Use the method under use any circumstances Use the method 2 Bene ts genereltty Generetlty use the uwtweigh risks method Use of method net y w usually recommended 3 8 unless otltter methods y mng e 4 t are net Do not use the evei lableteceeptable meth d 4 unacceptable Method not to be used health risk Source WHO 2004 Who Can Use Copper lUDs Can be used safely by women who Are of various age and parity counseled on expulsion risk Are postpartum postabortion or breastfeeding Have a chronic condition including hypertension cardiovascular disease diabetes liver or gall bladder disease Source WHO 2004 Who should not have an IUD inserted The copper IUD should not be inserted in women with Known or suspected pregnancy Cervical or endometrial cancer or unexplained vaginal bleeding Malignant trophoblastic disease or known pelvic tuberculosis Uterine distortion that impedes correct IUD placement Infection following childbirth or following incomplete abortion Source WHO39 2004 STIIHIVAIDS can affect IUD Eligibility i 7 7 i Category Initiation Continuation 2 2 IUD Counseling Topics a o Characteristics of IUDs Client s risk of STls Effectiveness and how the IUD works Insertion and removal procedures Instructions for use and followup visits Possible side effects and complications 39 Signs of possible complications I Dispelling Myths IUDs are not abortifacients do not cause infertility do not cause discomfort for the male partner do not travel to distant parts of the body are not too large for small women I Common Side Effects 7 During insertion some pain and cramping First few days light bleeding and mild cramping First few months heavier or prolonged menstrual bleeding intermenstrual bleeding andor cramping I IUD Use and Followup Teach clients how to check for strings with clean fingers after each menses expulsion most likely in first 6 months Schedule followup visits at 3 to 6 weeks 1 year yearly thereafter Return to clinic for questions problems or signs of complications Signs of Possible Complications Severe bleeding or gt Perforation abdominal cramping infection 35 days postinsertion Irregular bleeding gt Dislocation or andor pain every cycle perforation Fever chills Infection unusual vaginal discharge Signs of Possible Complications continued Pain during gt Infection intercourse perforation partial expulsion Missed period gt Pregnancy other signs of pregnancy uterine or expelled IUD ectopic Shorter longer or gt Partial or complete missing strings expulsion perforation Reducing Risks During Insertion Follow infection prevention procedures Follow manufacturer s instructions Use IUD only if sterile package is not damaged or opened and has not expired Antibiotic prophylactic is not generally recommended Tarnished or discolored IUDs are still effective Timing of IUD Insertion I Interval insertions any time during menstrual cycle if woman is not pregnant and has no signs of infection Postpartum insertions immediately after vaginal or cesarean delivery if no infection or hemorrhage within 48 hours or delay 6 weeks postpartum Postabortion insertions first trimester immediately if no infection Infection Prevention Procedures Wash hands Wear sterile gloves Carefully disinfect vagina and cervix 39 Use sterile lUDs and sterile or highlevel disinfected equipment Decontaminate instruments Safely dispose of contaminated waste rr I IUD Insertion Steps Inspect vagina and cervix uterus Perform bimanual exam Disinfect vagina and cervix opening to cervix M Sound uterus Insert IUD Perform all steps carefully and gently I Management of Perforation i If perforation occurs stop procedure remove IUD provide alternative contraception fOllowup after one week insert another IUD after next menses Management of Cramping Mild recommend ibuprofen or other pain reliever Severe or prolonged examine for partial expulsion perforated uterus or PID remove IUD if cramping is unacceptable to client I Management of Heavy Bleeding 1 If lasting more than 3 months examine for infection or tumors check for signs of anemia if present recommend iron tablets and ironrich foods ibuprofen may reduce bleeding remove IUD if health riskor unacceptable to client l Management of Missing Strings I Determine risk of pregnancy Perform pelvic exam probe for strings in cervical canal Give choice of another contraceptive method Tell client to check for strings after next menses n Insert another IUD if expulsion is confirmed and woman is not pregnant there is no damage from perforation Management of Pregnancy a Ask about exposure and sig nslsymptoms of pregnancy and perform pregnancy test If pregnant examine for possible ectopic pregnancy if possible remove IUD if not possible counsel client on risks of pregnancy with IUD in place Management of STls and PID If STls or PID are diagnosed Treat condition Leave IUD in place Counsel to abstain from sex or use condom until cured to prevent infection transmission Encourage partner treatment IUD Removal Can be done easily by any trained healthcare provider Be sure to follow infection prevention guidelines be slow and gentle counsel client that crampingbleeding may occur refer difficult removals to specially trained provider If desired a new IUD can be inserted immediately followrng rem oval


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