Chapter 4: Common Reproductive Issues

a. Copper

(Rationale: The ParaGard-TCu-380A is approved for 10 years and is nonhormonal. Its mechanism of action is based on the release of copper ions, which are spermicidal.)

b. Three days before and three days after ovulation

(Rationale: Typically, the unsafe period during the menstrual cycle is approximately three days before and three days after ovulation. An ovum is released from the ovary 14 days before the next menstrual period in a 28-day cycle.)

b. Causing uterine contractions to expel the uterine contents

(Rationale: Misoprostol works by causing uterine contractions, which help to expel the uterine contents. It has no effect on cervical dilation. Methotrexate is toxic to trophoblastic tissue. Mifepristone blocks the action of progesterone, which is responsible for preparing the endometrium for implantation and then maintenance of the pregnancy.)

a. Sleep difficulties
b. Diarrhea
c. Affective liability

(Rationale: According to the American Psychiatric Association, a woman must have at least five of the typical symptoms to be diagnosed with PMDD. These must occur during the week before and a few days after the onset of menstruation and must include one or more of the first four symptoms: affective liability; anxiety and tension; persistent or marked anger or irritability; depressed mood, feelings of hopelessness; difficulty concentrating; sleep difficulties; increased or decreased appetite; increased or decreased sexual desire; chronic fatigue; headache; constipation or diarrhea; or breast tenderness and swelling.)

a. Bradycardia
c. Reduced subcutaneous fat
d. Hypotension

(Rationale: Hypothermia, bradycardia, hypotension, and reduced subcutaneous fat may be observed in women with amenorrhea with anorexia nervosa as the contributing factor. Evidence of secondary sex characteristics would be a normal finding for a girl of this age.)

c. ECs simply prevent embryo creation and uterine implantation from occurring in the first place.

(Rationale: ECs prevent the embryo creation and uterine implantation from occurring. There is no evidence that ECs have any effect on already-implanted ovum or that they induce abortion. They do not protect against STIs and are less effective than regular birth control.)

b. Endometriosis

(Rationale: Risk factors for infertility include endometriosis, age older than 27 years, tubal blockages, weight variations, hormonal imbalances, fibroids, reduced oocyte quality, chromosomal abnormalities, congenital anomalies of the cervix and uterus, immune system disorders, chronic illnesses, sexually transmitted infections, history of PID, smoking and alcohol consumption, multiple miscarriages, and psychological stress. Dysmenorrhea is not an associated risk factor.)

c. Cultural considerations

(Rationale: The manner in which the various cultures, ethnic groups, and religious groups perceive and manage infertility are very different and must be considered when working with couples who have been unable to conceive. Nurses need to include awareness of these differences in their counseling of the couples as they try to help them achieve their goal of getting pregnant.)

c. Endometriosis

(Rationale: Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. Endometriosis is the most common cause of secondary dysmenorrhea. Other recognized causes include adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities.)

a. 84; 7

(Rationale: Research has confirmed that the extended use of active OC pills carries the same safety profile as the conventional 28-day regimens. The extended regimen consists of 84 consecutive days of active combination pills, followed by 7 days of placebo. The woman has four withdrawal-bleeding episodes a year.)

b. Cravings

(Rationale: ACDHO stands for: A - anxiety: difficulty sleeping, tenseness, mood swings, and clumsiness; C - cravings: for sweets, salty foods, chocolate; D - depression: feelings of low self-esteem, anger, easily upset; H - hydration: weight gain, abdominal bloating, breast tenderness; and O - other: hot flashes or cold sweats, nausea, change in bowel habits, aches or pains, dysmenorrhea, acne breakout.)

d. "I'll insert a new ring at the same time and day of every week."

(Rationale: The vaginal ring involves a three-week period of continuous use followed by a ring-free week to allow withdrawal bleeding. The ring is compressed and inserted into the vagina, as far back as possible, but precise placement is not critical. After three weeks, the ring is removed and discarded.)

d. Coitus interruptus method

(Rationale: Coitus interruptus involves the man controlling his ejaculation during sexual intercourse and withdrawing and ejaculating outside the vagina. The problem with this method is that the first few drops of true ejaculate contain the greatest concentration of sperm and if some pre-ejaculatory fluid escapes into the vagina, conception can occur. The cervical mucus ovulation method, basal body temperature method, and symptothermal method are various methods to try and calculate when the woman is ovulating so sexual intercourse can be avoided or barriers used to prevent impregnation.)

a. "Have your diaphragm refitted if you lose 10 pounds or more."

(Rationale: Diaphragms should be refitted after pregnancy, abdominal or pelvic surgery, or weight loss or gain of 10 pounds or more. A diaphragm usually is replaced every one to two years. A diaphragm should remain in place for at least six hours after intercourse. A contraceptive sponge, not a diaphragm, should be wetted with water before insertion.)

b. Reduction of caffeine intake
d. Vitamin and mineral supplements

(Rationale: Treatment options for PMS include lifestyle changes such as reduction of caffeine intake, a well-balanced diet with increased water intake, and limited alcohol intake. Vitamin and mineral supplements, NSAIDs, and diuretic therapy may be used. Antidepressants and antianxiety agents, not antipsychotic agents, may also be options.)

a. Increased abdominal fat
c. Hot flashes
d. Decreased bone density

(Rationale: Menopause may be associated with hot flashes, increased abdominal fat, vaginal dryness, decreased bone density, dry thinning skin, and increased waist size.)

a. Antibiotics

(Rationale: The effectiveness of OCs is decreased when the woman is taking antibiotics, thus the woman will need to use an alternative or secondary method during this period to prevent pregnancy.)

b. Intermittent sharp suprapubic pain

(Rationale: Sharp, intermittent spasms of pain, usually in the suprapubic area, are a common complaint associated with dysmenorrhea. Menorrhagia refers to abnormally long, heavy periods. Dysphoria is a common complaint associated with premenstrual syndrome. Chronic pelvic pain is commonly associated with endometriosis.)

c. Pelvic laparoscopy

(Rationale: A thorough history and pelvic examination may lead the health care practitioner to suspect endometriosis; however, the only certain method of diagnosing it is by visualizing it via a laparoscopy. A tissue biopsy can be obtained at this time and examined microscopically to confirm it.)

d. Tell the client to learn to live with it.

(Rationale: There are many treatable reasons for dysfunctional uterine bleeding. The client should be evaluated and all related disorders should be treated as needed. Telling the client to just learn to live with it ignores the possibility that her symptoms are related to a serious but treatable condition.)

a. Engaging in daily weight-bearing exercise

(Rationale: Engaging in daily weight-bearing exercise such as walking helps to reduce a woman's risk for osteoporosis. To prevent osteoporosis, women should increase their calcium and vitamin D intake. Avoiding excessive alcohol ingestion helps prevent osteoporosis. Limiting intake of cholesterol and saturated fats helps reduce the risk for cardiovascular disease, not osteoporosis.)

b. 10%

(Rationale: A woman experiencing PMS may have a wide variety of seemingly unrelated symptoms. PMS affects millions of women during their reproductive years; up to 75% report having one or more premenstrual symptoms, and up to 10% report disabling, incapacitating symptoms.)

a. Extreme and rapid weight gain
c. Pregnancy
d. Hypothyroidism

(Rationale: There are many factors that contribute to primary and secondary amenorrhea. They include extreme and rapid weight gain, pregnancy, hypo- or hyperthyroidism, depression, excessive exercise, eating disorders, and various chronic illness, just to name a few. The nurse should complete a thorough examination and obtain a complete history to eliminate the various known causes of amenorrhea.)

a. Toxic shock syndrome

(Rationale: The sponge provides protection for up to 12 hours but should not be left in place for more than 30 hours after insertion to avoid the risk of toxic shock syndrome.)

c. Depo-Provera

(Rationale: Depo-Provera is the trade name for an injectable form of progesterone-only contraceptive that is given every 12 weeks. It works by suppressing ovulation and the production of FSH and LH by the pituitary gland. Lunelle is an injectable form of OC. Ortho Evra is a patch-type contraceptive and Lybrel is an oral contraceptive that uses a 365-day combination dosing.)

b. 10%

(Rationale: A woman experiencing PMS may have a wide variety of seemingly unrelated symptoms. PMS affects millions of women during their reproductive years; up to 75% report having one or more premenstrual symptoms, and up to 10% report disabling, incapacitating symptoms.)

a. Extreme and rapid weight gain
c. Pregnancy
d. Hypothyroidism

(Rationale: There are many factors that contribute to primary and secondary amenorrhea. They include extreme and rapid weight gain, pregnancy, hypo- or hyperthyroidism, depression, excessive exercise, eating disorders, and various chronic illness, just to name a few. The nurse should complete a thorough examination and obtain a complete history to eliminate the various known causes of amenorrhea.)

a. Toxic shock syndrome

(Rationale: The sponge provides protection for up to 12 hours but should not be left in place for more than 30 hours after insertion to avoid the risk of toxic shock syndrome.)

c. Depo-Provera

(Rationale: Depo-Provera is the trade name for an injectable form of progesterone-only contraceptive that is given every 12 weeks. It works by suppressing ovulation and the production of FSH and LH by the pituitary gland. Lunelle is an injectable form of OC. Ortho Evra is a patch-type contraceptive and Lybrel is an oral contraceptive that uses a 365-day combination dosing.)