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Family Planning & Signs of Pregnancy

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***Previously Recorded***

Inside this tutoring session, we will help you as you study family planning for your OB patients! Come with questions about family planning, or if you have questions for those OB patients!

Video Transcript

I’m going to share my screen with you all and that way you can see my little notepad and we’ll go through it. Can you guys see it? Okay.
Okay. Awesome. All right. So first when we were talking about, um, this family planning, we’re going to talk first about our prevention and what that is going to look like. So of course there’s several different ways for prevention to occur. So the first one is going to, we’ll talk about, is the org okay? Just like this Oral Birth Control Pills. The thing to know here that’ll be important is going to be, that this needs to be for somebody that is going to be, very good at it. Like a reliable, sorry. Couldn’t think of the word reliable person. Okay. Because, um, you have to take them at the same time everyday, about the same time everyday in order for them to have the effectiveness that they’re supposed to have. So same time every day. Um, we want to also for this, you want to know about the antibiotics.
So if a patient’s taking antibiotics, then they are not going to be as effective. Um, so they’ll need a different form of antibiotic or a different form of birth control while they are on any oral antibiotic for anything. Um, the other thing here to know, kind of put under here is if you have a breastfeeding mom that wants to go back on birth control, the best option for her is going to be what’s called the Mini Pill. That’s a good test question too. So the Mini Pill, um, the Mini Pill is a progesterone only pill so it shouldn’t harm the breast milk supply, um, that horribly. So the mini pill is going to be what is suggested for them. The other things I want you guys to know that are important for these Oral Birth Control Pills are going to be women that are older.
Um, so just watching that age or smokers or history of DVT, um, not a good option. Right? They’re already at risk. They have, if they smoke, they’re at risk for blood clots. The pills put you at risk for blood clots anyways. So if you have a history of DVTs, if you smoke, which is going to increase your risk. And also being older increases your risk, then this is not going to be a good option, but there’s plenty of other options. Well, oral. The next one I’m going to talk about is that Intrauterine Device. And for sure if we just call it an IUD is that I need to underline that or italicize. Um, so an IUD. So with the IUD, this one, it’s going to be important. You don’t want them out. Well first let me tell you what this is. It’s kind of like a t shape.
Um, little piece of it can be copper, just a little instrument that is inserted inside the uterus, into the cervix and the uterus. And what it does is it just prevents pregnancy either from what it’s releasing or because it builds up the scar tissue that’s there. Um, and can alter hormones being released and all that. So, an IUD, that is one option. Obviously risks come with that because you’re putting something that doesn’t belong inside. So the important thing here to know because of that is going to be if a woman has PID, that’s Pelvic Inflammatory Disease. Okay. So PID is Pelvic Infalmmatory disease and that comes a lot for women that have a lot of STI. [inaudible] it’s basically just inflammation in the pelvic cavity. Um, very painful. And these women should not have an IUD because they’re going to be more at risk for worsening PID.
Obviously you put some of them, it doesn’t belong there. Right. So that makes sense. So for the PID, we don’t want them to get that they’re going to need a different option. Also. It’s also not going to be good for people that have many sexual partners because again, of the STI risk, right? That’s going to increase with more, um, for, we call it risky sexual behavior. So these women, um, or these are the risks that come with an IUD or things to be contraindicated. And you put that if I could spell contraindications. Okay. So those are contra-indications things to watch for with the IUD. The next one I’m going to kind of put these together is the Cervical Cap and Diaphragms, these are just things that are inserted in the kind of block from the sperm. Being able to enter the cervix, enter the uterus to um, have a pregnancy occur.
So the big thing to know here, these go in and they need to stay in okay. For six hours after intercourse because if you take it out too soon, sperm could be, um, could move and get their little way up there because those suckers can live longer than they should. So six hours is going to be your key there. You want to keep it in for that long, no more than 24 hours, but at least six hours. Um, and both of those have that. So that will be education to give to a patient. That would be important. Alright, Condoms, we’re getting to the end here of our prevention. So Condoms, this is the, basically the thing to note here, right, is it’s the way to prevent STIs. Um, we say it’s the only 100% way I will say, but genital warts, because they’re not always like they can be in the groin area, which the condoms isn’t going to protect that. But typically on questions are gonna say the only way it’s 100% effective. This is condoms and this as close as you’re going to get. And then our last one is of course, the only way to be 100% effective is Abstinence of not getting pregnant.
Okay. Easy enough. Those two next if we are trying to get pregnant. Okay. So these people were trying, so there’s a few things they can do. The first is Ovulation Tracking. So basically there’s a few ways they can track their ovulation by they can pee on a stick, right? Those ovulation predictor kits. So predictor kit, they get a smiley face. It means they’re ovulating. So that would be the time for them to have intercourse. So that’s one way. Another way is a kind of a Calendar Method. So with a Calendar Method, um, you kind of typically women will ovulate this’ll be important for you all to know. Ovulation occurs on day 14 on average for a cycle. So if they’re counting just by calendar from when they got their last period account, 14 days, and that is when they should ovulate again. Um, so that is when they would want to have intercourse cause that’s when the egg is drops, that’s when pregnancy would occur. Um, and another way is watching the mucus. So, um, Vaginal Mucus Discharge, it is a little bit stickier and stretchy when it is, um, ovulation time. So if people want to do that. And then our last one, which is the big one, and I’m going to show you guys, um, I’ll switch to the other screen so that you guys can see this after explaining it. So Ovulation tracking, that’s not my mental but by Basal Body Temperature tracking. So this is also, you’ll see it as BBT as the Basal Body Temperature. So what happens with this is a woman has to take her temperature every day at the same time in the morning before rising out of bed. Literally they cannot put their feet on them. Ground cannot sit up. They need to take their temperature and they’re going to be tracking that.
What they’ll see happen is the temperature will raise 0.4- 1 degree. Um, it’ll go up and that equals ovulation. As that temp goes up, they know that they are ovulating. So what happens is, and I show this on an image, this’ll be easier for those that are visual people. That temperature is going to do a dip first and that means the egg is released and then it’s going to go up that 0.4- 1 and that equals ovulation. All right, so let me see if I can pull up one a second to my other.
Image that I have. All right, hold on guys. I’m gonna reshare and we’ll do the whole screen.
Okay. So where I’m taking you now, this is in the Family Planning lesson that we have on NRSNG and I’ll give you guys the link at the end. So this is at around four minutes in seven ish seconds on the video. And you can see here, this is somebody that was tracking their temperature. So the temps are kind of all up. They have this dip and that’s where that egg is released. And then they have this rise and that is where, um, ovulation occurs. So what will happen after ovulation? Well, if they keep taking their temperature, if they are pregnant, which this person was pregnant, the temperature will stay up. If they did not get pregnant, they will see that tempt drop back down and just kind of do this. So that is how they do it. So the big key things here are the temperature every day before they rise the same time. So that’s like you have to be really consistent, waking up at the same time and all that. Take that temperature. So again, you have a dip that’s the egg release and then the rise is ovulation, she can hear me talking. I hit play.
Hopefully you guys can see that. Okay. All right. Everybody still with me?
I am going. Awesome. Okay. So hopefully that was helpful. And at the end I’ll put those links in. Um, so that is it for our family planning part. Now we’re gonna look at the pregnancy signs, which is super quick and I’m going to make it easy hopefully. And then we can answer any questions that you guys have. Okay. So Our signs of pregnancy, they are broken into either being Presumptive, Probable or Positive. So presumptive, presumptive means you might be, okay. So these are going to be things that the mom or the patient feels only her. Okay. So this is going to be more just think of it as your symptoms. Um, so this would be just your basic, the nausea, vomiting they’re having, bloating, breast tenderness. So all the things, all those basic symptoms that you think pregnancy are going to be felt by the mom.
Those are your presumptive signs. Um, and another little one here is Quickening. So Quickening for those that don’t know or don’t remember quickening is that first few movements that the mom feels of the fetus turning, moving, rolling, kicking, whatever it is. These little like butterfly flutters, um, that only she can feel because the baby’s not big enough yet. So those are all gonna be our presumptive. Our Probable. These mean? This means probably like you probably are pregnant. This is going to be the provider. Okay. So the provider is gonna notice these things. Um, so I have a few words here. I’ll give you guys that, um, definition of what they mean and then I’m going to show you, um, on a uterus. I know that sounds weird, but I, yeah. Okay, so Probable, the first thing here for probable is going to be Chadwick’s sign.
So Chadwick’s sign is a bluish purple tint that the cervix gets. And the reason why it changes is because they have all this increase in vascularity at the cervix. All this, you need a new blood flow coming in. So turns that cervix kind of bluish purple color. So that’s our Chadwick’s. And then Hegar’s. This one is going to be where we have a softening of the lower uterine segment, kind of where that uterus attaches. And I’ll show you on the thing in a second in this little be easier to remember. Goodell’s is our another one. And this is where we get softening of the cervical tip. So of the vaginal portion of the cervix, that lower portion of the cervix that the provider feels it softens, get softer, just everything’s getting more stretched out and relaxed because we’re making room for a baby.
Those are our signs. We will remember this and I should have put it in the, um, other order, but I’m gonna put it here. So we CGH and I’ll explain what that means in a second. It’s just kind of the order. So you’ll remember we start here at the Chadwick’s cervix , um, and then the tip and then up to the uterine segment. Just so you can remember the order, cause everybody always seems to get Hegars and Goodell’s. Um, switch. I often have to double check myself as well. Alright. And our last one here are our Positive. So this means for sure you definitely are pregnant. Um, so this is going to be things like fetal movement that’s felt by the provider. Again, um, it will be fetal heart rate. We hear heart tones in the abdomen, right? You should not have a heart rate in your abdomen unless you’re pregnant.
I would hope. Um, and then visual confirmation on an Ultrasound will be our other big positive sign. I want to real quick explain to you guys about the pregnancy test because that gets really confusing too. So a Urine Pregnancy Test is going to not be a positive sign, right? Because you have, it’s going to actually be a presumptive, just a home pregnancy test because you can have false positives. So that’s why it’s presumptive. A Blood test is only a probable sign because, um, the reason why it’s not positive is because there’s something called a molar pregnancy and there’s a whole lesson on that. You can watch it and look at the outline, um, for more information, but it’s basically where your body thinks it’s pregnant. It puts out all this HCG, which is what is detected on the blood test. So it picks up all this extra, extra HCG. It says, hey, we’re pregnant, but it’s actually, there’s no fetal tissue with this, so there’s no pregnancy. So that’s why it’s not positive. Um, so just keep those in mind for testing purposes as well. All right, I’m gonna give you guys a second. Just to make sure everyone’s jotted everything down or screenshot and whatever they want to do. And then I’ll go through these, um, the Chadwick Hegar’s and Goodell for you all.
Does anybody still need it or is everybody gotten what they need off that screen?
I’m gonna switch off, but I’ll save it in case we need that. Actually, let me real quick, cause I put my links down here. Let me get these for you guys and put them in our little chat box here. That’ll take you right to these two lessons. There’s the first one.
So those should be links that’ll take you right into it.
So let’s go through and talk about these. I’m the Chadwick, Goodell and all that. So that’s my uterus. Um, so the Chadwick sign is this. So here’s, this is our uterus or fallopian tubes, our ovaries. And then down here is the cervix, the tip of the cervix. So you can see there that bluish purple color. So it will change that color. And that means that it’s a positive Chadwick sign. So that bluish purple, we have extra blood flow going there because of pregnancies occurring. Um, extra blood flow everywhere, right? So Chadwick sign then. Remember we go in, in kind of reverse alphabetical order, so c and then g and then h. So Chadwick and then Goodell So Goodell is going to be the tip of the cervix is gonna be softened. Um, so again it’s getting soft stretchy. It’s going to be a positive.
Um, Goodell sorry, sign is going to be that softening of the cervical tip. Hegar’s, stop softening of the lower uterine segment. So this is kind of where the uterus, if this is inside of body attaches, so that’ll be kind of up in here as going to be the softening of the uterine segment. And so that’s going to be Hegar sign. So just remember Chadwick Goodell and then Hegar in order. So if we’re staying down at the cervix and then we move up to the uterus. So C G H. What questions do you guys have about anything that I’ve talked about or some that I didn’t mention that you think is important or anything else OB related on? I’m happy to answer
how accurate is a temperature mind. So it’s a really accurate if people are doing it correctly. So like I said, you can’t have not have had anything to eat or drink. I don’t think I mentioned that before. But literally like set your alarm for 6:00 AM every day 7:00 AM reach over and take the temperature and track it. Um, the problem is I think people don’t do it right. And then people that really, really want to be pregnant, I think any little change they see, um, can they think that they’re pregnant when they might not be? So just remember that 0.4 – 1 rise is going to be ovulation is it possible to do the IUD without your menstruation? You may not to have it inserted while you’re menstruating, Marissa? Yes. For Basal Body temperature while my is answering, yes, you have to be laying down. You don’t want to rise and nothing like don’t sit up, just grab it and do it. So there’s a lot to it. Um, I, I don’t know for sure about that if it can be an axillary temperature. Um, Chris and I, I, as far as I know with all oral, um, I guess if you’re, I just don’t know how accurate it would be doing the axillary.
okay. Marissa IUD so that if you’re asking about IUDs being inserted, typically they do it while someone’s menstruating because the cervix has opened up a little bit so it’s less painful, but they don’t have to, they can also insert an IUD. Someone will get it when they go for their postpartum check and maybe they, they’re not probably menstruating. Um, but that cervix, it’s like the best time to do it because the cervix is still opened a little, otherwise it’s more pain. I mean, gets painful anyways, but it’s more painful if they have to stretch into that cervix. Yeah. That’s the whole reason. I know it sounds kind of weird that they would do that. You’re welcome. Yeah. Like he wants to be in on that. What other questions do you guys have? What might be other causes of Chadwick, Goodell Hegar if it’s only probable? Um, that is a good question. I guess I would just say hormones. Um, I don’t know for a positive that would be, and I feel like
you’re probable means that you’re also a hundred percent sure they’re pregnant. The only reason why you’re not 100% assurance because you haven’t had like a visual confirmation or anything. I don’t think people typically have those. Um, chadwicks, Goodells and Hegar, Hegar unless they are pregnant. Um, but it’s just how they’ve classified it into their categories. But of course hormones are crazy and can cause any kind of weird thing to happen. Um, also that molar pregnancy that I talked about, uh, your uterus is like growing super fast and there is extra blood flow that’s going there when that is happening. So that could also be a reason. So you might have positive signs of that. Um, of those three when you have a molar pregnancy, which is actually not a true pregnancy,
do you get your period, when your on IUD? I think there’s different kinds and I think it depends on the patient. I’m not a hundred percent positive on that to be honest. I want to say no, but I could be totally wrong. Some people that take the medications that aren’t supposed to get a cycle at all still do. So it’s just kind of those weird hormone things. Yeah. You saw what on TV? A molar pregnancy. Oh, interesting. I had never heard of it until nursing school and I have never seen it. Although of course my, what I see it at, you know, cause I’m taking care of people that actually are having babies. But so a molar pregnancy, Jenna is where it’s so weird. Um, your body starts like, it’s basically these cells that rapidly divided the eggs actively divided, re over, actively divided, sorry. And um, the cell starts splitting, splitting and you have like triple, double, triple the genetic information, but not what you need.
Um, like you’ll have like 46, um, you know, x chromosomes a bunch of ys, like nothing that’s gonna create a baby. And so what happens is the body’s kind of going crazy. The symptoms of it are, the uterus grows super fast. Um, tissue is just growing, growing, growing, but it’s not fetal. Sometimes there can be pieces they’ll say, but typically no fetal tissue. There’s never a heartbeat. It’s never anything. Um, and so these women have to go on methotrexate for a year, uh, after or I don’t know if it’s a year, they have to go on methotrexate after for a few minutes. They cannot get pregnant or try to get pregnant for a year after. They also have to have blood work done, serial blood work done to make sure that HCG levels coming down because the HCG level on these women is through the root because the cells are just dividing, dividing, dividing, and the body thinks that’s pregnant and it’s not.
Um, let me see if I can find that lesson in a second and I’ll put the link in for you. Hysterical printing. I think you’re right. Cause as have some other names to it. It’s also like a Hydatidiform mole at some word, I can’t say, but molar pregnancy is another term for it. Um, when you mentioned the oral pill antibiotics, I didn’t understand that part. I didn’t understand that part. Can you please explain that part? Okay. So when a woman is taking an oral, um, birth control pill and she takes antibiotics, they say that the antibiotics can interfere just like a, um, interference between the two medications to make the oral contraception not as effective. So if someone is on antibiotics and they take oral birth control pill, then they need to use another form of birth control while they’re on that antibiotic. Does that make sense? Okay. Um, okay, let me real quick, I’m gonna jump over and grab our Molar lesson than on Molar Pregnancy for you guys that are interested. So this link will take you right to it.
Here we go. Oops. Let’s go. 10 mark goes to, yeah,
as soon as they’re done on the antibiotic, are they okay? Yes. So they want to keep taking the pill. There’s the link for molar pregnancy. Um, so Jenna, yes, they, you need to keep taking their oral birth control pill regardless if they get put on an antibiotic, they need to just use a condom or something else. Um, and then once the antibiotics done, they’re good to go and they don’t have to use another form of protection. So you still just keep taking the pill. So it shouldn’t be that they stop it. That education would just be that they need another form of birth control. Does that make sense?
Okay, perfect.
What are the questions you guys have? You’ve had some good questions.
And you’re welcome, Mary. All right guys. Well, if you don’t have any other questions, um, then that is it. And I hope you guys join me. I have few sessions, um, next week. So just check it out on the tutoring and you can see a few other OB ones that are coming your way. All right guys, go out and be your best self today. Happy Nursing.