Pain Flashcards
sexuality
- how a person thinks about themselves sexually
- Includes all aspects of human being that relate to being male, female, nonbinary, or genderfluid
sexual orientation
- person’s gender identity in relation to the gender to which they are attracted, and gender identity requires you to acknowledge and accept the LGBTQ+ (lesbian, gay, bisexual, transgender, queer, questioning, asexual, and others) continuum
- Anything that affects sexuality affects self concept
social aspects of sexuality
- culture
- interpersonal
- TV
- radio
- literature
- family
- school teaching
psychological aspects of sexuality
- attitudes
- feelings
- past experiences
moral aspects of sexuality
- religious
- humanistic
- pragmatic
biological aspects of sexuality
- sexual stimulation
- puberty
- reproduction growth and development
self-concept
- an idea of the self constructed from the beliefs one holds about oneself and the responses of others.
- Components of Self-Concept
- Personal Identity
- Body Image
- Role Performance
- Self-esteem
personal identity
- Conscious sense of individuality and uniqueness that evolves
through life - May also include beliefs & values
- Also includes gender identity
- how you view yourself
- ex: shy, outgoing, a mother, christian, muslim, male, female, etc.
body image
- Total conscious and unconscious disposition toward one’s body
- Develops partly from others attitudes and partly from individual’s own body exploration
- Ex: if someone says your too heavy or too thin, it affects how we view ourselves
- Idealized image (how they want to look) & mirrored image
- how you wanna look and feel and how you actually look should be close tgthr
role performance
- Person’s expected characteristic behavior in a social position
- Roles are ascribed (no choice) or assumed (chose the role)
- Gender role or sex role
- all behaviors reflecting
individual’s learned sense of masculinity & femininity, sex behavior, sexual relationships
- all behaviors reflecting
self-esteem
- One’s judgment of one’s worth
- how person’s standards and performance compare to others and to one’s ideal self
- Global self-esteem
- how much one likes oneself as a whole
- are you a good person and do you feel good as a whole?
- Specific self-esteem: how much you approve or value a certain part of yourself
- affects your global self esteem
factors that affect self-concept and sexuality: age
- As individual develops, conditions that affect self-concept change
- Development of sexuality begins with conception & continues throughout the lifespan
factors that affect self-concept and sexuality: family
- Values are influenced by family
- Gender identity
- Attitudes toward sexuality
- Body image
- Self-esteem
factors that affect self-concept and sexuality: culture
- US culture values youth, beauty, health
- Some cultures value age, weight
- Sexual nature of dress
- Rules about marriage, specific sex practices
- Expectations of role behavior
factors that affect self-concept and sexuality: stressors
- Ability to cope can strengthen or threaten self-concept
- Greater the number of resources a person has and uses the more positive the effect on self- concept
factors that affect self-concept and sexuality: religion/moral beliefs
- Influences sexual expression and expectations regarding sexual behavior
factors that affect self-concept and sexuality: previous experiences
- History of success –> positive self-concept, self-esteem
- Previous experience with sexuality affects current functioning
o Abuse
o Growing up with neg attitudes toward sexuality
factors that affect self-concept and sexuality: illness
- Trauma, surgery (e. g. mastectomy) can affect body image
- Illness can affect ability to perform role expectations
- Pain, joint disease can affect ability to perform sexually
- Cardiac/ respiratory disease –> fear of engaging in sexual activity
- Disease/ conditions can affect ability to attain sexual arousal
o Diabetes
o Circulatory disorders
o Neurological diseases (stroke, spinal cord injury)
o Menopause
o Depression/ anxiety
factors that affect self-concept and sexuality: drugs/medications
- Can alter one’s appraisal of a situation
- Alcohol decreases sexual response
nature of the problem
- How would you describe
yourself? - Which aspects of your
appearance do you like? - Tell me about things u do
that make you feel good
about yourself. - Tell me about your primary roles. How effective are you at carrying out each of these roles? Do you feel good about these roles?
onset and duration
- When did you start to think or feel differently about yourself?
- How long have you struggles with (body image, role performance, or self-esteem)
- Can you remember a time when you felt good about yourself?
- When did your primary roles change? What are the
changes?
effect on patient
- Tell me how your (loss of breast, hand function, fatigue) affects your
roles and independence. - What impact does your self-esteem have on your relationships?
- How does your self-esteem affect other areas of your life, such as decision making, socializing with friends?
- Have you considered hurting yourself (specify self-mutilation, suicidal gestures)
nursing assessment of self-concept
- Physical Exam
- Behavioral manifestations
- Posture: slumped over, looking down, not making eye contact
- Concealment of body parts
PLISSIT Model – P
- permission: discuss sexuality issues
- bring up topic that relates to sex and their medical issues
- “Would it be okay to discuss your sexual activity?”
PLISSIT Model – LI
- limited info
- related to sexual health problems being experienced
- specific to medical condition
- “with age, there is a decrease of estrogen that can limit dryness of the vagina and pain during the sexual act”
PLISSIT Model – SS
- specific suggestions
- only when the nurse is clear about the problem
- “I suggest you use K-y jelly lubricant before intercourse”
PLISSIT Model – IT
- intensive therapy
- referral to professional with advanced training if necessary
- if we can’t hep them refer them
- ” if that doesn’t work, i can refer you to either a sex therapist or a gynecologist who specializes in female sexual dysfunction”
dealing with inappropriate sexual behavior
- Communicate that
behavior is not acceptable - Set limits: Identify the behavior you expect
- i expect you to be fully clothed, hands to yourself
- Report behavior to someone in charge (nursing instructor, charge nurse, etc.)
- if you feel uncomfy go to someone higher up
assess sexual history
- Are you sexually active?
- With whom do you have sex: men, women, both?
- What are you using for contraception at this time?
assess reproductive history
- Assigned Female at Birth
- Age of menarche, menopause
- Pregnancies, live births
- Last Pap test
- Self breast exam
- Assigned Male at Birth
- Children
- Last prostate exam
- Self testicular exam
assess sexual self-concept
- Manner of dress: can tell you how they think abt themselves
- Comments about self and relationships
assess sexual knowledge
- Especially important with adolescents
assess for presence of health problems
- circulatory, endocrine, neurological, psychic –> impact ability to fxn sexually
assess medication/drug use
- ex: alcohol –> shunts blood from core to periphery
assess for signs of sexual abuse
- make sure you ask in private
- tattoos could mean sex trafficked
nursing diagnostic – situational low self-esteem
- A negative perception of self related to a loss of physical or psychological function or changes to one’s lifestyle or body
nursing diagnostic – impaired sexual fxning
- Difficulty participating or achieving satisfaction from sexual activity
nursing diagnostic – ineffective role performance
- Patterns of behavior and self-expression that do not match environmental context, norms or expectations
nursing diagnostic – disturbed self-concept
- a negative state of change about the way a person feels, thinks, or views himself or herself
- it may include a change in body image, self-esteem, or personal identity
projected outcomes
- Person will verbalize positive feelings about self –> how you will know
- Person will report satisfying sexual activity
- NOC
- Body image
- Self-esteem
- Sexual functioning
nursing interventions
- Encourage individual to substitute negative self talk with positive self talk
- Explore positive qualities and strengths
- Help individual identify distortions, inappropriate
or unrealistic standards
- Provide accurate information
- Sexual education
- Develop therapeutic relationship (makes pts more comfy)
- Help individual identify areas of strength
- Stress positive thinking
- Notice & verbally reinforce client strengths
- Encourage setting attainable goals
- Provide honest, positive feedback
nursing interventions categories
- Body image enhancement
- Self-esteem enhancement
- Role enhancement
- Health education
- Sexual counseling
evaluation
- Patient’s verbalizations about self_______
- Client’s degree of satisfaction with her sexual activity_____________
An 89 year old states, “I am a lost cause. I can’t even stand long enough to cook my own meals anymore.” Which of the
following is the most appropriate response?
A. “That must be difficult. What things are you still
able to do? (CORRECT. validating them and focusing on the positive)
B. “Well, that is to be expected at your age.”
C. “Do you have someone else to cook for you?”
D. “Are you a good cook?”
When asked to describe herself, a client with newly a diagnosed chronic illness describes only those roles involving
others (e. g. wife, mother, medical assistant) and no personal hobbies or interests. In planning her care the nurse should
include which of the following?
A. How her treatment will affect her ability to perform those roles. (CORRECT)
B.How to set goals for her to develop personal hobbies or interests.
C.That the family be present while the treatment plan is being
developed.
D.That she will need psychological counseling for role performance in addition to her medical treatment.
In taking the client’s health history it is important that the nurse
A. Discuss sexual concerns only if the client brings
them up.
B. Uses emotionally laden terms when discussing
sexual concerns.
C. Focuses only on physical factors that affect sexual
functioning.
D. Routinely includes a few questions related to sexual functioning. (CORRECT)
Which of the following is an appropriately stated projected outcome for the
nursing diagnosis:
Risk for ineffective sexuality patterns related to altered self concept 2°
mastectomy.
A. Patient will verbalize satisfaction with sexual
functioning. (CORRECT)
B. Patient will be able to look at mastectomy site without crying. = intervention
C. Patient will verbalize positive feelings about herself. = relates to self-concept
D. Patient will have effective sexuality patterns. = goal
Sally is 5’7”, weighs 105 pounds and believes she is fat. Which of the following most represents this perception?
A. Altered body image (CORRECT)
B. Altered personal identity
C. Excessive self-expectation
D. Altered gender role
A depressed patient is crying and verbalizes feelings of low self-esteem and self-worth such as, “I’m such a failure … I can’t do anything right.” What is the nurse’s best response?
- unstable and hysterical
- concern for their safety
A. Remain with the patient until he or she validates feeling more stable. (CORRECT)
B. Tell the patient that is not true and that every person has a purpose in life
C. Review recent behaviors or accomplishments that
demonstrate skill ability.
D. Reassure the patient that you know how he is feeling and that things will get better
