Sexual Health Flashcards
1
Q
Gordon’s Functional Health Patterns
A
- One of the 11 patterns is sexual and reproductive pattern. This is an integral component of a person’s health and wellbeing and can be impacted by changes in health, illness and treatments
- Sexual health history: approproate to age and situations: sexul relationships, changes and problems
- When appropriate; e.g. use of contraceptives- identify any problems
- Female→ When menstruation started? Last menstrual period? Menstrual problems?
- Examination: None generally required unless problem identified or symptomatic, or routine pap test
2
Q
Nurse’s role in promoting sexual health in Primary Health Care
A
- General practice is the main provider of sexual health care in NSW
- Practice nurses in primary care settings (GPs) can play a major role in promoting Sexual and reproductive health
- 55% of Australians diagnosed with an STI or blood borne virus (BBV) access treatment through a GP
- 8% access treatment through a public Sexual Health Clinic
- Symptoms is one of the main reasons people seek sexual health services. Many STDs are asymptomatic
- Opportunistic STO screening should be a routine part of any medical consultation in GP, especially in priority populations
- NSW STI program unit
Women present to their Primary health care provider (e.g. GP/practice nurse) for pap smears and contraception or if symptomatic - An opportunity to discuss breast care and other women’s health issues
- Men are less likely to present for preventative care and are often asymptomatic if they have an STI
- PCH is an opportunity for nurses to provide holistic and preventative primary health care
- Focuses on health promotion includes not only STI screening, but focuses on reproductive health as well
3
Q
Breast Care
A
- 1 in 8 women will be diagnosed with breast cancer in their lifetime
- Accounted for 27.2% of all cancers in women- 2nd most common cancer in women after lung
- Early detection saves lives- the earlier a cancer is discovered, the greater the chances of successful treatment
- 9 out of 10 breast changes are not due to cancer, but still need to be referred to a doctor
- Breast cancer is also diagnosed in men (chances are much lower)
4
Q
Risk factors of breast cancer
A
- Being female
- A strong family history of breast cancer
- Family history and genetic susceptibility
- Obesity and inactivity and diet
- Having previously been diagnosed with Breast Cancer
- Other risk factors: Having children after 30, or no children, not breast feeding, early age of first menstruation, increased alcohol intake, aging
5
Q
Breast Check- Education
A
- Encourage people to perform checks themselves
- A lump, lumpiness or thickening in the breast or armpit, especially if only in one breast
- A change in size or shape of breast
- Skin changes, such as dimpling or redness
- A change to the nipple, such as a rash, ulcer or itchiness
- An unusual or persistent pain
50-74, breast screening (Mammography)
6
Q
Cervical cancer and Pap test-screening
A
- In 2010 Cervical cancer was the 3rd most commonly diagnosed gynaecological cancer with 818 cases
- Commence age 25, Exit screen age 70-74
- If symptomatic, test done at any age
- Collects a sample from the cervix that detects early changes in the cells of the cervix
- Without treatment, these changes could lead to cancer
Nurse’s role:
- Last pap test and what was the result
- Any unusual symptoms such as breakthrough bleeding
- Irregular cycle, dyspareunia (pain with sex)
- Perform the test
7
Q
Cervical cancer vaccination- Gardasil
A
- Vaccinated against HPV types 6, 11, 16 and 18
- What is HPV? Human Papilloma Virus (aka wart virus)
- Gardasil prevents against cervical, vulvar, vaginal and anal cancer, precancerous or dysplastic lesions, genital warts and some types of anal cancers
- Vaccination program began in 2007, as of now it is also offered to boys as part of the school vaccination program
8
Q
Cervical cancer vaccination- Gardasil: ROLE FOR THE NURSE
A
- Asking young people that you may see in practice (male and female) if they have been vaccinated
- Educate
- Are there any missed doses
- Parents permission (if under 16 and willing)
- Since its introduction we are seeing declining rates of HPV in both young men and women
- Does not replace pap smear screening for women
9
Q
Contraception- History
A
- The OCP has been in Australia since the early 60’s
Some say it has revolutionised the way women live - Freedom to work- promoted equally
- Less children- better conditions
- Less mortality from ‘backyard abortions’
10
Q
Contraception- Types
A
- The pill (OCP) 2 main types
- The combined pill (COCP)
- Contains 2 hormones and stops the ovaries releasing an egg each month
- The progesterone only pill (POCP- mini pill)
- Changing cervical mucus so that sperm cannot pass through to fertilise the egg
- The pill is about 99.7% effective if taken properly, and only 91% effective with typical used
- The POCP needs to be taken at exactly the same time every day and may cause irregular bleeding patterns
11
Q
Emergency contraception (ECP)
A
- Available “over the counter”
- Delays ovulation
- Does not interrupt an established pregnancy or harm a developing embryo or foetus if taken early in pregnancy
- Continue with other contraception such as condoms for the rest of the cycle
- Take within 5 days
12
Q
CONTRACEPTION: NURSES ROLE
A
- Ask when was LNMP, normal cycle length, when did the intercourse occur
- May need to perform a pregnancy test if possibility of pregnancy
- Educate on outcomes. Discuss longer term contraception options
- Do they need an STI screen?
13
Q
Hormonal IUD
A
- Small T-shaped device that is fitted inside uterus
- Slowly releases a low dose of progesterone over 5 years; periods usually become lighter or may stop
- 99.8% effective
- Copper IUD- affects lining of uterus- 99% efficacy
- Nurse’s role: Assess for suitability
14
Q
What about men? - TSE
A
- Testicular cancer is a rare cancer. About 690 men are diagnosed yearly. This accounts for about 1% of all cancer in Australian men
- Testicular cancer occurs most often in men aged 20-40 years
- The average age at diagnosis is 35
- All men need to regularly perform TSE
15
Q
Testicular Self Examination
A
- All men should check their testicle regularly to become familiar with the usual feel of their testicles so that they know when there is a change
- TSE only takes a few minutes and should be done every 4 weeks
- Testicle→ Small, oval shaped sex gland that produces sex hormones and sperm
- Epididymis→ A series of small tubes attached to the back of the testicle that collect and store sperm. The epididymis connects to a larger tube called the vas deferens
- Scrotum→ A skin sack that houses the testicles
- Sperm production needs a temp around 4℃ lower than the body, which is why the testicles are located outside the body in the scrotum
16
Q
TSE Exam
A
- Each testicle feels like a smooth, firm egg
- One testical tends to hang lower than the other
- One testicle may be slightly larger than the other
- There is no pain or discomfort
17
Q
TSE Exam- Educating patients
A
- Make sure the scrotum is warm and relaxed. Maybe suggest in the shower
- It may help to do TSE in front of the mirror
- Check one testicle first than the other
- Gently roll one testicle using the fingers and thumbs of both hands
- Feel along the underside of the scrotum to find the epididymis that sits at the back of the testicle. It should feel like a little bunch of tightly coiled tubes
- Nurse’s role: Education
18
Q
Sexual Health Assessment: Purpose
A
- Ascertain the risk factors and degree of risk for contracting HIV or other STDs
- Deciding what tests need to be performed
- Contact tracing
- Identify areas for education concerning STDs
- Limit the spread or acquisition of STDs
- No judgemental attitudes→ - “We see lots of different types of…ask lots of different types of questions.”
19
Q
Sexual Health Assessment
A
- Listen carefully
- Open ended questions then more specific
- Use non technical language
- Ask for explanations
- Referral if more appropriate
20
Q
Useful Info
A
- Sexual exposure- Are you sexually active, when was the last time you had sex?
- Sexual partner: male or female? Regular or casual partner, sex worker?
- Location
- Sexual practices- What type of sex?
- Barrier/condom use
21
Q
Less Useful Info
A
- Sexual orientation: Are you gay? Some people do not identify as being gay, but may have sex with men
- Marital/partnership status: Are you married?
- Judgemental: You don’t sleep with prostitutes do you?
22
Q
Sexual Practices
A
- Vaginal or anal penetration occurred
- Ask about anal sex for both men and women: “I ask this question of all my patients/clients”
- For male to male sex ascertain if insertive or receptive penetration or both occurred
23
Q
Condom use
A
- Frequency of use: “How often do you use condoms?”
- Adequacy of use: Fit, timing, lubricant and breakage
- Reasons/circumstances for not using condoms. Eg. drug use
Where they can be obtained
24
Q
Males- Symptomatic questions
A
- Uterine discharge- colour, staining of underwear, duration
- Dysuria or urethral itch
- Urinary frequency/Haematuria
- Ulcers- location, duration, quantity, pain, similar episodes
- Lumps- location, duration, pain or itch
- Other symptoms- rashes, fever, lymph nodes, scrotal pain or swelling
25
Q
Females- Symptomatic questions
A
- Vaginal discharge- colour, amount, odour, itch, related to menses
- Dysuria- Urethral or local, urgency, fever, loin pain
- Ulcers/erosions- Location, duration, quantity, pain, similar episodes
- Lumps- Location, duration, pain or itch
- Other symptoms- rash, fever, lymph nodes, abdominal pain, dyspareunia
26
Q
Sexually Transmitted Infections
Priority groups
A
- Gay men and men who have sex with men
- Young people
- People living with HIV/AIDS
- CALD (People from culturally and linguistically diverse backgrounds)
- Aboriginal and Torres Strait Islander People
- PWID- (people who inject drugs)
- Sex workers
27
Q
Chlamydia
A
- Bacterial infection
- Over 82000 cases in 2012
- Most common notifiable disease in Australia
- Most at risk- young people 15-25
- Often symptoms
- Reinfection is common
- Easy to test and treat (and prevent)
- Longer term effects in women
28
Q
Gonorrhoea
A
- Bacterial infection
- Most at risk- men who have sex with men and Aboriginal people
- Symptomatic
- Treatment is ceftriaxone
- Some resistance is occurring
29
Q
HPV (Human Papillomavirus)
A
- Viral infection
- Transmitted skin to skin
- Treatable
- Often doesn’t cause problems and may go away on its own
- Many different strains (around 43 affect genital tract)
- Gardasil vaccinated against type 6, 1, 16 and 18
30
Q
HSV (Herpes Simplex Virus)
A
- Viral infection
- HSV2 Affects around 1 in 8
- Both HSV 1 (oral) and HSV 2 (genital) can cause genital herpes
- From asymptomatic > blisters, painful
- Skin to skin transmission with asymptomatic viral shedding
- Diagnosisses
- No cure treatment- episodic, suppressive therapy
- People may have one outbreak to many (E.g. If run down, immuno compromised)
31
Q
HIV (Human Immunodeficiency Virus)
A
- A virus that attacks the immune system over time
- Mainly in men having sex with men in Aus
- Around 1000 diagnoses per year
- Compromises the body’s defence systems
- Depletes T cells
- Treatment- Not curable
- Prevention
- Contact tracing
32
Q
HBV
A
- Acute or asymptomatic
- Mainly men having sex with men some Aboriginal populations
- Affects liver
- Varied outcomes from viral clearance to chronic infectiousness
- Vaccination- very effective worldwide push
- Vaccinate all partners
33
Q
Contact Tracing
A
- Decrease the incidence of STDs and BBVs in the community by interrupting the transmission cycle
- Is no substitute for prevention through effective education
- Contact tracing also ams to
- Decrease disease sequelae through the early detection and treatment of STDs and BBVs
- Provide info and education to effect behaviour change amongst people infected with or at risk of a STD or BBV
- Generally trace back 3 months
34
Q
Explain the reasons for contact tracing
A
- It’s really important for your partner to gets treated so you don’t get the infection again
- Most people with an ST don’t know that they have it because no symptoms but could have complications or pass onto a partner s
- Explain the methods and offer choice: Different methods (in person, phone, SMS, email or letter) might be needed for each partner
- Online resources exist (e.g. Let them Know)
