Week 4: Sexuality & Diversity Flashcards
Factors that interfere with a couples sexual expression
Infertility (inability to conceive after 1 year of unprotected sex)
Developmental status change (i.e. menopause)
Genetic testing
Unwanted pregnancies
Nursing Interventions pertaining to sexual health
Establishing a trusting, nonjudgmental therapeutic relationship
Emphasizing confidentiality
Teaching about sex and sexual health
Promoting responsible sexual health
- forms of sexual expression –> consent is mandatory for all encounters; no harm should come to self or others
- Prevention of unwanted pregnancy –> birth control
- Prevention of STIs –> either abstinence or condoms; clean needles; routine STI screening with tests of cure; avoid douching
- Sex education
Best time to initiate contraception
before engaging in any sexual activity
Which birth control method provides best protection against STIs?
Condoms ONLY
Reasons for permanent contraception
Patients are certain they don’t want more or any children
Considerations for types of birth control
Side effects & tolerance
Ease of use
Safety and effectiveness
Types of barrier methods (MOA)
MOA: create a barrier to prevent sperm from entering the vagina
Condoms
Diaphragms
Cervical caps
Contraceptive sponge
How to use a diaphragm
MOA: Diaphragms cover the cervix with a soft latex dome and should be used with a spermicidal
Timing:
Insertion –> up to 4 hours before intercourse
Removal –> at least 6 hours after intercourse
Requires fittings by MD
- must be refit if…
- pregnancy
- abdominal surgery
- weight change of 10 lbs
- replace q 1-2 years
Other characteristics…
- User-controlled
- Nonhormonal
- Only available by rn
- Only effective if used correctly
Key patient education re: OCPs
- do not protect against STIs - wear condoms for protection if you do not know the STI status of your partner
- Must be taken at the same time each day
Types of OCPs
Estrogen
Progesterone (POPs)
- I: womxn who are unable to take estrogen
- Inc r/o: breakthrough bleeding, pregnancy
- Benefits: some protection against ovarian and endometrial cancers
Combinations
Monophasic - fixed-dose hormones
Multiphasic - different doses of hormones throughout the cycle
Screening patients for OCPs (contraindications)
Contraindications:
- hx or r/o DVT
- allergies
- heavy smokers
- any thrombolytic disorders (VTE, CVA)
- estrogen-dependent cancer
- idiopathic vaginal bleeding
- pregnancy/lactation
- decreased effectiveness if taken with abx ***
Conduct a risk-benefit analysis based on
- Liver disease
- Breast/endometrial cancer
- Migraines
- CAD, CVD
- HTN
- Smokers * >25 yo
Injectable Contraceptive
Depo-Provera = medroxyprogesterone acetate
- injection q 12 weeks
- Primary SE: menstrual cycle disturbance and spotting
- MOA: suppresses ovulation and FSH & LH production by the pituitary; increases viscosity of cervical mucus; causes endometrial atrophy
IUDs (types, moa, benefits, ses)
= T-shaped device placed inside the uterus
Types
- hormonal/progesterone (mirena q5y, skyla q3y)
- nonhormonal/copper (paraguard q10y)
- Benefits (I: women with heavy, painful periods)
- Maintenance-free
- Periods usually become lighter, shorter, and less painful
MOA
- inhibits sperm mobility/viability
- changes transport of ovum in the fallopian tube
SEs
- Cramping with copper IUD
R/o
- Dislodgment
- PID
- Infection
Contraindications
- women with abnormal uteruses
Indications for tubal ligation
= desire for permanent sterilization
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- abdomen is filled with CO2 to expand the abdominal wall
- laparoscope inserted to clip or cauterize fallopian tubes
Erectile dysfunction (causes, risk factors, assessment, treatment)
= inability to attain or maintain an erection
Causes
- Psychogenic - anxiety, fatigue, depression, MH disorders, strained partner relationship, negative body image
- Organic :
- Endocrine: DM
- Vascular: CVD, HTN, high cholesterol
- Drug induced: antidepressants, antipsychotics, antiandrogens, glaucoma eye drops, chemo, anti-HTN
- Neurogenic: MS, CVA, Parkinson’s, SCI
- hormonal
- Penile etiology
- Alcohol
- Aging d/t atrophy of smooth muscles
Assessing
- hx: DM, SCI, CVD, alcoholism
- meds: antihypertensives, antidepressants, vasodilators
- degree of impotence
- length of time of disorder
Risk factors
- smoking
- CVD
- neuro disorders
- diabetes
- chronic pain
- respiratory disease
Androgens (types, SEs, drug/lab test interferences)
Types
testosterone, danazol, fluoxymesterone, methytestosterone
MOA = maintain male sex organs and characteristics
- Inc protein anabolism and RBC production
Indications
- Replacement therapy (hypogonadism, delayed puberty)
- Inoperable breast cancer
- Endometriosis tx
SEs
- Testicular atrophy
- Acne, Edema, Hirsutism (inc hair)
- Deepening voice
- Weight gain
- Antiestrogenic effects (flushing, sweating, emotional lability)
- Headache, dizziness
Drug/Lab Test Interference –> lasts for 2 weeks after d/c
- Thyroid function (falsely lower)
- Creatinine (falsely inc)
Nursing Considerations for Androgen patients
- Hx & PE
- Known allergies
- Pregnancy & lactation status
- Hepatic dysfunction
- CVD, breast or prostate cancer
- Assess CNS (affect, orientation, peripheral sensations and lab values) for baselines
Anabolic steroids (Actions, Indications, *AEs with off-label use, *drug-drug interactions)
Actions
- promote tissue-building
- reverse catabolic processes
- inc RBCs
Indications
- Anemias, cancers, angioedema
- promote weight gain and tissue repair
AEs with excessive off-label use
- Cardiomyopathy
- Hepatic carcinoma
- Personality changes
- Sexual dysfunction
Drug-Drug Interactions
- Oral anticoags (warfarin/coumadin) d/t inc r/o bleeding
- antiDM medications d/t metabolism changes
Viagra/sildenafil (MOA, duration, SEs)
MOA
- inhibits PFR5 receptors, allowing release of nitrous oxide –> prolonged smooth muscle relaxation –> allows blood flow through corpus cavernosum
Pharmacokinetics
- Route: PO
- Onset: 15-30 min
- Peak: 30-120 min
- Duration: 4h
SEs
- Headache
- Vision changes
- Flushing
- Dyspepsia
- UTI
- Rash
Perimenopause (define, occurrence, s/s)
= natural maturing of the reproductive system
Occurs ~ 2-8 years prior to menopause
S/s
- irregular menstrual cycles
- hot flashes
- sleep and mood changes
- weight gain/bloating
- headaches
- decreased vaginal lube
- night swears
- depression
Menopause (define, occurrence, s/s)
= 1 year without a menstrual cycle; universal and irreversible part of the female aging process; marks end of childbearing capabilities
Occurs ~50-51yo
S/s
- 12 mo w/o period
- Atrophy of breasts, uterus, fallopian tubes and ovaries
- Similar symptoms to perimenopause (hot flashes and night sweats most common)
- inc r/o osteoporosis (d/t dec estrogen)
Hormone Replacement Therapy (indications, risk factors)
Indications (short-term <5y use)
- Perimeno or menopause pts with severe vasomotor symptoms
- Prevention of osteoporosis
Increases r/o
- heart disease
- stroke
- breast cancer
PMS (patho, treatment, lifestyle mods)
= the cyclic occurrence of symptoms that are severe enough to interfere with life, and are consistent and predictable with the menstrual cycle
S/s
- Anxiety
- Cravings
- Depression
- Hydration (weight gain, bloating)
- Other (hot flashes, nausea, aches, acne)
Treatment
- Lifestyle changes: stress reduction, regular exercise, balanced diet (low salt) , increase water intake, decrease caffeine, stop smoking, limit alcohol
- Vitamins and minerals: multivitamin, Vitamin E, Calcium, Magnesium
- Meds: NSAIDs, OCPs, antidepressants, anxiolytics
Most common STD in US (s/s, tx, risk factorss)
Chlamydia
S/s
- often asymptomatic
- mucopurulent vaginal discharge, endocervicitis, inflammation of rectum or eye
Tx
- Single dose doxycycline + azithromycin
Risk factors
- adolesence
- multiple sex partners, or new sex partner
- sex without condoms
- OCP use
- pregnancy
- hx STIs
