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NU472 > Week 4: Sexuality & Diversity > Flashcards

Week 4: Sexuality & Diversity Flashcards

1
Q

Factors that interfere with a couples sexual expression

A

Infertility (inability to conceive after 1 year of unprotected sex)

Developmental status change (i.e. menopause)

Genetic testing

Unwanted pregnancies

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2
Q

Nursing Interventions pertaining to sexual health

A

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
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3
Q

Best time to initiate contraception

A

before engaging in any sexual activity

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4
Q

Which birth control method provides best protection against STIs?

A

Condoms ONLY

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5
Q

Reasons for permanent contraception

A

Patients are certain they don’t want more or any children

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6
Q

Considerations for types of birth control

A

Side effects & tolerance

Ease of use

Safety and effectiveness

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7
Q

Types of barrier methods (MOA)

A

MOA: create a barrier to prevent sperm from entering the vagina

Condoms

Diaphragms

Cervical caps

Contraceptive sponge

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8
Q

How to use a diaphragm

A

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
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9
Q

Key patient education re: OCPs

A
  • 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
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10
Q

Types of OCPs

A

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

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11
Q

Screening patients for OCPs (contraindications)

A

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
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12
Q

Injectable Contraceptive

A

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
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13
Q

IUDs (types, moa, benefits, ses)

A

= 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

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14
Q

Indications for tubal ligation

A

= desire for permanent sterilization

px

  • abdomen is filled with CO2 to expand the abdominal wall
  • laparoscope inserted to clip or cauterize fallopian tubes
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15
Q

Erectile dysfunction (causes, risk factors, assessment, treatment)

A

= 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
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16
Q

Androgens (types, SEs, drug/lab test interferences)

A

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)
17
Q

Nursing Considerations for Androgen patients

A
  • 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
18
Q

Anabolic steroids (Actions, Indications, *AEs with off-label use, *drug-drug interactions)

A

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
19
Q

Viagra/sildenafil (MOA, duration, SEs)

A

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
20
Q

Perimenopause (define, occurrence, s/s)

A

= 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
21
Q

Menopause (define, occurrence, s/s)

A

= 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)
22
Q

Hormone Replacement Therapy (indications, risk factors)

A

Indications (short-term <5y use)

  • Perimeno or menopause pts with severe vasomotor symptoms
  • Prevention of osteoporosis

Increases r/o

  • heart disease
  • stroke
  • breast cancer
23
Q

PMS (patho, treatment, lifestyle mods)

A

= 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
24
Q

Most common STD in US (s/s, tx, risk factorss)

A

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
25
Q

Trichomoniasis (s/s, tx, pt edu)

A

S/s

  • heavy yellow/green frothy discharge
  • vaginal itching and vulvar soreness
  • foul vaginal odor
  • vaginal redness
  • petechiae on cervix

Tx
- 1x 2g dose of po metronidazole for both partners

Pt edu:

  • NO ALCOHOL during treatment - will get violently ill
  • Avoid sexual activity until test of cure
  • Use condies
26
Q

Vulvovaginal candiasis (s/s, tx)

A

Inc risk with…

  • use of OCPs high in estrogen
  • broad spectrum abx

S/s

  • pruritus
  • thick, white, curdlike vaginal discharge
  • vaginal soreness and burning
  • vaginal erythema

Tx (-azole)

  • Miconazole cream
  • Clotrimazole tablet/cream
  • Tercanozole cream
  • Fluconazole po
27
Q

Most common viral infection in US

A

HPV (genital warts/condylomata)

28
Q

Preventing HPV

A

Primary
- HPV vaccine

Secondary
- Education: linking HPV and cervical cancer

29
Q

What cancer does HPV cause?

A

Cervical

30
Q

Nursing strategies to prevent UTIs

A

Vaccinations

Education

  • basic info re: transmission
  • safe sex behaviors
  • partners need treatment as well
  • target teens and parents re: STIs
  • barrier methods!!!

Resources

  • community resources
  • STI testing

Screening
- assess risk by discussing sexual partners

31
Q

LGBTQ health issues

A

LGBT youth are 2-3x more likely to attempt suicide

Public health infrastructure and access to quality health care

Partner inclusion

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