Theory 3110 Ch. 33,34,35

Sexually Transmitted Infections

-About 20 million people in the United States are diagnosed each year with an STI each year; almost half of them are 15 to 24 years of age. -STIs are transmitted from infected individuals to partners during intimate sexual contact. -Usually curable STIs: Syphilis (caused by bacteria, if left untreated, you can have long term neurological complications and even death can occur. It is transmitted from person to person by contact with the syphilis sore Gonorrhea: (also caused by a bacteria and very common STI. Chlamydia: (most commonly transmitted bacterial infection in the US. It can cause damage to the reproductive organs Trichomoniasis -Viral STIs: human papillomavirus (HPV) - is viral and most people don't know they have it. The vaccine protects against the cervical cancers. They are asymptomatic and self-limiting usually. herpes simplex virus (HSV) type II, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). -Genital herpes, HIV, and HPV are caused by viruses and cannot be cured, but patients can take antibiotics for gonorrhea, etc.

Scientific Knowledge Base of spirituality

-An individual's intrinsic spirit seems to be an important factor in healing. -Healing often takes place because of believing. -Spirituality has a positive impact on ability to cope with anxiety, stress, and depression. -A person's inner beliefs and convictions are powerful resources for healing.

Critical Thinking of Spirituality

-Apply knowledge, experience, standards, and attitudes. -Personal experience in caring for clients in spiritual distress is valuable when helping clients select coping options. -Each person has a unique spirituality. -The Joint Commission requires health organizations to provide for pastoral care. Critical thinking and the application of knowledge and skills help nurses enhance patients' spiritual well-being and health. Nurses who are comfortable with their own spirituality often are more likely to care for their patients' spiritual needs. Beliefs of a health care provider affect the discussion of treatment options with patients and ultimately their health care choices In setting standards for quality health care, The Joint Commission (TJC) (2017) requires health care organizations to acknowledge patients' rights to spiritual care and to provide for patients' spiritual needs through pastoral care or others who are certified, ordained, or lay individuals. The standards also require that you assess patients' beliefs and spiritual practices.

Nursing Process: Assessment of Spirituality

-Assessment expresses a level of caring and support -Taking a faith history reveals client's beliefs about life, health, and a Supreme Being -Through the client's eyes -Assessment tools -Listening -Ask direct questions or using open-ended questions to prompt them to tell their story -FICA (Faith, Importance, Community, Address) -Spiritual well-being (SWB) scale Effective assessment tools such as the SWB scale and FICA help you remember important areas to assess. Patient responses to the assessment items on the tools indicate areas that you need to investigate further. For example, if, after using the FICA tool with a young man who is having difficulty accepting a new diagnosis of prostate cancer, you find out that he does not want you or his pastor to help him address this issue, you need to spend time understanding how the patient plans to manage this new illness. -Look for clues such as a bible in the room. -Bc of HIPPA, we can't contact a certain faith chaplain to come but you can ask if they would like one to come or they can call for themselves. Faith/Belief: -Ask about a religious source of guidance -Understand the client's philosophy of life -When assessing a patient's faith, first determine his or her beliefs, especially those that influence hope. For example, ask how a patient believes a chemotherapy drug will affect a newly diagnosed form of cancer. Ask the patient whether he or she believes in the skill or competence of his or her physician. Determine which of your patient's beliefs guide him or her to find meaning in life events and to thus make decisions. Ask your patient whether he or she is able to live according to his or her beliefs. Finally, assess to what extent your patient interrelates with self, others, and/or a source of authority. Faith in an authority (such as a health care provider or senior family member) provides a sense of confidence that guides a person in exercising beliefs and experiencing growth. Assess a person's faith in an authority by asking "To whom do you look to for guidance in life?" The patient's response to an open-ended question such as this is likely to open the door for a meaningful discussion. Listen carefully and explore what is meaningful to the patient. Determine whether a patient has a religious source of guidance that conflicts with medical treatment plans and affects the options that nurses and other health care providers are able to offer patients. For example, if a patient is a Jehovah's Witness, blood products are not an acceptable form of treatment Life and self-responsibility: -Ask about a client's understanding of illness limitations or threats and how the client will adjust. -Individuals who accept change in life, make decisions about their lives, and are able to forgive others in times of difficulty have a higher level of spiritual well-being. During illness patients often are unable to accept limitations or do not know how to regain a functional and meaningful life. Their feelings and struggles often reflect spiritual distress. (Box 35.2) -Connectedness: People who are connected to themselves, others, nature, and God or another Supreme Being usually report higher levels of physical and emotional health. One way patients remain connected is by praying. Prayer is personal communication with one's higher power that provides a sense of hope, strength, security, and well-being; it is a part of faith. Patients often use prayer when other treatments are ineffective, when they are experiencing fear or anxiety, or when they feel that they have no control over what is happening to them -Life satisfaction: Spiritual well-being is tied to a person's satisfaction with life and what he or she has accomplished, even in the case of children. When people are satisfied with life and how they are using their abilities, more energy is available to deal with new difficulties and resolve problems. You assess a patient's satisfaction with life by asking questions such as "How happy or satisfied are you with your life?" or "Tell me how satisfied you feel about what you have accomplished in life" or "Describe what makes you feel dissatisfied with your life." -Culture: Spirituality is a personal experience within a cultural context. It is important to know a patient's cultural background and assess his or her values about the health care problem and impending treatment. It is common in many cultures for individuals to believe that they have led a worthwhile and purposeful life. Remaining connected with their cultural heritage often helps patients define their place in the world and express their spirituality. Asking them about their faith and belief systems is a good beginning for understanding the relationship between culture and spirituality -Fellowship and community: this includes the extent of the community of shared faith between people and their support networks. Many times social support from faith-based groups helps patients cope with illness and participate in health promotion behaviors ask questions such as "Who do you find to be the greatest source of support in times of difficulty?" or "When you've faced difficult times in the past, who has been your greatest resource?" -Ritual and practice: Assessing the use of rituals and practices helps you understand a patient's spirituality. Rituals include participation in worship, prayer, sacraments (e.g., baptism, Holy Eucharist), fasting, singing, meditating, scripture reading, and making offerings or sacrifices. Different religions have different rituals for life events. -Vocation: Individuals express their spirituality on a daily basis in life routines, work, play, and relationships. It is often a part of a person's identity and vocation. Questions to ask include, "How has your illness affected the way you live your life spiritually at home or where you work?" or "How has your illness affected your ability to express what's important in life for you?"

Nursing Process: Assessment

-Care should be client-centered -Direct questioning -Observe client nonverbal behavior -Use knowledge of developmental stages -Through the client's eyes -Coping behaviors -Significant others can share info -You can gather a lot of data through observation of nonverbal behavior and pay attention to your conversation with them. -Use your knowledge of stages to figure out which might be important to the patient and inquire about those aspects of person's life (think back to Erikson's stages of development) -You can help patient explore resources and strengths, etc.

Implementation

-Collaborate with the other team members and clients to promote healthy self-concept -Health promotion -Acute care -Restorative and continuing care Offer privacy and explain procedure -The key indicators of a patients self-concept are generally nonverbal (is the patient more satisfied) -Changes in self-concept take time. So we are looking for behavior traits that promote self concept

Factors Influencing Self-Concept (Cont.): Stressors

-Common stressors that influence self-concept -Body image is like stroke, colostomy, anorexia, obesity, Multiple sclerosis. -Identity is job loss, change in marital status, abuse or neglect, repeated failures -Role performance is the inability it balance career, promotion, empty nest, or responsibilities for aging parents

Critical Thinking of sexuality

-Integrate knowledge from nursing and other disciplines. -Have a thorough understanding of safe sex practices and risks and behaviors associated with sexual problems to anticipate how to assess a client and interpret findings. -patients may have different values than you do and recognize when your personal opinions get in the way

Scientific Knowledge Base

-Lifelong process -Parental influence (on self-concept are often rejected and peers become more important as that adolescence moves towards independence) -School-age: positively inflated -Adolescence: can adversely affect self-concept and self-esteem (this is the time where the secondary sex characteristics are seen an there are lots of bodily changes) -Adulthood -Self-concept affects perception of health Age 12-18 years: Identify vs. role confusion (examining beliefs and establishing future goals) In late teens to 40's: Intimacy vs Isolation (stable feelings about oneself and a successful role transition, increasing responsibility) -Self concept is always changing and it is based on a sense of competency, cultural identity, academic or employment related identity, personal characteristics that affect self expectations. -Self esteem is normally highest in childhood, fluctuates during adolescence, rises gradually during adulthood, and either diminishes or increases in old age, depending on the self-concept clarity. -In the later years, maybe someone has a declining physical or mental abilities and they are facing many losses of spouse or siblings, less choices and options, and you can counsel them about the meaningful use of time, give them aging resources, assess depression or substance abuse, and recognize and value that older adults lived experience.

Nurse's Effect on Patient's Self-Concept

-Nurses need to remain aware of their own feelings, ideas, values, expectations, and judgments: -Use a positive and matter of fact approach. -Build a trusting relationship. -Be aware of facial and body expressions. -Preventive measures, early identification, and appropriate treatment minimize the intensity of self-esteem stressors. -You have to be careful to have a poker face because patient's are looking at your reaction -Patients who are weak and debilitated might not be able to follow their usual grooming routine and maybe their hair is matted and oily. The nurse can provide oral and hair care for the patient. Making a dry clean bed can make you feel better. Don't talk to the patient from the door -Nurses need to assess and clarify these self-concept issues.

Spiritual Health

-Spiritual health represents a balance between their values, goals, and beliefs and their relationships within themselves and others.. -Spiritual health matures with increasing awareness of meaning, purpose, and life values. -Spiritual beliefs change as clients grow and develop.

Planning

-Synthesize knowledge, experience, critical thinking attitudes, and standards -Use concept map -Goals and outcomes -Setting priorities -Teamwork and collaboration -A goal could be the patient will describe themselves realistically and identify strengths, etc. You can help the patient identify these.

Planning of Spirituality

-Use knowledge about resources available for spiritual care to develop an individualized plan of care Critical thinking at this step is important because you reflect on previous experiences and apply knowledge and critical thinking attitudes and standards in selecting the most appropriate nursing interventions. Match the patient's needs with evidence-based interventions that are supported and recommended in the clinical and research literature. Use a concept map to organize patient care and show how the patient's medical diagnosis, assessment data, and nursing diagnoses are interrelated. -Goals and outcomes: A spiritual care plan includes realistic and individualized goals along with relevant outcomes. Goals for spiritual nursing care focus on helping patients integrate their own religious and spiritual beliefs with their health and illness states to give meaning to their lives. It is very important to collaborate closely with patients when setting goals for spiritual support and growth and choosing related interventions. Setting realistic goals requires you to know a patient well. Ex: • The patient expresses an acceptance of illness. • The patient reports the ability to rely on family members for support. • The patient initiates social interactions with family and friends. Spiritual priorities do not need to be sacrificed for physical care priorities. For example, when a patient is in acute distress, focus care to provide him or her a sense of control to minimize powerlessness. When a patient is terminally ill, spiritual care often is the most important nursing intervention in supporting patients and families in grief -Teamwork and collaboration: If a patient participates in an organized religion, with permission of the patient, involve members of the clergy or church, temple, mosque, or synagogue in the plan of care when appropriate. In a hospital setting the pastoral care department is a valuable resource. These spiritual care professionals offer insight about how and when to best support patients and their families. Spiritual care providers provide direct support in the form of actively addressing spiritual or religious needs of a patient and family, having discussions about family members' feelings and patient values, and reminiscing with families about a patient. Significant others such as spouses, siblings, parents, and friends need to be involved in the patient's care as appropriate.

1. The nurse is caring for a patient who has just had a near-death experience (NDE) following a cardiac arrest. Which intervention by the nurse best promotes the spiritual well-being of the patient after the NDE? 1. Allowing the patient to discuss the experience 2. Referring the patient to pastoral care 3. Having the patient talk to another patient who had an NDE 4. Offering to pray for the patient

1

6. The nurse is providing community education about how the sexual response changes with age. Which statement made by one of the adults indicates the need for further information? 1. "Health problems such as diabetes, chronic obstructive pulmonary disease, and hypertension have little effect on sexual functioning and desire." 2. "It usually takes longer for both sexes to reach an orgasm." 3. "Most of the normal changes in function are related to alteration in circulation and hormone levels." 4. "Many medications can interfere with sexual function."

1

7. The nurse is gathering a sexual health history on a patient being admitted to the hospital for surgery. Which question demonstrates a nonjudgmental attitude? 1. Can you tell me your sexual orientation? 2. How do you and your wife feel about intimacy? 3. Do you have sex with men, women, or both? 4. Do you have sexual intercourse at your age?

1

A nurse is working with an older adult who recently moved to an assisted-living center because of declining physical capabilities associated with the normal aging process. Which nursing interventions are directed at promoting self-esteem in this patient? 1. Commending the patient's efforts at completing self-care tasks 2. Assuming that the patient's physical complaints are attention-seeking measures 3. Minimizing time discussing memories and past achievements spent with the patient 4. Limiting decision-making opportunities for the patient to reduce stress

1

A patient hospitalized with heart failure states that she sees her illness as an opportunity and a challenge. Despite her illness, she is still able to see that life is worth living. Of which concept is this an example? 1. Hope 2. Faith 3. Values 4. Connectedness

1

A patient is diagnosed with end-stage renal disease. The patient tells the nurse, "I know I am going to be all right, and I will be healthy again. I believe in God, and He will make things right. My spouse and I have yet to tour the world." Which kind of spiritual belief does this patient exhibit? 1. Hope 2. Self-transcendence 3. Transcendence 4. Agnosticism

1

A patient who is depressed 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? 1. Remain with the patient until he or she validates feeling more stable. 2. Tell the patient that is not true and that every person has a purpose in life. 3. Review recent behaviors or accomplishments that demonstrate skill ability. 4. Reassure the patient that you know how he or she is feeling and that things will get better.

1

Based on knowledge of the developmental tasks of Erikson's industry versus inferiority stage, the nurse emphasizes proper technique for use of an inhaler with a 10-year-old boy. Why does the nurse do this? 1. Increase the patient's self-esteem with the mastery of a new skill. 2. Help him accept changes in his appearance and physical endurance. 3. Allow him to experience success in role transitions and increased responsibilities. 4. Assist him in appreciating his body appearance and function

1

In the FICA assessment tool for evaluating spirituality, what does the letter A stand for? 1. Address 2. Ambition 3. Adherence 4. Accessibility

1

The nurse is teaching a 10-year-old patient about personal hygiene. Which observation would indicate that the child has not reached an age-appropriate developmental stage? 1. His inability to understand and master brushing technique 2. The inability to accept age-related body changes 3. An inability to assess life goals 4. His inability to decide on a future career

1

Which physical sign often indicates the possibility of sexual abuse in children? 1. Chronic pain 2. Excessive masturbating 3. Vomiting or abdominal tenderness 4. Trauma to the labia, vagina, cervix, or anus

1

4. A 20-year-old patient diagnosed with an eating disorder has a nursing diagnosis of Situational Low Self-Esteem. Which of the following nursing interventions are appropriate to address self-esteem? (Select all that apply.) 1. Offer independent decision-making opportunities. 2. Review previously successful coping strategies. 3. Provide a quiet environment with minimal stimuli. 4. Support a dependent role throughout treatment. 5. Increase calorie intake to promote weight stabilization.

1,2

Which factor can affect body image in a 15-year-old female patient? Select all that apply. One, some, or all responses may be correct. 1. Cognitive and physical growth 2. Cultural and societal attitudes 3. Role performance 4. Fulfillment of role expectations 5. Achievement of identity

1,2

5. The nurse can increase a patient's self-awareness and self-concept through which of the following actions? (Select all that apply.) 1. Helping the patient define personal problems clearly 2. Allowing the patient to openly explore thoughts and feelings 3. Reframing the patient's thoughts and feelings in a more positive way 4. Having family members assume more responsibility during times of stress 5. Recommending self-help reading materials

1,2,3

In assessing a patient for self-concept and self-esteem, on which component would the nurse focus? Select all that apply. One, some, or all responses may be correct. 1. Identity 2. Body image 3. Role performance 4. Physical condition 5. Medical condition

1,2,3

Which element influences the achievement of identity in a person? Select all that apply. One, some, or all responses may be correct. 1. Sexuality 2. Gender 3. Ethnicity 4. Place of birth 5. Physical appearance

1,2,3

The nurse is obtaining a spiritual history from a patient admitted with renal failure. Which factor influences a patient's spirituality? Select all that apply. One, some, or all responses may be correct. 1. Age 2. Gender 3. Culture 4. Religion 5. Education

1,2,3,4,5

A senior nurse is talking with student nurses about spirituality. Which conceptual element is included in spirituality? Select all that apply. One, some, or all responses may be correct. 1. Transcendence 2. Faith and hope 3. Inner strength and peace 4. Meaning and purpose in life 5. Connectedness 6. Culture

1,2,3,4,5; Spirituality has five constructs or conceptual elements. Transcendence is the belief that there is an external force beyond the material world. Faith refers to a firm belief despite any evidence of a physical presence. Hope is a source that gives energy to move forward in life. Inner strength is a source of positive energy that drives a person in difficult times. Inner peace provides a calm, positive, and peaceful feeling. A spiritual person strives to find meaning and purpose to live a meaningful life. Connectedness refers to feeling connected with oneself, with others, and with an unseen force. Culture is not a part of spirituality.

Which statement about human immunodeficiency virus (HIV) is appropriate? Select all that apply. One, some, or all responses may be correct. 1. HIV is a bloodborne pathogen. 2. HIV spreads through oral-genital sex. 3. HIV is not found in bodily fluids. 4. HIV causes ectopic pregnancy. 5. The risk of contracting HIV can be reduced by the use of condoms.

1,2,5

10. The nurse is caring for a 50-year-old woman visiting the outpatient medicine clinic. The patient has had type 1 diabetes since age 13. She has numerous complications from her disease, including reduced vision, heart disease, and severe numbness and tingling of the extremities. Knowing that spirituality helps patients cope with chronic illness, which of the following principles should the nurse apply in practice? (Select all that apply.) 1. Pay attention to the patient's spiritual identity throughout the course of her illness. 2. Select interventions that you know scientifically support spiritual well-being. 3. Listen to the patient's story each visit to the clinic, and offer a compassionate presence. 4. When the patient questions the reason for her long-time suffering, try to provide answers. 5. Consult with a spiritual care adviser, and have the adviser recommend useful interventions.

1,3

When assessing a patient's adjustment to the role changes brought about by a medical condition such as a stroke, the nurse asks about which of the following? (Select all that apply.) 1. What are your thoughts about returning to work? 2. What questions do you have about your medications? 3. How has your health affected your relationship with your partner? 4. What level of physical activity are you able to perform? 5. What concerns do you have about another stroke?

1,3

9. The school nurse is counseling an adolescent male who is returning to school after attempting suicide. He denies substance abuse and has no history of treatment for depression. He says he has no friends or family who understand him. Critical thinking encourages the nurse to consider all possibilities, including which of the following? (Select all that apply.) 1. Adolescents often explore their sexual identity and expose themselves to complications such as sexually transmitted infections (STIs) or unplanned pregnancy. 2. Peer approval and acceptance are not important in this age-group. 3. Lesbian, gay, bisexual, and transgender (LGBTQ+) youth often experience stress from identification with a sexual minority group. 4. Knowledge about normal changes associated with puberty and sexuality can decrease stress and anxiety. 5. Adolescence is a time of emotional stability and self-acceptance.

1,3,4

An adolescent who is pregnant for the first time is at her initial prenatal visit. The women's health nurse practitioner (WHNP) informs the patient that she will be screening her for sexually transmitted infections (STIs). The patient replies, "I know I don't have an STI because I don't have any symptoms." Which responses by the WHNP would be appropriate? (Select all that apply.) 1. "Untreated STIs can cause serious complications in pregnancy, so we routinely screen pregnant women." 2. "Bacterial STIs don't usually cause symptoms, or you could have an asymptomatic viral STI." 3. "Chlamydia screening is recommended for all sexually active women up to age 25 even if asymptomatic." 4. "People between the ages of 15 and 24 are often asymptomatic and have the highest incidence of STIs." 5. "There is no need to screen for infection since you aren't having any problems or symptoms."

1,3,4

5. The nurse is providing education on sexually transmitted infections (STIs) to a group of older adults. The nurse knows that further teaching is needed when the participants make which statements? (Select all that apply.) 1. "I don't need to use condoms since there is no risk for pregnancy." 2. "I should be screened for an STI each time I'm with a new partner." 3. "I know I'm not infected because I don't have discharge or sores." 4. "I was tested for STIs last year, so I know I'm not infected." 5. "The infection rate in older adults is low because most are not sexually active."

1,3,4,5

A patient with heart disease asks the nurse if medications for heart disease can cause erectile dysfunction. Which drugs can cause erectile dysfunction? Select all that apply. One, some, or all responses may be correct. 1. Illicit drugs 2. Antidiabetics 3. Diuretic agents 4. Antiplatelet drugs 5. Antihypertensives

1,3,5

Which concept related to spiritual health is a patient experiencing when she states that she knows her husband loves her even when he cannot be by her side? 1. Faith 2. Hope 3. Transcendence 4. Connectedness

1; Faith is confidence about something without firm physical evidence. The patient verbalizing that her husband loves her even when he cannot be by her side is an indication of faith. Hope is a sense of motivation, which helps the patient live for and look to the future during difficult times. Transcendence is a state of existence above and beyond the limits of material experience. Transcendence affects the spirituality and spiritual health of a person. Connectedness is described as a connection within oneself, with others, and with the environment. The patient's affirmation of his or her partner's love does not indicate hope, transcendence, or connectedness.

2. The nurse is caring for a patient who is very depressed and decides to complete a spiritual assessment using the FICA tool. Using the FICA assessment tool, match the criteria on the left with the appropriate assessment question on the right. 1. F—Faith ___ 2. I—Importance of spirituality ___ 3. C—Community ___ 4. A—Interventions to address spiritual needs ___ a. Tell me if you have a higher power or authority that helps you act on your beliefs b. Describe which activities give you comfort spiritually c. To whom do you go for support in times of difficulty? d. Your illness has kept you from attending church. Is that a problem for you?

1a, 2d, 3c, 4b

4. The nurse is gathering a history from a 72-year-old male patient being admitted to a nursing home. The patient requests a private room. The nurse understands that: 1. The patient cannot be sexually active since he is moving into a nursing home. 2. The patient may be requesting a private room to facilitate an intimate relationship with his partner. 3. There is no need to take a sexual history since most older adults are uncomfortable discussing intimate details of their lives. 4. Older adults in nursing homes usually do not participate in sexual activity.

2

6. A patient has just learned she has been diagnosed with a malignant brain tumor. She is alone; her family will not be arriving from out of town for an hour. The nurse has been caring for her for only 2 hours but has a good relationship with her. What is the most appropriate intervention for support of her spiritual well-being at this time? 1. Make a referral to a professional spiritual care adviser. 2. Sit down and talk with the patient; have her discuss her feelings and listen attentively. 3. Move the patient's Bible from her bedside cabinet drawer to the top of the over-bed table. 4. Ask the patient whether she would like to learn more about the implications of having this type of tumor.

2

A patient states he does not believe in the existence of God. Which belief does this statement indicate about the patient? 1. Agnostic 2. Atheist 3. Academic 4. Anarchist

2

An emergency department nurse is caring for a patient who was severely injured in a car accident. The patient's family is in the waiting room. They are crying softly. The nurse sits down next to the family, takes the mother's hand, and says, "I can only imagine how you're feeling. What can I do to help you feel more at peace right now?" Which concept is the nurse demonstrating in this example? 1. Prayer 2. Presence 3. Coaching 4. Instilling hope

2

In planning nursing care for an 85-year-old man, which basic need is the most important to be met? 1. Assurance of sexual intimacy 2. Preservation of self-esteem 3. Expanded socialization 4. Increase in monthly income

2

The nurse asks the patient, "How do you feel about yourself?" Which aspect is the nurse assessing? 1. Identity 2. Self-esteem 3. Body image 4. Role performance

2

The nurse is a part of a campaign on cervical cancer that involves administering the human papillomavirus (HPV) vaccine. For which age-group is the HPV vaccine most effective? 1. 20 to 50 years of age 2. 11 to 26 years of age 3. 20 to 30 years of age 4. 25 to 35 years of age

2

Which action would the nurse take to address the "F" portion of the FICA assessment tool during an assessment of a patient's spiritual needs? 1. Establish overall life satisfaction. 2. Determine the patient's belief in a higher power. 3. Ask about the impact of the illness on work. 4. Evaluate the impact of the patient's family on health and illness.

2

Which primary developmental task would the nurse consider for a 9-year-old patient? 1. Communication of likes and dislikes 2. Mastery of new skill 3. Acceptance of body changes 4. Distinguishing self from environment

2

Which type of physical sign is often seen in adult victims of sexual abuse? 1. Unusual odor in the genital area 2. Vomiting or abdominal tenderness 3. Torn, stained, or bloody underclothing 4. Wounds that match the patient's "story"

2

5. A 44-year-old male patient has just been told that his wife and child were killed in an auto accident while coming to visit him in the hospital. Which of the following statements are assessment findings that support a nursing diagnosis of Spiritual Distress related to loss of family members? (Select all that apply.) 1. "I need to call my sister for support." 2. "I have nothing to live for now." 3. "Why would my God do this to me?" 4. "I need to pray for a miracle." 5. "I want to be more involved in my church."

2,3

6. Which of the following assessment findings suggest an altered self-concept? (Select all that apply.) 1. Uneven gait 2. Slumped posture and poor personal hygiene 3. Avoidance of eye contact when answering a question 4. Requests for visits from the chaplain 5. Frequent use of the call light

2,3

Which factor would influence an 80-year-old patient's current self-concept? Select all that apply. One, some, or all responses may be correct. 1. Living conditions 2. Adjustment to a role change 3. Adjustment to the loss of a spouse 4. Assurance of sexual intimacy 5. Behaviors of relatives providing care

2,3

Which component is included in the PLISSIT model of assessment? Select all that apply. One, some, or all responses may be correct. 1. Palliation 2. Permission 3. Limited information 4. Specific suggestions 5. Intravenous therapy

2,3,4

Which sexual disease is caused by bacteria? Select all that apply. One, some, or all responses may be correct. 1. Herpes 2. Syphilis 3. Chlamydia 4. Gonorrhea 5. Genital warts

2,3,4

7. A nurse is preparing to teach an older adult who has chronic arthritis how to practice meditation. Which of the following strategies are appropriate? (Select all that apply.) 1. Encourage family members to participate in the exercise. 2. Have patient identify a quiet room in the home that has minimal interruptions. 3. Suggest the use of a quiet fan running in the room. 4. Explain that it is best to meditate about 5 minutes 4 times a day. 5. Show the patient how to sit comfortably with the limitation of his arthritis and focus on a prayer.

2,3,5

9. A nurse is caring for a 40-year-old male diagnosed with Crohn's disease several years ago, resulting in numerous hospitalizations each year for the past 3 years. Which of the following behaviors interfere with the developmental tasks of middle adulthood? (Select all that apply.) 1. Sends birthday cards to friends and family 2. Refuses visitors while hospitalized 3. Self-absorbed in physical and psychological issues 4. Performs self-care activities 5. Communicates feelings of inadequacy

2,3,5

Which chief factor determines the self-concept of an individual? Select all that apply. One, some, or all responses may be correct. 1. Age 2. Identity 3. Body image 4. Gender 5. Role performance

2,3,5

8. The nurse reviews the health history of a 48-year-old man and notes that he was started on medications for elevated blood pressure and depression at his last annual physical. He tells the nurse that over the past 6 months he is having difficulty sustaining an erection. The nurse understands that: (Select all that apply.) 1. Nurses are not expected to discuss sexual issues with male patients and the physician should address this. 2. Sexual function can be affected by some medications. 3. Sexually transmitted infections (STIs) can cause complications such as erectile dysfunction and screening should be done. 4. Some men with health issues experience erectile dysfunction. 5. Medications used to treat hypertension and depression seldom interfere with sexual function.

2,4

10. A 53-year-old female being treated for breast cancer tells the nurse that she has no interest in sex since her surgery 2 months ago. The nurse is aware that: (Select all that apply.) 1. Sexual issues are expected in a woman this age. 2. Women experience sexual dysfunction more frequently than men. 3. Hypoactive sexual desire disorder (HSDD) occurs in women over 65 years of age. 4. Medical conditions such as cancer often contribute to HSDD. 5. Disturbances in self-concept affect sexual functioning.

2,4,52

When treating a patient who is Muslim, which factor would the nurse keep in mind? Select all that apply. One, some, or all responses may be correct. 1. Muslims consume alcohol in moderation. 2. Muslims do not eat pork. 3. Muslims do not pray 5 times a day. 4. Muslims do not eat meat on Fridays. 5. During Ramadan, Muslims eat only after sunset.

2,5

3. Which statement made by a patient who is recovering after recently experiencing third-degree burns shows connectedness? 1. "My pain medicine helps me feel better." 2. "I know I will get better if I just keep trying." 3. "I see God's grace and become relaxed when I watch the sun set at night." 4. "I feel so much closer to God after I read my Bible and pray."

3

4. A nurse is caring for a patient who is Muslim and has diabetes. Which of the following items does the nurse need to remove from the meal tray when it is delivered to the patient? 1. Small container of vanilla ice cream 2. A dozen red grapes 3. Bacon and eggs 4. Garden salad with ranch dressing

3

9. A nurse used spiritual rituals as an intervention in a patient's care. Which of the following questions is most appropriate to evaluate its efficacy? 1. Do you feel the need to forgive your wife over your loss? 2. What can I do to help you feel more at peace? 3. Did either prayer or meditation prove helpful to you? 4. Should we plan on having your family try to visit you more often in the hospital?

3

A 16-year-old female tells the school nurse that she doesn't need the human papillomavirus (HPV) vaccine since her partner always uses condoms. The best response by the nurse to this statement is: 1. "Latex condoms are the most effective way to eliminate the risk of HPV transmission." 2. "Your parents may not want you to receive the HPV vaccine since it has been shown to increase sexual risk taking and sexual activity." 3. "The HPV 9-valent vaccine is recommended for males and females even if they use condoms because it targets the specific viruses that cause cancer and genital warts." 4. "You are past the recommended age to receive the vaccine."

3

A couple is diagnosed as positive for the human immunodeficiency virus (HIV). Which information would the nurse include when educating this couple about HIV? 1. They should not engage in sexual intercourse. 2. Their children will also be HIV positive. 3. Their duration of survival would increase with treatment. 4. They can be cured by highly active antiretroviral therapy (HAART).

3

A person tries to meet the strenuous demands of employment while taking care of a family of six and manages to fulfill these responsibilities with great difficulty. Which role performance stressor is affecting this person? 1. Conflict 2. Ambiguity 3. Overload 4. Strain

3

How is a self-concept stressor defined? 1. The inability of an individual to distinguish self-concept from self-esteem. 2. An individual's belief that establishes that he or she is unworthy. 3. A real or perceived change that threatens a person's identity and body image. 4. The inability of an individual to reach an age-appropriate developmental stage

3

Which aspect is the primary contraceptive action of an intrauterine device (IUD)? 1. Prevents ovulation 2. Acts as a physical barrier 3. Prevents fertilization 4. Kills sperm cells

3

Which behavioral symptom is often found in children who have been victims of sexual abuse? 1. Depression 2. Facial grimacing 3. Physical aggression 4. Strong peer relationships

3

Which belief does an atheist profess? 1. A supernatural power governs the universe. 2. God is the ultimate being in the universe. 3. God does not exist. 4. Sins from the past have to be faced in the current life

3

Which complication from untreated sexually transmitted infections (STIs) is most serious in women? 1. Genital discharge and dyspareunia 2. Painful menstrual cycles 3. Infertility and pelvic inflammatory disease 4. Genital warts

3

3. A nurse who recently graduated from nursing school is providing discharge instructions to a patient who suffered a myocardial infarction (MI). The nurse knows that sexual issues are common after an MI but feels uncomfortable bringing up this topic. What is the best way for the nurse to handle this situation? (Select all that apply.) 1. Instruct the patient to discuss any sexual concerns with his or her partner after discharge. 2. Avoid discussing the topic unless the patient brings it up. 3. Ask a more experienced nurse to cover this with the patient and learn from the example. 4. Plan to attend conferences or training soon on how to discuss such issues. 5. Encourage the patient to discuss any personal concerns with the cardiologist.

3,4

A 30-year-old patient diagnosed with major depressive disorder has a nursing diagnosis of Situational Low Self-Esteem related to negative view of self. Which of the following are appropriate interventions by the nurse? (Select all that apply.) 1. Encourage reconnecting with high school friends. 2. Role-play to increase assertiveness skills. 3. Focus on identifying strengths and accomplishments. 4. Provide time for journaling to explore underlying thoughts and feelings. 5. Explore new job opportunities.

3,4

8. A nursing student is developing a plan of care for a 74-year-old-female patient who has spiritual distress over losing a spouse. As the nurse develops appropriate interventions, which characteristics of older adults should be considered? (Select all that apply.) 1. Older adults do not routinely use complementary medicine to cope with illness. 2. Older adults dislike discussing the afterlife and what might have happened to people who have passed on. 3. Older adults achieve spiritual resilience through frequent expressions of gratitude. 4. Have the patient determine whether her husband left a legacy behind. 5. Offer the patient her choice of rituals or participation in exercise.

3,4,5

1. A 50-year-old woman is recovering from a bilateral mastectomy. She refuses to eat, discourages visitors, and pays little attention to her appearance. One morning the nurse enters the room to see the patient with her hair combed and makeup applied. Which of the following is the best response from the nurse? 1. "What's the special occasion?" 2. "You must be feeling better today." 3. "This is the first time I've seen you look this good." 4. "I see that you've combed your hair and put on makeup."

4

The home health nurse is visiting a 90-year-old man who lives with his 89-year-old wife. He is legally blind and is 3 weeks' post right hip replacement. He ambulates with difficulty with a walker. He comments that he is saddened now that his wife has to do more for him and he is doing less for her. Which of the following is the priority nursing diagnosis? 1. Impaired Self Toileting 2. Lack of Knowledge Regarding Resources for the Visually Impaired 3. Disturbed Body Image 4. Risk for Situational Low Self-Esteem

4

The nurse understands that any weight change necessitates a resizing of the diaphragm. A loss or gain of how much weight would be significant? 1. 4 pounds 2. 6 pounds 3. 8 pounds 4. 10 pounds

4

Which dimension of spirituality includes "a sense of authentically connecting to one's inner self?" 1. Faith 2. Hope 3. Connectedness 4. Self-transcendence

4

An school nurse is providing information for parents of teenagers regarding human papillomavirus and the recommended HPV vaccination. What teaching point would the nurse include?A.HPV causes genital warts and cervical and other genital cancers B.HPV causes a single painless genital lesion and can lead to sterility C.50% of women between the ages of 14 and 19 are infected with HPV D.The HPV vaccination is only recommended for the female population

A

A nurse is caring for a client who was admitted for cardiac care. The client is Native American and believes in the benefit of a medicine man with healing powers (shaman). What should the nurse do when planning care for this client? Select all that apply A. Ensure privacy for the performance of healing rituals B. Recognize that feelings may not be shared with healthcare workers C. Check meal trays to verify meat is not served with dairy products D. Consult with a dietitian to ensure that the client receives a vegetarian diet E. Accept the decision that a heart transplant violates the belief that the heart is the body's soul

A, B

Which of the following populations have the highest incidence of STI? (Select all that apply.) A.Hispanic women age 15 to 24 years B.African-American men age 15 to 24 years C.Caucasian men age 50 to 58 years D.Caucasian women age 42 to 53 years

A,B ; Highest incidence of STIs occur in that 15-24 age group.

A RN is providing health check ups for clients in a clinic located in a predominantly LGBT community. Which health disparities should the nurse keep in mind related to this population? Select all that apply. A.LGBT youth are 4 times more likely to attempt suicide B.LGBT youth are 4 times more likely to be homeless C.Lesbians and bisexual females are more likely to be underweight D.Transgender people have a high prevalence of HIV and sexually transmitted infections E.LGBT populations have the lowest rate of tobacco, alcohol, and other drug use in the country

A,B, D

A nurse is caring for several clients from Hispanic/Latino cultures. Which beliefs can the nurse expect these clients to reflect? Select all that apply A.Prayer can result in miracles B.The family is the most important group C.Health is living in harmony with nature D.The body should be treated with respect E.Illness is an imbalance between ying and yang

A,B?, D

When caring for clients, the nurse must understand the difference between religion and spirituality. Religious care helps individuals: A.maintain their belief systems and worship practices. B.develop a relationship with a higher being. C.establish a cultural connectedness with the purpose of life. D.achieve the balance needed to maintain health and well-being.

A; religion is a state of doing.

Nursing Knowledge Base etc.

Abortion -19 percent of pregnancies end in abortion -Discuss in nonjudgmental manner Prevention of sexually transmitted infections (STIs) -20 million people in US are diagnosed with an STI each year -Spread during intimate contact -Establish trust, speak in a matter-of-fact manner -STIs may be caused by bacteria or a virus and they are through direct sexual contact. There are many STIs that have few or no early symptoms so they can unknowingly transmit the infection. Human immunodeficiency virus infection -Spread via intercourse, IV needles, and blood/blood products -Antibodies appear in blood 6 weeks to 3 months after infection -Blood borne pathogens and is present in most body fluids. Sometimes spread through sexual contact -If the infection is untreated, the person will live about 10 years -The last stage of it is AIDS and this happens when they start showing symptoms. It is fatal but the survival time is better now. -STIs and HIV has increased

Nursing Process of sexuality

Apply the nursing process/clinical judgement model and use a critical thinking approach in your care of clients. -Provides a clinical decision-making approach to help you develop and implement an individualized plan of care. -Assess all relevant factors, including physical, psychological, social, and cultural, to determine a clients's sexual well-being. Nurse's influence on the client's sexuality -Follow a positive and matter-of-fact approach -Self-esteem and sexuality can affect client outcomes

A 16 year old girl who has become sexually active asks the nurse, " What is the most effective way to prevent pregnancy?" Which method of preventing pregnancy should the nurse tell her is most effective? A.Using birth control pills B.Using spermicidal foam C.Abstinence from sexual intercourse D.Having an IUD inserted

C

You are assigned to care for a client who has just undergone a mastectomy for a malignant tumor. You would most appropriately classify this self-concept component as: A.identity stressor. B.sexuality stressor C.body image stressor. D.role performance stressor.

C

You are caring for a hospitalized client whose religion is Islam and has diabetes. Which of the following items do you need to remove from the meal tray when it is delivered to the client? A. container of sugar free vanilla ice cream B. a dozen red grapes C. three strips of bacon D. garden salad with Italian dressing E. blood pudding

C; Consumption of pork is not allowed.

You are caring for an adolescent client who underwent a gastric banding procedure 6 months previously. This adolescent tells you, "There is still a fat person inside of me." This type of statement illustrates a flaw in the self-concept of: A.identity. B.self-esteem. C.body image. D.role performance.

C; bc patients statement reflects her looks

Care: Religious versus Spiritual

Clients benefit from both types of care: Religious care: helping clients maintain faithfulness to their belief system and worship practices Spiritual care: helping people identify meaning and purpose in life, look beyond the present, and maintain personal relations as well as a relationship with a higher being or life force

Nursing Knowledge Base: Current Concepts in Spiritual Health

Constructs of spirituality -Self-transcendence: connecting to one's inner self. Self-transcendence is a positive force. It allows people to have new experiences and develop new perspectives that are beyond ordinary physical boundaries. Examples of transcendent moments include the feeling of awe when holding a new baby or looking at a beautiful sunset. -Connectedness: being intrapersonally connected within oneself; interpersonally connected with others and the environment; and transpersonally connected with God or an unseen higher power. Through connectedness patients move beyond the stressors of everyday life and find comfort, faith, hope, and empowerment -Faith: allowing people to have firm beliefs despite a lack of evidence. Faith enables people to believe in and establish transpersonal connections. Although many people associate faith with religious beliefs, it also exists without them. For example, one might have faith that all people are good, without being a practitioner of a religion. It is a cultural or institutional religion such as Judaism, Buddhism, Islam, or Christianity. It is also a relationship with a divinity, higher power, or spirit that incorporates a reasoning faith (belief) and a trusting faith (action). Reasoning faith provides confidence in something for which there is no proof. It is an acceptance of what reasoning cannot explain. Sometimes faith involves a belief in a higher power, spirit guide, God, or Allah. It is also the way a person chooses to live. It gives purpose and meaning to an individual's life, allowing for action. -Hope: referring to an energizing source orientating for future goals- trust and be optimistic -Spiritual well-being: The common dimensions of spiritual well-being include meaning and purpose, a sense of peace or fulfillment, and connectedness with others and God or a higher power. Those who experience spiritual well-being feel connected to others and are able to find meaning or purpose in their lives. Those who are spiritually healthy experience joy, are able to forgive themselves and others, accept hardship and mortality, and report an enhanced quality of life -Religion: more a "state of doing" or a specific system of practices associated with a particular denomination, sect, or form of worship. It is a system of organized beliefs and worship that a person practices to outwardly express spirituality. ex: attending church or synagogue. This can be hard when patients can't do this bc they are in the hospital.

Islam (muslims)

Consumption of pork and alcohol is prohibited. Followers fast during the month of Ramadan, and they only eat after sunset.

A student nurse is telling a faculty member that his client talked about gaining spiritual comfort from being focused on their inner self, including values and principles. The wise instructor explains this is an example of: A.Faith B.Community C.Interpersonal connection D.Self-transcendence

D

You are assigned to care for a client who retired 6 months ago. While providing care, you identify that this client is struggling emotionally with change. This situation is most likely associated with the self-concept component of: A.identity stressor .B.sexuality stressor. C.body image stressor. D.role-performance stressor

D

To assess, evaluate, and support a clients' spirituality, the best action a nurse can take is to: A. assist the client to use faith to get well. B. refer the client to the health care facility chaplain. C. provide the client with a variety of religious literature. D. determine the client's perceptions and belief system.

D; Bc this is a more clear, focused answer

Upon admission, when gathering a client's sexual history, nurses should: A.focus only on physical factors that affect sexual functioning. B.discuss sexual concerns only if the client raises questions or concerns. C.use emotionally laden terms when discussing sexual concepts. D.include questions related to sexual function.

D; Sexual function is an important part of taking a sexual history and it can indicate other problems the patient may be having.

Nursing Diagnosis

Examples of self-concept-related nursing diagnoses: -Disturbed Body Image -Disturbed Personal Identity (may have mental illness or can't distinguish themselves from others) -Impaired Role Performance (related to someone being dependent on others) Ex: Situational Low Self-Esteem related to pattern of failure as evidenced by negative speech -Often isolated data are defining characteristics for more than one nursing diagnosis.

Nursing Knowledge Base Cont.

Factors influencing sexuality -Sociocultural dimension of sexuality -Impact of pregnancy and menstruation on sexuality -Discussing sexual issues -Decisional issues -People assign different meanings to sexuality based on their gender, culture, education, socioeconomic status, and religion. -Some cultures encourage sexual intercourse during menstruation and pregnancy. Promoting or preserving sexual health -Contraception -Nonprescription contraceptive methods -Contraceptive methods that require a health care provider's intervention -Oral contraceptives cause hormonal changes to the uterine environment (pill). There are hormonal injections or implants under the skin or a transdermal patch that causes a change in the uterine environment and decreases the chance of contraception. An IUD is a device that is inserted into the uterus by a health care provider or nurse practitioner and inhibits the sperm and the egg from uniting. A latex condom is a thin rubber sheath over the penis to prevent the insertion of the sperm into the vagina. A diaphragm is a barrier method that must be used with a cream and inserted into the vagina and gives a protective barrier over the cervical opening. -What would affect a woman's choice of contraception? maybe desire for future fertility, side effects, if smoking, etc. It varies with income, age, marital status, or previous pregnancies of the woman. -Unplanned pregnancies occur in teenagers, ages over 40, and in low income white woman.

Nursing Knowledge Base

Factors influencing the development of self-concept -Erikson's theory of development -Each stage builds on the tasks of the previous stage -Successful mastery of each stage leads to a solid sense of self. -Self-esteem usually increases in early and middle childhood, adolescence, increases strongly in young adulthood, continues to increase in middle adulthood, and peaks between ages 60 and 70 years. -Self-esteem diminishes in old age; sharp drop in very old age33.1 developmental tasks -Erikson's emphasis on the generativity stage explains the rise in self esteem and self concept in adulthood. -Again, self esteem diminishes in old age and there is a sharp drop in that very old age.

Family Effect on Self-Concept Development

Family plays key role in self-concept -Children develop sense of self from family caregivers -Also gain accepted norms from family -Parents are the most important influences on a child development. -There are varying approaches with parenting and that could depend on the culture -High parental support and parental monitoring are related to greater self-esteem and lower risk behaviors -Positive communication and social support foster self-esteem and well-being in adolescence -You can always listen for self criticism an negative talk and try to correct. that, help the client develop realistic goals, and encourage the client to be as independent as possible and be supportive.

Russian Orthodox Church

Followers observe fast days and a "no-meat" rule on Wednesdays and Fridays. During Lent all animal products, including dairy products and butter, are forbidden.

Planning of sexuality

Goals and outcomes -Maintain the client's dignity and identity at all times -Develop an individualized plan of care -Set measurable goals and outcomes Setting priorities -Establish therapeutic relationship -Often include resuming sexual activities Teamwork and collaboration -Include other health care providers as appropriate -Make referrals to community resources -before you begin teaching, take the time to get to know your client and find out what they know about sexuality bc when you develop trust with them, they are more likely to discuss with you sensitive and embarrassing topics.

Implementation of sexuality

Health promotion -Educate clients about sexual health. -Provide regular health and screening examinations. Acute care -Illness and surgery create situational stressors that often affect a person's sexuality. Restorative and continuing care -In the home environment, it is important to provide information on how an illness limits sexual activity and to give ideas for adapting or facilitating sexual activity. -There are so many things you can teach as far as health promotion- some one that has PMS and for cramping, you can tell them to take aspirin or NSAIDS, take a warm bath or heating pad, decrease caffeine, exercise vaccines, encourage HPV vaccine between 11-26.

Implementation of Spirituality:

Health promotion -Establishing presence—involves giving attention, answering questions, having an encouraging attitude, and expressing a sense of trust; "being with" rather than "doing for" Supportive healing relationship -Mobilize hope: Mobilizing a patient's hope is central to a healing relationship. Hope motivates people to face challenges in life (Broadhurst and Harrington, 2015). Help patients find things for which to hope. For example, help a patient newly diagnosed with diabetes learn how to manage the disease in a way that will allow the patient to continue a productive and satisfying way of life. Hope is future oriented and helps a patient work toward goals. Hope helps patients work toward recovery. -Provide interpretation of suffering that is acceptable to client. -Help client use resources. -Nurses contribute to a sense of well-being and provide hope for recovery when they spend time with their patients. Establishing presence by sitting with a patient to attentively listen to his or her feelings and situation, talking with the patient, accepting or supporting the patient's need to cry, and simply offering Acute care -Support systems: Use of support systems is important for patients who are in any health care setting. They provide patients with the greatest sense of well-being during hospitalization and serve as a human link connecting the patient, the nurse, and the patient's lifestyle before an illness. The support system is a source of faith and hope and an important resource in conducting meaningful religious rituals. -Diet therapies: The intake of food satisfies and promotes a sense of comfort. Food and nutrition are important aspects of patient care and often an important component of some religious observances. Food and the rituals surrounding the preparation and serving of food are sometimes important to a person's spirituality. Consult with a dietitian to integrate patients' dietary preferences into daily care. In the event that a hospital or other health care agency cannot prepare food in the preferred way, ask the family to bring meals that fit into dietary restrictions posed by the patient's condition. -Supporting rituals: Nurses provide spiritual care by supporting patients' participation in spiritual rituals and activities. Plan care to allow time for religious readings, spiritual visitations, or attendance at religious services. Always respect the icons, medals, prayer rugs, crosses, or other items that a patient brings to a health care setting, and ensure that they are not accidentally lost, damaged, or misplaced. Restorative and continuing care -Prayer: The act of prayer gives an individual the opportunity to renew personal faith and belief in a higher being in a specific, focused way that is either highly ritualized and formal or quite spontaneous and informal. For example, a patient may choose to say a prayer just before leaving for a surgical procedure. A patient who is a follower of Islam will want to say daily prayers (Salah) five times a day. Prayer is an effective coping resource for physical and psychological symptoms -Meditation: creates a relaxation response that reduces daily stress. Patients who meditate often state that they have an increased awareness of their spirituality and of the presence of God or a Supreme Being. Meditation improves symptoms and depression in patients and helps patients move from negative to positive thoughts -Supporting grief work: Patients who experience terminal illness or who have suffered permanent loss of body function because of a disabling disease or injury require a nurse's support in grieving and coping with their loss. Your ability to enter into a caring, therapeutic, and spiritual relationship with patients supports them during times of grief

Nursing Knowledge Base of STIs

Human papillomavirus infection -50 to 75 percent of sexually active people acquire it -Vaccination available for young adolescents Chlamydia (most commonly reported infectious disease) -Affects about 3 million Americans each year -Spread by contact with fluids from infected site -Can cause PID, ectopic pregnancy and infertility in women -Causes few symptoms, screening recommended for sexually active women up to age 25 Locating and treating people with STIs: -Some people do not know that they are infected because symptoms may be absent or may go unnoticed. -Common symptoms include discharge from the vagina, penis, or anus; pain during sex or when urinating; blisters or sores in the genital area; fever. -Any contact with another person's body fluids around the head or an open lesion on the skin, anus, or genitalia can transmit an STI. -Embarrassment -Chlamydia and syphilis require reporting to the CDC

Components and Interrelated Terms of Self-Concept

Identity -Internal sense of individuality, wholeness, and consistency of a person over time Body image Involves attitudes related to body including physical appearance, structure, or function -Feelings about body image includes does someone feel feminine, or masculine, do they feel youthful or strong. -Body image is you middle image of you physical self that includes physical appearance and physical functioning. -Body image is more favorable in cultures in which girls describe reasonable views about physical appearance (ex: not looking at all the models in magazines and they report less social pressure for thinness) Role performance (reality): -Role performance is the way in which individuals perceive their ability to carry out significant roles. -Role performance can be defined as the action a person takes and behaviors he demonstrates in fulfilling a role -Instead of expectations, role performance is actually the reality. Self-esteem: -Self esteem is an individuals overall feeling of self worth or emotional appraisal of self- concept -Self esteem is how well a person likes themself. It is the difference between the ideal self and actual self -When we exceed our expectations, we have a higher self-esteem -For patients, a minor illness or a set back can make people really question their self esteem and shake their foundation -Being one's self, or living and authentic life, is the basis of true identity. And individuals appearance affects self- concept. -The achievement of identity is necessary for intimate relationships because individuals express identity through relationships with others. -Cultural differences in identity exist.

Factors Influencing Self-Concept

Identity stressors: -Particularly vulnerable during adolescence -Identity confusion Body image stressors: -Affect appearance, structure or function of a body part -Physical disability such as blindness, deafness, or paraplegia can interfere with a positive body image. Role performance stressors: -Role conflict, ambiguity, strain, and overload -Chronic illness can alter role performance, which can change an individuals identity and self esteem so we want to think about what we can do to enhance their self concept Self-esteem stressors: -Vary by developmental stage -Body image influences health and health behaviors. -A negative body image is associated with depression, smoking among adolescence, increased risk for unintended pregnancy, and STIs all related back to the poor self concept -Any change in health can be a stressor in someone's self competence

Native Americans

Individual tribal beliefs influence food practices.

Nursing Knowledge Base -Alterations in sexual health

Infertility -Inability to conceive after 1 year (12 months or more and woman is less than 34 years old) of unprotected intercourse Sexual abuse -Nurses must report child and elder abuse to the authorities Personal and emotional conflicts -Patients may have problems with one or more stages of sexual activity Sexual dysfunction -The absence of complete sexual functioning -As high as 40 percent in men and 60 to 80 percent in women

Mormonism

Members abstain from alcohol and caffeine.

Jehovah's Witnesses

Members avoid food prepared with or containing blood.

Nursing Diagnosis of sexuality

Possible nursing diagnoses related to sexual functioning include: -Problematic Sexual Behavior -Difficulty Coping -Lack of Knowledge of Contraception -Impaired Sexual Functioning related to inadequate role model -Impaired Sexual Functioning related to physical abuse

Nursing Diagnosis of Spirituality:

Potential diagnoses include: -Risk for Spiritual Distress -Defective Spiritual Distress -Hopelessness -Spiritual Distress -Decreased Spiritual Distress People more likely to have spiritual distress may come from issues with family, a recent loss, or they may have some type of mental or physical issues -Decreased Spiritual Distress is based on assessment findings that show a person's ability to experience and integrate meaning and purpose in life through connectedness with self and others. A patient with this nursing diagnosis has potential resources on which to draw when faced with illness or a threat to well-being. The nursing diagnosis Spiritual Distress creates a different clinical picture. Assessment findings reveal patterns that reflect a person's actual or potential dispiritedness (e.g., expressing lack of hope, meaning, or purpose in life; expressing anger toward God; or verbalizing conflicts about personal beliefs). Patients likely to experience spiritual distress include those who have poor relationships, have experienced a recent loss, or are suffering some form of mental or physical illness.

Critical Thinking

Requires: A synthesis of knowledge, experience, information gathered from clients and families -Critical thinking attitudes -Intellectual and professional standards -For self-concept, integrate knowledge from nursing and other disciplines. -Self-concept profoundly influences a person's response to illness. -To build self esteem for children, you can give that child your full attention to minimize distractions, invite that child to talk and promote feelings of success and know that child what to expect, and be patient. -To promote self- esteem in older adults, you can notice and affirm those positive physiological characteristics, help them explore new hobbies that they are capable of doing, reinforce new hobbies, encourage them to reminisce. -The physical body is only one dimension of a person, you never know what else is going on in their life.

Chapter 34: Sexuality Scientific Knowledge Base

Sexual development Sexuality -All aspects of being sexual, including sexual identity and choice of intimate partners -Do not assume people's knowledge on this. A married woman might not be sexually active, etc. Sexuality changes with each stage of development. -Infancy and early childhood (the first 3 years of life are crucial to gender identity, a child usually identifies with a parent of the same sex and develops a complementary relation with a parent of the opposite sex -School-age years: Generally has questions about emotional and physical aspects of sex. They need accurate information from home about the changes in their body and what to expect as they move through puberty. They tend to have the same sex friends -Puberty/adolescence: They need factual information about sexuality and sexual activity as they are establishing their value system and making decisions. They need to know about contraceptives, STI and sexual abuse. Emotional changes during puberty and adolescence are just as traumatic as the physical ones. Adolescence is often a time when adolescents explore their primary sexual orientation and they might identify with lesbian, gay, bisexual, or transgender. -Young adulthood -Middle adulthood -Older adulthood: Most older adults are sexually active and regard it as an important part of their life -Sexual problems are more likely to results from failing physical health and medication side effects from just aging alone. Sexual identity and sexual orientation Sexual identity: -How one thinks about oneself sexually Gender identity -A person's private view of maleness and femaleness Gender role -Feminine and masculine behavior exhibited Sexual orientation -A person's sexual identity in relation to the gender to which they are attracted -Sexual transmitted infections affect women more than men. It is more severe and frequent in women -How a person identifies with his or her sexuality influences that person's personality and general well being. -Sexuality affects everyone -Confidentiality is critical. Give them privacy and be aware that the patient can be uncomfortable about talking about sexuality -it is important that nurses are nonjudgmental an have a sound knowledge to provide appropriate care and education for our patients Sexuality stressors -Reproductive health issues -Lesbian, gay, bisexual or transgender, queer and other(LGBTQ+) stressors -Sexual dysfunction -Changing physical appearance and concerns about physical attractiveness -Hormonally stimulated changes -Sexually transmitted infections -Menopause -Sexual abuse, assault and rape

Christianity

Some Baptists, Evangelicals, and Pentecostals discourage use of alcohol and caffeine. Some Roman Catholics fast on Ash Wednesday and Good Friday. Some do not eat meat on Fridays during Lent.

Buddhism

Some are vegetarians and do not use alcohol. Many fast on Holy Days.

Judaism

Some observe the kosher dietary restrictions (e.g., avoid pork and shellfish, do not prepare and eat milk and meat at same time).

Hinduism

Some sects are vegetarians. The belief is not to kill any living creature

Factors Influencing Spirituality

Spiritual distress: -A disruption in the life principle that pervades a person's entire being and transcends the person's biologic and psychosocial nature. -It causes a person to doubt and feel a loss of faith bc they question how this could have happened to them. It causes people to question their identity, loss of faith, question spiritual values -Acute illness: Sudden, unexpected illness often creates spiritual distress. For example, both a 50-year-old patient who has a heart attack and a 20-year-old patient who is in a motor vehicle accident face crises that threaten spiritual health. The sudden illness or injury creates an unanticipated scramble to integrate and cope with new realities -Chronic illness: threatens independence and there can be a loss of purpose - "I have nothing to live for". It can causing fear, anxiety, and spiritual distress. Dependence on others for routine self-care needs often creates feelings of powerlessness. Powerlessness and the loss of a sense of purpose in life impair the ability to cope with alterations in functioning. Spirituality is an important dimension of how patients adapt to and live with chronic illness. -Terminal illness: fears about physical pain, isolation, and fears about unknown. When people are dying, you can tell them what to expect. Dying is a holistic process encompassing a patient's physical, social, psychological, and spiritual health (Finocchiaro, 2016). Terminal illness causes fears of physical pain, loss of independence, isolation, the unknown, and dying. It creates an uncertainty about what death means, making patients susceptible to spiritual distress. However, some patients have a spiritual sense of peace that enables them to face death without fear. Spirituality helps these patients find peace in themselves and their death. -Near-death experience: An NDE is a psychological phenomenon of people who either have been close to clinical death or have recovered after being declared dead. It is not associated with a mental disorder. Instead experts agree that NDE describes a powerfully close brush with physical, emotional, and spiritual death. For example, people who have an NDE after cardiopulmonary arrest often tell the same story of feeling themselves rising above their bodies and watching caregivers initiate lifesaving measures. Commonly, patients who have had an NDE describe it as feeling totally at peace, having an out-of-body experience, being pulled into a dark tunnel, seeing bright lights, and meeting people who preceded them in death. NDEs are often transformational and can be either positive or negative experiences listen to them and give them a chance to explore what happened.

Chapter 35: Spiritual Health Introduction

Spirituality -An awareness of one's inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself -Includes personal beliefs that help a person maintain hope and get through difficult situations. -The human spirit is powerful, and spirituality has different meanings for different people. -Nurses need to be aware of their own spirituality to provide appropriate and relevant spiritual care to others. -You have to be sensitive and present with the patient, despite if they have different beliefs. This is not a time to talk about yourself. -Spirituality positively affects physical and psychological. **Most people are comfortable with their beliefs or the lack their of. Your primary goal is to support their healing, not to connect or convert them to a different view.**

Evaluate Outcomes of Spirituality

Through the client's eyes This requires including the patient by determining whether his or her expectations were met. Ask patients whether you and the health care team met their expectations or whether there was anything else you could have done to enhance their spiritual well-being or to enable them to practice important religious rituals. Additionally, asking a patient "Have you felt comfortable in saying what you feel is important to you spiritually?" will help determine whether you developed an effective healing relationship. -Include the client in your evaluation of care. -Outcomes established during the planning phase serve as the standards to evaluate the client's progress. -Client outcomes: Attaining spiritual health is a lifelong process. In evaluating outcomes established during the planning phase, compare a patient's level of spiritual health with the behaviors and perceptions noted in the nursing assessment. Evaluation data related to spiritual health are usually subjective. -When outcomes are not met, ask questions to determine appropriate continuing care. Examples of questions to ask include the following: • Do you feel the need to forgive someone or to be forgiven by someone? • Which spiritual activities such as prayer or meditation were helpful to you? • Would you like for me to ask a friend, family member, or someone from pastoral care to talk with you? • What can I do to help you feel more at peace? • Sometimes people need to give themselves permission to feel hope when they experience difficult events. What can you do to allow yourself to feel hope again?

Assessment of sexuality

Through the client's eyes -Know client's expectations -Set aside personal views Factors affecting sexuality -Physical, functional, relationship, lifestyle, developmental, and self-esteem , self-concept issues, culture, social responsibility, etc. -Many cultures are different such as some could marry more than one person. -dyspareunia: painful intercourse. Usually in women, it could be from hormone changes, or UTI. Men could have UTI or erectile dysfuntion. Sexual health history PLISSIT Assessment of Sexuality: -Permission to discuss sexuality issues -Limited Information related to sexual health problems being experienced -Specific Suggestions—only when the nurse is clear about the problem -Intensive Therapy—referral to professional with advanced training if necessary -Use developmentally appropriate language when assessing children and adolescents -Address questions about abuse in private -You want to do a very detailed assessment if someone is pregnant, etc. -When you ask personal questions, make sure you provide pregnancy -Remember sexual relationships may not always be satisfactory for people. -There is domestic violence with partners and most often, the victim is the woman, and they may think they deserve the abuse, and do not like to speak up -Rape ranges from infants to adults, can range with either gender although woman are more commonly raped. Sexual dysfunction -Many illnesses, injuries, medications, and aging changes have a negative effect on sexual health. (heart disease or respiratory disease make them fatigued, etc.) Physical assessment -Teach breast and testicular self-examination -Instruct clients on the signs and symptoms of STIs -Sexuality involves the mind, body, and spirit and health status affects it such as healthy foods and exercise increase sexual activity.

Evaluation of sexuality

Through the client's eyes: -Ask questions about risk factors, sexual concerns, level of satisfaction Patient outcomes -When outcomes are not met, ask questions to determine appropriate changes in interventions -It is your sound knowledge that allows you to teach and respond sensitively to your patients -Examine your own beliefs and make sure you are knowledgable about your verbal and nonverbal. -Sexuality is more felt than observed, and sexual expression required intimacy that is not seen with just observation, therefore we have to ask patients about risk factors and concerns.

Evaluation

Through the client's eyes: -Patient's perceived success in meeting goals and outcomes. Patient outcomes: -Expected outcomes for a client with a self-concept disturbance include displaying behaviors indicating a positive self-concept, verbalizing statements of self-acceptance, and validating acceptance of change in appearance or function. -You can ask questions like what would you do if you can't return to work, etc. -There are cultural variations that can impact a person's self concept and self-esteem

Self-concept

an individual's view of self. It is subjective and involves a complex mixture of unconscious and conscious thoughts, attitudes, and perceptions. Self-concept, or how a person thinks about oneself, directly affects self-esteem, or how one feels about oneself. A loss of bodily function, decline in activity tolerance, and difficulty in managing a chronic illness are examples of situations that change a patient's self-concept. You will help patients adjust to alterations in self-concept and strengthen components of self-concept to promote successful coping and positive health outcomes. Self concept directly affects self-esteem and as nurses we need to help them with coping. -An individual's view of self -Subjective -Involves a complex mixture of unconscious and conscious thoughts, attitudes, and perceptions -Directly affects self-esteem -Thinks v. feels about oneself -Self concept is crucial for a person's well being throughout life. A person's self concept is that middle image or picture of self and it has the power to either encourage or discourage personal growth. -You might know, or not know if someone has an issue with self concept but you can pick up through nonverbal cues of slumped over, poor posture, personal hygiene, or poor eye contact. -Ex: think about a woman that has had a mastectomy or a patient that is badly burned, or one with an -ostomy. As a nurse you will help patient's adjust to these alterations in self concept and you want to do what you can to promote successful coping.