MS Exam 4: Chapter 74
what education should you provide your patient with about safe sex?
-use latex and polyurethane condoms for anal and vaginal intercourse or during oral-genital or oral-anal sexual contact -wear gloves for finger or hand contact with the vagina or rectum -abstinence -mutual monogamy -decreasing the number of sexual partners
what is the difference between STDs and STIs?
STIs that recur and become chronic = sexually transmitted disease (STD)
what should you teach your patient with genital warts?
-OTC wart treatment should not be used on genital tissues -Teach about transmission, incubation, treatment, complications, partner education -Recommend condoms to reduce transmission -Talk to women about getting their annual Pap smear
what are some barriers to talking about STIs?
-Older adults may lack awareness of their risk for STIs and HCPs may lack awareness that older adults are still sexually active -our culture is very private about sexuality, sexual behavior, and intimacy
what is gonorrhea?
-Sexually transmitted bacterial infection -Can be asymptomatic -First symptoms occur 3 to 10 days after sexual contact with infected person -thick, yellow or white discharge -Can cause PID, endometriosis, and salpingitis in females -Transmitted through direct sexual contact with mucosal surfaces
what is the assessment for genital warts?
-Single, small white or flesh-colored papillary growths that may grow into large, cauliflower-like masses -Warts may disappear and resolve, or recur -Pap and HPV DNA testing; other STI tests may be done as well -Wart biopsy needs to be done prior to any treatment
what do you need to educate the patient about with gonorrhea?
-Transmission -Medication education needed, especially if co-treating other infection -Possibility of re-infection -Risk for PID in women -Stop sexual activity until antibiotic therapy is done -Reportable -Cease sexual activity until antibiotic therapy is completed and symptoms are gone
what are the gender health considerations for STIs?
-Women are more easily infected, and have more asymptomatic infections -Young women sexually active with men have greatest risk for STI -Younger adults may have more unprotected sex -Postmenopausal women may not use barrier protection
what do you need to know about STIs?
-Worldwide health concern -Some STIs are reportable (Ohio department of health) -CDC provides regularly updated guidelines for treatment -Difficult topic for some people to discuss
what can happen if syphilis goes untreated?
-aortic valvular disease -aortic aneurysms -meningitis -hearing loss -weakness
what are the healthy people 2020 objectives?
-completely eliminate syphilis in U.S. -safer sex practices
how do you diagnose genital herpes?
-confirmed through viral cell culture -serology testing reveals whether it is HSV-1 or HSV-2
what assessment questions need to be asked for genital herpes?
-did you experience any itching or tingling sensations in the skin 1-2 days prior to the outbreak? -do you have any vesicles or ulcerations? -do you have a headache or fever? -do you have dysuria?
what are the interventions for gonorrhea?
-drug therapy: treatment of choice is ceftriaxone plus azithromycin, or doxycycline -EPT
what is the drug therapy for genital herpes?
-during primary outbreak, treatment is Acyclovir (Zovirax) and Famiciclovir (Valtrex) for 7-10 days -recurrent infections are only treated for 1-5 days -Acyclovir may be given IV for severe genital herpes
what are the complications of STIs?
-infertility -ectopic pregnancy -cancers -death
what are the long-term risks associated with genital herpes?
-neonatal transmission -increased risk for acquiring HIV
who is at risk for developing complications related to STIs?
-pregnant women -adolescents -men having sex with men -people with substance use disorders
how is syphilis transmitted?
-sexual contact -through blood -can also be transmitted through close body contact such as kissing -all syphilis lesions are highly contagious and should not be touched without gloves
what is Gardasil for?
-should be used for males and females age 9-26 years old -get them this before onset of sexual activity -recommended for men having sex with men and immunocompromised patients up to 26 years old
what triggers lesions to reappear in genital herpes?
-stress -poor nutrition -fever -sunburn -menses -sexual activity
which STIs are reportable?
-syphilis -Hep B and C
how do you care for genital herpes?
-taking analgesics -applying local anesthetics -icing the area -taking a sitz bath
what do you need to teach your patient with PID?
-to rest in semi-Fowler's position -encourage limited ambulation to promotor gravity drainage of infection, can help relieve pain
what is the drug therapy for genital warts?
-topical creams or gels (Condylox) -Cryotherapy is done with liquid nitrogen every 1-2 weeks until lesions are gone -TCA or BCA, podophyllin
what is genital herpes?
-Acute, recurring, incurable viral disease -HSV-1, HSV-2- either type can produce oral or genital lesions through oral-genital contact with an infected person -recurrence is not caused by reinfection, but when there is a viral shedding, the patient is infectious -Incubation—2 to 20 days -Primary outbreak may be asymptomatic but patient is still infectious -Most common STD in the U.S. -African American women are at greater risk
what are the interventions for PID?
-Antibiotic therapy (oral or parenteral)- relieve pain because they destroy the pathogens and decrease the inflammation caused by pathogen (chart 74-4 on page 1516) -Possible hospitalization depending on severity -Laparoscopic surgery to drain abscesses (drain will be in place post-op, measure the drainage and observe every 4-8 hours or as ordered)
what is the drug therapy for syphilis?
-Benzathine penicillin G (monitor for allergic reaction)- given IM one time -jarisch-herxheimer reaction may occur and presents with generalized aches, pain at the injection site, vasodilation, hypotension, and fever- treat with antipyretics and analgesics
what are the characteristics of lesions from genital herpes?
-Blisters/vesicles develop and once they rupture, they become painful ulcerations -Ulcerations are painful and causes burning during urination -Usually resolve within 2-6 weeks -Virus remains dormant after lesions have disappeared unless triggered by something
what is syphilis?
-Can become systemic and cause serious complications, including death -Primary, secondary, tertiary stages -Needs to be reported to the local health authority
what is Condylomata Acuminata (Genital Warts)?
-Caused by certain types of HPV -HPV is primary risk factor for development of cervical cancer -Incubation—2 to 3 months -Sexual contact can put people at risk for oral and anal cancers
what are the S&S of syphilis?
-Chancre is first sign of primary syphilis, usually takes 3 weeks after exposure to appear -Chancre usually disappears within 6 weeks, but patient is still infectious as now the syphilis is systemic (often mistaken as flu because of flu-like symptoms) -systemic syphilis has a rash that appears on the palms, soles of feet and mucus membranes
what is Chlamydia?
-Chlamydia trachomatis—intracellular bacterium, causative agent of genital chlamydial infections -Reportable to local health departments in all states -Often asymptomatic (pathogen may be present in genital tract for months without symptoms)- incidence is likely doubled compared to what is reported -African-American women between 15 and 24 a highest risk
what is the assessment for gonorrhea?
-Complete history -GU history -Sexual history -Allergies to antibiotics -May be asymptomatic or symptomatic (when S&S are accompanied by fever, it may mean PID or epididymitis, which can mean systemic infection) -Diagnostic swabbing may be done -Other STI testing should be done (syphilis, chlamydia, Hep B and C, HIV, herpes, and HPV) -sexual partners who have been exposed in the past 30 days should be tested (done by swabbing)
what is the assessment for chlamydia?
-Complete history -GU review (do they have vaginal or urethral discharge that is often green or yellow, dysuria, pelvic pain, irregular bleeding- spotting in between menses, bleeding after intercourse) -Psychosocial history -Sexual history
what is the assessment for PID?
-Complete history (get the acute S&S- tenderness in the tubes and ovaries or dull pelvic pain, irregular menses, super-acute pain that affects their gait) -Menstrual, obstetric, sexual, and family histories -History of previous PID and/or STI diagnosis -Contraceptive use -Reproductive surgery -Other risk factors (multiple sexual partners, being younger than 26, smoking, page 1515) -Sexual abuse -Lower abdominal or pelvic pain is most frequent symptom -May have vaginal bleeding, dysuria vaginal discharge, malaise, fever, chills -Pelvic examination may show discharge, "friable" cervix -Patient may be anxious and fearful -Patient may be hunched over protecting the abdomen- they may need help getting up
what is PID (pelvic inflammatory disease)?
-Complex infectious process -Organisms from lower genital tract migrate from endocervix upward through uterine cavity into fallopian tubes -Resultant infections (Endometritis, Salpingitis, Oophoritis, Parametritis, Peritonitis, or Tubal or tubo-ovarian abscess) -Sepsis and death can occur if treatment is delayed or inadequate -Leading cause of infertility -Related to increasing number of ectopic pregnancies in United States
what are the interventions for chlamydia?
-EPT: expedited partner therapy (provide prescriptions to the patient that they can give to their partner) -drug therapy: treatment of choice is azithromycin or doxycycline
what health teaching do you need to provide for drug therapy for syphilis?
-Follow-up evaluation at 6, 12, 24 months to establish if they need repeated treatment -Partner notification and treatment including risk for reinfection if partner goes untreated (all sexual partners must be prophylactically treated, preferably within 90 days of diagnosis) -Reporting to local health authority -May need psychosocial support
what is the assessment for syphilis?
-History of ulcers or rash -Sexual history -Risk assessment -Physical examination (USE GLOVES) -Chancre specimen (examined under dark field microscope to confirm T pallidum- syphilis organism -VDRL (venereal disease research laboratory) and RPR (rapid plasma reagent) tests- look for antibodies produced by the body in response to infection by T pallidum (patient will have a positive result for life once it is positive)
what laboratory and diagnostic assessments are done for PID?
-Laboratory assessment (obtain specimens from the cervix, urethra, and rectum, do CBC to look for increased WBC, and look at sedimentation rate and C-reactive proteins, which indicate inflammation) -Other diagnostic assessment (ultrasound to R/O appendicitis or tubal ovarian abscesses)
what education do you need to provide about chlamydia?
-Mode of transmission -Incubation period -Possibility of asymptomatic infection and the usual symptoms if present -Need for abstinence until treatment is completed -treatment of infection with antibiotics and need for completion of antibiotics -women should be screened for reinfection 3-12 months after treatment because of high risk of PID -the need for return for evaluation if symptoms recur -complications, which include PID, ectopic pregnancy, or infertility
The nurse is discussing methods of preventing sexually transmitted diseases (STDs). Which approaches does the nurse suggest for sexually active clients? Select all that apply. a. Abstinence b. Spermicidal cream c. Latex condoms d. Mutual monogamy e. Polyurethane condoms
A, C, D, E
Which sexually transmitted diseases are vaginal infections? Select all that apply. a. Chlamydia b. Endometritis c. Epididymitis d. Gonorrhea e. Proctitis f. Syphilis
A, D, F
A client has a history of syphilis infection. The nurse interprets that the client has been re-infected when which characteristic is noted in a penile lesion? 1.Papular areas and erythema 2.Cauliflower-like appearance 3.Induration and absence of pain 4.Multiple vesicles, with some that have ruptured
3
The nurse is assessing a client during a routine gynecologic examination. Which comment by the nurse shows the least respect for the client's personal values and beliefs? a. "Have you participated in homosexual relationships?" b. "How many sexual partners do you currently have?" c. "How often do you have intercourse?" d. "What type of protection do you use when you have sex?"
A
The nurse is assessing a male client who has been diagnosed with Chlamydia trachomatis. What clinical manifestation does the nurse expect to see? a. Dysuria b. Painless maculopapular rash in the perineal area c. Pustules on the glans of the penis d. Testicular edema
A
The nurse is counseling a client and the client's sexual partner on safe sex practices. Which of the couple's comments indicates a need for further education? a. "Condoms are for vaginal and anal sexual encounters, not for oral sex." b. "If the guy won't wear a condom, the female condom is just as effective." c. "We heard that latex condoms were better than natural membrane condoms." d. "We only use condoms once, and then throw them away."
A
The nurse is establishing a plan of care for a client with newly diagnosed pelvic inflammatory disease (PID). Which problem does the nurse place as the client's highest priority? a. Infection b. Infertility c. Reduced sexual drive d. Reduced self-esteem
A
The nurse is evaluating a client's response to antibiotic treatment for pelvic inflammatory disease (PID). Which finding indicates that the treatment is effective? a. Decreased pelvic tenderness b. Decreased vaginal discharge c. Increased appetite d. Increased libido
A
The nurse is teaching a group of young men about sexually transmitted diseases. What does the nurse tell them to look for in the primary stage of syphilis? a. A painless chancre b. A rash in the genital area c. Scrotal swelling d. Weeping discharge from the urethra
A
which assessment findings will the nurse expect for a client who is suspected of having pelvic inflammatory disease? select all that apply. a. vaginal bleeding b. fever c. lower abdominal pain d. constipation e. rigid abdomen
A, B, C, E
The nurse is planning care for a client who has a sexually transmitted disease (STD). Which interventions address the client's psychosocial needs? Select all that apply. a. Allowing the client to express fears and anxieties b. Approaching the client with a nonjudgmental attitude c. Ensuring that the client's sexual partner is aware of the diagnosis d. Referring the client to the appropriate support groups e. Reporting the STD to the public health department f. Sharing experiences about working with clients with STDs
A, B, D
You are collecting a history for a 25-year-old woman. She reports has lower pelvic pain, greenish cervical discharge, dysuria, and discomfort during intercourse. She states she has had five sexual partners in her lifetime since becoming sexually active at 16 years old, and was diagnosed with a gonococcal infection at the age of 21. She has smoked since she was 17. Which findings do you recognize that indicate risk for pelvic inflammatory disease (PID)?
Age younger than 26; symptoms of abdominal pain, painful urination and intercourse, and green discharge; multiple sexual partners; smoking; history of sexually transmitted disease; history of gonococcal infection.
A clinic nurse is providing expedited partner treatment (EPT) to a client who is newly diagnosed with chlamydia. What does the nurse do first? a. Confirms the diagnosis of the partner through appropriate testing b. Gives the drug and directions to the client for the partner c. Makes an appointment at the clinic for the partner d. Provides condoms for the client and partner to use
B
A nurse is counseling a client who tests positive for syphilis in an inner-city clinic that offers free sexually transmitted disease testing. What will the nurse tell the client about providing confidential treatment for the client and the client's partners? a. The client would notify sexual partners and encourage them to seek treatment. b. The client would provide accurate information about partners so prophylactic care can be initiated. c. Syphilis is not reportable to the local health agency and follow-up is voluntary. d. The clinic will provide information about this client to other potential partners until treatment is complete.
B
The nurse in the clinic is administering benzathine penicillin G (Bicillin C-R) intramuscularly to a client with primary syphilis. The client has never been treated with this particular form of the drug. What precaution does the nurse implement? a. Applies an ice pack to the injection site to minimize trauma to the client's skin b. Keeps the client in the clinic for 30 minutes to monitor for a possible allergic reaction c. Makes certain the client has a skin test for penicillin allergy prior to the injection d. Tells the client to refrain from all sexual activities for a minimum of 72 hours
B
While preparing to go home, the patient says that she still has some abdominal pain. What education will you provide? A.IM morphine will be needed. B.Sit in a semi-Fowler's position. C.Apply a cold pack to the lower abdomen. D.Implement bedrest when returning home, laying supine.
B
You review the patient's vital signs, which are BP 134/86, HR 90/min, RR 20/min, T 101.9º F. Which assessment finding do you recognize that supports the diagnosis of PID? A.Heart rate 90/min B.Temperature 101.9º F C.Blood pressure 134/86 D.Respiratory rate 20/min
B
What teaching points should you include for this patient who is being treated as an outpatient? (Select all that apply.) A."You can return to work tomorrow." B."Check your temperature twice a day." C."You should abstain from sexual intercourse." D."Be sure to take all the medications as directed." E."Make an appointment to see your provider within 72 hours of starting antibiotics."
B, C, D, E
A 20-year-old sexually active male reports symptoms of a low-grade fever, headache, malaise, muscular aches, sore throat, and a rash on his hands and feet. What condition does the nurse anticipate? A.HIV B.HPV C.Syphilis D.Gonorrhea
C
A client with newly diagnosed pelvic inflammatory disease (PID) is being started on antibiotics as an outpatient. What does the nurse tell the client about her home treatment regimen? a. "A rise in your temperature is expected for the first several days." b. "If you engage in sexual activity, be certain to use a latex condom." c. "Rest in a semi-Fowler's position to help with the infection and pain." d. "Return to the clinic in 7 to 10 days for a checkup."
C
The nurse is assessing a female patient who reports small, flesh-colored growths in her groin that come and go. What condition does the nurse anticipate? A.Syphilis B.Gonorrhea C.Genital Warts D.Pelvic inflammatory disease
C
The nurse is discussing the prevention of sexually transmitted diseases (STDs) with a group of young adults. What information does the nurse include? a. Female condoms are not effective in preventing the transmission of STDs. b. Spermicidal agents, when used with condoms, will prevent the transmission of STDs. c. The risk of STDs increases with the number of sexual partners. d. Using latex condoms always keeps STDs from spreading and infecting others.
C
The nurse is teaching a client who is diagnosed with gonorrhea. What does the nurse tell the client about the disease? a. "Close follow-up is required because treatment failure is common." b. "Do not engage in sexual activity until your blood tests are negative." c. "You are contagious even if you have no outward symptoms." d. "You are only infectious while the lesions are draining."
C
The nurse is teaching a female client about managing her sexually transmitted disease with antibiotics. Which client statement indicates that teaching has been effective? a. "I can resume having sex 24 hours after my first dose of antibiotics." b. "I will need to take an antacid 2 hours after taking the antibiotic." c. "I need to take these antibiotics for 14 days." d. "This antibiotic must be taken with food."
C
The nurse is teaching a group of young women about screening for chlamydia. Which client statement shows a correct understanding of these practices? a. "As a sexually active 19-year-old, I need to be screened every 2 years." b. "At age 30, I still need yearly testing, even if I am monogamous." c. "If I am a 40-year-old woman with a 'new' partner, I need to be screened again." d. "Self-collected urine specimen testing is not a reliable method for screening."
C
What does the nurse identify as the expected outcome when planning care for a patient being treated with antiviral drugs for genital herpes? A.Eradication of the infection B.No chance of transmitting the virus to a partner C.Decrease in the severity and frequency of recurrent outbreaks D.Prevention of viral shedding even when the patient is asymptomatic
C
the nurse gives a client an IM dose of penicillin G for primary syphilis. which client statement indicates a need for further teaching? a. i'll wait in the clinic for 30 minutes to be sure I don't have a reaction b. when I get home, I'll call my partner to tell them about my diagnosis c. if i have sex with someone, I don't have to worry about spreading the disease d. I plain to return to see my primary care provider for follow-up in 6, 12, and 24 months
C
The nurse is teaching a 19-year-old female with genital warts about her condition. Which client statement requires further education from the nurse? a. "There is no known treatment that will cure genital warts." b. "The warts may actually disappear or resolve without any treatment at all." c. "Genital warts may reappear at the same site." d. "Wart remover treatment from the drugstore will help me get rid of them."
D
The patient's cervical specimen is positive for N. gonorrhoeae. Her WBC, ESR, and C-reactive protein are also elevated. She is diagnosed with PID and will be treated as an outpatient. Which drug do you expect to be prescribed for this patient? A.Probenecid 1 g orally twice daily for 1 day B.Metronidazole (Flagyl) 500 mg IM once only C.Ceftriaxone (Rocephin) 25 mg IM twice daily for 1 day D.Doxycycline (Vibramycin) 100 mg twice daily for 14 days
D
what are the cultural and spiritual considerations for syphilis?
Hispanics and African Americans have higher rates of syphilis possibly related to less access to care
what are the gender considerations for syphilis?
LGBTQ patients are at increased risk for syphilis (page 1509)
what are the effects of drug therapy for genital herpes?
decrease the severity and promote healing and decrease the frequency or recurrent outbreaks (DO NOT CURE)
what is a complication of genital herpes?
encephalitis
what is the gender health considerations for chlamydia?
for men, ask about dysuria, frequent urination, and a mucoid discharge that is more watery and loss copious than a gonorrheal discharge. these S&S indicate urethritis, the main symptom of chlamydia infection in men. some men have the discharge only in the morning on arising. complications include epididymitis, prostatitis, infertility, and Reiter's syndrome, a type of connective tissue disease
what is the action alert for gonorrhea?
instruct women who are being treated for PID on an ambulatory care basis to avoid sexual intercourse for the full course of treatment and until their symptoms have resolved. ask them to check their temperature twice a day. teach them to report an increase in temperature to their HCP. remind them to be seen by the HCP within 72 hours from starting antibiotic treatment and then 1 and 2 weeks from the time of the initial diagnosis
what is a good referral to use for genital herpes patients?
national herpes resource center
what is the action alert for genital herpes?
remind patients to abstain from sexual activity while genital herpes lesions are present. sexual activity can be painful, and likelihood of viral transmission is higher. urge condom use during all sexual exposures because of the increased risk for HSV transmission from viral shedding, which can occur even when lesions are not present. teach the patient about how to use condoms
what is the cultural and spiritual consideration for gonorrhea?
significant health care disparities exist between age and racial groups. young (ages 15-24 years) African American women have the highest gonorrhea rate, followed by young African American men. the reasons for these differences are not known, although lack of access to health care may be a factor
what is epididymitis?
swelling or pain in the back of the testicle in the coiled tube, where sperm is stored and carried
what is the drug alert for genital wart drug therapy?
teach patients that after treatment with cryotherapy, podophylin, or TCA, they may experience impaired comfort, bleeding, or discharge from the site or sloughing of parts of warts. Instruct them to keep the area clean (shower or bath) and dry. Teach them to be alert for any signs or symptoms of infection or side effects of the treatment.
when do you need to start drug therapy for recurrent genital herpes?
within the first day the lesion appears or during the prodrome (tingling or itching sensation)
