Nursing Fundamentals II Sexuality, Reproductive

olanjones's version from 2016-08-08 04:39

Stages of Sexual Development NI/Teaching

Question Answer
Birth to 18 months- Given gender assignment; external genitals sensitive to touch, penile erections/vaginal lubricationSelf-manipulation of genitals is normal, Caregivers need to recognize these behaviors as common in children
1-3 years- Continues to develop gender identity; able to identify own genderBody exploration is normal, use names for body parts; Children from single-parent homes should have contact with adults of both sexes
4-5 years- Explores own/playmates body parts, learns to control feelings/behavior; Focuses love on parent of the other sexAnswer questions honestly/simply; Overreaction of masturbation can lead to feeling that sex is "bad"
6-12 years- Strong identification with parent of same gender, increased modesty; roles/concepts of gender as part of total selfAnswer questions with factual data, f/u with appropriate material; Parents should discuss basic info about sex, menstruation, reproduction
12-18 years- Primary/secondary sex characteristic develop, development of relationships (possibly sexual); At risk for pregnancy/STIsPeer groups have great importance in forming gender roles, parents influence values/beliefs; Require more info about sexual safety
18-40 years- Sexual activity common; Establishes own lifestyle & values (homosexual identity usu est. by mid-20s)Young adults require more info about contraception/STIs; Regular communication is required to understand partner's needs, work through problems/stress
40-65 years- Decreased hormone production (menopause btwn 40-55, climacteric gradual in men); Quality over quantity, est. moral/ethical standardsMay need help adjusting to new roles, encourage to look at the positive aspects of this time of life
65 & older- Interest in sex continues, activity may be less frequent; Vaginal secretions diminish/breasts atrophy, men produce fewer sperm/need more time for sex response May require counseling for adapting affection/sexual needs to physical limitations

Important Factors

Question Answer
5 Components of sexual health1. Sexual self-concept 2. Body image 3. Gender identity 4. Gender role behavior 5. Freedoms & responsibilties
Sexual orientationone's attraction to people of the same, other, or both genders
Gender identityone's self-image as male or female, includes biological, social, and cultural components (may or may not agree with biological sex)
Factors influencing sexualityFamily, Culture, Religion, Past & current factors (health, psychological, medicaitons, pain)
Dyspareuniapain during or immediately after intercourse (can be experienced by women and men)
Vaginismusinvoluntary spasm of the outer 1/3 of the vaginal muscles (makes penetration painful or impossible)
Vulvodyniaburning, stinging, irritation, or rawness of the vulva
Vestibulitissevere pain only on touch or attempted vaginal entry
Self breast examInspection before a mirror, palpation laying down (use finger pads of 3 middle fingers together, use circular motions), palpation standing/sitting
Testicular examRoll each testicle btwn thumb & fingers, palpate the epididymis, palpate vas defernes (should feel firm/smooth), inspect in front of a mirror

Sexual Misconceptions Myth vs Fact

Question Answer
Nearly all men over 70 have EDSexual ability is not lost due to age; changes are commonly due to medication/disease
Masturbation causes mental instabilitiesMasturbation is common and healthy
Sex weakens a personThere is no evidence that sex weakens a person
Women who have had an orgasm are more likely to get pregnantConception is not related to orgasm
"Nice girls" should not feel entitled to sexual satisfactionWomen advocate for their own sexual fulfillment
Size matters ;-)There is not evidence that a large penis provides greater satisfaction
Alcohol is a sexual stimulantAlcohol is a CNS depressant, chronic use is associated with ED
Intercourse during menstruation can damage vaginal tissueThere is no physiological basis for abstinence during menses
Face-to-face intercourse is moral/properThe position that offers the most pleasure/is acceptable to both partners is the correct one

Sexual Response Cycle Signs

Question Answer
Excitement/Plateau in both sexesMuscle tension increases, sex flush (esp. in chest), nipple erection
Excitement/Plateau in femalesErection of clitoris, vaginal lubrication, increase in labial size (2-3 x)
Excitement/Plateau in malesPenile erection, some penile lubrication (may contain sperm)
Orgasmic in both sexesRespirations increase, involuntary muscle spasms, diminished sensory awareness; Peak HR 110-180/min, RR 40/min or greater, BP increased from normal by 30-80 mmHg systolic, 20-50 mmHg diastolic
Orgasmic in femalesApprox 5-12 contraction in orgasmic platform at 0.8-sec intervals, contraction of pelvic floor and uterine muscles, varied pattern of orgasms
Orgasmic in malesRhythmic, expulsive contractions of penis at 0.8-sec intervals, emission of seminal fluid (closing of internal bladder sphincter), force of ejaculation varies among men but diminishes after first 2-3 contractions
Resolution in both sexesReversal of vasocongestion in 10-30 min, disappearance of myotonia within 5 min, genitals/breasts return to excitement states; other reactions inc- sleepiness, relaxation, emotions outbursts (crying, laughing)
Resolution in femalesno additional signs
Resolution in malesRefractory period during which the body will not respond to sexual stimulation, varies depending on age/other factors

Medication Effects on Sexual Function

Question Answer
AlcoholModerate amount: increased sexual functioning; chronic use: decreased desire, orgasmic dysfunction, ED
Alpha-blockersinability to ejaculate
Amphetaminesincreased sex drive, delayed orgasm
Amyl nitratereported enhanced orgasm, vasodilation, fainting
Anabolic steroidsdecreased sex drive, shrinking of testicles, infertility in men
Anti-anxiety drugsdeceased desire, orgasmic dysfunction in women, delayed ejaculation
Anticonvulsantsdecreased desire, reduced sexual response
Antidepressantsdecrease desire, orgasmic delay/dysfunction in women, delayed/failed ejaculation in men, painful erections
Antihistaminesdecreased vaginal lubrication, decreased desire
Antihypertensivesdecreased desire, erectile failure, ejaculation dysfunction
Antipsychoticsdecrease desire, orgasmic dysfunction in women, delayed/failed ejaculation in men
Barbiturateslow dose: increased sexual pleasure; large dose: decreased desire, orgasmic dysfunction, ED
Beta-blockersdecreased desire
Cardiotonicsdecreased desire
Cocaineincreased intensity of sexual experience; chronic use: decreased desire, sexual dysfunction
Diureticsdecreased vaginal lubrication, decreased sexual desire, ED
Marijuana increased intensity of sexual experience; chronic use: decreased desire, testosterone levels, and sperm; sexual dysfunction
Narcoticsinhibited desire and response; erectile and ejaculatory dysfunctions

Nursing Process Sexuality

Question Answer
Assessment: What groups should the nurse obtain a sexual history from?Those receiving care for pregnancy, infertility, or STIs; Those whose illness/therapy will affect sexual function; Those experiencing sexual problems
Assessment: What topics should be addressed in interview?Activity, Gender preferences, Positive/Negative aspects of function, Pain, Concerns about future function
Diagnosing: Relating directly to sexualityIneffective sexuality pattern; Sexual dysfunction
Diagnosing: Problems as etiologyDeficient knowledge; Ineffective relationship; Pain; Anxiety; Fear; Disturbed body image
Planning: Overall goalsMaintain, restore, or improve sexual health; Increase knowledge of sexuality; Prevent occurrence of STIs; Prevent unwanted pregnancy; Increase satisfaction with level of sexual functioning; Improve self-concept
Planning: Nursing actions for maintaining self-conceptProvide privacy during intimate body care; Give attention to client's appearance; Give clients privacy to meet sexual needs alone/with partner within physically safe limits
Implementation: TeachingTeach client about sexual health/function, responsible sexual behavior (prevention of STIs, pregnancy), self-exam technique for breasts/testicles
Implementation: Counseling- PLISSITPermission giving, Limited Information, Specific suggestions, Intensive therapy (Professional nurses function at the first two levels, refer client to skilled provider for SSIT)
Evaluation: If outcome not metRisk factors correctly identified? All significant fears/concerns conveyed by client? Was client more comfortable after discussion of sexual matters? Understand the teaching? Teaching compatible with culture? Ready to deal with?

Inappropriate Sexual Behavior

Question Answer
Why may clients expose themselves to the nurse?A need for attention; Communicate that the behavior is not acceptable, clarify consequences of continuation (withdrawal of services, no chance to resolve underlying concerns)
Why may the client ask the nurse to provide physical intimate care?Unmet needs for intimacy d/t hospitalization; Tell client how the behavior makes you feel
Why may a client grab/touch the nurse's genitals, make blatant sexual comments?Fear/anxiety over future ability to function sexually; Set firm limits, identify behavior you expect, report the incident to the charge nurse/PCP
Why may a client make comments about the nurses' desirability?Need for reassurance that they are still sexual beings/sexually attractive; Try to refocus client on real concerns/fears
Why may the client make comments to others about what they would like to do sexually with the nurse?Confusion/neurological impairment

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