NURSING PROCESS: THE PATIENT WITH A GENITAL HERPESVIRUS INFECTION
The health history and a physical and pelvic examination are important in establishing the nature of the infectious condi-tion. Additionally, the patient is assessed for risk for STDs. The perineum is inspected for painful lesions. Inguinal nodes are assessed because they often are enlarged and tender during an oc-currence of HSV.
Based on the assessment data, the patient’s major nursing diag-noses may include the following:
· Acute pain related to the genital lesions
· Risk for infection or spread of infection
· Anxiety related to the diagnosis
· Deficient knowledge about the disease and its management
The major goals for the patient may include relief of pain and dis-comfort, control of infection and its spread, relief of anxiety, knowledge of and adherence to the treatment regimen and self-care, and knowledge about implications for the future.
The lesions should be kept clean, and proper hygiene practices are advocated. Sitz baths ease discomfort. Clothing should be clean, loose, soft, and absorbent. Aspirin and other analgesics are usually effective in controlling pain. Occlusive ointments and powders are avoided because they prevent the lesions from drying.
If there is considerable pain and malaise, bed rest may be re-quired. The patient is encouraged to increase fluid intake, to be alert for possible bladder distention, and to contact her primary health care provider immediately if she cannot void because of discomfort. Painful voiding may occur if urine comes in contact with the herpes lesions. Discomfort with urination can be re-duced by pouring warm water over the vulva during voiding or by sitz baths. When oral acyclovir or other antiviral agents are prescribed, the patient is instructed about when to take the med-ication and what side effects to note, such as rash and headache. Rest, fluids, and a nutritious diet are recommended to promote recovery.
The risk of reinfection and spread of infection to others or to other structures of the body can be reduced by hand washing, use of bar-rier methods with sexual contact, and adherence to prescribed medication regimens. Avoidance of contact when obvious lesions are present does not eliminate the risk because the virus can be shed in the absence of symptoms, and lesions may not be visible to the woman. Avoiding stress, sunburn, and other stress-producing situations may decrease the episodes of recurrence.
Concern about the presence of herpes infection, future occur-rences of lesions, and the impact of the infection on future rela-tionships and childbearing may cause considerable anxiety in the patient. The nurse can be an important support, listening to the patient’s concerns and providing information and instruction. The patient may be angry with her partner if her partner is the probable source of the infection. She may need assistance and support in discussing the infection and its implications with her current sexual partner and in future sexual relationships. The nurse can refer the patient to a support group to assist in coping with the diagnosis.
Patient teaching is an essential part of nursing care of the patient with a genital herpes infection. This includes an adequate expla-nation about the infection and how it is transmitted, manage-ment and treatment strategies, strategies to minimize spread of infection, the importance of adherence to the treatment regimen, and self-care strategies. Because of the increased risk of HIV and other STDs in the presence of skin lesions, an important part of patient education involves instructing the patient to protect her-self from exposure to HIV and other STDs. Further details are included in Chart 47-2.
Genital herpes causes physical pain and emotional distress. Usu-ally, the patient is upset on learning the diagnosis. Therefore, when counseling the patient, the nurse should explain the causes of the condition and the manner in which it can be managed. Questions are encouraged because they may indicate that the pa-tient is receptive to learning.
The nurse can provide reassurance that the lesions will heal and that recurrences can be minimized by adopting a healthful lifestyle and by taking prescribed medications. Self-care measures for the person with genital herpes appear in Chart 47-2.
Expected patient outcomes may include:
1) Experiences a reduction in pain and discomfort
2) Keeps infection under control
a) Demonstrates proper hygiene techniques
b) Takes medication as prescribed
c) Consumes adequate fluids
d) Adopts healthy lifestyle (diet, adequate fluid intake, safer sex practices, stress management)
3) Uses strategies to reduce anxiety
a) Verbalizes issues and concerns related to genital herpes infection
b) Discusses strategies to deal with issues and concerns with current and future sexual partner
c) Initiates contact with support group if indicated
4) Demonstrates knowledge about genital herpes and strate-gies to control and minimize recurrences
a) Identifies methods of transmission of herpes infection and strategies to prevent transmission to others
b) Discusses strategies to reduce recurrence of lesions
c) Takes medications as prescribed
d) Reports no recurrence of lesions
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