NURSING PROCESS: THE PATIENT WITH A SEXUALLY
TRANSMITTED DISEASE
The patient should be
asked to describe the onset and progres-sion of symptoms and to characterize
any lesions by location and by describing drainage, if present. Protecting
confidential-ity is important when discussing sexual issues. When a detailed
sexual history is necessary, it is important to respect the patient’s right to
privacy. Brief explanations of why the information is asked are often helpful.
Clarification of terms may be necessary if the patient or nurse uses words
unfamiliar to the other. Ask-ing specific information about sexual contacts
usually should be done only when the nurse is part of a team that will contact
the partners for follow-up. In the history-taking process, discussion about the
patient’s understanding of responsibility to inform sexual partners may be
helpful in determining patient teaching goals.
During physical
examination, the examiner looks for rashes, lesions, drainage, discharge, or
swelling. Inguinal nodes are pal-pated to elicit tenderness and to assess
swelling. Women are ex-amined for abdominal or uterine tenderness. The mouth
and throat are examined for signs of inflammation or exudate. The nurse wears
gloves while examining the mucous membranes, and gloves are changed and
replaced after vaginal or rectal examination.
Based on assessment data, the patient’s major nursing
diagnoses may include the following:
·
Deficient knowledge about the
disease and risk for spread of infection and reinfection
·
Anxiety related to anticipated
stigmatization and to prog-nosis and complications
·
Noncompliance with treatment
Based on assessment data, potential complications that
may de-velop include the following:
·
Increased risk for ectopic
pregnancy
·
Infertility
·
Transmission of infection to
fetus resulting in congenital abnormalities and other outcomes
·
Neurosyphilis
·
Gonococcal meningitis
·
Gonococcal arthritis
·
Syphilitic aortitis
·
HIV-related complications
Major goals are increased patient understanding of the
natural history and treatment of the infection, reduction in fear, increased
compliance with therapeutic and preventive goals, and absence of complications.
Education about and prevention of the spread of STDs to
others is often accomplished simultaneously. Discussion about risk fac-tors
should emphasize that the same behaviors that led to infection with one STD may
introduce risk for any other STD, including HIV. Methods used to contact sexual
partners should be dis-cussed. The patient should understand that, until the
partner has been treated, continued sexual exposure to the same person may lead
to reinfection. Patients may need help in planning discussion with partners. If
the patient is especially apprehensive about this aspect, referral to a social
worker or other specialist may be ap-propriate. Such support is especially
important when the patient has newly diagnosed HIV infection.
The relative value of condoms in reducing the risk for
infection with STDs should be addressed. When appropriate, the patient should
be encouraged to discuss any reasons for resistance to con-dom use, so that
decision making about this preventive method can be facilitated.
The infected patient should be told what the causative
organ-ism is and should receive an explanation of the usual course of the
infection (including interval of potential communicability to others) and
possible complications. The nurse should stress the importance of following
therapy as prescribed and the need to report any therapeutic side effects or
symptom progression.
When appropriate, the
patient is encouraged to discuss anxieties and fear associated with the
diagnosis, therapy, or prognosis. By individualizing teaching efforts, factual
information applied to specific needs may offer reassurance. For example,
patients with HIV should be encouraged to participate in well-coordinated
programs in which support, education, counseling, and thera-peutic goals are
combined. Such programs are designed to offer coordinated care throughout the
course of disease progression.
In group settings (eg,
offered in an outpatient obstetric setting) or in a one-on-one setting, open
discussion about STD informa-tion facilitates patient teaching. Discomfort can
be reduced by factual explanation of causes, consequences, treatments,
preven-tion, and responsibilities. Because most communities have ex-panded STD
prevention resources, referrals to appropriate agencies can complement
individual educational efforts and ensure that later questions or uncertainties
can be addressed by experts. Patients can obtain more information by using the
CDC website (http:// w ww.cdc.gov/) or by using the voice mail number
(1-888-CDC FACT).
STDs may lead to PID and, with it, increased risk for
ectopic pregnancy and infertility.
All STDs can be transmitted to infants in utero or at the
time of birth. Complications of congenital infection can range from lo-calized
infection (eg, throat infection with N.
gonorrhoeae) to con-genital abnormalities (eg, stunting of growth or
deafness from congenital syphilis), to life-threatening disease (eg, congenital
herpes simplex virus).
STDs can cause
disseminated infection. The central nervous sys-tem may be infected, as seen in
cases of neurosyphilis or gono-coccal meningitis. Gonorrhea that infects the
skeletal system may result in gonococcal arthritis. Syphilis can infect the
cardiovascular system by forming vegetative lesions on the mitral or aortic
valves.
HIV, which is primarily
spread as an STD, leads to the profound immunosuppression of AIDS.
Complications of HIV infection include many opportunistic infections, including
Pneumocystiscarinii, Cryptococcus neoformans,
cytomegalovirus, and Myco-bacterium
avium.
Expected patient outcomes may include the following:
1) Acquires
knowledge and understanding of STDs
2) Demonstrates
a less anxious demeanor
a) Discusses
anxieties and goals for treatment
b) Inspects self for lesions, rashes, and discharge
c) Accepts
support education, and counseling when in-dicated
d) Assists
with sharing information about infection to sexual partners
e) Discusses
risk-reduction behaviors and safer sex prac-tices
3) Complies
with treatment
a) Achieves
effective treatment
b) Reports
for follow-up examination if necessary
4) Absence
of complications
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