Chapter 44 Nursing Care of Patients with Sexually Transmitted Infections

Answers CHAPTER 44 NURSING CARE OF PATIENTS WITH SEXUALLY TRANSMITTED INFECTIONS AUDIO CASE STUDY Janis Works at the STI Clinic 1. Hannah may not have been able to be open and honest about her feelings if her boyfriend was in the room. Some partners can also be controlling and may want to guide the conversation during an appointment. Having Hannah alone in the room likely changed the outcome of the appointment. 2. Having sex with that person would carry the same risk as having sex with all that person’s previous sexual partners. 3. Initially, flu-like symptoms can occur as well as urethritis, cystitis, mucopurulent cervicitis, and vaginal discharge. Vesicles and painful ulcerations on the genitals follow. VOCABULARY 1. (4) 2. (2) 3. (3) 4. (5) 5. (1) 6. (6) INFLAMMATORY DISORDERS 1. (1) 2. (3) 3. (2) 4. (5) 5. (4) BARRIER METHODS FOR SAFER SEX 1. Male latex condoms are less likely to break during intercourse than other types. Lubrication decreases the chances of breakage during use, but only water-soluble lubricants should be used because substances such as petroleum jelly (Vaseline) may weaken the condom. Condoms should never be inflated to test them because this can weaken them. Condoms should be applied only when the penis is erect. Condoms should either have a reservoir tip or be applied while holding approximately a half inch of the closed end flat between the fingertips to allow room for ejaculate without creating excessive pressure, which might break the condom. The penis should be withdrawn after ejaculation before the erection begins to subside while holding the top of the condom securely around the penis to avoid spillage. Condoms should never be reused and should be discarded properly after use so others will not come in contact with the contents. 2. Female condoms should be applied before any penetration occurs (even pre-ejaculation fluid can contain microorganisms). Lubrication decreases the chances of breakage during use, but only water-soluble lubricants should be used because substances such as petroleum jelly may weaken the condom. Female condoms should never be reused and should be discarded properly after use so others will not come in contact with the contents. 3. These may provide some protection for the cervix only. They are not effective barriers against STIs. 4. These may provide some barrier protection for manual and oral sexual activity. Although some groups suggest that male condoms may be split down one side and opened or that rubber dental dam material may be taped over areas that have lesions to avoid direct contact with blood and body fluid, this very high-risk behavior is not recommended. 5. Anal intercourse is a very high-risk activity for transmission of many types of STIs, as well as many intestinal organisms, and is not recommended. Homosexual organizations advise wearing double condoms and using water-soluble lubricants, preferably containing nonoxynol-9, to decrease the risk somewhat if engaging in this type of sexual activity. CRITICAL THINKING 1. Misunderstandings may include the following: • The mistaken idea that one blood test can diagnose all STIs • Misunderstanding about the time that may be required to treat STIs (if the disease is treatable) • Lack of understanding of the importance of interview information for diagnosing STIs • Lack of understanding of the importance of physical examination for diagnosing STIs 1 2 Chapter 44 Answers 2. The woman is an adult and has the right to make her own decisions. Unless James is her legal guardian, he has no legal right to information about her. He may be notified by a public health authority that he has been listed as a sexual contact by someone (anonymous) who has tested positive for a particular STI. However, if they have not yet become sexually intimate, he is not actually a contact. The only ethical and legal way that he can find out the information is by her choice (without coercion) to tell him. 3. Before any testing is done, both people should see the physician separately, be interviewed, be examined, and, if necessary, have samples taken for investigation. The physician should then order the tests that he or she deems necessary and counsel each patient about the test procedures, possible outcomes and treatments, and the expected time frame for return of results. A return visit may be arranged for a time after the physician should have received notification of results. 4. No, James is not going to get his answer about whether he has a contagious STI today. Even if he is a virgin, he may possibly have contracted an STI prenatally, so he must wait for test results. Recent exposure to some STI agents may not show positive results for a long period. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (4) is correct. Syphilis is associated with gummas. (1, 2, 3) are incorrect. 2. (3) is correct. Human papillomavirus causes genital warts. (1, 2, 4) cause other viral disorders. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 3. (1, 3, 4) are correct. Standard precautions are always appropriate, especially with possible herpes infection. Cesarean delivery may protect the baby from exposure. The obstetrician or midwife must be informed so decisions can be made for a safe delivery. (2) is incorrect. Teaching is appropriate, but reprimanding is not. (5) is incorrect. An antibiotic will not treat a viral infection and would need a physician’s order. (6) is incorrect. Reverse isolation would protect a patient who is immune compromised and is not appropriate in this case. 4. (4) is correct. A history and physical examination with diagnostic testing are the only ways to diagnose a sexually transmitted infection. (1) is untrue. (2, 3) are incorrect. Checking for lesions and using a condom are good ideas but will not prevent all sexually transmitted infections. 5. (4) is correct. Questioning a partner is only one small part of sexually transmitted infection prevention, so if the student believes this is adequate protection, more teaching is necessary. (1, 2, 3) are all correct statements and do not indicate a need for further teaching. 6. (1) is correct. The ulcer should be examined for diagnosis and treatment. (2, 3) may be upsetting to the patient because the ulcer may be from something other than a sexually transmitted infection. (4) Gentle cleaning is important, but a sexually transmitted infection can occur at any age. 7. (3) is correct. Urethritis causes painful, frequent urination and discharge. (1, 2, 4) are not symptoms of urethritis. 8. (1) is correct. Her pain should be assessed before intervention takes place. (2, 3, 4) may also be appropriate after assessment has taken place. 9. 2,400,000 units 8 mL 5,000,000 units = 3.8 mL 10. (4) is correct. An initial outbreak following infection with the herpes virus occurs 2 days to 2 weeks after exposure and may produce a flu-like condition. Urethritis, cystitis, and mucopurulent cervicitis with vaginal discharge may also be evident. (1, 2) are incorrect. Assessing the partner’s history or symptoms is not as important as educating the client on symptoms she may develop that require medical evaluation. (3) is incorrect. Use of a diaphragm will protect the cervix but will not reduce the risk of contracting a sexually transmitted infection.