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 Chlamydia, gonorrhea, syphilis, HIV, AIDS are all reportable to local authorities in every state  Both gonorrhea and Chlamydia can cause PID and scarring of the fallopian tubes, resulting in infertility problems.  Sexual partners, as well as the client, should be tested and treated for gonorrhea.  False-positive reactions can occur with syphilis, so do specific treponemal test  Encourage the client to have an annual Papanicolaou (Pap) test  Both partners need to be treated if one has STIs  Take immediate action if client on antibiotics has  Chills and fever as could indicate a persistent infection  vaccine can prevent genital warts caused by some strains of the human papilloma virus (HPV)  Clients should not limit voiding. Voiding while in the shower or tub should lessen the discomfort  Some of the same factors that place women at risk for STDs also place women at risk for PID  keep all clients for at least 30 mins after the administration of penicillin G  Allergic manifestations consist of rash, shortness of breath, chest tightness, and anxiety, depicting anaphylaxis and serum sickness.  When treating a client with an oral antibiotic for an STD, 8 to 10 glasses of fluid should be routine  The PLISSIT model of sexual assessment and intervention provide a framework for nursing interventions  Ch 59 Pre lecture quiz 1

In the male reproductive system, the testes have a dual function: __________________ and the secretion of the male sex hormone, testosterone. Time Spent - 00:00:18

Correct Response: spermatogenesis 2 The digital rectal examination (DRE), used to screen for prostate cancer, is recommended

annually for every man older than 50 years of age, or age 45, if at high risk. Time Spent - 00:00:06

Your Response:TRUE

3 Benign prostatic hyperplasia (BPH) symptoms develop over time with changes in the

urinary tract slow and insidious. Time Spent - 00:00:10

Your Response:TRUE

4 All surgical approaches for prostate disorders carry a risk of _____________ because of

the potential damage to the pudendal nerves.

Correct Response: impotence 5 Currently available pharmacologic agents used to treat erectile dysfunction (Viagra,

Cialis, and Levitra) are contraindicated in men who take __________, because taken together, these medications can cause severe hypotension. Time Spent - 00:00:16

Your Response: nitrates

6 _________________ is a persistent penile erection that may or may not be related to

sexual stimulation. Time Spent - 00:00:06

Your Response: priapism

7 ____________ cancer is the most common cancer in men other than nonmelanoma skin

cancer. Time Spent - 00:00:12

Your Response: Prostate

8 Testicular cancer is the most common cancer diagnosed in men between 15 and 35 years

of age. Time Spent - 00:00:05

Your Response:TRUE

9 Following a prostatectomy, the urine should be a light pink color within 1 week. Time Spent - 00:00:08

Your Response:FALSE

10 In most laboratories, prostate-specific antigen (PSA) values greater than 4 ng/mL are considered elevated and a positive indicator of prostate cancer. Time Spent - 00:00:09

Correct Response: FALSE

Ch 71 Pre lectuer quiz 1 Currently, there is no treatment for West Nile virus infection.

Time Spent - 00:00:04

Your Response:TRUE

2 Although the incubation period for chickenpox is about 21 days, it is during the _____

days before the rash develops that the newly infected host is capable of transmitting the virus to other susceptible contacts. Time Spent - 00:00:18

Correct Response: 2

3 The _________ ______ organism is responsible for the chickenpox infection. Time Spent - 00:00:11

Correct Response: Varicella zoster 4 Vancomycin-resistant Enterococcus (VRE) is the most frequently isolated source of health care--associated infections in the United States. Time Spent - 00:00:04

Your Response: FALSE

5 Penicillin G benzathine is the medication of choice for early syphilis or early latent

syphilis of less than 1 year's duration. Time Spent - 00:00:05

Your Response: TRUE

6 A nurse should wear a facemask within 3 to 6 feet of a hospitalized patient receiving

_________ precautions for an infection. Time Spent - 00:00:10

Your Response: droplet

7 A _____________ is a painless lesion at the site of primary syphilis infection which usually

resolves spontaneously within 3 to 12 weeks. Time Spent - 00:00:08

Your Response: chancre

8 The three usual modes of transmission for the human immunodeficiency virus are sexual, percutaneous, and perinatal. Time Spent - 00:00:05

Your Response: TRUE

9 The first tier of isolation guidelines, called standard precautions, is designed for the care

of all patients in the hospital and is the primary strategy for preventing health care-associated infections. Time Spent - 00:00:07

Your Response:TRUE 10

Calicivirus, also referred to as ___________, is the most common cause of foodborne illness and gastroenteritis in the United States. Time Spent - 00:00:11

Correct Response: norovirus

Lewis Questions Male 1. An older male patient is experiencing difficulty in initiating voiding and a feeling of incomplete bladder emptying. These symptoms of BPH are primarily caused by a. obstruction of the urethra. b. untreated chronic prostatitis. c. decreased bladder compliance. d. excessive secretion of testosterone.

2. Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a three-way urinary catheter with a 30-mL balloon. When he complains of bladder spasms with the catheter in place, the nurse should a. deflate the catheter balloon to 10 mL to decrease bulk in the bladder. b. deflate the catheter balloon and then reinflate to ensure that it is patent. c. encourage the patient to try to have a bowel movement to relieve colon pressure. d. explain that this feeling is normal and that he should not try to urinate around the catheter.

Which factors would place a patient at higher risk for prostate cancer (select all that apply)? a. Older than 65 years b. Asian or Native American c. Long-term use of an indwelling urethral catheter d. Father diagnosed and treated for early stage prostate cancer e. Previous history of undescended testicle and testicular cancer

A patient scheduled for a prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. In responding to this patient, the nurse should keep in mind that a. erectile dysfunction can occur even with a nerve-sparing procedure. b. retrograde ejaculation affects sexual function more frequently than erectile dysfunction. c. the most common complication of this surgery is postoperative bowel incontinence. d. preoperative sexual function is the most important factor in determining postoperative erectile dysfunction.

5. The nurse explains to the patient with chronic bacterial prostatitis who is undergoing antibiotic therapy that (select all that apply) a. all patients require hospitalization. b. pain will lessen once treatment has ended. c. course of treatment is generally 2 to 4 weeks. d. long-term therapy may be indicated in immunocompromised patient. e. if the condition is unresolved and untreated, he is at risk for prostate cancer.

6. In assessing a patient for testicular cancer, the nurse understands that the manifestations of this disease often include a. acute back spasms and testicular pain. b. rapid onset of scrotal swelling and fever. c. fertility problems and bilateral scrotal tenderness.

d. painless mass and heaviness sensation in the scrotal area.

7. The nurse should explain to the patient who has had a vasectomy that a. the procedure blocks the production of sperm. b. erectile dysfunction is temporary and will return with sexual activity. c. the ejaculate will be about half the volume it was before the procedure. d. an alternative form of contraception will be necessary for 6 to 8 weeks.

8. To decrease the patient’s discomfort over care related to his reproductive organs, the nurse should a. relate his sexual concerns to his sexual partner. b. arrange to have male nurses care for the patient. c. maintain a nonjudgmental attitude toward his sexual practices. d. use technical terminology when discussing reproductive function.

Lewis STI 1. The individual with the lowest risk for sexually transmitted pelvic inflammatory disease is a woman who uses a. oral contraceptives. b. barrier methods of contraception. c. an intrauterine device for contraception. d. a Norplant implant or injectable Depo-Provera for contraception.

2. The nurse is obtaining a subjective data assessment from a woman reported as a sexual contact of a man with chlamydial infection. The nurse understands that symptoms of chlamydial infection in women a. are frequently absent. b. are similar to those of genital herpes. c. include a macular palmar rash in the later stages. d. may involve chancres inside the vagina that are not visible.

3. A primary HSV infection differs from recurrent HSV episodes in that (select all that apply) a. only primary infections are sexually transmitted. b. symptoms are less severe during recurrent episodes. c. transmission of the virus to a fetus is less likely during primary infection. d. systemic manifestations such as fever and myalgia are more common in primary infection. e. lesions from recurrent HSV are more likely to transmit the virus than lesions from primary HSV.

4. Explain to the patient with gonorrhea that treatment will include both ceftriaxone and doxycycline because a. most patients need both drugs to eradicate the organism. b. coverage with more than one antibiotic will prevent reinfection. c. no single agent successfully eradicates both primary and recurrent infections. d. the high rate of coexisting chlamydial infection and gonorrhea indicates coverage with both drugs.

5. In assessing patients for STIs, the nurse needs to know that many STIs can be asymptomatic. Which STIs can be asymptomatic (select all that apply)? a. Syphilis b. Gonorrhea c. Genital warts d. Genital herpes e. Chlamydial infection

6. To prevent the infection and transmission of STIs, the nurse’s teaching plan would include an explanation of a. the appropriate use of oral contraceptives. b. sexual positions that can be used to avoid infection. c. the necessity of annual Pap tests for patients with HPV. d. sexual practices that are considered high-risk behaviors.

7. Provide emotional support to a patient with an STI by a. offering information on how safer sexual practices can prevent STIs. b. showing concern when listening to the patient who expresses negative feelings. c. reassuring the patient that the disease is highly curable with appropriate treatment. d. helping the patient who received an STI from his or her sexual partner in forgiving the partner.

Chapter 71: Management of Patients with Infectious Diseases Ch 57 Pages 1691 - 1694 Pages 2146 - 2150 1. Assess the factors contributing to the high incidence of sexually transmitted infections (STIs). 2. Describe the etiology, clinical manifestations, complications, and diagnostic abnormalities of gonorrhea, syphilis, chlamydial infections, genital herpes, and genital warts. 3. Compare and contrast primary genital herpes with recurrent genital herpes. Herpes   

Life-long, incurable infection Very common 2 strains o Herpes simplex virus type 1 (HSV-1)  More commonly associated with oral lesions  (Herpes labialis)  Can be spread through Oral sex  More common above waist  Gingivae, dermis, upper respiratory tract  Rarely, the CNS o Herpes simplex virus type 2 (HSV-2)  More common in the genitals (Herpes genitalis)  Very mild symptoms on first outbreak  Ulcers break and are more painful  Take 2-4 weeks to heal.  Almost always occurs below waist o Genital tract or perineum  Reoccurring outbreaks- with prodromal symptoms of  genital pain  tingling or shooting in legs or  buttocks

Etiology Genital herpes   

Having 1 type does not confer immunity against getting the other Transmission occurs when an infected individual is symptomatic Asymptomatic shedding occurs without symptoms being apparent o Impossible to predict when this will occur

Manifestations 

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Primary episode (cont.) o Ulcerative stage  Lesions rupture and form shallow, moist ulcerations Final stage o Spontaneous crusting and epithelialization of erosions occur Process from prodrome to healing varies & can take about 3 weeks o Local inflammation and pain o Regional lymphadenopathy o Systemic flu-like symptoms o Urination may be painful Autoinoculation can occur if active lesions are touched or scratched Recurrence can occur in year following primary episode o Symptoms are less severe o Lesions usually heal more quickly o HSV-1 genital infections recur less frequently than HSV-2 infections Over time, both decrease in frequency Common triggers o Stress, fatigue, sunburn, general illness, immunosuppression, menses Greatest risk for transmitting infection exists when active lesions are present o Possible to transmit virus when no visible lesions or symptoms are present o Majority of HSV transmission occurs during asymptomatic periods

Complications 

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Rare but serious complications o Blindness o Encephalitis o Aseptic meningitis Genital ulcers ↑ risk of acquiring HIV o HSV lesions can be more severe and persistent in HIV-infected patients Can be transmitted from mom to baby during birth o Highest risk during primary episode o Can infect skin, eyes, mouth, CNS o Significant morbidity and mortality when disseminated o An active genital lesion is usually an indication for cesarean delivery Can have an impact on psychologic wellbeing, relationships, sexual lives o Teach patients how to talk to sexual partners

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Refer for counseling Help patients understand treatment options and management of condition

Diagnosis        

Viral culture Polymerase chain reaction Blood test Reported symptoms Confirmed by visual exam Cultures of lesion sample can differentiate between HSV-1 and HSV-2 Blood tests for antibodies are highly accurate Usually appear by 12 weeks after exposure

InterprofessionalCare 

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Antiviral medications can o Shorten duration of viral shedding o Shorten healing time of lesions o Reduce frequency of outbreaks by 75% Start treatment before diagnostic confirmation o Reduces duration of ulcers o Reduces risk of transmission 3 antiviral agents are available o Acyclovir o Valacyclovir o Famciclovir Prescribed for primary and recurrent infections Can be used daily as suppressive therapy Teach patients to keep lesions clean and dry Putting water on perineum during urination can reduce pain Local anesthetics: lidocaine gel Analgesics: ibuprofen, acetaminophen, aspirin, acetaminophen with codeine ice packs

Genital Warts   

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Genital Warts Genital wart (Condylomata acuminata) Caused by human papillomavirus (HPV)  About 150 papillomavirus types  40 types can be sexually transmitted.  90% of genital warts are caused by HPV types 6 and 11 About 360,000 people get genital warts each year Not reportable in most states

Etiology and Pathophysiology

▪ HPV is transmitted ▪ Skin-to-skin contact ▪ Incubation period ranges from weeks to months to years ▪ Infection with 1 type of HPV does not prevent infection with another type

Etiology and Pathophysiology ▪ HPV is transient ▪ Can resolves spontaneously usually after 1-2 years ▪ Can persist when warts or no longer visible after treatment ▪ unclear whether removing visible genital warts helps to: ▪ clear the virus ▪ cure the virus, or ▪ reduces a person’s ability to transmit the virus.

Diagnostic Studies   

Most early lesions are not visually detectable Warts may be confused with condylomata lata of secondary syphilis, cancer, or benign growths. Testing should be done to rule out other conditions o Syphilis, cancer, benign growth

Diagnosis *Visual inspection *Biopsy

Complications    

Few long-term complications 90% of warts are caused by noncancerous strains of HPV Certain strains can lead to cancer Psychosocial burden due to cosmetic appearance of lesion

Interprofessional Care 

3 HPV vaccines currently availableare:

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o ▪ Gardasil o ▪ Cervarix o ▪ Gardasil 9 Given in 3 IM doses over a 6-month period CDC recommends all children be vaccinated at ages 11-12

InterprofessionalCare      

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Vaccines do not treat active HPV infection Should be given before start of sexual activity ideally Reduces risk of anal cancer May protect against oropharynx cancer Are difficult to treat Primary goal of treatment o Removal of symptomatic warts o chemical or ablative methods o Patient applied topical treatments May not decrease infectivity Does not destroy virus, just infected tissue o Recurrence and reinfection are possible o Long-term follow-up is advised Cryotherapy with liquid nitrogen Electrocautery laser therapy intralesional use of α-interferon surgical excision o Above may be indicated if warts do not regress with other therapies o Tx regimen for primary genital herpes infections includes acyclovir 400 mg 3 times daily for 7 to 10 days. The patient is taught to abstain from intercourse until the lesions are gone. Pt education: o Sitz baths may be used to relieve discomfort caused by the lesions. o Recurrent genital herpes episodes usually are shorter than the first episode. o The virus can infect sexual partners even when you do not have symptoms of infection. o Antiviral meds decrease number of outbreaks but do not cure infections o Herpes Zoster is not contagious to those who have had chickenpox o Unilateral, localized, nodular skin lesions

4. Explain the collaborative care of gonorrhea, syphilis, chlamydial infections, genital herpes, and genital warts. 5. Integrate the nursing assessment and nursing diagnoses, for patients who have an STI.

6. Describe the nursing management of patients with STIs. Ch 71 Sexually transmitted Infections 

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Education about prevention of STIs: o information about risk factors and behaviors that can lead to infection. o Using straightforward language and personal testimonials for targeted audiences (e.g., people who want information about protecting themselves) o conducting presentations in trusted establishments (e.g., churches, health care facilities) are recommended educational strategies. Syphilis acute and chronic infectious disease c/b the spirochete Treponema pallidum. acquired through sexual contact or may be congenital in origin. Stages of Syphilis o primary, secondary, and tertiary. o stages reflect the time from infection and the clinical manifestations observed in that period and are the basis for treatment decisions. Primary syphilis o occurs 2 to 3 weeks after initial inoculation with the organism. o painless lesion at the site of infection is called a chancre. o lesions usually resolve spontaneously within 3 to 12 weeks, with or without treatment o A single injection of penicillin is recommended to treat primary syphilis. This will treat the mother and pre...