Sexual Disorders

1
Sexual Disorders

• Nurses role in assessing the problems
• Categories of sexual disorders
• Causes of the disorders
• Related issues

2
Issues involved

• Legal consent vs. coercion
• Moral norms, standards, values
• Effect level of functioning, self-esteem,
  relationships with others
• Sexuality experience of ones sexual self

3
Categories

• Sexual dysfunction disorders
• Sexual response cycle.
• Emotional, physiological, medications, chemicals
• Paraphilias
• Pedophilia, exhibitionism, voyeurism, incest,
  fetishism, frotteurism, sexual masochism, sexual
  sadism
• Lifelong, chr. disorder
• Gender identity disorders transexualism
• Depression due to difficulty finding an accepting
  partner

4
Criteria for gender identity disorder-Children

• A strong persistent cross-gender identification
  
• Stated desire or insistence that he/she is the
  other sex
• In boys, dressing in female attire in girls,
  wearing only masculine clothing
• Make-believe play or fantasies of being the other
  sex
• Desire to participate in games pastimes of
  other sex
• Prefers playmates of other sex
• Feelings of discomfort with own sex or
  inappropriateness in gender role of own sex

5
Criteria for gender identity disorder-Adolescents
Adults

• A strong persistent cross-gender identification
• Stated desire to be the other sex
• Frequently passes as the other sex
• Desires to be treated as the other sex
• Conviction that he/she has typical feelings
  reactions of other sex
• Feelings of discomfort with own sex or
  inappropriateness in gender role of own sex

6
Female sexual dysfunction
7
Male sexual dysfunction
8
Biological Causes of Sexual Disorders

• General illness cold, fatigue, influenza, renal
  and urologic disorders
• Severe and persistent dis DM, MS,
• Hormonal disorder hypopituitary dis. DM.
• Alcohol and drug use
• Pain arthritis, back pain, obesity, vaginal
  infection,
• Age perimenopausal and postmenopausal
• Others radiation therapy

9
Drug-induced sexual dysfunction

• Alcohol libido, sperm production
• Tobacco small peripheral vasculature
• CNS depressants benzodiazepine ie Valium
• Barbiturates phenobarbital, secobarbital
• Antipsychotics Thorazine, Mellaril, Stelazine
• Antidepressants Elavil, Tofranil, Norpramin,
• Anticonvulsant Dilantin,
• Others Lithium, Marijuana, Cocaine, Inderal,

10
Psychological Causes of Sexual Disorders

• Ignorance, lack of knowledge
• Anxiety, fear of failure, poor body image
• Partners or selfs demand for performance
• Judgmental thought
• Poor relationship choices lack of trust, power
  struggles
• Childhood or adult sexual abuse or trauma
• Major life change, lose partner

11
Nursing diagnoses

• Altered family process
• Altered sexuality patterns
• Anxiety
• Ineffective coping
• Knowledge deficit
• Social isolation
• Potential for violence self-directed or other

12
Nursing Care

• Nurse-patient Relationship accepting, empathic,
  nonjudgmental,
• Self-awareness discuss feelings with colleagues
• Communication tech
• Sexuality comfort level, privacy
• Referrals commonly used
• Support groups for perpetrators and victims
• Legal obligation mandatory report of sexual
  abuse of children

13
Dealing with the sexually inappropriate client

• Set limit firm, clear, consistent
• Documentation
• clients behavior (from the 1st episode
  throughout the history)
• Ns actions taken
• Consult with supervisor getting support
• Removing self from any contact with the client
• Legal action

14
Tips for Communication

• Giving rationale for question
• Giving statements of generallynormally
• Identifying sexual dysfunction
• Identifying sexual myths
• Identifying feelings about masturbation,
  homosexuality
• Obtaining and giving information
• Closing the history other questions?

15
Conclusions

• Sexual dysfunctions r/t psychological,
  physiological, pharmacological factors
• Paraphilias involve sexual activity with objects,
  children, and consenting or nonconsenting adults
• Efforts to achieve sexual pleasure do not give
  individuals the right to violate the rights of
  others through coercion control
• Gender identity disorder in adults involves
  persistent discomfort with ones biological sex.
• Normalize a range of sexual behaviors in
  counseling, helping the pt to discuss his
  feelings about himself his problems. N s
  primary role is referral

16
Eating Disorders

• Criteria for diagnoses
• Signs symptoms
• Etiology
• Issues in treatment
• Care plan

17
Significance - Eating disorder

• Strikes earlier in adolescence prevalence is
  0.5-2 in US.
• The average age dropped from 14.5 years (2001) to
  12 years (2003)
• Ranked as the nations 3rd worst health problem
  for girls younger than 18, trailing obesity and
  asthma
• High-achieving children from successful,
  middle-class families -- most vulnerable
• Involves dysregulation of multiple
  neurotranmitters and behavioral, cultural, and
  familial factors

18
Anorexia Nervosa (Dx)

• Refusal to maintain BW at a minimum level
• Fear of gaining weight
• Overvaluing of shape or weight or denial of
  seriousness of low weight
• Absence of at least 3 consecutive menstrual
  cycles
• Restricting binge-eating/purging type

19
Anorexia Nervosa

• Insidious onset on the perfect little girl
• Category dieter purgers
• Socially isolated/withdrawal
• Competitive obsessive about their activities
• Complications hypotension, bradycardia,
  hypothermia, constipation, dry skin,
• Mortality rate 8-18

20
Etiology

• Biological G-I problems, serotonin level
• Sociocultural thin ideal
• Family genetics, enmeshed R, conflict
• Cognitive attention calling, controlling
• Behavioral - reinforced
• Psychodynamic Freuds basic drive

21
Interesting numbers
22
Nursing Diagnoses

• Altered nutrition less than body requirements
• Decreased cardiac output
• Risk for injury (electrolyte imbalance)
• Body image disturbance
• Anxiety
• Low self-esteem

23
Nursing Care

• IPR enemy vs. ally
• Close observation
• Body weight, eating behavior, activity level
• Self-esteem listening, strengths,
• Making contract with the client
• Health education weightlifting running
• Family involvement, social skill training
• Others anxiety, depression

24
Bulimia Nervosa (dx)

• Uncontrolled binge eating
• Control shape and weight by extreme dieting,
  excessive exercising, self-induced vomiting,
  taking laxatives or diuretics, using diet pills,
  abuse of enemas
• Persistent over concern with body shape and weight

25
Bulimia Nervosa

• Adolescent or early adulthood female
• Chronic intermittent
• Anxious, lonely, bored, uncontrollable craving
  for food
• Medical complications
• Depression

26
Etiology

• Biological hypothalamic dysfunction
• Sociocultural
• Family enmeshed, noncohesive
• Cognitive behavioral low self-esteem, extreme
  concerns about body shape and weight, strict
  dieting, binge eating, compensatory behavior
• Psychodynamic -

27
Nursing Diagnoses

• Altered nutrition less than body requirements
• Powerlessness
• Fluid volume deficit
• Ineffective individual coping
• Disturbance in body image
• Anxiety

28
Nursing Care

• N-Pt R help-seeking vs. manipulation
• Pts feeling about their behaviors
• Respect vs. embarrassment
• Reinforce the strengths
• Health education sense of control
• Social skill training vs. loneliness
• Psychopharmacology - antidepressants

29
Dieting Myths

• Myth 1 Skipping meals is a good way to lose
  weight
• Myth 2 fasting is a good way to cleanse the body
• Myth 3 Eating after 8pm causes weight gain
• Myth 4 Certain foods, like grapefruit or cabbage
  soup, can burn fat.

30
Dieting Myths (contd)

• Myth 5 Eating red meat makes it harder to lose
  weight.
• Myth 6 You must avoid all fast food when dieting
• Myth 7 Low-fat and no-fat foods are much lower
  in calories

31
Highlight on caring for the clients with eating
disorder

• To get people to acknowledge their illness
• 5-15 are men most often at age 14 and then
  again at age 18
• Helpful flag a significant weight changes
• Constipation, abdominal pain and bloating, cold
  intolerance, and wither lethargy or excess
  energy low blood pressure and pulse rate,
  sometime with peripheral edema
• They need to reach out for help

32
(No Transcript)
33
Sleep Disorder

• Physiology of sleep
• Sleep Stages
• NREM Sleep
• REM Sleep
• Sleep-Regulating Processes
• Circadian Rhythm
• Endogenous vs. exogenous factor
• Homeostasis
• Balance o f sleep and awake

34
Influences on Sleep

• Developmental Changes
• Newborns and Infants
• Children
• Adolescents
• Young and Middle Adults
• Older Adults myth
• Amount of sleepF (genetics, preferences,
  lifestyle, environment)

35
Influences on Sleep (Contd)

• Medical Disorders and Treatments ie. Asthma,
  hyperthyroidism, COPD
• Drugs and Chemical Substances ie alcohol,
  lithium, cocaine- CNS was affected
• Circadian rhythm - Jet lag

36
Sleep Disorders

• Etiology
• Signs and Symptoms/Diagnostic Criteria
• Dyssomnias abnormalities in the amount, quality,
  or timing of sleep
• Narcolepsy
• breathing-related sleep disorders
• periodic limb movement disorder
• insomnia
• Parasomnias abnormal behavioral or physiological
  events associated with sleep
• sleepwalking
• tooth grinding

37
Narcolepsy

• Def excessive daytime sleepiness, associated
  with cataplexy
• Etiology unknown might r/t genetics
• incidence 0.02-0.16
• Symptoms begins in adolescence young
  adulthood. Every aspect of daily life is
  affected. Depression is common
• Treatment stimulant ie Ritalin TCA
• Care scheduled naps

38
Obstructive Sleep Apnea Hypopnea Syndrome
(OSAHS)

• Etiology collapse of the upper airway
• Symptoms hypopnea apnea, snore loudly, gasp or
  choke during sleep, lapses in memory, slowed
  reaction time, falling asleep while working
• Prevalence middle-aged men women in the
  menopausal years
• Risk factor obesity large neck

39
OSAHS

• Care sleep in side-lying or prone position.
  Weight loss
• Implications May lead to hypertension, heart
  failure, stroke

40
Periodic Limb Movement Disorder (PLMD) Restless
Leg Syndrome (RLS)

• Def symptoms legs move repetitively during the
  night - frequent nighttime arousal
  nonrestorative sleep and excessive daytime
  sleepiness
• Prevalence 3.9
• RLS associated with disagreeable leg
  sensations, ie pain, cramping an itching at
  bedtime
• Prevalence 5.5
• aging and female
• Both PLMD RLS are associated with
  musculoskeletal disorder, heart disease, OSAHS,
  cataplexy, mental health problems, physical
  activity near bedtime

41
PLMD RLS

• Treatment
• Others musculoskeletal disorders, heart dis.
  OSAHS,

42
Sleep Deprivation

• Effects on functioning accident,
  gastrointestinal, psychiatric, and cardiovascular
  dis.
• Implications for health care workers -

43
Insomnia Most prevalent sleep disorder

• Def difficulty initiating or maintaining sleep
  for at least 1 month and it is not part of
  another sleep disorer
• Primary Insomnia no identified cause
• Psychophysiologic Insomnia
• Implications distress in social, occupational,
  or other areas of functioning

44
Insomnia Predisposing factors

• Genetics, personality, copying style
• Normal developmental events ie pregnancy,
  postpartum period, menopause
• Environmental/situational characteristics -
• Medical disorders, acute illness
• Psychiatric disorders,
• Drugs/ substances

45
Sleep deprivation

• Def a persistent or recurrent pattern of sleep
  disruption - excessive sleepiness or insomnia
  resulting from a mismatch between the persons
  sleep-wake schedule and circadian sleep-wake
  pattern
• Cause significant stress or impairs social or
  occupational functioning
• Decreased alertness vigilance, slow cognition
• Motor vehicle accidents, major industrial
  accidents

46
Partial sleep deprivation

• Work related (shiftwork)
• 20 of pop works shifts beyond typical working
  hours
• Biologic rhythms disturbed
• Alertness, memory, cognition impaired
• Leads to G-I, cardiovascular dis.
• Risk factor for injury

47
Comorbidities Dual Diagnoses

• 40-45 of insomnia hypersomnia pt has mentally
  ill
• Mood Disorders 4x higher
• Anxiety Disorders cant relax, cant sleep
• Schizophrenia
• Substance abuse

48
Interdisciplinary Goals Treatment

• Sleep Hygiene habit structure routine,
  environment,
• Cognitive-Behavioral Treatment sleep
  restriction, relaxation, stimulus control
• Hypnotic Drugs benzodiazepines, reduce anxiety
  and promote sleep
• Nonbenzodiazepines ie zolpidem (Ambien), zaleplon
  (Sonata) less likely to produce tolerance or
  hangover

49
Application of the nursing process for the client
with sleep disorders

• Assessment
• Nursing Diagnosis
• Planning
• Implementation
• Treat primary medical or psychiatric illness
• Education and counseling
• Referral to a sleep disorders center
• Structuring the environment to promote sleep
• Reduce risk for accidents and injury
• Evaluation

50
(No Transcript)