Mary C. T...rsing (20 Sexual Disorders and Gender Dysphoia @ 237 i SEXUAL DYSFUNCTIONS Sexual dysfunctions may occur in any phase of the sexual response cycle. Types of sexual dysfunctions include the following: 1. Sexual Interest/Arousal Disorders a. Female Sexual Interest/Arousal Disorder: This disorder is characterized by a reduced or absent interest or pleasure in sexual activity (APA, 2013). The individual typically does not initiate sexual activity and is commonly unreceptive to partner's attempts to initiate. There is an absence of sexual thoughts or fantasies and absent or reduced arousal in re- sponse to sexual or erotic cues. The condition has persisted for at least 6 months and causes the individual significant distress. b. Male Hypoactive Sexual Desire Disorder: This disorder is defined by the DSM-) as a persistent or recurrent defi- ciency or absence of sexual fantasies and desire for sexual activity. In making the judgment of deficiency or absence, the clinician considers factors that affect sexual functioning, such as age and circumstances of the person’s life (APA, 2013). The condition has persisted for at least 6 months and causes the individual significant distress. c. Erectile Disorder: Erectile disorder is characterized by marked difficulty in obtaining or maintaining an erection during sexual activity or a decrease in erectile rigidity that interferes with sexual activity (APA, 2013). The problem has persisted for at least 6 months and causes the individual significant distress. Primary erectile disorder refers to cases in which the man has never been able to have intercourse; sec- ondary erectile disorder refers to cases in which the man has difficulty getting or maintaining an erection but has been able to have vaginal or anal intercourse at least once. 2. Orgasmic Disorders a. Female Orgasmic Disorder: Female orgasmic disorder is defined by the DSM-5 as. a marked delay in, infrequency of, or absence of orgasm during sexual activity (APA, 2013). It may also be characterized by a reduced intensity of orgasmic sensation. The condition, which is sometimes referred to as anorgasmia, has lasted at least 6 months and causes the individual significant distress. Women who can achieve orgasm through noncoital clitoral stimulation but are not able to experience it during coitus in the absence of manual clitoral stimulation are not necessarily catego- rized as anorgasmic. A woman is considered to have primary orgasmic disorder when she has never experienced orgasm by any kind of stimulation. Secondary orgasmic disorder exists if the woman has experienced at least one[Projection of blame or responsibility for problems] [Rationalizing personal failures] [Hypersensitivity to slight criticism] [Grandiosity] Goals/Objectives Shart-term Goal Client will accept responsibility for and verbalize the connection between substance use or gambling behaviors and negative consequences, Long-term Goal By time of discharge, client will exhibit increased feelings of self- worth as evidenced by verbal expression of positive aspects about self, past accomplishments, and future prospects. Interventions With Selected Rationales 1. Be accepting of client and his or her negativism. Av attitude of acceptance enhances feelings of self-worth. 2. Spend time with client to convey acceptance and contribute toward feelings of self-worth, 3. Help client to recognize and focus on strengths and accom- plishments. Discuss past (real or perceived) negative conse- quences related to substance use or gambling, but minimize amount of attention devoted to them beyond client’s need to accept responsibility for them. Client must accept responsibility for own behavior before change in behavior can occur. Minimizing attention to past failures may help to eliminate negative ruminations and increase client's sense of self-worth. 4. Encourage participation in group activities from which client may receive positive feedback and support from peers. 5. Help client identify areas he or she would like to change about self and assist with problem-solving toward this effort. Low sedf~ worth may interfere with client’s perception of own problem-solving ability. Assistance may be required. 6. Ensure that client is not becoming increasingly dependent and that he or she is accepting responsibility for own behaviors. Client must be able to function independently if be or she is to be successful within the less- structured community environment. 7. Ensure that therapy groups offer client simple methods of achievement. Offer recognition and positive feedback for actual accomplishments. Successes and recognition increase self-esteem. ao % hd Alat Tampilan Mobile Bagi PDF ke DOCinteraction. 2. Client verbalizes and demonstrates comfort with gender iden- tity in interactions with others. m@ LOW SELF-ESTEEM Definition: Negative evaluation and/or feelings about one’s own capabilities (NANDA4, 2018, pp. 272-275) Possible Contributing Factors (“related to”) [Rejection by peers] Lack of approval and/or affection Repeated negative reinforcement [Lack of personal satisfaction with assigned gender] Defining Characteristics (“evidenced by”) [Inability to form close, personal relationships] [Negative view of self] 236 MM ALTERATIONS IN PSYCHOSOCIAL ADAPTATION [Expressions of worthlessness] [Social isolation] [Hypersensitivity to slight or criticism] Reports feelings of shame or guilt Self-negating verbalizations Lack of eye contact Goals/Objectives Short-term Goal Client will verbalize positive statements about self, including past accomplishments and future prospects. Long-term Goal Chent will verbalize and demonstrate behaviors that indicate sel f- satisfaction with gender identity, ability to interact with others, and a sense of self as a worthwhile person. Interventions With Selected Rationales 1. To enhance the child’s self-esteem: a. Encourage the child to engage in activities in which he or she is likely to achieve success. b. Help the child to focus on aspects of his or her life for which positive feelings exist. Discourage rumination about situations that are perceived as failures or over which the client has no control. Give positive feedback for theseb. Family Influences: Several theories exist that relate the development of separation anxiety to the following dynam- ics within the famil * Overattachment to the mother (primary care; Separation conflicts between parent and c Enmeshment of members within a family Overprotection of the child by the parents Transfer of parents’ fears and anxieties to the children through role modeling Symptomatology (Subjective and Objective Data) Symptoms of separation anxiety disorder include the following: 1. In most cases, the child has difficulty separating from the mother, although occasionally the separation reluctance is Disorders—infancy, Childhood, Adolescence Mo 47 directed toward the father, siblings, or other significant individual to whom the child is attached. . Anticipation of separation may result in tantrums, erying, screaming, complaints of physical problems, and clinging behaviors. 3. Reluctance or refusal to attend school is especially common in adolescence. 4. Younger children may “shadow” or follow around the person from whom they are afraid to be separated. 5. During middle childhood or adolescence, they may refuse to sleep away from home (e.g., at a friend’s house or at camp). 6. Worrying is common and relates to the possibility of harm coming to self or to the attachment figure. Younger children may have nightmares to this effect. 7. Specific phobias may be present. 8. Depressed mood is frequently present and often precedes the onset of the anxiety symptoms, which commonly occur follow- ing a major stressor. Nn Common Nursing Diagnoses and Interventions for the Client With Separation Anxiety Disorder (Interventions are applicable to various health-care settings, such as in- Go =) — hd Alat Tampilan Mobile Bagi PDF ke DOCNeurocognitive disorder, 53 Noncompliance, 200, 216, 256, 260 Orgasmic problems, 237-240 Overeating, compulsive, 251, 254,259 Pain, 312-314, 374 Paranoia, 114 Paraphilic behaviors, 244-247 Phobias, 170-171, 174, 175, 242, 270, 305 Powerlessness, 145-146, 198, 199, 201, 20 323-324 Projection of blame, 32, 38, 100, 292, 294, 342 203, 204, 226, 236, 243, 266, 306-308, Regression/regressive behaviors, 117, 120, 126, 128, 136, 139, 143, 148, 194, 212, 214, 216, 223, 280, 372 Repression, 104, 192, 222, 338 Risk taking, 36 Risk-prone health behavior, 201-203, 330-332 Ritualistie behaviors, 21, 54, 169, 175, 176, 179, 180, 181 Self-destructive behavior, 274 n, low, 37-38, 45-46, 64-66, 99-101, 141-143, 235-236, 265-267, 285-287, 204-206 Self-tmage, 226-227, 233-234, 262-264 Self-mutilative behaviors, 43, 274, 275-277, 278, 284 Sensory perception, disturbed, 163-165, 214-215, 227-229 Sexual abuse/assault, 185, 221, 240, 242, 272, 287, 301, 302, 304, 390-391 Sexual behaviors, 247-248 Social interaction, impaired, 19-2 234-235, 281-283, 296-297 al isolation, 64,99, 116, 120-121, 137, 141, 143-145, 191, 232, 236, 269, 303, 332-333 Spiritual distress (risk for), 384-385 Stealing, 28 Stress from caring for chronically ill person, 333-335, 403-405 Stress from locating to new environment, 203-204, 375 Substance abuse behaviors, 69-70, 96 Suicide, 31, 79, 93, 116, 134, 136, 137-139, 195-197, 206, 232, 236, 271, 275, 304, 311, 317, 393, 397-398 Suspiciousness, 58, 61, 63, 86t, 114, 118, 121, 1 ats =) % hd Alat Tampilan Mobile Bagi PDF ke DOC 23, 34-35, 44-45, 49-50, 143-145, 165-166, 129, 159, 162, 268, 289, 3425 v q cl c. Identifying sign on outside of restroom door d. Large clock, with oversized numbers and hands, appropri- ately placed e. Large calendar, indicating one day at a time, with month, day, and year identified in bold print f, Printed, structured daily schedule, with one copy for client and one posted on unit wall g. “News board” on unit wall on which current national and local events may be posted 3. Encourage client’s attempts to communicate. If verbalizations are not understandable, express to client what you think he or she intended to say. It may be necessary to reorient client frequently. The ability to conrmunicate effectively with others may enhance self-esteent. 4. Encourage reminiscence and discussion of life review. Also discuss present-day events. Sharing picture albums, if possi- ble, is especially good. Reminiscence and life review help the client resume progression through the grief process associated with disappointing life events and increase self-esteem as successes are reviewed, . Encourage participation in group activities. Caregiver may need to accompany client at first, until he or she feels secure that the group members will be accepting, regardless of limi- tations in verbal communication. Positive feedback from group members will increase self-esteem. w 66 @ ALTERATIONS IN PSYCHOSOCIAL ADAPTATION 6. Offer support and empathy when client expresses embarrass- ment at inability to remember people, events, and places. Focus on accomplishments 40 promote positive self-esteem. 7. Encourage client to be as independent as possible in self-care activities. Provide written schedule of tasks to be performed. Intervene in areas in which client requires assistance. The ability to perform: independently preserves self-esteenr. Outcome Criteria 1. Client initiates own self-care according to written schedule and ao = % td Alat Tampilan Mobile Bagi PDF ke DOC