Common Health Problems in Diagnostic Testing For Sexually

Transmitted Infections
Adolescent
HIV/AIDS
 Sexually Transmitted Diseases
Physical examination,, and thorough
Infectious diseases most commonly transmitted
medical history, plus one or more of the
through sexual contact
following blood tests in individuals 18
• Can also be transmitted by months of age or greater: Rapid HIV test
completed on blood or saliva, ELISA
• Blood
(Enzyme-Linked Immunosorbent Assay)
• Blood products antibody blood test. If the sample tests
positive for HIV, the more-accurate Western
• Autoinoculation
blot antibody blood test or an HIV nucleic
Risk Factors acid test is recommended
• Having unprotected sex Chlamydia
• Having sexual contact with multiple Physical examination, including pelvic exam
partners. in young women, and thorough medical
• Anyone forced to have sexual history, plus laboratory analysis of cervical
intercourse or sexual activity secretions or urine, to detect presence of C.
trachomatis.
• Misuse of alcohol or use of recreational
drugs Gonorrhea
• Injecting drugs plus laboratory testing of cervical, vaginal or
• Being young penile secretions.

• Men who request prescriptions for Pelvic Inflammatory Disease (PID)

drugs to treat erectile dysfunction plus one or more laboratory tests of cervical
Signs & Symptoms or vaginal secretions, ultrasound imaging
exam. Severely ill patients may be
 Sores or bumps on the genitals or in the hospitalized and given antibiotics
oral or rectal area
intravenously.
 Painful or burning urination
 Discharge from the penis Genital Warts/Human Papillomavirus
 Unusual or odd-smelling vaginal (HPV) 
discharge
 Sore, swollen lymph nodes, particularly Physical examination, including pelvic exam
in the groin but sometimes more in young women, and thorough medical
widespread history, plus a Pap smear. If the Pap smear
 Unusual vaginal bleeding is abnormal, colposcopy and cervical biopsy
 Pain during sex may be done.
 Lower abdominal pain
 Rash over the trunk, hands or feet Genital Herpes
 Fever herpes virus blood test and culture.
Surgical and Medical Procedures HIV testing

Medical and surgical procedures are Case finding

sometimes recommended for the treatment
Surveillance
of viral STDs.
Chlamydial Infections Treatment
This includes:
Drug therapy
HPV: Procedures to remove HPV genital
warts include cryotherapy (freezing), Abstinence from sexual intercourse for 7
electrocautery (burning), injection of days after treatment
interferon into warts, laser treatment, and
Follow-up care for persistent symptoms
surgery.
Treatment of partners
Hepatitis: In some cases, major liver
damage can occur from hepatitis infections Encourage use of condoms
and a liver transplant may be needed.
Prevention: limit the number of sexual
Nursing Care Management partner & use condoms & spermicides

Gonorrhea Genital Herpes Treatment

Drug therapy • Drug therapy Symptomatic care

Treatment generally instituted without Genital hygiene
culture results Treatment in early stage is
curative Loose-fitting cotton underwear

•Most common . IM dose of ceftriaxone Lesions clean and dry

(Rocephin)
barrier methods during sexual activity
All sexual contacts of patients must be
evaluated and treated Pain: dilute urine with water, local
anaesthetic
Patient should be counseled to abstain
from sexual intercourse and alcohol during
treatment
Reexamine if symptoms persist after
treatment

Syphilis

Drug therapy

Benzathine penicillin G (Bicillin)

Aqueous procaine penicillin G

Monitor neurosyphilis

Confidential counseling and

Amenorrhea (uh-men-o-REE-uh) • Prolactin Test

is the absence of menstruation, often • Hormone Challenge Test

defined as missing one or more menstrual • Imaging Test
periods.
• Ultrasound Tests

• Magnetic Resonance Imaging (MRI)

Primary amenorrhea refers to the absence of
menstruation in someone who has not had a • Scope Tests
period by age 15. The most common causes of
primary amenorrhea relate to hormone levels,
although anatomical problems also can cause Surgical and Medical Procedures
amenorrhea.
Common medical treatments for
Secondary amenorrhea refers to the absence of secondary amenorrhea include:
three or more periods in a row by someone
who has had periods in the past. Pregnancy is • Birth control pills or other types of
the most common cause of secondary hormonal medication.
amenorrhea, although problems with hormones
• Medications to help relieve the
also can cause secondary amenorrhea.
symptoms of PCOS. Clomiphene
Risk Factors citrate (CC) therapy is often
• Family history prescribed to help trigger ovulation.

• Eating disorders • Estrogen replacement therapy (ERT).

ERT may help balance hormonal
• Athletic training
levels and restart the menstrual
• History of certain gynecologic cycle in women with POI (Primary
procedures
Ovarian Insufficiency) or FXPOI
Signs & Symptoms (Fragile X-Associated Primary
Milky nipple discharge Ovarian Insufficiency).

Hair loss • Surgical treatment for amenorrhea

is not common, but may be
Headache recommended in certain conditions.
Vision changes These include:
Pelvic pain • Uterine scarring. This scarring
sometimes occurs after removal
Diagnostic Testing
of uterine fibroids, a cesarean
• Pregnancy Test section, or a dilation and curettage
• Thyroid Function Test (D&C), a procedure in which tissue is
removed from the uterus to
• Ovary Function Test diagnose or treat heavy bleeding or
to clear the uterine lining after a
 miscarriage.Removal of the scar
tissue during a procedure called a
hysteroscopic resection can help
restore the menstrual cycle.
Nursing Care Management
 counsel and educate patients

 address the diverse causes of

amenorrhea, the relationship to sexual
identity, possible infertility

 inform the woman about the purpose

of each diagnostic test sensitive
listening, interviewing, and presenting
treatment options

 Nutritional counseling

 Emphasize healthy life style

 Dysmenorrhea  • Suprapubic

• Cramps or painful menstruation  Radiating to thighs & back

• Sharp, intermittent pain or dull aching  Nausea, vomiting, dizziness

pain, in the pelvis or lower abdomen  Diarrhoea
Classified as:  No pelvic pathology
• Primary dysmenorrhoea SD
• Secondary dysmenorrhoea  Later age of onset
Primary dysmenorrhea  is the name for  Starts 2 or more years after menarche
common menstrual cramps that come back
over and over again (recurrent) and aren’t due  Begins more than few hours before
to other diseases. Pain usually begins one or menses
two days before you get your period or when
 Dysmenorrhoea with anovulatory
bleeding actual starts. You may feel pain
cycles
ranging from mild to severe in the lower
abdomen, back or thighs.  H/O IUCD, recurrent PID
If you have painful periods because of a  F/H/O endometriosis
disorder or an infection in your female
reproductive organ, it is called secondary  Pelvic pathology on examination
dysmenorrhea.
Risk Factors Diagnostic Testing
 Attempts to lose weight Ultrasound
 Depression/anxiety Other imaging Tests
 Heavy menses (CT scan or MRI)
 Smoking Laparoscopy

Surgical and Medical Procedures

Signs & Symptoms
• Pain relievers
PD
• Hormonal Birth Control
 With or shortly (6 months) after
menarche • Surgery

 Fluctuating, spasmodic cramps • Surgical Removal of the uterus

 “Labour-like” Nursing Care Management

 Begins few hours before or with  Elicit an Accurate Menstrual History
menses  Provide Confidentiality and
Communicate Therapeutically
 Most intense first 24-36 hours  Administer Culturally Sensitive Care
 Lasts 2-3 days  Promote Independence and Self-Care
HEALTH PROBLEMS COMMON thinking and reasoning skills.
IN ADOLESCENT
4. Sleep apnea
OBESITY & ANOREXIA
People who are overweight and living with obe
NERVOSA
having sleep apnea. This is because they tend to
Reporter: Abegail B. Virtudazo the neck, making the airway shrink. 5. High blood
Extra fat tissue in the body requires more oxyge
vessels will need to circulate more blood to the
your heart must work even harder to pump blood a

OBESITY- complex disease

involving an excessive amount of SIGNS AND SYMPTOMS
body fat. It is a medical problem that • Difficulty in sleeping.
increases risk of other diseases and
other health problems, such as heart • Back and/or joint pains.
disease, diabetes, high blood pressure • Excessive sweating.
and certain cancers.
• Intolerance to heat.
• Infections in skin folds.
• Fatigue.
RISK FACTORS
• Depression.
Type 2 diabetes
• Feeling of shortness of breath 
Type 2 diabetes occurs when your blood sugar is higher than normal. Over
time, this can lead to other health issues, like heart disease, nerve damage,
stroke, kidney disease, and vision problems.NURSING MANAGEMENT FOR
OBESITY
2. Heart disease
Waist Circumference- is another
Heart disease is more prevalent in people with obesity. People with obesity
way to assess and classify a person’s
have higher than normal blood pressure, low-density lipoprotein (LDL)
Health risks increase if the waist
cholesterol, triglycerides, and blood sugar, all of which contribute to heart
circumference is greater than 40
disease.
inches in men and greater than 35
3. Stroke inches in women.
A stroke can cause damage to brain tissue and result in a range
Waist-to-Hip Ratio-ofisdisabilities,
another tool
including speech and language impairment, used
weakened muscles,
to assess andThis
obesity. changes
ratiotois a
method of describing the distribution
of both subcutaneous and visceral
adipose tissue.
Body Shape- is another method of
identifying those who are at a higher
risk for health problems Individuals
with fat located primarily in the
abdominal area, an apple-shaped
body, have android obesity.
MEDICAL AND SURGICAL
TREATMENT FOR OBESITY
Medical treatments of obesity include
primary prevention, dietary
intervention, increased physical
activity, behavior modification, and
pharmacotherapy. Surgical treatment
for obesity is based on the extensive
neural-hormonal effects of weight loss
surgery on metabolism, and as such is
better termed Metabolic Surgery.  school, home or a job, a
DIAGNOSTIC TEST FOR OBESITY
• blood tests to examine and
cholesterol glucose levels
• Liver function Test
• Diabetes Screening
• Thyroid test
• heart tests, such as
an electrocardiogram (ECG or
EKG)
• A measurement of the fat
around your waist is also a
good predictor of your risk for
obesity-related diseases.
ANOREXIA NERVOSA- also called
anorexia, is a potentially life-
threatening eating disorder that is
characterized by self-starvation and
excessive weight loss.
RISK FACTORS
• Genetic- People who have a
first-degree relative like –a
parent, sibling or child who has
the disorder, have higher
chances of having anorexia.
• A change in life- A new
relationship breakup, death or
illness of a loved one, can bring
emotional stress and increase
risk of anorexia.
• Starvation- Unhealthy dieting
may cause starvation.
Starvation affects the brain
causing mood changes, rigidity
in thinking, anxiety and
reduction in appetite.

SIGNS AND SYMPTOMS
• Fear of gaining weight or
becoming fat even when
severely underweight.
• Body image disturbance.
• Amenorrhea or absence of
menstrual period.
• Depressive symptoms such as
depressed mood, social
withdrawal, irritability, and
insomnia.
• Preoccupation with thoughts of
food.
• Feelings of ineffectiveness.
• Inflexible thinking.
Diagnostic Tests
Physical exam. This may
include measuring your height
and weight; checking your vital
signs, such as heart rate, blood
pressure and temperature;
checking your skin and nails for
problems; listening to your
heart and lungs; and examining
your abdomen.
Lab tests. These may include a
complete blood count (CBC)
and more-specialized blood
tests to check electrolytes and
protein as well as functioning
of your liver, kidney and
thyroid. A urinalysis also may
be done.
Psychological evaluation. A
doctor or mental health
professional will likely ask
about your thoughts, feelings
and eating habits. You may also
be asked to complete
psychological self-assessment
questionnaires.
Other studies. X-rays may be
taken to check your bone
density, check for stress
fractures or broken bones, or
check for pneumonia or heart
problems. Electrocardiograms
may be done to look for heart
irregularities.
Medical Management
• Nutritional rehabilitation and
weight restoration- Clients
receive nutritionally balanced
meals and snacks that gradually
increase caloric intake to a
normal level for size, age, and
activity.
• Family-based
therapy- Individuals with
anorexia nervosa may respond
best to family-based treatment,
also known as the Maudsley
 method, an established
therapeutic modality for
Nursing Assessment
achieving and maintaining
remission from anorexia History- Family members often
nervosa. describe clients with anorexia
nervosa as perfectionists with
• Cognitive behavioral therapy
above-average intelligence,
(CBT)-is an evidence-based,
achievement oriented,
effective treatment for bulimia
dependable, eager to please,
nervosa (BN); behavioral
and seeking approval before
approaches to avoiding
their condition began; clients
undesirable eating habits are
with bulimia, however, often
used, including diary keeping;
have a history of impulsive
behavioral analyses of the
behavior such as substance
antecedents, behaviors, and
abuse, shoplifting, as well as
consequences (so-called ABCs)
anxiety, depression, and
associated with binge eating
personality disorders.
and purging episodes; and
exposure to food paired with General appearance and
progressive response motor behavior- Clients with
prevention regarding binge anorexia appear slow, lethargic,
eating and purging. and fatigued; they may be
emaciated depending on the
• Interpersonal psychotherapy-
amount of weight loss.
Interpersonal psychotherapy
(IPT) addresses specific issues Mood and affect- Clients with
in the interpersonal arena that eating disorders have labile
create the context for and moods that usually correspond
stimulate dynamic tensions that to their eating or dieting
spur the patient’s symptoms; behaviors.
these generally encompass such Though processes and
processes as grief, role content- Clients with eating
transitions, role conflicts or disorders spend most of the
disputes, and interpersonal time thinking about dieting,
deficits. food, and food-related
behavior.
 Self-concept- Low self-esteem
is prominent in clients with
eating disorders.
Substance Abuse
Substance abuse refers to the excessive use of a
drug or alcohol that is detrimental to one's self,
society, or both. This includes two definitions,
the physical and psychological dependence.
Physical dependence is cause by prolonged use
of a drug which causes an altered physiologic
state in which withdrawal symptoms develop
when the use is discontinued. Psychologic
dependence refers to a state of intense need to
continue the use in the absence of physical
dependence.
Risk Factors
Includes genetic influences, predispositions,
family and peer influences, individual
personality traits, and societal influences.
Signs and Symptoms
Physical Sign and Symptoms
 Bloodshot eyes
 Sudden weight loss
 Poor hygiene
 Interrupted sleep patterns
 Changes in complexion
Behavioral Signs
 Ignoring responsibilities
 Secretive behavior
 Financial Distress
Psychological Signs
 Depression and anxiety
 Low self-esteem
 Poor motivation
 Irritability and mood swings
Diagnostic Test
A toxicology test or screening may check for up
to thirty different drugs at once. These may
include prescription drugs, nonprescription
drugs and illegal drugs, such as cocaine and
heroin. Testing is often done on urine or saliva
instead of blood because many drugs will show
up in a urine or saliva sample. This can help
establish the nature and level of drug use.
Nursing Management
Nursing care of a client with substance abuse
include nursing assessment and diagnosis.
Assess the client's history, thought process and
content, sensorium and intellectual process,
and general appearance and motor behavior.
Diagnose the client based on the assessment
data. The following are some of the major
nursing diagnosis for substance abuse: Risk for
injury related to substance intoxication or
withdrawal, Ineffective coping related to
inadequate support system or coping skills, and
Ineffective denial related to underlying fears
and anxiety.
Suicide
Suicide is the intentional act of killing oneself. It
is a serious public health problem that is
increasing exponentially in every part of the
world. Majority of the patients who engage in
suicidal attempts have a psychiatric disorder.
Mood disorders such as depression and bipolar
manic-depression are by far the most prevalent
condition linked to suicide.
Risk Factors
Health
 Mental health condition
 Serious physical health conditions
including pain
 Traumatic brain injury
Environmental
 Prolonged stress, such as harassment,
bullying, divorce, financial crisis, and
other life transitions or loss
 Stigma associated with mental illness or
help-seeking
 Access to lethal means such as firearms
and drugs
 Exposure to another person’s suicide
Historical
 Previous suicide attempts
 Family history of suicide
 Childhood abuse, neglect, or trauma
 Looking for a way to end their lives,
such as searching online for methods
 Withdrawing from activities
 Isolating from family and friends
 Sleeping too much or too little
 Visiting or calling people to say goodbye
 Giving away possessions
 Aggression
 Fatigue
Verbalization
 Killing themselves
 Feeling hopeless
 Having no reason to live
 Being a burden to others
 Feeling trapped
 Unbearable pain
Medical Management
Lithium
Lithium is used for the treatment of mania and
the maintenance treatment of bipolar disorder.
it is a very effective mood stabilizer. A number
of studies has described the anti-suicidal
benefits of lithium for individuals on long-term
maintenance. Lithium reduces relapse of mood
disorders.

Suicide Warning Signs

Mood Antidepressants

 Depression The selective serotonin reuptake inhibitors

 Anxiety (SSRIs) have been recommended for the
 Loss of interest treatment of depressive disorders when suicide
 Irritability risk is present.
 Shame/Humiliation Antianxiety Agents
 Agitation/Anger
 Relief/Sudden Improvement Any one of several rapidly acting, anti-anxiety
agents (eg, clonazepam, a benzodiazepine) are
Behavior candidate pharmaceutics for use in emergency
 Increase use of alcohol or drugs psychopharmacology for anxiety reduction in
patients who exhibit suicidal behaviors.
 providing support, and education to the
family and friends
Nursing Management

 Document the level of suicide risk of the

patient, the nature of associated risk
(e.g., self-harm, sexual exploitation),
and the steps to be taken to ensure the
patient's safety, for example, requiring
a 'special' nurse, and the frequency of
re-assessment.

Hight Risk: conduct re-assessment at least twice

daily

Medium Risk: conduct re-assessment at least

daily

Low Risk: conduct re-assessment at least

weekly.

 Consideration of appropriate night

sedation to assist the patient’s rest and
sleep appropriate exploration of the
patient’s difficulties, stressors, their
responses and coping strategies. These
may include:

– identification of potential stressors

– identification of adaptive coping responses

– identification of support person/s

– recognition of significant events, especially

those

that involve loss, death of a significant person

or

anniversary of divorce or death

 Promotion of recovery through

supportive or other psychotherapy,
including documentation of the
patient’s developing and understanding
of their recovery pathway
 etails of ongoing liaison with the family
and friends to assist in assessment of
ongoing risk in the patient as well as