A CASE OF ANXIETY RELATED TO

UNPROTECTED SEXUAL INTERCOURSE

Presented by: Group 2Q
 II. INTRODUCTION
Anxiety is the most common, or frequently occurring, mental disorders (Munir et al., 2019). They encompass a group of conditions that share extreme or
pathological anxiety as the principal disturbance of mood or emotional tone. Anxiety, which may be understood as the pathological counterpart of normal
fear, is manifest by disturbances of mood, as well as of thinking behavior, and physiological activity. The anxiety disorders include panic disorder (with and
without a history of agoraphobia), agoraphobia (with and without a history of panic disorder), generalized anxiety disorder, specific phobia, social phobia,
obsessive-compulsive disorder, acute stress disorder, and post-traumatic stress disorder. In addition, there are adjustment disorders with anxiety features, and
disorders due to general medical conditions and substance-induced anxiety disorders (Greenberg et al., 1999).
When feeling anxious, the person has difficulty in identifying the cause of the uneasy tension or the nature of the anticipated event. The emotion can be
puzzling for the person experiencing it. In purest form anxiety is diffuse, objectless, unpleasant and persistent. Anxiety is a state of heightened vigilance
rather than an emergency reaction, anxiety is marked by elevated arousal – subjective and physiological arousal. Anxiety tends to be shapeless, grating along
at lower level of intensity; it is onset and offset are difficult to time and it lacks clear bolder. Anxiety is not a lesser and pale from a fear and many instances,
it is more difficult to tolerate than fear. It is unpleasant, unsetting, persistent, pervasive and draining. Intense and prolonged anxiety can be disabling and even
destructive.
One example of anxiety is sexual anxiety, is defined as "fear, worry, or anxiety. These feelings can be caused by stress, negative experiences from the past,
or a variety of other factors. Given that it is one of the most prevalent sexual complaints affecting up to 25% of men and 16% of women. People may
experience severe anxiety as a result of it, and they may even avoid sexual activity.
Reasons for unprotected sex include biological imperatives, risk-taking, pregnancy ambivalence, relationship strengthening, lack of contraception or
knowledge of and cost of contraception, lack of negotiating power, significant and/or heightened sexual desire (Foster, Higgins, Biggs, Holtby & Brindis
(2011).
According to World Health Organization (WHO) anxiety disorder are the most common mental disorder affecting 301 million people in 2019, more
women are affected by anxiety than men. People with anxiety may experience excessive fear or worry about a specific situation, including (1) Generalized
anxiety persistent and excessive worry about daily activities or events (2) Social anxiety disorder, highly level of fear and worry about social situations that
might make the person feel humiliated, embarrassed or rejected and lastly is (3) Agoraphobia (excessive fear, worry and avoidance of situations that might
 III. OBJECTIVE OF THE CASE
I. General
This case study aims to come up with in-depth understanding and will be able to obtain knowledge, develop attitudes towards the care of a
patient who has concerns regarding a presumed unintended pregnancy due to unprotected sexual intercourse and develop skills in
establishing a holistic and comprehensive nursing care plan for all the aspects that contribute to and affect the patient's condition in the said
situation.

II. Specific
A. Knowledge:
•To be able to understand the pathophysiology and etiology of the case being presented.
•To acquire knowledge of the patient’s case, their causes and interventions.
• To recognize the contributing factors associated of the diagnosis.
B. Skills
• To collect further information or data from the client in order to sufficiently address the primary problems.
• To systematically present the data pertinent to the case being gathered.
• To recommend appropriate preventive measures for safe sex.
• To demonstrate communication skills in educating the client.
C. Attitude:
•To raise the level of awareness of the client about safe sex practices and the significance of contraceptive use.
•To help patient through counseling approaches from psychological factors secondary to unintended pregnancy.
 IV. PATIENTS PROFILE
• Name: K.W
• Address: N/A
• Age: 18 y/o
• Gender: Female
• Religion: N/A
• Occupation: Student
• Marital Status: Single
• Number of children (if applicable):
• Chief complaint: Come to planned parenthood for pregnancy test because condom broke during sexual
intercourse the night before and extremely nervous about the pregnancy because she is beginning college on
scholarship soon.
• Date of admission: N/A
• Ethnicity: N/A
• Educational Attainment: High School Graduate
• Admitting diagnosis/ Final diagnosis:
 V. NURSING HEALTH HISTORY
• HISTORY OF PRESENT HEALTH:
2 days prior to the consult, the patient had engaged in sexual intercourse and then
suddenly claimed that while having coitus, there was a condom break. She denies other
sexual activity aside from that incident in between her Last Menstrual Period, and that last
LMP was normal. She claimed she was nervous about the possibility of getting pregnant,
so hence consulted and requested a pregnancy test.

• PAST HEALTH:
The patient had taken contraceptives before but she discontinued when she felt
something when she began to gain more weight and begin to feel anxiety, she had no
chronic diseases, no trauma, no known allergies, and she had no past surgery, she is
complete immunization. The patient had no travel history and no previous hospitalization.
 VI. PHYSICAL ASSESSMENT
A. General Survey 3.Mood
1.Appearance and behavior Interactions:.
Observations: How do you feel about the health concerns you are
What is the client wearing? It is appropriate for the environment? experiencing?
Not applicable data She extremely nervous about pregnancy
Any visible alterations in function? Not applicable data Observations:
Note steadiness of gait, movements, posture. Not applicable data Note non verbal communication: body language, eye contact,
Is the client awake and alert? Not applicable data gestures, affect, facial expression. Not applicable data
How is the hygiene and grooming? 4.Thought processes, thought content, and perceptions
~ Hair Observations:
~ Clothes Note logical progression of client’s speech and explanations. Not
~ Teeth applicable data
~ Skin Are the client’s statements relevant to the situation? Yes
~ Nails Do the client’s perceptions of the situation seem grounded in
Is the client awake and alert? Yes reality? Not applicable data
Does the client respond appropriately to questions? Yes 5.Cognitive functions
2. Speech and language Observations:
Observations:
Is client oriented to time, place, and person? Not applicable
Note characteristics of speech (quantity, rate, volume, fluency). Not data
applicable data
Note the client’s ability to maintain a attention on a
Body Parts Technique Norms/ Actual Findings Analysis Interpretation
Standard (with reference)

Abdomen Inspection Assessing your Normal findings Normal Physical examination plays
patient’s abdomen a key role in patient
Auscultation might be diagnosis and is an
Percussion can provide critical documented as: essential part of every
information about his
Palpation internal organs. “Abdomen flat, clinical encounter of the
patient with the physician.
Always follow this symmetrical with An abdominal
sequence: inspection, no bulging, examination can give
auscultation, swelling, diagnostic clues regarding
most gastrointestinal and
percussion, and discoloration. Skin genitourinary pathologies
palpation. Changing intact.” and may also give insight
the order of these Abnormal findings regarding abnormalities of
assessment other organ systems. A
techniques could alter
might be well-performed
the frequency of documented as: abdominal examination
“Client grimacing decreases the need for
bowel sounds and detailed radiological
make your findings with shallow investigations also plays
less accurate. irregular breathing. an important role in
Abdomen patient management.
distended.”
 VIII. DEVELOPMENTAL MILESTONE
Theorist: Freud
Age/Sex: 18/Female
Stage: Genital Stage
Norms/Standard (References): The libido re-emerges
after its latent period and is directed towards peers
of the other sex, marking the onset of mature adult
sexuality. Individuals start to become sexually mature
and begin to explore their sexual feelings and desires
more maturely and responsibly.
(https://www.simplypsychology.org/psychosexual.ht
ml)
Patient's Description: Patient K.W. is 18 years old who
comes to Planned Parenthood for a pregnancy test.
She is extremely nervous about pregnancy because
she is beginning college. There have been no other
acts of unprotected intercourse since her last LMP.
 X. ANATOMY AND PHYSIOLOGY
NERVOUS SYSTEM
The nervous system is the significant controlling, regulatory, and communicating system in the body. This is the command of all mental activity
incorporating thought, learning, and memory. Through its receptors, the nervous system keeps us mindful of our environment, both external and
internal. It also sends indications between the brain and the rest of the body, including internal organs. In such a way, the nervous system’s
activity controls the ability to move, breathe, see, think, and more.
The nervous system has two main parts:
Central Nervous System
Peripheral Nervous System

CENTRAL NERVOUS SYSTEM

It contains the brain and spinal cord that is responsible for receiving, processing, and responding to sensory information.
The important mediators of anxiety in the central nervous system are thought to be norepinephrine, serotonin, dopamine, and gamma-
aminobutyric acid (GABA).
PERIPHERAL NERVOUS SYSTEM
It is made up of nerves that branch off from the spinal cord and extend to all parts of the body. These nerves set up the communication network
between the CNS and the body parts.
The peripheral nervous system is further subdivided into:
somatic nervous system
Somatic Nervous System
The somatic nervous system is a segment of the peripheral nervous system associated with the voluntary control of
movements via the help of skeletal muscles. It is reliable for all the parts we are aware of and can knowingly influence, including
the activity of our arms legs, and other parts of our body.
Autonomic Nervous System
The autonomic nervous system is a visceral efferent system, which means it sends motor instincts to the visceral organs. It
works automatically and continuously, without conscious effort, to innervate smooth muscle, cardiac muscle, and glands. It is
associated with heart rate, breathing rate, blood pressure, body temperature, and other visceral activities that work together to
maintain homeostasis.
It is the one that produces your fight-or-flight response, which is developed to enable you to defend yourself or run away from
danger.
When you are under stress or anxious, this system starts into action, and physical symptoms can appear — headaches, nausea,
shortness of breath, shakiness, or stomach pain.
The autonomic nervous system has two parts:
Sympathetic division
Parasympathetic division
Sympathetic Nervous System
It could be named your “automatic” nervous system, as it is reliable for numerous functions that you don’t have to think about to control. This can
include command of your heart rate, blood pressure, digestion, urination, and sweating, among other functions.
It is best known for its role in reacting to dangerous or stressful situations. In these crises, your sympathetic nervous system triggers to speed up
your heart rate and produce more blood to areas of your body that demand more oxygen or other responses to support you get out of danger. In
conclusion, your sympathetic nervous system controls your “fight-or-flight” response. Danger or stress activates your sympathetic nervous system,
which can result in several things to occur in your body. In response to danger or stress, your sympathetic nervous system may affect your:
•Eyes: Enlarge your pupils to let more light in and improve your vision.
•Heart: Increase your heart rate to enhance the delivery of oxygen to other parts of your body.
•Lungs: Relax your airway muscles to enhance oxygen delivery to your lungs.
•Digestive tract: Slow down your digestion so its energy is drawn away to other areas of your body.
•Liver: Activate energy stores in your liver to an energy that can be utilized quickly.
The autonomic nervous system, particularly the sympathetic nervous system, intervenes with most of the symptoms of anxiety. The amygdala plays
a crucial part in fortifying fear and anxiety. Patients with anxiety disorders have been establish to indicate intensified amygdala reaction to anxiety
cues. The amygdala and limbic system structures are attached to prefrontal cortex regions, and prefrontal-limbic activation abnormalities may be
reversed with psychological or pharmacologic interventions.
Parasympathetic Nervous System
It dominates in quiet “rest and digest” conditions. The main objective of the PNS is to preserve energy to be used later and to control bodily
functions like digestion and urination.
REPRODUCTIVE SYSTEM
The female reproductive system is designed to carry out several functions. It consists of internal and external body parts that are involved in
fertility, reproduction and sex. The female reproductive anatomy includes parts inside and outside the body.
Female Reproductive Anatomy
EXTERNAL
The main external structures of the female reproductive system include:
• Labia majora: Enclose and protect the other external reproductive organs. Literally translated as "large lips," the labia majora are relatively large
and fleshy, and contain sweat and oil-secreting glands. After puberty, the labia majora are covered with hair.
• Labia minora: Literally translated as "small lips," the labia minora can be very small or up to 2 inches wide. They lie just inside the labia majora,
and surround the openings to the vagina and urethra.

• Bartholin's glands: These glands are located beside the vaginal opening and produce a fluid (mucus) secretion.
• Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion that is comparable to the penis in males. The clitoris is covered
by a fold of skin, called the prepuce, which is similar to the foreskin at the end of the penis. Like the penis, the clitoris is very sensitive to
stimulation and can become erect.
INTERNAL
The internal reproductive organs in the female include:
•Vagina: The vagina is a canal that joins the cervix (the lower part of the uterus) to the outside of the body. It also is known as the birth canal.
• Cervix: The cervix is the lower part of the uterus that connects the uterus to the vagina.
• Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a developing fetus. The uterus is divided into two parts: the cervix,
which is the lower part that opens into the vagina, and the main body of the uterus, called the corpus. The corpus can easily expand to hold a
developing baby. A channel through the cervix allows sperm to enter and menstrual blood to exit.
• Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the uterus. The ovaries produce eggs and hormones.
• Fallopian tubes: These are narrow tubes that are attached to the upper part of the uterus and serve as tunnels for the ova (egg cells) to travel from
the ovaries to the uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the fallopian tubes. The fertilized egg then moves to
the uterus, where it implants into the lining of the uterine wall.
Female Reproductive Physiology
The Menstrual Cycle

The menstrual cycle is the monthly cycle of changes in the ovaries and the lining of the uterus, regarded as a periodic preparation for pregnancy
and fertilization. A discharge of blood out through the vagina, which is menstruation, occurs to discard the monthly buildup of the lining of your
uterus. The average cycle is 28 days, with periods lasting 2 to 7 days. A regular menstrual cycle indicates the proper functioning of reproductive
organs and provides essential hormones for various body functions, including those related to pregnancy.
The entire duration of a Menstrual cycle can be divided into four main phases:
Menstrual Phase
Menstrual phase begins on the first day of menstruation and lasts till the 5th day of the menstrual cycle. The following events occur during this
phase:

• The uterus sheds its inner lining of soft tissue and blood vessels which exits the body from the vagina in the form of menstrual fluid.
• Blood loss of 10 ml to 80 ml is considered normal.
• You may experience abdominal cramps. These cramps are caused by the contraction of the uterine and the abdominal muscles to expel the
menstrual fluid.
Follicular Phase
This phase also begins on the first day of menstruation, but it lasts till the 13th day of the menstrual cycle. The following events occur during this
phase:

• The pituitary gland secretes a hormone that stimulates the egg cells in the ovaries to grow.
• One of these egg cells begins to mature in a sac-like-structure called follicle. It takes 13 days for the egg cell to reach maturity.
• While the egg cell matures, its follicle secretes a hormone that stimulates the uterus to develop a lining of blood vessels and soft tissue called
endometrium.
Ovulatory Phase
On the 14th day of the cycle, the pituitary gland secretes a hormone that causes the ovary to release the mature egg cell. The released egg cell is
swept into the fallopian tube by the cilia of the fimbriae. Fimbriae are finger-like projections located at the end of the fallopian tube close to the
ovaries and cilia are slender hair-like projections on each Fimbria.

Luteal Phase
This phase begins on the 15th day and lasts till the end of the cycle. The following events occur during this phase:
• The egg cell released during the ovulation phase stays in the fallopian tube for 24 hours.
• If a sperm cell does not impregnate the egg cell within that time, the egg cell disintegrates.
• The hormone that causes the uterus to retain its endometrium gets used up by the end of the menstrual cycle. This causes the menstrual phase of
the next cycle to begin.

Sexual Response Cycle

 XI. PSYCHO- PATHOPHYSIOLOGY
Sign and symptoms:
→UNPLANNED PREGNANCY
Mood swings
→WORRIED
→LACK OF KNOWLEDGE TO →PREGNANCY Increased Heart Rate
CONTRACEPTION
→SEXUAL DESIRE
→STI
Irritability
Worry and Fear
Panic attacks
 XIII. DRUG STUDY
Date Name of the drug Mechanism of Indication Contra Side Effect Nursing
action indication Responsibility

Generic name: Levonorgestrel binds Levonorgestrel is Known Significant: *Assess patient’s

to progesterone and widely used as an hypersensitivity. Severe Abdominal knowledge about the
Levonorgestrel Pain drugs
androgen receptors emergency Undiagnosed
Brand Name: Mirena contraceptive, often Heavy Menstrual *Inquire to the patient if
and slows the release vaginal bleeding
dose/dosage/route of gonadotropin- referred to as the Breast cancer
Bleeding she has an allergy to
Oral 1 tablet (30mg) "morning-after pill" Nausea and medications specifically
releasing hormone Liver disease vomiting to levonorgestrel
taken as soon as (GnRH) from the or "Plan B." It can Severe Breast Cancer * Educate the patient
possible hypothalamus. This be taken within a malabsorption Fatigue
few days after about the drug use, side
process results in the syndromes Headache effects, as well as
unprotected Dizziness possible adverse effects.
suppression of the intercourse to
normal physiological allergy, *Assess pt’s v/s prior to
reduce the risk of severe liver disease administration of the
luteinizing hormone pregnancy. It works
(LH) surge that drug in order to have the
by preventing or basis after
precedes ovulation delaying ovulation, administration
interfering with * Assess pt v/s after
fertilization, or administration of
inhibiting levonorgestrel
implantation
 XIV. TREATMENT
Date Name of Indications/ purpose Nursing responsibilities
Treatment

Present Birth control pills Acts as a primary preventive action, reducing the
(during the chances of women getting pregnant,
consultation) counteracting the numerous risks of unprotected
sexual intercourse, and reducing the incidence of
unintended pregnancy, particularly in young
women.
- Initiate a counseling session with the patient with
the inclusion of encouraging and consistent use of
contraceptive pills when a sexual intercourse sti
- Consulting with doctors, especially gynecologists,
in administering oral contraceptive pills.
- Mandatory monitoring of the patient for side effects
and reactions to medication through follow-up
checkups

Present Cognitive behavioral A counseling approach that aims to develop
(during the therapy coping skills whereby they can learn to change
consultation) their own thinking, problematic emotions, and
behaviors in order to achieve a positive outcome
for young women with impending anxiety and
greatly minimize their fear about the implications
of unprotected sexual intercourse.
- Utilize clear communication; thus, nurses need to be able to
communicate sensitively and compassionately, allowing recipients
of care to be better educated about their own health, which could
enable them to embrace proactive health and wellness strategies. -
Creating a patient-positive care environment—a safe and non-
judgmental environment—and establish rapport with the patient
that will allow them to feel comfortable and express their
thoughts, concerns, and worries without fear of judgment. - Taking
nursing notes to record and identify the client’s health status,
actual or potential health care problem, and all necessary
information that will contribute to continuity of care for the
patient.
 XV. PROBLEM IDENTIFICATION AND PRIORITIZATION
Nursing Diagnosis/Cues
Anxiety secondary to unprotected sexual
intercourse
Type and Rank Justification
Problem-Focused The main problem is the patient giving
the signs (worried, extremely nervous) for
anxiety and falls into the 2nd most
important category in Maslow's hierarchy
of needs which is the safety need and
emotional security is part of it. Providing
emotional security to the patient can help
a patient be ready to absorb and follow
accordingly the proper teaching of the
nurse regarding her concerns.
 XIV. NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING
Subjective Data Anxiety related to Short term goal
• Condom broke during situational crisis as After 1 day of nursing
sexual intercourse the manifested by persistent intervention the client will
night before as verbalized worry or fear fully understand the
by the patient. importance of safe sexual
activity using
Objective Data contraceptives together
• Extremely nervous with their functions and on
because she is beginning how it will be use or take.
college on a scholarship
soon After 3 week of nursing
intervention, there will be
no pregnancy
Long term goal
After nursing intervention
the client will maintain
taking and using
contraceptives until she is
ready
IMPLEMENTATION
•Therapeutic communication
with the client. Provide
factual information about
safe sex, types of
contraceptives specifically
Emergency Contraceptives,
and give types of EC that she
can use in times of
emergency and its proper
use, to practice safe sex
• Inform the client about the
side effects of the medication
in the client's body when
used.
• Do a pregnancy test after 3
weeks of last unprotected
sexual activity to determined
the effectiveness of EC
EVALUATION
Short term goal
After 1 day of nursing
intervention the client fully
understand the importance of
safe sexual activity using
contraceptives together with
their functions and on how it
will be use or take. - Goal
met
After 3 week of nursing
intervention, no pregnancy
happened
Long term goal
After nursing intervention
the client continue to
maintain taking and using
 XVIII. IMPLICATIONS OF THE CASE TO THE
FOLLOWING AREA
A. Nursing research
B. Nursing education
C. Nursing practice (clinical)
 XX. BIBLIOGRAPHY
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%20cues

Johnson T. (2022). Your Guide to the Female Reproductive System. WebMD Editorial Contributors
https://www.webmd.com/sex-relationships/your-guide-female-reproductive-system

Marshall S. et al, (2023). Phases of Menstrual Cycle. Menstrualpedia Technologies Private Limited
https://www.menstrupedia.com/articles/girls/cycle-phases

Cabandugama P. K. (2023). Making your practice a patient positive environment. Physician Practice.
https://www.physicianspractice.com/view/making-your-practice-a-patient-positive-environment

Dafei M. et al, (2021). The effect of cognitive–behavioral counseling of pregnant women with the presence of a spouse on stress, anxiety, and postpartum
depression. J Educ Health Promot. 2021; 10: 131.
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Munir S. & Takov V. (2022). Generalized Anxiety Disorder. StatPearls Publishing vol. [12][13][14].
https://www.ncbi.nlm.nih.gov/books/NBK441870/

Mcleod S. (2023). Freud’s Psychosexual Theory And 5 Stages Of Human. SimplyPsychology. Development.https://www.simplypsychology.org/psychosexual.html