NUR 106 (MEDICAL SURGICAL NURSING 1-

STUDENT ACTIVITY SHEET LECTURE)

BS NURSING / THIRD YEAR
Session # 48

LESSON TITLE: CARE OF PATIENTS WITH STD’S Materials:

LEARNING OUTCOMES:
1. Discuss the pathophysiologic responses to STD’s
2. Assess the at-risk and sick adult client’s health
status/competence
3. Formulate with the client a plan of care to address needs
/problems and based on priority
4. Implement safe and quality nursing interventions with
client to address needs/ problems
5. Institute appropriate corrective actions to prevent
or minimize harm arising from adverse effects
6. Compare and contrast patients with STD’s with regard
to cause, incidence, clinical manifestations,
management, and the significance of preventive health
care.
Book, pen and notebook, index card/class list
References:
Hinkle, J. L., & Cheever, K. H. (2014). Brunner &
Suddarth's textbook of medical-surgical nursing
(Edition 13.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
Anef, C. D. R. D., & Faan, R. P. L. W. M. (2012).
Medical-Surgical Nursing: Patient-Centered
Collaborative Care, Single Volume (Ignatavicius,
Medical-Surgical Nursing, Single Vol) (7th ed.).
Saunders.
Fapwca, C. C. R. P. J. B. M., & DNSc Rn Bc, H. J.
H. (2008). Study Guide for Medical-Surgical
Nursing: Clinical Management for Positive
Outcomes (8th ed.). Saunders.

Porth, C., & Kunert, M. P. (2005).

Pathophysiology: concepts of altered health
states. 7th ed. Philadelphia: Lippincott Williams &
Wilkins.

Williams, L. S. 1., & Hopper, P. D. (2015).

Understanding medical surgical nursing. Fifth
edition. Philadelphia: F.A. Davis Company.

Lewis, S. M., Collier, I. C., & Heitkemper, M. M.

(1996). Medical-surgical nursing: Assessment and
management of clinical problems.

Lesson Preview (15 minutes)

Sexually transmitted diseases are infections that are spread from person to person through intimate sexual contact, STD’s
are dangerous because they are easily spread and it is hard to tell just by looking who has an STD. To delve further into
the student’s perspective on this topic the instructor should raise questions regarding the topic
1. What are the different kinds of STD’s?
Candidiasis. Trichononas vaginalis vaginitis. Cervicitis: acute and chroni. Syphilis. Herpes Simplex. Gonorrhea.
Human Papillomavirus (HPV)
2. What are the different microorganisms involved in STD’s?
Chlamydia, gonorrhea, and syphilis
3. How will you assess a person that presents signs of STD’s?
Blood tests. Urine samples. Fluid samples.
MAIN LESSON (50 minutes)
(Please read chapter 47 management of patients with female reproductive disorders in your book Brunner and
Suddharth’s Medical-Surgical Nursing 13th edition)

Sexually-transmitted Diseases
Sexually transmitted diseases (STDs) — or sexually transmitted infections (STIs) — are generally acquired by sexual contact.
The organisms (bacteria, viruses or parasites) that cause sexually transmitted diseases may pass from person to person in
blood, semen, or vaginal and other bodily fluids.
 NURSING CARE PLAN
Nursing Diagnosis Intervention Evaluation
 Fatigue related to  Assess sleep patterns and note changes in thought  Reports improved sense of
decreased metabolic processes and behavior. energy.
energy production,  Recommend scheduling activities for periods when
increased energy patient has most energy. Plan care to allow for rest  Maintains weight or display
requirements periods. Involve patient and SO in schedule planning. weight gain toward desired
 Encourage patient to do whatever possible: self-care, sit goal.
 Imbalanced Nutrition: in chair, short walks. Increase activity level as indicated. 
Less Than Body Verbalizes awareness of
 Monitor physiological response to activity: changes in feelings and healthy ways
Requirements related
BP, respiratory rate, or heart rate. to deal with them.
to increased
 Identify energy conservation techniques: sitting,
metabolic
breaking ADLs into manageable segments. Keep travel  Verbalizes understanding
rate/nutritional needs
ways clear of furniture. Provide or assist with ambulation of condition/disease
(fever/infection)
and self-care needs as appropriate. process and potential
 Anxiety related to complications.
threat to self-concept,
 Weigh as indicated. Evaluate weight in terms of
threat of death,
premorbid weight. Compare serial weights and
change in
anthropometric measurements.
health/socioeconomic
status, role  Plan diet with patient and include SO, suggesting foods
functioning from home if appropriate. Provide small, frequent meals
and snacks of nutritionally dense foods and non-acidic
foods and beverages, with choice of foods palatable to
 Deficient patient. Encourage high-calorie and nutritious foods,
Knowledge some of which may be considered appetite stimulants.
related to Note time of day when appetite is best, and try to serve
unfamiliarity with larger meal at that time.
information  Provide frequent mouth care, observing secretion
resources precautions. Avoid alcohol-containing mouthwashes.
 Provide rest period before meals. Avoid stressful
procedures close to mealtime.
  Assure patient of confidentiality within limits of situation.

 Provide accurate, consistent information regarding

prognosis. Avoid arguing about patient’s perceptions of
the situation.

 Be alert to signs of withdrawal, anger, or inappropriate

remarks as these can be signs of indenial or depression.
Determine presence of suicidal ideation and assess
potential on a scale of 1–10.

 Explain procedures, providing opportunity for questions

and honest answers. Arrange for someone to stay with
patient during anxiety-producing procedures and
consultations.

 Explain procedures, providing opportunity for questions

and honest answers. Arrange for someone to stay with
patient during anxiety-producing procedures and
consultations.

 Review disease process and future expectations.

 Determine level of independence or dependence and
physical condition. Note extent of care and support
available from family and SO and need for other
caregivers.
 Instruct patient and caregivers concerning infection
control, using good handwashing techniques for
everyone (patient, family, caregivers); using gloves
when handling bedpans, dressings or soiled linens;
wearing mask if patient has productive cough; placing
soiled or wet linens in plastic bag and separating from
family laundry, washing with detergent and hot water;
cleaning surfaces with bleach and water solution of 1:10
ratio, disinfecting toilet bowl and bedpan with full-
strength bleach; preparing patient’s food in clean area;
washing dishes and utensils in hot soapy water (can be
washed with the family dishes).
 Discuss medication regimen, interactions, and side
effects

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to you. You can now ask questions and debate among yourselves. Write
the correct answer and correct/additional ratio in the space provided

Situation: the following questions pertains to the clinical decision making skills and knowledge of a registered nurse caring
for various patients with STD’s
1. A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:
a) Why the disease is transmittable only when visible lesions are present.
b) The need for the use of petroleum products.
c) The option of disregarding safer-sex practices now that he's already infected.
d) The importance of informing his partners of the disease.

RATIO: STDs can cause serious health problems, especially if they're not found and treated. Some  STDs can
lower the chances of having babies in  the future if not treated early on.  Telling a past or current partner gives that
person the chance to get checked out and, if needed, treated.

2. Katrina Sterrett, a 26-year-old preschool teacher, is being seen by a physician who is part of the internist group where you
practice nursing. She is undergoing her annual physical and is having many lab tests done as a condition of her
employment and upcoming wedding. She is returning for her results and is devastated to learn that she has the sexually-
transmitted infection, gonorrhea. What would contribute to her ignorance of her condition?
a) Being asymptomatic
b) All options are correct
c) Being sexually inactive
d) Knowing the signs and symptoms of STIs

RATIO: Many women who have gonorrhea are asymptomatic, a factor that contributes to the spread of the disease.

3. Within the free clinic where you practice nursing, you hold weekly sexual education classes open to the public. Within
the classroom, you communicate the CDC's numbers for the incidence of STIs and their impact upon public health. Which
is the fastest-spreading bacterial STI in the United States?
a) Gonorrhea
b) Chlamydia
c) Herpes simplex 1
d) HPV

RATIO: Chlamydia is the most common and fastest-spreading bacterial STI in the United States.

4. A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission
and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm
not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed?
a) Do nothing because the client's sexual habits place him at risk for contracting other STDs.
b) Educate the client about why it's important to inform sexual contacts so they can receive treatment.
c) Inform the health department that this client contracted an STD.
d) Inform the client's sexual contacts of their possible exposure to
chlamydia.

RATIO: The nurse should educate the client about the disease and how it impacts a person's health. Further education
allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client
confidentiality unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality.
Doing nothing for the client is judgmental; everyone is entitled to health care regardless of his health habits.

5. A 16-year-old patient comes to the free clinic and is diagnosed with primary syphilis. The patient states that she contracted
this disease by holding hands with someone who has syphilis. What is the most appropriate nursing diagnosis for this
patient?
a) Alteration in comfort related to impaired skin integrity
b) Fear related to complications
c) Noncompliance with treatment regimen related to age
d) Knowledge deficit related to modes of transmission

RATIO: Syphilis is spread mainly by sexual contact and may be congenital. The patient displays knowledge deficit about
the modes of transmission for syphilis.

6. A 22-year-old patient has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this
diagnostic test may imply infection with:
a) Human papillomavirus (HPV).
b) Chlamydia trachomatis.
c) Candida albicans.
d) Trichomonas vaginalis.

RATIO: Although a Pap smear does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV
infection. An abnormal Pap smear is not indicative of chlamydial infection, trichomoniasis, or candidiasis.

7. A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care
provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should
the nurse give the patient?
a) "It's important to start treatment soon, so you will be prescribed pills today."
b) "I'd like to give you an HPV vaccination if that's okay with you."
 c) "There is a chance that these will clear up on their own without any treatment."
d) "Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory
disease."

RATIO: Genital warts may resolve spontaneously, although this does not preclude recurrence. Pharmacologic treatments
are topical and vaccination is ineffective after infection has occurred. HPV infection is not correlated with pelvic
inflammatory disease (PID).

8. A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe?
a) Tetracycline
b) Ceftriaxone
c) Penicillin
d) Levofloxacin

RATIO: The microorganism N. gonorrhoeae has become increasingly resistant to penicillin and tetracyclines, and
fluoroquinolones (such as levofloxacin). Therefore, the current CDC (2006) recommendation for treating gonorrhea is a
single intramuscular dose of a broad-spectrum cephalosporin such as ceftriaxone (Rocephin) or oral dosing with
cefixime (Suprax).

9. A client with a history of HSV-2 infection asks the nurse about future sexual activity. Which of the following responses would
be most appropriate?
a) "Inform all potential sexual partners about the infection, even if it is inactive.".
b) "Use a condom during sexual activity if the infection becomes active again."
c) "If the infection has healed, you probably don't have to use a condom."
d) "Refrain from all sexual activity until you don't have another outbreak for a year."

RATIO: The nurse should advise the client to inform all potential sexual partners of the HSV infection even if it is in an
inactive state. The nurse should also advise the client to use a condom during sexual activity even if the disease is
dormant and to avoid sexual contact if the infection is active. Condoms do not protect skin and mucous membranes left
exposed.

10. A male client reports urethral pain and a creamy yellow, bloody discharge from the penis. The nurse associates these
characteristics with which of the following sexually transmitted infections?
a) Gonorrhea
b) Candidiasis
c) Chancroid
d) Trichomoniasis

RATIO: In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody
discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted,
and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress
to pustules, and then rupture.

LESSON WRAP-UP (10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: One Minute Paper

This strategy provides a structure for students to record their own comprehension and summarize their learning. It also
gives teachers opportunity to identify areas that need re-teaching, and areas of student interest.
One-Minute Paper: answer the two questions below within one minute, write it down in ¼ sheet of paper
1) What was the most useful or the most meaningful thing you have learned this session?
The concepts of the different sexually-transmitted diseases.

2) What question(s) do you have as we end this session?

N/A
(for the next lesson Please read chapter 52 management of patients with HIV infection and AIDS in your book
Brunner and Suddharth’s Medical-Surgical Nursing 13th edition)