Health Problems Common in Adolescents
Pathay, Antoniette Jane | BSN 12-J | NRG 204
SUBSTANCE ABUSE
➢ Develop when a person’s use of
alcohol or another substance such
as drugs leads to health issues,
disability, and or not adhering to
responsibilities at home, work, or
school. This disorder is also called
drug addiction. In the last edition of
the DSM, DSM-IV, there were two
categories: substance abuse and
substance dependence. DSM-5
merges these two categories into
one called “substance use disorder.”
Causes
The exact causes of drug abuse,
dependence, and addiction are not
known, but various factors are thought
to contribute to the development of
substance-related disorders.
➢ Biologic factors. Children of
alcoholic parents are at higher risk
for developing alcoholism and drug
dependence than are children of
nonalcoholic parents.
➢ Psychological factors. Children of
alcoholics are four times as likely to
develop alcoholism compared with
the general population; some
theorists believe that inconsistency in
the parent’s behavior, poor role
modeling, and lack of nurturing pave
the way for the child to adopt a
similar style of maladaptive coping,
stormy relationships, and substance
abuse.
➢ Social and environmental
factors. Cultural factors, social
attitudes, peer behaviors, laws, cost
and availability all influence initial
and continued use of substances.
Clinical Manifestation
Each substance use disorder is
classified as its own disorder. Here are
the most common substance use
disorders in the United States:
➢ Alcohol. Alcohol is a central nervous
system depressant that is absorbed
rapidly into the bloodstream; initially,
the effects are relaxation and loss of
inhibition; with intoxication, there is
slurred speech, unsteady gait, lack of
coordination, and impaired attention,
 concentration, memory, and
judgment.
➢ Sedatives, hypnotics, and
anxiolytics. This class of drugs
includes all central nervous system
depressants, barbiturates,
nonbarbiturate hypnotics, and
anxiolytics, particularly
benzodiazepines; the effects of the
drugs, symptoms of intoxication, and
withdrawal symptoms are similar to
those of alcohol.
➢ Stimulants (amphetamines,
cocaine). Stimulants are drugs that
stimulate or excite the central
nervous system; intoxication from
stimulants develops rapidly; effects
include the high or euphoric
feeling, hyperactivity, hypervigilance,
talkativeness, anxiety, grandiosity,
hallucinations, stereotypic or
repetitive behavior, anger, fighting,
and impaired judgment.
➢ Cannabis (marijuana). Cannabis is
the most widely used illicit substance
in the United States; research has
shown that cannabis has short-term
effects of lowering intraocular
pressure; symptoms of intoxication
include impaired motor coordination,
inappropriate laughter, impaired
judgment, and short-term memory,
and distortions of time and
perception.
Assessment and Diagnostic Findings
Various diagnostic studies may also
demonstrate evidence of SADs-related
organ dysfunction.
➢ PPD. A positive PPD is a frequent
finding among substance abusers
living in crowded conditions.
➢ Hematology. Additional laboratory
clues include mild anemia with
macrocytosis, folate deficiency,
thrombocytopenia, granulocytopenia,
abnormal liver function tests,
hyperuricemia, and
elevated triglycerides.
Medical Management
Clients being treated for intoxication and
withdrawal, or detoxification are
encountered in a wide variety of medical
settings from emergency departments to
outpatient clinics.
➢ Alcoholics Anonymous
(AA). Alcoholics Anonymous was
founded in the 1930s by alcoholics;
this self-help ground developed the
12-step program model for recovery,
which is based on the philosophy
that total abstinence is essential and
that alcoholics need the help and
support of others to maintain
sobriety.
Nursing Management
Nursing Assessment
Assessment of a client with substance
abuse disorder include:
➢ History. Client with a parent or other
family members with substance
abuse problems may report a chaotic
family life, although this is not always
the case.
➢ Thought process and content. During
the assessment of thought process
and content, clients are likely to
minimize their substance abuse,
blame others for their problems, and
rationalize their behavior.
➢ Sensorium and intellectual process.
Clients generally are oriented and
alert unless they are experiencing
lingering effects of withdrawal.
➢ General appearance and motor
behavior. Assessment of general
appearance and behavior usually
reveals appearance and speech to
be normal.
➢ Self-concept. Clients generally have
low self-esteem, which they may
express directly or cover with
➢
Nursing Diagnosis
Based on the assessment data, the
major nursing diagnosis for substance
abuse are:
➢ Risk for injury related to
substance intoxication or
withdrawal.
➢ Ineffective denial related to
underlying fears and anxieties.
➢ Ineffective coping related to
inadequate support system or
coping skills.
➢ Imbalance nutrition: less than
body requirements related to
drinking alcohol instead of eating
nourishing food.
➢ Chronic low self-esteem related
to retarded ego development.
Nursing Care Planning and Goals
Treatment outcomes for clients with
substance use may include the
following:
➢ The client will abstain from
alcohol and drug use.
➢ The client will express feelings
openly and directly.
➢ The client will verbalize
acceptance of responsibility for
his or her own behavior.
➢ The client will practice
nonchemical alternatives to deal
with stress or difficult situations.
➢ The client will establish an
effective after-care plan.
Nursing Interventions
Nursing interventions for a client with
substance abuse include:
➢ Providing health teaching for
client and family. Clients and
family members need facts about
the substance, its effects, and
recovery.
➢ Addressing family issues. Without
support and help to understand
and cope, many family members
may develop substance abuse
problems of their own, thus
perpetuating the dysfunctional
circle; treatment and support
groups are available to address
issues of family members.
➢ Promoting coping skills. Nurses
can encourage clients to identify
problem areas in their lives and to
explore the ways that substance
 use may have intensified those
problems.
Evaluation
Goals are met as evidenced by:
➢ The client was able to abstain
from alcohol and drug use.
➢ The client was able to express
feelings openly and directly.
➢ The client was able to verbalize
acceptance of responsibility for
his or her own behavior.
➢ The client was able to practice
nonchemical alternatives to deal
with stress or difficult situations.
➢ The client was able to establish
an effective after-care plan.
STD
Sexually transmitted diseases (STDs) —
or sexually transmitted infections (STIs)
— are generally acquired by sexual
contact. The bacteria, viruses or
parasites that cause sexually
transmitted diseases may pass from
person to person in blood, semen, or
vaginal and other bodily fluids.
Causes
STDs or STIs can be caused by:
➢ Bacteria. Gonorrhea, syphilis and
chlamydia are examples of STIs
that are caused by bacteria.
➢ Parasites. Trichomoniasis is an
STI caused by a parasite.
➢ Viruses. STIs causes by viruses
include HPV, genital herpes and
HIV.
Clinical Manifestation
➢ STDs or STIs can have a range
of signs and symptoms, including
no symptoms. That's why they
may go unnoticed until
complications occur or a partner
is diagnosed.
➢ Signs and symptoms that might
indicate an STI include:
➢ Sores or bumps on the genitals or
in the oral or rectal area
➢ Painful or burning urination
➢ Discharge from the penis
➢ Unusual or odorous vaginal
discharge
➢ Unusual vaginal bleeding
➢ Pain during sex
➢ Sore, swollen lymph nodes,
particularly in the groin but
sometimes more widespread
➢ Lower abdominal pain
➢ Fever
➢ Rash over the trunk, hands or
feet
Assessment
Several screening tests are used to
diagnose infection.
➢ Confirming Diagnosis: Signs and
symptoms may occur at any time
after infection, but AIDS isn’t
officially diagnosed until the
patient’s CD4+ T-cell count falls
 below 200 cells/mcl or associated
clinical conditions or disease.
➢ CBC: Anemia and idiopathic
thrombocytopenia (anemia
occurs in up to 85% of patients
with AIDS and may be profound).
Leukopenia may be present;
differential shift to the left
suggests infectious process
(PCP), although shift to the right
may be noted.
➢ PPD: Determines exposure
and/or active TB disease. Of
AIDS patients, 100% of those
exposed to active Mycobacterium
tuberculosis will develop the
disease.
➢ Serologic: Serum antibody test:
HIV screen by ELISA. A positive
test result may be indicative of
exposure to HIV but is not
diagnostic because false-
positives may occur.
➢ Western blot test: Confirms
diagnosis of HIV in blood and
urine.
➢ Viral load test:
➢ RI-PCR: The most widely used
test currently can detect viral
RNA levels as low as 50
copies/mL of plasma with an
upper limit of 75,000 copies/mL.
➢ bDNA 3.0 assay: Has a wider
range of 50–500,000 copies/mL.
Therapy can be initiated, or
changes made in treatment
approaches, based on rise of viral
load or maintenance of a low viral
load. This is currently the leading
indicator of effectiveness of
therapy.
➢ T-lymphocyte cells: Total count
reduced.
➢ CD4+ lymphocyte count (immune
system indicator that mediates
several immune system
processes and signals B cells to
produce antibodies to foreign
germs): Numbers less than 200
indicate severe immune
deficiency response and
diagnosis of AIDS.
➢ T8+ CTL (cytopathic suppressor
cells): Reversed ratio (2:1 or
higher) of suppressor cells to
helper cells (T8+ to T4+)
indicates immune suppression.
➢ Polymerase chain reaction (PCR)
test: Detects HIV-DNA; most
helpful in testing newborns of
HIV-infected mothers. Infants
carry maternal HIV antibodies
and therefore test positive by
ELISA and Western blot, even
though infant is not necessarily
infected.
➢ STD screening tests: Hepatitis B
envelope and core antibodies,
syphilis, and other common STDs
may be positive.
➢ Cultures: Histologic, cytologic
studies of urine, blood, stool,
spinal fluid, lesions, sputum, and
secretions may be done to
identify the opportunistic
infection. Some of the most
commonly identified are the
following:
➢ Protozoal and helminthic
infections: PCP,
cryptosporidiosis, toxoplasmosis.
➢ Fungal infections: Candida
albicans (candidiasis),
Cryptococcus neoformans
(cryptococcus), Histoplasma
capsulatum (histoplasmosis).
➢ Bacterial infections: malignancies are suspected
Mycobacterium avium- (diagnostic confirming test for
intracellulare (occurs with CD4 PCP).
counts less than 50), miliary ➢ Barium swallow, endoscopy,
mycobacterial TB, Shigella colonoscopy: May be done to
(shigellosis),Salmonella identify opportunistic infection
(salmonellosis). (e.g., Candida, CMV) or to stage
➢ Viral infections: CMV (occurs with KS in the GI system.
CD4 counts less than 50), herpes
simplex, herpes zoster. Medical Management
➢ Neurological studies, e.g., Medical management focuses on the
electroencephalogram (EEG), elimination of opportunistic infections.
magnetic resonance imaging
(MRI), computed tomography
(CT) scans of the brain;
➢ Treatment of opportunistic
electromyography (EMG)/nerve
infections. For Pneumocystis
conduction studies: Indicated for
pneumonia, TMP-SMZ is the
changes in mentation, fever of
treatment of choice; for
undetermined origin, and/or
mycobacterium avian complex,
changes in sensory/motor
azithromycin or clarithromycin are
function to determine effects of
preferred prophylactic agents; for
HIV infection/opportunistic
cryptococcal meningitis, the
infections.
current primary treatment is IV
➢ Chest x-ray: May initially be
amphotericin B.
normal or may reveal progressive
➢ Prevention of opportunistic
interstitial infiltrates secondary to
infections. TMP-SMZ is an
advancing PCP (most common
antibacterial agent used to treat
opportunistic disease) or other
various organisms causing
pulmonary complications/disease
infection.
processes such as TB.
➢ Antidiarrheal therapy. Therapy
➢ Pulmonary function tests: Useful
with octreotide acetate
in early detection of interstitial
(Sandostatin), a synthetic analog
pneumonias.
of somatostatin, has been shown
➢ Gallium scan: Diffuse pulmonary
to be effective in managing
uptake occurs in PCP and other
severe chronic diarrhea.
forms of pneumonia.
➢ Antidepressant therapy.
➢ Biopsies: May be done for
Treatment for depression in
differential diagnosis of Kaposi’s
patients with HIV infection
sarcoma (KS) or other neoplastic
involves psychotherapy
lesions.
integrated with imipramine,
➢ Bronchoscopy/tracheobronchial
desipramine or fluoxetine.
washings: May be done with
➢ Nutrition therapy. For all AIDS
biopsy when PCP or lung
patients who experience
 unexplained weight loss, calorie
counts should be obtained, and
appetite stimulants and oral
supplements are also
appropriate.
Nursing Management
➢ Nursing assessment includes
identification of potential risk factors,
including a history of risky sexual
practices or IV/injection drug use.
➢ Nutritional status. Nutritional status is
assessed by obtaining a diet history
and identifying factors that may
affect the oral intake.
➢ Skin integrity. The skin and mucous
membranes are inspected daily for
evidence of breakdown, ulceration,
or infection.
➢ Respiratory status. Respiratory
status is assessed by monitoring the
patient for cough, sputum production,
shortness of breath, orthopnea,
tachypnea, and chest pain.
➢ Neurologic status. Neurologic status
is determined by assessing the level
of consciousness; orientation to
person, pace, and time; and memory
lapses.
➢ Fluid and electrolyte balance. F&E
status is assessed by examining the
skin and mucous membranes for
turgor and dryness.
➢ Knowledge level. The patient’s level
of knowledge about the disease and
the modes of disease transmission is
evaluated.
Diagnosis
The list of potential nursing diagnoses is
extensive because of the complex
nature of the disease.
➢ Impaired skin integrity related to
cutaneous manifestations of HIV
infection, excoriation, and diarrhea.
➢ Diarrhea related to enteric pathogens
of HIV infection.
➢ Risk for infection related to
immunodeficiency.
➢ Activity intolerance related
weakness, fatigue, malnutrition,
impaired F&E balance, and hypoxia
associated with pulmonary
infections.
➢ Disturbed thought processes related
to shortened attention span, impaired
memory, confusion, and
disorientation associated with HIV
encephalopathy.
➢ Ineffective airway clearance related
to PCP, increased bronchial
secretions, and decreased ability to
cough related to weakness and
fatigue.
➢ Pain related to impaired perianal skin
integrity secondary to diarrhea, KS,
and peripheral neuropathy.
➢ Imbalanced nutrition, less than body
requirements related to decreased
oral intake.
Planning & Goals
Goals for a patient with HIV/AIDS may
include:
➢ Achievement and maintenance of
skin integrity.
➢ Resumption of usual bowel pattern.
➢ Absence of infection.
➢ Improve activity intolerance.
➢ Improve thought processes.
➢ Improve airway clearance.
➢ Increase comfort.
➢ Improve nutritional status.
➢ Increase socialization.
➢ Absence of complications.
➢ Prevent/minimize development of
new infections.
➢ Maintain homeostasis.
➢ Promote comfort.
➢ Support psychosocial adjustment.
➢ Provide information about disease
process/prognosis and treatment
needs.
Nursing Interventions
The plan of care for a patient with
AIDS is individualized to meet the
needs of the patient.
➢ Promote skin integrity. Patients are
encouraged to avoid scratching; to
use nonabrasive, nondrying soaps
and apply nonperfumed moisturizers;
to perform regular oral care; and to
clean the perianal area after each
bowel movement with nonabrasive
soap and water.
➢ Promote usual bowel patterns. The
nurse should monitor for frequency
and consistency of stools and the
patient’s reports of abdominal pain or
cramping.
➢ Prevent infection. The patient and
the caregivers should monitor for
signs of infection and laboratory test
results that indicate infection.
➢ Improve activity intolerance. Assist
the patient in planning daily routines
that maintain a balance between
activity and rest.
➢ Maintain thought processes. Family
and support network members are
instructed to speak to the patient in
simple, clear language and give the
patient sufficient time to respond to
questions.
➢ Improve airway clearance. Coughing,
deep breathing, postural drainage,
percussion and vibration is provided
for as often as every 2 hours to
prevent stasis of secretions and to
promote airway clearance.
➢ Relieve pain and discomfort. Use of
soft cushions and foam pads may
increase comfort as well as
administration of NSAIDS and
opioids.
➢ Improve nutritional status. The
patient is encouraged to eat foods
that are easy to swallow and to avoid
rough, spicy, and sticky food items.
Evaluation
Expected patient outcomes may
include:
➢ Achieved and maintained of skin
integrity.
➢ Resumption of usual bowel pattern.
➢ Absence of infection.
➢ Improved activity intolerance.
➢ Improved thought processes.
➢ Improved airway clearance.
➢ Increased comfort.
➢ Improved nutritional status.
➢ Increased socialization.
➢ Absence of complications.

SUICIDE
Suicide is the intentional act of killing
oneself. Suicidal thoughts are common
in people with depression,
schizophrenia, alcohol/substance abuse
and personality disorders (antisocial,
borderline, and paranoid). Physical
illness (chronic illness such as HIV,
AIDS, recent surgery, pain) and
environmental factors (unemployment,
family history of depression, isolation,
recent loss) can play a role in the
suicide behavior.
Causes
Suicidal thoughts have many causes.
Most often, suicidal thoughts are the
result of feeling like you can't cope when
you're faced with what seems to be an
overwhelming life situation. If you don't
have hope for the future, you may
mistakenly think suicide is a solution.
You may experience a sort of tunnel
vision, where in the middle of a crisis
you believe suicide is the only way out.
There also may be a genetic link to
suicide. People who complete suicide or
who have suicidal thoughts or behavior
are more likely to have a family history
of suicide.
Clinical Manifestation
Symptoms of a major depressive
disorder according to DSM-IV-TR
diagnostic criteria:
➢ Depressed mood. The affect of a
depressed person is one of sadness,
dejection, helplessness, and
hopelessness.
➢ Anhedonism. There is decreased
attention to and enjoyment from
previously pleasurable activities.
➢ Weight changes. Unintentional
weight change of 5% or more in a
month.
➢ Change in sleep pattern. Sleep
disturbances are common,
either insomnia or hypersomnia.
➢ Agitation or psychomotor
retardation. A general slowdown of
motor activity commonly
accompanies depression.
➢ Tiredness. Physically there is
evidence of weakness and fatigue-
very light energy to carry on with the
activities of daily living (ADLs).
➢ Worthlessness or
guilt inappropriate to the situation
(probably delusional).
➢ Difficulty thinking, focusing, and
making decisions.
➢ Hopelessness, helplessness, and/or
suicidal ideations.
Assessment and Diagnostic Findings
A number of tests should be conducted
to diagnose depression.
➢ Beck Depression Inventory is a
psychological test used to
 determine symptom onset,
severity, duration, and
progression.
➢ Dexamethasone suppression test
showing failure to suppress
cortisol secretion in depressed
patients (although test has high
false-negative rate).
➢ Toxicology screening suggesting
drug-induced depression.
➢ Diagnosis is confirmed if DSM-V-
TR criteria is met.
Medical Management
A wide range of effective treatments is
available for major depressive disorder
➢ Psychotherapy. There are a number
of evidence-based
psychotherapeutic treatments for
adults with major depressive disorder
such as behavioral therapy, cognitive
therapy, cognitive behavioral
analysis system of psychotherapy,
interpersonal psychotherapy,
problem-solving therapy, and self-
management or self-control therapy.
➢ Electroconvulsive therapy.
Electroconvulsive therapy is a highly
effective treatment for depression.
➢ Simulation techniques. Transcranial
magnetic stimulation (TMS) is
approved by the FDA for use in
adults patients who have failed to
respond to at least 4 adequate
medication and/or ECT treatment
regimens.
Nursing Management
Nursing Assessment
➢ Subjective cues. Include
verbalization of inability to cope
or ask for help, sleep disturbance
and fatigue, abuse of chemical
agents, and reports of muscular
or emotional tensions, and lack of
appetite.
➢ Objective cues. Include lack of
goal-directed behavior or
resolution of problem; inadequate
problem solving, decreased use
of social support, inability to meet
role expectations/basic needs,
and destructive behavior toward
self (e.g. overeating,
smoking/drinking, overuse of
prescribed/OTC medications, and
illicit drug use)
Nursing Diagnosis
➢ Ineffective Coping related to
situational or maturational crises
➢ Hopelessness related to long-
term stress
➢ Fatigue related to stress and
anxiety
Planning and Goals
➢ To determine degree of
impairment
➢ To assess coping abilities and
skills
➢ To assist client to deal with
current situation
➢ To provide for meeting
psychological needs
➢ To promote wellness
Nursing Interventions
➢ Provide for patient’s physical
needs. Assist with self-care and
personal hygiene. Encourage
patient to eat. Give warm milk or
 back rubs at bedtime to improve ➢ Patient’s ability to identify
sleep. ineffective coping behaviors and
➢ Plan activities for times when the consequences.
patient’s energy level peaks. ➢ Verbalization of awareness of
➢ Assume active role in initiating own coping abilities and of
communication. This can be done feelings congruent with behavior.
by sharing observation of ➢ Meet physiological needs as
patient’s behavior, speaking evidenced by appropriate
slowly and allowing ample time expression of feelings,
for him to respond, encouraging identification of options, and use
him to talk and write down of resources.
feelings, and by providing a
structured routine which may
include noncompetitive activities.
➢ Avoid feigned cheerfulness, but
don’t hesitate to laugh with him
and point out the value of humor. AMENORRHEA
➢ Educate patient about
depression. Explain that
depression can be eased by
expressing feelings and engaging
in pleasurable activities.
Emphasize that there are
effective methods available for
relief of symptoms.
➢ Help patient recognize distorted
perceptions and link them to his
Amenorrhea is the absence of menses
depression.
and can occur for a variety of reasons;
➢ Ask patient whether he thinks
some are normal during the course of a
about death or suicide. Signal an
woman’s life, while others may be a side
immediate need for consultation
effect of medication or a sign of a
and assessment. Risk of suicide
medical problem.
is higher with lifting of depressed
mood. Causes
➢ Stress the need for medication
compliance. Review adverse Amenorrhea can be intermittent or
effects with the patient. transient; however, it can also be a
permanent condition resulting from
Evaluation dysfunction of the hypothalamus,
➢ Patient’s ability to assess current pituitary, ovaries, uterus or vagina. The
situation accurately. most common cause of amenorrhea in
women of childbearing age is pregnancy
and lactation.

Assessment and Diagnostic Findings
When working a patient up for
amenorrhea, be sure to ask about the
following:
➢ Age at menarche (if applicable)
➢ Menstrual cycle – interval
between menses, length, and
flow
➢ Details regarding puberty and
secondary sex characteristics
➢ Symptoms of hyperandrogenism
(hirsutism, acne, male pattern
hair loss)
➢ Number of pregnancies
(terminations, miscarriages
and/or live births)
➢ Use of medications, including
hormones (contraceptive or
hormone replacement therapy)
➢ Medical and surgical history
➢ Weight and exercise history
➢ Nutritional lifestyle
➢ Stress (psychological, severe
illness or injury)
➢ Family history of delayed puberty
Medical Management
Treatment of primary amenorrhea is
directed at correcting the underlying
pathology (if possible) and prevention of
complications of the disease process.
Special consideration is directed to the
individual woman’s treatment goal (i.e.,
fertility plan, relief of pain, reduction of
symptoms, or resumption of menses).
Nursing Management
➢ Provide support
➢ Encourage increased intake if the
patient has a low body weight
➢ Educate patient on causes
DYSMENORRHEA
Dysmenorrhea causes severe and
frequent cramps and pain during your
period. It may be either primary or
secondary.
➢ Primary dysmenorrhea. This
occurs when you first start your
period and continues throughout
your life. It is usually life-long. It
can cause severe and frequent
menstrual cramping from severe
and abnormal uterine
contractions.
➢ Secondary dysmenorrhea. This
type is due to some physical
cause. It usually starts later in life.
It may be caused by another
medical condition, such as pelvic
inflammatory disease or
endometriosis.
Causes
➢ Women with primary
dysmenorrhea have abnormal
contractions of the uterus due to
a chemical imbalance in the
body. For example, the chemical
 prostaglandin control the
contractions of the uterus.
➢ Secondary dysmenorrhea is
caused by other medical
conditions, most often
endometriosis. This is a condition
in which endometrial tissue
implants outside the uterus.
Endometriosis often causes
internal bleeding, infection, and
pelvic pain.
Clinical Manifestation
➢ Cramping in the lower abdomen.
➢ Pain in the lower abdomen and/or
lower back.
➢ Pain radiating down the legs.
➢ Nausea, vomiting and/or
diarrhea.
➢ Weakness.
➢ Fainting.
➢ Headaches.
Assessment and Diagnostic Findings
Physicians can identify dysmenorrhea
based on symptoms. They then
determine whether dysmenorrhea is
primary or secondary.
➢ History
➢ History of present illness should
cover complete menstrual history,
including age at onset of menses,
duration and amount of flow, time
between menses, variability of
timing, and relation of menses to
symptoms.
➢ Clinicians should also ask about
➢ The age at which symptoms
began
➢ Their nature and severity
➢ Factors that relieve or worsen
symptoms (including the effects
of contraceptives)
➢ Degree of disruption of daily life
➢ Effect on sexual activity
➢ Presence of pelvic pain unrelated
to menses
➢ Response to acetaminophen or
nonsteroidal anti-inflammatory
drugs (NSAIDs)
➢ Review of systems should include
accompanying symptoms such as
cyclic nausea, vomiting, bloating,
diarrhea, and fatigue.
➢ Past medical history should
identify known causes, including
endometriosis, uterine
adenomyosis, or fibroids. Method
of contraception should be
ascertained, specifically asking
about IUD use.
➢ Past surgical history should
identify procedures that increase
risk of dysmenorrhea, such as
cervical conization and
endometrial ablation.
➢ Sexual history should include
prior or current history of sexual
abuse or other traumatic events.
Medical Management
➢ Dysmenorrhea Treatment and
Nursing Care Drug Therapy
➢ NSAIDS/ Prostaglandin blockers -
➢ Oral Contraceptives
➢ Relaxation Techniques
➢ Heat Therapy
➢ Exercise
➢ Other
➢ Acupuncture
➢ Transcutaneous nerve stimulation
 Nursing Management
Nursing Diagnosis and Interventions for
Menstruation Disorders - Dysmenorrhea
Acute Pain related to increased uterine
contractility, hypersensitivity
Imbalanced Nutrition Less Than Body
Requirements related to the nausea,
vomiting.
Ineffective individual coping related to
emotional excess.
Nursing Interventions for Dysmenorrhea
1. Acute Pain related to increased
uterine contractility, hypersensitivity.
Goal: pain reduced client
Nursing Interventions:
1. Warm the abdomen.
Rational: may cause vasodilation and
reduce the spasmodic contractions of
the uterus.
2. Massage the abdominal area that
feels pain.
Rational: reduce pain due to the
stimulus of therapeutic touch.
3. Perform light exercise
Rational: it can improve blood flow to the
uterus and muscle tone.
4. Perform relaxation techniques.
Rational: reduce the pressure to get
relaxed.
5. Give the natural diuresis (vitamin)
sleep and rest.
Rational: reduce congestion.
2. Ineffective individual coping related to
emotional excess.
Nursing Interventions:
1. Assess client's understanding of her
illness.
Rational: maternal anxiety of the pain
will be greatly influenced by knowledge.
2. Determine the additional stress that
accompanies it.
Rational: stress can impair the
autonomic nervous response, so it is
feared to increase the pain.
3. Provide an opportunity to discuss how
the pain.
4. Help clients identify coping skills
during the period covered.
Rational: the use of behavior
management techniques can help
clients adapt to the pain they
experienced.
5. Give the period of sleep or rest.
Rational: the pain and fatigue due to
spending a lot of body fluids tends to be
a problem that must mean a lot of the
body tends to be significant problems
that must be addressed immediately.

6. Push the skills of stress, such as

relaxation techniques, visualization,
guidance, imagination and deep
breathing exercises.
Rational: it can reduce pain and