Content check — Fundamentals of Nursing, Chapter 33: Sexuality

Case Study 33.3.1 §33.3 source ↗

Mr. Morales, a 46-year-old male, is being seen in the clinic for an annual wellness examination. During the examination, Mr. Morales reports that he has been having trouble achieving and maintaining erections during sex. He states, “My wife is getting frustrated and so am I. I’m not even that old yet. Why is this happening to me?”

Past Medical History

Medical history: Type 2 diabetes, hypertension, depression
Family history: Both parents alive and well, mother has hypertension and depression.
Social history: Married x twenty years, two teenage children. Wife recently diagnosed with breast cancer.
Current medications:

• Fluoxetine (Prozac) 20 mg PO daily

• Metoprolol (Lopressor) 50 mg PO twice daily

Recognize cues: Based on the provided information, what cues are most significant for the nurse to recognize?

Answer

First, the nurse must recognize the patient’s report about being unable to achieve or maintain an erection is significant because sexual dysfunction can negatively impact overall health. The nurse should also recognize the patient is actively being treated for depression and hypertension based on the current medications listed.

Case Study 33.3.2 §33.3 source ↗

Mr. Morales, a 46-year-old male, is being seen in the clinic for an annual wellness examination. During the examination, Mr. Morales reports that he has been having trouble achieving and maintaining erections during sex. He states, “My wife is getting frustrated and so am I. I’m not even that old yet. Why is this happening to me?”

Past Medical History

Medical history: Type 2 diabetes, hypertension, depression
Family history: Both parents alive and well, mother has hypertension and depression.
Social history: Married x twenty years, two teenage children. Wife recently diagnosed with breast cancer.
Current medications:

• Fluoxetine (Prozac) 20 mg PO daily

• Metoprolol (Lopressor) 50 mg PO twice daily

Analyze cues: What might be some contributing factors to the patient’s reported erectile dysfunction (ED) symptoms?

Answer

The nurse should recognize that both antidepressant and antihypertensive medications can contribute to the development of ED and this patient is on both types of medications. The patient also has a history of diabetes, which has been linked to ED. Additionally, the patient is experiencing depression, which may impact his sexual health and well-being.

Case Study 33.3.3 §33.3 source ↗

Mr. Morales, a 46-year-old male, is being seen in the clinic for an annual wellness examination. During the examination, Mr. Morales reports that he has been having trouble achieving and maintaining erections during sex. He states, “My wife is getting frustrated and so am I. I’m not even that old yet. Why is this happening to me?”

Past Medical History

Medical history: Type 2 diabetes, hypertension, depression
Family history: Both parents alive and well, mother has hypertension and depression.
Social history: Married x twenty years, two teenage children. Wife recently diagnosed with breast cancer.
Current medications:

• Fluoxetine (Prozac) 20 mg PO daily

• Metoprolol (Lopressor) 50 mg PO twice daily

Prioritize hypotheses: The nurse recognizes the patient’s symptoms are consistent with erectile dysfunction (ED) and that it may be partially caused by his current health status and medications. What other information should the nurse obtain from the patient at this time regarding potential causes of his ED symptoms?

Answer

The nurse should gather information about potential psychological and psychosocial factors that may be causing the ED symptoms. The nurse should first ask more about the patient’s depression and if he feels that it is being treated effectively. The nurse should also gather information about the patient’s body image, stress level, culture, religion, and lifestyle to gain a better understanding of any risk factors that may be present and contributing to his ED symptoms.

Case Study 33.4.4 §33.4 source ↗

Refer back to Unfolding Case Study #5: Part 1 for a review on the patient data.

Nursing Notes

1035:
Patient expresses concern about erectile dysfunction. He reports frustration about being unable to participate fully in sexual intercourse with his wife. He reports his wife is also frustrated with the situation, especially given her new diagnosis of breast cancer. He states, “I don’t want to start taking Viagra in my 40s. That’s just embarrassing. Surely there is something else I can do. My wife thinks I don’t want to have sex with her because she has cancer, which isn’t even remotely true. My body is failing me.”

Generate solutions: The nurse prepares to report the patient’s concerns to the treating provider. What interventions does the nurse anticipate the provider might order?

Answer

The nurse should anticipate the provider will want to obtain a more thorough history of the symptoms. Additionally, the nurse should anticipate the provider may suggest a combination of medications and counseling to treat the ED symptoms. The provider may also suggest counseling or support groups for spouses of cancer patients.

Case Study 33.4.5 §33.4 source ↗

Refer back to Unfolding Case Study #5: Part 1 for a review on the patient data.

Nursing Notes

1035:
Patient expresses concern about erectile dysfunction. He reports frustration about being unable to participate fully in sexual intercourse with his wife. He reports his wife is also frustrated with the situation, especially given her new diagnosis of breast cancer. He states, “I don’t want to start taking Viagra in my 40s. That’s just embarrassing. Surely there is something else I can do. My wife thinks I don’t want to have sex with her because she has cancer, which isn’t even remotely true. My body is failing me.”

Take action: The nurse is getting ready to discuss the use of medications to treat the patient’s ED symptoms. Thinking about how the nurse can act as both an educator and a role model, how might the nurse go about handling this conversation?

Answer

Because providing education about sexual health topics can be sensitive and difficult, the nurse should first create a safe and supportive environment for the patient to openly discuss his concerns. As an educator, the nurse should provide the patient with factual and easy-to-understand information about the potential causes of ED and what treatments are available. The nurse must employ good communication skills during this discussion, such as by using active listening and nonjudgmental language to create a safe place for the dialogue to occur. The nurse should focus on the facts, ensure that the patient understands that his symptoms are not his fault, and provide him with the education and resources that he needs to make informed decisions about his sexual health.

Case Study 33.4.6 §33.4 source ↗

Refer back to Unfolding Case Study #5: Part 1 for a review on the patient data.

Nursing Notes

1035:
Patient expresses concern about erectile dysfunction. He reports frustration about being unable to participate fully in sexual intercourse with his wife. He reports his wife is also frustrated with the situation, especially given her new diagnosis of breast cancer. He states, “I don’t want to start taking Viagra in my 40s. That’s just embarrassing. Surely there is something else I can do. My wife thinks I don’t want to have sex with her because she has cancer, which isn’t even remotely true. My body is failing me.”

Evaluate outcomes: What are some examples of positive patient outcomes that the nurse should assess for after providing the patient with information about treatment options for his ED symptoms?

Answer

First and foremost, the patient should express an understanding of the provided information. The patient should also feel empowered to take control of his sexual health decisions versus feeling bad that he needs pharmacologic assistance to maintain an erection. Long-term positive outcomes after treatment initiation would include improvement in ED symptoms and less sexual frustration reported by both the patient and his wife.