NSG122 Exam 5 Blueprint

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Herzing University *

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122

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Chemistry

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Jan 9, 2024

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Page 1 of 13 NSG 122 Fundamentals EXAM V Exam Blueprint Unit 13: Nursing Support of Fluid, Electrolyte, & Acid-Base Balance Topic: Location Fluid Loss: definitions and Types A. Sensible B. Insensible - Fluid is lost from both sensible and insensible A. Sensible losses can be measured and include fluid lost during urination, defecation, and wounds. B. Cannot be measured or seen and includes: - fluid lost from evaporation through the skin and - as water vapor from the lungs during respiration. NSG122.13.01.01. Fluid Intake: Regulation A. Hypothalamus- controls? B. Kidneys-controls? C. Metabolic Oxidation? A. Fluid intake is regulated by the thirst mechanism and the thirst control center is located w/in the hypothalamus. The thirst control center is stimulated by intracellular dehydration (the loss of deprivation of water from the body or tissues) and decreased blood volume. B. Fluid output/ approximately 1500 mL as urine from the kidneys C. Fluid intake approximately 300 mL from metabolic oxidation - Water is an end product of the oxidation that occurs during the metabolism of food substances, specifically carbs, fats, and protein NSG122.13.01.01 Fluid and Electrolyte: Regulation A. Adrenal Glands B. Pituitary Glands C. Thyroid glands A. Regulate blood volume and sodium and potassium balance by secreting aldosterone, a mineral corticoid secreted by the adrenal cortex, causing sodium retention (water retention) and potassium loss. - It helps the body CONSERVE sodium, save chloride and water, and EXCRETES potassium. B. Stores and releases ADH C. ↑ blood flow in the body and ↑ renal circulation NSG122.13.01.02. Body Fluid Compartments: Types A. Intracellular fluid (ICF) within cells B. Extracellular fluid (ECF) outside of cells - The body produces balance by shifting fluids and solutes between the ECF and the ICF. A. Shift of fluids and transporting materials to and from intracellular compartments include: - Organs and body systems: kidneys, Gi tract, nervous system, CV system, lungs, adrenal glands, pituitary glands, thyroid glands, parathyroid glands - Osmosis: water moving from an area of lesser concentration to an area of greater concentration. Osmosis stops when concentration is equalized on both sides of the membrane. - Diffusion: Solutes move from an area of higher concentration to an area of lower concentration until the concentration is equal on both sides. NSG122.13.01.03

Page 2 of 13 - Active transport: Solutes are moved/pumped from an area of lower concentration to an area of higher concentration. - Capillary filtration: Results from the force of blood pushing against the walls of the capillaries. Depends on both arterial and venous blood pressure. B. Includes: - Intravascular fluids- plasma - Interstitial fluids- surrounds tissue cells including lymph - Transcellular fluids-cerebrospinal, synovial, intraocular, pleural fluid, sweat, and digestive secretions - Infants have more ECF and are at ↑ risk for fluid volume deficits bc ECF is more easily lost from the body Fluid Volume: Signs and Symptoms: Deficit A. Intercellular B. Intracellular A. Hyponatremia/ hypernatremia B. Hypokalemia/hyperkalemia C. Hypocalcemia, hypercalcemia D. Hypomagnesia/ hypermagnesia E. Hypophosphatemia/ hyperphosphatemia F. Hypochloremia/ hyperchloremia NSG122.13.02.01 Fluid Volume: Excess A. Most Accurate Assessment of Fluid Volume? A. Fluid I/O- alert family and caregivers the need to measure all fluids entering and leaving the body B. daily weight – more accurately depicts fluid balance status. C. lab studies (CBC) D. physical assessment: skin and tongue turgor, edema, moisture, tearing, salivation, facial appearance, temp, VS ) - NSG122.13.02.01 Fluid Volume Deficit: Third Space fluid shift: Definition A. Definition B. Deficit in ECF occurs C. Becomes trapped in the body D. Causes: Burns, Sepsis, ect A. refers to a distributional shift of body fluids into the transcellular compartment such as the pleural peritoneal or pericardial areas, joint cavities, the bowel, or an excess accumulation of fluid in the interstitial space. B. W/ 3 rd space fluid shift a deficit in ECF volume occurs C. The fluid moves out of the intravascular spaces (plasma) to any of the transcellular compartment spaces where once they’re trapped, the fluid is not easily exchanged w/ ECF. - Fluid isn't lost but it is trapped in another body space for a period of time and is essentially unavailable for use. D. 3 rd Space Shift may occur as a result of a severe burn, bowel obstruction, surgical procedures, pancreatitis, ascites, or sepsis. NSG122.13.01.03 Diuretics A. Potassium sparing, loop, and thiazide NSG122.13.01.03

Page 3 of 13 A. Types B. What electrolytes to monitor B. Sodium, potassium, phosphate, and chloride Alcohol (ETOH) Withdrawal A. electrolyte imbalances B. Monitor? A. Hypomagnesia and hypophosphatemia B. Muscle weakness, tremors, tetany, seizures, heart block, change in mental status, hyperactive deep tendon reflexes and respiratory paralysis. NSG122.13.01.03 ABGs: Interpretation Values and Causes: Acidosis: Ph Value A. Normal ph B. Acidosis C. Alkalosis When normal pH is exceeded in either direction, death can occur A. In between 7.35-7.45 -7.4 is the optimal blood pH. B. Condition characterized by an excess of H ions or loss of base/bicarb ions in ECF - pH below 7.35 C. occurs when there’s a lack of H ions or a gain of base/ bicarb ions - pH above 7.45 NSG122.13.01.04 * ABGs: Compensation A. Metabolic buffers B. HCO3: meaning and normal value C. CO2: Meaning and normal value D. Metabolic problem- Respiratory system compensates— E. Respiratory system problem- Renal system compensates A. A substance that prevents body fluids from becoming overly acidic or alkaline. B. Reflects bicarb level of the body and normal value is 22- 26 C. Regulates carbonic acid and normal value is 35-45. D. Metabolic acidosis: the lungs attempt to ↑ CO2 excretion by ↑ the rate and depth of respirations which occurs within a short time. However, respiratory compensation is generally not adequate. Metabolic Alkalosis: The body attempts to compensate by retaining CO2. - Respirations become slow and shallow, and periods of no breathing may occur. E. Metabolic acidosis: Kidneys attempt to compensate by retaining bicarb and by excreting more hydrogen. Metabolic alkalosis. The kidneys attempt to excrete excess water and sodium ions with the excessive bicarb. And retain hydrogen ions. NSG122.13.01.04 ABG A. Which value/result on AG indicates Acidosis or alkalosis? A. ABG findings are obtained through analysis of an arterial blood sample. B. The pH of the plasma blood indicates balance or impending acidosis or alkalosis. C. The blood's O2 and CO2 gas values are also reported, providing info regarding the effectiveness of the respiratory system. NSG122.13.01.04 ABG Interpretation: A. Respiratory Acidosis B. Respiratory Alkalosis A. ↓ pH <7.35, ↑ CO2, Normal HCO3 B. ↑ pH >7.45, ↓ CO2, Normal HCO3 NSG122.13.01.04 Electrolytes: Sodium: Food choices and teaching A. Hypernatremia: B. Hyponatremia A. Avoid foods high in sodium such as processed chees, lunch meats, canned soups/veggies, salted snack foods and eliminate use of table salt. B. - NSG122.13.02.02

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Page 4 of 13 Fluid Volume Assessment A. Assessment First B. Daily Volume C. Fluid preferences D. Offer fluids on a schedule A. – B. The care plan specifies the amount of fluid to be ingested in 24 hours C. Patients preference, choose or assist with choosing fluids that must provide the calories and electrolytes needed by the patient. If patients dislike taking fluids or for gelatin, popsicles, ice water or other alternative sources of liquid. D. Always have fluids readily available for the patient. Take care to avoid a situation in which patients are unable to secure their own fluids. Encourage the patient to participate in one's own care by helping to keep a record of intake. NSG122.13.02.02 Fluid Volume Assessment: A. Fluid Volume Deficit: Signs and Symptoms / Findings B. Fluid Volume Excess: Signs and Symptoms / Findings A. Change in mental status, ↑ body temp and HR, ↓ BP, ↓ skin turgor, dry oral mucosa, cracked lips, furrowed tongue, scanty dark urine, sudden weight loss r/t -inability to obtain or swallow fluids (oral pain and debilitation), extremes of age, vomiting, diarrhea, burns, excessive use of laxatives, excessive diaphoresis, fever. B. Pitting edema, shiny skin, up to 10lb weight gain, dyspena w/ exertion, feeling weak and fatigued, adventitious breath sounds, ↑ BP, r/t- renal failure, decreased cardiac output, Excessive IV infusion fluid intake, excessive sodium intake NSG122.13.02.01 Fluid Volume : Treatment A. Fluid Volume Deficit: Treatment B. Fluid Volume Excess: Treatment A. Increase foods w/ high water content, offering a variety of fluids B. Enemas, laxatives, antacids, OTC drugs, or herbal meds to promote urination NSG122.13.02.02 Electrolytes: Diet Modification A. Foods High and low in Sodium B. Foods high and low in Potassium A. High: processed cheese, lunch meats, canned soups and vegetables, salted snack foods B. High: bananas, citrus fruit, apricots, melons, broccoli, potatoes, raisins, lima beans NSG122. 13.02.02 Fluids: Types: when to use: Clinical examples A. Isotonic solution B. Hypertonic solution C. Hypotonic solutions A. Total osmolality close to that of ECF; replaces ECF B. Hypotonic to plasma; replaces ICF C. Hypertonic to plasma NSG122.13.02.03 Fluids: Types: Which type are they? A. Isotonic- 0.9% Normal Saline, Lactated Ringers A. Normal Saline- Not desirable as routine maintenance solution bc it provides only sodium and chloride, which are provided in excessive amounts -May be used to expand temporarily the extracellular compartment if circulatory insufficiency is a problem; NSG122.13.02.03

Page 5 of 13 B. Hypotonic- 0.45% Normal Saline; 0.33% Normal Saline (basic fluid for maintenance) C. Hypertonic- 10% Dextrose in Water; 5% Dextrose in 0.9% Normal Saline Also used to treat hypovolemia, metabolic alkalosis, mild hyponatremia, hypercalcemia. LR- Contains multiple electrolytes and about the same concentrations as found in plasma. Note that this solution is lacking in magnesium. B. 0.33% Sodium Chloride- Provides sodium chloride and free water. -Sodium and chloride allow kidneys to select and retain needed amounts. -Free water desirable as aid to kidneys and elimination of solutes. 0.45% Sodium chloride-a hypotonic solution that provides sodium and chloride and free water. Used as a basic fluid for maintenance needs. C. 5% dextrose in LR solution- Supplies fluid and calories to the body. Replaces electrolytes. Shifts fluid from the intracellular compartment into the intravascular space, expanding vascular volume. 5% dextrose and .9% Sodium chloride- Used to treat SIADH. Can temporarily be used to treat hypovolemia if plasma expander is not available. Selected IV Solutions and Uses: A. Isotonic: 9% Normal Saline • Uses? Lactated Ringers • Uses? B. Hyportonic • Uses? C. Hypertonic 5% dextrose in 0.9% Normal Saline D. • Uses? A. Normal saline- Used with admin of blood transfusions. LR- Using the treatment of hypovolemia, burns and fluid loss from GI sources. B. 0.33% Sodium chloride- Used in treating hypernatremia. 0.45% normal saline- Used as a basic fluid for maintenance needs. Often used to treat hypernatremia because the solution contains a small amount of sodium, it dilutes the plasma sodium while not allowing it to drop too rapidly. C. 5% dextrose in LR solution- Replaces electrolytes. Shifts fluid from the intracellular compartment into the intravascular space, expanding vascular volume. 5% dextrose and 9% sodium chloride- Used to treat SIADH. Can temporarily be used to treat hypovolemia if plasma expander is not available. NSG122.13.02 Fluid Volume Replacement A. Which Solution? Maintenance Fluid A. Which Solution? A. Isotonic, Hypotonic, Hypertonic B. 0.45% NaCl (1/2 strength normal saline) Central Venous Access: Port A. Long term B. Where located? C. X ray needed before use A. A long term CVAD is an implanted port which consists of a subq injection port attached to a catheter. B. The distal catheter tip dwells in the lower segment of the superior vena cava at or near the cavoatrial junction (CAJ), the point at which the superior vena cava meets and melds into the superior wall of the right atrium, and NSG122.13.02.03

Page 6 of 13 the proximal end or port is usually implanted in a subcutaneous pocket of the upper chest wall. C. Confirmation of tip location either by post procedure chest radiograph or by technology used during the placement procedure is required prior to use and should be documented in the pts health record Peripheral Venous Access: Infiltration A. Keep site and tubing visible B. Site stabilization device C. Asses q4 hours Infiltration: the escape of fluid into the subq tissue Complication/ cause: dislodged needle or penetrated vessel wall A. Discontinue the infusion if symptoms occur and restart the infusion at a different site -S/S: swelling, pallor, coldness or pain around the infusion site; significant ↓ in the flow rate B. Use site stabilization device C. Check infusion site every hour for signs / symptoms NSG122.13.02.04 Peripheral Venous Access: Phlebitis A. What is Phlebitis B. Signs of Phlebitis C. RN steps when phlebitis is assessed? A. Inflammation of the wall vein B. Warm red skin C. -Discontinue the infusion immediately -Apply warm compresses to the affected site -Restart IV at other site -Avoid further use of the vein NSG122.13.02.04 Administering Blood: Hemolytic Infusion Reaction A. What is a hemolytic Infusion reaction? B. Why does it occur? C. Signs and symptoms patient may report? D. Difference between allergic reaction and hemolytic infusion reaction? A. A life threatening complication risk associated with blood product transfusion B. Incompatibility w/ blood C. - Immediate onset - Facial flushing - Fever - Chills - Headache - Low back pain - Shock D. Allergic reaction- Allergy to transfused blood -hives, itching, anaphylaxis NSG122.13.02.05 Administering Blood (transfusion): Steps 1. Steps for blood infusion? 2. What to look out for? 1. Administering- Blood typing and cross matching -Blood type -Rh factor -selecting blood donor -initiating transfusion In itiation and Transfusion-Two adults in the presence of the patient should perform pretransfusion safety checks together prior to blood product administration. -Confirmation of the patient's identity with at least two independent recipient identifiers, such as the patient's full name and birthdate, is critical. -The patient's blood type and Rh factor should also be checked against the blood type and Rh factor of the transfusion product NSG122.13.02.05

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Page 7 of 13 -the nurse should always confirm the donation identification number (a code to track the blood back to its donor) and the expiration date and date/time of issue of the blood product. -Bar codes on blood products provide an additional safety measure to identify, track, and assign data to transfusions. In addition, the facility that prepared the blood must be identified. -Blood or blood components may be transfused via a 20- to 24-gauge peripheral venous access device for an adult. 2. Transfusion reactions – allergic reaction, febrile reaction, hemolytic transfusion reaction, circulatory overload, bacterial reaction Unit 14: Nursing Support of Diverse Patient Populations Self-Concept: Assessment A. Patient’s description B. Body image C. Self esteem D. Role performance A. It’s important to identify and label a pts positive self- concept as it is to note problems. -Developmental changes -Trauma -Biological sex dissonance -Cultural dissonance -Strengths/ Fears -Personal characteristics and traits B. Patients experiencing illness or trauma resulting in body disfigurement, altered functioning, or life crises that arrest development and thwart the achievement of life goals are at high risk for problems related to self-concept and should be assessed more carefully. If potential problems surface during the interview, a more thorough assessment should be carried out. RISK FACTORS: - loss of body part or function - disfigurement - developmental changes ASSESS (1,2) pts response to the deformity/limitation, including (3,4) changes in independence-dependence patterns and in socialization and communication. 1. Adaptive responses: Pt exhibits signs of grief and mourning (shock, disbelief,denial, anger, guilt, acceptance) 2. Maladaptive responses: Patient continues to deny and to avoid dealing with the deformity or limitation, engages in self-destructive behavior, talks about feelings of worthlessness or insecurity, equates NSG122.14.01.02

Page 8 of 13 deformity or limitation with whole person, shows a change in ability to estimate relationship of body to environment. 3. Adaptive responses: Pt assumes responsibility for care (makes decisions), develops new self-care behaviors, uses available resources, interacts in a mutually supportive way w/ family 4. Maladaptive responses: Patient assigns responsibility for his or her care to others, becomes increasingly dependent, or stubbornly refuses necessary help. C. You can obtain a quick indication of a patient's self-esteem by using a graphic description of self-esteem as the discrepancy between the “real self” (who we think we really are) and the “ideal self” (who we think we would like to be). The greater the discrepancy, the lower the self-esteem; the smaller the discrepancy, the higher the self-esteem. A person's ideal self may differ dramatically from the current sense of self and may positively or negatively influence behavior and personal development. If a more detailed assessment is needed, the concepts of socialization and communication, significance, competence, virtue, and power should be explored next. RISK FACTORS: -Unhealthy interpersonal relationships -Failure to achieve developmental milestones -Failure to achieve life goals -failure to live up to personal moral code -sense of powerlessness D. role performance , is easily compromised by illness and injury. Thus, all people whose roles are altered or compromised are at risk for disturbances in self-concept. Role performance may also be affected by: role ambiguity (failure to completely and accurately understand what a role demands) role stress (disparity between what one believes the role demands and what one is able to offer), and role overload (limited time because of other commitments makes it impossible to meet realistic role expectations). RISK FACTORS: -loss of valued role -ambiguous role expectations -conflicting role expectations

Page 9 of 13 -inability to meet role expectations Low Self Esteem: Reframing A. Definition? B. How can we use this technique? C. How does this allow the patient to alter their perspective from a negative to positive view? A. The general principle is to help the pt alter his/her perspective of a situation from a more neg. view to a more pos. view. B. - Help the pt identify and describe in detail how the pt thinks and feels about situations r/t self concept. - Explore w/ the pt alternative ways of viewing the same situation - Teach the pt to red flag faulty thinking behavior as soon as the patient C. Once a person can view his or her situation more positively, a wider variety of behavioral options, coping mechanisms, or internal or external supports can be identified and activated. NSG122.14.01.03 Cultural: Adaptation to majority culture A. Behaviors B. Characteristics A. Culture helps shape what is acceptable behavior for people in a specific group. It is shared by and provides an identity for members of the same cultural group. B. Culture is learned by each new generation through both formal and informal life experiences. Language is the primary means of transmitting culture. The practices of a particular culture often arise because of the group's social and physical environment. Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group's needs. Culture influences the way people of a group view themselves, have expectations, and behave in response to certain situations. Because a culture is made up of people, there are differences both within cultures and among cultures. NSG122.14.02.01 Culturally Congruent Care: Culture Shock A. Definition A. Culture shock may result in psychological discomfort or disturbances, bc the patterns of behavior a person found acceptable and effective in his or her own culture may not be adequate or even acceptable in the new culture. The person may then feel foolish, fearful, incompetent, inadequate, or humiliated. These feelings can eventually lead to frustration, anxiety, and loss of self-esteem. NSG122.14.02.01 Culturally Congruent Care: Health History A. Native Americans : Heart disease, Cirrhosis, DM, Fetal alcohol syndrome. African Americans: HTN stroke, sickle cell anemia, lactose intolerance, and keloids. NSG122.14.02.01

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Page 10 of 13 A. Common health problems B. Common risk factors C. Encourage Healthy practices Asians. HTN, Liver cancer, Lactose intolerance, Thalassemia. Hispanics: DM, Lactose intolerance. Whites: Breast cancer, heart disease, HTN, DM, obesity. Eastern European Jews: Cystic fibrosis, Gaucher's disease, spinal muscular atrophy, Tay Sachs disease. B. Physiologic Variations, food and nutrition, and socioeconomic factors (highest risk are children, older people, families headed by single mothers, and the future generations of those now living in poverty.) C. Culturally Congruent Care: Mental Health A. Some cultures Mental Health is a stigma B. Some cultures wish to deal with mental health issues within the family, not the healthcare system C. Can be accepted reaction of their culture A. Some traditional Chinese people consider mental illness, stigma and seeking psychiatric help a disgrace to the family. B. Hispanic people deal with problems within the family and considerate inappropriate cell problems to a stranger. C. Times of high stress or anxiety, some Puerto Ricans may demonstrate A hyperkinetic seizure like activity known as ataques. This behavior is a culturally accepted reaction. NSG122.014.02.01 Culturally Congruent Care: Religious/ Healing Ceremonies A. Steps Nurse’s can do to provide? A. Incorporate factors from the patient's cultural background into health care whenever possible if the practices would not be harmful to the patient's health. To ignore or contradict the patient's background may result in the patient refusing care or failing to follow prescribed therapy. Modify care to include traditional practices and practitioners as much as possible, and be an advocate for patients from diverse cultural groups. Accommodate the cultural dietary practices of patients as much as possible. Dietary departments in many hospitals and long-term care facilities can provide meals that are consistent with special dietary practices. Families may be encouraged to bring food from home for patients with particular preferences when this practice does not violate policy. Teaching patients and families about therapeutic diets may also be appropriate within the framework of particular cultural practices. NSG122.014.02.02

Page 11 of 13 Culturally Congruent Care: Pain A. React/express pain differently B. Some beliefs/ cultures may not use pain medication A. Some cultures allow or even encourage the open expression of emotions related to pain, whereas other cultures encourage suppression of such emotions. * Be sensitive to nonverbal signs of discomfort, such as holding or applying pressure to the painful area, avoiding activities that intensify the pain, and uncontrollable spontaneous expressions of discomfort such as facial grimacing and moaning. You also shouldn't consider patients who freely express their discomfort as constant complainers with excessive requests for pain relief. Pain is a warning from the body that something is wrong. Pain is what the patient says it is, and every complaint of pain should be assessed carefully. B. Herbs, plant sources, herbal teas. Cutaneous simulation- massage vibration, heat, cold or nerve stimulation Therapeutic touch -intentional act that involves an energy transfer from the healer to the patient to stimulate the patient's own healing potential. Acupuncture -Long used in China, is a method of preventing, diagnosing and treating pain and disease by inserting special needles into the body at specified locations. Acupressure - a deep pressure massage of appropriate points of the body. NSG122.014.02.02 (x2) Culturally Congruent Care: Beliefs A. How Nurse’s can assess for patient beliefs A. An assessment of the patient's spirituality—including beliefs and practices, the effect of these beliefs on everyday living, spiritual distress, and spiritual needs— should be included in each comprehensive nursing history . • H— Sources of H ope, meaning, comfort, strength, peace, love, and connection • O—O rganized religion • P—P ersonal spirituality and practice • E—E ffects on medical care and end-of-life issues If the patient reveals a spiritual problem, use interview questions to determine the specific nature of the problem, its probable causes, its related signs and symptoms, when it began and how often it occurs, how it affects everyday living, its severity and whether it can be treated independently by nursing or needs to be referred, and how well the patient is coping. NSG122.014.02.04 Spirituality and Culture: Meeting the patient’s needs A. Patient requests should be A. Respect pts need for privacy or quiet during periods of prayer. B. -Assist the pt to obtain devotional objects and protect them from loss or damage -Arrange for pt wishing to receive the sacraments to do so NSG122.014.02.04

Page 12 of 13 respected, if safe B. Support patient’s decisions and incorporate in care, if safe -Arrange for pts minister, priest, or rabbi to visit if the pt so wishes Becoming a healing prescence: Open yourself. Intend to be a healing presence. Prepare a space for healing presence to take place. Honour the one in your care, offer what you have to give, receive the gifts that come. Live a life of wholeness and balance. Caring: A. Gender identity definition? B. Sexual orientation? Definition C. Biological Sex? Definition D. Body image? definition A. Gender identity: The inner sense a person has of being male or female (or other), which may be the same as or different from the person's biological sex. B. Sexual orientation: Refers to romantic, emotional, affectionate or sexual attraction to other people. C. Biological sex: The term used to denote chromosomal sexual development: male (XY) or female (XX), external and internal genitalia, secondary sex characteristics and hormonal states. D. - NSG122.14.03.01 Caring: Gender identification/ Identity A. Confirm gender preference B. Ask patient how they would like to be addressed A. Heterosexual, gay/lesbian, bisexuals, transsexual, asexual, and questioning B. Preferred pronouns NSG122.14.03.01 Caring: Alternate forms of Sexual expression: Definitions A. Pedophilia B. Masochism C. Voyeurism D. Sadism E. Which are reportable? A. The practice of adults gaining sexual fulfillment by performing sexual acts with children. Involves children who by nature of their age and maturity, cannot consent to sexual activity. Pedophilia is wrong, illegal, and maladaptive in all cases. B. Gaining sexual pleasure from the humiliation of being abused. C. The achievement of sexual arousal by looking at the body of someone other than one’s sexual partner. Although it's not inherently wrong, some voyeurs develop complex means to spy on others that involve violations of privacy that are illegal. D. The practice of gaining sexual pleasure while inflicting abuse on another person. E. ALL ARE REPORTABLE NSG122.14.03.01 Caring: Sexual expression: Impotence A. New medications have revolutionized tx for erectile dysfunction. Sildenafil, vardenafil, tadalafil are the meds. B. Premature/ Delayed ejaculation, DM2 NSG122.14.03.02

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Page 13 of 13 A. Assess medications B. Assess Disease processes C. Depression C. Common causes can be physiologic or psychological - Various illnesses, tx for these illnesses, and personal anxieties. Even mild depression can affect desire and sexual functioning. STI: Sexually transmitted Infections: Teaching A. Which can be cured/treated with Antibiotics B. Which cannot be reversed/ cured C. STIs that are parasitic A. Chlamydia, gonorrhea, and syphilis- left untreated the effects can be devastating . B. HIV, AIDS, HPV, hepatitis C. Trichomoniasis (Trich), scabies, lice, and giardia NSG122.14.03.02