Primary Nursing Diagnosis

Infection related to bacterial invasion

OUTCOMES. Risk control: Sexually transmitted diseases

INTERVENTIONS. Teaching: Safe sex; Medication management; Fertility preservation

U PLANNING AND IMPLEMENTATION Collaborative

Treatment of gonorrhea is primarily pharmacologic, with antibiotic regimens. The Centers for Disease Control and Prevention (CDC) recommends that treatment for gonorrhea include concomitant therapy for chlamydia, because it is found in 20% to 40% of all patients with gonorrhea. Both partners should be treated at the same time and instructed to avoid sexual activity until negative cultures are obtained. If the male partner is symptomatic, the female should be treated even before culture results are obtained to prevent infertility. If a woman has an intrauter-ine device (IUD) in place, it may be removed.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Ceftriaxone and doxycycline (Cefixime, Ciprofloxacin, Ofloxacin, and Levofloxacin are also recommended by the CDC for use in lieu of Ceftriaxone)

125 mg IM single dose

100 mg PO bid for 7 days

Third-generation cephalosporin

Broad-spectrum antibiotic (tetracycline)

Effective regimen recommended by the CDC; treats chlamydia also, because both STIs often present simultaneously

Azithromycin

1 g PO single dose

Macrolide antibiotic

Can be used as an alternative for doxycyline

Erythromycin

800 mg qid

Macrolide antibiotic

Used as an alternative for doxycycline for pregnant women

Quinolones (do not use if infection was acquired in Asia/Pacific Islands owing to quinolone resistance)

Varies by drug

Antibiotic

Can be substituted for ceftriaxone single dose

Erythromycin ointment (0.5%); tetracycline 1%

Apply to conjuctiva once at delivery

Macrolide antibiotic

Ophthalmic prophylaxis; prevents newborn blindness if maternal-newborn transmission occurred

384 Guillain-Barré Syndrome

Independent

In addition to explanations of all current treatments, teach patients strategies to prevent reinfection with gonorrhea because no natural immunity develops. Additional instruction focuses on transmission of gonorrhea and identification of symptoms of other STIs. Because of the confidential and private nature of the health history and health teaching, interact with the patient in a private location where you are unlikely to be interrupted. Many experts in STIs recommend that treatment be initiated before questioning the patient about all sexual contacts so that patients will not avoid treatment when they learn that STIs are reported to the Department of Public Health. Help the patient who has had multiple sexual partners compile a list so that the partners can be notified and treated. Note that this procedure is apt to be embarrassing and stressful for the patient, who will require support and a nonjudgmental approach from the nurse.

Instruct the patient about safe sexual practices. If the patient has several sexual partners, encourage her or him to receive regular checkups to screen for STIs. Remind patients that latex condoms are the only form of birth control known to decrease the chance of contracting an STI. Provide the patient and partner with the STI hotline number: 1-800-227-8922.

Comfort measures are important. Loose, absorbent undergarments that the patient changes frequently will decrease discomfort from the genitourinary mucous discharge. Discuss the importance of perineal or penile cleansing and good hand-washing techniques. Sitz baths may help decrease lower abdominal discomfort.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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