In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of lifestyle choices in order to:

  • Assess the client's lifestyle choices (e.g., home schooling, rural or urban living)
  • Assess client's attitudes/perceptions on sexuality
  • Assess client's need/desire for contraception
  • Identify contraindications to chosen contraceptive method (e.g., smoking, compliance, medical conditions)
  • Identify expected outcomes for family planning methods
  • Recognize client who is socially or environmentally isolated
  • Educate the client on sexuality issues (e.g., family planning, safe sexual practices, menopause, impotence)
  • Evaluate client alternative or homeopathic health care practices (e.g., massage therapy, acupuncture, herbal medicine and minerals)

Assessing the Client's Lifestyle Choices

In addition to all of the life style choices discussed above in the previous section, there are also social and educational life style choices made by individuals and family units. For example, the individual or family makes choices about whether or not they want to live in an urban, suburban or rural geographic area, whether or not they will send the children to a public or private school in their community or they will choose to home school their children.

All of these life style choices have their advantages and their disadvantages, and, when the nurse assesses that a particular life style choices is adversely affecting the individual, family or group, the nurse educates the client about some alternative life style choices that may be better for the client.

For example, home schooling may be advantageous for some clients because home schooling gives the parent(s) the ability to control the flow of the education in order to facilitate a child's movement beyond their grade level when they are an exceptional and gifted student, but it becomes disadvantageous when the levels of stress within the home increase as the result of the time and effort that goes into home schooling. At this time, the nurse will explore alternative options and choices with the family in terms of this home schooling life style choice.

Similarly, a family may elect to live in a rural area rather than a suburban or urban area. Some of the advantages of living in a rural area include the fact that there is no traffic congestion or air pollution; however, there are also disadvantages to urban living. Some of these include social isolation and the lengthy commute to shopping centers and grocery stores. This life style choice may negatively impact on the rural living client when they are no longer able to drive to the stores and when the children within the family unit are not developing in terms of their social relationships with their peers and other children other than those in the family unit. Again, the nurse will explore alternative options and choices with the family in terms of this rural living life style choice.

Assessing the Client's Attitudes/Perceptions on Sexuality

Attitudes and perceptions relating to sexuality vary among individual patients and also among those with a particular culture and/or religion that promote specific practices, beliefs and values relating to sexuality and related issues such as same sexual unions, contraception, polygamy, premarital sex and premarital cohabitation.

Regardless of the source of a patient's attitudes, perception and beliefs relating to sexuality, nurses identify these things and incorporate them into the plan of care without any judgments and regardless of the nurse's attitudes and perceptions about sexuality.

Assessing the Client's Need and Desire for Contraception

When patients have the need and desire for contraception, the nurse must support their choices regardless of the nurse's own preferences, practices and beliefs. At times, patients will express their need for contraception in a very direct manner and, at other times, the client may be reluctant to discuss sexuality and related issues like contraception. Nurse must, in these cases, establish trust with the patient and facilitate the client's open expression of their thoughts without the fear of judgements and without embarrassment.

When counseling and educating male and female clients about contraception, the nurse incorporates information about the benefits of each type of contraception, the risks associated with each, the costs, the convenience, barriers to compliance with the contraceptive regimen, and possible contraindications associated with some types of contraception.

Methods of contraception include hormonal agents, physical barrier methods, a physical mechanical means, personal techniques, and surgical procedures like combination oral contraceptives, a female condom, coitus interruptus, and a male vasectomy, respectively.

Among the many contraceptive methods are:

  • Abstinence
  • Coitus interruptus, referred to as withdrawal
  • Natural family planning based on the calendar method of calculating ovulation days
  • The basal body temperature method to determine days of ovulation
  • A male condom
  • A female condom
  • Injectable depomedroxyprogesterone acetate
  • Combination oral contraceptives
  • 91-day combination oral contraceptives
  • Combination transdermal patch contraceptive
  • A diaphragm
  • Cervical cap
  • Spermicidal agent
  • Contraceptive vaginal ring
  • Intrauterine devices like Copper T380, Skyla, and Mirena - T-shaped, polyethylene IUD with a reservoir
  • Female sterilization
  • Vasectomy
  • Emergency contraceptive pills
  • Minipill emergency contraception method
  • Progesterone agonist/antagonist pills

Identifying Contraindications to Contraceptive Methods

Some forms of contraception are contraindicated as based on the client's life style choices, their level of compliance and their medical conditions.

For example, women who have a history of deep vein thrombosis and who are cigarette smokers cannot use oral contraceptives because they are at risk for clots and strokes when this method of contraception is used.

The following contraceptive methods and their typical contraindications are shown below:

  • Transdermal contraceptive patches: A history of cigarette smoking, deep vein thrombosis, cardiac disease and cancers such as estrogen related cancers such as breast cancer
  • Diaphragm: A client history of toxic shock syndrome and a latex sensitivity when a latex diaphragm is used
  • Combined oral contraceptives: A history of cigarette smoking, deep vein thrombosis, cardiac disease and cancers such as estrogen related cancers such as breast cancer
  • Emergency contraception: This is contraindicated among women with vaginal bleeding and also among women who may have been pregnant well prior to taking this emergency contraception.
  • Vaginal contraceptive rings: A history of cigarette smoking, deep vein thrombosis, cardiac disease and cancers such as estrogen related cancers such as breast cancer

Poor rates of compliance and a desire for sexual spontaneity are reasons to discourage the use of such contraceptive methods such as the use of a diaphragm, condom, and oral contraception that is taken on a daily basis.

Identifying the Expected Outcomes for Family Planning Methods

The expected outcomes for family planning methods include the lack of unwanted pregnancies, having children when the time is right and also having a sexually satisfying relationship.

Some examples of expected outcomes relating to family planning methods include the client will:

  • Demonstrate a knowledge of the various methods of contraception specific to their needs and personal choices
  • Not have an unplanned or unwanted pregnancy
  • Have a satisfying sexual pattern without the fear of pregnancy
  • Be able to plan pregnancy

Recognizing the Client Who is Socially or Environmentally Isolated

According to the National North American Nursing Diagnosis Association International, isolation is defined as "Aloneness experienced by the individual and perceived as imposed by others and a negative or threatening state".

Some of the objective defining characteristics, signs and symptoms of social isolation are the lack of social supports, sadness, depression, hostility, a flat affect, withdrawal, developmental delays and the lack of communication with others.

Some of the client's subjective defining characteristics include the client's expressions of aloneness, rejection, a lack of purpose in life, and an inability to meet the expectations of others.

Social isolation can occur as the result of many factors and forces such as geographic distance, mental illness, a poor level of self-esteem, poor coping, a physical deformity, the lack of mobility, alterations in the client's bodily image, and even a medical disease that affects the client or a family member which leads the client's homebound status.

Registered nurses assess isolation as part of a complete client history, and depending on the etiology of the isolation, the registered nurse will plan interventions, in collaboration with other health care professionals, to overcome so that the client will be able to:

  • Identify one's feelings in reference to isolation
  • Enhance one's level of self-esteem and self worth
  • Participate in social interactions that are consistent with one's strengths, weaknesses, and personal preferences
  • Refine their interactive and communication skills in order to prepare the client for increased levels of social involvement and participation

Educating the Client on Sexuality Issues

In addition to contraception and family planning, as just discussed, clients often also need education relating to other sexuality issues like safe sexual practices, changes in sexuality secondary to developmental milestones like pregnancy and menopause, impotency and sexual dysfunction.

Some of the safe sexual practices that registered nurses educate their clients about, in addition to birth control to prevent unwanted pregnancies, are ways to prevent sexually transmitted diseases including the correct use and application of a male and female condom, the dangers associated with rectal sex, immunizations to protect against sexually transmitted diseases and the avoidance of substances such as alcohol and drugs that can decrease the person's vigilance in terms of safe sexual practices.

Sexuality during pregnancy is impacted by a number of different things including the couples' feelings about the pregnant woman's changing body, maternal fatigue, morning sickness, breast tenderness, back pain, unsubstantiated beliefs about the dangers of sexual intercourse during pregnancy, and a decreased or increased libido during pregnancy. Some of the myths revolving around sex during pregnancy that have to be debunked by the nurse include the unwarranted fear that sexual intercourse will cause a miscarriage and that sex during pregnancy will harm the developing fetus. The couple should be advised that, with a normal pregnancy, sexual intercourse is permissible and encouraged.

Sex during and after menopause may also have some issues associated with it. In addition to the physical and emotional changes associated with menopause such as vaginal dryness, mood changes and normally occurring bodily changes, the client may experience a lack of sexual desire. Again, the nurse should assess the dyad (the woman in combination with the sexual partner) to determine the etiology of any sexual concerns and problems and then address them. For example, vaginal dryness can be corrected with vaginal lubricants, low dose vaginal estrogen creams, and higher dose estrogen hormonal therapy; and the lack of sexual arousal can be treated with a PDE inhibitor, similar to Viagra, that increases blood flow to the female genitalia and sex therapy and counseling.

Sexual dysfunction and male impotency can result from a number of causes including some medications diabetes, radiation therapy, terminal disease, some surgical procedures and trauma. Depending on the etiology of the impotence or sexual dysfunction, the client can be educated about some alternatives like medication, surgical interventions and alternatives to sexual intercourse.

Evaluating the Client on Alternative or Homeopathic Health Care Practices

According to the American Society of Homeopathy, "Homeopathy or Homeopathic Medicine, is the practice of medicine that embraces a holistic, natural approach to the treatment of the sick. Homeopathy is holistic because it treats the person as a whole, rather than focusing on a diseased part or a labeled sickness. Homeopathy is natural because its remedies are produced according to the U.S. FDA-recognized Homeopathic Pharmacopoeia of the United States from natural sources, whether vegetable, mineral, or animal in nature."

According to the American Association of Naturopathic Physicians, "Naturopathic medicine is a distinct primary health care profession, emphasizing prevention, treatment, and optimal health through the use of therapeutic methods and substances that encourage individuals' inherent self-healing process. The practice of naturopathic medicine includes modern and traditional, scientific, and empirical methods."

Like other alternative treatments, some homeopathic approaches may not be substantiated as effective in the professional literature. The U.S. Food and Drug Administration does research on these homeopathic treatments and they confirm their safety; however, they do not confirm or support their effectiveness. Additionally, some of these homeopathic treatments and interventions can also have adverse side effects.

In addition to homeopathic and naturopathic medicine, chiropractic services are used by many clients. Chiropractors employ spinal manipulation and deep massage, among other treatments, particularly for the relief of chronic pain resulting from back and neck injuries. These treatments are typically safe; however, clients who are adversely affected with a spinal cord compression and/or are taking anticoagulant medications should avoid chiropractic care.

Other alternative and complementary interventions will be briefly discussed below:

  • Magnets: At the current time, the National Institutes of Health (NIH) states that magnets are not scientifically effective, however, many clients claim that they are effective in reducing pain, particularly arthritic pain and the pain associated with fibromyalgia.Magnets are not considered a safe treatment for clients with a pacemaker or insulin pump because these internally implanted devices can be adversely affected by the magnetic force of the magnet.
  • Massage: Massage is done by nurses, nursing assistants and other health care professionals such as a licensed massage therapist and a physical therapist. Massage is effective for the relief of pain and stress and it also promotes comfort and sleep.
  • Meditation: Meditation, which can be spiritual for some clients, is effective for the relief of stress, anxiety and pain, particularly when the person is able to move their thoughts and concentration inward rather than focusing on the pain and other stressors. Meditation is often combined with imagery.
  • Prayer: Scientific data now indicates that prayer is effective for the relief of stress, anxiety and pain, and unlike meditation, prayer is often religious.
  • Heat and Cold Applications: Heat and cold are effective for the relief of muscular pain. When heat or cold applications are done, the heat or cold should remain in place for no longer than 10 minutes because a longer duration will reverse the effects of the heat or cold that was applied.
  • Deep Breathing: Deep breathing and taking deep cleansing breaths are effective for the relief of pain, muscular tension and stress. As previously discussed, the techniques are shown to be effective with tension, pain, anxiety and fatigue.
  • Progressive Muscular Relaxation: Progressive muscular relaxation, with or without the guidance and coaching of the nurse, relieves muscular tension, pain and stress. Progressive muscular relaxation stimulates the parasympathetic nervous system and it decreases the autonomic nervous system stimulation. This technique is often done in combination with meditation and other alternative therapies.
  • Distraction: Distraction entails turning one's focus of attention to something other than the stressor that the person is experiencing. For example, a person can read a book, watch their favorite television show or consciously concentrate on something other than the person's pain or anxiety.
  • Imagery: This alternative, complementary strategy is done when the person focuses and concentrates on peaceful and relaxing sights such as a sunset on the beach or the running water of a stream rather than the current here and now. This strategy is often used with meditation and other alternative, complementary strategies.
  • Biofeedback: Biofeedback helps some clients with their relief of pain and stress. This alternative, complementary strategy entails the use of a monitoring device that measures things like the client's heart rate and blood pressure. As the client is performing, progressive relaxation or meditation, for example, the client is able to see their heart rate and blood pressure reduce.
  • Hypnosis and Self Hypnosis: Self-hypnosis and hypnosis done with a hypnotist can provide the client with relief from anxiety, stress, and pain. The client, which or without the guidance of a hypnotist, moves into a deep state of relaxation.
  • Transcutaneous Nerve Stimulation (TENS): Transcutaneous nerve stimulators transmit low electrical impulses through the skin (transcutaneous) to the area that is painful. This nerve stimulation alters the client's pain modulatory pathways, thus decreasing the pain.
  • Acupuncture: This eastern medicine technique employs the insertion of thin, sterile needles under the skin to reduce pain. Like acupressure, this Chinese alternative, complementary strategy has been used since ancient times.
  • Acupressure: Similar to acupuncture, this ancient Chinese therapy uses pressure instead of needles.
  • Reiki: Reiki, another eastern medicine technique, is done when the therapist places their hands on or near the person's body to promote the client's energy field and its own natural healing processes. Some belief that reiki is effective for a wide variety of things such as the relief of pain, depression and fibromyalgia.
  • Music Therapy: Music therapists interact with clients for singing, movement to music, creating music and listening to music. Not only is music therapy a form of leisure and diversion, many clients benefit from it in terms of stress and pain reduction.
  • Mind-Body Exercises: Yoga and tai chi are two examples of mind-body exercises. Mind-body exercise techniques combine meditation, deep cleansing breathing, and bodily movement.
  • Herbs, Minerals, and Supplements: Some herbs, minerals and supplements are scientifically deemed as safe and effective and others are not scientifically effective and they can also lead to harm. For example, some herbs may interact with and diminish the therapeutic effects of medications. Nurses, therefore, must assess and determine what herbs, minerals and supplements the client is taking and then determine whether or not these substances are interfering with the client's therapeutic regimen.

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