Reproductive Nursing Spring 2024 Student Copy_425a10e28b9ec37f73ffa2bb0f6b9da8

Reproductive Nursing Overview

  • Presented by Jennifer Hibbard, BSN, RN.

  • Core Chapters:

    • RN Adult Medical Surgical Nursing ATI: Chapters 2 and 64-67

    • RN Maternal Newborn Nursing ATI: Chapters 1-2

    • RN Pharmacology for Nursing ATI: Chapters 29 & 30

LGBTQIA Populations

  • Definition: Includes individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual.

  • Diversity: Encompasses various races, ethnicities, ages, and socioeconomic backgrounds.

  • Healthcare Needs: Care should be culturally sensitive and compassionate.

Terminology Definitions

  • Sexuality: Individual's personal expression and experience of intimacy.

  • Sexual Orientation: Preferences based on sexual attraction, behaviors, and identity.

  • Gender Identity: Personal self-concept of gender, which may differ from sex assigned at birth.

  • Gender Dysphoria: Discomfort or distress due to discrepancy between gender identity and assigned sex at birth.

Understanding Sexual Orientation

  • Heterosexual: Attraction to different gender.

  • Gay: Attraction to the same gender.

  • Lesbian: Women attracted to same gender.

  • Bisexual: Attraction to more than one gender.

Gender Identity Categories

  • Cisgender: Gender aligns with assigned sex at birth.

  • Gender-nonconforming: Gender expression differs from cultural norms.

  • Transgender: Identifying as a gender different from assigned sex.

  • Nonbinary: Identifying as a gender outside the male-female binary.

Gender Dysphoria Details

  • Not all gender-nonconforming individuals experience gender dysphoria.

  • DSM-5-TR Criteria: At least 2 identifiers for a minimum of 6 months.

  • Health Professional Actions: Discuss gender roles, medical affirmation (hormones, procedures), and psychotherapy referrals.

Health Promotion & Disease Prevention

  • STI Screening: Annual for sexually active individuals for chlamydia, gonorrhea, syphilis, and HIV.

  • Care considerations for gender dysphoria clients during examinations.

  • Contraceptive Use: Encourage condom use to decrease HIV risk.

  • Cancer Screenings: Transgender clients need education on cancer risks and recommended screening continuations.

Healthy People 2030 Goals

  • Health Improvement: Focus on enhancing health and safety of LGBTQIA populations, especially adolescents.

  • Adolescents:

    • Decrease bullying.

    • Reduce illicit drug use.

    • Decrease suicidal thoughts.

Adding Data Collection for LGBTQIA Populations

  • Introduce surveys for better data on LGBTQIA needs.

  • Engage more states in collecting standard data on sexual orientation and identity.

STI Prevention and Management

  • HIV Goals: Reduce new infections, promote knowledge of HIV status, decreased diagnoses.

  • Syphilis Control: Focus on men who have sex with men for annual screening.

Social Determinants of Health

  • Key Factors: Economic stability, physical environment, education, food access, community support, health care.

Assessment of Health Risks for LGBTQIA Populations

  • Mental health conditions, including depression and anxiety.

  • Physical health examinations should include screening for BMI and cardiovascular conditions.

Patient-Centered Care Strategies

  • Children: Assess gender play and preference during health visits.

  • Adolescents: Discuss sexuality, substance use, and bullying; identify gender dysphoria respectfully.

  • Older Adults: Recognize stressors due to lifelong discrimination; provide inclusive care.

Nursing Actions for Inclusive Care

  • Create a gender-affirming environment to mitigate bias.

  • Use inclusive language and ask for preferred names/pronouns.

Interprofessional Care Teams

  • Include healthcare providers, mental health professionals, endocrinologists, pediatricians, social workers.

Gender-Affirming Care Procedures

  • Discuss hormonal therapy and surgical options related to transitioning.

  • Fertility preservation discussions prior to puberty suppression.

Hormonal Therapy in Adolescents

  • Initial Evaluation: Confirm gender dysphoria and ensure informed consent.

  • Monitor physical development throughout treatment.

Hormonal Therapy for Adults

  • Assess for pre-existing conditions before initiating therapy.

  • Emphasize the importance of education regarding gender alignment surgeries.

Medications in Gender-Affirming Treatment

  • Estrogen/Estradiol: Assists in feminization and is administered via PO, transdermal, or injections; monitor for risks of cancer.

  • Testosterone: Induces masculinization, available in several forms, and requires monitoring for side effects.

Surgical Procedures in Transgender Healthcare

  • General Requirements: Continuous hormonal therapy for 1 year, living as the identified gender, >18 years of age.

  • Common Surgeries: Follicular reconstruction, hysterectomy, orchiectomy.

Nursing Interventions for Surgical Care

  • Ensure informed consent and prepare education for postoperative care.

  • Monitor postoperative complications such as infection or bleeding.

Routine Reproductive Exams

  • Breast Exams: For cancer screenings (ACS recommendations).

  • Pelvic Exams: Essential for reproductive health; includes Pap tests and HPV testing.

Assessing STIs During Routine Care

  • Evaluate risks, perform necessary screenings, and educate clients about prevention.

Specific STIs Management

  • HIV: Monitor symptoms and promote routine screenings.

  • Chlamydia & Gonorrhea: Annual screenings based on sexual activity; treat partners.

  • Trichomoniasis: Diagnostic tests and screening recommendations for at-risk populations.

Client Education and Support

  • Focus on self-monitoring techniques, prevention strategies, and support group recommendations.

  • Emphasize the importance of attending follow-up appointments and addressing changes in health.