Related To: [Check those that apply]
As evidenced by: [Check those that apply]
Patient’s Diagnosis: –
Date:-
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| Nursing Interventions | Scientific Rationale |
|---|---|
| Assess the impact of diagnosis and treatment on the patient’s sexual functioning and self-concept. | Sexual dysfunction affects every individual differently. It is important not to assume its meaning but rather explore it with the individual and allow him or her to give meaning to the changes. |
| Assess the patient’s readiness to discuss sexual concerns. | Gentle, sensitive, open-ended questions allow patients to signal their readiness to discuss concerns. |
| Initiate discussion about effects of treatment on sexuality and reproduction, using, for example, the PLISSIT model. | The PLISSIT model provides an excellent framework for discussion. This four-step model includes the following: (1) Permission—give the patient permission to discuss issues of concern; (2) Limited Information—provide patient with information about expected treatment effects on sexual and reproductive function, without going into complete detail; (3) Specific Suggestions—provide suggestions for managing common problems that occur during treatment; and (4) Intensive Therapy—although most individuals can be managed by nurses using the first three steps in this model, some patients may require referral to an expert counselor (Taylor & Davis, 2006). |
| If a female patient is of childbearing age, inquire if pregnancy is a possibility before treatment is initiated. | Pregnancy will cause a delay in treatment. The patient may be referred to a fertility specialist. |
| Discuss possibility of decreased sexual response or desire. | This may result from side effects of chemotherapy. Informing patient may allay unnecessary anxiety. |
| Encourage patients to maintain open communication with their partners about needs and concerns. | Encouraging open dialogue promotes intimacy and helps prevent ill feelings or emotional withdrawal by either partner. |
| Discuss the possibility of temporary or permanent sterility resulting from treatment. | This discussion could open the door to explaining possibility of sperm banking for men before chemotherapy treatment or oophoropexy (surgical displacement of ovaries outside the radiation field) for women undergoing abdominal radiation therapy. The patient may need referral to a fertility specialist. |
| Teach patients the importance of contraception during treatment if relevant. Discuss issues related to timing of pregnancy after treatment. Suggest that patients receive genetic counseling before attempting pregnancy, as indicated. | Healthy offspring have been born from parents who have received radiation therapy or chemotherapy, but long-term effects have not been clearly identified. |
| For patients undergoing lymphadenectomy for testicular cancer, explain that ejaculatory failure may occur if the sympathetic nerve is damaged, but erection and orgasm will be possible. | If ejaculatory failure does occur, the patient should know that artificial insemination is possible because the semen flows back into the urine, from which it can be extracted, enabling the ovum to become impregnated artificially. |
| If appropriate, explain that a silicone prosthesis may be placed after orchiectomy. Consult the health care provider about the potential for this procedure. | This will help the scrotum achieve a normal appearance. |