COLLEGE OF NURSING

Silliman University
Dumaguete City
RESOURCE UNIT ON SEXUAL DISORDERS
SUBMITTED TO:
Ms. Gielle L!" O#a$ana
SUMITTED B%:
CABURIAN& MONI'UE (%LIE C.
CADORNA& BLANC)E *ENELO*E S.
LE+EL III , A-
+ISION
A leading Christian institution committed to total human development for the well being
of society and environment.
MISSION
Infuse into the academic learning the Christian faith anchored on the gospel of Jesus
Christ; provide environment where Christian fellowship and relationship can be nurtured and
promoted.
Provide opportunities for growth and ecellence in every dimension of the !niversity life in
order to strengthen character competence and faith.
Instill in all members of the !niversity community an enlightened social consciousness and
a deep sense of "ustice and compassion.
Promote unity among people and contribute to national development.
RESOURCE UNIT ON SEXUAL DISORDERS
Time Allotment: 1 hour and 30 minutes
Topic Description: This topic deals with sexual disorders. It includes discussion of the different theories, types, and its nursing care management.
entral o!"ecti#e: At the end of the ward class, the learners will gain $nowledge, de#elop !eginning s$ills and demonstrate positi#e attitude towards the care of
clients%
indi#iduals with sexual disorders.
S.e/i0/ O#1e/tives C!ntent
At the end of the ward class, the learners shall
satisfactorily:
Descri!e the different terms related to the topic.
&ecogni'e the characteristic of a client with
sexual disorder from #arious theoretic
perspecti#es.
I. Definition of terms:
I.1 (ender Identity) how a person sees himself or herself, whether masculine, feminine, or somewhere in)
!etween.
I.* (ender &oles) the roles a person is expected to perform as a result of !eing male or female in a
particular culture
I.3 Androgyny) the !elief that most characteristics and !eha#iors are human +ualities that should not !e
limited to one specific gender or the other
I., Transsexuals)
I.- ross)dressers) typically males who cross dress to express the feminine side of their personality
I.. /araphilias) are disorders of de#iant sexuality.
I.0 1exual Desire Disorder)
I.2 1exual A#ersion Disorder) An a#oidance of or a#ersion to genital sexual contact
I.3 1exual Arousal Disorder). /atients are interested in sex, !ut not enough to complete a sex act
1.10 4rgasmic Disorder) /atients are partially or completely una!le to experience sexual climax.
1.11 1exual /ain Disorder) These disorders in#ol#e pain during the sex act.
II. Biophysica Theories
II.1Interpersonal Theory
5 6arry 1tac$ 1ulli#an de#eloped a comprehensi#e examination of interpersonal relationships called the
interpersonal theory of psychiatry. 6e considered the healthy person as a social !eing with the a!ility to
li#e effecti#ely in relationships with others. 7ental illness was #iewed as any degree of lac$ of
awareness of the process in interpersonal relationships. &elationships were #iewed as the source of
anxiety, maladapti#e !eha#iors and personality formation.
5 A central theme of this theory is anxiety and its relationship to the formation of the personality. 1ulli#an
#iewed anxiety as:
prime moti#ator of !eha#ior
!uilder of self esteem
great educator in life
5 1ulli#an descri!ed the cogniti#e process in terms of the three modes of experience: prototaxic,
parataxic, syntaxic
/rototaxic experience 8 initial type, characteri'ed !y sensations, feeling, and fragmented images
of short duration
/arataxic experience 8 e#ents that occur at the same time !ut are not logically connected are
#iewed as !eing casually related
1yntaxic experience 8 highest le#el of experience, are logically interrelated and contri!ute to
logical thin$ing
5 There are six stages of personality de#elopment form !irth to maturity, which is di#ided according to
the capacity for communication and integration of new interpersonal experiences. 9xperiences during
each stage are influenced !y those of the pre#ious one.
1tage of
De#elopment
De#elopmental
tools
De#elopmental
tas$
Interpersonal
needs
ogniti#e mode
of experience
Infancy :!irth).
months;
ry, mouth,
satisfaction
response,
emphatic
communication,
emergency
reactions, autistic
in#ention
<earning to count
on others to meet
needs
=eed for contact /rototaxic
hildhood :13
months). years;
<anguage, anus,
self, identification,
anxiety, autistic
in#ention,
emergency
reaction: anger,
shame, guilt, dou!t
<earning to
accept, in relati#e
comfort,
interferences with
wishes
=eed for adult
participation in
acti#ities
<argely parataxic
>u#enile :0)3
years;
ompetition,
compromise,
cooperation
<earning to form
satisfactory
relationship with
peers
=eed for peers
and need for
acceptance
7ostly syntaxic
/readolescence
:10)1* years;
apacity to lo#e,
colla!oration,
consensual
#alidation
<earning to relate
to chums of same
sex
=eed for chum,
friend or lo#e one
1yntaxic
9arly adolescence
:13)1, years;
<ust, anxiety <earning to
!ecome
independent?
learning to
esta!lish
satisfactory
relationships with
mem!ers of the
opposite sex
=eed for intimacy syntaxic
<ate adolescence
:1-)*1 years;
(enital organs <earning to
!ecome
interdependent?
learning to form
dura!le sexual
relationship with
selected mem!er
of opposite sex
=eed for
heterosexual
relationship
@ully syntaxic
5 The personality achie#es some degree of sta!ility at the end of the "u#enile era !ut continues to
de#elop !eyond this time and has the potential for correcti#e experiences. The "u#enile and
preadolescent eras contain the greatest opportunity for correcti#e experiences.
II.*Aeha#ioral Theory
5 I#an /a#lo#
7echanistic principles: indi#idualBs !eha#ior is under the control of past learned experiences and
current en#ironmental circumstances. onditioning is a type of learning where there is a stimulus
and reinforcement.
5 A.@. 1$inner
Analysis of human !eha#ior o!ser#ed in the current situation, why a specific !eha#ior starts and
what in the current situation ma$es it rewarding for the person to continue the !eha#ior. This
happens through operant conditioning where positi#e and negati#e reinforcement response
fre+uency and shaping are in#ol#ed. &einforcement is any e#ent contingent upon the response of
the organism, that alters the future li$elihood of that response. /ositi#e reinforcement is a reward
for selected !eha#ior, and negati#e reinforcement !ring anxiety producing sanctions against
whate#er !eha#ior is in progress. &esponse fre+uency refers to how often a response is gi#en
while shaping is guiding the indi#idual in achie#ing the desired !eha#ioral response.
5 Colpe
Aeha#ior is a series of ha!itual responses to a series of stimuli.
/rinciple of reciprocal inhi!ition 8 if a pleasant or anxiety reducing state is experienced at
the same time, the anxiety pro#o$ing stimulus is introduced. This new experience
diminishes the anxiety response to the stimulus.
Anxiety hierarchy 8 hierarchical relationships are esta!lished among anxiety producing
stimuli. Cith this approach, a more accepta!le !eha#ior is su!stituted for the symptom !y
learning another way of coping with the underlying anxiety.
1ystematic desensiti'ation 8 a counter conditioning techni+ue for extinguishing
maladapti#e responses and replacing them with more accepta!le :adapti#e; responses.
5 >ohn Dollard and =eal 7iller
&einforcement or rewards as the essential ingredient for forming a new stimulus response.
Dri#e 8 a stimulus with sufficient strength to impel the person into the acti#ity.
primary dri#e 8 essential for sur#i#al, are innate and in close contact with
physiological processes such as hunger, pain, and sex.
1econdary dri#e 8 e#ol#e during growth and direct !eha#ior. 1timuli of these dri#es
generally replace primary dri#e stimuli.
ue 8 is a stimulus that determines the nature of the response. &esponse relates to a
gi#en cue to an en#ironment.
&einforcements :rewards; 8 this strengthen the connection !etween a gi#en response and
a particular cue and lead to a participation of a response. Chen a response is not
reinforced, extinction of the !eha#ior occurs.
onflict 8 opposition !etween two dri#es experience simultaneously in response to the
same situation.
II.31ociocultural Theory
sociocultural theories introduce a change in emphasis from intrapsychic indi#idualistic approach
to an action oriented, community !ased theory that lin$s a sociocultural system to mental health.
5 (eorge 7ead
the de#elopment of self through the childBs interaction with significant others.
1ociali'ation 8 an approach which is an extremely complex action)interaction networ$.
&ules 8 they ac$nowledge explicit or implicit norms defined !y a particular culture.
<a!els 8 this arise from norms de#iations and are a powerful force in deciding the fate of
the people who are la!eled.
onsensual #alidation 8 consensus within a particular group.
5 Thomas 1'as'
The effects of sociocultural #aria!les on la!eling !eha#ior that does not conform to social norms
as de#iant.
II.,Aiologic Theory
5 !ased on the !elief that mental illness is a disease in the same sense as dia!etes or high !lood
Discuss comprehensi#ely the different types of
/araphilias.
pressure. 7ental illness results from a!normalities in !rain structure and chemistry. The mental
diseases of the !rain manifest themsel#es primarily !y a!normalities in !eha#ior, emotion, and thin$ing.
5 influence of genetics and organic factors on the personBs de#elopment of a psychiatric illness
:defecti#e genes, en#ironmental stresses;.
III. Types of !araphiias
III.1 @etishism
5 in#ol#es ha#ing oneBs sexual energies fixated on to a manufactured o!"ect, rather than onto another
human !eing. @re+uently, fetish o!"ects are garments such as shoes, underwear, panties or !ras. They
may !e made of particular materials such as leather or ru!!er. It is common for a person with a fetish to
not !e a!le to achie#e orgasm without in#ol#ing their fetish o!"ect in the sexual act :e.g., !y getting their
partner to wear the fetish o!"ect;. Although not specifically mentioned in the D17, persons who
chronically rely on pornography for sexual arousal pro!a!ly +ualify as fetishists.
5 it can manifest in two ways, one more extreme than the other. 4ne form associates coitus with some
o!"ect :most fre+uently womenDs panties or other undergarments;. It is relati#ely harmless if the action is
ta$en playfully and is accepta!le to the personDs partner. @ocus on certain parts of the !ody :feet, hair,
ears, etc; aside from those part of the pleasura!le foreplay, can !ecome fetishistic in its hold on the
indi#idual.
5 The more extreme form of fetishism is when a nonli#ing o!"ect completely su!stitutes for a human
partner, such as underwear, !oots, and shoes or such textured o!"ects as #el#et or sil$. 6ere, orgasm is
achie#ed when the person is alone, fondling the o!"ect.
III.* Trans#estic @etishism
5 occurs when an otherwise EnormalB heterosexual male has fantasies a!out and%or acts out dressing up
in womanBs clothing. 1uch cross dressing is commonly experienced as sexually stimulating.
5 sexual arousal is produced !y the accompanying thought or image of the person as a female :referred
to as FautogynyphiliaG;. These images can range from !eing a woman with female genitalia to that of a
#iew of the self fully dressed as a woman with no real attention to genitalia. ComenBs garments are
arousing primarily as sym!ols of the indi#idualBs femininity not as fetishes with specific o!"ecti#e
properties.
III.3 1exual 1adism
5 1exual sadism is infliction of physical or mental suffering :e.g., humiliation, terror; on the sex partner
to stimulate sexual excitement and orgasm.
5 7ost sexual sadists ha#e insistent, persistent fantasies in which sexual excitement results from
suffering inflicted on the partner, consenting or not. 7ild sadism is a common sexual practice? when it
!ecomes pathologic is a matter of degree. 1exual sadism is not rape, a complex amalgam of sex and
power o#er the #ictim. 1exual sadism is diagnosed in H 10I of rapists.
5 7ost sadistic sexual !eha#ior occurs !etween consenting adults. As is the case with masochism,
sadism is usually limited in scope and not harmful. In some people, the !eha#iors escalate to the point
of harm. Chen practiced with non consenting partners, sexual sadism constitutes criminal acti#ity and is
li$ely to continue until the sadist is apprehended. 1exual sadism is particularly dangerous when
associated with antisocial personality disorder :see /ersonality Disorders: luster A;. This com!ination
of disorders is particularly recalcitrant to any form of psychiatric treatment.
III., 1exual 7asochism
5 1exual masochism is intentional participation in an acti#ity that in#ol#es !eing humiliated, !eaten,
!ound, or otherwise a!used to experience sexual excitement.
5 1adomasochistic fantasies and sexual !eha#ior !etween consenting adults is #ery common.
5 7asochistic acti#ity tends to !e rituali'ed and chronic. @or most participants, the humiliation and
!eating are simply acted out? participants $now that it is a game and carefully a#oid actual humiliation or
in"ury. 6owe#er, some masochists increase the se#erity of their acti#ity with time, potentially leading to
serious in"ury or death.
5 7asochistic acti#ities may !e the preferred or exclusi#e mode of producing sexual excitement. /eople
may act on their masochistic fantasies themsel#es :eg, !inding themsel#es, piercing their s$in, applying
electrical shoc$s, !urning themsel#es; or see$ out a partner who may !e a sexual sadist. Acti#ities with
a partner include !ondage, !lindfolding, span$ing, flagellation, humiliation !y means of urination or
defecation on the person, forced cross)dressing, or simulated rape.
5 Treatment of this disorder is often ineffecti#e.
3.- Auroerotic Aphyxia
5
3.. 9xhi!itionism
5 9xhi!itionism is the exposure of oneDs genitals in a pu!lic place. <i$e gam!lers, pyromaniacs and
other impulse)"un$ies, exhi!itionists cycle through periods of increasing tension that are only relie#ed !y
the ErushB of exposing themsel#es to strangers :occasionally accompanied !y mastur!ation;.
5 It is the most prominent sexual offense leading to arrest and ma$es up one third of all sexual crimes.
@rom the psychological point of #iew, there are three characteristic features of the exhi!ition. @irst, it is
always performed for un$nown women? second, it always ta$es place where sexual intercourse is
impossi!le, for example in a crowded shopping mall? and third, it must !e shoc$ing for the un$nown
woman or it seems to lose its power to produce sexual arousal in the indi#idual. 9xhi!itionists are not
assaulti#e and are considered more of a nuisance than an actual danger.
3.0 Joyeurism
5 Joyeurism or Epeeping tomB !eha#ior is achie#ement of sexual arousal !y o!ser#ing people who are
na$ed, disro!ing, or engaging in sexual acti#ity. Chen o!ser#ation is of unsuspecting people, this
sexual !eha#ior often leads to pro!lems with the law and relationships.
5 Desire to watch others in sexual situations is common and not in itself a!normal. Joyeurism usually
!egins during adolescence or early adulthood. Adolescent #oyeurism is generally #iewed more leniently?
few teenagers are arrested. Chen #oyeurism is pathologic, #oyeurs spend considera!le time see$ing
out #iewing opportunities. 4rgasm is usually achie#ed !y mastur!ating during or after the #oyeuristic
acti#ity. Joyeurs do not see$ sexual contact with the people !eing o!ser#ed.
5 In many cultures, #oyeurs ha#e ample legal opportunities to watch sexual acti#ity. Chen laws are
!ro$en and sex offender status is conferred, treatment usually !egins with therapy, support groups, and
11&Is. If these drugs are ineffecti#e, antiandrogens should !e considered? full informed consent and
appropriate monitoring of li#er function and serum testosterone le#els are re+uired.
5 It is not diagnosa!le as a disorder unless it !ecomes a compulsi#e part of a personBs sexual routine.
3.2 @rotteurism
5 in#ol#es a compulsion to ru! oneBs self against strangers others in a sexual manner. <i$e
exhi!itionism and other impulse control disorders, frotteurism tends to in#ol#e a cycle of tension !uildup
that is relie#ed !y acting out in EexcitingB ways.
3.3 4!scene /hone alling
5
3.10 /edophilia
5 occurs when a sexually mature adult fantasi'es a!out or engages in sexual !eha#ior with pre)
pu!escent children.
5 this paraphilia is radically different from exhi!itionism and #oyeurism in its se#erely damaging impact
on the non consenting partner, a child. 4rdinarily, the pedophiliac is someone who has ready access to
the child. The child or parent would ha#e no reason to suspect that the indi#idual has a pedophilic
orientation.
5 /edophiles tend to ha#e preferences for male or female children :!ut not !oth;. They may !e
exclusi#ely child focused, or they may also !e interested in adult sexuality. /edophiles commonly
rationali'e their de#iant !eha#ior :which may include fondling only, or actual child)rape; as !eing
educational and for the childBs !enefit. They may also !elie#e that their child #ictim has sexually
seduced them. It is fairly common that the pedophile will threaten the child so as to $eep their predatory
sexual !eha#ior secrete. Aecause the pedophile often is the parent or step)parent of the #ictim child, or
has wor$ed hard to gain the confidence of the parents, there are often few percei#ed safe people and
places who a child could report their #ictimi'ation to any way.
5 /edophilia often leads to imprisonment? medical management should include drugs and
psychotherapy.
5 In most cases, the adult is $nown to the child and may !e a family mem!er, stepparent, or a person
with authority :eg, a teacher;. <oo$ing or touching seems more pre#alent than genital contact.
6omosexual males typically ha#e a less close ac+uaintanceship with the child. /edophiles may !e
Descri!e in their own words the different types of
sexual dysfunctions.
attracted only to children :exclusi#e; or also adults :nonexclusi#e;.
5 1ome pedophiles limit their sexual acti#ities to their own children or to close relati#es :incest;.
5 /redatory pedophiles, many of whom ha#e antisocial personality disorder, may use force and threaten
to physically harm the child or the childDs pets if the a!use is disclosed. The course of pedophilia is
chronic, and perpetrators often ha#e or de#elop su!stance a!use or dependence and depression.
5 /er#asi#e family dysfunction, including marital conflict, is common.
5 Identifying a pedophile often poses an ethical crisis for health care practitioners. They can try to
protect the pri#acy of the patient !ut must protect the community of children. /ractitioners should $now
the reporting re+uirements in their state. If practitioners ha#e reasona!le suspicion of child sexual or
physical a!use, it must !e reported to authorities.
I". Types of Se#$a Dysf$nctions
,.1 1exual Desire Disorder
5Indi#iduals with this disorder ha#e little or no sexual desire to ha#e an a#ersion to sexual contact.
a. 6ypoacti#e 1exual Desire Disorder
5 This disorder may !e present when a person has decreased sexual fantasies and a decreased or
a!sent desire for sexual acti#ity. In order to !e considered a sexual disorder the decreased desire must
cause a pro!lem for the indi#idual. In this situation the person usually does not initiate sexual acti#ity
and may !e slow to respond to his%her partnerDs sexual ad#ances. This disorder can !e present in
adolescents and can persist throughout a personDs life. 7any times, howe#er, the lowered sexual desire
occurs during adulthood, often times following a period of stress.
,.*1exual A#ersion Disorder
5 A person who acti#ely a#oids and has a persistent or recurrent extreme a#ersion to genital sexual
contact with a sexual partner may ha#e sexual a#ersion disorder. In order to !e considered a disorder,
the a#ersion to sex must !e a cause of difficulty in the personDs sexual relationship. The indi#idual with
sexual a#ersion disorder usually reports anxiety, fear, or disgust when gi#en the opportunity to !e
in#ol#ed sexually. Touching and $issing may e#en !e a#oided. 9xtreme anxiety such as panic attac$s
may actually occur. It is not unusual for a person to feel nauseated, di''y, or faint.
,.31exual Arousal Disorder
5. /atients are interested in sex, !ut not enough to complete a sex act
a. @emale 1exual Arousal Disorder
5 descri!ed as the ina!ility of a woman to complete sexual acti#ity with ade+uate lu!rication.
1welling of the external genitalia and #aginal lu!rication are generally a!sent. These symptoms must
cause pro!lems in the interpersonal relationship to !e considered a disorder. It is not unusual for the
woman with female sexual arousal disorder to ha#e almost no sense of sexual arousal. 4ften, these
women experience pain with intercourse and a#oid sexual contact with their partner.
!. 7ale 1exual Arousal Disorder
5 Ina!ility to gain an erection or ina!ility to maintain an erection once it has occurred.
,.,4rgasmic Disorder
5 /atients are partially or completely una!le to experience sexual climax. This may occur despite
ade+uate sexual interest and arousal.
a. @emale 4rgasmic Disorder
5 @emale orgasmic disorder occurs when there is a significant delay or total a!sence of orgasm
associated with the sexual acti#ity. This condition must cause a pro!lem in the relationship with the
sexual partner in order to !e defined as a disorder.
5 The (/ must ta$e into account the patientDs age, pre#ious sexual experience and ade+uacy of
sexual stimulation.
b. 7ale 4rgasmic Disorder
5 A lengthy delay or a!sence of orgasm following normal excitation, erection and ade+uate
stimulation.
5 Chen a male experiences significant delay or total a!sence of orgasm following sexual acti#ity, he
may ha#e male orgasmic disorder. In order to !e +ualified as a disorder, the symptoms must present
a significant pro!lem for the indi#idual.
c. /remature 9"aculation
5 9"aculation occurring with only minimal stimulation, either !efore penetration or soon afterwards, in
either case ceratinly !efore the patient wishes it. Again the (/ must ta$e into account the patientDs
age, pre#ious sexual experience, extent of sexual stimulation and Dno#eltyD of the sexual partner.
5 Chen minimal sexual stimulation causes orgasm and e"aculation on a persistent !asis for the
male, he is said to ha#e premature e"aculation. The timing of the e"aculation must cause a pro!lem
for the person or the relationship in order to !e +ualified as a disorder. /remature e"aculation is
sometimes seen in young men who ha#e experienced premature e"aculation since their first attempt
at intercourse.
,.-1exual /ain Disorder
5 These disorders in#ol#e pain during the sex act.
a. Dyspareunia
5 &ecurrent pain associated with intercourse, !ut in women not due to #aginismus, poor lu!rication,
and in women and men not due to drugs or other physical causes
Discuss thoroughly the nursing care of clients
with sexual disorder using the nursing process.
5 Dyspareunia is a sexual pain disorder. Dyspareunia is genital pain that accompanies sexual
intercourse. Aoth males and females can experience this disorder, !ut the disorder is more common
in women. Dyspareunia tends to !e chronic in nature.
!. Jaginismus
5 An in#oluntary or persistent spasm of the muscles of the outer third of the #agina, again not
attri!uta!le to physiological effects of physical causes. Jaginismus may !e either lifelong or recent?
generali'ed to all sexual encounters or specific to certain partners or situations.
". Appication of the N$rsin% !rocess
Assessment /lanning Implementation 9#aluation
5 descri!e any
difficulties you ha#e
experienced with sexual
performance or
satisfaction
5 what are your feeling
and concerns a!out
sexuality
5 how satisfied are you
with your sexual
relationship
5what $ind of changes
would you li$e to ma$e
in your sexual
relationship
5 what $ind of negati#e
sexual experiences
ha#e you had
5 setting of short)term
and long)term goals
regarding patientBs
specific condition
/sychotherapeutic
management:
5 nurse)patient
relationship ) the nurse
must ha#e an accepting
empathic and
non"udgmental attitude if
patients are to !e
comforta!le enough to
disclose pro!lems with
sexuality. The nurse may
also need to inter#ene to
discuss self)esteem
issues, anxiety, guilt and
empathy for #ictims. @or
perpetrators, it is
necessary to deal with
physical and emotional
dimensions. The nurse
also colla!orates with
social wor$ers and
chaplains if patient
choose, a!out feeling
and religious !eliefs.
Discuss possi!le
referrals with patient and
>
family mem!ers and
refers patient to sex
therapist if necessary.
&eferral to outpatient
treatment programs are
therapy groups for
specific disorder.
5 /sychopharmacology )
the nurse assesses all
medications for side
effects that affect sexual
performance or
dysfunction. 7en with
paraphilias are treated
with agents to lower
testosterone le#el which
reduces their sex dri#e.
Androgen therapy
with oral and parenteral
preparations 8 reduced
recidi#ism rates in male
sexual aggressors.
1electi#e
serotonin reupta$e
inhi!itors :11&I; 8
includes fluoxetine
:/ro'ac; and sertraline
:Koloft;. Lse for
paraphiliacs and related
disorders.
5 7ilieu 7anagement 8
patients with sexual
disorders and
dysfunctions !enefit
from groups dealing
with self)esteem,
asserti#eness, anger
management, social
and relationship s$ills,
sex education, and
stress management.
1elf help groups
such as sex addicts
anonymous 8 !enefit
those with paraphilias.
7ulti dimensional
treatment plan using a
com!ination of
education and
cogniti#e, !eha#ioral,
and family inter#ention
must !e used to reduce
recidi#ism for sexual
offenders.
CASE STUD&
>ourard Colff, .0 year old, has !een admitted to inpatient unit. 6is wife died two years ago? he has one
daughter and three grandchildren. Aill is presently employed !ut ahs few friends or ho!!ies. 6e #isits his
daughter and grandchildren approximately once a month, does not date, and does not any female
companions. @or the past year, he has noticed an increase in sexual fantasies concerning children. 6e did not
act on the fantasies until a wee$ ago when he was !a!ysitting for his youngest grandchild, 2 year old
1tephanie. 6e admits to fondling 1tephanieBs !reast !ut denies other sexual contact with her. >ourard states to
the nurse, FI ne#er thought I would !e capa!le of such a horri!le thing. I deser#e to die. I e#en thought of $illing
myself.G
D17)IJ Diagnosis: 7a"or depression, /edophilia
Assessment Diagnosis Planning Implementation Evaluation
> areas of strength:
employed, visits
daughter and
grandchildren,
remorse for contact
Potential for
self directed violence
related to guilt, as
evidenced by suicidal
ideation
Shortterm goals:
!he patient
"ill state he no
longer has thoughts
of suicide.
> #ursepatient
relationship
Instruct patient
to approach staffs
"hen suicidal thought
> Patient reports he is
no longer suicidal.
"ith child, first
offense
> Problems: death of
"ife, fe" friends,
disturbing se$ual
fantasies, and
suicidal ideation
Se$ual
dysfunction related to
lac% of significant
other, as evidenced
by fondling child
Social
Isolation related to
lac% of social
support, as evidenced
by loneliness
Patient "ill
discuss se$ual
concerns and needs,
and methods to
satisfy this needs.
&ongterm goals:
Patient "ill
contact support
groups and senior
citi'en organi'ations.
Patient "ill
schedule outpatient
appointment of
further assessment of
se$ual disorder.
occur.
Discuss
feelings of guilt,
remorse, anger,
loneliness, and lo"
selfesteem.
Discuss the
patient(s beliefs and
values about se$uality
"ith him.
Discuss and
help the patient to
identify se$ual
concerns, needs, and
methods to satisfy
them.
)eferrals: "ill
attend senior citi'ens(
activities "ith a friend.
Appointment
scheduled at a se$ual
disorders clinic.
>Psychopharmacology:
Pro'ac *+ mg ,
am
> -ilieu -anagement
.roups
focusing on self
esteem and anger
management
assertiveness training,
and discharge
planning.