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STIs Practicum Journal Entry
This practicum is one of the most fascinating experiences in my clinical practice. Dealing with patients diagnosed with sexually transmitted infections (STIs) is challenging as most of the patient are hesitant to talk openly to a nurse or doctor about their experiences, which makes it challenging during clinical decision making processes (American Congress of Obstetricians and Gynaecologists, 2011).
Mrs. Kate (pseudo name) a 21 year old college student presented to the clinic with complaints of itchiness around her genitalia, sharp burning sensation during sexual intercourse and had noted whitish discharge that had foul smell. From the clinical manifestation, I gathered that the patient is suffering from an infection, which could be either sexually transmitted infections (STIs) or urinary tract infections (UTIs). There is a thin line that separated the two, which indicated the need for further laboratory test.
According to Centre for disease control and prevention (CDC), UTIs and STIs clinical manifestations are non-specific and are a common to problem for females. This highlights the likelihood of misdiagnosis. The common clinical manifestation for the urogenital diseases includes a burning sensation during urination, vaginal discharges and pelvic pain. However, in UTIs infection, vaginal discharge with awful smell is normally absent. The patient with urinary tract infection tends to have fever. A pelvic exam, urine culture and vaginal culture results indicate that the patient had yeast vaginal infection (CDC, 2013).
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One of the challenges experienced during this practicum was during sexual history assessment. Initially, the patient was hesitant to disclose the information because it is a taboo and also she believed that disclosing this information would victimize her. After reinforcing the issue of confidentiality, the patient became relaxed and disclosed the sensitive information.
The sexual history assessment was done using the general guide of the ‘5 Ps.’ This included the number of sex partners, the type of sexual activity, the rates of use of protection, and use of contraceptives. This helped me understand the patient literacy and perspectives about UTI (Schuiling and Likis, 2013).
The patients seemed somewhat distressed when I gave her the diagnosis results. However, she was cooperative all through the care plan. The patient was advised to have regular check up with the gynaecologists. This is because sexually transmitted infections (STIs) have short and long term impacts that can be life threatening. The short term impacts include emotional disturbances due to physical changes.
The long term effects include genital sores, inflammation, infertility issues and pelvic inflammatory reactions. Fortunately, genital yeast infections like other sexually transmitted infections (STIs) is manageable if diagnosed early and proper medication regimen is provided (CDC, 2013).
The patient had tried to manage the itchiness and pain using Tylenol (OTC) and vaginal cream, which yielded little success. The patient was given fluconazole 150 mg and Terconazole 80 mg both orally administered one suppository/day for at least 3 days. The medication ensured that the patient did not get recurrent infection. The patient was encouraged to observe hygiene and practice abstinence during the medication regimen. Other hygiene measures such as mutual monogamy, abstinence and avoid of douching practices.
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This practicum was very enlightening, especially on ways to practice cultural competency. I noticed that sexually transmitted infections (STIs) education focuses in specific information on signs and symptoms which seems to be the worst case scenarios and a taboo to most of the community.
The only down to earth guidance is abstinence and use of condom. If not handled with care, the interaction with the patient could affect patient psychosocial status. I have learnt a lot from this practicum and will use the knowledge to help other patients to identify risk factors and practice preventive measures (Schuiling and Likis, 2013).
References
American Congress of Obstetricians and Gynecologists. (2011). Guideline for adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Centers for Disease Control and Prevention (CDC). (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from http://stacks.cdc.gov/view/cdc/13174
Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
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During this practicum, a 25 year old female presented to the healthcare facility with complains of severe cramp pain that occurs about one week before her menses, during the menstrual cycle and a week after the cycle ends. The patient complains that her menstrual cycles is irregular, and gets heavy periods with some clots. The patient reported to the clinic due to sharp pain that radiated from the chest. The patient had lived with this condition for 12 years. She has been managing the disease using alternative tradition medicines, which has not been effective.
Review of the system was conducted and laboratory tests were performed (urinalysis, urine culture, pregnancy test and wet prep). The differential diagnosis identified included amenorrhea, endometriosis, and ovarian cysts without explanation. Ovarian cysts were suspected due to presence of pelvic pain before the onset of period. However, this is not likely because the patient did not complain of fever and vomiting. Amenorrhea is suspected due to presence of pelvic pain. However, this is not likely as the key indicator of amenorrhea is absence of menses (Domino, Baldor, Golding, 2014).
To make a definitive diagnosis physical test was performed. Under the supervision of my preceptor, I conducted a pelvic exam. This included palpating pelvis areas to check abnormalities such as cysts and scars. The pelvic exam was negative. An ultrasound was requested to capture the image of the reproductive organs. The results indicated that the patient was suffering from endometriosis (American Congress of Obstetricians and Gynaecologists, 2011).
Treatment made included pain relive medication to help manage the painful cramps. The patient was also given Lo Loestrin Fe which has been found to be effective in management of pain. The increase and decrease of hormones during the menstrual cycle makes the endometrial implants to thicken.
Using this hormone therapy, it slows down the growth which prevents the implantation of the endometrial tissue. However, the patient was educated that although these medications manage the pain, they are not a permanent fix for this health complication. The symptoms can reoccur after stopping the treatment (CDC, 2013).
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The patient was also advised on ways to manage pain using home remedies. This includes the use of heating pad to relax the pelvic muscles, which helps in reducing pain. OTC non-steroidal anti-inflammatory drugs such as Motrin IB. The patient is advised to eat health and exercise regularly as it helps improve the pain (Buttaro et al., 2013).
During this practicum, I have learnt that issue of endometriosis is poorly understood in the society. This is probably because of the common myth of “etiquette menstruation” where the society believes that menstruation is a private affair and must not be discussed in public. Most of women conceal their suffering, which makes them to suffer in silence. As advanced nurse practitioner, it is our responsibility to raise awareness on endometriosis to encourage the affected persons to speak up, and seek medication early (CDC, 2013).
During the research, I also realized the common modalities between ovary cysts, amenorrhea and endometriosis. This includes the similarity in the clinical manifestation, test and diagnosis procedures and treatment. In these three reproductive systems disorders, they are clinically manifested by presence of pelvic pain before the onset and after menstrual cycle.
The test diagnosis of these disorders includes ultrasound, Pregnancy tests, urinalysis and urine culture. In management of the disease, most of them are managed using OTC pain killers, hormone therapy or invasive methods. Therefore, I need to research more on these reproductive disorders to ensure that I deliver effective care when serving the affected community (American Congress of Obstetricians and Gynecologists, 2011).
References
American Congress of Obstetricians and Gynecologists. (2011). Guideline for adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Buttaro, T., Trybulski, J., Bailey, P., & Sandberg-Cook, J. (2013). Primary Care, 4th Edition. Philadelphia, PA: Lippincott Williams & Wilkins.
Centers for Disease Control and Prevention (CDC). (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from http://stacks.cdc.gov/view/cdc/13174
Domino, F. J.; Baldor, R.A.; Golding, J (Ed.). (2014). The 5-minute clinical consult standard 2015 (23rd ed, Kindle Edition). Philadelphia, PA: Lippincott Williams & Wilkins.
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Sexually Transmitted Infections
This practicum is one of the most fascinating experiences in my clinical practice. Dealing with patients diagnosed with sexually transmitted infections (STIs) is challenging as most of the patient are hesitant to talk openly to a nurse or doctor about their experiences, which makes it challenging during clinical decision making processes (American Congress of Obstetricians and Gynaecologists, 2011).
Mrs. Kate (pseudo name) a 21 year old college student presented to the clinic with complaints of itchiness around her genitalia, sharp burning sensation during sexual intercourse and had noted whitish discharge that had foul smell. From the clinical manifestation, I gathered that the patient is suffering from an infection, which could be either sexually transmitted infections (STIs) or urinary tract infections (UTIs). There is a thin line that separated the two, which indicated the need for further laboratory test.
According to Centre for disease control and prevention (CDC), UTIs and STIs clinical manifestations are non-specific and are a common to problem for females. This highlights the likelihood of misdiagnosis. The common clinical manifestation for the urogenital diseases includes a burning sensation during urination, vaginal discharges and pelvic pain. However, in UTIs infection, vaginal discharge with awful smell is normally absent. The patient with urinary tract infection tends to have fever. A pelvic exam, urine culture and vaginal culture results indicate that the patient had yeast vaginal infection (CDC, 2013).
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One of the challenges experienced during this practicum was during sexual history assessment. Initially, the patient was hesitant to disclose the information because it is a taboo and also she believed that disclosing this information would victimize her. After reinforcing the issue of confidentiality, the patient became relaxed and disclosed the sensitive information.
The sexual history assessment was done using the general guide of the ‘5 Ps.’ This included the number of sex partners, the type of sexual activity, the rates of use of protection, and use of contraceptives. This helped me understand the patient literacy and perspectives about UTI (Schuiling and Likis, 2013).
The patients seemed somewhat distressed when I gave her the diagnosis results. However, she was cooperative all through the care plan. The patient was advised to have regular check up with the gynaecologists. This is because sexually transmitted infections (STIs) have short and long term impacts that can be life threatening. The short term impacts include emotional disturbances due to physical changes.
The long term effects include genital sores, inflammation, infertility issues and pelvic inflammatory reactions. Fortunately, genital yeast infections like other sexually transmitted infections (STIs) is manageable if diagnosed early and proper medication regimen is provided (CDC, 2013).
The patient had tried to manage the itchiness and pain using Tylenol (OTC) and vaginal cream, which yielded little success. The patient was given fluconazole 150 mg and Terconazole 80 mg both orally administered one suppository/day for at least 3 days. The medication ensured that the patient did not get recurrent infection. The patient was encouraged to observe hygiene and practice abstinence during the medication regimen. Other hygiene measures such as mutual monogamy, abstinence and avoid of douching practices.
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This practicum was very enlightening, especially on ways to practice cultural competency. I noticed that sexually transmitted infections (STIs) education focuses in specific information on signs and symptoms which seems to be the worst case scenarios and a taboo to most of the community.
The only down to earth guidance is abstinence and use of condom. If not handled with care, the interaction with the patient could affect patient psychosocial status. I have learnt a lot from this practicum and will use the knowledge to help other patients to identify risk factors and practice preventive measures (Schuiling and Likis, 2013).
References
American Congress of Obstetricians and Gynecologists. (2011). Guideline for adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Centers for Disease Control and Prevention (CDC). (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from http://stacks.cdc.gov/view/cdc/13174
Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
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Amenorrhea Practicum Journal Entry
During this practicum, a 25 year old female presented to the healthcare facility with complains of severe cramp pain that occurs about one week before her menses, during the menstrual cycle and a week after the cycle ends. The patient complains that her menstrual cycles is irregular, and gets heavy periods with some clots. The patient reported to the clinic due to sharp pain that radiated from the chest. The patient had lived with this condition for 12 years. She has been managing the disease using alternative tradition medicines, which has not been effective.
Review of the system was conducted and laboratory tests were performed (urinalysis, urine culture, pregnancy test and wet prep). The differential diagnosis identified included amenorrhea, endometriosis, and ovarian cysts without explanation. Ovarian cysts were suspected due to presence of pelvic pain before the onset of period. However, this is not likely because the patient did not complain of fever and vomiting. Amenorrhea is suspected due to presence of pelvic pain. However, this is not likely as the key indicator of amenorrhea is absence of menses (Domino, Baldor, Golding, 2014).
To make a definitive diagnosis physical test was performed. Under the supervision of my preceptor, I conducted a pelvic exam. This included palpating pelvis areas to check abnormalities such as cysts and scars. The pelvic exam was negative. An ultrasound was requested to capture the image of the reproductive organs. The results indicated that the patient was suffering from endometriosis (American Congress of Obstetricians and Gynaecologists, 2011).
Treatment made included pain relive medication to help manage the painful cramps. The patient was also given Lo Loestrin Fe which has been found to be effective in management of pain. The increase and decrease of hormones during the menstrual cycle makes the endometrial implants to thicken.
Using this hormone therapy, it slows down the growth which prevents the implantation of the endometrial tissue. However, the patient was educated that although these medications manage the pain, they are not a permanent fix for this health complication. The symptoms can reoccur after stopping the treatment (CDC, 2013).
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The patient was also advised on ways to manage pain using home remedies. This includes the use of heating pad to relax the pelvic muscles, which helps in reducing pain. OTC non-steroidal anti-inflammatory drugs such as Motrin IB. The patient is advised to eat health and exercise regularly as it helps improve the pain (Buttaro et al., 2013).
During this practicum, I have learnt that issue of endometriosis is poorly understood in the society. This is probably because of the common myth of “etiquette menstruation” where the society believes that menstruation is a private affair and must not be discussed in public. Most of women conceal their suffering, which makes them to suffer in silence. As advanced nurse practitioner, it is our responsibility to raise awareness on endometriosis to encourage the affected persons to speak up, and seek medication early (CDC, 2013).
During the research, I also realized the common modalities between ovary cysts, amenorrhea and endometriosis. This includes the similarity in the clinical manifestation, test and diagnosis procedures and treatment. In these three reproductive systems disorders, they are clinically manifested by presence of pelvic pain before the onset and after menstrual cycle.
The test diagnosis of these disorders includes ultrasound, Pregnancy tests, urinalysis and urine culture. In management of the disease, most of them are managed using OTC pain killers, hormone therapy or invasive methods. Therefore, I need to research more on these reproductive disorders to ensure that I deliver effective care when serving the affected community (American Congress of Obstetricians and Gynecologists, 2011).
References
American Congress of Obstetricians and Gynecologists. (2011). Guideline for adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Buttaro, T., Trybulski, J., Bailey, P., & Sandberg-Cook, J. (2013). Primary Care, 4th Edition. Philadelphia, PA: Lippincott Williams & Wilkins.
Centers for Disease Control and Prevention (CDC). (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from http://stacks.cdc.gov/view/cdc/13174
Domino, F. J.; Baldor, R.A.; Golding, J (Ed.). (2014). The 5-minute clinical consult standard 2015 (23rd ed, Kindle Edition). Philadelphia, PA: Lippincott Williams & Wilkins.
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Life Cycle of the Female Menstrual Cycle
1. Discuss the initiation of puberty and the role that hormones play during this period in the adolescent’s life span.
The puberty and adolescence are one of the fascinating transitions in human growth and development. It is during this period that sexual maturity occurs. The initiation age of puberty is normally between 8 and 15 years, but it is mainly influenced by person’s genetic composition and the environmental factors. During this period, more sex hormones are secreted by the gonads.
The hormones are responsible for the major physical and biological changes including acceleration of growth in height and weight, development of secondary sexual characteristics such as thelarche, voice changes and growth of public. The period lasts for two to three years but ends when the individual sexual reproduction matures (American Congress of Obstetricians and Gynaecologists, 2011).
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2. Discuss the menstrual cycle and the phases involved in the menstrual cycle. What is the role of various hormones during each phase and what is the significance of each?
The two predominant hormones in menstrual cycles are oestrogen and progesterone which are secreted by the ovaries. During the first days of the cycle, the levels of oestrogen and progesterone hormones are low. In day five (Follicular phase), one egg in the ovary is selected. The suppressed levels of oestrogen cause the secretion of follicle stimulating hormones by the pituitary gland. This hormone facilitates the formation of follicle.
The follicle stimulates the secretion of oestrogen which promotes the formation of the endometrial wall. Day 6 to day 14, the oestrogen levels rise progressively as it prepares for ovulation process. The 14th day of the menstruation cycle is the ovulation day. It is this day that the egg breaks free from the follicle, and migrates to the fallopian tube (luteal cycle).
During this cycle, the corpus luteum develops as a result of release of Luteinizing hormone from the pituitary gland. This promotes the secretions of progesterone, which causes proliferation of endometrium for readiness of implantation. If no fertilization takes place, the levels of the progesterone and oestrogen decreases, and endometrium is shed off (the menstrual phase). This marks the beginning of the next cycle (Blakemore et al., 2010).
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3. Compare and contrast the hormones relevant during the menstrual cycle and menopause. What changes occur in the woman’s body as she prepares to enter menopause?
The main changes observed as women prepare for menopause is irregular menstruation cycle is controlled by various hormones. This stage also involves mood swings, vaginal dryness, hot flashes, changes in their sex drive, and insomnia. During menopause, the reproductive hormones levels become imbalanced which causes changes in menstruation cycle. The few ovarian follicles develop and its responsiveness to follicle stimulating hormone reduces.
Additionally, ovaries produce less estradiol, androgens and progesterone causing the production of follicle to stop. This is due to the low estrogen and progesterone levels, which makes the levels of the Follicle stimulating hormone and luteinizing hormone to remain high. This causes shortened and irregular menstruation cycles- the key indicators of onset of the menopause (Trickey, 2011). Eventually, these hormonal changes make menstruation to stop.
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4. Tanner staging during puberty has been used for decades. Tanner staging also estimates when to expect to see these changes in boys and girls. Yet it seems that girls and boys are “maturing faster” today than in previous decades. Do you believe this is a true statement?that adolescents are maturing at an earlier age? If so, what do you believe is the cause of this? If you disagree with this statement, give rationale for why.
Yes, today’s adolescent’s maturity occurs faster than the average age. This fact is attributable to improved health environmental factors. However, there is no exact cause for this because each child’s development and growth is unique and is influenced by various factors such as environmental toxins, socioeconomic status, physical activity and presence or presence of disease. Healthy children with healthy lifestyle mature at a faster rate as compared to the malnourished (Trickey, 2011).
References
American Congress of Obstetricians and Gynecologists. (2011). Guidelinesfor adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Blakemore, S., Burnett, S., & Dahl, R. (2010). The role of puberty in the developing adolescent brain. Human Brain Mapping, 31(6), 926-933. http://dx.doi.org/10.1002/hbm.21052
Trickey, R. (2011). Women, hormones & the menstrual cycle. Fairfield, Vic.: Ruth Trickey/Trickey Enterprises (Victoria).
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Endometriosis: Lack of knowledge and awareness
Research questions
The critical challenge that faces endometriosis community is inadequate factual awareness. Endometriosis is a challenge that keeps most women mired in menstrual myths, misinformation, delayed or under-diagnosis, under treatment, and lack of support. The societal and cultural bias about menstruation has kept the disease invalidated, diminished and ignored. This legacy of misinformation covering this illness is spread from medical educators, patients and the next generation (Ferreira et al. 2016).
The paper seeks to explore existing knowledge on socio-psychological impact of endometriosis on the lives of women. By doing this, it will provide insight into ways of increasing awareness of the disease. The research question is “What is the socio-psychological impact of endometriosis on women’s health? What are the impacts of increased awareness of endometriosis on women’s health?”
Clinical relevance
Endometriosis has remained in the twilight for centuries because the society has failed to recognize the existence of this disease. Research estimates that one in ten women in their reproductive age suffer from endometriosis. Endometriosis is often dismissed as a ‘normal’ problem among women. It affects 176 million women across the globe causing them to endure a life of pain and in some cases, infertility.
Endometriosis has exerted massive economic and social costs at individual and society levels. In the US, it is estimated that 7.6 million women are affected and this accounts for $ 80.4 billion a year. This number is comparable to diabetes yet there are only a small percentage of the afflicted patients who have sought help and are aware of the disease. (Moradi et al, 2013).
Research estimates that most of the primary doctors are not aware of endometriosis markers, which often makes the vast number of women to be underdiagnosed and undertreated. It is estimated that 61% of women suffering from endometriosis were told that it is normal to have painful periods when under treatment. It takes about 9.28 years to get a definitive diagnosis.
An average woman will take 4.67 years to report the issue and the physicians will take about 4.61 years to make the definitive diagnosis. During that time, the women continue to suffer severe pain and they are not in a position to socialise, work, or have a stable sexual relationship (Heidemann et al, 2013).
Most of the research studies have covered various aspect of the disease. However, most of these aspects are redundant in nature and lack translational benefit. A better part of the research study is directed towards the pharmaceutical diagnosis, but it fails to examine the far-reaching impact of the disease. The enduring lack of awareness exists at all societal levels; hence, this has led to average diagnostic delay which is often a catalyst for delayed effective treatment (Moradi et al. 2013).
Early intervention and increased awareness of the disease is important. This is because it helps to reduce the disease morbidity, incidences of infertility, and disease progression across women of all ages. Also, increased awareness is important because it helps the affected women to make informed decisions about their health. Furthermore, increased awareness will facilitate delivery of correct information upon which the healthcare providers can base their healthcare decisions to make timely diagnosis (Ferreira et al. 2016).
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Research design
To effectively address these research questions, the systematic review method will be adopted. This method is preferred due to its ability to include diverse concepts in qualitative and quantitative studies from several disciplines. Therefore, this review draws its synthesis from critical narrative instead of performing the classic systematic review methodology. The classical narrative method will adhere to PRISMA principles as much as possible.
This method is preferred due to its ability to provide exhaustive review of the current literature and published papers on endometriosis awareness, and its impact on women’s lives. The method is cost effective as minimal resources and time is needed. The results generated from this study can be generalized, they are reliable, and can be considered on the context of evidence based practice (Burns & Grove, 2011).
The study design pitfall is the issue of study variables. This is because systematic review study variables vary, but tend to have the same outcome. Some of the reviews will only analyse certain variables such as gender and age factors that may not be allocated to other studies. During the critical synthesis of these ideas, the variables studied in each of original studies will be put into consideration.
A systematic search will be done on multidisciplinary data bases including PubMed, CINAHL plus, Cochrane Library, EBSCOhost, SU database, and PsyARTICLES. Appropriate terms for searching the disease will be developed by reviewing the abstracts, titles and keywords, which will help to identify papers that have information on socio-psychological impact of endometriosis and its increased awareness (Burns & Grove, 2011).
The systematic review will take broad view of the issue because there are limited studies on the impact of endometriosis or the effects that arise due to lack of disease awareness. The work will include information from the various disciplines including sociology and psychology to establish the holistic picture on the impact of endometriosis.
The articles that will be explored include the peer reviewed articles from English language journals. Due to the scarcity of the information on endometriosis, its impact and prevention strategies, no date restrictions will be imposed. However, reviews, commentaries, opinions, and clinical studies will be excluded (Burns & Grove, 2011).
Conclusion
Increased public knowledge and awareness will facilitate early identification of disease onset and facilitate timely intervention of the disease. This will reduce associated morbidity, infertility and associated clinical symptoms. It is time to alleviate the culture of menstrual misinformation by ensuring that the public get timely and authoritative education. Therefore, increased knowledge and awareness will change the presumptuous perspectives and misleading attitudes that normally perpetuate myths about endometriosis.
References
Burns, N., & Grove, S. (2011). Understanding Nursing Research (5th ed.). Elsevier. ISBN-13: 9781437707502
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Sex Selection
Introduction
For decades, sex selection has been a controversial issue. Choosing the sex of a child is often viewed as a justifiable act since there is no harm done to anyone. I believe that gender selection creates balance in a family and it is culturally viewed as a desirable practice that seeks to fulfill social norms. However, there are ethicists who believe that sex selection reinforces the idea of sexual discrimination within our societies (Caulfield & Brownsword, 2012).
This explains why there are renewed efforts from civil societies and government to analyze arguments presented by different authors who either support or oppose the idea of sex selection.
This essay analyzes the meaning of human dignity from two different perspectives. Furthermore, the essay examines how human dignity is defined by our expression of choices and as an inherent value of the society. Based on a case study, the essay describes the social attitudes, norms and circumstance that influence such choices, and their impact on our understanding of human dignity. The essay presents justifications of particular actions concerning sex selection and analyzes some of the features of human dignity that can be put at risk due to actions arising from these two perspectives mentioned therein above.
The concept of human dignity
Human dignity is defined based on the belief that dignity is inherent; hence, human beings posses specific capabilities that are not found in other creatures. It is these features that help to distinguish human beings from other creatures. However, choosing a child’s sex does not define the inherent dignity of human beings. Permitting gender selection is considered as discrimination against a specific gender making it less valuable (Chapman &Benn, 2013).
There are various social reasons for sex selection. Some of these reasons include having a family balance, replacing the deceased child, cultural reasons et cetera. However, these reasons do not define human dignity especially in situations where boys are preferred more than girls. (Kalfoglou et al, 2013).
Kalfoglou et al (2013) views sex selection as an idea that reinforces sexual discrimination. As a result, human dignity is viewed as a situation where a certain gender is prevented from existing and the action is perceived to be justifiable because most people have not been victims of this cruelty. Therefore, individuals created by choice have do not have a reason to complain.
In spite of the reasons that seek to justify sex selection, it is considered to undermine human dignity; thus, causing harm to the wider society. Sex selection has often led to gender disparities in many countries especially in Asian countries such as China and India. This trend has led to patriarchal societal agreements perceived to discriminate girls and women (Mudde, 2010).
The social attitudes, norms and circumstances that influence such perspective
Due to advanced technology, sex selection culture has become popular and this has had a negative impact on females. Parents who are able to access technology have the ability of controlling the sex of their children; hence, they are able to escape the societal stigma of failing to give birth to a son. Many parents avoid giving birth to girls since they are viewed as individuals not worth living .Parents perceive that sex selection gives them the ability to choose what type of children they want in terms of sex. However, this process equates children to products (Webb, 2014).
Sex selection can make parents not to accept some of their shortcomings; hence, lowering the child’s self esteem. Having a strong preference for a specific sex can cause harm for the unwanted sex including rejection and killings to avoid societal blames and eliminate shame. However, proponents of this idea argue that it is normal for such ideas to be rejected at the first instance especially when people are unfamiliar with the idea.
Those opposing the idea of sex selection argue that that having children is not a right that one can put conditions to as children should be viewed as gifts from God (De Melo-Martín, 2013). These arguments are based on our cultural beliefs.
According to Caulfield & Brownsword (2012), traditional patterns of giving gifts recommend that a gift should be taken without putting any condition to it. A gift is something should be accepted unconditionally and the same case applies to children. From a cultural perspective, sex selection promotes the idea of treating children as a commodity, which is more or less similar to buying and selling of children. Choosing some of the features one wants is acceptable only to products like cars or other commodities, but this concept does not apply to human beings. Therefore, sex selection is often used to discriminate a specific gender.
Justification of specific actions in relation to human dignity
Proponents of sex selection argue that everyone has the right to live his life as he pleases so as long as the person does not cause harm or infringe upon other peoples’ rights. The harm principle implies that individuals opposing sex selection need to prove that the action is going to cause harm to others. In this case, sex selection does not cause harm to anybody. Proponents of sex selection argue that the practice is considered harmful based on sociological and psychological assumptions .They further argue that sex selection is an act that is contrary to religious or moral beliefs (Smolin, 2013).
A report by The Task Force on ethics and laws highlights the common objection arguments used to reject the idea of sex selection. The report indicates that sex selection is compared to mocking God. However, such arguments have been applied to all medical innovations. . It started by rejecting the use of chloroform to relieve pain associated with childbirth. This act was viewed as going against God’s will. Such arguments also applied to the use of inoculation (Li & Pantano, 2013).
Ironically, previous medical innovations viewed as going against God’s will have become part of acceptable medical practices; hence, such objections have not been taken seriously. In fact, such arguments are considered as religious claims .Proponents of sex selection argue that individuals should only refrain from the idea if it contravenes their religious beliefs, but laws should not be imposed on people based on other people’s religious views (Dondorp et al, 2013).
Human dignity that can be jeopardized by actions arising from this perspective
Defining human dignity based on our expression of choices affects public opinion about such ideas. If these perspectives are not comprehensively analyzed through research, public opinion will be flawed. The main concern is that people can use limited philosophical analysis to influence policy discussions .
The definition of human dignity should not be derived from the fact that it is an individual choice, but the practice should be viewed from both public and professional bioethical discussions as recommended by Ethics Committee of the American Society for Reproduction (Medicine, 2015).
Human dignity as a societal inherent value
In the second perspective, it is worth noting that the society often values children’s inherent worth. This limits some of the parents’ choices regarding gender selection. Parents who consider gender selections are said not to uphold societal norms and values which is the societal description for human dignity. According to McGowan & Sharp (2013), parents who select their children’s sex because of non-medical reasons are considered to be immoral in the eyes of the society.
From this perspective, human dignity is viewed as pride in oneself or having the sense of self worth as a human being to live a meaningful life .Therefore, any situation that compromises or humiliates this position is considered as a threat to human dignity. Choosing a particular gender over the other for non-medical reasons places expectations on a specific child, and this fails to recognize the personhood of an individual.
Therefore, sex selection fails to adhere to individual inherent characteristics .Children are often viewed as their parent’s property yet they are their own person .Putting too much expectations on the selected children does not give them the respect they deserve; hence, making them not to be autonomous as human beings are supposed to be (Claassens et al., 2013).
Parents who select the sex of their children view their children as a different person instead of the individual the child is suppose to be. Wudarczyk et al (2013) argues that choosing the sex of a child is failing to respect the human intrinsic values of the individual child. In summary, children need to be valued based on their intrinsic worth as human beings. In other words, the values of children should not be attached to specific characteristics.
Social attitudes, norms and circumstances that influence such perspective
In western societies, there is no preferred sex, but selection of sex is based on creating gender balance in the family by having both boys and girls. These common occurrences are observed in Australia, Sweden, and the UK. Even though sex selection does not have negative effects in these countries, Asian countries like China, Korea and India are faced with challenges associated with sex selection due to cultural beliefs. These countries prefer boys to girls and this has led to more than 10 million abortions within the last 20 years (Moskovian, 2013).
Activists in Asia are calling for the ban of sex selection. However, due to the different reasons parents in the UK and India have for choosing the sex of their children, banning sex selection which is a worldwide practice will not change the situation especially in India. So long as there are religious and economic incentives attached to boys, banning sex selection will not have any effect especially in Asian countries.
Given the fact that majority of UK population would still prefer their first children to be boys, sex selection technology will be misused to fulfill desires of these parents. In Asian countries, banning sex selection will not change the cultural norms being practiced in these regions (Dyal, 2014).
Justification of specific actions in relation to human dignity
There are claims doing rounds that sex selection does not promote the inherent human value, and this is considered as an intuitive reaction, but not a reasonable moral response. The fact that certain human actions are unnatural does not necessary make these actions morally wrong. For example, heart transplant is unnatural but it is meant to save human life (De Melo-Martin, 2013).
The fact that those opposed to the claims that selection of sex should be applicable for medical purposes are not considerate to the fact that medical technologies helps couples with sex-linked genetic disorder to bear a healthy child. This does not translate to misuse of technology to fulfill their personal desires. Furthermore, those in support of sex selection argue that this practice eliminates girls in a humane way as compared to other methods like abortion or neglect, meaning that girls whose birth can be avoided will not be exposed to oppression or discrimination (Tregenza-Parker, 2013).
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In the current health care systems, physicians provide services that do not have direct medical benefits, but add value to individuals who seek for such services like cosmetic surgeries and ultrasound. The same view is applicable when it comes to sex selection. Offering sex selection services is also viewed as misuse of limited medical resources, but offering other services like face-lifts is not considered as s misallocation of limited medical resources. According to WHO Press (2011), the idea of sex selection has been misrepresented in most cases.
The most common argument is that sex selection causes social imbalances of sexes in India and China. The concern whether sex ratio is a threat to the western societies is more of a intuitive reaction devoid of concrete evidence .The idea of calling sex selection a sexist sin is not justifiable because most parents who prefer choosing the sex of their children do so based on the fact that they are motivated by the idea of having children from both sexes. People who believe that raising a boy is different from a girl are those who base their thinking on cultural values of children whereby girls are considered to be different from boys (Cooley &Chesnokova,2011).
Human dignity that can be jeopardized by actions arising from this perspective
The facts that arguments against sex selection are more about their consequences, these arguments are based on assumptions; hence, it is not easy to prevent some of the consequences from happening. It is not essay to draw legal lines to permit some forms of sex selection while limiting others. The main worry in such a situation is how parents are likely to spend their money on technology to ensure that their children are born with the specifications they want.
This can often lead to misuse of technology. The other concern is that if sex selection is acceptable, it will make one sex preferable than the other. As a result, it will make it hard to promote anti-discriminatory measures in several countries (Lee, 2016).
Conclusion
It not surprising that sex selection is controversial. , Different people justify their reasons for gender selection viewing it as a desirable practice that seeks to fulfill societal norms. Others view sex selection as a practice that reinforces discrimination while at the same time it goes against the inherent nature of human value. These two perspectives can describe human dignity from different views.
The case study of sex selection helps us to understand some of the social attitudes, norms and circumstances that can influence our choices and how sex selection from these two perspectives can impact on our understanding of human dignity based on the justification presented in support of this action.
Some of the justifications presented in the essay are likely to influence the perception of individuals in understanding the meaning of human dignity; hence, influencing our actions. In conclusion, it is important to define human dignity from a multi-dimensional perspective as compared to defining it from isolated arguments to accurately establish its meaning.
References
Caulfield, T., & Brownsword, R. (2012). Human dignity: a guide to policy making in the Biotechnology era? Nature Reviews Genetics, 7(1), 72-76.
Chapman, A. R., & Benn, P. A. (2013). Noninvasive prenatal testing for early sex identification: A few benefits and many concerns. Perspectives in biology and medicine, 56(4), 530-547.
De Melo-Martín, I. (2013). Sex selection and the procreative liberty framework. KennedyInstitute of Ethics Journal, 23(1), 1-18.
Dondorp, W., De Wert, G., Pennings, G., Shenfield, F., Devroey, P., Tarlatzis, B., & Diedrich,
K. (2013). ESHRE Task Force on ethics and Law 20: sex selection for non-medical reasons. Human Reproduction, 28(6), 1448-1454.
Cooley, D. & Chesnokova, I. (2011). Sex Selection Abortion in Kazakhstan: Understanding a Cultural Justification, Developing World Bioethics 11, (3). 159–60.
De Melo-Martin, I. (2013). The Ethics of Sex Selection. Ethics and Emerging Technologies, 90.
Dyal, M. (2014). Whether sex-selection for non-medical reasons, using pre-implantation geneticdiagnosis, should be permitted in the UK. University of Birmingham.
Ethics Committee of the American Society for Reproductive Medicine. (2015). Use of Reproductive technology for sex selection for nonmedical reasons. Fertility and Sterility, 103(6), 1418-1422.
Kalfoglou, A. L. et al (2013). Ethical arguments for and against sperm sorting for non-medical sex selection: a review. Reproductive biomedicineonline, 26(3), 231-239.
Lee, M. Y. K. (2016). From the case of sex discrimination to the ideas of equality and equal opportunities. InEthical Dilemmas in Public Policy (pp. 111-127). Springer Singapore.
Li, Q., & Pantano, J. (2013). The Demographic Consequences of Gender Selection Technology. Review of Economics and Statistics, Vol. 95, (5): 1549–1561.
McGowan, M. L., & Sharp, R. R. (2013). Justice in the context of family balancing. Science,Technology & human values, 38(2), 271-293. Current opinion in psychiatry, 26(5), 474.
Tregenza-Parker, G. (2013). Sex Selection for Family Balancing? A Legal and Ethical Analysis.
Smolin, D. M. (2013). Sex Selection, the Missing Girls of China and India, and the Challenges of Technological Control of Procreation. Regent JL & Pub. Pol’y, 6, 49.
Moskovian, A. (2013). Bans on Sex-Selective Abortions: How Far is Too Far?. HastingsConstitutional Law Quarterly, 40(2).
Mudde ,A. (2010).‘Before You Formed in the Womb I Knew You’: Sex Selection and Spaces of Ambiguity, Hypatia 25 (3).563–64.
Webb, D. C. (2014). The Sex Selection Debate: A Comparative Study of Sex Selection Laws in the United States and the United Kingdom. South Carolina Journal of International Lawand Business, 10(1), 6.
WHO Press (2011). World Health Organization, Preventing Gender-based Sex Selection: An Interagency Statement OHCHR, UNFPA, UNICEF, UN Women and WHO. Geneva. WHO Press
Wudarczyk, O. A.et al (2013). Could intranasal oxytocin be used to enhance relationships? Research imperatives, clinical policy, and ethical considerations.
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SOAP Note for a Patient with; Ectopic Pregnancy
Subjective
A 30-year-old female, gravid 1, para1+0.The patient complained of abdominal pain in the right adnexal area which was generalized. She complained of dizziness, light headedness, and syncope. She experienced abnormal uterine bleeding for three days. She had not undergone and gynecological operation and had been on folic and iron supplements. Her menarche was at the age of 14years. Her menses were regular and used to last for 5days and occurred every 28days.The patient had used hormonal implant for three years and had been removed three months ago. She had not received her menses for two months. She was sexually active and had post-coital bleeding. She used to take alcohol on a regular basis.
Objective
The patient was sick looking and was groaning in pain.On palpation, there was generalised abdominal tenderness, and unilateral adnexal mass was present on the right hypochondria. Her vital signs were; Temperature -36.7degrees Celsius, blood pressure-98/56 mm/Hg, pulse-50beats/min. On bimanual examination, there was cervical motion tenderness. Her Serum HCG levels were 4500 IU/l; a trans-vaginal Ultrasound revealed a tubal mass in absence of intrauterine gestational sac.
Assessment
Ectopic pregnancy which leads to acute abdominal pain and bleeding (Marion & Meeks, 2012).
Ovarian torsion resulting in localized lower abdominal pain radiating to the back or thigh and nausea and vomiting
A Urinary tract infection leading to lower abdominal pain and dysuria and increased micturition
Appendicitis presenting with guarding abdominal pain and nausea and vomiting. Diagnosis of ectopic pregnancy was made due to the acute abdominal pain, associated bleeding, and increased βhCG levels
Plan
The overall goal of management was to preserve the life of the mother, and this was managed through termination of pregnancy and reconstruction of the implantation site. The patient was given a bed rest ensure that she had reduced activity (Marion & Meeks, 2012). The patient was cannulated and started on intravenous fluids to restore the fluid volume deficit. Blood samples for the laboratory were obtained. Relaxation techniques were used to relieve pain.
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Medical management
The patient was put on intramuscular methotrexate. Methotrexate is a folic acid antagonist which deters cell division. The products of conception degenerates and detaches from the uterus leading to death (Epee-Bekima & Overton, 2013). Viability of the cytotrobhoblast is prevented together with β-hCG secretion (Wright, Busbridge & Gard, 2013).
Surgical management
Laparoscopic salpingectomy was considered to be the primary treatment of the ectopic pregnancy. Salpingectomy was conducted so as to repair the ruptured fallopian tube (Marion & Meeks, 2012).
Alternative management
Expectant management, the ectopic pregnancy could be waited to resolve on its own. However, this would be followed by β-hCG measurement and trans-vaginal ultrasound to confirm whether the disorder has resolved (Epee-Bekima & Overton, 2013).
Follow-up
The patient was advised to visit the clinic after 3-4 weeks for b-hCG measurement and ultrasonography. The patient was also advised on early pregnancy clinic visits.
Reflection notes
Patient involvement: I would carefully advise my patient of the advantage associated with any of the treatment approaches and ensure she fully participates in the selection of the mode of therapy. The use of laparoscopy could be used so as to come up with the diagnosis so as to minimize use of Surgery is the primary form of treatment. In addition to that, a less surgical procedure such as laparoscopic approach would have been used since it is associated with minimal intra-operative blood loss and hospital stay.
Marion, L. L., & Meeks, G. R. (2012). Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clinical obstetrics and gynecology, 55(2), 376-386.
Mergenthal, M. C., Senapati, S., Zee, J., Allen-Taylor, L., Whittaker, P. G., Takacs, P., … & Barnhart, K. T. (2016). Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols human chorionic gonadotropin trends and patient outcomes. American Journal of Obstetrics and Gynecology.
Practice Committee of the American Society for Reproductive Medicine. (2013). Medical treatment of ectopic pregnancy: a committee opinion. Fertility and Sterility, 100(3), 638-644.
Wright, S. D., Busbridge, R. C., & Gard, G. B. (2013). A conservative and fertility-preserving treatment for interstitial ectopic pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology, 53(2), 211-213.
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Assisted Reproduction Technology
History of Assisted Reproduction Technology
In July 1983, the first successful human-human transfer of an embryo resulting in pregnancy was announced. Biggers and John report that the procedure took place at the Harbor-UCLA Medical Center under the supervision of Dr. John Buster. Subsequently, the first birth was reported in February 1984. It is estimated that between then and now, about 350,000-50,000 babies have been born following this procedure (Biggers and John 123).
The embryo was transferred from the woman in whom it was developing to another woman to the woman who gave birth 38 weeks after. Henceforth, this was considered milestone breakthrough for women who were infertile (Biggers and John 121). It has given light to embryo donation and the use of human oocyte as an alternative to adoption for these women.
The Uses and Benefits
According to Wagner, embryo transfer or assisted reproduction technology is used for women with infertility challenges such as, blocked and damaged oviducts or those whose fallopian tubes have been removed. Women with ovulation disorders can also take advantage of this technology. As well, it can also be utilized in case of men with male factor infertility (low sperm count or sperm immobility) and persons with genetic disorders (Wagner, Marsden, and Patricia 1028).
Same gender couples and individuals who choose to be single can also use this technology. The benefits that come with freezing of embryos include the ability to store them in case you are at risk of injury or death.it is important for persons who conditions that require medical attention, which affects their fertility (Wagner, Marsden, and Patricia 1028). Freezing of embryos is also beneficial people undergoing sex-change operations. Finally, it gives people a chance to become donors and assist individuals with infertility problems.
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Problems and Risks
The only known problem with embryo transfer surface when a donor who is not registered participates without the consent of Human Fertilization and Embryology Authority (HFEA) clinic. This compromises your health and that of the child because of lack of stringent screening and testing procedures (Wagner, Marsden, and Patricia 1030). Also, it becomes unclear on who is the legal parent of the child as this can allow the donor to take the legality. Furthermore, it will be impossible for this child to have any information of the donor since it will be missing in the HFEA files.
Apart from this, there are also several risks surrounding this technology (Wagner, Marsden, and Patricia 1028). As with other medical processes, fertility medications have side effects, which range from headaches, ovarian hyperstimulation syndrome breath shortness, and fainting. Additional risks include; bleeding and infections during egg retrieval, the chance of multiple pregnancies and associated psychological and emotional stress (Wagner, Marsden, and Patricia 1028).
Society Viewpoints
There are some social aspects outlined by (Schoolcraft et al. 863). Some people, especially in professional settings, are of the opinion that this technology should be left to same gender couples only. In Asian countries, it is only allowed for married couples only (Schoolcraft et al. 866). It widely practiced in European countries while it is prohibited in South America because of religious reasons (Schoolcraft et al. 867). This is because Christians consider this technology immoral. Other people argue that the stress and pain that come with this procedure can make difficult for the parent to bond with the child.
Personal Effect
This technology has no significant effect on me because from my perception people should be given a chance to choose the mode of reproduction they consider most favorable. It is therefore not under my jurisdiction to judge it as wrong or right (Schoolcraft et al. 864). It is, therefore, a matter of individual choice because it only involves the individuals who choose it.
Wagner, Marsden G, and Patricia A St Clair. “Are in-vitro fertilization and embryo transfer of Benefit to all?” The Lancet 334.8670 (2014): 1027-1030. Web. http://www.ncbi.nlm.nih.gov/pubmed/2572751
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