Gonorrhea Nursing Diagnosis and Nursing Care Plan

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Gonorrhea Nursing Care Plans Diagnosis and Interventions

Gonorrhea NCLEX Review and Nursing Care Plans

Gonorrhea is a sexually transmitted infection caused by a bacterium, Neisseria gonorrhoeae, which may affect both men and women. Most frequently, gonorrhea affects the throat, urethra, and rectum.

It can also affect the cervix in females. Gonorrhea can be spread through vaginal, oral, or anal intercourse. Offspring of infected mothers can also be infected during vaginal birth, most frequently affecting the eyes.

There are ways to prevent gonorrheal transmission, such as abstaining from sexual activities, using a condom during intercourse, and avoiding engagement with multiple sexual partners. Due to the increased possibility that men would experience urogenital symptoms and the higher diagnosis rate among men who have sex with men, gonorrhea infection has a modest male prevalence.

Signs and Symptoms of Gonorrhea

Men who have contracted gonorrhea may exhibit the following symptoms:

  • a pus-like discharge coming from the penis’s tip
  • painful urination
  • painful or swollen testicle
  • increased frequency or urgency of urination
  • swelling and discoloration at the penile opening
  • anal pruritus and soreness
  • rectal bleeding or discharge
  • painful bowel movements

Women who have gonorrhea may have the following signs and symptoms:

  • increased vulvar leaking
  • painful urination
  • increased frequency or urgency of urination
  • vaginal bleeding between periods (i.e., post-coital vaginal bleeding)
  • sharp pelvic or abdominal pain
  • painful penetrative vaginal sex
  • rectal bleeding or discharge
  • painful bowel movements

Gonorrhea can also affect the mouth and throat. The symptoms of oral gonorrhea may include:

  • persistent sore throat
  • swelling of cervical lymph nodes
  • inflammation and redness of throat

Cause of Gonorrhea

Neisseria gonorrhoeae is an obligate human pathogen that typically causes cervicitis in women and urethritis in men. Obligate pathogens are microorganisms that need to cause disease to facilitate disease transmission from one host to another.

These bacteria require a host to survive; they cannot exist independently. Gonorrheal urogenital infections, which are most frequently but not exclusively found in women, can induce endometritis, pelvic inflammatory disease, infertility, and/or life-threatening morbidity through ectopic pregnancy when left undiagnosed and/or untreated.

N. gonorrhoeae is transmitted when there is a contact with exudates from the mucous membranes of gonorrhea-infected individuals.

  • Sexual transmission: Sexual intercourse with a partner with gonorrhea can spread the pathogen through the mouth, vagina, or anus.
  • Vertical transmission: If a mother with gonorrhea did not receive treatment during the perinatal period, they could pass the illness to the newborn during vaginal delivery.
  • Autoinoculation. The conjunctivae or the rectum may also get infected through autoinoculation from an infected genital site.

Risk Factors to Gonorrhea

Men who have sex with men and sexually active people under the age of 25 are more likely to contract gonorrhea. Additional elements that could raise one’s risk include:

  • having unprotected sex with a new partner
  • having unprotected sex with multiple sexual partners
  • having unprotected sex with someone from an area with high gonorrhea burden
  • having sexual contact with a person with gonorrhea or other sexually transmitted diseases
  • being sexually active under 25 years of  age
  • those who engage in sex work involving money or drugs
  • those who have a history of sexually transmitted and blood-borne infections (STBBIs)

Complications of Gonorrhea

Undiagnosed and/or untreated gonorrhea can lead to serious complications such as:

  • Female infertility. Gonorrhea has been linked to pelvic inflammatory illness, which can extend to the uterus and fallopian tubes (PID). PID increases the risk of pregnancy problems, scarring of the fallopian tubes, and infertility thereby necessitating immediate and prompt treatment.
  • Male infertility. The epididymis, a small, coiled tube that houses the sperm ducts in the back of the testicles, can become inflamed as a result of gonorrhea (epididymitis). Untreated epididymitis might cause infertility.
  • Spread of infection to the joints and other bodily systems. The gonorrhea-causing bacterium can travel via the circulation and infect several body organs, including the joints. Possible side effects include a fever, rash, skin sores, joint discomfort, edema, and stiffness.
  • Heightened risk of contracting HIV/AIDS. An individual with gonorrhea is more susceptible to contracting HIV, leading to AIDS. Individuals who both have HIV and gonorrhea can readily transmit the disease to their partners.
  • Complication in newborns. Infants that acquire the disease during vaginal birth may manifest blindness, scalp sores, and infections.

Diagnosis of Gonorrhea

Diagnostic tests for gonorrhea should usually include:

  • Examination of discharge.  Direct identification of the gonococcal pathogen in urogenital, anorectal, pharyngeal, or conjunctival swab specimens allows for the diagnosis of gonorrhea.  Examination of first-catch urine can also detect gonorrhea. This type of test, which can take many days, requires a laboratory culture. The clinical suspicion of gonorrhea is confirmed by the finding of N. gonorrhoeae or its genetic signature in genital or extragenital samples using nucleic acid amplification (NAATs), culture, or light microscopy of stained smears. The best test for gonorrhea infection is NAAT testing, which finds the genetic material (DNA) of N. gonorrhoeae. This kind of test can be carried out using either a urine sample or a swab collected from a probable infection location.
  • Blood tests. A blood test may occasionally be used by a medical expert to identify gonorrhea, however, this might not be definitive.
  • Screening tests. In addition to urogenital screening, populations who engage in anogenital sex and/or insertive oral sex will need to be screened for gonorrhea from the anus and pharynx. Pharyngeal and rectal gonococcal infections are common symptoms, as shown by the widespread use of NAATs to screen at-risk asymptomatic patients.

Treatment for Gonorrhea

The treatment for gonorrhea should usually include:

  • Antibiotics. On the basis of historical information, such as sexual activity with a person who has a STI or a clinical examination suggestive for a STI, such as penile drip or atypical vaginal discharge, empiric medication for gonococcal infections is frequently given during the initial clinical appointment. In most cases, gonorrhea can be cured with modern antibiotics. The recommended treatment for gonorrhea is ceftriaxone which should only be administered intramuscularly once daily. A medical expert will probably also recommend an oral drug, such as doxycycline twice daily for seven days. The CDC has modified its previous recommendations (ceftriaxone with azithromycin) because N. gonorrhoea are becoming increasingly resistant to azithromycin. In patients who have a life-threatening hypersensitivity reaction to cephalosporins or beta-lactam antibiotics, aztreonam monotherapy can be administered to treat gonorrhea. Directly observed therapy, as recommended by the World Health Organization, encourages adherence to therapy and reduces treatment failures brought on by noncompliance.
  • Health education. Engagement in sexual activities must only be continued a week after finishing the antibiotic regimen despite alleviation of symptoms. Patients should also notify their partners about their condition and allow them to undergo treatment as well. Patients should receive counseling regarding the need for microbiologic confirmation of a cure for N. gonorrhoeae if they receive alternative treatment, if substantial co-morbidities like HIV are present, or if symptoms linger. In order to prevent recurrent treatment failure, retesting can offer antibiotic susceptibilities. Patients with gonorrhea infection are more likely to acquire other STIs, such as HIV. Within a year of receiving an HIV diagnosis, as many as 27% of patients also receive a gonorrhea diagnosis.

Nursing Diagnosis for Gonorrhea

Gonorrhea Nursing Care Plan 1

Acute Pain

Nursing Diagnosis: Acute Pain related to the infectious process secondary to gonorrhea as evidenced by painful urination, pain and swelling of testicles in males, and pelvic or abdominal pain in females.

Desired Outcomes

  • The patient will identify the causes of the condition.
  • The patient will employ non-analgesic methods of prevention to relieve pain.
  • The patient will take analgesics as prescribed.
  • The patient will report the pain as controlled or managed.
Gonorrhea Nursing InterventionsRationale
Characterize the pain according to location, quality, onset, duration, frequency, and severity. Identify the precipitating and alleviating factors.This identifies if there is a need for interventions and monitors their effectiveness. This may also indicate the development or resolution of symptoms.
Observe non-verbal signs of discomfort, particularly the inability to effectively communicate.This allows prompt management of symptoms. The effectiveness of comfort measures and drugs is increased with timely intervention.
Encourage the patient to communicate their pain by using therapeutic dialogue.This can decrease the fear and anxiety of the patient thereby decreasing the overall perception of pain intensity.
Minimize environmental factors that may affect the patient’s reaction to discomfort (e.g., irradiation, room temperature).This encourages relaxation and a sense of well-being.
Teach the implementation of non-pharmacological methods (ex.: relaxation, guided imagery, music therapy, distraction, application of heat and cold, massage, hypnosis, therapeutic activity).This promotes relaxation and mindfulness. Mindfulness is a skill of being present in the moment.
Administer analgesics, as prescribed.This provides pain relief and reduces fever.
Encourage the patient to get enough sleep or rest.The amount of hours of sleep the night before is one of the most crucial indicators of pain intensity. As sleep quality increases, the need for analgesics decreases.
Perform palliative measures such as massage and repositioning.This decreases muscle tension and promotes muscle relaxation.

Gonorrhea Nursing Care Plan 2

Hyperthermia

Nursing Diagnosis: Hyperthermia related to inflammatory reactions secondary to gonorrhea as evidenced by increased body temperature beyond the normal range.

Desired Outcomes: 

  • The patient will demonstrate absence of hyperthermia as manifested by a body temperature within the normal range.
  • The patient will have heart rate and respiratory rate within the normal range.
  • The patient will have no headache and skin discoloration.
Gonorrhea Nursing InterventionsRationale
Monitor the patient’s vital signs.Heart rate and blood pressure increase as hyperthermia advances.
Assess the patient’s body temperature every 2 hours, or when there is an alteration in the patient’s condition.Making accurate treatment decisions and identifying temperature trends will be more efficient by using a consistent temperature measurement technique, location, and device. When compared to core temperature methods, all non-invasive methods for measuring body temperature have accuracy and precision variations that are specific to each type and method. Take note that there is a 0.5°C variation in temperatures between measuring core temperature and other non-invasive techniques.
Observe the patient’s skin color. Note and report for any discoloration.Typically, gonorrhea only manifests symptoms at the site of initial infection. However, a small percentage of patients may experience infection spread from the bloodstream to other body organs, particularly the skin, joints, or both. Over infected joints, the skin may be warm and erythematous. Small, red skin spots may develop, commonly on the arms and legs. The patches may contain pus and are slightly painful.
Increase the patient’s fluid and nutritional intake.Dehydration may need to be treated with fluid resuscitation. Patients who are significantly dehydrated are unable to sweat, which is essential for evaporative cooling.
Apply warm compression over the patient’s groin and axilla.Sexually-transmitted infections, such as gonorrhea, may cause swollen lymph nodes in the groin.  If the swollen lymph nodes are tender and painful, apply a warm, wet compress to the affected area.
Administer antipyretics, as prescribed.Gonorrhea can enter the uterus or fallopian tubes in women and result in pelvic inflammatory illness (PID). Abdominal discomfort and fever are two possible symptoms that can range from fairly moderate to extremely severe.

Gonorrhea Nursing Care Plan 3

Impaired Urinary Elimination

Nursing Diagnosis: Impaired Urinary Elimination related to the  inflammatory process secondary to gonorrhea as evidenced by painful urination.

Desired Outcome: 

  • The patient will demonstrate no disturbance in urination as manifested by painless urination and normal urine odor and color.
  • The patient will demonstrate behaviors to prevent retention or urinary infection.
  • The patient will maintain a balanced input and output, free of bladder distension or urinary leakage. 
Gonorrhea Nursing InterventionsRationale
Monitor the patient’s voiding pattern. Note if there are changes in the urine frequency, odor, consistency, volume, and color. Compare the urine output with the patient’s fluid intake. Identify the specific gravity.This describes bladder function characteristics (effectiveness of bladder emptying, renal function, and fluid balance). Take note that complications of the urinary system are a major cause of mortality.
Observe signs of urinary frequency, burning, urgency, and incontinence. Take note of the size or force of the urinary stream. Palpate the bladder after urination.This provides information on the extent of elimination interference. Following a void, fullness over the bladder is a sign of insufficient emptying or retention and necessitates treatment.
Monitor the patient’s typical pattern of urination and instances of incontinence.A number of patients only experience incontinence in the morning after their bladders have collected large volumes of urine overnight.
Evaluate the accessibility of toilet facilities.If physical limitations make it difficult for patients to use the restroom, they might need a commode by their bed.  

Gonorrhea Nursing Care Plan 4

Anxiety

Nursing Diagnosis: Anxiety related to threat to self-concept, interpersonal transmission and contagion, separation from support system, and fear of transmission of the disease to family/ loved ones secondary to gonorrhea as evidenced by increased tension, apprehension, feeling of hopelessness, insomnia, sympathetic stimulation, restlessness, and fear of unspecific consequences.

Desired Outcomes:

  • The patient will verbalize awareness of feelings and identify ways to cope with them.
  • The patient will demonstrate an appropriate range of feelings and decreased fear and anxiety.
  • The patient will demonstrate problem-solving skills.
Gonorrhea Nursing InterventionsRationale
Assess the patient’s level of anxiety. Observe signs of high levels of anxiety such as tachycardia, tachypnea, and non-verbal cues of anxiety.Recognition of these signs will allow for immediate management of symptoms.
Instruct the patient to perform relaxation techniques.This can ease the patient’s anxiety and promote relaxation for a sound mind.
Provide accurate and consistent information on the diagnosis, treatment, and prognosis of the disease. Avoid arguments related to the patient’s perception of the situation.This can reduce the patient’s anxiety and enable them to make choices and decisions based on reality.
Provide a safe space for the patient to openly discuss feelings about their condition.This helps the patient feel a sense of acceptance without judgment and promotes a sense of dignity and control over the situation.
Allow the patient to express fear, anger, and despair without confrontation. Reassure that expression of those feelings are normal and must be released appropriately.Acceptance of these feelings is the initial step, allowing the patient to deal with the situation.
Identify the patient’s support systems and encourage interaction with their family or significant other.This reduces feelings of isolation and loneliness. If support systems are not available, rapid assistance from other sources can be required.
Provide reliable and consistent information and support for the significant other.This improves interpersonal communication and decreases fear and anxiety.    
Include the significant other when making significant decisions related to the patient’s condition.This ensures the patient has a support system and gives the significant other a chance to be involved in the patient’s life. Separate care consultations and visiting hours may be required if the patient’s family and significant other are in disagreement.
Refer to psychiatric counseling (i.e., psychiatric clinical nurse specialist, psychiatrist, social worker), as directed.When dealing with a diagnosis or prognosis, more help may be needed, particularly if suicidal thoughts are present.
Provide contact with other resources as needed, such as a spiritual advisor or hospice personnel.This allows for the discussion of spiritual issues. This may also reduce patient/SO concern about care and assistance during the end of life.

Gonorrhea Nursing Care Plan 5

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to lack of exposure/recall, misinterpretation of information, cognitive limitation, and unfamiliarity with information sources secondary to gonorrhea as evidenced by questions/request for information, inaccurate follow-through of instructions, statement of misconception, and development of preventable complications.

Desired Outcomes: 

  • The patient will verbalize and interpret an understanding of the condition, disease course, and any potential complications.
  • The patient will determine the association between the symptoms and disease process and correlate these symptoms to their underlying causes.
  • The patient will verbalize their understanding of therapeutic needs.
  • The patient will execute the necessary steps correctly and provide justification for their decisions.
  • The patient will participate in the treatment plan and make the necessary lifestyle modifications.
Gonorrhea Nursing InterventionsRationale
Review the progression of the condition and the outlook.This provides a knowledge base so the patient can make educated decisions.
Determine the patient’s physical state and degree of independence or reliance. Note the level of assistance and care provided by family and the patient’s significant other as well as the necessity for additional carers.Assists in determining the level of care, management of symptoms, and identifying the need for more resources.    
Review the disease’s means of transmission, particularly if it has just been discovered.Eliminates false beliefs and enhances patient and public safety. Targeting preventative programs requires accurate epidemiological data.
Emphasize the importance of regular skincare, which includes checking the perineum, pressure points, and skin folds as well as giving adequate ointments and cushioning for protection.A barrier to infection is provided by healthy skin. It is crucial to take precautions to avoid skin disturbance and its implications.
Talk about the patient’s medication schedule, interactions, and side effects.Improves cooperation or enhances the likelihood that the therapeutic regimen will be successful.
Emphasize the value of getting enough rest.This increases energy and coping skills while managing fatigue.
Encourage exercise and activities at a level that the patient can handle.Increases the patient’s sense of well-being by stimulating endorphin release in the brain.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Nursing Stat Facts
Nursing Stat Facts

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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