Anya Olivarez

BSN 2-B

Case Scenario D
She also Angela Is a 22-year-old Chinese transgender male to female person. She seems
nervous and does not make eye contact. English is not her first language. She is currently going
through estrogen hormone therapy. She has a history of depression and drug use. Angela was
referred by a local CBO to your clinic to obtain an annual physical examination.

Discussion questions

1. Estrogen Hormone Therapy Where does she receive therapy?

Such knowledge is not provided by the facts. However, it said that she is now undergoing
estrogen hormone therapy, which might suggest that she was prescribed estrogen pills by a
non-licensed practitioner or that she purchased over-the-counter estrogen pills at a local drug
store. The data also show that she sought assistance from a local CBO, which might be an LGBT
community with an internal physician who administers estrogen tablets to its members, or it
could indicate that they have their own supply of such pills that they distribute to its members.

Is she using clean needles,- Yes, since a doctor would never tell a patient not to use clean
needles.

Are their side effects? Blood clot in a deep vein, excessive triglycerides, a form of fat (lipid) in
the blood, gallstones, weight gain, elevated liver function tests, decreased libido, infertility

2. Assess Social Support —

Does she have family? — Yes,

1. Due to gender discrimination in the family and community, the possibility of leaving China
exists.
2. In order to better express herself and be appreciated for who she is, she traveled to the
Philippines and sought assistance from a local CBO.
3. She took medications to cope with the depression she felt as a result of having to leave her
country and family due to discrimination.
4.She is unable to converse because English is not her native tongue.

Do they appear to be supportive of her gender identity and transition? — Yes, she should have
a support system, which would be her counselor, because before undergoing the transition, the
patient must be counseled and undergo a psychological evaluation.
If not, what impact does this have on her? It will affect her; she may experience depression,
social isolation, and suicidal ideation as a result. When a person lacks a support system, it has a
significant influence on their social, emotional, spiritual, physical, and mental well-being.
 Case Scenario for Human Sexuality

Situation A
Wang Wei is a 22 year old Chinese American male who is gay and has had multiple partners
over the last several years. He recently graduated from college and has found a position as an
engineer in a prestigious firm. As the only male child, his parents are very proud of his
accomplishments. He has been experiencing flu-like symptoms for several weeks and upon the
urging of his friends, has visited a clinic outside of his community. Wang Wei  chose this clinic
because he does not want to run into any friends or associates of his family. He has not yet
disclosed his sexual orientation to his family because of their traditional values and expectations
regarding the role of the male child. His older sister is the only member of his family to whom he
has disclosed his sexual orientation. Although they are not close, she is accepting of his
lifestyle. Although the Wang Wei’s father speaks some English, his mother speaks primarily
Chinese. Wang Wei reports that he has been “dating” but currently there is no one special in his
life.

 Discussion  questions 
1. What are the traditional views and values that affect Wang Wei’s sexual orientation?
- “The role of being a son”

2  What steps should Wang Wei undertake to disclose his sexuality?

- The first step is he should accept himself before he expect other to accept him if he already
accept his self he would be ready to disclose his sexual orientation to his family and take
whatever consequences he will face.

3. What important role should significant others play in helping Wang Wei?
- Support/ Group system. Group of people whose their to support Wang Wei.

4. Will joining a support group help him understand and accept himself in his chosen sexual
orientation? Explain your answer.
- Yes, because it will help him find peers that can and will understand him and his situation.

5. Discuss other Cultural Competence issues that may impact retention into care and treatment.
- The culture of the religion Jehovah’s witness where in they are forbidden to have blood
transfusion because it is considered for them.

Situation B
Jenice is a 25 year old African American transgender male to female person, presented to the
hospital following an altercation with her new lover, Max. She reported being thrown from the
third floor balcony by Max who thought she was born female. During their tryst Max found out
that Jessie was transgendered. Jessie suffered several broken bones and injuries. On the front
of the chart, the patient was listed as male but, preferred to be addressed as Jessie. She
requested that only female medical personnel enter her room. A third year male resident
physician was assigned to care for the patient; he required that a female medical student
accompany him. It was very apparent that the patient and resident physician were
uncomfortable during the encounter. Jessie never made eye contact with the resident physician
and would only speak to the student. On leaving Jessie’s room, the resident physician referred
to her as a “she-male”. Jessie overheard him. It was discovered that the patient was HIV
positive, refused to take anti-retrovirals and had little to no family support. 
Discussion Questions 
1. What is the best way to proceed in this case? 
- Best way handle this is to focus on the care of the patient. Request for female staff needs to
be respected and initiated by the hospital.

2. How can barriers to care be identified and overcome with Jenice? 

- There is a need of interdisciplinary team, social work, psych, nurses, MD to work with patient’s
situation and help her open with the health care providers.

3. How could the resident physician be more culturally sensitive? 

- Any healthcare provider should not be judgmental to their patient and be sensitive to their will
being. As a nurse you need to be the patients advocate.

4. Should members of the hospital be legally involved in Jenice’s altercation with his partner?
Explain further.
- Hospital needs to coordinate with authorities/women’s desk for reporting physical injuries. This
depends on the severity of injury that will determine what is fightfully punishable by law.
Hospitals are liable to report any suspecting result from domestic violence.

5. What kind of support or resources can you get for Jenice?

- Counselor and be their client advocate, try to find a support system for Jessie.

6. Discuss other Cultural Competence issues that may impact retention into care and treatment.
- Discrimination, Harassment, and Voilence against transgenders.

Situation C
Maria is a 26 year old Latina male to female transgender who was diagnosed with HIV one
month ago. She has been working at a restaurant for the past 6 months and lives with her
parents. Maria seeks treatment at a community clinic that serves Latino patients. She has been
faithful in keeping appointments. Maria trusts her provider, and she admits to having multiple
sex partners in the past but is now in a monogamous relationship with Jessie, a 42 year old
attorney. She has no history of mental illness. During her most recent visit to the clinic, her
latest labs are as follows: 
CD4+ T cell count: 410 cells/mm3 
HIV RNA: 79,000 copies/mL
 Hepatitis C Antibody: Positive 

Discussion Questions 
1. How do you proceed in this case? 
- I will follow the treatment plan, which is address the medical problem

2. Are there any behavioral factors that need to be addressed before Maria is started on an
antiviral regimen? 
- Her partner needs to be involved in the care. With HIV, it is necessary to do sexual contact
tracing.

3. What approach should be taken to assess Maria’s ongoing drug use? 

- To asses drug use, Doctors needs to compare previous lab result to see the effectiveness of
treatment, then patient education on medication administration.

4. Are there any ethical concerns that need to be addressed during this encounter? 
- Ethical implication, if partner knows about the medical condition because her partners medical
condition because her partner is also at risk for HIV and hepatitis.

5. What is Maria’s current support mechanism? 

- Her partner Jessie and her provider

6. What ethical responsibilities, if any, does the clinic have to Maria? 

- Ethical responsibilities is for provider to prode his/her services with respect for human rights.
Advocate of human dignity

7. Discuss other Cultural Competence issues that may impact retention into care and treatment
- Cultural Competency is to provide treatment to patients non judgementalism, cultural
sensitivity, self- concept, open-mindedness. Issues that impact retention care and treatment.
Provider need to provide safe environment, non-judgmental and awareness model of treatment,
and compliance with treatnment.

Situation E
You are a nurse at a university student health clinic taking care of a 22 year-old male student
named Jake. When obtaining a history from Jake, you discover he is in a fraternity and has
many sexual relationships with women. When gauging his safe sex practices, Jake states: “I
rarely wear condoms. I just don’t like the way they work because I can’t feel as much when I
wear one! I do pull-out to make sure that the girl I am with doesn’t get pregnant. And when it
comes to STDs, the girls I am with are clean and I am not worried about diseases. Besides, I
am not gay so I can’t get AIDS!”

Discussion Questions 
1.What are some communication techniques that are appropriate in discussing sexual    
   relationships in the young adult population?
- Jakes misconception about safe practices was HIV are only for gay population and pregnancy
does not occur in withdrawal. Discussing that multiple partners increases the risk of STDs more
in unprotected sex. Educate patient the pre-ejaculation happens and may result in unwanted
pregnancy.

2. Identify some of Jake’s misconceptions regarding his safe sex practices in general    
   and in-relation to pregnancy.
- Jake is sexually active and can protect himself by using condoms or practice abstinence.
Female condom is also available in some cases. Germicidal are not effective in protecting
individual from STDs.

3. Jake associated AIDS only with gay people. Is his correlation correct?  Do heterosexuals also
need to be concerned about HIV Infection? Explain your answer.
- No, he is wrong because as long as you are sexually active you can always get HIV.
Heterosexuals need to be concerned with HIV because with it may not start from them but the
person they are having sex. Condoms can prevent pregnancy as well.
4. What are some ways Jake can better protect himself and his sexual partners from potential
disease or pregnancy?
- Jake can protect himself by wearing condom while engaging in a partner and educate him to
not have multiple partners when having sex. Condoms can prevent pregnancy as well.

Does he get social support from? His fatenity group.

Where does he stay? Did not say in the scenario.

5. As a healthcare provider, how will you address Jake’s attitude towards his beliefs?
- Is he using Substances?- the facts do not provides for such information but since he belongs
to a fraternity, it could be assumed.

If so what kind? Asses for HIV/Hepatitis C risk if needles are involved- none

6. Assess Sexual History and Risk

Has he been tested for HIV/STDs?- If involved in commercial sex work, ask about use of
condoms admits to alcohol and crystal meth use and attends drug/sex parties. Did not imply on
the scenario but I hope he got tested for HIV/STD since he has been multiple partners. If he is
using illegal drugs then do drug test.