Proxemics and Kinesics 3.

Posture– communicates a great deal of

information about you. The way in which you
• Proxemics– deals with the amount of space that
sit, stand, slump or slouch provides information
people feel it necessary to set between themselves
about your sex, status, self-image, attitudes and
and others.
emotional state. For example. sitting with your
head in your hands often indicates that you are
• Kinesics– is the broad field solely concerned with feeling low, whereas sitting with your feet on
the interpretation of nonverbal behaviors that are the desk may be interpreted by others as a sign
associated with body movement, posture, facial of your feeling of superiority.
expression and eye contact.

Types of Proxemics 4. Facial expression– refers to certain movements

or conditions of the facial muscles that facilitate
1. Intimate distance– is that which is used for very the nonverbal communication of some thought,
confidential communications. This zone of emotion, or behavior. Facial expression is the
distance is characterized by 0 to 18 inches feet main channel We use to decode emotional
of space between two individuals. states or reactions of others to a message, and
they generally mirror the intensity of people's
2. Personal distance (18 to 36 inches)– is used for thoughts and feelings.
talking with family and close friends. Although it
gives a person a little more space than intimate 5. Eye contact– is a natural byproduct of effective
distance, it is still very close in proximity to that communication. To look, someone in the eves is
of intimacy, and may involve touching. to invite him to communicate with you. Eye
contact indicates degree of attention or
3. Social distance (4 to 12 feet)– is used in interest, influences attitude change or
business transactions, meeting new people and persuasion, regulates interaction,
interacting with groups of people. Social communicates emotion, defines power and
distance has a large range in the distance that it status, and has a central role in managing
can incorporate. impressions of others.

4. Public distance– is measured at 12 to 25 feet

between persons. This is the acceptable
distance between a speaker and an audience.

Components of Kinesics Messages

1. Gestures– are the movements of hands, face, or

other parts of the body in a way that conveys
meaning, either in conjunction with verbal
communication such as frowning while saying
harsh words against someone, or in isolation
such as smiling at a stranger to express pleasure
at ones presence.

2. Body Movement– is the voluntary or

involuntary movement of parts of the body
such as hands, feet, legs, and shoulders, which
may either reinforce or contradicts what is
communicated verbally. There are various body
movements that send bodily signals.
Gender Dysphoria Signs and Diagnosis:
In children, these symptoms include at least six of the
Gender dysphoria– is a condition where a person following:
experiences discomfort or distress because there's a
mismatch between the biological sex and gender a. Insisting on or strongly desiring the gender that
identity. It's sometimes known as gender incongruence. differs from one that was assigned at birth.
According to the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5), people who experience b. Wanting to wear the clothing of the gender with
intense, persistent gender incongruence can be given which they identify.
the diagnosis of "gender dysphoria."
c. Strongly preferring friends of the gender with
Biological sex– is assigned at birth, depending on the which they identify.
appearance of the genitals.
d. Strongly preferring toys, activities, and games
Gender identity– is the gender that a person typically aimed at the gender. with which they
"identifies" with or feels themselves to be. identify.
While biological sex and gender identity are the same
e. Preference for cross gender roles during play or
for most people, this is not the case for everyone. Some
people may have the anatomy of a man, but identify make believe.
themselves as a woman, while others may not feel
f. Refusing masculine or feminine toys, games, and
they're definitively either male or female. If the gender
identity matches the gender assigned at birth, this is activities that don't match their gender identity.
called cisgender. For example, if you were born
biologically as a male, and you identify as a man, you g. Deep dislike of the genitals they were born with.
are a cisgender man.
h. Strong desire for sex characteristics, such as
Gender Dysphoria –is a recognized medical condition, breasts or penis, that match their gender
for which treatment is sometimes appropriate. identity.
Transgender– refers to identifying as a gender that is Treatment in children:
different from the biological gender assigned when you
were born. For example, if were born biologically 1. family therapy
2. individual child psychotherapy
female and were assigned a female gender, but you feel
a deep inner sense of being a man, you are a 3. parental support or counselling
transgender man. 4. group work for young people and their parents
5. Regular reviews to monitor gender identity
Transsexual– is a person who physically transitions development
from male to female or vice versa. 6. Hormone therapy

Treatment in Teenagers and Adults:

1. mental health support, such as counselling

2. puberty blockers cross sex hormone treatment
3. speech and language therapy - to help alter voice,
to sound more typical of your gender identity
4. hair removal treatments, particularly facial hair
peer support groups, to meet other people with
gender dysphoria
5. "relatives' support groups, for your family
6. surgical reassignment (penectomy, vaginoplasty in
natal male,; mastectomy or phalloplasty in a natal
female).
Gender Dysphoria

Nursing Interventions

1. Assess patient's well-being with transition

2. Assess social effect of transition

3. Assess the progression and the degree of

masculinization or feminization

4. Monitor mood cycles and adjust medication as

indicated

5. Discuss any family issues

6. Counsel regarding sexual activity

7. Review and reconcile medication use

8. If post-surgery, keep the surgical site clean and

follow-up exams to monitor healing and assess for
sis of infection.

9. Monitor function of genitals and donation sites

10. Encourage health care maintenance, including pap

smear, breast exam, mammogram, STD screening,
and prostate screening

11. Monitor loss of neo-vaginal depth/length if dilation

isn't done

12. Assess for skin tears and pain with rough dilation or
sexual penetration

13. Teach patients that they can still get their opposite
sex partners pregnant. To make enough sperm,
patients should stop taking feminizing hormones for
at least 3-6 months. Likewise, patients can get
pregnant whether they are taking hormones or not.

14. Teach transgender patients to use birth control

without hormones. Advise the patients to be aware
that unprotected sex not only leads to unwanted
pregnancies, but also puts them at risk for STDS.
Paraphilias 7. Transvestism – or transvestic fetishism, refers to the
practice by heterosexual males of dressing in female
Paraphilia– are abnormal sexual behaviors or impulses
clothes to produce or enhance sexual arousal. The
characterized by intense sexual fantasies and urges that
sexual arousal usually does not involve a real partner
keep coming back. The urges and behaviors may involve
but includes the fantasy that the individual is the female
unusual objects, activities, or situations that are not
partner as well. Some men wear only one special piece
usually considered sexually arousing by others.
of female clothing, such as underwear, while others
Paraphilic Disorders fully dress as female, including war style and make-up.
Cross-dressing as a transvestite is not a problem unless
1. Exhibitionism ("Flashing") – involves someone it is necessary for the individual to become sexually
exposing their genitals to an unsuspecting stranger. The aroused or experience sexual climax.
individual with this problem, sometimes called a
"flasher.," feels a need to surprise, shock, or impress 8. Voyeurism ("Peeping Tom")–this disorder involves
their victims. achieving sexual arousal by observing an unsuspecting
and non-consenting person who is undressing or
2. Fetishism–people with fetishes have sexual urges unclothed or engaged in sexual activity. This behavior
associated with non-living objects. The person becomes may conclude with masturbation by the voyeur. The
sexually aroused by wearing or touching the object. A voyeur does not seek sexual contact with the person
related disorder, called partialism, involves becoming they are observing.
sexually aroused by a body part, such as the feet,
breasts, or buttocks 9. Autogynephilia– is defined as a male's propensity to
be sexually aroused by the thought of himself as a
3. Frotteurism– with this problem, the focus of the female. It is the paraphilia that is theorized to underlie
person's sexual urges is on touching or rubbing their transvestism and some forms of male-to-female (MtF)
genitals against the body of a non-consenting, transexualism. It encompasses sexual arousal with
unfamiliar person. cross-dressing and cross-gender expression that does
4. Pedophilia– people with pedophilia have fantasies, not involve women's clothing per se.
urges, or behaviors that involve illegal sexual activity 10 Asphyxiophilia/hypophilia– is the practice of self-
with a child or children. The children involved are strangulation, usually used for masturbatory purposes,
generally 13 years of age or younger. if done improperly, it can lead to unconsciousness or
5. Sexual Masochism– individuals with this disorder use even death.
the act - real, not simulated - of being humiliated, Causes of Paraphilia:
beaten, or otherwise made to suffer in order to achieve
sexual excitement and climax. These acts may be 1.Some experts believe it is caused by a childhood
limited to verbal humiliation, or they may involve being trauma, such as sexual abuse.
beaten, bound, or otherwise
2. Objects or situations can become sexually arousing if
6. Sexual Sadism– individuals with this disorder have they are frequently and repeatedly associated with a
persistent fantasies in which sexual excitement results pleasurable sexual activity.
from inflicting psychological or physical suffering
Treatment :
(including humiliation and terror) on a sexual partner.
1.Cognitive Behavior Therapy - Aversive Conditioning
(using negative stimuli to reduce or eliminate a
behavior), Covert Sensitization (patient is relaxed and
made to visualize scenes of deviant behavior followed
by a negative event.

2. Empathy Training - helping the offender take on the

perspective of the victim and better identify with them.
3. Pharmacologic interventions may be used to suppress
sexual behavior.

Medications that may be considered in the treatment of

paraphilic disorders include the following:

a) Antidepressants (eg, selective serotonin reuptake

inhibitors [SSRis])

b) Long acting gonadotropin-releasing hormones

c) Antiandrogens - medications that reduce

testosterone in males to reduce sexual drives
Ex. Spironolactone, Megestrol Acetate
Phenothiazines

d) Mood stabilizers

Nursing Interventions for Paraphilic Disorders and

Sexual Dysfunctions:

a. Determine stressors. Help client determine time

dimension associated with the onset of the
problem and discuss what was happening in his
or her life situation at that time.

b. Encourage discussion of disease process.

Encourage client to discuss disease process that
may be contributing to sexual dysfunction;
ensure that client is aware that alternative
methods of achieving sexual satisfaction exist
and can be learned through sex counseling if he
or she and partner desire to do so.

c. Identity factors that affect client's sexuality.

Note cultural, social, ethnic, racial, and religious
factors that may contribute to conflicts
regarding variant sexual practices.

d. Be accepting and nonjudgmental. Sexuality is a

very personal and sensitive subject, the client is
more likely to share this information if he or she
does not fear being judged by the nurse.

e. Provide positive reinforcement. Observe client

behaviors and the responses he or she elicits
from others; give social attention (e.g., smile,
nod) to desired behaviors.
Sexual Dysfunction Disorders 7. Premature ejaculation. The DSM-IV-TR describes this
disorder as persistent or recurrent ejaculation with
Sexual Dysfunction Disorders –which can be described
minimal sexual stimulation before, on, or shortly after
as an impairment or disturbance in any of the phases of
penetration and before the person wishes it In DSM-5,
the sexual response.
premature ejaculation is defined as a persistent or
Types of Sexual Dysfunction recurrent pattern of ejaculation occurring during
partnered sexual activity within about one minute
1. Hypoactive sexual disorder. This disorder is defined following vaginal penetration and before the individual
by the DSMs as persistent or recurrently deficient wishes it
sexual or erotic thoughts, fantasies, and desire for
sexual activity. 8. Dyspareunia. is defined as recurrent or persistent
genital pain associated with sexual intercourse, in either
2. Sexual aversion disorder. This disorder is a man or a woman, that is not caused by vaginismus,
characterized by a persistent or recurrent extreme lack of lubrication, another general medical condition,
aversion to, and avoidance of, al (or almost all) genital or the physiological effects of substance use.
sexual contact with a sexual partner. In the
development from DSM-IV.TR to DSM-5 (APA, 2013), 9. Vaginismus. is characterized by an involuntary
the diagnosis of sexual aversion disorder (SAD has been constriction of the outer third of the vagina, which
removed.) prevents penile insertion and intercourse. In DSM-5, the
spasm-based definition of vaginismus was omitted, and
3. Female sexual arousal disorder. This disorder is vaginismus was combined with dyspareuma, the other
identified in the D5M-IV.TR (APA, 2000) as a persistent "sexual pain disorder," which resulted in genitourinary
or recurrent inability to attain, or to maintain until pelvic pain/penetration disorder (GPPPD).
completion of the sexual activity, an adequate
lubrication or swelling response of sexual excitement. Causes of Sexual Dysfunction:
Itis defined in the DSMS as lack of, or significantly
1. Stress is a common cause of sexual dysfunction.
reduced, sexual interest/arousal.
2. Other causes include:
4. Male erectile disorder. This disorder is defined in the - sexual trauma .
DSM-5 as the recurrent inability to achieve an erection, - psychological issues diabetes
the inability to maintain an adequate erection, and/or a - heart disease or other medical conditions
noticeable decrease in erectile rigidity during partnered - drug use alcohol use
sexual activity.. - certain medications

5. Female orgasmic disorder (Anorgasmia). This disorder

is defined by the DSM-M-TR as a persistent or recurrent
delay in, or absence of, orgasm following a normal
sexual excitement phase. As classified by the DSM-5,
female orgasmic disorder is characterized by difficulty
experiencing orgasm and/or markedly reduced intensity
of orgasmic sensations.

6. Male orgasmic disorder (Retarded Ejaculation). With

this disorder, the man is unable to ejaculate, even
though he has a firm erection and has had more than
adequate stimulation. This disorder is also known as
delayed ejaculation (DE) or delayed orgasm (DO).
Delayed ejaculation (DE) is defined in DSM-5 as a
persistent difficulty or inability to achieve orgasm
despite the presence of adequate desire, arousal, and
stimulation.
Alzheimer's Disease 6. Head injury. Some studies have shown a link
between Alzheimer's disease and a major head
Alzheimer's Disease
injury.
- The most common type of dementia. 7. Other factors. High cholesterol levels and high
- It is a progressive disease beginning with blood pressure may also raise your risk.
mild memory loss and possibly leading to
Cognitive Disturbances in Dementia and Alzheimer's
loss of the ability to carry on a conversation
Disease:
and respond to the environment.
- Alzheimer's disease involves parts of the a. Agnosia: Failure to recognize or identify
brain that control thought, memory, and objects despite intact sensory function
language.
- It can seriously affect a person's ability to b. Amnesia: Loss of memory caused by brain
carry out daily activities. degeneration

Dementia vs. Alzheimer's

c. Apraxia: Inability to perform motor activities
Dementia and Alzheimer's disease aren't the same. despite intact motor function
Dementia – is an overall term used to describe
d. Aphasia: Language disturbance in
symptoms that impact memory, performance of daily understanding and expressing the spoken
activities, and communication abilities. word.
Alzheimer's disease– is the most common type of EXPRESSIVE
RECEPTIVE
dementia. Alzheimer's disease gets worse with time and
GLOBAL
affects memory, language, and thought.

Dementia–is a syndrome, not a disease. A syndrome is a Stages of Alzheimer's Disease

group of symptoms that doesn't have a definitive 1. Mild Alzheimer's Disease. People experience greater
diagnosis.
memory loss and other cognitive difficulties. Problems
Dementia– is a group of symptoms that affects mental can include wandering and getting lost, trouble handling
cognitive tasks such as memory and reasoning. money and paying bills, repeating questions, taking
longer to complete normal daily tasks, and personality
Dementia–is an umbrella term that Alzheimer's disease and behavior changes. People are often diagnosed in
can fall under. It can occur due to a variety of this stage.
conditions, the most common of which is Alzheimer's
disease. 2. Moderate Alzheimer's Disease. In this stage, damage
occurs in areas of the brain that control language,
Etiology of Alzheimer's Disease reasoning, sensory processing, and conscious thought.
1. Molecular and Cellular Changes in the Brain, Memory loss and confusion grow worse, and people
Presence of amyloid plaques and neurofibrillary begin to have problems recognizing family and friends.
tangles in the brain They may be unable to learn new things, carry out
2. Age. The risk for Alzheimer's goes up as one gets multiset tasks such as getting dressed, or cope with new
older. For most people, it starts going up after age situations. In addition, people at this stage may have
65. hallucinations, delusions, and paranoia and may behave
3. Gender. Women get the disease more often than impulsively.
men. 3. Severe Alzheimer's Disease. Ultimately, plaques and
4. Family history. People who have a parent or tangles spread throughout the brain, and brain tissue
sibling with Alzheimer's are more likely to get it shrinks significantly. People with severe Alzheimer's
themselves. cannot communicate and are completely dependent on
5. Down syndrome. It's not clear why, but people others for their care. Near the end, the person may be
with this disorder often get Alzheimer's disease in in bed most or all of the time as the body shuts down.
their 30s and 40s.
Treatment: In Communicating with Clients

1. Pharmacology. Cholinesterase inhibitors; 1. Adapt to the communication level of the client.

a. COGNEX (Tacrine) 2. Use a firm volume and a low-pitched voice to

b. ARICEPT (Donepezil Hydrochloride) communicate.
c. RIVASTIGMINE (Exelon)
3. Stand directly in front of the client and maintain eye
d. GALANTAMINE (Razadyne)
contact.
2. Reminiscence Therapy. encourages a patient either in
4. Call the client by name and identify self; wait for a
individual or group settings, to discuss their past and
response.
review their lives. They can also identify past coping
strategies that can support them in current stressful 5. Use a calm and reassuring voice.
situations. They can also use reminiscence to maintain
self-esteem, stimulate thinking, and support the natural 6. Use pantomime gestures if the client is unable to
healing process of life review. understand spoken words.

Note: Activities that facilitate this therapy include 7. Use slow, clear, verbal communication techniques.
writing an account of past events, making a tape 8. Use short words and simple sentences.
recording and playing it back, explaining pictures in old
family albums, drawing a family tree and writing to old 9. Ask only one question at a time and give one
friends. direction at a time.

General Nursing Interventions 10. Repeat questions if necessary but do not rephrase.

1. Orient client to the environment.

2. Furnish environment with familiar possessions

3. Maintain independence.

4. Provide consistent routines.

5. Provide mental stimulation with simple games or

activities

For Wandering Clients

1. Provide a safe environment.

2. Close and secure doors.

3. Use identification bracelets and electronic

surveillance.