More-ch. 21 abuse

Documentation for a patient seen in the ED for rape should include? Select all that apply A.Threats B.Location of Incident C.Circumstances surrounding the assault D.Verbatim verbiage E.All of the above

E

SART

Sexual Assault Response Team

nursing interventions if partner violence is supected -make sure medical attnetion is provided -document injuries on a ___ -ask permission to ___ -set up ___ in private and ensure confidentiality -assess in no threatening manner information concerning: sexual abuse, physical abuse, emotional abuse, abuse in children, drugs of abuse, suicide or homocide ideation -encourage patient to talk about the incident without interrupting them without judgement -ask how patient is faring with children in the home

body map take picture interview

nursing assessment and rape trauma victims -assess and document the event including presence of threats -gather data that may be used as ___ in court -after consent has been signed, ___ should be obtained from clothing, fingernails, hair, pubic hair -assess for evidence of physical trauma -use photos and drawings -perform ___ examination -perform physhological assessment -perform mental status exam -determine ___ used -identify the victims support systems

criminal evidence forensic evidence pelvic the drug

___ is a risk factor for someone becoming an abuser also, the intergenerational violence theory of family says that behaviors are developed through ___, ___, and ___ ___ abuse is considered a contributing factor in many cases of intimate partner violence, elder abuse, and child abuse

domestic violence role modeling identification human interaction intergenerational

physical abuse: -usually encompasses ___ in addition to physical harm -kicking, hitting, pushing, choking, burning, using weapons, and shoving down the stairs

emotional abuse

phases of domestic violence cycle 1. ___ 2. ___ 3. ___

honeymoon phase tension building phase serious (acute) battering phase

IPV

intimate partner violence

honeymoon stage (stage 1) of domestic violence abuser: -___ behavior like brings gifts and flowers and doing special things for the victim -contrite (extremely apologetic) -sorry, makes ___ victim: -___ -hoping for change -wants to ___ partners promises

loving promises to change trusting believe

tension building stage (stage 2) of the domestic violence cycle abuser: -edgy, has ___ -becomes very ___ -minor ___ and ___ victim: -feels ___ -feels like "___" -feels helpless -becomes ___ -accepts ___

minor explosions verbally abusive hits and slaps other incidents begin tense and afraid walking on egg shells compliant blame

emotional abuse: -includes ___, excessive ___, -ignoring ___ -yelling and swearing -mocking -___ , ___ -threat and intimidation -denying abuse -___ the victim

name calling criticism accomplishments locking the victim in a room isolating blaming

scope of practice for a sexual assault nurse examiner SANE -perform a ___ of the surviror -collect ___ -provide expert ___ regarding forensic evidence collected -support the physiobiological needs of the surviror -be part of the ___ -and work closely with ___ and the prosecutors office

physical examination forensic evidence teistimony SART law envorcement agencies

mental illnesses that may develop related to rape trauma -depression -anxiety -difficulties with daily functioning -low ___ -___ -self destructive behaviors subtance abuse -higer rates of ___

self esteem eating disorders suicide

economic abuse: -a form of neglect and occurs when the dependent person has monetary resources (money) ___

withheld

A guest lecturer from a treatment program for perpetrators of abuse is describing the program to a group of nursing students. The program uses cognitive behavioral techniques. Which of the following would the lecturer include as a focus of the program? Select all that apply. a. Identifying what the perpetrator thinks about before the incident b. Determining the perpetrator's emotional & physical responses to the thoughts c. Exploring the perpetrator's actions that eventually lead to violence d. Identifying the behaviors in the survivor that led to the violence e. Determining the extent of guilt or remorse experienced by the perpetrator

Answer: a, b, c Rationale: Cognitive behavioral interventions target three elements: (1) what the batterer thinks about before a battering incident, (2) the batterer's physical and emotional response to these thoughts, and (3) the batterer's actions that progress to violence (yelling, throwing things). The group teaches members to recognize and interrupt negative feelings about their partners and to reduce physiological arousal through relaxation techniques.

The nurse is working in the emergency department with a client who was raped 1 hour ago. Which is most important for the nurse to remember when planning care? a. The client should set aside any angry feelings until physical care is completed. b. Evidence collection according to procedures is not as important as treating the client's injuries. c. The nurse will need to make decisions for this client. d. The client may feel threatened by some of the procedures.

D

____ is an unfortunate consequence of rape and occurs frequently in victims. Common symptoms associated with PTSD include:• ___ the trauma: Recurrent nightmares about the rape, flashbacks, or uninvited, intrusive thoughts during the day or night• ___: Called "psychic numbing," involves not experiencing feelings of any kind• ___ behaviors and actions: Avoidance of all places and activities, as well as thoughts or feelings, that could recall events about the rape• ___ psychological arousal characteristics: Exaggerated startle response, hypervigilance, sleep disorders, or difficulty concentrating• ___ and ___: Fear of being alone, fear of sexual encounters, and fear of the indoors or outdoors are just some examples• Nightmares and difficulty sleeping

PTSD re-experiencing social withdrawal avoidance increased fears and phobias

A nurse is caring for an elderly client who arrived at the emergency room with injuries following a physical assault with a baseball bat. The client tells you that their son is responsible for the injuries. Place the following nursing actions in order from the highest importance to the lowest importance. All options must be used .a. Remove the significant other from the room with the client .b. Conduct an assessment of the client. c. Notify the physician of the client's injuries and situation. d. Notify the police of the assault.

ABCD Rationale: The priority in this situation is the safety of the client. Therefore, the significant other should be removed from the room with the client to prevent further injury. The nurse should complete a full assessment of the client and then notify the physician of the assessment findings and situation. In cases of assault the police will need to be notified because this is a criminal act. The final intervention should be calling a meeting of the interdisciplinary team to evaluate the clients situation and identify all available resources.

A woman in a relationship characterized by a long history of battering and abuse tells the nurse, "We've had a rough time lately. I admit it: He beat me last night but then said he was sorry." Which event would the nurse expect to occur next in this relationship? a. Another beating by the abusive partner b. Love, gifts, and praise from the abusive partner c. A brief period during which the partners ignore each other d. The abusive partner leaves the relationship for a short time

Answer: B . Rationale: The cycle of violence consists of three phases: (1) tension-building phase, (2) acute battering phase, and (3) honeymoon phase. The question scenario shows acute battering, so a period of loving calm is likely to follow.

A nurse is caring for a client who was admitted for suspected abuse. The client is quiet and withdrawn. Which of the following actions should the nurse take to promote client communication? A. Invite a family member to be present for the nursing history. B. Provide basic wound care for obvious physical injuries. C. Probe the client to offer a factual account of the abuse. D. Be direct and honest when speaking with the client.

Answer: D Rationale: The nurse promotes communication to the client who is quiet and withdrawn by using direct and honest communication. This manner which conveys support fosters trust between the client and nurse to promote communication for the withdrawn client.

A nurse is working with a client who is anticipating the possibility of leaving an abusive relationship. In helping the client make the decision to leave or to stay in the abusive situation, which would be most important for the nurse to do? a. Ensure that the client can effectively describe the behaviors inherent in each phase of the cycle of domestic violence .b. Inform the client that if leaving the abusive situation, there is a possibility the partner will attempt to fatally injure the client. c. Assist the client in finding a new apartment and a new job so to be safe after leaving the current situation. d. Suggest that the client legally change his or her name and move out of state to be safe from future harm.

Answer: b Rationale: Survivors must understand the cycle of violence and the danger of homicide that increases as violence escalates or when the survivor attempts to leave the relationship. Although survivors also need information about resources (e.g., shelters for battered women), legal services, government benefits, and support networks, the nurse first needs to discuss the possibility of the perpetrator's reaction and the possibility of extreme violence leading to death.

A patient presents with mechanical fall resulting in multiple lacerations, extensive facial bruising & jaw fracture. The patient should be evaluated for____ A.Self-Mutilation B.Anxiety Disorder C.Intimate Partner Violence D.Borderline Personality Disorder

Answer: c, Intimate Partner ViolenceRationale:IPV can be identified if the following anomalies exist:Discrepancy between injury and explanation of how it occurred, minimization of how It occurred and fear of partner or other individual

A nurse interviews a person abducted and raped at gunpoint by an unknown assailant. The person says, "I can't talk about it. Nothing happened. I have to forget!" What is the person's present coping strategy? a. Somatic reaction b. Repression c. Projection d. Denial

Answer: d Rationale: Disbelief is a common finding during the acute stage following sexual assault. Denial is evidence of the disbelief. This mechanism may be unconsciously used to protect the person from the emotionally overwhelming reality of rape. The patient's statements do not reflect somatic symptoms, repression, or projection.

if partner violence is suspected, a complete ___ and approprirate testing needs to be performed a gynecologic exam may need to be done is rape was part of the abuse - STI's and evidence collection assess for signs of internal injuries, concussions, and injuries, stranulation on neck assess the patients support system, suicide potential, perforated eardrums, coping responses including ___, ___ abuse, denial, self harm

physical examination learned helplessness substance abuse

serious (acute) battering phase (phase 3) of domestic violence cycle -___ incident -the victim may try to ___ or may ___ -the tension becomes unbearable -the victim may ___ to get it over with

serious battering incident cover up the injury look for help provoke and incident

acute (disorganization) phase of rape trauma syndrome: -most common responses are ___, ___, and ___ -the acute or disorganization phase is characterized by ___ reactions such a generalized pain throughout the body, -___ and ___ disturbances -and emotional reactions such as ... long term phase of the rape trauma syndrome: -may not occur until months or years after -flashbacks, ___, phobias, somatic and gynecological symptoms -emotional reactions such as ...

shock, numbness, disbelief physical reactions eating and sleep anger, fear, anxiety, guilt, humiliation, embarassment, self blame, mood swings nightmares depression panic disorder suicide ideation and attemps PTSD is the long term consequence of sexual abuse

cognitive behavioral therapy of a abuse perpetrator focuses on 3 things 1. what the batterer ___ 2. the batterer's ___ responses to these thoughts 3. the batterer's ___ that ___ (___)

thinks about before a battering incident physical and emotional actions that progress to violence (yelling, throwing things)

signs/symptoms of child abuse that the nurse should look for -the abused child appears ___ or ___ of a parent or caregiver -the child may be ___ or have a history of ___ -they may resist telling about the abuse out of attachment to the parent of fear of retribution later when home

timid fearful disheveled (untidy, disordered) absence from school

GHB (gamma hydroxybutyric acid), Rohypnol, & Ketamine are drugs associated with sexual assault? True or False

true

risk factors for becoming an abuser -poverty or ___ -communities with inadequate resources or overcrowding -social isolation of families -___ abuse -early ___ -inadequate coping skills -family member with ___

unemployment substance parenthood chronic health condition