Mother Baby Ricci Ch 9

A female client tells the nurse "My boyfriend is going to stop drinking, so I know he won't hit me again." What is the nurse's best response?

"Abuse is a learned behavior, not caused by alcohol."

A victim of rape is prescribed emergency contraception. After teaching the client about this therapy, the nurse determines that the teaching was effective based on which client statement?

"It contains high doses of a typical birth control pill"

A nurse is caring for a woman who has presented to the emergency department seeking treatment after being raped. Which statement best demonstrates the nurse's attempt to fulfill the initial nursing responsibility to this client?

"You didn't deserve this abuse; I'm here to help you in anyway I can."

THE ABCDES OF CARING FOR ABUSED WOMEN-C is

*Confidentiality*, since the woman might believe that if the abuse is reported, the abuser will retaliate. Interview her in private, without her partner or family members being present. Assure her that you will not release her information without her permission.

THE ABCDES OF CARING FOR ABUSED WOMEN-S is

*Safety*, the most important aspect of the intervention, to ensure that the woman has resources and a plan of action to carry out when she decides to leave.

Only of ________ rapists are arrested and convicted.

1%

THE ABCDES OF CARING FOR ABUSED WOMEN-D is *documentation*, which includes the following:

1. A clear quoted statement about the abuse in the woman's own words. 2. Accurate descriptions of injuries and the history of them. 3. Information on the first, the worst, and the most recent abusive incident. 4. Photos of the injuries (with the woman's consent).

THE ABCDES OF CARING FOR ABUSED WOMEN-E is *education* about the cycle of violence and that it will escalate:

1. Educate about abuse and its health effects. 2. Help her to understand that she is not alone. 3. Offer appropriate community support and referrals. 4. Display posters and brochures to foster awareness of this public health problem.

__________ of 16 rapists walk free.

15

PTSD symptoms usually begin within

3 months of the incident, but occasionally may only emerge years later.

Only _______ of rapists will ever spend a day in jail.

6%

RU-486

A drug approved by the Food and Drug Administration for abortion in the first 49 days of gestation.

Abusers often exhibit childlike aggression or

Antisocial behaviors

ASSESSING FOR POSTTRAUMATIC STRESS DISORDER To assess the presence of physical symptoms:

Are you having trouble sleeping? Have you felt irritable or experienced outbursts of anger? Do you have heart palpitations and sweating? Do you have muscle aches and pains all over?

A 36-week-gestation client presents in the ER with a broken arm. The client states "she fell while cooking dinner." During the assessment, the nurse notes no prenatal care for this pregnancy, as well as bruises in multiple stages of healing on the client's abdomen, arms, and chest. What action will the nurse perform next?

Ask the client how she acquired the bruises

The Danger Assessment Tool helps women and health care providers

Assess the potential for homicidal behavior in an ongoing abusive relationship.

Violence typically occurs

At home

If you need to leave a domestic violence situation immediately, turn to ____________________ for assistance in gathering this material

Authorities

Nurses at an urban emergency department seek to develop a plan to help women involved in abusive relationships. Which component is critical to the success of the plan?

Avenues for referral

Abusers fail to accept responsibility or

Blame others for their own problems.

Phase 2—Acute battering:

Characterized by uncontrollable discharge of tension. Violence is rarely triggered by the victim's behavior: she is battered no matter what her response. The start of the battering episode is unpredictable and beyond the victim's control.

Type I female genital mutilation (FGM) entails removal of the

Clitoris

Abusers have few

Close relationships

(Abuse) Primary prevention is aimed at breaking the abuse cycle through

Community educational initiatives by nurses, physicians and nurse practitioners, law enforcement, teachers, and clergy

Sexual assault nurse examiners (SANE) are specially trained to

Conduct sexual assault evidentiary exams for rape victims Collect forensic evidence Provide access to crisis intervention Conduct STI testing Administer emergency contraception

Abusers can be

Criticism

A 16-year-old girl is seen in an emergency department following a rape. The management of a rape victim should be directed primarily toward:

Decreasing guilt and increasing self-esteem.

RAPE RECOVERY-Reorganization

Denial and suppression do not work, and the survivor attempts to make life adjustments by moving or changing jobs and uses emotional distancing to cope

Abusers are emotionally

Disregulated

ASSESSING FOR POSTTRAUMATIC STRESS DISORDER To assess the presence of intrusive thoughts:

Do upsetting thoughts and nightmares of the trauma bother you? Do you feel as though you are actually reliving the trauma? Does it upset you to be exposed to anything that reminds you of that event?

ASSESSING FOR POSTTRAUMATIC STRESS DISORDER To assess the presence of avoidance reactions:

Do you find yourself trying to avoid thinking about the trauma? Do you stay away from situations that remind you of the event? Do you have trouble recalling exactly what happened? Do you feel numb emotionally?

Type IV female genital mutilation (FGM) entails removal of the

Encompasses all other mutilations of the female Genital area such as Pricking Piercing Cutting Cauterizing Scraping of the vaginal tissue Incisions to the clitoris and vagina Burning Scarring Cauterizing of tissue with the aim of tightening or narrowing the vagina

A nurse is working in a community hospital situated in an area with a history of grievous assaults on women, including rape. The nurse discovers that most rape victims come to the hospital but leave without seeking medical treatment. Which intervention should the nurse perform to ensure that rape victims get legal and medical aid?

Ensure that the appropriate law enforcement agencies are apprised of the incident.

THE ABCDES OF CARING FOR ABUSED WOMEN-B is

Expressing the *Belief* that violence against women is not acceptable in any situation and that it is not her fault. Demonstrate by your actions and words that you believe her disclosure.

Which occurrence is a biologic indicator of post traumatic stress disorder (PTSD)?

Flashbacks

The ABCDES, a modified tool developed by Holtz and Furniss, provides a

Framework for providing sensitive nursing interventions to abused women

(Abuse) Tertiary prevention: activities are geared toward helping severely abused women and children recover and become productive members of society and rehabilitating abusers to stop the cycle of violence. These activities are typically long term and expensive.

Helping severely abused women and children RECOVER and become productive members of society and rehabilitating abusers to stop the cycle of violence. These activities are typically long term and expensive.

Abusers have a tendency to

Hold grudges

The abuser expresses his feelings of ______________ through violence or aggression toward others

Inadequacy

Abusers often lack

Insight

Elder mistreatment (i.e., abuse and neglect) is defined as

Intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder.

Abusers might have a history of trouble with the

Justice system

What prevents a woman from escaping an abusive situation?

Lack of sense of control

Violence is a

Learned behavior

Abusers are prone to feeling

Misunderstood, mistreated, or victimized

Abusers refuse to share____________

Power

Abusers frequently get into

Power struggles

The strongest predictor of abuse during pregnancy is

Prior abuse.

THE ABCDES OF CARING FOR ABUSED WOMEN-A

ReAssuring the woman that she is not alone. The isolation by her abuser keeps her from knowing that others are in the same situation and that health care providers can help her.

Studies have shown that the more victimization a woman experiences, the more likely it is she will be

Revictimized

(Abuse) Secondary prevention focuses on

Screening high-risk individuals and dealing with victims and abusers in EARLY STAGES, with the goal of PREVENTING PROGRESSION of abuse

Incest is defined as

Sexual activity between persons so closely related that marriage between them is legally or culturally prohibited

A client who is abused fails to report the abuse primarily because of which reason?

She feels responsible for causing the incident.

RAPE RECOVERY-Integration and recovery

Survivor begins to feel safe and starts to trust others. She may become an advocate for other rape victims

The abused should not use phone cards because

They leave a trail to follow

PTSD symptoms must last more than ______________ to be considered PTSD

a month

When a pregnant client is abused during her pregnancy, what complication is likely to occur after birth due to the abuse?

postpartum depression

SAVE MODEL-EVALUATE, educate, and refer this client by asking her:

・What type of violence was it? ・Is she now in any danger? ・How is she feeling now? ・Does she know that there are consequences to violence? ・Is she aware of community resources available to help her?

SAVE MODEL-SCREEN all of your clients for violence by asking:

・Within the last year, have you been physically hurt by someone? ・Do you feel you are in control of your life? ・Within the last year, has anyone forced you to engage in sexual activities? ・Can you talk about your abuse with me now? ・In general, how would you describe your present relationship?

SAVE MODEL-VALIDATE the client by telling her:

・You believe her story. ・You do not blame her for what happened. ・It is brave of her to tell you this. ・Help is available for her. ・Talking with you is a hopeful sign and a first big step.

Number of states that have elder abuse laws

50

Explain to the woman that:

・Abuse is never OK. She didn't ask for it and she doesn't deserve it ・She is not alone and help is available ・Abuse is a crime and she is a victim ・Alcohol, drugs, money problems, depression, or jealousy does not cause violence, but these things can give the abuser an excuse for losing control and abusing her ・The actions of the abuser are not her fault ・Her history of abuse is believed ・Making a decision to leave an abusive relationship can be very hard and takes time

FOUR PHASES OF RAPE RECOVERY

・Acute phase (disorganization) ・Outward adjustment phase (denial) ・Reorganization ・Integration and recovery

RAPE RECOVERY-Outward adjustment phase (denial)

・Appears outwardly composed and returns to work or school ・Refuses to discuss the assault and denies need for counseling

PROTECTING YOURSELF AGAINST DATE RAPE DRUGS

・Avoid parties where alcohol is being served. ・Never leave a drink of any kind unattended. ・Don't accept a drink from someone else. ・Accept drinks from a bartender or in a closed container only. ・If a drink is left unattended, pour it out, don't drink it ・Don't drink anything that tastes or smells strange ・Don't drink from a punch bowl or a keg. ・If you think someone drugged you, call 911.

Some of the myths about violence

・Battering of women occur only in lower socioeconomic classes. ・Substance abuse causes the violence. ・Violence occurs to only a small percentage of women. ・Women provoke their partners to abuse them.

SAVE MODEL-ASK direct questions in a nonjudgmental way:

・Begin by normalizing the topic to the woman. ・Make continuous eye contact with the woman. ・Stay calm; avoid emotional reactions to what she tells you. ・Never blame the woman, even if she blames herself. ・Do not dismiss or minimize what she tells you, even if she does. ・Wait for each answer patiently. Do not rush to the next question. ・Do not use formal, technical, or medical language. ・Avoid using leading questions; be direct and to the point. ・Use a nonthreatening, accepting approach.

Injuries of abuse can include

・Bruises on their chest and abdomen ・Scars from blunt trauma ・Minor lacerations or weapon wounds on the face, head, and neck

Date rape drug Gamma hydroxybutyrate

・Called "liquid ecstasy" or "easy lay" ・Takes effect in about 15 minutes and can last 3 to 4 hours ・White powder or liquid ・May cause unconsciousness, depression, and coma

Type II female genital mutilation (FGM) entails removal of the

・Clitoris ・Labia minora

Type III female genital mutilation (FGM) entails removal of the

・Clitoris ・Labia minora ・Labia majora Infibulation

Possible nursing diagnoses related to violence against women might include the following:

・Deficient knowledge related to understanding the cycle of violence and availability of resources ・Anxiety related to threat to self-concept, situational crisis of abuse ・Situational low self-esteem related to negative family interactions ・Powerlessness related to lifestyle of helplessness ・Compromised individual and family coping related to abusive patterns

Physical and emotional sequelae of IPV may include

・Depression ・Insomnia ・Chronic pain ・Difficulty trusting others ・Low self-esteem ・Thoughts of suicide ・Substance abuse ・Anger issues ・Atypical chest pain ・Other kinds of somatic symptoms

The nurse is asked to provide information for a task force addressing abuse in the community. Which preventions tactics are suggested?

・Develop and teach high school courses on parenting and normal child growth and development. ・Promote activities that encourage self-esteem in young adults. ・Role-model for caregivers caring behaviors with children. ・Educate those who were abused as children, and offer them professional help to break the

It is essential to assist the woman by assessing her safety and the safety of her children. To do this, speak to the woman alone and ask her:

・Does she feel safe going home after her meeting with you? ・Does she need an immediate place of safety for herself or her children? ・Does she have a plan of escape if she becomes at risk for her safety? ・Does she need to consider an alternative exit from this building? ・Who are the people she could contact for help or support?

When leaving an abusive relationship, take the following items:

・Driver's license or photo ID ・Social Security # or green card/work permit ・Birth certificates for you and your children ・Phone numbers for social services or women's shelter ・The deed or lease to your home or apartment ・Any court papers or orders ・A change of clothing for you and your children ・Pay stubs, checkbook, credit cards, and cash ・Health insurance cards

If abuse is detected, the nurse can do the following to enhance the nurse-client relationship:

・Educate the woman about the connection between the violence and her symptoms. ・Help the woman acknowledge what has happened to her and begin to deal with the situation. ・Offer her referrals so she can get the help that will allow her to begin to heal.

Date rape drug Gamma hydroxybutyrate produces

・Euphoria ・An out-of-body high ・Sleepiness ・Increased sex drive ・Memory loss.

Phase 3—Reconciliation (honeymoon)/calm phase:

・First, the abuser is ashamed of his behavior. The batterer tries to minimize the abuse and blame it on the partner. The batterer becomes loving, kind, and apologetic and expresses guilt. ・Then the abuser works on making the victim feel responsible. This loving behavior strengthens the bond between partners and will probably convince the victim, once again, that leaving the relationship is not necessary.

Sexual abuse includes:

・Forcing the woman to have vaginal, oral, or anal intercourse against her will ・Biting the victim's breasts or genitals ・Shoving objects into the victim's vagina or anus ・Forcing the woman to do something sexual that she finds degrading or humiliating ・Forcing the victim to perform sexual acts on other people or animals

Injury of abuse sequelae:

・Headaches ・Hearing loss from ruptured ear drums ・Joint pain ・Sinus infections ・Teeth marks ・Clumps of hair missing ・Dental trauma ・Pelvic pain ・Breast or genital injuries

Physical abuse includes:

・Hitting or grabbing the victim so hard that it leaves marks ・Throwing things at the victim ・Slapping, spitting at, biting, burning, pushing, choking, or shoving the victim ・Kicking or punching the victim, or slamming her against things ・Attacking the victim with a knife, gun, rope, or electrical cord ・Controlling access to health care for injury

Sexual violence includes

・IPV ・Human trafficking ・Incest ・FGC ・Forced prostitution ・Bondage ・Exploitation ・Neglect ・Infanticide ・Sexual assault.

The Danger Assessment Tool is based on research that showed several risk factors for abuse-related murders:

・Increased frequency/severity of abuse ・Presence of firearms ・Sexual abuse ・Substance abuse ・Precipitated by arguments and conflicts ・Generally violent behavior outside of the home ・Control issues (e.g., chores, friends, job, money) ・Physical abuse during pregnancy ・Suicide threats or attempts (victim or abuser) ・Child abuse

Risk factors for IPV in men

・Individual factors ・Relationship factors ・Community factors ・Societal factors.

Abusers come from all walks of life and often have feelings that are not in line with the macho image they would like to project like

・Insecurity ・Powerlessness ・Helplessness

Symptoms of PTSD are divided into three groups:

・Intrusion (re-experiencing the trauma, including nightmares, flashbacks, recurrent thoughts) ・Avoidance (avoiding trauma-related stimuli, social withdrawal, emotional numbing) ・Hyperarousal (increased emotional arousal, exaggerated startle response, irritability)

Date rape drug Ketamine

・Known as "Special K," "vitamin K," ・Acts on the CNS very quickly to separate perception and sensation

Date rape drug Rohypnol (flunitrazepam)

・Known as "roofies," "forget pills," "mind erasers," and the "drop drug" ・Liquid or pill that ・No odor, taste, or color ・10 times as strong as diazepam (Valium) ・Effects can be felt within 30 minutes and produces memory loss for up to 8 hours

Providing support and allow the woman to grieve for her losses by:

・Listening to and clarifying her reactions to the traumatic event ・Discussing shock, disbelief, anger, depression, and acceptance

The response of nurses to battered women can have a profound effect on their willingness to open up or seek help. Some responses to assist successful communication in these circumstances could include:

・Listening—"I hear and understand what you are saying." Being listened to can be an empowering experience for a woman who has been abused. ・Communicating belief—"That must have been very frightening for you." ・Validating the decision to disclose—"It must have been difficult for you to talk about this today." ・Emphasizing the unacceptability of this violence "You don't deserve to be treated this way."

Adult women with a history of incest exhibit a clinical syndrome that includes

・Low self-esteem ・Difficulty with intimate relationships ・Sexual dysfunction ・Flashbacks and nightmares ・Repeated victimization ・Suicidality ・Depression ・Eating disorders ・Substance abuse

A nurse is working in a local community health care facility where she frequently encounters victims of abuse. For which signs should the nurse assess to find out if a client is a victim of abuse?

・Mental health problems such as depression, anxiety, or substance abuse ・Injuries on the face, head, and neck ・Reported history of the injury inconsistent with the presenting problem

Types of abuse experienced by the older woman may include

・Physical abuse ・Neglect ・Emotional abuse ・Sexual abuse ・Financial/exploitation abuse

Many victims of battered woman syndrome were abused as children and may have

・Poor self-esteem ・Poor health ・PTSD, depression ・Insomnia ・Low education achievement History of ・Suicide attempts ・Injury ・Drug and alcohol abuse

Financial abuse includes:

・Preventing the woman from getting a job ・Sabotaging a current job ・Controlling how all money is spent ・Failing to contribute financially

The nurse who has experience in caring for women who have been abused knows that goals for a client of abuse may fall into which categories?

・Primary prevention ・Secondary prevention ・Tertiary prevention

Research has found that children who witness IPV are at risk for developing

・Psychiatric disorders ・Posttraumatic stress disorder (PTSD) ・Developmental problems ・School failure ・Violence against others ・Low self-esteem

When caring for an abused woman, the nurse uses the ABCDES framework to provide interventions. Which components are part of this framework?

・Reassurance that the woman is not alone in this situation ・Maintenance of confidentiality of the information reported ・Education about the cycle of violence and its escalation ・Plan of action and resources for safety for when the woman decides to leave

Date rape drugs

・Rohypnol ・Gamma hydroxybutyrate (GHB) ・Ketamine

SAVE MODEL

・Screen ・Ask ・Validate ・Evaluate

RAPE RECOVERY-Acute phase (disorganization)

・Shock ・Fear ・Disbelief ・Anger ・Shame ・Guilt ・Feelings of uncleanliness ・Insomnia/nightmares ・Sobbing

Emotional abuse includes:

・Swearing or threatening to hit the victim ・Forcing the victim to perform degrading or humiliating acts ・Threatening to harm children, pets, or close friends ・Humiliating the woman by name-calling and insults ・Threatening to leave her and the children ・Isolation from family and friends ・Destroying valued possessions ・Controlling the victim's every move

Strengthen the woman's sense of control over her life by:

・Teach coping strategies to manage her stress ・Assist with activities of daily living to improve her lifestyle ・Allow her to make as many decisions as she can Educate her about the symptoms of PTSD and their basis

Encourage the woman to establish realistic goals for herself by:

・Teaching problem-solving skills ・Encouraging social activities to connect with other people

The cycle of violence comprises three distinct phases:

・Tension-building phase ・Acute battering phase ・Honeymoon phase

A group of nursing students are preparing a talk on violence against women and how to prevent it. They want to list characteristics of intimate partner violence and should include which characteristics?

・Use and abuse of substances such as alcohol ・Negative affect (hostility and depression) ・History of childhood abuse ・Current unemployment ・History of antisocial behavior

Phase 1—Tension building:

・Verbal or minor battery occurs. Almost any subject, such as housekeeping or money, may trigger the buildup of tension. There is a breakdown of communication. ・Victim attempts to calm the abuser. Victim feels like "walking on egg shells" around the abuser.