Sexual Violence

A client tells the nurse, "I was raped eight years ago but never told anyone. Nevertheless, the memories haunt me every day. I should be over it by now." Which statement is the nurse's most appropriate response?

"It sounds like you're judging yourself for continuing to struggle with your reaction." NOT: "Are you now ready to engage in counseling to deal with your reactions to this experience?"

Their emotional state and psychological needs should be assessed within...

24 to 48 hours by phone after being treated.

Often the physical examination and the collection of evidence are performed by...

A gynecologist, an ED attending physician, or a SANE. The person who collects the evidence should be forensically trained in the collection of such data

The acute phase of rape-trauma syndrome?

Acute: Begins immediately after crisis. Typical reactions to crisis often reflect cognitive, affective, and behavioral disruptions. The most common responses are shock, numbness, and disbelief. A person may appear self-contained and calm. At other times, cognitive function may be impaired, and the person may have difficulty making decisions, solving problems, or concentrating. Or the person may cry, become hysterical, be restless or agitated, or even smile or laugh. The acute, or disorganization, phase is characterized by physical reactions such as generalized pain throughout the body, eating and sleeping disturbances, and emotional reactions such as anger, *agression*, fear, anxiety, guilt, humiliation, embarrassment, self-blame, and mood swings. There is no "normal" response to a sexual assault.

Rape Kits

An institutional protocol for evidence, collection and use. Correct preservation of body fluids and swabs is essential because DNA (deoxyribonucleic acid; genetic mapping) can help identify the rapist. If a date rape drug is suspected, a urine sample should be collected.

Ketamine

Anesthetic frequently used in veterinary practice; also *hallucinogenic substance* related to PCP (phencyclidine). Later, survivor may be confused, paranoid, delirious, and combative with drooling and hallucinations. *shortest duration of 30-60mins*

Sexual offenders commonly have what diagnosis?

Antisocial personality disorder.

What measures should a nurse take when assessing a rape victim?

Ask questions using descriptive terms. Ask questions in a nonjudgmental tone. Ask the client to talk at a comfortable pace. (Don't ask the client to explain the assault in detail, because this can make the client feel more embarrassed and traumatized)

What may help ameliorate the acute anxiety and agitation that follows sexual assault trauma?

Benzodiazepine

GHB (y-hydroxybutyric acid)

CNS depressant, needs 12 hours to be excreted from the body. Rapidly metabolized; difficult to detect in emergency departments and other treatment facilities. -commonly used to treat narcolepsy *effects usually lasts 1-4 hours* demonstrating *euphoria, nausea and vomiting, hypotonia, and respiratory depression*.

Which statements accurately describe the effects of child sexual abuse on the adult client? Select all that apply.

Child sexual violence results in higher rates of suicide. Childhood sexual abuse results in higher rates of mental health issues. Untreated child sexual violence may result in drug and alcohol abuse. Sexually abused children may suffer from posttraumatic stress disorder.

What are the appropriate methods of implementation for sexual assault victims?

Compassionate, nonjudgemental, empathetic care. Patients need to hear and understand that the rape it not their fault and confidentiality should be stressed repeatedly. It is important to help survivors and their significant others separate the issues of vulnerability from blame. Although individuals may have made choices that made them more vulnerable to assault, they are not to blame for the rape.

What should always be available to any person who has been sexually assaulted?

Crisis counseling

What indicates the presence of semen?

Elevated prostatic acid phosphate levels.

Rape includes intercourse in the vagina, anus, or mouth and is a __________ offense, which means it is among the most serious crimes a person can commit

Felony

When identifying the victims support system, what do you need to ask permission for, and what do you need to explain?

Identify the victim's support system (e.g., family, friends, others the person trusts), and ask for permission to involve them. Explain possible delayed reactions that might occur.

If no SART is available...

If no SART is available, information on support groups, therapists, and attorneys who work with sexual assault survivors should be provided before the person leaves the ED. A list of safe houses should also be available for those involved in intimate partner violence (IPV).

LGBTQ community is at risk for...

LGBTQ community is at risk for violence in the form of bullying, harassment, physical assault, and increased suicide (attempted or completed) because of the negative way they are perceived and treated in many parts of society.

Recovery evaluation?

Most patients eventually will be able to resume their previous lives after supportive services and crisis counseling or therapy. If survivors are relatively free of signs of PTSD and their lifestyles are close to their lifestyles before the rape, the recovery is considered successful. Too often, without counseling of some kind various sequelae of the assault may remain for years or even a lifetime.

A nurse is discharging a client who sought treatment after experiencing a sexual assault. What information is given priority when providing the client with discharge instructions?

NO: Information regarding options to prevent an unwanted pregnancy (may be male or female) NO: The phone number to the local police department NO: Scheduled a follow-up appointment with a rape crisis counselor (doesn't guarantee that they will want to or end up going) YES: A written list of common physical, social, and emotional reactions following sexual assault (this is the only one that will help them no matter what)

A nurse is assessing a client who experienced a sexual assault. Which of the following findings indicate the client is experiencing an emotional reaction of rape-trauma syndrome? Select all that apply.

NO: genitourinary soreness NO: difficulties with low self esteem (the question was asking for immediate emotional reaction, because that's what rape-trauma syndrome is) NO: sleep disturbance YES: Emotional outbursts YES: Difficulty making decisions

Verbatim statements vs Narrative documentation? Is it appropriate to administer prophylactic treatment for std's?

Narrative documentation is when you word for word write the whole story they said, verbatim is when you take significant pieces of information from what was stated and document client stated "..." You want to use verbatim statements when documenting Yes it is for the purposes of safety.

It is important to listen to the patient and let the patient talk. Should we press the patient to talk?

Never. When people feel understood, they feel more in control of their situation.

You'll want to explain to the patient the signs and symptoms that many people experience during the long-term phase of rape-trauma syndrome. What are the teaching points?

Nightmares, phobias, anxiety, depression, insomnia, somatic symptoms (*know that complaints of numbness is about the acute phase not somatic symptoms*). This is because many individuals think they are going crazy and are not aware that this is a process that many people in their situation have experienced.

Rohypnol (flunitrazepam)

Potent benzodiazepine; 10 times stronger than diazepam. Detected in urine for up to 72 hours. *effects usually last 2-12 hrs*

What may be helpful for symptoms of PTSD such as hyperarousal, agitation, and insomnia and the treatment of depression and panic attacks?

SSRI's

Define sexual assault

Sexual assault is an act of violence, power, and hate—not sex—and most often results in devastating severe and long-term trauma. It is often committed in the context of unequal power in order to demonstrate dominance and control In 2012 the U.S. Department of Justice (DOJ) updated the definition of sexual violence by adding: "The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim." Sexual violence occurs when a perpetrator commits sexual acts without a victim's consent, or when a victim is unable to consent. Sexual assault/sexual violence (SV) is an umbrella term encompassing the crimes of rape, date rape, acquaintance rape, gang rape (two or more perpetrators), marital/partner rape, sexual molestation, incest, statutory rape, and sexual assault of

Sexual assault occurs in...

Sexual assault occurs in all age groups, genders, cultures, and socioeconomic backgrounds, but some groups appear to be more vulnerable and some situations are more conducive to sexual assault.

SART & SANE

Sexual assault response team The purpose of SARTs is to help victims of sexual violence cope with the present and aftermath of sexual violence. Sexual assault nurse examiners SANEs are forensic nurses who have been certified to work with victims of sexual violence. Some of the functions of the SANE are to perform a physical examination of the survivor, collect forensic evidence, provide expert testimony regarding the forensic evidence collected, support the psychobiological needs of the survivor, be part of the SART, and work closely with law enforcement agencies and the prosecutor's office

Not surprisingly, most perpetrators of sexual abuse report being ___________ ___________ as children. Some other characteristics include:

Sexually assaulted as children. • Impulsive and antisocial tendencies • Association with sexually aggressive and delinquent peers • Preference for impersonal sex • Hostility toward women • Childhood history of sexual and physical abuse, or witnessing family violence as a child • Membership in a gang • Belonging to a societal group that often refuses to acknowledge acts of sexual assault (e.g., some parts of the military, prisons, and even parts of the Peace Corps to a smaller degree)

A sexual assault victim who arrives at the ED should & should not be... left alone. The staf should provide privacy, and the victim should be a priority in triage.

Should not be left alone. The staff should provide privacy, and the victim should be a priority in triage.

To collect evidence, what must be done first?

Signature of informed consent

In the emergency department, a rape victim is examined and evidence is collected. How will this care be reimbursed?

State government will pay for their care

What is something to stress towards the patient when it comes to their survival?

Stress that the patient did the right thing to save his or her life. This is because victims of rape might feel guilt or shame. Reinforcing that they did what they had to do to stay alive can reduce guilt and maintain self-esteem.

What are options for support follow-up?

Support group Group therapy Rape counselor Crisis counseling Individual therapy Depression and suicidal ideation are frequent sequelae of rape. The sooner the intervention, the less complicated the recovery may be.

An elderly widow tells the nurse, "Since my sister-in-law's death, her husband has been making advances at me. He tried to come in my home with a bottle of wine. Even though he's family, I'm afraid of what might happen if I let him in." Which action should the nurse take first?

Support the widow to clarify her thoughts and feelings about the situation. NOPE Explain to the widow how to obtain an order of protection (restraining order). NOPE Positively reinforce the widow for addressing the problem with a caring professional. YES Educate the widow about sexual assault and violence, including the importance of prevention. NOPE

What are the common date rape drugs?

The date rape drugs γ hydroxybutyrate (GHB) (<*this one causes salty taste*), flunitrazepam (Rohypnol) , and ketamine (<*this one causes hallucinogens*) are used mostly

The long-term phase of rape trauma?

The delayed, or organization, phase may not occur until months or even years after the events and is characterized by flashbacks, nightmares, and phobias as well as *somatic* (*know that complaints of numbness is about the acute phase not somatic symptoms*) and gynecological symptoms. Emotional reactions may include depression, panic disorder, and suicidal ideation and attempts, and substance abuse is more prevalent among survivors of sexual assault. However, PTSD is the long-term consequence of sexual assault.

Long-term goals for rape-trauma syndrome

The ideal outcome is that the person eventually will be able to: • Find ongoing support to help the individual deal with the many confusing and terrifying issues and thoughts regarding the event(s). • Return to precrisis level of functioning with minimal or no residual symptoms (survivor). • Experience hopefulness and confidence in going ahead with life plans. • Have comfortable and enjoyable sex (for some, it may take many years for this to happen). *Experiencing comfort in relationships can be displayed this way, in other words, having happy relationships*

Short-term goals for rape-trauma syndrome

The patient will: • Have a short-term plan for handling immediate situational needs before leaving the ED. • Have a written list of common physical, social, and emotional reactions that may follow a sexual assault before leaving the ED. • State the results of the physical examination completed in the ED. • Have written access to information on obtaining competent legal counsel and community supports (individual or group) before leaving the ED. • Have a follow-up appointment with a rape counselor or crisis counselor. • Have support from family and friends. • Have a list with telephone numbers of clinics or rape crisis counselors.

Most rapists do not acknowledge...

Unfortunately, most rapists do not acknowledge the need for change. No single method or program of treatment has been found to be totally effective.

Who have higher vulnerability?

Women, children 8-12, people 16-19, older adults, those who were raped before the age of 18, drug and alcohol use by the perpetrator and victim, women and children in poverty. When looking at ethnicity and culture, sexual violence against indigenous women is widespread- as well as Native American and Alaskan Native women. (plus as learned in class, pregnant women)

Which nursing intervention is consistent with the protocol for a sexual assault medical examination? Select all that apply.

YES: Performing a psychological assessment of the client YES: Collecting and preserving any forensic evidence (because the medical examination is already being taken place, as the question states.) YES: Performing a complete examination to identify physical trauma YES: Determining drug use by either the assailant or the survivor NO: Determining whether the client wants to exercise legal options (that's not something you take care of)

As a part of the assessment process, what should the nurse do with the clothing worn by a client who has been sexually assaulted?

YES: Preserve the clothing in accordance with agency policy. NO: Ask the woman what she would like the nurse to do with the clothing.

Another consideration is that ________ _______ drugs are cleared from the body fairly quickly, and detecting them in the emergency department or other treatment center is often difficult. A urine sample must be obtained within a certain period of time to prove the existence of date rape drugs.

date rape

A victim of rape who is unconscious has been admitted to the hospital. The blood tests revealed that the client has consumed a high dose of γ-hydroxybutyric acid (GHB). What should the nurse anticipate in this situation? Select all that apply.

endotracheal intubation, benzodiazepine injection bc demonstrates euphoria, nausea and vomiting, hypotonia, and respiratory depression.

What are examples of crisis counseling?

referrals to the family physician, community psychologist, or community rape crisis line, for example

Men experience the _________ symptoms women do after being sexually abused.

same, It is just as important for a man to receive counseling for sexual trauma as it is for a woman

It is the responsibility of ________ of assault to make the decision to report the crime and it is the responsibility of _________ __________ _____________ to offer support, to provide information on obtaining legal counsel, and—with the patient's permission—to secure....

survivor, heath care worker to secure forensic evidence (evidence that can be used in court) by a qualified person for future prosecution.

An assaulted woman may not report her abuse because the woman:

• Believes it is her fault (But it is inappropriate to deliberately ask them "do you feel this is your fault") • Does not consider the incident sexual assault • Does not want to report her abuser for fear of reprisal • Does not want to get her "friend" or "date" in trouble • Does not want others to know about the assault • Cannot remember the incident clearly enough to feel she would be believed by others. especially if she had been drinking and/or taking other drugs

Common reactions in children who have been sexually abused include:

• Fear of being alone, of going to sleep, or of strangers • Outbursts of anger • Increased isolation • Physical symptoms such as headaches, stomach or genital discomfort, and skin rashes in the genital area • Regression to early behaviors, such as a return to bedwetting or not wanting to sleep alone. • Inappropriate sexual behaviors, such as sexually acting-out with other children or excessive masturbation.

Common reactions to a sexual assault in adults are:

• Feelings of fear, anxiety, anger, and sadness • Flashbacks or *intrusive thoughts* about the assault • Outbursts of anger • Eating and sleeping disturbances • Depression • Suicidal thoughts or self-harming behaviors • Increased use of alcohol or drugs • Changes in relationships with friends, family, and lovers • Decreased desire for sex

Caution is advised about the use of pejorative language when documenting the history, findings, and verbatim statements. For example:

• Instead of "alleged," use reported. • Instead of "refused," use declined. • Instead of "intercourse," use penetration. • Instead of "in no acute distress," describe the behavior.

Common symptoms of PTSD related to sexual assault include the following:

• Re-experiencing the trauma: Recurrent nightmares about the rape, flashbacks, or uninvited, intrusive thoughts during the day or night • Social withdrawal: Called "psychic numbing," involves not experiencing feelings of any kind • Avoidance behaviors and actions: Avoidance of all places and activities, as well as thoughts or feelings, that could recall events about the rape • Increased psychological arousal characteristics: Exaggerated startle response, hypervigilance, sleep disorders, or difficulty concentrating • Fears and phobias: Fear of being alone, fear of sexual encounters, and fear of the indoors or outdoors are just some examples • Nightmares and difficulty sleeping: Vivid nightmares of the event that wake the individual and cause terror, disturb sleep, and prevent sleep -NOT a sign of PTSD: Reacts aggressively whenever spoken to in a manner perceived as disrespectful