Abuse in women

Question 1

Clinical indicators of partner abuse

Answer 1

Delay in seeking treatment
Inconsistent Over attentive partner
History of child abuse
Under 49

Question 2

Questions to ask

Answer 2

Physically hurt
Afraid of partner
Tension in the relationship How do you resolve conflict

Question 3

Barriers to seeking help

Answer 3

Emotional bonds
Children
Financial dependent Shame
Fear they will not be believed

Question 4

Psychological presentation

Answer 4

Insomnia
Depression Suicidal
Anxiety
Somatoform
PTSD
Eating disorder 
Drug and alcohol

Question 5

Physical presentation

Answer 5

Obvious injury
Bruises of various healing 
Chronic pelvic/abdominal pain
STDs
Chronic headaches

Question 6

How to take a history of abuse

Answer 6

HELP
History -effect,onset pattern, worst case, greatest fear
Esteem
Life situation 
Praise her efforts

Question 7

Assess safety of woman and children

Answer 7

How safe do you feel
What do you need in order to feel safe
Frequency Severity
Obsession
Weapons

Question 8

What us rape

Answer 8

Sexually penetration of a person without their conesent and aware they are not consenting

Question 9

When is consent not valod

Answer 9

Submits because fear harm, unlawfully detained

Mistaken about the sexual nature/identity of the person

Question 10

Precontenplative

Stage and suggestions

Answer 10

Unaware of problem

Make connections between symptoms and problems at home

Question 11

Contemplative stage and suggestions

Answer 11

Identifies issues

Ambivalent Encourage the possibility of change

Question 12

Decision stage

Answer 12

Some catalyst for change

Explore resources available

Question 13

Action stage

Answer 13

Plan and act
Talk to family
Leave
Restraining order
Police

Question 14

Maintenance

Answer 14

Praise

Question 15

Relapse

Answer 15

Support

Question 16

Conditions which prelude immediate forensic assessment following sexual assault

Answer 16

Head injury
Impaired consciousness Untreated pain from injuries
Shock from concealed blood loss

Question 17

Investigations to consider with sexual assault

Answer 17

Primary injuries–>imaging, skeletal survey, CXR, CT head
Pelvic examination–>trauma
STDs–>smear: gonorrhea, chlamydia, trichomonas, serology: HIV, Hep B, Syphillis
Pregnancy test–>emergency contraception

Question 18

Examinations

Answer 18

General
Head and neck
Mouth
Chest/CV
Abdomen
Pelvic
Neurological
Musckuloskeletal

Question 19

Management

Answer 19

Will need investigations
Emergency contraception
HIV prophylaxis
Antibiotics for STI
F/U pregnancy test
Forensic assessment and samples

Question 20

History

Answer 20

Chief complaint
Onset
Incident location
Did you recognise the assailants
Did you report
Description of the assault
Assault objects
Sexual assault
Condoms
Ejaculation
Type of intercourse
Foreign objects
LMP, contraceptives, pain
Location of worst pain
Radiation, severity
Alleviating, exacerbating
Bleeding/bruises
LOC
Headache, blurred vision, dizzy, weak, numb
SOB, papitations
Blood in stool/urine, vaginal bleeding
NV abdo pain
Joint pain
Medical, surgical, family, social, occupation, allergies