Abuse in women Flashcards
Clinical indicators of partner abuse
Delay in seeking treatment
Inconsistent Over attentive partner
History of child abuse
Under 49
Questions to ask
Physically hurt
Afraid of partner
Tension in the relationship How do you resolve conflict
Barriers to seeking help
Emotional bonds
Children
Financial dependent Shame
Fear they will not be believed
Psychological presentation
Insomnia Depression Suicidal Anxiety Somatoform PTSD Eating disorder Drug and alcohol
Physical presentation
Obvious injury Bruises of various healing Chronic pelvic/abdominal pain STDs Chronic headaches
How to take a history of abuse
HELP History -effect,onset pattern, worst case, greatest fear Esteem Life situation Praise her efforts
Assess safety of woman and children
How safe do you feel What do you need in order to feel safe Frequency Severity Obsession Weapons
What us rape
Sexually penetration of a person without their conesent and aware they are not consenting
When is consent not valod
Submits because fear harm, unlawfully detained
Mistaken about the sexual nature/identity of the person
Precontenplative
Stage and suggestions
Unaware of problem
Make connections between symptoms and problems at home
Contemplative stage and suggestions
Identifies issues
Ambivalent Encourage the possibility of change
Decision stage
Some catalyst for change
Explore resources available
Action stage
Plan and act Talk to family Leave Restraining order Police
Maintenance
Praise
Relapse
Support
Conditions which prelude immediate forensic assessment following sexual assault
Head injury
Impaired consciousness Untreated pain from injuries
Shock from concealed blood loss
Investigations to consider with sexual assault
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
Examinations
General Head and neck Mouth Chest/CV Abdomen Pelvic Neurological Musckuloskeletal
Management
Will need investigations Emergency contraception HIV prophylaxis Antibiotics for STI F/U pregnancy test Forensic assessment and samples
History
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
