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NUR 201 Week 11 > Abuse & Neglect Survivors > Flashcards

Abuse & Neglect Survivors Flashcards

1
Q

Is defined as the maltreatment of one person by another

A

Abuse

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2
Q

Can be either physical or emotional

A

Neglect

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3
Q

Also known as domestic violence; is physical abuse between domestic partners

May be known as spousal abuse, domestic or family violence, wife or husband ___, or IPV (intimate partner violence)

A

Battering

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4
Q

?

Are potentially traumatic events that can happen from ages 0-17; can have major impacts on one’s physical and mental health

  • These experiences can be things like violence, abuse, or neglect; witnessing violence; having a family member attempt or die by suicide; having a family member w/a substance abuse problem or a mental health problem; or instability due to parental separation or household members being in jail or prison
A

Adverse Childhood Experiences (ACEs)

! Are linked to chronic health problems, mental illness, & substance abuse problems later in adulthood

! Can also negatively impact education, job opportunities, & earning potential

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5
Q

! ACEs can be prevented

A

What can nurses do to reduce the effects of ACEs?

→ Reducing stigma around seeking help for parenting; some of the challenges people face with parenting
→ Stigma around substance abuse & mental health issues
→ Promote a safe & stable, nurturing relationship between parents & children

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5
Q

! ACEs can be prevented

A

What can nurses do to reduce the effects of ACEs?

→ Reducing stigma around seeking help for parenting; some of the challenges people face with parenting
→ Stigma around substance abuse & mental health issues
→ Promote a safe & stable, nurturing relationship between parents & children

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6
Q

Predisposing factors to violent behaviors

Biological Theories
> Neurophysiological influences
> Biochemical influences
> Genetic influences
> Disorders of the brain

A

Psychosocial Theories
> Psychodynamic Theory
> Learning Theory

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7
Q

The ___ is responsible for impulse control & effective processing

Appears to be less well modulated in people w/aggression; responses to fear are reduced

A

amygdala

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8
Q

The limbic prefrontal cortex has a primary role in aggression

A

Areas of the brain known as the striatum play a critical role in selection & inhibition of effective cognitive & motor responses & have identified as dysfunctional in pts w/ aggression

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9
Q

Neurotransmitters have been implicated in aggression as well & include an increase in norepinephrine and dopamine & a decrease in serotonin

A
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10
Q

Biochemical influences

An increase in ___ release that’s been seen in cases of aggression as well as the relationship between testosterone & cortisol levels that are assoc w/aggression

A

dopamine

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11
Q

Genetic influences

Studies have found a potential role for the X-linked monoamine oxidase (a gene in the etiology of anti-social behaviors)

A

Disorders of the brain

Organic brain syndromes assoc w/various cerebral disorders have been implicated in the predisposition to aggressive & violent behaviors like brain tumors, particularly in the area of the limbic system & the temporal lobe

Trauma to the brain resulting in cerebral changes & dz’s such as encephalitis & temporal lobe epilepsy have also been implicated

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12
Q

____Theory

> Modeling behavior is more likely when the individual perceives the person as prestigious or influential. Individuals who were abused as children &/or who witnessed domestic violence as a child are more likely to manifest reactive aggression as adults

> Behaviors can also be modeled from influences from the media, like video games & movies

A

Learning

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13
Q

____ Theory

> These are some psychological theories that have been implicated in violent behavior & this is the idea that unmet needs for satisfaction and security results in poor self control

> Aggression & violence supply this individual w/a dose of power & prestige that inc their self-esteem

A

Psychodynamic

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14
Q

Predisposing Factors to violent behaviors

  • Sociocultural theories
  • Societal influences
A

⇢ Aggressive behavior is primarily a product of one’s culture in social structure

> Poverty, unemployment, family breakdown, exposure to violence, lack of social support and bullying are predisposing factors

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15
Q

Medications used to treat aggression

⇢ SSRI’s
⇢ Mood stabilizers
⇢ Anti-adrenergic agents
⇢ Antipsychotics

A

Anti-adrenergic agents

  • Such as beta blockers; have been shown to reduce aggression in some individuals & this is done by dampening the excessive noradrenergic activity
16
Q

___

  • Includes both typical & atypical
  • Have been helpful in the control of aggression & violence, particularly for individuals w/comorbid psychosis; this is a result of the dampening of dopamine
A

Antipsychotics

17
Q

___

  • Have been shown to reduce irritability & aggression & this is consistent w/the theory of reduced serotonin activity in aggression
A

Selective serotonin reuptake inhibitors (SSRI’s)

18
Q

____

  • These are important in reducing the overactivation of the limbic system
  • Includes Tegretol, Dilantin, & Depakote
  • Lithium has also been used effectively in violent pts
A

Mood stabilizers

19
Q

IPV (Intimate Partner Violence)

IPV includes physical & sexual violence, stalking, & psychological aggression, which can include coercive tactics

  • Can be by a current or former intimate partner
  • One person believes that they’re entitled to control the other
A

This type of violence can occur between heterosexual or same-sex couples & does not require sexual intimacy

  • Males can also be the target & females can be the victimizer
  • IPV generally starts early and continues throughout the lifespan
  • Power is gained in control through intimidation and fear
20
Q

Victim

  • Most often females
  • Experience guilt, fear, shame, anger
  • Isolated
  • Low self-esteem
A

Victimizer

  • Low self-esteem
  • Jealous, possessive
  • May have been abused
  • May have been subject to extreme discipline
21
Q

Cycling of battering

> Continues as a cycle & often has shorter phases in between phases 1 and 2

> The victim will stay out of fear; fear for her own life or for the lives of her children. The victim often suffers from low self-esteem & feels powerless; fears retaliation; fears losing custody of her children

> The victim may be physically or financially dependent on the abuser; may lack a support network; & there may be cultural or religious reasons

A

> Victim may also feel hopeless or lack awareness of the reality of the situation

> When a victim leaves an abusive relationship, she’s at a 75% greater risk of being killed by the partner & the abuse often does not stop once the person has left

> The decision to leave must be theirs to make; they need empowerment in their decisions & to be provided w/resources, support, & referrals

22
Q

? phase

> Is the most violent & shortest phase
Violence is justified by the abuser
Victim may try to find a safe place to hide; help is sought if the injury was severe or if the woman fears for her life, for her children’s lives

A

Phase 2 Acute battering

23
Q

? phase

> Minor battering incidents may occur
Abuser is angry w/little provocation & the victim believes it’s her fault

A

Phase 1 Tension-building

24
Q

? phase

> The abuser is calm, loving, promises to stop, apologizes, shows romantic gestures, & the victim wants to believe that this is true & stays in the relationship

A

Phase 3 Honeymoon

25
Q

Child abuse

Signs of physical abuse [child]

> burns, bites, bruises, broken bones, or black eyes
fading bruises or other marks
frightened of the parents (or other adults)
reports injury
abuses animals

A

Signs of physical suspect [caregiver]

! lack of believable explanation
! negative view of child
! uses harsh discipline
! h/o abuse as child
! h/o animal abuse

26
Q

Risk factors for child abuse include children under 4, special needs that may increase caregiver burden [disabilities, mental health issues, & chronic physical illness]

A

Risk factors for perpetrators –

> parents’ lack of understanding of children’s neglect; child development & parenting skills

> a parental history of child abuse or neglect; substance abuse &/or mental health issues (i.e., depression)

> parental characteristics such as a young age; a low education; single parenthood; a large number of dependent children & low income

> nonbiological or transient caregivers in the home (i.e., the mother’s male partner)

> parental thoughts & emotion that tend to support or justify maltreatment behaviors

27
Q

Family risk factors -

> social isolation; family disorganization, dissolution, & violence (including IPV); parenting stress; poor parenting-child relationship, & negative interaction

A

Community risk factors –

> community violence; concentrated neighborhood disadvantage (e.g., high poverty & residential instability); high unemployment rates; high density of alcohol outlets; poor social connection

28
Q

Child abuse

Signs of emotional abuse [child]

  • extremes in behavior
  • not behaving age appropriate
  • physical or emotional delays
  • suicide attempt
  • lack of parental attachment
A

Signs of suspect [caregiver]

! blames, belittles, berates child
! unconcerned
! rejects child

29
Q

Child neglect (can be physical or emotional)

Signs of emotional neglect [child]

  • freq school absence
  • begging/stealing
  • lack of medical care
  • unkempt, not dressed for weather
  • alcohol/drug use
  • reports of no caregiver @ home
A

Signs of suspect [caregiver]

  • indifferent to child
  • apathetic, depressed
  • irrational/bizarre behavior
  • alcohol or drug use
30
Q

Sexual abuse (can incl sexual exploitation; perpetrators are in most cases known to the victim)

Signs of sexual abuse [child]

> has difficulty walking/sitting
suddenly refuses to change for gym or to participate in physical activities
reports nightmares or bedwetting
experiences a sudden change in appetite
bizarre, sophisticated, or unusual sexual behavior
becomes pregnant or contracts an STD
runs away
reports sexual abuse
attaches quickly to strangers

A

Signs of suspect [caregiver]

! unduly protective of the child or severely limits the child’s contact w/other children, esp of the opposite sex

! secretive & isolated

! jealous or controlling w/family members

31
Q

Incest

Incestuous relationship

  • father is domineering, impulsive
  • mother is passive, aware or suspicious, may alternate between caring or competing
  • begins @ 8-10
  • child - confused, love/hate relationship
  • Typically, this involves an impaired sexual relationship between the parents
  • About 1/3 of children who are abused or neglected in childhood become perpetrators of the same kind of abuse as parents
  • Revelations of incest as a child are often revealed after death of the perpetrator
A

Adult survivor of incest

  • lacks trust
  • low self-esteem, poor self-identity
  • absence of sexual pleasure
32
Q

Sexual Violence

> Sexual aggression is an act of aggression, not passion, & is an act of power & dominance

> Sexual violence includes any act of sexual coercion, including penetration, unwanted sexual contact & noncontact & unwanted sexual experiences

A

> Rape includes a surprise attack, statutory rape, date rape, marital rape, & can happen at any age

33
Q

Victim

  • highest risk 34 or younger, lower income, living in rural area
A

Victimizer

  • sexual sadists
  • exploitative predators
  • men who fantasize of sex they believe cannot be achieved w/o the use of force
  • are displacing anger & rage
34
Q

Victim Responses (feelings of powerlessness & intimidation)

  • expressed response pattern
    > the survivor expresses feelings of fear, anger, & anxiety, often through behavior such as crying, sobbing, restlessness, & tension
  • controlled response pattern
A
  • compounded rape reaction
    > the survivor can develop substance abuse, depression, & suicide
  • silent rape reaction
    > the survivor tells no one, suppresses the anxiety until a future time when forced to face a sexual crisis. This reactivates the trauma
35
Q

?

  • feelings are masked; the survivor is calm, composed, & subdued
  • in the days & weeks > the attack, the victim often experiences physical manifestations, & these include contusions & abrasions, headache, fatigue, sleep pattern disturbances, stomach pains, N/V, vaginal discharge & itching, burning upon urination, rectal bleeding & pain
  • emotional manifestations include rage, humiliation, embarrassment, desire for revenge, & self-blame; fear of physical violence & death can also occur
A

controlled response pattern

36
Q

Nursing diagnoses for the survivors of abuse

→ Rape-trauma syndrome
→ Powerlessness
→ Risk for delayed development

A

Nursing Interventions

→ Tending to physical injuries
→ Staying w/the client to provide security
→ Assisting the client to recognize options
→ Promoting trust
→ Reporting suspected child abuse or neglect

37
Q

Treatment modalities

> Crisis intervention
Safe house or shelter
Family therapy

A
  • In crisis intervention, the goal is to help survivors return to their previous lifestyle as quickly as possible. The client should be involved in the intervention from the beginning
    > This promotes a sense of competency, control, & decision-making b/c an overwhelming sense of powerlessness accompanies the rape experience
  • Active involvement by the survivor is both a validation of personal worth & the beginning of the recovery process

NUR 201 Week 11 (5 decks)

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