Comm Final: old content Flashcards
-certain boundaries
Types of Communities
Territorial, neighborhood, geographic
-defined by political views has a certain area
types of communities
Geopolitical
- church, breast cancer survivors
types of communities
Special interest/feeling
-doesn’t have to be geographic, when something very unusual happens and brings people together Ex: 9-11 George bush and Clinton came together for commercial
types of communities
Phenomenological
- people who have the knowledge to fix something, can’t physically fix but know how
types of communities
Solution
crosses boundaries;
-water pollution =fish dying bc waste/ anyone affected by problem Ex: white river=everywhere it hits
types of communities
Problem ecology
- they can fix the problem physically Ex: maintenance
types of communities
Action capability
- do you have the supplies, people, what it takes Ex: Can be humans, time, supplies, money
types of communities
Resource
- can be ongoing or temporary Ex: big convention is temporary, parking is long term problem
types of communities
Need
- can come from anywhere or anybody Ex: all the ppl worried about the closing of Hannah avenue
types of communities
Concern
- vested in that community, concerned not about self but what it looks like Ex: they care what the neighborhood looks like / pink house people upset/neighborhood association=want input to make changes
Characteristics of a Healthy Community
Sense of ownership
zoning (commercial property vs. residential);
- environmental issues Ex: in fountain square they have the highest rate of resp disease because of the coke plant=can’t have the school here, gave the city land free on the stipulation can’t be sued for sickness, moved further away
Characteristics of a Healthy Community
Concern for the future
- chain of command, policy procedure
- some sort of procedure for disputes
Characteristics of a Healthy Community
Mechanism for disputes in place
-Ex: pta meeting student voice opinion then the parents and committees hear what is said /switched to school uniform
Characteristics of a Healthy Community
Communication recognized at all levels
- are the members of the community able to discuss things calmly, maturely, and not just a free for all / able to voice concerns analyze to get a solution (BEHAVIOR OF THE COMMUNITY)
Characteristics of a Healthy Community
Ability to identify, analyze, and organize
- Ex: block party do people show up
Characteristics of a Healthy Community
Participation in community events
-thinking about resource centers, Ex: do people use fitness center, interested in being healthy, health fair do they come
Characteristics of a Healthy Community
High level of wellness
- do people want to be in charge Ex: Are they interested enough to run for school board, do people vote
Characteristics of a Healthy Community
Decision-making involvement
-does it have a plan in case of emergency Ex: uindy made a plan for shooting event, working tornado siren
Characteristics of a Healthy Community
Emergency preparedness
-ACCESS, WIC, social security office, community center
Characteristics of a Healthy Community
Resources available to all
- Maintain or improve a strength- focus is on prevention from getting ill
- Risk factors- be proactive
- Community request
- Community needs
Community-focused nursing diagnosis
- 2 or 3 diagnoses, decide if you’re going to do it
Community-focused nursing diagnosis
Problem Analysis
- what can you do in the time you have
Community-focused nursing diagnosis
Prioritizing
= identifies problem using common terms, describe what it is
Community-focused nursing diagnosis
Problem Correlates
= states the target for intervention Ex: in school specify grade and which school
- Relationship of correlate to problem
- Data supportive of relationship
Community-focused nursing diagnosis
Population/aggregate
=1. Identify several concerns/problems
- Select the concern of greatest priority
- Should be related to Healthy People 2020= goals for the nation
- Leading Health Indicators=barometer on how we are doing
Differences between community diagnosis and acute care diagnosis
Community-Focused Nursing Diagnosis
- Determine the degree to which goals to which goals were met.
- Facilitates additional decision-making.
- Identifies strengths and areas for improvement.
- Accountability for results: intended and unintended.
What are the assets and pitfalls
evaluation
-was content appropriate
Relevance
aspects of evaluation
-learning that occurred, satisfied with outcome, eval form=check mark
aspects of evaluation
Effectiveness
-enough people, time, handouts (supplies) , proper reading level Ex: 250 show up 125 handouts
aspects of evaluation
Adequacy
- may not see the long term effects, demonstrating what they learned
aspects of evaluation
Impact
-cost and effort worth the benefit
aspects of evaluation
Efficiency
-will the project be able to go on without our group, who will pick up, empowerment, is intended and how
aspects of evaluation
Sustainability
)-midpoint of semester what is good and not good, how are you doing on progress of meeting goals
aspects of evaluation
Progress (formative
- education, good indicator of what they learned at that time, doesn’t show lasting impact or retained long term
Quasi-experimental (pre and posttest)
tools of evaluation
- describes the meaning of the experience, how you interpret, doesn’t give any statistics or data, qualitative data
tools of evaluation
Interpretive evaluation
- best to observe a change in behavior Ex: return demonstration, can have bias, not good for long term effects
tools of evaluation
Observation
- questionnaire
tools of evaluation
Oral or written questions
- write about in long narrative from beginning to end, doesn’t show strong of sense of nursing interventions were the reason for the outcome, no link
tools of evaluation
Case description
- long term, Marion county health department
tools of evaluation
Health status statistics
- form of data collection, what you see, hear, and smell
Methods
Timing- different on the weekends, working not a lot of people around
Multiple sets of eyes
Data Collection
Windshield Survey
-Assess everything you see, hear, smell from the vehicle.
One or more people take notes.
One or more people take pictures, video, etc………….
One person drives, and only drives!
-Live in poverty, pollution, lots of open areas, no windows, warm, higher socioeconomic status further back, cloths were donated, fresh water 1 mile away
Windshield Survey
- Common characteristics of people on the street or frequenting businesses/ watch people
- Neighborhood gathering places
- Rhythm of community life
- Housing quality and location
- Geographic boundaries
General windshield survey
-Roads (signs, condition), Sidewalks, Demographics (somewhat), Business, Police, fire department, other public services, Health care institutions, Appearance of area, Media, Faith-based facilities, Parks (open space and green space), People, Cars, Condition of homes, Transportation, Politics, Ethnicity, Education
specific windshield survey
-walking in the community
Data Gathering Methods
a. Community Reconnaissance
- have with a community leader/ unbiased overview, get a lot of very accurate in-depth information/ takes a while to write up and summarize
Data Gathering Methods
In-depth interview
-the way they are dressed, asking people in the community
Data Gathering Methods
Informal conversation
- windshield survey/ verify findings with community leader, eliminate bias Ex: browse stores and expiration dates, may see what they want to see
Data Gathering Methods
Observation
-online, look at stats
Data Gathering Methods
Review of documents
- open meetings, u need a moderator(coordinator), time for all to speak , a lot of info on diff issues
Data Gathering Methods
Town hall meeting
- similar to town hall meeting, must have a moderator, moderator sets tone and focus, disadvantage= get community bias
Data Gathering Methods
Focus group
- have community tell you the needs, may get low return rate, reading level must know possible level 8th grade
Data Gathering Methods
Surveys/questionnaires
- you look at pop, same kind of thing like project
A. data collection Ex: breathing issues at senior center
B. monitoring health status
C. identifying problems
D. Inform community about data findings Ex: senior center in certain town
E. report data findings to that population
F. Evaluation- reassessment, quality, how well it worked, any aspect of public health services
Core Functions of Public Health Nursing-
1. Assessment
- making an emergency preparedness plan, will enforce laws that are related to health and safety, research for new info and solutions, PHN have to have data and scientific knowledge to back it up
Ex: active tb and have small children they have to enforce that is endangerment to the child, they will go in and inform and tell them they must get treatment to stay in home
Core Functions of Public Health Nursing
Policy Development
- making sure that services are available Ex: when you move into this community another phn will come to visit you, forwarding records, giving report to new phn,
A. competent health care work- to take proper care of someone with certain disease Ex: teach CNA on a communicable diseases
B. educate and empower people
C. mobilize community partnerships- identify other things that are coming up, assuring that it is there
Core Functions of Public Health Nursing
Assurance
A person held in “safekeeping” in order to be free from:
1) Violence 2) Bodily Harm/Abuse 3) Persecution 4) Death
What is a Refugee?
Karen Refugees usually take exile in the refugee camps
Very primitive by our standards
Why is Thailand Important?
Chin refugees usually seek exile in
Their camps are also viewed as very primitive by our standards
Why is Malaysia Important?
-Depends on where they resided in Burma as well as the tribe to which they belonged, I94- tells where they came from/They tell us who they are and what part of Burma they are from
Look similar – U.S. State Dept. paperwork tells us Burmese culture and tribe
Different religious callings – Buddhists vs. Christian
Camps look similar
Main Goal is the same: SURVIVAL
How Do We Tell The Difference in Refugees?
are Burmans, Mon, Rakhine and Shan – predominantly Buddhists and literate
Geography of Burmese Refugees
*Valley-dwelling people
are Chin, Kachin, Karen/Karenni and Wa – predominantly Christian – Baptist and Catholic largest Christian groups – largely non-literate
Geography of Burmese Refugees
Hill people
- Rice is essential to daily existence – synonymous to life itself (diabetes risk)
- Tropical monsoon climate – why they wear opened-toed sandals and no winter coats
- Emphasis on family and community
- A respect for elders and ancestors
- Americans encounter 3 main groups of Burmese: Burmans, Karen and Chin
Shared Cultural Burmese Characteristics
To be able to find another country to call home where they are free from harm
To be given a second chance at life where they will not have to live in fear
To resettle where they will find others like themselves
To find and experience the American dream – live free and have all that we have
Why Did Refugees Start Coming to Indianapolis?
Crowded, Very Unlike a “home” – they are simply a place to be held “safely”, No furniture, No plumbing, No stoves – cook over an open flame, Stand in lines waiting for a bowl of rice, Sleep on a straw mat on the ground, Truly communal type living
-8/8/88 the day of the four 8’s when a huge military uprising (SLORC) occurred and an estimated 3000 Burmese people were killed
Refugee Camps:
: fails to stimulate an immune response, incorrect route, storage issues, exposure to light, no seroconversion.
Primary failure
: initial immunity is established, but immune response weakens over time.
Secondary failure
– consistent, expected level of a disease/event in the population or geographic area
-usually have some cases of the disease regardless of anything else, baseline number. Ex: pertussis in US, foodborne botulism in Alaska
endemic \
disease occurance
- a higher level of an endemic event Ex: cholera incidence rate among Asians and Pacific islanders
hyperendemic disease occurance
– unexpected occurrence of an infectious disease in a limited geographic area during a limited period of time. Ex: yellow fever in Philadelphia 1793
outbreak
disease occurance
– a clear, unexpected increase of an infectious disease in a geographic over a given period of time, excess of normal expectancy (Similar to outbreak. Use outbreak at beginning and then switch to epidemic when it goes on and on and grows.) Ex: polio just one case- is supposed to be eradicated
epidemic
disease occurance
– steady occurrence of a disease that is spread through countries and/or worldwide Ex: aids/hiv, H1N1
pandemic
disease occurence
- a highly prevalent problem that is commonly acquired early in life and decreases as age increases. Ex: malaria in sub-Saharan Africa 75% of deaths were children, trachoma in villages of Saudi Arabia
holoendemic
disease occurence
- irregular pattern with occasional cases found at irregular intervals. Ex: Cerebro-spinal meningitis
sporadic
disease occurance
= identify risk factors at the earliest stage
-don’t have to be done every year
Screening
1. Purpose
- it will produce results each time, suspect someone of having will know will determine results
screening
Reliability
- are the results accurate
screening
Validity
- correctly identifies those persons with the disease, has to be right level, won’t use till other dx test have been done, overly can have false-positives
screening
Sensitivity
- correctly identify person that does not have the disease , may get false- negatives when really sensitivity is to low= they really do have the disease
screening
Specificity
breaking down the proportion of person of a positive test that actually have that
screening
Positive predictive value-
- proportion of person of a negative test that don’t have it
screening
Negative predictive value
going out after all of the determinants and focused on treatment/ taking analytical epi and applying it to a situation
Applied epidemiology
not focused on intervention, tells story about what happened, focus on distribution of it how far it got and who go it
- Describes distribution of health outcomes using person, place, & time.
- Narrative regarding what happened from beginning to end
- Time affected by secular trends
- Time affected by point epidemic
- Does not focus on clinical intervention.
- Based on surveillance data.
Descriptive epidemiology
- cause and treatment, determinants
-Aims to find cause and treatment.
Analyzes determinants – how and why?
-Factors that influence observations of health and illness.
-Must have observational data from descriptive studies or conduct observation as part of the analytic study.
Analytical epidemiology studies
- type of prospective, long term(longitudinal) and requires follow up
*Prospective cohort study Ex: watch people for a while and see if disease dev
-best estimate of disease incidence and risk
Reduces bias because waiting to see if it happens
study multiple affects
Disadvantage: long follow up=attrition rate, large number of subjects, expensive, exposure factors may change, doesn’t work well with rare disease= not enough of them
Cohort study
analytical
– compare persons with the disease to those that do not, rigorous criteria to be able to participate, can be a control group
-questions the causality better, less data and resources
Retrospective cohort study
analytical
Advantages: can estimate the risk, lesser number of subjects, less money, quicker, can investigate more than one exposure, best design for rare disease, best for disease with a relatively clear onset
Disadvantage- attrition rate, not well suited for rare exposure,
Retrospective cohort study
analytical
Case-control
correlation studies, relationship between the cause of disease, does not calculate the risk cause or incidence rate, can’t definitively substantiate the cause
Quick to plan and conduct, hypothesis is generated Ex: what causes disease
Disadvantage: Can’t calculate the risk incidence or prevalence, not good for rare disease
Retrospective cohort study
analytical
Cross-sectional:
- investigator initiates a treatment or intervention to influence the risk for or course of disease, test whether interventions can prevent disease or improve health , person is randomly assigned to a particular group an intervention is applied and effects are measured
Experimental design
- evaluates the effectiveness of an intervention
Disadvantage: is it fair to withhold treatment if treatment truly appears to have effect, expensive in terms of time, personnel, facilities, and supplies
experimental epidemiological studies
Clinical trial
- similar to clinical in that an investigation determines what the exposure or intervention will be, deal with health promotion and disease prevention rather than treatment of existing disease, intervention is usually undertaken on a large scale and unit of treatment is a community, region, or group rather than individuals
-involve educational, programmatic, or policy interventions - best means for testing whether changes in knowledge or behavior, policy, programs or other mass interventions are effective
Disadvantage- may take years for evident,
-Comparable community populations without similar interventions for comparative analysis are often difficulty to find - it is difficult and unethical to prevent the control communities from making use of generally available information=effectively making them different from the intervention communities
-cam be expensive, require a large staff, have complicated logistics, and need extensive communication about the study
experimental epidemiological studies
. community trials
- subjects are randomly assigned to groups, randomization is used, best way to show causality bc of the objective way in which the subjects are assigned, prospective and provide the clearest evidence of correct temporal sequence / double blind study
experimental epidemiological studies
Control group vs. experimental group
avoids bias, treatments are assigned to pts so that all possible treatment assignments have a predetermined probability but neither subject nor investigator determines the actual assignment
Randomization:
control group experimental epidemiology
- one side, many entities involved, organizations that cross geo-political barriers, UNICEF working with WHO
Global Health Organization Types
1. Multilateral
- two sides, parties share a common problem/ Indonesia sending fruit with bugs to a developed country (japan), countries have to work together to fix the problem= Indonesia inspects it and Japan does too
Global Health Organization Types
Bilateral
- funding from private groups like faith groups or philanthropic groups, International Red Cross= very well organized does get some money from government, Bill Gates Foundation , Johnson & Johnson
Global Health Organization Types Nongovernmental Organizations (NGO
where you provide services and supplies to needy countries while trying to sell your own products
Realized giving different kinds of products might not be culturally or ethnically sensitive = on what products should be supplied Ex: birth control to Africa that is a big no no
May upset economy with outside goods= sensitive to what is in place
Global Health Organization Types
NGO
Commodification:
- umbrella which everything falls, worldwide network, strictly for world’s health problems, holistic (education), universal voice for global health, may look at problems that come from politics, will work with the UN- budgeting, program planning, and providing assistance, poor nation of international health services
Global Health Organization Types
World Health Organization (WHO)
- not a global health organization, hallmark of global health, US statistic goal and objectives, model used for other countries
Global Health Organizations
1. Healthy People 2020
- used by other countries, not an organization but an example used by other countries to see how other countries can work together, removed barriers of trade to provide more services to each country (meds, jobs, food, banking industry improved)
Global Health Organizations
North American Free Trade Agreement
-multilateral, international children’s fund, developed after WW2, works with WHO, needs are huge, children under 5 and their mothers, primarily on needs of children work with families focusing on the families, better life for children across the globe
Global Health Organizations
UNICEF
Multilateral, Part of the United systems, American Public Health Organization, regional arm of WHO, improves living standards in Latin/South American Countries, if Brazil can help us with something, current focus right now it is looking at infrastructure dev in remote areas and AIDS
Global Health Organizations
PAHO- Pan American Health Organization,
- NGO, significant health problem- who you call and who will arrive first, vast majority are volunteers, some paid administration, provide relief to victims- war, natural disasters/ impartial and neutral
Global Health Organizations
International Red Cross
- lend money to lesser developed countries to directly or indirectly (infastructure, education) improve health, low interest free loans, grants for education , communication and infrastructure
Global Health Organizations
World Bank
- all functions but focuses on credit worthy poor countries, may get paid back sometime in the future like Indonesia- have things that can develop but need more help
Global Health Organizations
International Bank for Reconstruction and Development (IRBD)
- all functions but for poorest countries, not a lot of help of getting paid back, philanthropic
8. International Council of Nurses- largest council of nurses and the first, focuses on to providing world with competent nurse force, taking some of the providers for education, works with WHO, unite nurses, advance the profession, influence world health policy
Global Health Organizations
International Development Association (IDA)
NGO/PVO, food for those affected by war or natural disaster, don’t have to be catholic, needs of population, 94% is utilized outside of US
Global Health Organizations
Catholic Relief Services-
NGO, Drs. Without Borders, controversial, considered neutral and can go into controversial countries ,human rights advocate, provide services with or without permission
Global Health Organizations
Medecins Sans Frontieres-
-may choose provider, regional care
Sweden
antiquated system, gap in economic classes
China-
- lack of adequate services in rural areas, half of all citizens have no health care at all
Mexico
- National Health Service, Primary Care Trusts, severe nursing shortage, long wait lists for specialists and surgery
United Kingdom
- the provinces are the key providers, rationing of services
Canada
before 10,000 bc stone age, small groups of population were all separated, not a lot of contact between them
-little opportunity for different views to clash, self-sufficient, little opportunity for exchange of disease, abandon housing when waste took too much room=get into the ground and crops
Ex: now we stop eating Mexican tomato’s because contaminated
Hunting and gathering:
- small groups began to combine with other small groups= increase pop and density / greater supply and demand , animals living in closer proximity to the humans=bugs, disease, illness
- Problems: salmonella, anthrax, qfever, tb prevalent during this age
- not enough plant life to sustain= poor nutrition, water resources contaminated=dysentery, cholera, typhoid, hep a Ex: Burmese move in have tb bc dense area
settled villages
- 6,000bc to 1600bc, large urban areas had to form , more pop, demand on resources, manufacturing =live closer to where they work more needs , increase need for waste removal/ start to dev more sophisticated water system/ formal towns develop=waste and trash problems bring issues=rats came-carry diseases
- rats would come from anywhere, newer disease happening=direct contact, through their waste
- rats=brought the plague=bubonic plague(black death) -red sores flu, small pox
Preindustrial area
: industry increase, industrial waste pollution issue=air, land, water, civil war=make weapons/ war ends poor working conditions
Mercenary soldiers to come help fight- bring disease
-Problems: Resp disease increased=pneumonia bronchitis , epidemics-illness in large proportion episodes of illness=diphtheria, small pox, typhoid, measles, malaria, yellow fever (spread by travel)
Industrial cities
-1700-1800
infectious disease caused the largest amount of death ever, health disparities in socioeconomic status
- end of century disease chronic- cardiac, peripheral vascular, obesity, diabetes
- increased refined sugar and fat= what we ate caused disease others adopted western ways
- occupational hazards, mental disorders=stress, modern convinces promoted by sedentary lifestyle
1900 to the present:
– cause of death = contagious diseases
– 1st African American PHN
Early 1900’s
A. Jessie Sleet
Rural nursing
- “Town and Country Nursing Services”
- Industrial nursing
- School nursing
- Metropolitan Life Insurance Company
- Frontier Nursing Service (Mary Breckinridge
Early 1900’s
B. American Red Cross:
- marine hospital health service
1902
: come in with uproar and commotion with what is normal
-Mary Mallon was a cook and a carrier of typhoid fever, people at this restaurant started to get sick, lived the rest of her life in quarantine
Ex: today people in public health we don’t throw them away, we find ways to deal with it, we still quarantine= talk through door or wave from the window
1907 – “Typhoid Mary”
– Family planning * -birth control, abstinence, Md only treated, didn’t have informed consent no education
-broke laws to have birth control legal
Ex: relate to now: she laid the ground work for the right women have to know, also for ed meds
books she wrote: “What Every Girl Should Know” “What Every Mother Should Know”
1916
Margaret Sanger
- no one had anything, couldn’t borrow anything, public health increased the cost of health care because the demand was greater,
- those who have had health care but now don’t increase the need for help
The Great Depression
1920-1940
- study from infection to death with African American subjects, ethics didn’t tell people they had the disease, still gave placebos when they saw them getting sick, really started to look at the ethics with research
Tuskegee Syphilis Study
1920-1940
- Center for Disease Control
- World Health Organization -trade and new illnesses
- Water fluoridation - a lot of resistance at first, after 5 years , help with germs in water and diminish dental problems
- Polio vaccine - Sulk makes
1940’s to 1960’s
- “The Pill” -big issue with giving women choices
- Environmentalism - if didn’t focus on this then some of the environmental issues would be present
- Tobacco recognized as a hazard
- War on Poverty
- Head Start -preschool for low income and underprivileged family, can be daycare service= allows parent to be able to work= increase money
- Small pox eradication began
- Small pox officially eradicated worldwide
- EPA -environmental protection agency came from environmentalism
- WIC
1960’s to 1980’s
- we became complacent with infectious disease, the ventilation of air condition became contaminated in the hotel and all the people who got sick went to the conference/ now we need to inspect buildings
Legionnaire’s Disease (1977)
- AIDS- formally diagnose
- Food labeling- rechange through generations
- Genome Project-completed early, mapped out genetics
- Healthy People 2000 - goals
- Development of list of 20th century achievements in public health.
1980’s to 2000
- Younger parents- edu on controlling anger, resources, not alone call on services, control impulse
- Socially isolated
- Lower SES
- Less formal education- learning what is abuse
- Inadequate support systems
- Poor parenting skills
- Victim of child abuse-siblical
- Single parent family(unrelated partner=resentment toward child)- you are the only outlet talk to someone about issues , don’t snap
Characteristics of a Child Abuser/Victims
A. Abuser:
- vulnerable
1. Birth to 3 years old- very vulnerable
2. Disability- drain and stress, need more resources
3. Chronic high stress environment
4. Crowded living conditions
5. Lower SES
6. Premies- bring home, a lot of extra needs, especially if first child
7. Unrelated caregivers- nursing home=tired of working
Characteristics of a Child Victim
Known by the victim
- 80% are adults
- Work with children: risky job, priest and pastors
- Long-term abuse
- Controlling behaviors: huge issue
- Need power: in control, want to leave lose control
Characteristics of Sexual Abuser/ Victim
A. Abuser:
- 10% of men are victims
- 20% of women
- Reluctant to report: deeply personal crime
- Males less likely to report
- Males most likely to be abused by another male
- 9-years-old is the mean age for abuse =parent who is overly concerned about the child, don’t want you in there
Characteristics of Sexual Victim
- Usually male.
- Sexually aggressive peers.
- Drug and alcohol use.
- Accepting of dating violence.
- Prefer impersonal sex: able to justify, see as object
- Impulsive tendencies: gang mentality= wouldn’t norm do on own
- Anti-social behavior.
A. Dating Violence Abuser
- 16 to 24 years of age.
- May have friends who are also victims.
- Occurs in victims own living quarters.
- 16% of college women
- Previous assault.
B. Dating Violence Victim
- edu to prevent snapping, belittle child in front of friend=makes uncomfortable victim takes it
various stages of healing=episodes of abuse
Forms: beating, biting, burning, hair pulling, hitting, punching, kicking, scalding, shaking, shoving, slapping, throwing, tying up, torturing
Range of severity: minor bruising, scratches, gazes, cuts, eye injuries, fractures, injuries to brain, damage to internal organs
Note- signs of fresh wounds or bruises and old scars might be an indication that the child has suffered from more than one occasion
Physical Abuse
Not abused as a child- won’t tolerate
No children
Power- money, main bread winner
Children become the focus of violence- try to get kids out
Supportive friends and family near by- middle of night able to run to them
Frequent and severe battering-escalated to broken bones, feel like they will die if they stay
Did not see their mothers beaten.
Victims Who Leave……
- forehead, nose, head injuries involve parietal bone, occiput, or forehead, chin, palm of hand, elbows, knees, shins
Accidental Injuries places
- involve bony prominences
- match the history
- are in keeping with the development of the child
Accidental injuries typically
- Abusers are smart= cloths cover, prime areas
- black eyes= bilateral seledum, soft tissue of cheeks, intra cranial injuries, mouth- bite marks on tongue= can be accidental if fall, inner aspect of arms= not radially visible , back and side of tongue
- pinch marks, chest and abd= usually, can be trauma from car accident, forearms when raised to protecting self, any groin or genital injury= sexual abuse, inner aspects of tights, soles of feet
- spiral fractures
Intentional Injuries
Ears, side of face, neck, and top of shoulders= very unusual
intentional injuries
A. Triangle of safety:
-injuries to both sides of the body, injuries to soft tissue, injuries with particular patterns, any injury that doesn’t fit the explanation, delay inpresentation, untreated injuries
Remember concerns raised by
Nature of injury, past and present
Repeat MD or ER visits
Blames another party
Inconsistent Hx
Story d/n match history
Present with complaint about anything except the abusive injury
Disproportionate response of alleged abuser- clingy (red flag)
Refuse tests and treatment- lose nerve
Delay in seeking treatment- hoping will heal on own
Absence of parents- caregiver take to be seen like babysitter
Inappropriate response of the alleged victim- too much or too little
Warning Signs of Abuse
- surface, different stages of healing, rigged outline, bc move around a little bit before get away, drag mark trying to get away, irregular
Accidental Cigarette Burns
circular, deeper wounds, where they are located, more uniform
Intentional Cigarette Burns:
: irregular with variable severity in appearance (some areas with blistering some without)
- typically no recognizable patterns and burs are not circumferential
- unprotected areas
- general location is flexor and anterior surfaces
- severity varies, predominance of superficial, first degree burns
- few in number, all of same apparent age and stage of healing
- edges are indistinct and irregular
- splash marks are present
Characteristics of Burns Accidental
regular and more uniform appearance
- recognizable pattern with symmetry and regularity, circumferential = minimal splash marks: common for immersion burns
- areas that are relatively protected ( butt, genitals, thighs)
- general location is extensor and posterior surfaces
- severity is relatively uniform with predominance of deeper second and third degree
- multiple wound in various stages of healing
- edges are clear and sharply demarcated
- no splash marks
Characteristics of Burns non-accidental:
- no exact line
Immersion Injuries
1. Accidental
- specific demarcation
Causes of Scald Injuries- hot drinks 44%, cooking liquids and hot food 22%, boiled water 20%, hot tap water 14%
Intentional
immersion injury
- Twisting injury, Rotational pattern
Rare in children – unless abused
Spiral Fracture
may come from sports- skiing snowboarding, roller skating
Accidental injury
spiral fracture
- ankles, hands, throat
* big red flag, only happen if tied up unwillingly / not accidental
Ligature Marks
- can be accidents because they don’t have lines that are spreading out, not very common Ex: gunshot= few lines
Linear Skull Fracture
- non-accidental, lines look like a spider web, usually chronic injury, head trauma from weapon Ex: baseball bat
Stellate Skull Fracture
single, linear, narrow, usually parietal bone, no associated intracranial injury, unilateral, non-depressed, only one cranial bone, does not cross suture line
accidental skull fracture-
- multiple, stellate, wide > 3mm, any location, intracranial injury present, bilateral, complex depressed growing and enlarging, may be multiple cranial bones, crosses suture lines
intentional skull fracture
- 30% die or have lifelong complications
- Head larger than body proportions
- Weak neck muscles
- Large amount of water
- Results in tearing of vessels and neurons
- don’t know till proven in court, can have finger marks on back and front because holding really tight
- neck muscles are pretty flexible in an infant
- babies are especially susceptible to injury when they are shaken bc their connecting tissues and bone structure have not sufficiently developed to offer any protection
Abusive Head Trauma (AKA = Shaken Baby Syndrome)
- brain bangs against the skull
- small blood vessels between the brain and the skull are tearing causing bleeding
- large blood clots can form pressing against the brain and causing massive swelling
- blood vessels in retina are red and big because detached
- blood between two hemispheres, vertebrae can crush spinal cord bc weak neck muscle
- injuries can result in brain damage, retardation, paralysis, blindness, deafness, and death
Abusive Head Trauma (AKA = Shaken Baby Syndrome)
- flu-like sx
- vomiting
- poor eating
- listless
Symptoms of Abusive Head Trauma
*General
- posturing
- seizures
- decreased LOC, respiratory function
*Severe
sx abusive head trauma
- seizure disorder
- visual impairment
- developmental delays
- cerebral palsy
- hearing impairment
- cognitive impairment
Long-term effects
sx abusive head trauma
Primary Agriculture based
Burma is also well known as a major producer of illegal opium in the northern region bordering Laos and Thailand referred to as the “Golden triangle”
Burmese Economy
- hitting, kicking, pushing, slapping, burning, or forces or causes injuries
- engaging in sexual contact without consent
- -#1; failing to meet basic needs life food, clothing, medical care, housing
- Financial-
- leaving elder alone, no longer providing care
- harming self-worth, well0being; name calling, scaring
Types of Elder Abuse
- Physical
- Sexual
- Neglect
- Abandonment-
- emotional
