Final Exam Flashcards
Characteristics of a domestic abuser
- Most often, male partner abusing female partner
- Views partner as belonging to them
- Strong feelings of inadequacy
- Low self-esteem
- Poor problem-solving and social skills
- Negative affect (hostility, depression)
- Hx of abuse in childhood
- Substance abuse
DV Community resources
- Individual therapy/counseling
- Group therapy
- Support & self-help groups
- Shelters
DV Treatments/Interventions
- Restraining or protection orders
- PTSD treatment
- Recognition of stalking
- Arrest laws for DV in all 50 states
DV and same sex couples
DV occurs with same statistical frequency as heterosexual couples
- Fewer protections
Cycle of Abuse Stages
Violent episode
- Emotional, physical or sexual
- Increase in intensity and frequency
Honeymoon Period
- Duration: weeks-month, but shortens with repeated occurrences
- Behavior: regret, apologies, gifts, promises abuse won’t happen again
Tension-building Phase
- Behavior: arguments, silent treatment, complaints
Violent episode
- Tension-building phase ends in a violent outburst, and the cycle begins again
Therapeutic communication for DV victims
- Most DV patients won’t seek care for abuse –> ask every visit if they and their children feel safe
- Help develop a safety plan
- Believe & listen to the victim, maintain confidentiality, remind them it is not their fault, say “you have a right to be safe and respected”
- Accept and respect victim’s decisions
Generation-to-generation continuum of violence
Violence is a learned behavior
- pts with a hx of abuse more likely to react with violence
- must break the continuum of violence
Victim profiles
- Rarely describes self as abused (d/t gaslighting & battered woman syndrome)
- Feel as though it’s their fault, like they have a personality flaw or are inadequate
- Many have hx of abuse as children
Abuser profile
Feelings of insecurity, powerlessness, & helplessness
Refusal to share power; must control victim
Where does DV typically occur?
At home
Violence during pregnancy (what is it, factors leading to, signs of abuse)
Pregnancy is a time of escalating violence in an already troubled relationship
Factors leading to violence during pregnancy
- Inability to cope with stressors (esp in unwanted pregnancy)
- Young couples
- Low education levels, unemployed
- Hx of abuse
- Paternity doubts
- Women become focused on selves/babies, father can become jealous
Signs of abuse during pregnancy
- Missing prenatal visits
- Difficulty during pelvic exams, unrealistic fears
- Weight fluctuations
- Nonadherence to tx
Increased r/o postpartum depression
- s/s: insomnia, substance abuse
Forms of child abuse (most common, others)
Most common: neglect or failure to prevent harm
Intentional injury, physical abuse
Abandonment
Sexual assault
Overt torture
S/s of child abuse
Serious injuries (fractures, burns, lacerations) with no reported hx of trauma
Delay of seeking tx for serious injuries
Sexual assault: high incidence of UTIs, bruised/red/swollen genitalia, bruising of rectum
Inconsistent hx or changes in child’s hx
Evidence of old, unreported injuries
Mandated reporting (define, resources)
All 50 states have laws requiring HCPs to report any SUSPICION (don’t need proof) of child or elder abuse
- HCPs have protection from legal liability if reports are made in good faith
Resources: hotline available for HCPs if concerned/confused
Priority nursing interventions for working with abused child
*** Child safety and well-being is #1 priority
Psychiatric evaluation
Therapy
Social services
Family therapy and other requirements for parents
Assessing Abuse (where does this most often occur, who is most at risk, s/s)
EDs most often the 1st place victims of violence go to seek help
- persons with disabilities at highest risk
S/S
- abuse –> unexplained bruises, lacerations, abrasions, head injuries, fractures
- neglect s/s –> malnutrition/dehydration; a dependent person shows evidence of inattention to hygiene, nutrition, or unmet medical needs
- physical health problems (anxiety, insomnia, GI issues)
- explanations of injuries do not fit the symptoms
Nursing interventions for sexual assault patients (goals, management, physical exam, other tx)
Goal: encourage patient to gain a sense of control over their life
Management
- bring to private room and have HCP available ASAP
- provide support, privacy and sensitivity
- only have client tell story 1x to prevent retraumatization
- encourage counselling and f/u care
Physical Exam & Specimen
- must have written, witnessed consent form
- ask if patient has bathed or showered
- take urine drug test w/in 96 hours
- place each clothing article in separate paper bag
Tx
- STI prophylaxis (IM rocephin, po flagellin)
- Preventing pregnancy –> plan B
Rape trauma syndrome stages
- Acute disorganization phase
- expressed state of shock, disbelief, fear, guilt, humiliation, anger
- controlled state in which feelings are masked - Phase of denial and unwillingness to talk about incident
- Phase of heightened anxiety, fear, flashbacks, sleep disturbances, other PTSD like symptoms
- Phase of reorganization
- patient puts incident into perspective
Why do elders avoid reporting abuse?
Often their caretakers are family members, so they want to protect their family
Fear losing support
Antidepressants black box warning
There is an increased r/o thoughts of suicide within first few weeks of tx
Assess patient frequently in first few weeks and educate!
Suicide common characteristics
Ambivalence - lots of uncertainty and mixed feelings; may change mind often
Most common in men
Risk factors for suicide
Previous attempts
- first 3 months-2 years after attempt most vulnerable
Family hx of suicide (i.e. “granting permission”)
Loss of parent at young age
Communication of SI, plans for suicide, **means to carry out the plan
Risky behavior (i.e. driving fast, driving drunk)e
Nursing Interventions
Goal: provide a safe environment, preventing harm to self or others
- Environmental safety: no cords, plastic utensils, sharp objects, sheets
- Suicide precautions: q10m checks, 1:1 supervision (explain purpose), maintain safe distance, don’t corner yourself
Treat comorbidities
Take on authoratative role
- Ask direct questions re: suicide and ideation
- Never ignore hints of SI
Support systems lists
Emergency management of suicide attempts
Treat consequences of attempts
Prevent further self-injury and promote safety
Crisis intervention
