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NU472 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Characteristics of a domestic abuser

A
  • 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
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2
Q

DV Community resources

A
  • Individual therapy/counseling
  • Group therapy
  • Support & self-help groups
  • Shelters
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3
Q

DV Treatments/Interventions

A
  • Restraining or protection orders
  • PTSD treatment
  • Recognition of stalking
  • Arrest laws for DV in all 50 states
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4
Q

DV and same sex couples

A

DV occurs with same statistical frequency as heterosexual couples

  • Fewer protections
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5
Q

Cycle of Abuse Stages

A

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

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6
Q

Therapeutic communication for DV victims

A
  • 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
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7
Q

Generation-to-generation continuum of violence

A

Violence is a learned behavior

  • pts with a hx of abuse more likely to react with violence
  • must break the continuum of violence
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8
Q

Victim profiles

A
  • 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
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9
Q

Abuser profile

A

Feelings of insecurity, powerlessness, & helplessness

Refusal to share power; must control victim

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10
Q

Where does DV typically occur?

A

At home

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11
Q

Violence during pregnancy (what is it, factors leading to, signs of abuse)

A

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

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12
Q

Forms of child abuse (most common, others)

A

Most common: neglect or failure to prevent harm

Intentional injury, physical abuse

Abandonment

Sexual assault

Overt torture

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13
Q

S/s of child abuse

A

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

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14
Q

Mandated reporting (define, resources)

A

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

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15
Q

Priority nursing interventions for working with abused child

A

*** Child safety and well-being is #1 priority

Psychiatric evaluation

Therapy

Social services

Family therapy and other requirements for parents

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16
Q

Assessing Abuse (where does this most often occur, who is most at risk, s/s)

A

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
17
Q

Nursing interventions for sexual assault patients (goals, management, physical exam, other tx)

A

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
18
Q

Rape trauma syndrome stages

A
  1. Acute disorganization phase
    - expressed state of shock, disbelief, fear, guilt, humiliation, anger
    - controlled state in which feelings are masked
  2. Phase of denial and unwillingness to talk about incident
  3. Phase of heightened anxiety, fear, flashbacks, sleep disturbances, other PTSD like symptoms
  4. Phase of reorganization
    - patient puts incident into perspective
19
Q

Why do elders avoid reporting abuse?

A

Often their caretakers are family members, so they want to protect their family

Fear losing support

20
Q

Antidepressants black box warning

A

There is an increased r/o thoughts of suicide within first few weeks of tx

Assess patient frequently in first few weeks and educate!

21
Q

Suicide common characteristics

A

Ambivalence - lots of uncertainty and mixed feelings; may change mind often

Most common in men

22
Q

Risk factors for suicide

A

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

23
Q

Nursing Interventions

A

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

24
Q

Emergency management of suicide attempts

A

Treat consequences of attempts

Prevent further self-injury and promote safety

Crisis intervention

25
Q

ANA Code of Ethics statement on euthanasia

A

States that the nurse “should provide interventions to relieve pain and other symptoms in the dying patient consistent with palliative care practice standards and may not act with the sole intent to end life” (2015, p. 3)

Not accepted

Palliative care only

26
Q

ADHD Clinical s/s

A

S/s usually begin before 7yo

Inattention

Impulsivity

Distractibility

Hyperactivity

Disruption in…

  • learning
  • socialization
  • compliance
27
Q

Common medication used to tx ADHD (MOA, pt edu)

A

Methylphenidate (Ritalin, Concerta)

  • moa: psychostimulant; increase attention span while decreasing impulsivity
  • pt. edu:
    • take in morning to prevent sleep disruptions
    • can decrease appetite –> eat before taking
28
Q

School setting modifications

A

Behavior therapy

Classroom restructuring as a part of an individualized education program

  • providing more structure and planning
  • provide emotional support throughout the day
  • encourage educational advocacy
  • utilize positive reinforcement mechanisms
29
Q

Meds to treat spasticity (goal, types, SEs)

A

Goal: assist cerebral palsy patients to gain optimal development and function within the constraints of their disease

Types

  • Baclofen
  • Diazepam
  • Botox (dantrolene sodium)
  • Anticholinergics

SEs

  • Anticholinergics: drooling
    • tx - Scopolamine or Botox can decrease saliva and improve drooling
30
Q

Baclofen patient edu for CP patients

A

Must drain continuously, patient will have baclofen pump

  • check site of pump for redness/swelling
  • replace q5-7 y
  • med refill q3 months

Call PCP for…

  • Temp > 101.5 OR persistent incisional site pain
  • Rupture
  • Dislodgement
  • Blockage

Post-placement, avoid…

  • Tummy sleeping for 4 weeks
  • Tub baths for 2 weeks
  • Twisting/stretching

Post-incisional site healing…

  • Resume normal activity
  • Wear loose clothing
  • Always carry medical ID and emergency info cards
31
Q

Cerebral palsy (patho & onset)

A

Patho
- nonprogressive, lifelong disorder d/t abnormal development or damage to the motor area of the brain

S/s - mild-severe impairment range

  • c/b abnormal motor patterns and postures
  • spasticity & ataxia

Onset

  • Infancy or early childhood
  • 80% develop CP prenatally
32
Q

Trisomy 21 (Down Syndrome) patho, RFs

A

Presence of all or part of a 3rd 21st chromosome

Most common chromosomal abnormality associated with intellectual disability

RFs
- Maternal age >35, with increasing risk with age

33
Q

Complications r/t to Down Syndrome

A

Cardiac defects & congenital heart disease (40-50% of pts)

Vision & hearing impairments

Increased susceptibility to infection

GI disorders

  • Celiac disease
  • Imperforate anus
  • Hirschsprung disease and chronic complications

Sleep apnea

Thyroid Disease

Higher risk for obesity and T1 DM

34
Q

Nursing Interventions for Failure to Thrive

A

Observe parent/child interactions, especially during feedings
- assess for neglect or educational opportunities

Develop feeding schedule
- get diet hx via 3-day food diary

Weigh daily, I&Os

35
Q

Meds used to decrease cerebral edema (indications, MOA, SEs, NIs)

A 
Osmotic diuretics (i.e. mannitol, hypertonic 3% saline)
I: traumatic brain injuries 
MOA: dehydrates brain tissue to decrease edema
SEs: 
- change in hydration status
- F&E instability 
NIs:
- monitor serum osmolality (NR: 285-295)
- monitor F&E and hydration

Corticosteroids (i.e. dexamethasone)
I: nontraumatic brain injuries like tumors
moa: reduces edema surrounding tumor

NU472 (5 decks)

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