ICL 8.5: Sexual Assault Evaluation Flashcards
what is domestic violence?
not an isolated invidivual event but rather a pattern of multiple tactics and repeated events
assaults are repeated against the same victims by the same perpetrator
how prevalent if domestic violence?
1 in 4 women
what is the presentation of DV?
- headache, neck or back pain, vague complains, frequent ER visits
- digestive problems
- weight loss.gain
- sexual dysfunction
how is DV related to pregnancy?
30% of assaults begin during the first pregnancy
pregnancy women have twice the risk of battery
240,000 pregnancy women are subject to DV each year
what are signs of abuse in patients of DV?
- unexplained bruises, lacerations, etc.
- delays in treatment
- appear embarrassed, evasive, anxious or depression
- partner is unwilling to leave, uncooperative, domineering, etc.
- injuries don’t match the history given
- expresses fear of returning home or her children’s safety
what is medical exception to hearsay?
the rule that says that you as a provider when interviewing a patient can chart quotation marks of what the patient said and then later can read it on the stand in court
described medical history, past or present symptoms or sensations, their inception, etc.
what are the resources for DV?
- social work
- chaplain
- SANES nurses in the ER
- locale sources: lucas county crisis response team
how do we screen everyone for in the ED for strangulation?
- thyroid cartilage fracture
- trauma consult
- admitted to the hospital
what is choking?
blocked airway due to an internal obstruction
what is strangulation?
the occlusion of blood vessels and/or airway as a result of external pressure applied to the neck
can you visibly see DV?
only 50% have no external injuries
20% have petechia but they’re really hard to see…
what are petechia?
continuous pumping of blood into capillaries which then rupture if they can’t get back to the heart
only happens in 20% of patients
you have to do a full head to toe assessment because sometimes you really can’t see the petechia, they’re in weird areas
what is the presentation of previous strangulation?
- can present as urination/defication on themselves
- choking
- headache, dizziness
- difficulty speaking
- petechia
- head injuries
what structures under the skin can be effected during strangulation?
- vasculature
arterial vessels take 11 pounds for 5-10 seconds for unconsciousness – there is increased risk for thrombolysis or embolism
takes 4 lb of pressure for 10-20 seconds to occlude a vein
- MSK
how do you do evidence collection for strangulation?
swabs for touch DNA and bodily fluids
there’s no set kit for this technically like there is for a rape kit
is there mandated reporting for DV?
yes!
- in Ohio you must report: any person giving aid to a sick or injured person shall negligently fail to report to law enforcement authorities any gunshot or stab wound treated or observed by the person or any serious physical harm to persons that the person knows or has reasonable cause to believe resulted from an offense of violence
- must offer police reporting; but if they don’t want to file the report that’s fine – however, if the person has to go to surgery though due to serious physical harm from assault then you do have to report it no matter what (ex. break of long bone, ICH); if they are discharged then you don’t have to report it
- must offer STD prophylaxis to sexual assault victims
what is forensic nursing?
the application of legal aspects of healthcare, combined with bio-psychosocial education of the registered nurse used in the scientific investigation of trauma and/or death related to medical-legal issues
so it’s the application of the nursing process to public or legal proceedings
what is a SANE nurse?
RN specifically trained to provide care to sexual assault victims
they conduct medical forensics examinations too
SANE = sexual assault nurse examiner
how long do you have to collect evidence for sexual assault?
up to 96 hours
aka 4 days later
SANE exam is free!! the government pays for the exam if they’ve been sexual assaulted but they dont have to file a report
do sexual assault victims have to file a police report?
no
they can seek psychological and medical support without involving the police
hospital can submit anonymous kits at any victim requires
does matter how much you’ve had to drink, rape is NEVER the victims fault! however you can’t do evidence collection till the patient is clinically sober to get consent to do the collection (must pass MMI)
who are SANE nurses specialize to work with?
- child abuse/neglect
- elder abuse/neglect
- DV
- domestic assault
- criminal assault
what is in a rape kit?
- paperwork; includes hospital and county evidence was collected from, must have appropriate chain of custody from SANE nurse to crime lab
- consent form filled out by patient; do MMI if necessary
- body map; complete PE and then indicate on the body map form
- photography of injuries/evidence to match body map
- narrative history from the patient which the nurse records
- what type of vaginal penetration occurred? oral? anal? did their assailants mouth touch their genitals? did they ejaculate and where? lubrication use? strangulation? douche? BM? vomiting? change of clothes/bathing? ate? brushed their teeth?
- are you menstruating?
- condom use?
- last date of consensual sex? were their other people?
- include underwear
- envelope for prophylaxis aka patient education and STI prophylaxis
- swabs of areas that were licked, kissed, bitten or ejaculation sites – swab fingernails and vagina and vulva; also swab inside vagina and exterior of anus, strangulation area
seal the evidence once collected and include paperwork; give copy to the police of paperwork if police report is going to be filed; then police department in the area WHERE the patient was assaulted will handle it from there
what is human trafficking?
sex trafficking: recruitment, harboring and transpiration providing or obtaining of a person for commercial sex act
labor trafficking too
what are red flags for labor trafficking?
- dehydration
- heat/stress/stroke
- MSK injures
what is sex trafficking signs?
- persistent STDs
- abnormally high number of sex partners
- trauma to vagina
76% have been to the ED while they were being trafficked! we need to better about screening
how do you identify victims of sex trafficking?
- international victims; difficulty communication
- accompanies by a controlling person
- missing identification
- signs of physical abuse
- submissive/fearful behavior
- physically and psychologically controlled by traffickers
- do not consider themselves a victim
- trained by trafficker to tell lies and false stories
- victims distrust of service providers and law enforcement
- frequently moved from place to place
- reluctant to explain
what are the flags for coercion and control?
- inability to keep appointments
- unable to present ID and documents
- addictive behaviors
what are the consequences of trafficking?
once seduced pimps use torture tactics to control their victims
victims have:
- STDs
- PTSD
what is elder abuse?
we don’t have to know something is happening, we just have to be concerned for abuse to report it for anyone over the age of 60 in the state of ohio
applies to physical, sexual, psychological, neglect, abandonment, and financial abuse all count if it’s someone over 60
how do you report elder abuse?
lucas county adult protective services you can report to and reports are confidential and can be done anonymously
