Spousal/Child Abuse Flashcards
define neglect
failure or refusal to provide basic emotional or physical needs
define physical abuse
physical harm causing pain or injury
define emotional/psychological abuse
includes intimidation, isolation, manipulation, coercion or threats
define sexual abuse
any nonconsensual sexual contact
age of legal consent in Canada is 16
define elder abuse
physical, emotional, financial or sexual abuse or neglect of any vulnerable elder by a person in a trusted relationship
define factitious disorder imposed on another (Munchausen by proxy)
mentally well caregiver producing/fabricating symptoms in another under their care, often their child, with no gains from assuming the sick role
describe questions to include in a Partner Violence Screen (PVS)
have you been hit, kicked, punched or otherwise hurt by someone in the past year? If so, by whom?
do you feel safe in your current relationship?
is there a partner from a previous relationship who is making you feel unsafe now?
- more than 1 positive answer denotes abuse with high specificity, good sensitivity
- “because emotional, physical, and sexual violence and abuse can be prevalent, i now ask all my patients about safety and sexual health”
risk factors for abuse
children and elderly cognitive/physical disability mental illness low SES isolation (i.e recent immigrants or recently relocated) pregnancy previous history of abuse caregiver burnout
what are red flags for abuse
partner refuses to leave room during interview
partner answers questions for patient
caregivers present themselves as highly knowledgeable, overly friendly with medical staff
delayed presentation for a pathology or condition (i.e presenting late in pregnancy with no prenatal care)
description of injury is inconsistent with the mechanism
previous ER visits or admissions especially for multiple unexplained physical symptoms
what to ask on general ROS if suspect abuse
headaches memory loss disordered sleep poor concentration avoidant behaviour weakness/dizziness chronic pain palpitations tachycardia chest pain hyperventilation abdominal pain bleeding
what to ask once partner violence screen is positive or you highly suspect abuse
onset identity of assailant time and place description of event(s) frequency severity recent change in frequency or severity use of weapon specific physical injuries
what to ask about safety when screening for abuse
assess basic needs (clothing, food, safe shelter, medications)
feeling unsafe at work/home/school
SI
self harm
identify others who may be in danger
abusers access to victim or weapons
threats
HI
what to ask if an adult presents with signs of abuse
children in the home?!?!?
what signs might suggest drug facilitated abuse
memory loss or intoxication inconsistent with EtOH consumption
what to ask on PMHx during abuse history
recurrent UTIs fibromyalgia chronic pain IBS migraines chronic fatigue leukemia ITP hemophilia osteogenesis imperfecta ricketts osteoporosis ehlers danlos congenital syphillis sunburns animal bites erythema multiforme seizure disorder falls/immobility previous fracture
previous pregnancies, abortions, miscarriages
chronic pelvic pain
dyspareunia
contraception
what social information to elicit when suspect abuse
relationships with family members other close relationships social support network source of income financial dependence on abuser financial abuse by caregiver childhood abuse childhood development
on CV exam, what part of the body should you check for abuse
examine breasts for signs of assault
what physical exam signs are characteristic of abuse
injuries with characteristic patterns like bite marks, belt/whip marks, cigarette burns
sprains/dislocations/fractures consistent with attempted defense
bruises at multiple stages of healing and atypical locations
what type of exam should you offer to do in an OSCE for abuse
gyne exam
what must be done if you suspect child abuse
legal obligation to report to MCFD
report if “reasonable or probably suspicion”
what are some psychosocial interventions that can be offered in the case of abuse
ensure victim safety by offering admission ot hospital or shelter
social work for information about shelters, legal services, financial support, childcare options employment, counseling
provide reassurance and validation
report to appropriate agency and assess risk to others in home like siblings or children
full psych assessment especially for emotional or behavioural disturbances, developmental delay–close follow up
victim support groups
group and family therapy
what can you offer the abuser
monitoring
educations
psychotherapy
substance use counseling
how common is child abuse
1/5 children under 18
what is the most important factor in the proper diagnosis of child abuse
CONSIDERING child abuse
what kinds of questions can you ask a child to screen for abuse
do you know why you are here?
what things do you worry about?
what happens in your family when someone gets in trouble?
has anyone ever made you do something you did not want to do?
ask abut problems in the family, specifically how family members cope with stress
what signs on history from a childs caregiver suggests abuse
inconsistent history with mechanism of injury, or between the injury and developmental stage of the child
inconsistency between caregiver reports or on repeated questioning of the same caregiver
inappropriate delay in seeking medical attention
inappropriate response to severity of the injury
inappropriate interactions between child and caregiver
interaction between caregiver and medical staff is hostile, threatening, demanding
what type of physical exam is required if you suspect abuse
complete exam required, leaving genitalia for last–usually requires inspection only
what are signs of shaken baby syndrome
decreased LOC increased ICP full fontanelle widened sutures lethargy vomiting retinal hemorrhages intracranial hemorrhage
what are “weird” fractures in a child that suggest abuse
ANY fracture in a child under 2
clavicle scapula vertebral bodies spiral fractures fractures in different stages of healing
should you tell caregiver your abuse concerns and that you are going to notify ministry
yes–convey in a non judgemental way your concerns of abuse and the duty to notify
