Violence - Exam 2 Flashcards
What are the top 3 forms of human trafficking mentioned in lecture?
sex, labor and organ
Labor thought to be more common, but less reported
Where do you tend to see higher number of human trafficking? What city has the most?
Especially prevalent in large, multicultural cities
Washington DC
Who falls victim to trafficking?
People with little or no “safety net” are especially vulnerable to human trafficking!
economic hardship, violence at home, unhoused people, natural disasters, political instability, undocumented immigrants
What are warning signs of human trafficking?
social disconnect
sudden or dramatic change in behavior
signs of being denied basic necessities
lack of personal possessions
Accompanied by a controlling individual
“Coached” history
What should you do if you suspect human trafficking?
contact federal law enforcement!
provide pt with reporting information
build rapport with pt
DOCUMENT!!
Roughly ____ of domestic violence (DV) victims are female. What is key phrase in domestic violence?
85%
“Significant and sustained harm”
_____ of all violent crime experienced by women is DV or intimate partner violence (IPV). About ____ female murder victims are murdered by husbands, boyfriends or ex-partner
20%
1 in 3
DV/IPV is more common in _____ populations. Victimization often occurs for the first time before the ____
LGBTQIA+
age of 25
What is the average length of domestic or IP victimization before presentation to health care providers or police?
4 years
Estimated at least ____ American women and _____ American men will be physically assaulted by a partner or ex-partner during their lifetime
1 in 4
1 in 10
_____ threatening, controlling, or harmful behavior imposed on a victim in a domestic or household setting without regards for the victim’s rights, feelings, body or health
domestic violence
_____ repeated pattern of harmful, threatening or controlling behavior as above
Abuse
What are the risk factors for DV/IPV?
race: black and indigenous
pregnancy
16-24 years old
substance abuse
prior exposure to violence
_____ is the leading cause of death among pregnant women
homicide
What are s/s of DV/IPV?
chronic pelvic pain
sexual dysfunction
chronic/recurrent vaginitis
Anxiety or tearfulness before or during pelvic or breast examination
persistent multiple body complaints
What are the 4 stages of the cycle of abuse?
What is the single most important thing a provider can do for a battered woman?
ASK about violence
When should pregnant pts be screened for s/s of DV/IPV?
at first prenatal visit
at least once per trimester
at postpartum check-up
When are DV/IPV disclosure rates higher?
Patients are asked face-to-face rather than through a questionnaire
Behaviorally specific descriptions rather than terms like “abuse”, “domestic violence” or “rape” are used
need to ask pt when they are NOT in the presence of their partner
What are 3 specific DV/IPV screening tools?
Hurt, Insult, Threaten, and Scream (HITS)
Woman Abuse Screening Tool (WAST)
Partner Violence Screen (PVS)
Who are mandatory reporters in the state of WV? How long do you have? What must you document?
“any medical, dental, or mental health professional”
Must report no more than 24 hours after suspecting abuse or neglect
Must document evidence leading to suspicion of violence
Survivors of DV/IPV have a high rate of _______. What should you do?
psychiatric symptomatology
Referral for psychiatric screening and counseling
Psychotherapy
Psychiatric medication
Detoxification and substance abuse treatment
Patient advocacy groups
What should you do if your pt won’t leave the abusive situation?
–Do not place blame or accuse patient
–Document thoroughly
–Support patient
–Follow-up with patient
______ any sexual act performed by one person on another without the person’s consent
sexual assault
_____ sexual intercourse with a female under an age specified by state law (14-18 yrs)
statutory rape
_______ contact or interaction between a child and an adult when the child is being used for sexual stimulation of that adult or another person
child sexual abuse
______ is mandated reporting in all 50 states
child sexual abuse
What is most sexual assault motivated by?
desire for degradation, terrorization, and humiliation of the victim
Assault is a demonstration of power, anger, or sadism
Pt who were sexually assaulted rarely come right out and say that, what will they likely complain of?
Complaints of being “mugged” but also very concerned about STDs or AIDS
_____ is a very common clinical finding in sexual assault survivors
Vaginal irritation
may also have rectal pain and bleeding if anal penetration
What is the associated timing for the acute phase of rape-trauma syndrome? What are some s/s?
Acute phase - hours to days
Presentation ranges from complete loss of emotional control to an unnatural calm and detachment
In rape-trauma syndrome, after the first 2 weeks what happens?
initial reactions of shock, numbness, withdrawal and denial usually abate
can present with a variety of symptoms:
disturbed eating or sleeping patterns
GI irritability
MSK soreness, fatigue, tension headaches, startle reactions
What is the associated timing for the delayed phase of rape-trauma syndrome? What are some s/s?
months-years after assault
Chronic anxiety, feelings of vulnerability
Loss of control and self-blame
Depression
Sexual dysfunction
Psychologic distress: mistrust of other, phobias, depression
Suicidal ideation
_____ is a common long term sequela of rape-trauma syndrome. 33-50% report ______
PTSD: including nightmares and flashbacks
suicidal ideation
When examining a sexual assault survivor, consider the use of a ________ and request assistance of a _______
sexual assault assessment kit
Sexual assault nurse examiners (SANE)
What history is important to ask the survivor?
ask about last consensual act!!
What is important to note in the PE of a survivor?
Note bruises, abrasions, lacerations to areas such as the neck, back, buttocks, extremities
Note bite marks, especially around genitals and breasts
May have injuries to mouth and pharynx with oral penetration
document any injuries with photographs/drawings in the medical record
When documenting a sexually assault case, **what phrasing needs to be avoided? **How should you document it?
Recommended to use “consistent with the use of force”
NOT “rape” or “assault”
When doing a pelvic exam on a survivor, what substance needs to be avoided? What should be used instead?
NO lube!!
only use saline to moisten the speculum
How long is their evidence of coitus in the vagina?
up to 48 hours after attack
Sperm may persist in cervical mucus up to 17 days
What tests should be offered to the patient?
Offer baseline serology for hepatitis B, HIV, syphilis
Test for Trichomonas, gonorrhea, chlamydia
emergency contraceptions: need to get negative pregnancy test prior
What samples should be collected as evidence in a sexual assault case?
Pubic hair combings
Fingernail scrapings
Skin washings and clothing
collect saliva (if within a few hours)
What should be offered for the empiric tx of STIs? What vaccine?
Ceftriazone IM
Metronidazole
Doxy
HPV vaccine should be offered
______ should be offered to EVERY survivor. When can you release the survivor?
counseling -> Offer even if individual appears to be in control of his or her emotions
Do not release from facility until specific follow-up plans are made and agreed upon by patient, physician and counselor!!
What is the recommended follow up after the sexual assault?
Follow up 2 weeks after assault to repeat PE and collection of additional specimens
