Week 3 pt 3: Ran out of time in lecture Flashcards
Define intimate partner violence (formerly domestic violence)
1) Intentionally abusive behavior by person in close relationship with the victim
2) Verbal abuse
3) Intimidation
4) Social isolation
5) Physical or sexual assault
Describe the epidemiology of IPV
1) Estimated at ~2mil cases/year
-Likely understated because victims are fearful of disclosing abuse
2) 54% of women in ER report being threatened/injured by their partners at some point
3) 24% reported injuries from current partner
List some effects of IPV
1) Significant health, social, and economic effects
2) 1/3rd of female IPV victims have injuries that necessitate medical intervention
3) Many victims develop PTSD and suicidal ideation
4) Higher rate of depression and disability than non-abused women
Social services:
Describe their inadequacy
1) – 1/3rd of women who request refuge are turned away due to lack of space
-Often forced to return to the violent home
-Higher risk of homelessness and substance abuse
Describe how to address IPV
1) Important to ask women (when alone with them) if they feel safe at home
2) If they report being hurt or threatened, carefully document physical findings
3) Victim’s perception is distorted through abuse and isolation
-Might believe that she is at fault or did something to deserve the abuse
-HCP should reassure victim that help is available and partner’s behavior is unacceptable
What is your responsibility in addressing IPV?
-Obtain consent first
-Implement a screening approach
-Acknowledge trauma
-Assess immediate safety of patient and children (mandated reporting)
-Review options and help establish safety plan
-Provide referrals and educational material
-Document interactions
-Follow up at subsequent visits
-Inform authorities (refer to state laws)
List + describe the RADAR checklist
1) Remember to ask about IPV
2) Ask directly and clearly in a private setting
-“Has anyone ever abused/hit/threatened/frightened you?”
3) Document all information (even if the abuse is only suspected)
-Follow local laws for reporting
4) Assess patient’s safety
5) Review possible options
-Family members? Safety? Shelters? Support groups?
True or false: Sexual Assault and Rape has different definitions in different states
True
Define rape
-Forcing sexual contact under the threat of violence
-Victim has predominant feeling of fear for their life or fear of mutilation
Medical consultation should begin with establishing a supportive caring relationship; describe how to do this
1) Be mindful of victim’s sense of control
2) Keep the purposes of this encounter in mind
1. Provide acute medical care
2. Gather evidence
3. Transition patient into long-term care and psychological recovery
Medical care for SA: Describe what SARTs need to do
1) 1st Obtain consent (legal requirement and aspect of emotional care for the patient); allow pt to regain control
2) Establish an environment that allows you to ask detailed questions to ascertain risk of injury and infection
3) Physical examination needed to evaluate possible injuries
-Photographs or sketches of injured area should be discussed with victim; specimens
4) Testing
-CDC recommends gonorrhea and chlamydia testing
-Evaluation for BV and candidiasis from vaginal discharge is prudent
-HIV, Hep B/C, and syphilis testing is needed for baseline evaluation
Medical care for SA: Describe the prophylaxis
1) Antibiotics suggested
2) Hep B vaccine should be administered to unvaccinated victims
-Referral to HIV specialist should be considered if there’s any suspicion/risk for HIV
3) Tetanus toxoid
4) Offer emergency contraception
-Tennessee Abortion-Inducing Drug Risk Protocol Act went into effect 1/1/23
-Prevents abortion inducing drugs (mifepristone, misoprostol) from being delivered by mail
-Must be dispensed in the physical presence of the physician after evaluation
True or false: Sexual assault involves immediate and long-term psychological effects
True
Describe the first stage of “Rape trauma syndrome”
1) Acute/disorganization phase (days to weeks)
-Immediate: calm, inattentive
-Progresses to anxiety, guilt, fear, shame, disbelief
-Somatic symptoms: headache, irritable bowel symptoms
-Behavioral symptoms: overeating, alcohol abuse, substance abuse
Describe the second stage of “Rape trauma syndrome” where the victim resumes normal life but is dealing with inner turmoil
1) Hypervigilance
2) Anxiety and exaggerated startle response
3) Nightmares and flashbacks
-Can be triggered by individuals that look similar to the perpetrator
-Can also occur during pelvic examination
5) Difficulty re-establishing sexual relationships
6) Hesitant to enter new relationships
7) Sexual dysfunction like vaginismus (involuntary tightening of vaginal muscles), impaired lubrication, or loss of orgasmic capability
Describe aftercare planning for SA
1) Careful follow-up must be arranged
Phone or in-person follow up at 24 – 48 hours
1-week follow up is needed to follow up on prophylactic therapies, review lab results, and monitor progress
2) HIV testing should be performed at 72 hrs (latest), 6w, 3m, and 6m weeks regardless of prophylaxis measures
3) Ensure that the patient has a safe place to go to and means of transportation
4) Provide referral information in writing: Medical support, psychosocial support
