WEEK 4: Abuse Flashcards
Abuse involves systematic strategies used to obtain dominance and control over others and can be displayed in a variety of ways, such as
psychological, physical, emotional, economic, and sexual.
Individuals who have experienced abuse are at higher risk for developing
substance use disorders, anxiety disorders, depressive disorders, eating disorders, borderline personality disorder (BPD), and posttraumatic stress disorder (PTSD).
define physical abuse
The intentional inflection of bodily harm or pain on others.
how would perpetrators of physical abuse harm
kicking
hitting
slapping
pushing
strangling
or biting
Potential Signs of Physical Abuse: body findings
bruising, lacerations, burn marks, fractured bones, puncture wounds, wounds in various stages of healing
Potential Signs of Physical Abuse: general appearance
ripped or torn clothing, broken eyewear, disheveled hair and clothing
define emotional abuse
The intentional infliction of mental anguish through means of intimidation and humiliation.
Potential Signs of Emotional Abuse/Mental Mistreatment
Changes in usual behavior, such as social withdrawal or non-responsive communication
Loss of self-esteem
Anxiety provoked by the presence of certain people
Client’s report of enduring verbal or mental mistreatment
define sexual abuse
Any forced, inappropriate, or unwanted sexual contact and actual or threatened sexual violence
examples of sexual abuse/violence
photographs that are sexually explicit, indecent exposure, unwanted touching, rape, forcing individuals to engage in sexual acts, or coerced nudity
luring
Use of internet technology to enable the sexual abuse of others.
Potential Signs of Sexual Abuse
Sudden changes in behavior such as fear of people or places
Sexually explicit behavior or sex play
Regression to younger behaviors such as bedwetting
Developmentally inappropriate interest in human sexuality
Discomfort, bruising, or bleeding around the breasts, anus, or genital area
Unexplained or recurring sexually transmitted infections (STIs)
Underclothing that is damaged or contains bloodstains
Client’s report of being sexually assaulted
define neglect
The failure of a caregiver to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety, and well-being are threatened with harm.
define abandonment
When an individual has been left in circumstances in which they suffer serious harm, a caregiver’s identity or whereabouts are unknown, or the caregiver has failed to maintain contact or provide reasonable support for a specified period of time.
Potential Signs of Neglect or Abandonment
Unattended or untreated health problems
Dehydration, malnutrition, untreated pressure injuries, and poor personal hygiene
Hazardous living conditions (improper electrical work, no running water or heat)
Poor living conditions (visible dirt, insect infestation, soiled bedding, fecal/urine smell, insufficient clothing)
Desertion of a vulnerable individual
Client’s report of being abandoned or mistreated
economic abuse/exploitation define
Misuse of another person’s financial resources, with or without permission
examples of economic abuse/exploitation
stealing, forging checks, promising to pay bills for a person but keeping the money for themselves, and falsifying wills or financial records
Potential Signs of Exploitation/Economic Abuse
Sudden banking and accounting changes (unexplained withdrawals, transfers, or the addition of unauthorized names onto accounts)
Abrupt changes in availability of funds, possessions, wills, or other financial documents
Individual does not remember signing financial records
Client’s report of exploitation
Which of the following forms of abuse should the charge nurse identify as being the hardest to identify?
emotional
why is emotional abuse harder to detect
because no physical evidence is apparent
aggression vs. anger
aggression is ACTIONS intended to harm someone
anger is an EMOTION that can be positive or negative
how can anger be positive
when its controlled, it can lead to evoke positive changed
what can happen from negative anger
hypertension, headaches, insomnia, and digestive issues, and potentiates the possibility of harm to self and others
how can anger be displayed
cursing, sarcasm, yelling, breaking an inanimate object, or making a fist, but is not often followed by an aggressive act
Individuals who have demonstrated aggressive behaviors, and those who have been diagnosed with schizophrenia, autism spectrum disorder (ASD), or attention-deficit/hyperactivity (ADHD), are found to have higher serum levels of
serotonin subtype 5-hydroxytryptamine (5-HT)
Individuals who have the following disorders are more prone to acting out violently
Substance use disorder
Traumatic brain injuries (TBI)
PTSD
Bipolar I disorder
Impulse control disorders
Attention deficit hyperactivity disorder (ADHD)
Examples of ACES include the following.
Experiencing violence, abuse, or neglect
Family member attempted or died by suicide
Observing violence in the home
Unsafe or unstable home environment (substance misuse, mental illness, parental or sibling separation)
Examples of questions asked to determine ACEs, prior to the age of 18
Were you made to feel afraid by an adult in your household?
Were you injured by an adult in the household?
Were you touched in a sexual manner by anyone in the home that was at least 5 years older?
Abuse, aggression, and violence can be accompanied by comorbidities such as
schizophrenia, psychosis, anxiety disorders, substance use disorders, bipolar disorder with mania, major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), conduct disorders, and personality disorders
Risk Factors Associated with Abuse, Aggression, and Violence
History of violence
Being the victim of a crime
Witnessing abuse or violence
Poor self-esteem and inadequate coping skills
No presence of positive role models throughout childhood
Adverse childhood experiences
Research has demonstrated a link between deficient variations of the MAO-A gene and aggressive behavior, including an increase in
5-HT levels
MAO-A gene
This abnormal gene was originally found in several families. The condition associated with this abnormal gene is called Brunner syndrome, a rare genetic condition that is characterized by impulsivity, aggression, mild cognitive impairment, and violence.
Clients experiencing unwelcomed thoughts that may trigger abusive actions, aggression, or violence have been known to employ the following defense mechanisms:
displacement and undoing
displacement
Redirecting troublesome or difficult thoughts to a safer person, animal, or inanimate object.
undoing
When an individual performs a behavior in an attempt to resolve unwanted thoughts or feelings associated with a previously completed behavior.
aka trying to “undo” the wrong by making it up with doing a nice or good thing
An example of undoing
when a client emotionally abuses their partner in front of others but the next day buys them the new piece of clothing they wanted
example of displacement
abuser being angry at coworker but taking it out on their child or partner as an alternative
The following behaviors are often seen in clients prior to violent or aggressive actions
Declining to eat or drink
Attempting to leave the area before discharge
Verbally antagonistic toward staff or visitors
Harming self
Staring
Pacing
Destroying inanimate objects
A nurse is providing care to a client who has acknowledged they have become violent with family members when “they just don’t listen!” Which of the following warning signs should the nurse recognize often precede violence? (Select all that apply.)
Rips multiple pages out of a novel (destroying inanimate object)
Refuses breakfast and afternoon snack (declining food or drinks)
Pacing
Attempting to leave area before discharge
cycle of violence
for IPV and other forms of violence
phase 1: build up
phase 2: acute
phase 3: honeymoon/reconciliation
Strategies to Help Prevent Intimate Partner Violence (IPV)
Teach skills needed for healthy relationships to both youth and adults
Empower peers to provide preventive strategies
Provide early intervention and education to at-risk families/individuals
Help create safer environments (school, workplace)
Reinforce economic stability
Intensify support to survivors
Approaches used by stalkers include the following
Following and watching their target
Obtaining entry into target’s car or house and leaving items to let them know they can enter at anytime
Showing up unannounced at target’s home, workplace, or school
Nuisance phone calls, emails, text messages, etc.
Bullying, considered an adverse childhood experience (ACE), is defined
as uninvited behaviors from one youth or group of youths to another that are aggressive in nature.
forms of bullying include the following
Kicking, hitting, tripping
Teasing and name-calling
Excluding targets from group or spreading rumors
Destruction of property belonging to target
Strategies to Prevent Cyberbullying From Occurring
Paying attention to what is posted online and knowing who can see it
Keep caregivers aware of online activities
Tell an adult if you get a message that frightens you
Keep your passwords secret from peers and friends but inform caregivers
Always be kind online
Survivors of abuse/violence may…
Deny anything happened.
Be fearful of what will happen to them once they leave the facility.
Be wary of health care professionals.
Demonstrate a lack of concern about their own needs.
Be sleep deprived or malnourished.
approach to interview survivors of violence and abuse
allow the survivor to have control of where they want to sit, take breaks, etc
do not touch survivor without permission!
remember that they may be wary of being open
what is the best way for nurses to avoid self-bias
reflect on their own personal beliefs
pharmacological interventions for long-term control of aggression
antipsychotics (benzodiazepines, mood stabilizers, anticonvulsants, and antidepressants)
For clients who have been physically restrained, administration of sedating medications, such as
lorazepam or haloperidol, is common.
active shooter model to safety
run
hide
fight
nursing process: recognizing cues of aggression
Restlessness and pacing
Increased agitation with verbal or physical threats to self or others
Impaired thoughts
nursing process: planning for aggression
pharm interventions
de-escalation
restraint or seclusion
Define Nonsuicidal self-harm (NSSH)
intentional harming of self and involves such acts as cutting (most prevalent), scratching, biting, carving words or designs into skin, burning, hair pulling, headbanging, and any other self-inflicted destruction of body tissue
what age group is NSSH most often seen in
adolescents
While the intent of NSSH is not death, evidence suggests that clients using self-harm as a
coping mechanism are at risk of becoming dependent upon their actions and normalizing NSSH into long-term coping strategies, potentially leading to more serious injuries, including suicide
long-term effects of NSSH
Infections
Scarring
Excessive bleeding
Shame and guilt
Reduced sense of self
Social isolation
Possible warning signs of NSSH
Unexplained scars
Fresh cuts, burns, scratches, or bruises that cannot be explained
Excessive rubbing of skin that leads to a burn
Keeping sharp objects available but hidden
Keeping arms and legs covered despite weather conditions
Poor interpersonal relationships
Personal identity issues
Unpredictable and impulsive emotions/behavior
Feelings of worthlessness, helplessness, and/or hopelessness
nursing interventions of NSSH
Early recognition
Available and affordable treatment resources
Educational and supportive services
Therapeutic Questions to Ask Someone Experiencing NSSH
What prompted you to do this?
What happened prior to this?
What do you feel when you do this?
is NSSH seen more in females or males
females
role the neurological system plays in relation to aggression
Excessive amygdala reaction and inadequate regulation of the prefrontal area will increase the likelihood on aggression in the client
hostile aggression examples
aka examples of aggression
hitting someone when you get mad
what neurotransmitter plays a significant role in aggression
excess of serotonin
role of a forensic nurse
provide legal testimony as requested by the client
warning sign examples of NSSH
wearing a long-sleeve shirt in summer time (to hide cuts or other injuries)
chlopromazine
an IM injection use for a client acutely becoming aggressive
at what stage of the cycle of violence would the abuser become affectionate towards the victim
respite
aka phase 3: honeymoon phase
mental health history that can lead someone to being aggressive or violent
schizophrenia
autism
TBI
sexual abuse victim
bipolar disorder
medication: caring for a client who is demonstrating aggressive behavior towards others and is not responding to verbal interventions.
Ziprasidone
vital signs with anxiety
increased HR and BP, which can escalate to physical violence
Brunner syndrome
rare disorder from MAOA gene
characterized by impulsivity, aggression, mild cognitive impairment, and violence
therapeutic principles for the use of seclusion
containment, isolation, and decrease in sensory input
reason why individuals engage in self-harm
express emotions that may be embarrassing to show
define ACEs
a traumatic event that a child experiences before the age of 18
