Patient Assessment
What is the priority when assessing clients that may have been through sexual assault/domestic violence?
Provide a safe and private environment
If there is a (Female) sexual assault patient assigned to a male nurse, what nursing intervention would take place?
Who is at the highest risk for being a victim of violence?
Pregnant women in a bad/unstable relationship is at a very high risk
Rape:
Rape is the perpetration of an act of sexual intercourse with a person against his or her will and without consent, whether that will is overcome by force, fear, drugs, or intoxicants. It is also considered rape if the victim is incapable of exercising rational judgement because of mental deficiency or because he or she is younger that the age of consent (which varies among states from 14 to 18 years).
True or False?
Sexual assault can occur in marriage.
True.
If we needed a sexually assaulted patient to take their clothes off for body assessment, what else would we say to the patient?
Explain to the patient that we need to visualize any potential injuries.
What is important for our patient to realize if they have to take off their clothes for assessment?
Need to make sure that they feel secure and in control of their own body
What are the symptoms of an abuser?
self-doubt, depression, alcohol, substance, and low self-esteem
Silent Rape Reaction:
the survivor doesn't report or tell anyone about the sexual assault, including family, friends or authorities.
True or False?
Registered RN's are mandated reporters.
True.
What are some signs and symptoms to suspect of child abuse?
-does the story match up?
-does the child present with bruises? burns? scratches? fractures (rib & spiral fractures)?
What are some characteristics that a vulnerable person may have?
low self-esteem, hopelessness, and powerlessness
True or False?
Abusers will emotionally manipulate the victim, which prevents them from being independent, like getting a job or higher education.
True.
Sexual Assault:
any pressured or forced sexual contact.
True or False?
An abuser may have violent outbursts, poor coping skills, poor impulse control, and likely a victim during childhood.
True
What are the different types of emotional reactions?
1. Expressed reaction: consists of emotional outbursts, including crying, laughing, hysteria, anger and incoherence.
2. Controlled reaction: is ambiguous. The survivor can appear calm and have blunted affect, but can also be confused, have difficulty making decisions, and feel numb.
What are the different types of violence?
neglect, physical abuse, emotional abuse, sexual abuse, elder abuse, marital rape.
What is the nursing care for a client who has experienced rape?
-physical assessment before the client has showered, changed clothes (if possible)
-ask the client to tell you about what happened
-the client may not want to disclose information. (that's okay. Be supportive, non judgmental, and ensure safety.)
-give the client the freedom to make their own decisions (help them regain a sense of control)
-SANE nurse!
-the client may need to undergo therapy to assist them in coping with the trauma that they experienced.
-they may need to be treated for sexually transmitted diseases.
-they may need help with an unplanned pregnancy- supporting them regardless of the decision made
What is a sane nurse?
Sane Nurse= Sexual Assault Nurse Examiner
-a registered nurse who are examiners that have completed additional training and education to provide comprehensive health care to survivors of sexual assault.
What is Psychological abuse? (AKA Emotional Abuse)
-name calling (stupid, disgusting, worthless)
-belittling
-screaming
-yelling
-destroying property
-refusing to speak to the victim
-ignoring the victim
-social anxiety
-depression
-eating disorders
What does the cycle of violence consist of?
3 phases.
Tension Building- shoved or pushed.
Battering- committing more severe actions
Honeymoon- trying to make amends, be remorseful
How could a patient respond/reaction to rape/sexual assault?
-muscle tension, headaches, sleep disturbances
-GI issues (nausea, anorexia, diarrhea, abd. pain)
-GU issues (genital pain/discomfort)
What are some things that can happen with Silent Rape Reaction?
-abrupt changes in relationships with partners
-nightmares
-increased anxiety during the interview
-marked changes in sexual behavior
-sudden onset of phobic behaviors
-no verbalization of the occurrence of the sexual assault
Age Specific Assessments for Infants/Children?
-shaken baby syndrome
-bruising at any point before 6 months of age
-delay in seeking treatment for significant injuries
-injuries that are inconsistent with the described incident
-high incidence or urinary tract infections (sexual abuse)
-bruised, red, or swollen genitalia
-evidence of old injuries not reported (old fractures on x-rays)
Age specific assessment: Older adults?
-look for bruises, lacerations, abrasions or fractures in which the physical appearance doesn't match the history of mechanism of injury
-the victim may lack needed eyeglasses or hearing aides
-the victim may be denied food, fluids, or medications
-they may be restrained in a bed or chair
-unpaid bills
-poor personal hygiene