Abuse, Violence, and Neglect: An Overview

Abuse, Violence, and Neglect Overview

• Abuse is the mistreatment of someone by another person through cruel or violent actions.

Forms of Abuse

• Physical abuse involves intentional contact causing physical pain, injury, or suffering, including improper confinement or restraint.
• Emotional abuse includes verbal or nonverbal actions that threaten, intimidate, or humiliate someone, and causing someone to remain in a threatening situation.
• Sexual abuse involves non-consensual or unwanted sexual contact, which can be verbal, visual, or physical.
• Financial abuse involves controlling a person's ability to acquire, use, and maintain financial resources, prevalent among the elderly.

NCLEX/Test World Simplified Steps

• Prioritize safety for yourself and others involved.
• During assessment, consider life-threatening needs first.
• Maintain objective and unbiased documentation.
• Make referrals, report the findings, and consult with appropriate agencies acting as a patient advocate.

Child Maltreatment Highlights

• Child maltreatment includes any recent act or failure to act leading to a risk of serious physical harm or death, regardless of the caretaker's intent.
• Unexplained injuries at different healing stages is a red flag.
• Physical child abuse involves non-accidental injuries inflicted by a parent, caregiver, or responsible person.
• Signs of emotional child abuse from the child include extremes in behavior, delayed development, and lack of parental attachment.
• Signs of emotional child abuse from the parent include constant blame, belittling, lack of concern, and rejection of the child.
• Sexual abuse varies by source and state.
• Characteristics of neglect are stuttering, enuresis, truancy, failure to thrive, malnourishment, and overeating.
• Physical child neglect includes inadequate weight gain, poor hygiene, inappropriate clothing.
• Behavioral child neglect includes learning difficulties, inappropriate coping, fatigue, stealing, and excessive absences.

Nursing Actions for Child Abuse and Neglect

• Ensure safety for yourself and the patient.
• Address life-threatening injuries using ABCs.
• Document meticulously and objectively with a thorough physical assessment.
• Interview both parents and children using open-ended questions.
• Report all suspected abuse and neglect cases within 48 hours (Texas nurses).

Abusive Head Trauma

• "Shaken baby syndrome" results in brain injury from violent shaking.
• Parents can be charged even without intent, and the baby can be taken away.

Elder Abuse Overview

• Elder abuse involves intentional harm or risk of harm to an older adult by a caregiver.
• Dementia, Alzheimer's, and decreased self-care abilities increase susceptibility.
• Indicators of elder abuse are injuries, inconsistent explanations, depression, confusion, behavior changes and fluctuating finances.
• Interventions for elder abuse include safety measures, assessments, screening, documentation with photos, and reporting.

Intimate Partner Violence (IPV) Dynamics

• IPV follows cycles that starts with abuse, followed by abuser apology/excuses, then tension builds again.
• Victims exhibit powerlessness.
• Abusers hold a position of power.
• Victims stay due to fear for their lives or children, loss of support, or religious beliefs.

Interventions for IPV and Sexual Violence

• Initial crisis interviews target specific incidence.
• Safe houses maintain confidentiality.
• Family therapy teaches problem-solving skills.
• With violence, minors and elderly adults do not have a choice regarding police reports
• Provide violence victims with physical exams, rape kits, pain management, and psychosocial support.
• Teach safety measures and restoring control during the whole process.

Addictive Behavior Terminology

• Addiction: Substance use continues despite negative impacts.
• Use: Ingestion, smoking, sniffing, or injection of mind-altering substances.
• Abuse: The substance is being used for intoxicating purposes beyond what is normally intended.
• Withdrawal: Displays symptoms of ceasing the substance use
• Detoxification: Safe drug withdrawal
• Relapse: Repeating the cycle

Substance Withdrawal Highlights

• Substance withdrawal involves physiological and mental adjustments upon discontinuing a substance.
• Negative reactions occur when substance use decreases drastically.
• Maintaining respiratory and cardiac function is the first thing on the list.

Treatment and Recovery from Abuse

• The goal is to recover from the abuse including the patient and family.
• Relapse is an expected part of addiction.

Impact of Drugs of Abuse

• Abuse occurs with any kind of drug.
• Cause a rapid release of brain chemicals creating a biological need or craving for more of the same thing.

Neonatal Abstinence Syndrome (NAS)

• NAS occurs when a baby is born drug-dependent due to the mother's drug use during pregnancy.
• Abuse increases a risk for miscarriages and stillbirths.
• Findings include hyperactivity, jitteriness, respiratory distress, and feeding difficulties.
• Interventions include positioning the infant, suctioning the airway, decreasing stimuli, and swaddling.
• Monitor I&O, obtain samples for screening, and administer medications, it is also important to soothe and call CPS.

General Assessment for Substance Abuse

• Ask if they think they need or want to cut back, or in the past year if they used substances how they did not mean to.
• Collect info about the drugs used, methods, quantities, timing of use, and patterns.
• Client safety is #1 priority.

Focus during Substance Abuse

• Stabilize the patient for withdrawal and support them through the steps through with and protecting them from violence.
• Educate the public what comes from the use of drugs whether it will be physical, emotional, psychosocial etc.

Substance Abuse Aftercare

• Achieving and maintaining sobriety.
• Patients may change their old friends to make way for newer healthier people to be around.

Substance Abuse Treatment

• Can be done from the ER to in and out patient psychiatric units.
• Halfway houses and clinic/centers are also available
• Alcoholics Anonymous and women of sobriety are also available

Top Addictive Drugs

• Alcohol, nicotine, cannabis, depressants, stimulants, opiates, hallucinogens, inhalants.

Alcohol Details

• ETOH: no calories or nutritional value.
• Legal intoxication Blood Alcohol Content level is 0.08-0.10.
• Alcohol is a CNS depressant that depends on the person.

Alcohol Stages

• CNS depressant to mild sedation, to coma, to repiratory failure and even death.
• Impaired speech, motor functions are common

Alcohol Withdrawal Indicators

• Starts 4-12 hours after your initial intake reduction.
• Tremors, sweating, and anxiety, hyper alertness, elevated pulse and BP, insomnia, anxiety, restlessness, and N/V

Alcohol Long Term Effects

• Wernicke Encephalopathy
  • Thiamine and B1 deficiency
  • Confusion, paralysis of the ocular with weird muscle movements, ataxia, somnolence, and even stupor
• Korsakoff’s Amnestic Syndrom
  • Confusion
• Delirium Tremens (DTs)
  • Can start a few hours into weeks after but has tremors, hallucinations, etc
• TX can vary
  • Gastric lavage and also supporting respiratory.

Alcohol Overdose

• Can cause vomiting and is a rapid intake.
• hypotension and and cardiovascular shock can happen

Alcohol Detoxification and Medications

• Must be closely monitored
• Valium, Librium, and Ativan are used
• Also use B1, and folic acid.
• Disulfiram(Antabuse), Naltrexone, Topiramate are used

CNS Depressants

• Slows down your CNS.
• Most people end up depressed.
• Benzos and more can be included for sedative ones

CNS Indicators, Overdose, and Agonists

• Low rate of metabolosim.
• Benzos can be fatal to the body.
• Activated charcoal can be used.
• NO REVERSAL agent.

Stimulants CNS and Nicotine

• Activates dopamine receptors to reward the drug
• *- 5A and Rs are used.
• CNS can occur from the withdrawals

Cannabis Effects

• Depresstion similar to alcohol.
• Increase relaxation and paranoia
• Impaired motor coordination, inappropriate and heightened appetitie.
• treat symptoms

Opiate Side Effects

• Synthetic
• Too much of an agonist

TX for Opiates and side effects

Methadone and Clonidine are very popular.

• Pinpoint pupils and etc can be found in many people. Also known is that you are gonna start withdrawing!

Substance Considerations

• Hospitalized people should withdraw. Denial is very real Texas Pear Assisant Program is available

COPD

• PATH is limited during exhilation Main concern is can not be broken down Passe and tobacco

COPD Managment

• Smoking
• Vaccines
• Steroids

COPD education

• Therapy with oxygen is helpful.

Airways

• ABGs are acids and bases

7. 35-7.45 normal

• PCO2 35-45 mmHg
• HCO3-22-26 mEq/ Maintain is homeostatic.

Bloods

Radial or femoral Heparins test must be used.

Know your ABGs 7. 35 9. 45 Use the the ROME to rememeber that. Increased respirations help breath down, retain help for higher. PH LEVEL is also imporant in that moment

• *-Vent Settings include: Tidal volume, FiO2 (amount of o2), PEEP (alveoli stay open
• Must maintain correct placement**

Care

• Turn and alarm are needed
• Must note placement
• Dont turn off alarms

Complications

• Pneumonia and high pressure is a big deal

Cares for ventilators

• Eleivation can help

• suctioning and chlorohexidine too

• Oral swab and check for lungs

• Check ready ness for what the patient needs from the lungs

• Dysnea can lead to soemthing like lungs

• can treat with meds

Head and Neck Malignancy

Highest rf is smoing paired with alchool

• Surgery and meds are used here Radiation is used in this instance PEG are also good and can swallow

• Teach pt on this

• Lung Cancer

• #Metastais is really quick

• Check if cancer comes bad after

• Bronchoscopy and etc Vats can be useful