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What are potential symptoms of a compounded reaction following a rape trauma?
Which symptom is associated with the acute response phase of Rape Trauma Syndrome?
What characterizes the outward adjustment phase after experiencing rape trauma?
Which behavior is typically avoided during the re-experiencing symptoms of Rape Trauma Syndrome?
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What can be a long-term consequence of an untreated silent rape reaction?
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What is one of the strongest forms of learning that influences aggressive behavior?
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Which of the following best describes operant conditioning?
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How does negative reinforcement function in the context of traumatic experiences?
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What does the psychoanalytical theory suggest about aggression?
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Which area of the brain is associated with emotional responses and aggression according to the neurobiological theory?
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What role does positive reinforcement play in aggressive behavior during childhood?
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What resources are often made available for students during discussions on violence and advocacy?
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Which of the following is NOT a characteristic addressed in the study of abuse and assault?
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What is one potential biological factor that can affect aggression?
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How might social learning theory explain aggressive behavior?
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Which factor is associated with an increased risk of violence among young boys?
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What role does socioeconomic status play in the risk of violence?
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In terms of societal influences, why might men be less likely to report abuse?
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What environmental factor can contribute to an increase in violence?
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What type of injuries are commonly associated with domestic violence victims that may lead to headaches or neck pain?
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Which psychosocial issue can lead to increased aggression?
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How does substance abuse relate to violent behavior?
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Why might victims of domestic violence often explain their black eyes with implausible stories like running into a doorknob?
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What condition is most commonly associated with repeated head trauma in domestic violence victims?
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What is one of the highest risks for a victim of domestic violence?
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What should nurses address as part of the short-term interventions for a possible domestic violence victim?
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What could be a reason a domestic violence victim remains in an abusive relationship?
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What is a common physical sign that may indicate ongoing abuse in domestic violence victims?
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Which approach is recommended for nurses when questioning a patient about potential domestic violence?
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What is a primary goal in the reorganization phase after trauma?
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Which nursing diagnosis is associated with the victim/survivor of sexual assault?
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What is an important consideration when providing care to a sexual assault patient?
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What aspect is essential in trauma recovery as part of overall care?
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Which nursing intervention is recommended during the assessment of a sexual assault patient?
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Which diagnosis represents a risk for the abuser in sexual assault cases?
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What is a key factor to prevent revictimization in trauma care?
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Why is it important for the interview with a sexual assault patient to be conducted promptly?
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Which of the following is a common characteristic of an adult survivor of incest?
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What may be a reason for a parent withholding medical care from a child?
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Which of the following is a sign typically associated with physical abuse in children?
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What is a common behavioral trait of a child abuser?
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Which of the following cultural or personal beliefs may lead to neglect in a child?
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Which nursing intervention is essential for addressing the immediate needs of a domestic violence victim?
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What may be a significant barrier for a victim of domestic violence to leave an abusive situation?
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What is a common sign of neglect in children?
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Which of the following roles can shelters provide to abuse victims?
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What psychological characteristic is often seen in individuals who suffered abuse as children and may become abusers?
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Which of the following is a behavioral characteristic commonly observed in child victims of abuse?
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What long-term mental health issue is associated with Adverse Childhood Experiences (ACEs)?
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Which physical sign may indicate neglect in the elderly?
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Which characteristic is common in elderly victims of abuse?
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What psychological condition can arise from experiences related to abuse in children?
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What is a typical reaction of a child exhibiting signs of sexual abuse?
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Which behavioral sign could indicate psychological trauma in adolescents?
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What is the definition of sexual assault?
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Which phase of the cycle of battering involves the batterer expressing regret and affection?
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What is commonly observed in battered women in terms of physical signs?
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Which of these is a typical profile characteristic of an abuser?
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What is one reason victims of intimate partner violence often choose to stay in their relationships?
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During which phase of the cycle of battering does actual physical abuse primarily occur?
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Which mental health issues are often experienced by victims of intimate partner violence?
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Which of the following behaviors might indicate that an individual is a victim of intimate partner violence?
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Which characteristic is often associated with the profile of a victim of intimate partner violence?
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What is a common justification a victim might use to rationalize staying in an abusive relationship?
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What factor commonly contributes to the risk of an individual becoming an abuser?
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What is the legal obligation of nurses regarding suspected abuse cases?
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Which action is crucial when preserving evidence from a trauma victim?
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Which of the following does NOT represent a common type of evidence to preserve?
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What should a nurse assess in a patient to determine possible trauma-related issues?
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What is the primary goal of trauma recovery in patient care?
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How should a nurse ensure they are evaluating a patient in a safe environment?
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Which aspect is essential when documenting wounds from undiagnosed trauma?
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What approach should nurses take to avoid adding to a trauma victim's experience?
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What is a common emotional reaction for victims within hours after experiencing a rape?
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What demographic is most commonly associated with perpetrator profiles of stranger rape?
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Which nursing diagnosis is specifically related to a victim of sexual assault?
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Which phase of the Rape-Trauma Syndrome is characterized by social withdrawal and avoidance behaviors?
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What is a key component of trauma-informed care for survivors of abuse?
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What type of rape involves the perpetrator being acquainted with the victim?
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Why might marital rape still face challenges in legal prosecution despite being illegal?
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Which emotional response is a characteristic of the silent rape reaction?
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Which intervention is recommended when assessing a sexual assault patient?
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What is a common long-term emotional reaction following the initial trauma of rape?
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Study Notes
Predisposing Factors for Aggression
- Modeling: Learning by observing and imitating behaviors, such as a parent exhibiting aggression, increases the likelihood of similar responses.
- Operant Conditioning: Reinforcement (positive or negative) of behaviors strengthens their likelihood. Example: A child throwing a temper tantrum and receiving a desired toy.
- Negative Reinforcement: A behavior that removes a negative stimulus is reinforced. Example: A person with PTSD avoiding cars to prevent discomfort from past trauma.
- Psychoanalytic Theory: Proposes that individuals are inherently aggressive due to unmet basic needs.
- Neurobiological Theory: Focuses on brain chemistry and how imbalances in neurotransmitters (e.g., norepinephrine, dopamine, serotonin) and brain injuries can contribute to aggression.
- Social Learning Theory: Individuals learn aggressive behaviors by witnessing them in their surroundings, such as within a gang.
- Sociological Theory: Society and culture can influence the acceptability of aggression. Example: Societal norms may make men less likely to report abuse, downplaying violence against them.
- Psychosocial Issues: Isolation, negative family relationships, impulsivity, unrealistic expectations, and stress can increase aggression.
Risk Factors for Violence
- Age: Individuals aged 15-24 have a higher risk of homicide.
- Culture: Different cultures have varied perceptions of acceptable violence.
- Socioeconomic Status: Poverty can lead to increased stress and contribute to violence due to factors like lack of supervision, dangerous environments, and limited positive activities for children.
- Absent Father: Research shows that boys under 13 without fathers are at a higher risk for violence and gang involvement.
- Domestic Violence: 30% of women killed by homicide are victims of their spouse, boyfriend, or former partner.
- Neighborhood: Areas with financial struggle and overcrowding are associated with higher crime rates and violence.
- Schools: Schools that lack enforcement or have poor student performance can contribute to violence due to peer pressure.
- Values & Beliefs: Cultural or religious values can influence attitudes towards violence.
- Substance Abuse: Individuals under the influence may become targets or commit crimes for substance needs.
Physical Signs of Battered Women
- Injuries: Head, neck, and shoulder injuries often result from grabbing or hair pulling.
- Headaches & Neck Pain: Common complaints from injuries in these areas.
- Black Eyes: Frequently seen, often with implausible explanations, like running into a doorknob.
- Injuries during Pregnancy: A sign of potential abuse.
- Sprains, Dislocations, and Broken Bones: May be in various stages of healing.
- Object Patterns: Marks on the body left by objects used in assault.
- Repeated ER Visits: Frequent healthcare visits can indicate underlying abuse.
- TBI: Acute and cumulative effects from repeated trauma.
- Chronic Traumatic Brain Encephalopathy: A type of TBI common among domestic violence victims from repeated head blows.
Reasons Women Stay in Abusive Relationships
- Retaliation: Fear of the abuser's violence against themselves and their children.
- Loss of Custody: Fear of losing children if they leave.
- Financial & Physical Dependence: Abusers may control finances, isolate the victim, or prevent their employment.
- Lack of Support Network: Limited resources and isolation may hinder escape.
- Hopefulness: The victim may believe the abuser will change.
- Lack of Attention to Danger: Minimizing the severity of their situation.
Nursing Interventions
- Short-Term: Assess immediate danger, ensure the patient is not blamed, address physical injuries, provide privacy, and allow emotional expression.
- Long-Term: Explore home care services or alternative living arrangements for safety.
- Specific Questions: Initially use broad questions like "How are things at home?" followed by more specific ones based on observations, like "You seem anxious; is everything alright at home?"
Long-Term Reactions to Domestic Violence
- Compound Reactions: Emergence of additional symptoms like depression, suicide, substance abuse, psychotic behaviors, or suicidal ideations.
- Silent Rape Reaction: Victims do not disclose the assault leading to potential changes in relationships, nightmares, anxiety, sexual behavior changes, phobias, and fears without acknowledging the assault.
Rape Trauma Syndrome
-
Major Symptoms:
- Re-experiencing Trauma: Nightmares, flashbacks, and intrusive memories.
- Social Withdrawal: Psychic numbing, detachment, and lack of emotional responses.
- Avoidance: Active efforts to avoid thoughts, feelings, and situations related to the assault.
- Increased Physiological Arousal: Exaggerated startle reactions, hypervigilance, sleep disturbances, and difficulty concentrating.
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Phases:
- Acute: Initial response lasting between days and weeks, characterized by heightened or diminished alertness, numbness, disorganized thoughts, nausea, and intense anxiety.
- Outward Adjustment: Months to years following the assault, survivors may appear normal while struggling internally, potentially engaging in coping mechanisms (healthy like therapy or unhealthy like substance abuse).
- Underground: Survivors return to normal life for years but repress and do not fully process the trauma. Unresolved issues may persist.
- Reorganization: Beginning to deal with the trauma, which can be triggered by external events reminding them of the experience.
- Renormalization: Adjusting to life after trauma.
Nursing Diagnoses for Sexual Assault
-
Victim/Survivor
- Powerlessness
- Risk for delayed development
- Rape-trauma syndrome
- Ineffective coping
- Interrupted family processes
- Hopelessness
- Risk for self-abuse
- Pain
- Post-trauma response
- Low self-esteem
- Impaired skin integrity
-
Abuser
- Ineffective individual coping
- Knowledge deficit
- Noncompliance
- Altered role performamce
- Self-esteem disturbance
- Impaired social interaction
- Risk for violence
- Spiritual distress
- Risk for trauma
Nursing Care for Sexual Assault
- Privacy: Provide a closed curtain room.
- Non-Judgmental: Avoid judgmental language and emotional reactions.
- Control: Allow the patient to control aspects of their care (e.g., requesting a female nurse).
- Nursing Process: Avoid asking "why" questions. Focus on the abuser's actions.
- Empowerment: Provide resources but allow the patient to make decisions for themselves.
- Weapons: Check that the patient and their partner do not have weapons.
- Universal Screening: Screen all patients because anyone can be a victim.
- Trauma Recovery: Trauma recovery is essential for overall care.
- Avoid Minimizing Trauma: Ignoring or minimizing trauma can lead to revictimization and continued traumatization.
Interviewing Sexual Assault Patients
- Purpose: The interview guides care and evidence collection.
- Timing: Complete the interview at the beginning of the visit with law enforcement present.
- Patient Comfort: Prioritize patient comfort.
- Dress: Encourage the patient to remain fully dressed if possible.
Types of Abuse
- Intimate partner violence (IPV) includes spousal abuse, domestic violence, and battering.
- Child abuse includes physical, emotional/psychological, sexual, and neglect.
- Elder abuse can be physical, emotional, sexual, or neglect.
- Neglect is the failure to provide for physical and emotional needs.
- Financial abuse involves the misuse of an elder's finances.
- Sexual assault includes rape (marital, statutory), and date rape.
Intimate Partner Violence (IPV)
- 1 in 5 women and 1 in 7 men experience IPV.
- Victims often rationalize abuse and fear leaving due to threats.
- Victims may feel isolated, inadequate, and powerless.
- Abusers may have experienced childhood abuse and have low self-esteem.
- Abusers may be extremely jealous and possessive, socially isolated, and have low impulse control.
- Substance abuse is common among abusers.
- The cycle of battering includes tension-building, acute battering, and honeymoon phases.
Physical Signs of Battered Women
- Injuries to the head, neck, shoulders, extremities.
- Black eyes.
- Injuries sustained during pregnancy.
- Pattern injuries caused by objects.
- Repeated visits to emergency rooms and healthcare facilities.
- Multiple injuries in varying stages of healing.
- Traumatic brain injury.
Why Do They Stay?
- Fear of retaliation, losing custody of children, and physical/financial dependence.
- Lack of support networks, cultural and religious beliefs.
- Hopefulness and a lack of awareness of the danger.
Nursing Interventions
- Immediate safety measures and address physical injuries.
- Ensure privacy and allow the patient to express feelings.
- Provide referrals and resources.
Safe Houses/Shelters
- Provide shelter, peer support, therapy, financial assistance, social services, childcare, legal help, and emotional support.
- Length of stay varies.
Child Abuse
- Child abusers often suffered abuse as a child and expect children to fulfill their emotional needs.
- They are prone to depression, frequent anger outbursts, low frustration tolerance, and substance abuse.
- Common physical signs of child abuse include various stages of healing, cigarette burns, burns to the hands or body, sprains, dislocations, fractures, and internal injuries (including shaken baby syndrome).
- Emotional/psychological abuse includes belittling, ignoring, and blaming.
- Sexual abuse includes using a child for sexual pleasure.
- Neglect is the failure to provide physical or emotional needs.
- Neglect signs include uncleanliness, hunger, inappropriate clothing, and lack of medical/emotional care.
Father-Daughter Incest
- Father profile includes being domineering, physically abusive, fearful of exposure, and victimizing the oldest child.
- Mother profile includes passivity, submissiveness, competitiveness, and denial of the incest.
Adult Survivor of Incest
- Common characteristics include lack of trust, low self-esteem, poor sense of identity, feelings of guilt, sexual dysfunction, depression, anxiety, and a search for intimacy.
- They frequently participate in abusive adult relationships.
Medical Child Abuse
- May include Munchausen by Proxy, now referred to as factitious disorder.
- Includes a parent withholding medical care for an illness, often due to religion or personal belief systems.
- These situations pose ethical challenges for medical providers.
Behavioral and Psychological Characteristics of Child and Adolescent Victims
- Physical/Emotional/Psychological: Fearful of caregiver, developmental delays, may not cry during painful procedures, poor academic performance, acts overly adult or infantile, self-injury, suicidal ideation, runs away, drug and alcohol use.
- Sexual: Unusual interest or avoidance of sexual things, sleep problems, nightmares, unusual sexual knowledge for age, claims their body is dirty or damaged, fear about their genitals, drawings, games, or fantasies reflecting molestation.
Behavioral and Psychological Characteristics of Child and Adolescent Victims
- ACEs (Adverse Childhood Experiences) increase the risk for physical and mental health issues.
- Long term issues include depression, eating disorders, , anxiety, hypersexuality, suicidal ideation, borderline personality disorder, and Post-Traumatic Stress Disorder (PTSD).
Physical Signs of Abuse and Neglect in the Elderly Physical
- Malnourishment.
- Dehydration.
- Fecal or urine smell.
- Dirt, fleas or lice.
- Pressure ulcers, sores, skin rashes.
- Bruises, abrasions, fractures, hematomas, and grip marks on arms.
- Multiple injuries in varying stages of healing.
- May lack needed items like medications, glasses, hearing aids, etc.
Behavioral and Psychological Characteristics in Elderly Victims
- May have physical or mental impairments.
- Demonstrate aggressive or overly submissive behavior.
- Fearful of reporting abuse.
- Dependent on the caregiver.
- Make excuses for the perpetrator.
- Low self-esteem.
- Hopelessness.
- Financial issues.
Sexual Assault
- Any type of sexual act in which an individual is coerced or forced to submit against their will.
- Rape is an act of aggression, not passion.
Stranger Rape Profiles
- Perpetrator: Ages 25-44, 54% Caucasian, 32% African American, married/cohabiting, 62% use weapons, they want to terrorize, not cause injury.
- Victim: Ages 16-34, single women, close to home, not chosen for any reason (just there).
Acquaintance Rape
- Aka "date rape".
- The rapist knows the victim, including first dates, dating for months, and just friends.
- Many acquaintance rapes occur on campuses, but many go unreported.
Marital Rape
- Illegal in all states since 1993.
- Some states still have exemptions for husbands.
Rape vs. Statutory Rape
- Rape is non - consensual sexual intercourse by force, while statutory rape is sexual intercourse with a minor.
Manifestation of Rape
- Initial emotional reactions include expressed (crying, sobbing, restlessness, tension) and controlled (calm, composed, subdued affect).
- Long term reactions include compounded (additional symptoms, depression, suicide, substance abuse, psychotic behaviors,) and silent rape reactions (victim tells no one about the assault).
Rape-Trauma Syndrome
- Major symptoms include re-experiencing the trauma, social withdrawal, avoidance of behaviors and actions, and increased physiological arousal characteristics.
- The phases of the rape-trauma syndrome are acute, outward adjustment, underground, reorganization, and renormalization.
Nursing Diagnoses for Sexual Assault
- Powerlessness.
- Risk for delayed development.
- Rape-trauma syndrome.
- Ineffective coping.
- Interrupted family processes.
- Hopelessness.
- Risk for self-abuse.
Nursing Care for Sexual Assault
- Provide privacy.
- Create a non-judgmental relationship.
- Allow the patient a sense of control (e.g., wanting a female nurse).
- Implement care plans for survivors of abuse.
Interviewing the Sexual Assault Patient
- Interviews are essential to direct care and guide evidence collection.
- It should be completed at the beginning of the visit with law enforcement present.
- The patient's comfort should be prioritized (e.g., being fully dressed, having a support person present).
- The interview should include medical history (allergies, LMP, recent consensual intercourse), patient barriers, emotional response, and prior experiences with similar situations.
Trauma-Informed Care
- The foundation of all treatment modalities for survivors of abuse or neglect.
- Requires universal screening, as anyone can be a victim.
- Trauma recovery is essential to overall care.
- Ignoring or minimizing trauma can contribute to further trauma and re-traumatization.
The Nursing Process
- Assessment involves gathering data from various sources and includes physical, psychological, and behavioral characteristics.
- Nurse should assess for signs of conflict in patient-significant other interactions.
- Be aware of non-verbal signs of tension escalation.
Mandated Reporting
- Nurses have a legal obligation to report findings in accordance with state laws.
- Mandatory reports include child abuse and neglect, elder abuse and neglect, and abuse or neglect of a dependent individual.
- Reporters are immune from civil or criminal repercussions when acting in good faith.
Nursing Preservation of Evidence
- Priority intervention is medical stabilization.
- Crime-related evidence is essential to the process.
- Common types of evidence include clothing, bullets, gunshot powder, bloodstains, hairs, fibers, grass, glass fragments, paint, and wood.
- Clothing should be placed in paper bags (never use plastic bags), sealed, dated, timed, and signed.
- Clothing should not be shaken.
- A sexual assault nurse examiner (SANE) may be called to the ER for sexual assault cases.
- Treatment and evaluation of sexually transmitted infections (STIs) should occur.
- Pregnancy risk evaluation and prevention should occur.
- Crisis intervention and arrangements for follow-up counseling should occur.
Types of Evidence
- Physical, transient, touchable, trace.
Investigation of Wounds
- A detailed documentation of injuries is essential when clients present with undiagnosed trauma.
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Description
This quiz explores various theories behind aggression, including modeling, operant conditioning, and psychological factors. It delves into both behavioral and neurobiological perspectives, highlighting how learning and social interactions influence aggressive behaviors. Test your understanding of these concepts and how they relate to human behavior.
