Assault Q2 Presentation PDF

Assault Nurs191 Kasey Williamson, MSN, RN, RNC-OB Objectives Use nursing process to determine evidence-based care for the woman during her reproductive years.  Examples are:  Menstruation  Menopause  Violence against women  Screening  Screening of everyone is important  Ques...

Assault Nurs191 Kasey Williamson, MSN, RN, RNC-OB Objectives Use nursing process to determine evidence-based care for the woman during her reproductive years.  Examples are:  Menstruation  Menopause  Violence against women  Screening  Screening of everyone is important  Questions to ask? Domestic Abuse Endemic  How are individuals targeted for abuse?  Vulnerable situations  Who is most likely to be targeted?  Adolescents  College – Reliance w/ funds  Within a committed relationship – Invested (children, finances)  Older adult (vulnerable, fixed income, physical limitations)  Sexual Assault: Not gender specific Touching or penetration without consent Unwanted sexual contact Unwanted touching of an intimate part Forced anal, oral, or genital penetration More than 50% all rapes were by an intimate partner 1 out of 4 college students have experienced rape Care of the survivor of sexual violence Assess injuries for immediate intervention Rape trauma nurse  Rape Kit  Chain of evidence Care and Know  Stay with them (highest risk for suicide)  Listen  Offer emergency contraception  Rape trauma syndrome (PTSD – can be triggered for a long time)  Theory of the cycle of violence  Medicolegal Valid written consent for:  examination  Photographs of injuries  laboratory tests  release of information  laboratory samples Appropriate “chain of evidence” documentation  Nursing Management Assessment- Subjective  History of assault Penetration, ejaculation, extragenital acts Activities since assault Inquire about safety Menstrual and contraceptive history Medical history Emotional status Current symptoms of injuries Nursing Management Assessment- Objective  General Physical Examination  Vital signs and general appearance  Extragenital trauma  Pelvic Examination (not done by us)  Laboratory Assessment  Chain of Evidence  Obtain baseline STI screening  Collaborative Management Initial  Treat shock and other urgent medical problems (e.g., head injury, hemorrhage, wounds, fractures).  Assess emotional state.  Contact support person(social worker)  Do not clean the patient until all evidence is collected. (do not shower until examined)  Collect clothing (put on gown, clothes go into sheets for evidence)  Obtain forensic evidence  Maintain chain of evidence for all legal specimens.  Collaborative Management Ongoing  Monitor vital signs and emotional status.  Provide clothing as needed.  Counsel patient about confidential HIV and STI testing.  Care of injuries and emotional trauma  Protection of legal rights (consent/HIPAA)  Recommendation of continued follow-up and services of rape crisis center  Collaborative Management Preventative  Tetanus  Vaccinate PRN  Hepatitis B  Vaccinate PRN  Pregnancy  Emergency contraception (plan B or copper IUD)  Follow-up for pregnancy test in 2–3 wk  STI’s  Testing for HIV, syphilis, and hepatitis B may be done at 6– 8 wk Education Self care Next steps Follow up Resources Prevention  Be careful to avoid victim blaming