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NSG 322 > Topic 9: Abuse, Neglect, & Violence > Flashcards

Topic 9: Abuse, Neglect, & Violence Flashcards

1
Q

what is a crisis?

A

acute, time-limited occurrences experienced as overwhelming emotional reactions to a stressful situational, developmental or persons perception of an event

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2
Q

what is the nurses goal when a client is in a crisis?

A

return the individual to a pre-crisis level of functioning

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3
Q

developmental (maturational) crisis

A

related to PREDICTABLE transitions of human development, adapting to new life roles

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4
Q

situational crisis

A

arise from an EXTERNAL rather than internal source and is frequently UNANTICIPATED

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5
Q

adventitious crisis (crisis of disaster)

A

not a common part of everyday life, RARE, generally large scale and impacts community (natural disaster, RAPE, battery, assault)

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6
Q

existential crisis

A

questioning life purpose or spirituality

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7
Q

Phase 1 of Crisis

A

person confronted by conflict and responds with increased anxiety
-stimulates problem solving techniques and defense mechanisms in an effort to solve problem and decrease anxiety

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8
Q

Phase 2 of Crisis

A

threat persists so anxiety continues to increase
-TRIAL-AND-ERROR attempts to solve problem and restore balance

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9
Q

Phase 3 of Crisis

A

trial-and-error attempt FAIL, anxiety escalate to severe/panic levels
-person may withdrawal and flight

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10
Q

Phase 4 of Crisis

A

problem is not solved after considerable time and effort, so anxiety can overwhelm person (anxiety to illness)
-ASSESS FOR SUICIDAL THOUGHTS/PLANS

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11
Q

primary care

A

promotes health and reduces mental illness to decrease incidence of crisis, do this BEFORE CRISIS STRIKES
-education, resources, coping skills

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12
Q

secondary care

A

Strategy: client SAFETY & establish interventions during an acute crisis to PREVENT PROLONGED ANXIETY
- stress reduction, support/assistance, medication

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13
Q

tertiary care

A

provide support for those who have experienced severe crisis and are now RECOVERING from crisis
-CISD, rehab, outpatient clinics, legal party for IPV

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14
Q

critical incident stress debriefing (CISD)

A

A system of psychological support designed to reduce stress on emergency personnel after a major stress-producing incident
-The primary emphasis is to inform and empower a homogeneous group after a threatening or overwhelming traumatic situation.

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15
Q

abuse and neglect is prevalent among

A

all groups of people, it has no bounds

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16
Q

Phase 1: introductory phase

A

the purpose and overview of the debriefing process id presented
-confidentiality is assured
-team members identified
-questions answered

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17
Q

Phase 2: fact phase

A

participants are assisted in discussing the facts of the incident from their perspective

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18
Q

Phase 3: thought phase

A

all participants are asked to discuss their initial thoughts about the incident

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19
Q

Phase 4: reaction phase

A

participants engage in freewheeling discussion about the worst, most painful part of the incident

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20
Q

Phase 5: symptom phase

A

participants describe cognitive, physical, emotional, and behavioral experiences at the time of the incident and ongoing

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21
Q

Phase 6: teaching phase

A

feelings of participants affirmed
guidance is provided regarding future symptoms and stress management techniques

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22
Q

Phase 7: re-entry phase

A

debriefing process thus far is reviewed and any new topics are discussed
team members provide encouragement and additional resources then summarize the experience

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23
Q

the intent of abuse/neglect is to…

A

cause harm and have control over someone else

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24
Q

signs of domestic violence include:

A

-recurrent ED visits attributed to being “accident prone”
-somatic symptoms: anxiety, nightmares, GI disturbances
-signs of depression

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25
Q

cycle of violence

A

-tension
-confrontation
-reconciliation
-honeymoon

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26
Q

tension building phase

A

· The abuser has minor explosions; may become verbally abusive, minor hitting, slapping, etc.· The victim feels tense, afraid, helpless, becomes compliant and accept blame “walking on eggshells”

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27
Q

acute battering phase

A

· Tension becomes unbearable; the victim may provoke an incident to get it over with. The victim may cover up the injury or may look for help

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28
Q

honeymoon phase

A

· Abuser has loving behavior like bringing gifts and flowers, says sorry and makes promises to change· Victim is trusting, hoping and believes change

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29
Q

overindulgence

A

TYPE OF NEGLECT where child is “appeased” by giving them whatever they want, and can lead to inactivity and obesity

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30
Q

nurse responsibilities for child abuse

A

REPORT IMMEDIATELY
-safety and wellbeing of the child
-reassure the child the situation is not their fault

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31
Q

who does the nurse report child abuse to?

A

report to doctors first, not CPS

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32
Q

nurse responsibilities for IPV

A

-nonjudgemental care
-assist victim in contacting law enforcement IF THEY WANT TO
-documentation
-community resources (in a safe manner)

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33
Q

elder abuse

A

the abuse or neglect of older family members, >80 y/o at risk (physical, emotional, financial, neglect, self neglect, sexual)

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34
Q

sexual violence is often an act of…

A

violence, power, and control, often has nothing to do with sex

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35
Q

what is the most used date rape drug?

A

alcohol

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36
Q

Gamma-hydroxybutyrate (GHB) is…

A

hard to detect by testing because it clears QUICKLY from the body

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37
Q

antidote for flunitrazepam (Rohyphol)

A

flumazenil

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38
Q

what drugs cause anterograde amnesia?

A

GHB and ketamine

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39
Q

what drug causes retrograde and anterograde amnesia?

A

flunitrazepam (Rohyphol)

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40
Q

ketamine causes a dissociative reaction which makes the client feel like they are in a…

A

dreamlike state

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41
Q

what are the two ways a crisis can result in?

A
  1. fall apart and decompensated
    or
  2. problem-solve and grow through the process
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42
Q

client outcomes are impacted by…

A

-Individual, family, and community perception of & response to the crisis
-Coping abilities, resiliency
-Availability of outside supports

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43
Q

clients with the best outcomes…

A

-Feel safe, connected, calm & hopeful
-Have access to social, physical & emotional supports
-Find ways to help themselves

44
Q

what individuals is abuse and neglect prevalent in?

A

*Prevalent among ALL social divisions: ethnic, religious, age, social & socioeconomic groups

45
Q

what are the four primary categories of abuse & neglect

A

emotional
physical
sexual
neglect

46
Q

emotional abuse

A

Includes name calling, excessive criticism, ignoring accomplishments, yelling and swearing, mocking, isolating, locking the victim in a room, threats and intimidation, and denying abuse and blaming the victim.

47
Q

physcial abuse

A

usually encompasses emotional abuse in addition to physical harm

48
Q

sexual abuse

A

vaginal or anal rape, oral or manual toughing inappropriate comments ect

49
Q

neglect

A

inconsistent provision of food water shelter sanitation or other basic needs

50
Q

Bandura’s Social Learning Theory

A

Learning occurs when we observe other people and model their behavior
-“this is how I grew up, this is what I learned” this is how my parents were and that’s why I treat others like this , does not make them more likely but it is. possibility

51
Q

Signs that May Indicate Abuse or Neglect

A

*Recurrent emergency department (ED) visits, attributed to the client being “accident prone”
*somatic symptoms reflecting anxiety or chronic stress
*signs of depression

52
Q

the cycle of violence

A

tension building phase
acute battering phase
honey moon phase

53
Q

tension building phase

A

· The abuser has minor explosions; may become verbally abusive, minor hitting, slapping, etc.
· The victim feels tense, afraid, helpless, becomes compliant and accept blame “walking on eggshells”

54
Q

Acute battering phase

A

· Tension becomes unbearable; the victim may provoke an incident to get it over with. The victim may cover up the injury or may look for help

55
Q

honeymoon phase

A

· Abuser has loving behavior like bringing gifts and flowers, says sorry and makes promises to change
· Victim is trusting, hoping and believes change

56
Q

Which defense mechanism is used by the abuser during the Reconciliation/Honeymoon Phase?

A

Undoing

57
Q

child abuse

A

*Any recent act or failure to act on the part of a parent or caregiver that results in death, serious physical harm, sexual abuse, or exploitation, or any act or failure to act that presents an immediate risk of serious harm.

58
Q

The Child Abuse Prevention and Treatment Act (CAPTA) of 1974

A

provides states with federal funding and guidance to support abuse prevention, assessment, investigation, prosecution, and treatment activities.

59
Q

Emotional abuse (child)

A

can range from verbal threats or belittling to public shaming, sometimes parents even post their child’s “failures” on social media.

60
Q

Overindulgence

A

is actually considered a type of neglect (appease a child or keep a child “happy” / “busy” by providing whatever the child wants: unhealthy snacks, unlimited screen time.
-This leads to serious adjustment issues and social impairments, as well as obesity and medical conditions as a result of obesity.

61
Q

Overindulgence is neglect & can result in:

A

*Lack of empathy
*Social/emotional impairment
*Obesity & related physical issues

62
Q

what is the most immediate concern with child abuse

A

ensure the child’s safety and well-being.

63
Q

Mandatory reporting

A

Nurses, other health care providers MUST legally report suspicion of abuse to the appropriate child protective agency

64
Q

mandatory reporting and proof

A

*The person reporting suspected abuse or neglect does NOT need to have proof of the abuse or neglect - the authorities will perform the investigation per their procedures and the laws.

65
Q

What is intimate partner violence (IPV)?

A

A pattern of assault and course of behaviors that may include physical injury, psychologic abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats between current or former partners of an intimate relationship, regardless of gender or marital status

66
Q

IPV: denial and blame

A

Denies that the abuse occurs; shifts the responsibility to the partner

67
Q

IPV: emotional abuse

A

Belittles, criticizes, insults, uses name calling, and undermines

68
Q

IPV: control through isolation

A

Limits the family or friends, controls activities and social events, tracks the time or mileage on the car, monitors activities, stalks the partner at work, takes the partner to and from work or school, and may demand permission to leave house

69
Q

IPV: control through intimidation

A

*Instills fear through threats
*Breaks things, destroys property, abuses pets, displays weapons, threatens children, and threatens homicide or suicide
*Increases physical, sexual, and psychologic abuse

70
Q

IPV: control through economic abuse

A

Controls the money. If the partner works, the batterer calls excessively and forces the partner to miss work.

71
Q

IPV: control through power

A

Makes all the decisions, defines the role in the relationship, treats the partner like a servant, and takes charge of the home and social life.

72
Q

Three questions are usually sufficient to reveal IPV:

A

1.Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?
2.Do you feel safe in your current relationship?
3.Is there a partner from a previous relationship who is making you feel unsafe now?

73
Q

Signs of abuse may include

A

burns, bruises, scars, and other wounds in various stages of healing, particularly around the head and neck.

74
Q

when is it mandatory to report IVP

A

if the victim is a minor or vulnerable adult

75
Q

what is key in the reporting obligations of IVP

A

DOCUMENTATION

76
Q

if the patient is not ready to take action regarding IVP, what can be done

A

SAFETY PLAN; provide community resource information (in a safe manner, some individuals put help cards in their shoe)

77
Q

how can the nurse help a patient who is a victim of IVP

A

*Assist victim in contacting law enforcement if he or she chooses to press charges
*Do not attempt to convince the victim to pursue legal action
*Remain nonjudgmental regardless of the victim’s decision

78
Q

what is elder abuse?

A

the physical or psychological mistreatment or neglect of elderly individuals

79
Q

what are the types of elder abuse

A

*Physical
*Emotional
*Financial (exploitation)
*Sexual
*Neglect
*Self-neglect

80
Q

characteristics of victims of elder abuse

A

*>80 years at highest risk
*Risk of death as a result of abuse increases by 3 times
*Females, Caucasians, more at risk

81
Q

Signs of abuse are very similar to the victim of IPV… Additional red flags include the following:

A

*Fear of being alone with caregiver
*Obvious malnutrition
*Bedsores or skin lesions
*Begging for food
*Needs medical and/or dental care
*Left unattended for long periods
*Reports of abuse and neglect
*Passive, withdrawn, and emotionless
*Concern over finances and missing valuables

82
Q

reporting obligations: elder abuse

A

The elderly are often considered a vulnerable population due to their advanced age, and therefore may meet requirements for Adult protective services

83
Q

what is sexual assault?

A

an act of violence, power, and control, it is not about sex

84
Q

Most sexual assaults in young people are _____ ______. 90% of victims know their attacker.

A

date rapes

85
Q

Outcomes of sexual assault

A

-Mental Health Issues: Including depression, suicidal ideation, and substance use
-Sexually-transmitted infections (STIs)
-Unplanned, undesired, and/or teenage pregnancy

86
Q

Commonly Implicated “Date-Rape” Drugs

A

alcohol (most frequently used)
gamma-hydroxybutyric acid (GHB)
flunitrazepam (Rohypnol)
ketamine

87
Q

gamma-hydroxybutyric acid (GHB) affects the

A

CNS

88
Q

gamma-hydroxybutyric acid (GHB) is extremely dangerous when

A

mixed with alcohol - likely to cause respiratory depression and may be a fatal combination

89
Q

gamma-hydroxybutyric acid (GHB) causes

A

anterograde amnesia

90
Q

why is gamma-hydroxybutyric acid (GHB) hard to detect

A

it clears from body quickly (within hours)

91
Q

gamma-hydroxybutyric acid (GHB) is also used therapeutically for

A

*narcolepsy (with cataplexy)

92
Q

flunitrazepam (Rohypnol) classification

A

potent benzodiazepine

93
Q

flunitrazepam (Rohypnol) causes

A

retrograde and anterograde amnesia
The “forget” drug, “roofies”

94
Q

ketamine classification

A

*Hallucinogenic / psychedelic / dissociative drug (derived from PCP)

95
Q

ketamine causes

A

anterograde amnesia

96
Q

Victim who arrives at the ED should:

A

-Be a priority in Triage, not be left alone and should have privacy provided.
-Receive psychologic support, medical care, documentation of pertinent history, and a thorough physical examination.

97
Q

The Sexual Assault Nurse Examiner (SANE): Forensic nurse who works with the victims of SV:

A

-Perform physical examination on the survivor.
-Collect forensic evidence.
-Provide expert testimony and forensic evidence.
-Provide support and the psychobiologic needs of survivor.
-Accurate and meticulous Documentation

98
Q

Rape-Trauma Syndrome

A

Variant of posttraumatic stress disorder (PTSD) and is a common sequela of psychologic trauma.

99
Q

acute phase: typical reactions to a crisis

A

The most common responses are shock, numbness, and disbelief.

100
Q

long term phase: teach patient what to expect and how the will feel after sexual violence

A

all victims will deal with the event in their own manner
-Re-experiencing the trauma
-Social withdrawal
-Avoidance behaviors and actions
-Increased psychologic arousal characteristics
-Fears and phobias
-Nightmares and difficulty sleeping

101
Q

interventions for sexual assault

A

-Attend to Physical needs and injuries, assess SI
-Offer emergency contraception
-Screen for HIV, Hepatitis B and syphilis
-Administer prophylactic treatment for STDs
-Immunize for tetanus if there are abrasions and >5 years since last immunization
-Crisis counseling/psychotherapy

102
Q

who are forensic experts in the hospital that can help with sexual assault victims

A

*Sexual Assault Nurse Examiner (SANE)

103
Q

Many _______ are mandated to be reported

A

sexually-transmitted infections (STIs)

104
Q

anterograde amnesia

A

an inability to form new memories

105
Q

retrograde amnesia

A

an inability to retrieve information from one’s past

106
Q

Most important for the nurse to develop with an IPV patient…

A

a safety plan

107
Q
A

NSG 322 (12 decks)

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