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Repro Week 4 > ICL 8.5: Sexual Assault Evaluation > Flashcards

ICL 8.5: Sexual Assault Evaluation Flashcards

1
Q

what is domestic violence?

A

not an isolated invidivual event but rather a pattern of multiple tactics and repeated events

assaults are repeated against the same victims by the same perpetrator

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2
Q

how prevalent if domestic violence?

A

1 in 4 women

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3
Q

what is the presentation of DV?

A
  1. headache, neck or back pain, vague complains, frequent ER visits
  2. digestive problems
  3. weight loss.gain
  4. sexual dysfunction
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4
Q

how is DV related to pregnancy?

A

30% of assaults begin during the first pregnancy

pregnancy women have twice the risk of battery

240,000 pregnancy women are subject to DV each year

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5
Q

what are signs of abuse in patients of DV?

A
  1. unexplained bruises, lacerations, etc.
  2. delays in treatment
  3. appear embarrassed, evasive, anxious or depression
  4. partner is unwilling to leave, uncooperative, domineering, etc.
  5. injuries don’t match the history given
  6. expresses fear of returning home or her children’s safety
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6
Q

what is medical exception to hearsay?

A

the rule that says that you as a provider when interviewing a patient can chart quotation marks of what the patient said and then later can read it on the stand in court

described medical history, past or present symptoms or sensations, their inception, etc.

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7
Q

what are the resources for DV?

A
  1. social work
  2. chaplain
  3. SANES nurses in the ER
  4. locale sources: lucas county crisis response team
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8
Q

how do we screen everyone for in the ED for strangulation?

A
  1. thyroid cartilage fracture
  2. trauma consult
  3. admitted to the hospital
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9
Q

what is choking?

A

blocked airway due to an internal obstruction

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10
Q

what is strangulation?

A

the occlusion of blood vessels and/or airway as a result of external pressure applied to the neck

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11
Q

can you visibly see DV?

A

only 50% have no external injuries

20% have petechia but they’re really hard to see…

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12
Q

what are petechia?

A

continuous pumping of blood into capillaries which then rupture if they can’t get back to the heart

only happens in 20% of patients

you have to do a full head to toe assessment because sometimes you really can’t see the petechia, they’re in weird areas

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13
Q

what is the presentation of previous strangulation?

A
  1. can present as urination/defication on themselves
  2. choking
  3. headache, dizziness
  4. difficulty speaking
  5. petechia
  6. head injuries
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14
Q

what structures under the skin can be effected during strangulation?

A
  1. vasculature

arterial vessels take 11 pounds for 5-10 seconds for unconsciousness – there is increased risk for thrombolysis or embolism

takes 4 lb of pressure for 10-20 seconds to occlude a vein

  1. MSK
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15
Q

how do you do evidence collection for strangulation?

A

swabs for touch DNA and bodily fluids

there’s no set kit for this technically like there is for a rape kit

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16
Q

is there mandated reporting for DV?

A

yes!

  1. in Ohio you must report: any person giving aid to a sick or injured person shall negligently fail to report to law enforcement authorities any gunshot or stab wound treated or observed by the person or any serious physical harm to persons that the person knows or has reasonable cause to believe resulted from an offense of violence
  2. must offer police reporting; but if they don’t want to file the report that’s fine – however, if the person has to go to surgery though due to serious physical harm from assault then you do have to report it no matter what (ex. break of long bone, ICH); if they are discharged then you don’t have to report it
  3. must offer STD prophylaxis to sexual assault victims
17
Q

what is forensic nursing?

A

the application of legal aspects of healthcare, combined with bio-psychosocial education of the registered nurse used in the scientific investigation of trauma and/or death related to medical-legal issues

so it’s the application of the nursing process to public or legal proceedings

18
Q

what is a SANE nurse?

A

RN specifically trained to provide care to sexual assault victims

they conduct medical forensics examinations too

SANE = sexual assault nurse examiner

19
Q

how long do you have to collect evidence for sexual assault?

A

up to 96 hours

aka 4 days later

SANE exam is free!! the government pays for the exam if they’ve been sexual assaulted but they dont have to file a report

20
Q

do sexual assault victims have to file a police report?

A

no

they can seek psychological and medical support without involving the police

hospital can submit anonymous kits at any victim requires

does matter how much you’ve had to drink, rape is NEVER the victims fault! however you can’t do evidence collection till the patient is clinically sober to get consent to do the collection (must pass MMI)

21
Q

who are SANE nurses specialize to work with?

A
  1. child abuse/neglect
  2. elder abuse/neglect
  3. DV
  4. domestic assault
  5. criminal assault
22
Q

what is in a rape kit?

A
  1. paperwork; includes hospital and county evidence was collected from, must have appropriate chain of custody from SANE nurse to crime lab
  2. consent form filled out by patient; do MMI if necessary
  3. body map; complete PE and then indicate on the body map form
  4. photography of injuries/evidence to match body map
  5. narrative history from the patient which the nurse records
  6. what type of vaginal penetration occurred? oral? anal? did their assailants mouth touch their genitals? did they ejaculate and where? lubrication use? strangulation? douche? BM? vomiting? change of clothes/bathing? ate? brushed their teeth?
  7. are you menstruating?
  8. condom use?
  9. last date of consensual sex? were their other people?
  10. include underwear
  11. envelope for prophylaxis aka patient education and STI prophylaxis
  12. swabs of areas that were licked, kissed, bitten or ejaculation sites – swab fingernails and vagina and vulva; also swab inside vagina and exterior of anus, strangulation area

seal the evidence once collected and include paperwork; give copy to the police of paperwork if police report is going to be filed; then police department in the area WHERE the patient was assaulted will handle it from there

23
Q

what is human trafficking?

A

sex trafficking: recruitment, harboring and transpiration providing or obtaining of a person for commercial sex act

labor trafficking too

24
Q

what are red flags for labor trafficking?

A
  1. dehydration
  2. heat/stress/stroke
  3. MSK injures
25
Q

what is sex trafficking signs?

A
  1. persistent STDs
  2. abnormally high number of sex partners
  3. trauma to vagina

76% have been to the ED while they were being trafficked! we need to better about screening

26
Q

how do you identify victims of sex trafficking?

A
  1. international victims; difficulty communication
  2. accompanies by a controlling person
  3. missing identification
  4. signs of physical abuse
  5. submissive/fearful behavior
  6. physically and psychologically controlled by traffickers
  7. do not consider themselves a victim
  8. trained by trafficker to tell lies and false stories
  9. victims distrust of service providers and law enforcement
  10. frequently moved from place to place
  11. reluctant to explain
27
Q

what are the flags for coercion and control?

A
  1. inability to keep appointments
  2. unable to present ID and documents
  3. addictive behaviors
28
Q

what are the consequences of trafficking?

A

once seduced pimps use torture tactics to control their victims

victims have:

  1. STDs
  2. PTSD
29
Q

what is elder abuse?

A

we don’t have to know something is happening, we just have to be concerned for abuse to report it for anyone over the age of 60 in the state of ohio

applies to physical, sexual, psychological, neglect, abandonment, and financial abuse all count if it’s someone over 60

30
Q

how do you report elder abuse?

A

lucas county adult protective services you can report to and reports are confidential and can be done anonymously

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