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Substance Abuse and Violence

Terms in this set (36)

Substance Abuse and Violence
✯ _________ _________ and _________
▪︎ Care of the women with substance abuse
▪︎ Historical factors contributing to violence against women
▪︎ Intimate Partner Violence (IPV)/ Domestic Violence
▪︎ Sexual Violence
Substance Abuse
✯ _________ _________
▪︎ Substances commonly abused during pregnancy:
⇢ Marijuana- no evidence of teratogenic effects (problems, birth defects, learning issues, etc..). However, smoking anything will lead to fetal exposure and should be avoided.
⇢ Cocaine- Fetal risks: Spontaneous abortion (early on in pregnancy), placental abruption (tachycardia, HTN, & vasoconstriction sets this up), IUGR (impaired blood flow through the placenta impairs the fetus from getting nutrients that it needs), preterm birth, still birth
・Leads to vasoconstriction, HTN, tachycardia. Fetal risk here.
・Q: How does cocaine use affect placental blood flow?
⇢ Placental vasoconstriction prevents blood flow through the placenta and prevents the fetus from getting the nutrients and oxygen that it needs.
Marijuana
✯ Substances Commonly Abused During Pregnancy; __________
▪︎ No evidence of teratogenic effects (problems, birth defects, learning issues, etc..). However, smoking anything will lead to fetal exposure and should be avoided.
Cocaine
✯ Substances Commonly Abused During Pregnancy; __________
▪︎ Fetal risks
⇢ Spontaneous abortion; Can occur early on in pregnancy
⇢ Placental abruption; Tachycardia, HTN, & vasoconstriction set this up
⇢ IUGR; Impaired blood flow through the placenta impairs the fetus from getting nutrients that it needs
⇢ Preterm birth
⇢ Still birth
⇢ Leads to vasoconstriction, HTN, tachycardia. Fetal risk here.
▪︎ Q: How does _______ use affect placental blood flow?
⇢ Placental vasoconstriction prevents blood flow through the placenta and prevents the fetus from getting the nutrients and oxygen that it needs.
Substance Abuse
✯ _________ _________
▪︎ Substances commonly abused during pregnancy:
⇢ PCP- Hallucinogen.
・Overdose leads to HTN, hyperthermia, diuresis, coma- may harm fetus.
⇢ Ecstasy- Derivative of amphetamines.
・May lead to childhood learning and memory impairment
⇢ Heroin- CNS Depressant.
・Fetal risks: preterm birth, IUGR, withdrawal.
・Signs of the baby going through withdrawal may have a high pitched cry that is difficult to console, ability to eat large amounts then vomit that feeding, sweating, skin excoriation, projectile vomititng, loose stool. Would do abstinence scoring on them to see how they are doing with the withdrawal.
・Methadone is often used as treatment to block withdrawal symptoms
PCP
✯ Substances Commonly Abused During Pregnancy; __________
▪︎ Hallucinogen.
⇢ Overdose leads to HTN, hyperthermia, diuresis, coma- may harm fetus.
Ecstasy
✯ Substances Commonly Abused During Pregnancy; __________
▪︎ Derivative of amphetamines.
⇢ May lead to childhood learning and memory impairment
Heroin
✯ Substances Commonly Abused During Pregnancy; __________
▪︎ CNS Depressant.
⇢ Fetal risks: preterm birth, IUGR, withdrawal.
⇢ Signs of the baby going through withdrawal may have a high pitched cry that is difficult to console, ability to eat large amounts then vomit that feeding, sweating, skin excoriation, projectile vomititng, loose stool. Would do abstinence scoring on them to see how they are doing with the withdrawal.
⇢ Methadone is often used as treatment to block withdrawal symptoms
Substance Abuse
✯ __________ __________
▪︎ Clinical Therapy
▪︎ Detoxification
⇢ She may be hospitalized to try and wean off of some of these medications. They do not recommend just cold turkey cutting the drug while a women is pregnant. This could have adverse outcomes on the baby.
▪︎ Maintenance and support therapy
⇢ Methadone is used for heroine addicts. May do this with pregnant patients.
▪︎ Urine screenings
⇢ Is she using again and says she's not? What is she using? How much is she using? How should we treat the baby if it shows signs of withdrawal? This screening can be very helpful in answering these questions..
Domestic Violence
✯ ________ _________
▪︎ Definition: Gaining Power and control over an individual in the relationship through manipulative behaviors.
▪︎ Partners may be dating, living together, married, or divorced
▪︎ Q: What percent of perpetrators are men?
⇢ 95% of perpetrators are men.
⇢ There are different perpetrator circumstances.
▪︎ Types of abuse:
⇢ Psychological abuse;
・He is emotionally abusing her, putting her down, making her feel bad about herself, calling her names, belittling her.
・May isolate her from others like her friends and family (Isolation). He can restrict her actions. Forbid her from seeing other people.
・Economic abuse can occur. He can prevent her from getting a job. Asserting his dominance over her in this way. Keeping her finically dependent on him.
・Can make threats or coerce her. Might use intimidation to make her feel afraid. May smash things, harm pets, displaying weapons, yelling, stalking, etc...
⇢ Physical abuse;
・Can include battery.
⇢ Sexual abuse;
・Can include a myriad of activities. Including, but not limited to, Rape.
Domestic Violence (Intimate Partner Violence)
✯ Historical Factors Contributing to Violence Against Women; _______ _______
▪︎ Traditional male dominance in relationships
⇢ Whether it's in a marriage or the head of the household in the family being the father. As it pertains to male and female relationships, the male often expected the female or the wife to do what he asks.
▪︎ Marital Conflict
⇢ Can lead to violence if things are stressful.
▪︎ Low Socioeconomic status
⇢ Can add more stress into the relationship. Potentially leading to violence against women.
▪︎ Cultural hypermasculinity
⇢ Where the male is the dominant one in the relationship.
⇢ Today, violence against women is unacceptable.
Cycle of Abuse
✯ _______ of _______
▪︎ This theory includes tension building, battering, and the honeymoon period.
▪︎ Tension Building
⇢ Here tension is building. Aggression is starting to build up. The man may be starting to blame the women for things. He may be starting to act out aggressively. Maybe breaking things. She is sensing danger during this time, but is hoping that the relationship can get better. As the tension starts to build up there can be an acute incident. This leads to the next part.
▪︎ Battering
⇢ Or the acute assault. This is typically the briefest part of the cycle. During this time there is acute violence, unpredictable behavior, and major destructiveness here. This is followed by the next period.
▪︎ Honeymoon Period
⇢ Lack of battery and abuse at this time. Women is grateful for that. It can also be apologetic behavior after the abuse. The man can be saying "I love you so much. You're the best thing that ever happened to me". He could be buying her flowers and filled with guilt. going out of his way to make himself shine in the eyes of the women. This then slowly builds into the tension building stage again.
▪︎ Cycle Repeats Itself
Violence and Abuse
✯ Myths Surrounding Partner ______ and ______
▪︎ Battering is infrequent
⇢ About 1/3 of all women will experience some kind of abuse in their lifetime. 10% of all women will report this abuse.
▪︎ Abused women often provoke the abuse
⇢ 'She pushed him over the edge'. Gives permission to the abuser to act that way. We should all understand that we are all responsible for our own behavior. Even if somebody is being somewhat inappropriate, it does not allow someone to act abusively towards that person. Abused women are not provoking the abuse. It is up to the other person who is doing the abuse to act in a way that promotes diplomacy and self-control.
▪︎ Drugs and ETOH cause abuse
⇢ There are higher rates of abuse in situations with drugs and ETOH. However, this is not an excuse to abuse another person. We're all in control and responsible of our own behavior.
▪︎ Abused women can easily leave the situation
⇢ Easy for many people not in the relationship to tell them to leave. Woman may stay in an abusive situation due to finances (especially if they are dependent on the male), kids are involved (concerned about how it will effect them), love hate relationship with the abuser, and if she does leave what are the long term implications, She may feel that her safety is in jeopardy if she leaves now. Need to have a plan in place.
▪︎ Violence is a low income issue
⇢ Low income can lead to stress in a relationship. However, violence is something that can take place in any SES. Any age, culture, or race. Not just a low income issue. Low income patients may report it to hospital mores. Those with higher incomes can report it privately and take care of matters that way.
▪︎ Abused women are safe during pregnancy
⇢ Physical abuse is often aimed at the breast/torso area. Often times the abuser finds the pregnancy a threat. Not all of the attention is on him. This can be a time where abuse can be initiated or actually perpetrated (become worse).
Perpetrators
✯ Characteristics of _________
▪︎ Race?
⇢ Can be of any race.
▪︎ Age?
⇢ Can be of any age.
▪︎ Education?
⇢ Can be of any educational attainment level.
▪︎ Insecurity
▪︎ Inferiority
▪︎ Powerless
⇢ Trying to get some control and power out of their abusive behaviors or sexual abuse.
▪︎ Helpless
▪︎ Jealous
▪︎ Often select a woman who is vulnerable
⇢ So they can be the dominant one in the relationship and she would be dependent on him.
▪︎ Create dependence
⇢ Can be financial. Could put her in a situation where she is isolated and doesn't have a relationship with family or friends.
▪︎ Emotionally immature and aggressive
⇢ Can have the abuse cycle take place due to this. May lead to battery or sexual abuse.
▪︎ Many were exposed to abuse as a child
Domestic Violence
✯ _______ __________: Nursing Assessment
▪︎ Respect, trust, and advocacy
⇢ Build a relationship with the patient. Going to respect her as a human being, ask her questions, and take her word for it. Don't want to push her too hard on this.
⇢ Build a relationship that has trust at the base of it, so that she feels that she can tell you the truth.
⇢ Going to advocate for her, her desires, and rights.
▪︎ Listen to her
⇢ Maker her feel heard and we'll believe what she says.
▪︎ Stress myths
⇢ Stress that she didn't do anything to make this happen. It is unacceptable behavior.
▪︎ Let her talk at her own speed
⇢ Not going to push her. Ask open ended questions. Be concerned and document things in her own words.
▪︎ May have conflicting feelings toward abuser
⇢ May be in the honeymoon period.
▪︎ Should she leave?
⇢ Want to make sure that she can leave safely and has a plan together.
▪︎ Signs of abuse:
⇢ Neuro signs
・Headaches, tension headaches, migraines, hearing loss, detached retinas
⇢ Gyn signs
・Reports of painful intercourses, frequent STIs, pelvic pain
⇢ OB signs
・Late prenatal care, recurrent therapeutic abortions, recurrent spontaneous abortions
⇢ GI signs
・IBS, feeling of a lump in the throat
⇢ Musculoskeletal signs
・Fibromyalgia, painful joints
⇢ Psychiatric Signs
・Panic, anxiety, mood disorders, substance abuse, eating disorders
⇢ Constitutional Signs
・Abrasions, sleep disturbances, appetite problems, decreased concentration, frequent use of tranquilizers
⇢ Trauma
・Injury to her female organs, accident histories (more than usual), having sexual trauma, history of frequent old fractures
⇢ Other Signs
・History of frequently missed appointments, neglected appearance, and the way she relates to HCP like lack of eye contact. See if she is not acting appropriately given the situation. Defensive injuries. Delayed reports of symptoms or seeking care for injuries way after the incident occurred.
Domestic Violence
✯ _______ __________: Nursing Care Management
▪︎ Routinely ask about violence
⇢ Since we can't rule any patient out.
▪︎ Ask privately
⇢ Try to have the perpetrator leave the room or ask at a time when he is not there.
▪︎ Ensure confidentiality
⇢ This way the patient feels that she can trust us.
▪︎ Interdisciplinary care
⇢ If she has questions or concerns we can get things like social work involved.
▪︎ Abuse assessment tool
⇢ With questions can be used.
▪︎ Document Findings
⇢ In the patients own words. "She States..." and put it in quotes. Even if the patient is using slang it's important to use their own words. This documentation can become part of a legal record.
▪︎ Safety Plan
⇢ We can help her in our care with her and/or the care of the social worker by coming up with a safety plan. Does she have a list of phone numbers? Where could she go? Who could she call?
Abuse
✯ ________: Nursing Assessment
▪︎ Questions to ask...
⇢ Upon admission we ask all patients the following questions. Knowing that statistics are about 1/3 women are abused and pregnancy is often a threat to abusers. OB at time of admission is a great time to intervene for these women.
▪︎ Within the last year, have you been kicked, slapped, pushed or threatened?
▪︎ Since you have been pregnant, have you been kicked, slapped, pushed, or threatened?
▪︎ Within the last year, has anyone forced you to engage in sexual activities?
▪︎ Are you afraid of anyone at home or an ex?
▪︎ If YES..., by who? Total number of times? Was this reported?
⇢ If she has her significant other with her, often times these men will not leave their side. They will answer questions for her and she will defer to them to answer questions.
⇢ Want to ask these when we are alone with the patient.
Abuse
✯ ______: Nursing Assessment - Observe Partner Behavior
▪︎ May request to remain present at all times
⇢ Won't leave the room.
▪︎ May answer questions for the patient
▪︎ May monitor her responses
▪︎ May become agitated
⇢ With the staff doing the caring and with the women also.
Safety Plan
✯ Nursing Care: ______ _______
▪︎ We can do this with the patient or social work can get involved to help.
▪︎ Have essentials ready (money, keys, documents)
▪︎ Establish a code with friends/ family
⇢ Example: "Pizza for dinner" actually means I'm in trouble and need help.
▪︎ Safe Place
⇢ Should be able to identify a safe place she can go. Can include a friend or family members house, the hospital, or police.
▪︎ Law enforcement
⇢ How can she contact them. She can dial 911. Can drive there.
▪︎ Shelters Hotlines
⇢ Provide info on shelters where she can stay while awaiting housing if she plans to leave the situation.
▪︎ Children Services
⇢ If the children have been abused or if they need special services or accommodations while she is getting away from the situation children services might be able to help with that.
▪︎ Important that we discharge her with a plan
⇢ Especially if she is not willing to get out of the situation right now. It can potentially be dangerous or harmful if she leaves without a plan in place.
Sexual Assault
✯ Sexual Violence; ________ _________
▪︎ Unwanted sexual touching or penetration.
Rape
✯ Sexual Violence; ________
▪︎ Forced penetration or intercourse including both physical force and psychological coercion.
⇢ One type of sexual assault.
⇢ Sexual intercourse can mean vaginal, anal, or oral penetration by the perpetrator.
Power Rape
✯ Sexual Violence - Types of Rape (Based on Motive); ________ ________
▪︎ Motive is asserting dominance
▪︎ May feel that victim enjoys rape
⇢ Not doing it because the want to have intercourse. This is abuse and a way of asserting dominance.
▪︎ Most common form of stranger rape
Anger Rape
✯ Sexual Violence - Types of Rape (Based on Motive); ________ ________
▪︎ Motive is retaliation for wrongs against him
▪︎ Often violent rapes
⇢ Sometimes these are rapes of older women.
Sadistic Rape
✯ Sexual Violence - Types of Rape (Based on Motive); ________ ________
▪︎ Motive is torture and mutilation
▪︎ Antisocial perpetrator
Acquaintance Rape
✯ Sexual Violence - Types of Rape (Based on Motive); ________ ________
▪︎ Victim and perpetrator have had previous interaction
▪︎ Use trust to initiate the rape
⇢ Perpetrator may say "we are going to have sex tonight". This is not about the sex. It is an act of violence and abuse. Typically about gaining power and control over the victim.
▪︎ Estimated 70-80% of Rapes are this type
⇢ Could be someone they work with, classmate, date-rape, spouse, or a family member.
Stranger Rape
✯ Sexual Violence - Types of Rape (Based on Motive); ________ ________
▪︎ Victim and perpetrator do not know each other
▪︎ May be sudden and unexpected attack
▪︎ More likely to threaten
⇢ With a gun or weapon
Rape
✯ Sexual Violence; Common Myths about ________
▪︎ Only "those kind" of women are raped
⇢ Women of all ages, cultures, types, professional, uneducated, etc.. can be raped.
▪︎ You can identify a rapist by stereotyping them
⇢ Rapist do not have a certain appearance or specific characteristics specific to them.
▪︎ Rape is driven by nature
⇢ Rape is an act of violence and it is not based on the sex.
▪︎ Women who drink and take drugs are setting themselves up to be raped
⇢ Putting blame on the victim. The perpetrator is responsible for his own actions. Regardless of the women's actions, she is not setting herself up to be rape.
▪︎ If the woman relaxes, it won't be so bad
⇢ Not something that the women enjoys or should enjoy. This act is not consensual.
▪︎ Women frequently lie about being raped
⇢ Statistically this is an infrequent occurrence. Do need to take their word for what they say if they come in with reports of being raped and document what they say.
▪︎ Fighting makes rape worse.
⇢ In many cases the fighting makes it more difficult to perform the act.
Drugs
✯ Sexual Violence; Roles of _____ in Sexual Assault
▪︎ May be used to sedate the victim
⇢ Date rape drugs. Commonly sedatives, hypnotics, and tranquilizers.
▪︎ Makes memory of the event difficult
▪︎ May have difficulty remembering details about the perpetrator and the event
⇢ Who was it that raped her? Who were they? Did they use any birth control?
Rape Trauma Syndrome
✯ _______ _________ ________
▪︎ The psychological response women go through after rape.
Disorganization
✯ Rape Trauma Syndrome - Acute Phase; ________
▪︎ From rape- 3 weeks
⇢ Can be shorter or longer depending on the women.
▪︎ Characterized by fear, shock, denial, sleep disturbances
▪︎ May appear composed or crying
⇢ May be composed in the ED because she is still in that shock/denial phase or she may be crying and sacred.
▪︎ May feel guilty, unclean
⇢ May try to douche to feel clean even if that takes the ability to find the perpetrator.
Denial
✯ Rape Trauma Syndrome - Outward Adjustment Phase; ________
▪︎ Appears "over it"
⇢ Now going back to her normal life. Going back to school and work.
▪︎ May move or increase security measures
⇢ Feels that if she changes her environment the problem will leave.
⇢ May want some form of self-protection like a gun to protect herself.
Reorganization
✯ Rape Trauma Syndrome; ________
▪︎ Following the Acute Phase and Outward Adjustment Phase.
▪︎ Feelings of depression/ anxiety
▪︎ May develop phobias
⇢ Example: If the rape happened outside of a bar she may become phobic of bars.
▪︎ May have nightmares
▪︎ Desire to discuss rape
⇢ May seek counseling.
▪︎ May report gyn problems
⇢ Such as pain with intercourse, disinterest in intercourse, menstrual problems
▪︎ Long term physiological/ psychological issues
⇢ Long term physiological example; If she had vaginal intercourse and birth control wasn't used she could be pregnant.
⇢ Psychological issues can include panic/anxiety disorders and PTSD.
Integration and Recovery
✯ Rape Trauma Syndrome; ________ and ________
▪︎ Women begin to integrate the rape experience into their life and go through recovery.
⇢ Many times during this period the women will become an advocate against sexual assault and advocating for women's rights.
Silent Reaction
✯ Rape Trauma Syndrome; ________ ________
▪︎ When a women is silent after a rape and never seeks any care or discusses it. This can impede and effect the way she feels after the rape.
PTSD (Post Traumatic Stress Disorder)
✯ ________
▪︎ There are 4 components needed in order to have this disorder
▪︎ Exposure to traumatic event
⇢ In this case a rape
▪︎ Reexperience traumatic event through thoughts/ flashbacks/Nightmares
▪︎ Avoid stimuli associated with trauma
⇢ Patient may avoid sexual intercourse, places that remind her of where it happened, or places that remind her of the perpetrator
▪︎ Persistently heightened awareness
⇢ May have difficulty going to sleep, phobias, severe anxieties associated with this, etc..
▪︎ Q: How does this affect healing?
⇢ It can impede the women's ability to heal. How can she integrate this into her life if she is in this condition. Going to try and work with her as a goal to get through this so she can be on her road to healing.
SANE (Sexual Assault Nurse Examiner)
✯ Sexual Violence Nursing Management: _______
▪︎ Many emergency departments have this type of specially trained nurse available to work with patients who have gone through sexual violence.
▪︎ Rape is a trauma and crime
⇢ We treat this physiologically, psychosocially, and legally it is a crime.
▪︎ Obtain history
▪︎ Prevention of STIs
⇢ Therapy will take place for this. Will often order prophylactic antibiotics to help prevent some STIs under these circumstances. Since gonorrhea, chlamydia, and some other STIs can be treated with antibiotics.
▪︎ Prevention of pregnancy
⇢ Emergency contraception may be ordered. It can be used pretty effectively 72-96 hours, depending on which form it is, after the incident.
▪︎ Collect evidence:
⇢ Clothes
・We'll label it. Presence of fluid or semen may be present. However, this does not indicate any sexual assault occurred. This is not up to nurses to decide. It's up to legal authority.
⇢ Swabs of fluid
・Or any secretions. Can be in the vaginal area or mouth as well. Often times there is sexual dysfunction on the part of the perpetrator. Sometimes they may use a condom and we may not find anything.
⇢ Hair and fingernail scrapings
・Looking for loose pubic hairs or potentially hairs that may have transferred. The woman's hair & any loose hairs will be collected for testing.
・If she was fighting the rape she may have tissue or cellular debris under her nail that belongs to the perpetrator. This can be helpful in identification.
⇢ Blood samples
・To see if there are any infections.
⇢ Urine samples
・If she was drugged what did they drug her with.
⇢ Photographs
・If there was any additional trauma. Need consent to do so.
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