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48 Cards in this Set
- Front
- Back
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Define battering
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the actual or threatened physical injury
-intimidation through an insidious and repetitive process |
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What are some forms of battering
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sexual, physical, psychological
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What is the prevalence of DV
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>1/3 of women
50% of murdered women are killed by male partners 12% of murdered males are killed by female partners A victim every 11 seconds |
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3 characteristics of a batterer
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usually male
known at a personal level was abused or witnessed abuse as a child |
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What are some reasons that women stay in an abusive relationship
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protect child
woman may think she can change her abuser the abuser will revert back to the way he was |
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What are some predictors of DV
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Witnessing violence growing up
abused as a child use violence or force to solve problems Jealous of other relationships regardless of sex |
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Describe the consequences of physical injuries on a battered woman
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death
low quality of life isolation |
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Discuss the approach to the patient in ascertaining the presnse of abuse as well as the patients immediate danger
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Screen everyone!
Ask: who lives at home? Are you or have you ever been in a relationship in which you felt uncomfortable, were harmed or were afraid? are you afraid of your current spouse/partner? Has your current spouse/partner ever hurt your children? How about your pets? Are there guns in the house? Encourage making a safety plan with the patient |
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What is the clinicians role in the tx and management of Domestic abuse
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The clinician must screen everyone
Must provide resources for the patient that can remain hidden Encourage making a safety plan with the patient |
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Resources for a victim of DV
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hotlines
social worker police ?? |
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Define what it means to be LBGT
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Gay, lesbian, and bisexual are the ways in which people identify themselves and is different from sexual behavior
Transgender: born male or female and is taking the steps to become the other sex |
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Explain the myths, labels and stereotypes associated with being LGBT
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?
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What are the stages that an individual goes through when deciding to come out
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pre-coming out
coming out exploration first relationship integration |
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Pre-coming out
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child may not yet know what being LGB is but they associate with a specific gender
They are not consciously aware of same-sex feelings |
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Coming Out
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individuals acknowledge their homosexual feelings which may be a confusing homosexual thought or fantasy but may not understand the meaning
age 13-18 |
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Exploration
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experimentation with their sexual identity
May have a developmental lag in sexual adolescence |
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First Relationship
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an intimate and stable committed relationship and learning how to function in a same sex relationship
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Integration
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A way of acquiring a positive homosexual identity that ususally takes 10-14 years about the the first awareness of same-sex feelings
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What are 5 resources and support groups that can be helpful for individuals that are LGBT
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?
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What is the appropriate role and attitude of health care providers in treating LGBT patients
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We cannot assume heterosexuality and we must address sexual behaviors and identity
We must try to detect substance abuse problems and mental illness Address confidentiality Provide LGBT info in the waiting room and exam room Display LGBT themes on the walls Distribute Free condoms Post a nondiscrimination statement that includes LGBT individuals Alter hx forms and oral hx taking to improve knowledge of patients sexuality and signal interest and a nonjudgmental attitude |
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What is the prevalence of homosexuality in the US
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in 1994 9.1% of men and 4.3% of women in the US reported engaging in same-sex sexual behavior since puberty and 2.8% of men and 1.4% of women self-identify as gay or lesbian
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What is sexual orientation continuum
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The term encopasses emotional and physical experiences which includes sexual desire, behavior, and identity
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Describe the clinical concerns associated with each stage of the "coming out" process
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Not in the book?
Depression? Sexual promiscuity? Substance abuse? Risky behavior? |
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What are some screening questions during the medical hx concerning sexual orientation
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are you sexually active?
are you sexually active with men, women, or both? Have you ever had sex with a man (woman)? Do you have any safe sex questions? With men, women, or both? How do you identify your sexuality? Lesbian, Gay, Bisexual, Transgender, heterosexual, celibate, not sure/don't know If you are LGBT, are you out to your friends? |
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Identify obstacles to health care that a transgendered patient might encounter
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Discuss health risks unique to the LGBT community
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possible inc rates of breast cancer and ovarian cancer in women
gay men are at an inc risk of anal cancer esp if they smoke, have HPV, and multiple sexual partners HIV/AIDS greater risk for the receiver WSW are at risk of herpes, HPV, trichomonas, and bacterial vaginosis Gonorrhea and Chlamydia are rare (unless they had recent sex with a male partner) There have been 4 cases of female-to-female orogenital transmission of HIV |
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What is a health care disparity?
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a distinct pattern of differences in health status and well-being across population groups
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What is health inequality
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patterns of differences in health care access, quality, utilization of health services, satisfaction or outcomes
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How do patient factors influence accessto and the use of health care services
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difficulty communicating (low income and less educatio)
patient preferences treatment refusal Care seeking behaviors and attitudes differences in clinical presentation of sxs |
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How do provider factors influence the use of health case services
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bias, discrimination, and racism
clinical uncertainty beliefs/stereotypes about behavior or health of patients |
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What are some of the health systems- level factors that influence access to and the use of health care services
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lack of interpretation and translation services
time pressure on health professionals Available and mix of health providers Fragmentation in systems of financing and delivery of care |
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Who is at an inc risk of health care disparity
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age/generational minorities (children, adolescents, and elders)
Developmental/acquired disability Religion/spirituality Racial/ethnic minorities SES Sexual Orientation: LGBT Indigenous heritage National origin (refugees) Gender |
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What are some actions that health care professionals can take to eliminate health care dispartities
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Develop cultural competence
Medical interview technique For LGBT pts: confidentiality, be upfront, educate youth on safe sex practices, be open For adults with disabilities: respect pt as a person and focus on the person not their disability; make sure to apologize if you make a mistake |
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What are some barriers that influence access to health services for sexual minorities, socio-cultural group, and ethnic populations
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-Poor communication with docs
-Mistrust of healthcare system (esp AA) -Distrust of Western Medicine (esp Hispanics) -Poor communication, cultural barriers, prefer native healers and self care (Asians) -avoidance of health care (LGBT) -Lack of access to equipment and low confidence levels (disabled pts) -Religious issues (ObGyn, organ transplants, disability, pain) |
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PA Act 148
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confidentiality and informed consent about HIV screening and breaking confidentiality
Focus: testing, prevention, education, and confidentiality |
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Some phases for sexual history and risks of STIs
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Are you sexually active?
Do you use safe sex methods? Have you ever had an STI? Which one(s? and When? You can get an STI by have sex orally, anally, vaginally, and via sex toys You can get HIV through the methods above, and blood and breast milk and needles |
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How are STIs transmitted?
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oral, anal, vaginal, sex toys, sharing needles, blood, breast milk (HIV),
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What are some barriers used to prevent STIs
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condoms (male and female), dental dam, abstain
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Describe risk factors for contracting HIV and STIs
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HIV is transmitted through the exchange fo bodily fluids: during unprotected sex (vaginal/anal), by direct inoculation of the virus (contaminated needles, blood products, or transplanted organs), mother to child transmission during preggers, birth, and breast feeding.
Multiple partners High risk sex |
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Discuss the health care workers approach to a patient at risk for or dx with HIV
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explain transmission
discuss ways to prevent contraction of STI If dx explain the next steps- tx, mental health, counseling, community resources, importance of notifying all contacts, how to prevent transmission to others |
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Incidence of alcohol abuse in US
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8-10% of population
Any alcohol use: 51.6% (129 million) Binge Use: 23.3% (58.1 million) Heavy Use: 6.9% (17.3 million) |
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Incidence of substance abuse
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20.1 Americans aged 12 and over were current illicit drug users (8% of the population aged 12 or older)
Pot: 15.2 million Hallucinogens: 1.1 million psychotherapeutics: 6.2 million cocaine: 1.9 million heroin: 0.2 million inhalants: 0.6 million |
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What is the inter-relationship between psychopathology and substance abuse
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Pts with mental disorders have an inc risk for substance abuse
Pts with substance abuse disorders have an inc risk for mental disorders |
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What are some screening tools
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CAGE
AUDIT (alcohol only) SSI (alcohol and other drugs) TWEAK (preggers) GAIN (teens) CAGE-AID (alcohol and drugs) |
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What are alcohol withdrawal symptoms
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delirium tremens, seizures, excitoneruotoxicity, or death
CNS withdrawal: hyper-excitable vomiting or shaking |
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What are cocaine and amphetamine withdrawal symptoms
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crash with craving: fatigue, lack of pleasure, anxiety, irritability, sleepiness, agitation or extreme suspicion
(no vomiting or shaking) amptheamines: more intense, depression, fatigue, vivid unpleasant dreams, insomnia, or sleeping too much, inc appetite and agitation |
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Goals of detox
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provide a safe withdrawal from drug dependence and enable the patient to become drug free
time to adjust without drugs psychological readjustment |
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Detox protocols
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measure the time of withdrawal signs or symptoms
substitude long-acting drugs for short-acting drugs of addiction |
