Iv Test 1 Psych Dom Violence. Sex Assault

Front 1

Profile of victim of domestic violence?

Back 1

- low self-esteem
- learned helplessness
- isolated from family
- accepts blame for batter's actions

Front 2

Profile of abuser?

Back 2

- low self esteem
- isolated from others
- jealous

Front 3

Cycle of battering; the 3 phases?

Back 3

Phase 1: Tension building
Phase 2: Acute Battering incident
Phase 3: Honeymoon

Front 4

Domestic violence -- effects on children?

Back 4

- children learn what they see
- get psychosomatic illnesses
- turn to drugs/alcohol
- blame themselves

Front 5

How should nurse treat the battered woman?

Back 5

- create supportive environment
- Separate from spouse
- Do focused assessment, ie hx of injuries, etc
- be direct: Ask, "do you have fears for your safety?"
- Doc injuries, asessment q's and responses
- regardless of responses, provide referrals ie Jersey Battered Women's Service

Front 6

Are most rapes impulsive acts ?

Back 6

False, most rapes are well-planned events

Front 7

Is the primary motive for rape sexual?

Back 7

False, most rapists are married or have sex partners

Front 8

Are most rapists strangers to the victim?

Back 8

False, over 50% of cases, the rapist knows the victim

Front 9

Date rape?

Back 9

forced sex where rapist is known to victim

Front 10

Marital rape became a crime in all states in 1993. T or F

Back 10

T

Front 11

Define:
- Anger rape
- Power rape
- Statutory rape

Back 11

- Anger rape- excessive brutality; unplanned and impulsive; motivated by revenge
- Power rape- intent to command and master another person
- Statutory rape- sex betw man older than 16 and woman under age of consent (which varies by state from 14-21)

Front 12

What are 2 diff behaviors shown by rape victims brought to ER?

Back 12

- Expressed response pattern- where victim expresses fear, anger, cries, sobs,etc
OR
- Controlled response pattern- feelings are masked or hidden and victim is calm and subdued

Front 13

Rape victims can have short-term, long-term effects and other reactions such as:
A- Compounded Rape Reaction?
B- Silent Rape Reaction?

Back 13

A- addl symptoms: depressed and suicidal, substance abuse, pschotic behavior
B - victim tells no one of attack and anger is suppressed until another sexual crisis reactivates the unresolved feelings

Front 14

Describe the nursing interventions for rape victim brought to ER?

Back 14

1) COMMUNICATE: You are safe here; I'm sorry it happened; It's not your fault
2) EXPLAIN every assessment procedure and conduct these in caring, nonjudgemental way.
3) Ensure PRIVACY by limiting caregivers
4) ENCOURAGE client to TALK but don't probe
5) DISCUSS support, assistance, and referrals
6)TREAT physical injuries
7) DOCUMENT

Front 15

Is suicide a behavior or disorder?

Back 15

behavior

Front 16

95% who attempt or commit suicide have a diagnosed mental disorder such as:
- major depression and bipolar
- substance abuse, schizoid

Back 16

T

Front 17

Elderly are double the
suicide risk vs teens; white men over 80 are at greatest risk
- In men, risk rises after 65
- In women, fairly constant thru life, declines after 65

Back 17

T

Front 18

Describe the 5 levels of suicide behavior?

Back 18

1- SUICIDAL IDEATION- freq & specific thoughts of death and ways to die
2- PLANNING- logical plan in place to kill oneself
3- GESTURE- behavior or activity that is dangerous or harmful, but not potentially lethal ( ie, taking non-lethal pill overdose)
4- ATTEMPT - clear, self-destructive actions with good probability of success that did not result in death.
5- SUCCESSFUL SUICIDE

Front 19

- Women attempt more suicide, men succeed more often. ( men 70%, women 30%)
- Whites are at highest risk
Suicide rate for single persons is twice as high as married
- Divorced, sep, or widowed have suicide rates 4 - 5x higher than married
- People in highest & lowest are at higher risk than middle class
- Suicide rates are higher among docs, dentists, musicians, police, lawyers, insurance agents
- Religious people are less likely to attempt suicide
- Higher risk with family hx, esp same-sex parent
- Higher risk for persons who have had a prior attempt
- loss of loved one through death or sep, lack of employment, financial worries increase suicide risk

Back 19

T

Front 20

Other risk factors for suicide
- pts on antidepressants- early in trmt
- insomnia
- alcohol abuse
- psychosis with command halluciations ( that tell pt to kill himself or others)
- chronic painful or disabling disease.

Back 20

T

Front 21

What are interventions for high suicide risk pt?

Back 21

- ASK client directly re suicidal thoughts, etc.. don't beat around the bush
- CREATE SAFE ENV - remove suicide risks such as belts, shoelaces
- AGREE TO CONTRACT W PT- written or verbal, ie pt agrees if suicide thoughts, then he'll tell nurse 1st before acting on it
- MAINTAIN CLOSE OBSERVATION - 1 on 1; check every 15 min; have room close to nurse station
- SPECIAL CARE W MEDS ADMIN- so pt actually takes them vs "cheeking" them
- FREQ IRREGULAR ROUNDS- so pts can't figure out when no one's around to kill themselves
- ENCOURAGE EXPRESSION OF FEELINGS

Front 22

What is #1 nursing intervention for suicidal pts?

Back 22

Establish therapeutic rel'ship

Front 23

List expected outcomes for suicidal pt upon discharge?

Back 23

- decreased feelings of hopelessness upon discharge
- pt identifies coping mechanisms
- no harm to self
- pt sets realistic goals for self and future
-pt able to express optimism and hope for future

Front 24

Mentally ill pts bill of rights is posted in every psych ward
- What are their Bill of Rights?

Back 24

Mentally ill pts still maintain:
- their civil rights
- client consent is required since historically mentally ill pts were abused
- Freedom from harm - remember these pts had forced lobotomies
- treated with dignity & respect
- Confidentiality
- participate in care planning; pt must sign that they agree w plan
- that a due process is followed in civil commitment, ie pt can have lawyer, family member available so they're not being railroaded.
- pt has right to treatment; must document that therapy is occurring; didn't nec occur before the 60's
- pt has right to refuse trmt
- pt must give informed consent
- strict policy to follow re restraint & seclusion

Front 25

What's most important concept re commitment of mentally ill pt?

Back 25

- Least restrictive alternative: means providing treatment in least restrictive environment using the least restrictive treatment;
ex: if pt comes to ER because he threatened to kill himself, and informs screener that he realizes he needs help and is willing to go to the hospital; the screener would put you in as voluntary rather than involuntary because this is less restrictive env

Front 26

Pts have a right to receive unopened mail, but not necessarily allowed to send unopened mail if pt is making threats; if pt has hx of making threats, the nurse would dial the phone number & you would sit with them

Back 26

T

Front 27

what is an emergency commitment?

Back 27

- an involuntary, 72 hr psych eval; we as nurses will see this most often; typically pt is brought into ER; screeners see pt; must document why pt is there and there must be direct evidence (can't be hearsay)
- in those 72 hrs, another psychiatrist must assess the pt and fill out 2nd set of papers to extend stay for usually another 7 days, may be 14 days
- Then due process occurs where a judge from county courthouse comes to hosp and reads psychiatrist's rept and listens to pt who can be represented by lawyer, and then the judge makes the decision whether or not to keep the pt involuntarily committed
-

Front 28

What are the 3 criteria for emergency or involuntary commitment?

Back 28

- danger to self
- danger to others
- inability to care for yourself due to mental condition

Front 29

A judge can also send you to a 72 hr evaluation; if pt has been arrested and is pleading insanity; if there are active charges against pt, pt can't go to regular hosp, but to a forensic psychiatric institute

Back 29

T

Front 30

Pt must give 48 hrs notice in writing before being discharged if voluntary commitment

Back 30

T
health care team must make decision: does pt need to be screened and move to an involuntary status, could they discharge them, or discharge them AMA (against medical advice)

Front 31

What is the legal basis that allows a judge to commit a pt?

Back 31

parens patriae - ie the state can act like a father to protect those who can't care for themselves

Front 32

Privileged communication- law allow some info given to professional from client to remain secret during litigation.
However, the privilege whether or not to release the info belongs to the client; the nurse can't decide, only the client
- these laws exclude any communication re: abuse, communicable disease (pt who got on plane w TB), public safety, commission of felony

Back 32

T
Duty to Warn (Tarasoff 1976)- protective privilege ends where the public peril begins
- you must warn someone at risk
Resp of nurse when hearing this info: immediate documentation and notification to health team

Front 33

In an emergency (danger to self or others), restraints or seclusion may be initiated without a doctor's order.
- However, within 1 hr a verbal or written order must be obtained.
- if under 18, order must be written
- if over 18, can be written or verbal order
- chemical restraints (meds) may be given to involuntary pt against their wishes if emergency (danger to self or others) but must have an order

Back 33

T