Family Violence/Gender Dysphoria
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What are the 5 types of abuse?
What is family violence? Spouse abuse?
- Family violence: physical injury to or mental anguish by one family member to another
- the deprivation of essential services by a caregiver
- Spouse abuse: the mistreatment or misuse of one spouse by the other, can range from shoving and pushing to choking and battering
What is the prevalence and common comorbidities of violence?
- prevalence: half of all americans have experienced violence in their families
- Comorbidity: secondary effects of violence; anxiety, depression, suicidal ideation
What are some statistics of violence?
- more common in intimate partners than immediate family members
- current or former bf/gf committed most violence
- more common in female victims
What does violence require?
a perpetrator, vulnerable person, crisis situation
What are the characterisitcs of a vulnerable person? (women)
- pregnancy may trigger or increase violence
- violence may escalate when wife makes move toward independence
- greatest risk for violence when the women attempts to leave the relationship
What are the characteristics of a vulnerable person? (children)
- younger than 3
- perceived as different
- remind parents of someone they dont like
- product of an unwanted pregnancy
- interference with emotional bonding between parent and child
What are the characteristics of a vulnerable person? (older adult)
- poor mental status or physical health
- dependent on perp
- female, older than 75 years, white, living with a relative
- elderly father cared for by daughter he abused as a child
- elderly woman cared for by husband who has abused her in past
What are the characteristics of perpetrators?
- consider their own needs more important than the needs of others
- poor social skills
- extreme pathological jealousy
- may control family finances
What is the cycle of violence?
- Tension building stage: Man (tolerance for frustration declining, angry with a little provocation, increased jealousy) Woman (very nurturing, complint, stays out of way, rationalizes his anger, "He's under so much stress")
- Acute battery stage
- Honeymoon stage: repeat tension-building
How should you assess a suspected violence victim?
- Always do it alone!!
- Should include: violence indicators, level of anxiety and coping responses, family coping patterns, support systems, suicide and pr homicide potential, drug and alcohol use
What is important for a nurse to do regarding violence and self assessment?
- Nurse's response to violence
- frustration, sad, helplessness
- Anger, blaming victim, fear
- Nurses need objectivity and self-assessment
What planning is necessary for violence?
- guidelines developed by: the joint commission and the nursing network to violence against women
- (The general tolerance of violence in America must be addressed if long-lasting changes are to be made)
What are the nursing diagnoses for violence; Outcomes?
- Diagnoses: risk for injury, risk for violence
- Outcomes: Abuse protection; abuse recovery
What are the basic level nursing interventions for violence?
- Basic level: support family and individual- safe plan- escape and safe house
- Case management
- Milieu therapy: stabilize home situation, violence- free; economic support
- Self care activities-goal is empowerment
- Health teaching: new parents, teenage parents attitude toward infant
What is rape?
forced sexual intercourse including both psychological coercion as well as physical force. forced sexual intercourse means penetration by the offender(s). Includes attempted rapes, male as well as female victims and all sexuality. Attempt verbal threats of rape.
What is rape-trauma syndrome?
- A variant of PTSD
- -Acute phase: immediately after assault. Symptoms of acute phase: shock, disbelief, disorganization in lifestyle, confusion, poor concentration, poor decision making, somatic, hysteria, crying, smiling DENIAL, gives person time to prepare for reality (protections action)
- -Long-term reorganization phase: 2 or more weeks after assault
- reactions: intrusive thoughts of event, flashbacks, dreams, insomnia, anxiety, ood wings,
- Pobias/fears of: being indoor/outdoor, being alone/crowds
- Sequelae: anxiety, depression, suicide, difficulty with daily functioning, sexual dysfunction, somatic symptoms
What is the application of the nursing process in rape? (assessment)
- gather data from victim, accompanying people, police.
- Ascertain the level of: client anxiety
- coping mechanisms, support systems, signs and symptoms of emotional trauma, signs and symptoms of physical trauma
What is the application of the nursing process in rape? (planning/outcomes)
- diagnosis of: rape trauma syndrome
- demonstrate degree of trust in primary nurse
- accept care of physical injuries
- initiate behaviors consistent with grief response
What are the basic interventions for rape victims?
- communicate the following: I am very sorry this happened to you; you are safe here; I am very glad you are alive; what can i do to help you right now
- most important: you are not to blame. you are a victim. It was not your fault. Whatever decisions you made at the time of the assault were the ones because you are alive
What is a sane nurse?
- sexual assault nurse examiner
- clinical forensic registered nurse
- specialized training to provide care to sexual assault victims
- physical and psychosocial exam
- collection of physical evidence
- provide therapeutic interactions to minimize trauma and initiate healing
- coordinate referrals
- involved in judicial processing of sexual assault
- interventions: tx and documentaton of injuries; photographs of injuries, written descriptions, samples, urine screen for pregnancy and drugs; maintain proper chain of evidence, *ensure samples are labeled, sealed, refrigerated and locked
- tx and evaluation of STD's ( counseling and prophylactic antibiotcs
- Pregnancy risk eval and prevention (Ovral-morning after pill)
What resources are available for rape victims
- website: www.rainn.org; rape, abuse, and incest national network; (national largest anti-sexual assault organization)
- hotline: 1-800-656-HOPE
What are the types of sexual disorders?
Paraphilias: exhibitionism, fetisism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism
What is exhibitionism?
- recurrent, intense sexual urges behaviors or sexually arousing fantasies of at least 6 months involving the exposure of one's genitals to an unsuspecting stranger
- Almost 100% of cases, perps are males, victims are female
- Most have rewarding sexual relationships with adult partners
What is fetishism?
- intense sexual urges, behaviors or sexually arousing fantasies of at least 6 months duration involving the use of a nonliving objects (usually objects associated with human body e.g. shoe, stockings gloves)
- Fetish objects utilized during masturbation or sexual activity to produce excitement
- Transvestic fetishism: cross-dressing
- Problems arise: when the object creates more arousal that partner
What is frotteurism?
- intense sexual urges, behaviors or fantasies of at least 6 months duration involving touching and rubbing against non-consenting person.
- Sexual excitement is derived from actual touching or rubbing not from coercive act; usually males
- fantasizes relationship with victim while rubbing genitals against body or touching victims genitalia
What is pedophilia?
- intense sexual urges, behaviors or sexually arousing fantasies of at least 6 months duration involving sexual activity with a pre-pubescent child
- Age of molester is at lest 16
- majority of child molestations involve genitalia fondling or oral sex. Vaginal or anal penetration of child usually in cases of incest
- May involve undressing the child, looking, exposing themselves, masturbating in the presence or touching child. Onset usually occurs in adolescence, chronic course
What is sexual masochism?
- intense sexual urges, behaviors or sexually arousing fantasies of at least 6 months involving the act of being humiliated, beaten, bound, or otherwise made to suffer (being raped, being restrained or beaten by partner)
- may result in death if involving sexual arousal by oxygen deprivation
- Chronic disorder; may progress to point where person cannot achieve sexual satisfactions without
What is sexual sadism?
- intense sexual urges, behaviors, or sexually arousing fantasies of at least 6 months duration involving acts in which the psychological or physical suffering/humiliation of the victim is sexually exciting
- Activities may be fantasized or acted on with a consenting or non-consenting partner
- sexual excitement occurs in response to suffering of the victim
- Examples: restraints, beating, burning, raping, cutting, torture even killing
- Chronic illness-worse over time
What is voyeurism?
- Intense sexual urges, behaviors or sexually arousing fantasies of at least 6 months duration involving the act of observing an unsuspecting person who is naked in the process of disrobing or engaging in sexual activity
- sexual excitement is achieved through act of looking, no attempts at contact
- "peeping tom", masturbation may occur at them of incident or later as the person fantasizes about the act. onset usually before age 15; usually chronic
- Most enjoy satisfying relationship with adult partners
What are the paraphilias NOS?
- telephone scatologia
- internet sex
What is the tx for paraphilias?
No therapy needed if: consenting adults, not illegal, not harmful to partner
(peeping tom and pedophilia always illegal)
What is gender identity? core gender identity?
- the sum of those aspects of personal appearance and behavior culturally attributed to masculinity or femininity
- Core gender identity: the deep inner feeling a child has about whether he or she is a male of female
What are DSM-5 criteria for gender dysphoria?
- An individual's strong and lasting cross-gender identification and their persistent discomfort with their biological gender role. This discomfort must cause a significant amount of distress or impairment in the functioning of the individual
- Unique condition
- Gender incongruence
What is the tx for gender dysphoria?
- Reassignment surgery
- Tx secondary problems (depression, anxiety, decreased self esteem)
What's the prognosis of gender dysphoria?
- Long-term follow up studies have shown positive results for many transsexuals who have undergone gender reassignment surgery
- Significant social, personal, and occupational issues may result from surgical sex changes. Psychotherpay
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