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For this weeks assignment, select one of the diagnoses that we are studying this week

Health Science

For this weeks assignment, select one of the diagnoses that we are studying this week. Present the epidemiology, morbidity, (and mortality if appropriate) pathophysiology, subjective and objective presentation, differential diagnosis, and clinical management of the disease you have selected. Support your work with evidence from the literature. Use high level evidence to support your discussion. Do not use mid or low level evidence including, but not limited to, patient information portals (Mayo Clinic Online, Medscape, Web MD), or diagnosis associations (Arthritis Foundation, American Lung Association, American Diabetes Association).

 

Chapter 13 Intimate Partner Violence Margaret M. Glembocki Kerri D. Schuiling Definitions (1 of 2) • IPV: the victimization of a person with whom the abuser is currently or has been in an intimate, romantic, or spousal relationship. • Adolescent relationship abuse: pattern of repeated acts in which an individual physically, sexually, or emotionally abuses another person whom the abuser is dating or in a relationship with, regardless whether the relationship is opposite or same sex, and either one or both parties are minors. – Abuser’s goal is power and control over the victim. Definitions (2 of 2) • Domestic violence: sometimes used instead of IPV but includes other forms of violence such as elder abuse and child abuse. • Victim: criminal justice system term that describes an individual who has experienced a reported assault. • Survivor: community-based women’s advocacy program term for women who have experienced IPV. • Patient: health care term for individuals who are seeking care due to IPV. Epidemiology • IPV accounts for 22% of all violent crime experienced by women living in the U.S. • 25%–33% of all women will be physically assaulted by an intimate partner within their lifetime; 9% will report being raped; 17% will report sexual violence other than rape; and 48% will report psychological aggression. Types of IPV (1 of 2) • Physical violence: the intentional use of physical force with the potential for causing death, disability, injury, or harm. • Sexual violence (five categories): (1) rape or penetration of the victim, (2) victim was made to penetrate someone else, (3) nonphysically pressured unwanted penetration, (4) unwanted sexual contact, and (5) noncontact unwanted sexual experience. Types of IPV (2 of 2) • Stalking: a pattern of repeated, unwanted attention and contact that causes fear or concern for one’s own safety or the safety of someone else (e.g., family member or friend). • Psychological aggression: the use of verbal and nonverbal communication with the intent to harm another person mentally or emotionally, and/or to exert control over another person. Sexual and Reproductive Coercion (1 of 2) • Separate category of IPV that involves the use of power and control related to reproductive health. • Two types of reproduction coercion – Sabotage of contraceptive methods: promoting pregnancy by interfering with contraception. – Pregnancy coercion and pregnancy pressure: acts of violence or threatening behavior if a partner does not observe the perpetrator’s wishes about continuing or terminating a pregnancy. Sexual and Reproductive Coercion (2 of 2) • Sexual coercion includes behaviors that pressure a partner to engage in sex without using physical force. • All patients who experience sexual and reproductive coercion are at high risk for long-term health issues such as alcohol or drug abuse, sexually transmitted infections, HIV, and risky sexual behaviors. Interventions for Sexual and Reproductive Coercion • Plan for care should include – differential diagnosis of pregnancy coercion and IVP; and – alternative resources and programs. • Create a safe environment. • Inform the patient about mandatory reporting laws. Theories of IPV • Two theories on IPV: general family violence perspective and the feminist perspective. – Family violence theorists view IPV as an aspect of the larger issue of family violence. – Feminist theories treat IPV as an issue of gender and the patriarchal domination of men over women. • Walker cycle of abuse – – – – Tension-building phase Acute-battering incident Reconciliation phase Calm or loving phase Health Impacts • Individuals and communities are affected. • High economic cost, significant collateral health-related impacts, and long-term effects. • Clinicians should explore the possibility of sexual assault or forced sexual intercourse for all women presenting with gynecologic symptoms, particularly multiple or persistent gynecologic symptoms. Risk Factors of IPV • Clinician should stop the cycle of abuse. • Awareness of risk factors helps clinician identify at-risk women. See Table 13-1. Screening and Health History • Primary care settings during periodic examinations at all visits for new concerns. • Most battered women do not come to healthcare facilities with obvious trauma or injuries. • Obtain focused history; perform systematic physical examination. • Be supportive. Woman who has been abused is not always forthcoming about it. Screening Tools • Screen periodically, including first prenatal, each trimester, and postpartum visits. • Multiple tools are available. – Abuse Assessment Screen (AAS). See Box 13-1. – Campbell’s Danger Assessment (DA). See Box 13-2. – Sheridan’s Harassment in Abusive Relationships: A Self-Report Scale (HARASS). See Box 13-3. Screening for TBI • Traumatic brain injury (TBI) can be caused by IPV. • HELPS screening tool can indicate more screening is needed. – – – – – Hit in the head or face? Emergency room treatment? Loss of consciousness? Problems concentrating or remembering? Sickness after injury? Physical Examination (1 of 2) • Conduct like any other exam of adult female. • Careful attention to signs of injury, past and present; measure all bruises. • Most injuries affect face, chest, breasts, and abdomen. • If sexual violence occurred, include pelvic exam. • Assess immediate safety and provide referrals. Physical Examination (2 of 2) • Thorough exam – – – – Mental health Neurologic system Gastrointestinal system Sexual and reproductive health Strangulation • Strangulation: reduction of blood flow to and from the brain due to external compression of the blood vessels in the neck. – Common and dangerous form of IPV that causes a variety of health problems and is difficult to detect. – Immediate loss of consciousness, loss of sphincter control, and raspy voice. – Delayed symptoms include petechiae on the face and eyes, bruising, bleeding from the ear, and other mental or physical health problems. Documentation • Document all findings in patient’s record using correct medical forensic terms. • IPV histories must be thorough and objective. • Required components for documenting injuries – Size – Location – Complete description of wound or injury • Photograph evidence of injuries. Use body maps and diagrams. Management • Base clinical intervention on four principles. – – – – Empowerment Childbearing cycle-stage specificity Abuse-stage specificity Cultural competence • Provide encouragement to seek help. Special Populations (1 of 2) • Adolescents: 9% report IPV. • Sex trafficking of adolescents: signs include history of multiple partners, frequent visits for reproductive health conditions, and frequent testing for sexually transmitted infections or pregnancy. • Women veterans: routine IPV screening and comprehensive IPV care within the Veterans Health Administration. Special Populations (2 of 2) • Pregnant women: violence can increase or decrease during pregnancy; abuse can affect the fetus. • Women with disabilities: may be reliant on abusive partner; shelter or agency must be able to accommodate women with disabilities. • Elderly women: 500,000 to 1.5 million elders subjected to abuse and neglect each year. Influences of Culture • Cultural awareness: process that allows the clinician to interact sensitively with persons from other cultures. • Cultural skill: process in which the clinician learns how to assess the woman’s cultural values, beliefs, and practices without solely relying on written “facts” about a specific cultural group. • Different cultures may see IPV differently. • Screening tools should be adapted to other cultures. Prevention • Encourage change so violence toward women is not accepted. • Place priority on development of healthy relationships across the life span, with special focus on children and adolescents. Violence Against Women Act • VAWA addresses domestic violence, dating violence, sexual assault, stalking, and human trafficking. • VAWA reauthorized every 5 years. • 2013 revision has many guidelines for Native Americans; lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals; and victims of human trafficking.

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