Substance Abuse and Domestic Violence – Flashcards

Patient advocate -"Advocacy is the heart and soul of nursing practice, nurses believe they hold the patients' safety and care in their hands,"

*Alcohol -most used and abused drug -ED visits related to alcohol consumption have almost doubled since early 2000s *Illicit drugs -9.5% of Americans 12 or older report current illicit drug use

-Excessive Consumption: increased effects of morbidity and mortality -Chronic Alcohol: linked to liver disease -Heavy drinking/ binge drinking: increased risk of atrial fibrillation -Up to one drink/ day increases risk of breast cancer by 4% -HTN is a common detrimental effect

-Marijuana: most common -Cocaine/ crack -Heroin -Hallucinogens -Inhalants -Prescription meds used non-medically: second most common -Impacts health, relationships, future jobs, school, career -3 most commonly used prescription opioid: 1. Oxycodone 2. Hydrocodone 3. Methadone

-8.5% aged 12 or older -Alcohol dependence/ alcoholism *chronic progressive disease that is treatable *Not curable -Accurate diagnosis is needed for appropriate treatment

*Pregnant Women: -18% drink during 1st trimester -4.2% during 2nd -3.7% during 3rd -no amount is determined safe -recommended all women who are pregnant should be screened for alcohol use *Fetal Alcohol syndrom

*Aging adult: 65 or older *Prevalence of current use decreases with age *Older adults have increased risk of alcohol use... -liver metabolism and kidney function decrease -Less tissue mass, so it stays in the blood -Poly-pharmacy -Increased risk for falls, depression, GI problems

-May be unreliable: consider the disposition of the patient -Private, confidential, non-judgmental environment -Alcohol use screening -Do you sometimes drink beer, wine, or other alcoholic beverages -If yes, how many times in the past year have you has five or more drinks a day (men) or four or more drinks a day (women). -Patterns

- 12 oz beer or cooler - 8-9 oz of malt liquor - 5 oz of table wine - 3-4 ox of fortified wine - 1.5 oz of spirits - 3 oz martini= 1 standard drink

*Determine if there is a maladaptive pattern of use causing impairment or distress... *In the past 12 months has your drinking repeatedly caused... -shown tolerance -shown signs of withdrawal - kept drinking despite problems - spent a lot of time drinking or anticipating or recovering -spent less time on other matters or activities *Also ask about illicit drugs ( avoid word illicit)

-Have you ever thought you should CUT down on your drinking? -Have you ever been ANNOYED by criticism of your drinking? -Have you ever felt GUILTY about your drinking -Do you drink in the mooring? ( EYE-opener) *possible alcohol if 2 or more

*Screening Women ( pregnant) -tolerance -worry eye-opener -amnesia -kut down * 2 points for each tolerance and worry * 1 point for everything else

-Short Michigan Alcoholism Screening Test-geriatric -10 questions -Yes or no answers - yes is 1 points; no is 0 points - 2 or more points= alcohol problem and need for further assessment

*Alcohol use disorders identification Test *Covers 3 domains of drinking - Alcohol consumption ( q's 1-3) -Drinking behavior/ dependence (q's 4-6) -Adverse consequences from alcohol (q's 7-10) *Maximum points= 40

-If patient is determined to has at-rsik drinking of illicit substance use: -You are drinking more than is medically safe -I strongly recommend that you cut down and I am willing to help -If patient has an alcohol use disorder clearly state: -I believe that you have an alcohol use disorder -I strongly recommend that you quit and I am willing to help

-craving alcohol -irritability -anorexia -abdominal pain -fatigue -chills/ fever - muscle cramps - palpitations - sweating -tachycardia -HTN -disorientation -slurred speech - staggered gait - poor dexterity -tremors -Hallucinations/ illusions

-Used to determine severity of withdrawal symptoms -Drives appropriate interventions to avoid seizures delirium tremens -DTs can cause death

-dilated pupils -runny nose - tachycardia -fever - elevated BP - sweating - Diarrhea - Restlessness - Insomnia - Nausea - Vomiting - Malaise - Tremor - Muscles ache - Joint pains

*Talk with social work - set up resources at home -Local AA or NA programs -local al-anon groups -in-pateint rehabilitation centers

*Types of violence -Intimate partner violence - Child abuse/ neglect - adolescent relationship violence -Elder abuse/ neglect

-Physical or sexual violence -Psychological or emotional abuse or coercive tactics

-Every 9 seconds in the US a woman is assaulted or beaten -1 in 3 women and 1 in 4 men have been physically abused by an intimate partner -1 in 5 women and 1 in 7 men have been severely physically abused by an intimate partner -15% of all violent crime is domestic violence (DM) -19% of DV includes a weapon - ONLY 34% of people who are injured by intimate partners receive medical care *Power of control wheel/ struggle

1. Anger, blaming, arguing 2. Battering 3. Honeymoon stage 4. Repeat

1.Neglect: failure to provide for basic physical, educational, medical, and emotional needs 1.Physcial Abuse: punching, beating, kicking, burning, shaking, otherwise harming a child 3. Sexual Abuse: fondling genitals, incest, penetration, rape, sodomy, indecent exposure, exploitation through prostitution or production of pornographic materials 4. Emotional Abuse: pattern of behavior that harms a child's emotional development or sense of self worth such as when there is frequent belittling, rejection, threats, and withholding of love and support

-1:4 girls and 1:6 boys will be sexually abused before age 18 - Almost 70 % of reported sexual assaults happen to kids under age 17 -median age for kids abused is 9 -More than 20% of kids are sexually abused before age 8 -30-40% are abused by family members -50% are abused by someone the family knowns and trusts -40% are abused by older or larger children they know - 10% are abused by strangers

-Physical, sexual or psychological/ emotional violence within a dating relationship -includes stalking -Abuse may be in person or electronically -May be present or former partner

*Physical Abuse: -violent acts that result or could result in injury, pain, impairment, or disease *Physical Neglect: - failure of family or caregiver to provide basic goods and services such as food, shelter, healthcare, and meds *Psychological Abuse: -behavior that results in mental anguish *Psychological Neglect: -Failure to provide basic social stimulation *Financial Abuse: -Intentional misuse of elderly person's financial and material resources *Financial Neglect: -Failure to use elderly person's assists to provide needed services *90% of abusers are family members

-MUST report for elderly, children, and other vulnerable population -Report if there is a suspicion -DO NOT need proof to call

-Physical -Emotional -Abuse during pregnancy -Long term/ chronic affects -Elder: *complications from injuries *infections *stress can cause cardiac complications *STIs more complicated than in younger adults -Children: *immediate consequences *Long-term: interrupted bond between caregiver and child; can lead to changes in brain structure and chemistry -70-80% of children who are sexual abuse survivors report excessive drug/ alcohol abuse -Children who are abused are more likely to commit felony assault or domestic violence -over 75% of serial rapists were sexually abused as kids

-Routine, universal screening for IPV means the following: *Asking every woman at every health care encounter if she has been abused by a husband, boyfriend, or other intimate partner or ex-partner -Required by most nursing professional organizations

-Preceed questions so that the patients do not feel targeted. -Procedure: *It is appropriate to show concern and distress about degree of violence *abuse is not the woman's fault *Express concern and reassure patient that help is possible *Inform health problems can occur from violence

-No validated screening tool -Observe for risk factors: *Alcohol or substance Abuse *Early onset of sexual activity or risk behaviors *Signs of mental illness or poor performance at school -Ask pertinent questions: *Have you felt unsafe in relationships? *Is a partner from a previous relationship making you feel unsafe now? *Have you been physically assaulted or otherwise hurt by your boyfriend or dating partner when he/she has been angry? *Have you ever been hurt by a dating partner to the point where it left a mark or bruise?

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*May have an impact on current health condition -Assess and document prior abuse: IPV, childhood abuse, and prior rapes -Mental status examination important in cases of IPV or elder abuse, for potential head trauma or neurologic symptoms -All survivors of violence should be given a mental status examination, with attention to mental health problems associated with violence: depression, suicidality, PTSD, substance abuse, and anxiety

*Medical history important part of evaluation -Previous hospitalizations, injuries, or does he/she suffer from any chronic medical conditions? -Take medications that may cause easy bruising? -History of repeated visits to hospital? -Delays seeking care for other than minor injury? *If child is verbal, history should be obtained away from caretakers through open-ended questions or spontaneous *Documentation -When documenting history and physical findings of child abuse and neglect, use words child has used to describe how his or her injury occurred -Remember the possibility that the abuser may be accompanying the child -If child is nonverbal, use reports of caregivers -Know your institutional protocol for obtaining history in cases of suspected child maltreatment Some protocols may delay a full interview until it can be done by a forensically trained

*Important components of physical examination of known survivor of IPV or elder abuse include the following: -Complete head-to-toe visual examination, especially if patient is receiving health services for reported abuse -Health evaluations for known or suspected elder abuse and neglect should include baseline laboratory tests, including a complete blood count with platelet level, basic blood chemistries, serum liver function tests, a coagulation panel, and urinalysis

*Visual inspection of child from head to toe is important in any physical examination -Significant injuries can be hidden under clothing, diapers, socks, and long hair -Bruising in "atypical" places such as buttocks, hands, feet, and abdomen is exceedingly rare and should arouse concern -Any bruise in shape of an object should be considered highly specific for abuse -Bruising found in nonmobile children should raise concern for further injury, including fractures and intracranial injury

*Documentation of IPV, child abuse, and elder abuse must include the following: -Detailed, nonbiased progress notes -Use of injury maps -Photographic documentation in health record -Other aspects of abuse history, including reports of past abusive incidents, can be paraphrased with use of partial direct quotations -Written documentation of histories of IPV and elder abuse needs to be verbatim but within reason -Critical to document exceptionally poignant statements made by victim that identify perpetrator and severe threats of harm made by perpetrator

*Suspect IPV when she says no to AAS, but there are other indicators associated with IPV *In addition, providers need to be alert for conditions associated with IPV including the following: -Gynecologic problems, especially STIs, pelvic pain, and complaints of sexual dysfunction -Chronic irritable bowel syndrome, back pain, depression, symptoms of PTSD,

*Domestic violence (DV) occurs cross-culturally -It may be more difficult to determine in many cultural groups -Lifetime prevalence of DV occurs significantly higher among racial and ethnic minorities -Highest rates of IPV is found in multiracial women (54%) -Death rates are higher among refugee and immigrant women

*Societal stressors -Poverty, fear of seeking help due to racism and discrimination or lack of knowledge *Legal regulations -Legal status may be complicated by immigrant status -Fear of legal action being taken *Lack of access -Inability to access health/medical services due to knowledge or fear -Limited amount of mental health resources available *Cultural values and gender roles -Privacy or shame associated

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-YWCA -Children's Advocacy Center -Woman's Shelters -National Center for Elder Abuse