Maternity study guide Chapter 30 PDF

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O'Meara: Maternity, Newborn, and Women's Health Nursing: A Case-Based Approach...

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Chapter 30 Anorexia Nervosa- is when calorie restriction below that required for weight maintenance, A fear and profound anxiety about being overweight despite being underweight, A perception of body weight that is distorted and disproportionately important to the patient. Sufferer may deny medical significance of perception and behavior. Binge eating disorder- is frequent binging—or bouts of overeating—without inappropriate compensatory behaviors, such as purging or excessive exercise. Bulimia nervosa- is defined as recurrent binge eating with inappropriate compensatory behaviors (purging, excessive exercise, and the use of medications such as laxatives and diuretics) in an attempt to control weight gain at least once weekly for a minimum of 3 months Human trafficking -is often conceptualized as the import of humans from one part of the world to another for unpaid labor Intimate partner violence- is any actual or threatened psychological, sexual, or physical harm of one current or past intimate partner by the other. Sexual assault- is used to describe any sexual act performed on another person without that person’s consent. The use of force is not necessary to the definition. Sexual assault nurse evaluation- and the nurses are often called SANE nurses. These nurses are trained and certified by the International Association of Forensic Nurses to perform thorough, consistent, expedited, high-quality examinations and specimen collection with sensitivity and compassion. Sexual minority women- The term SMW may be used to describe a woman who identifies as lesbian, bisexual, pansexual, transgender, gay, or polyamorous. Transman- female-to-male are often used to describe a person assigned female at birth who identifies as male Transwoman- male-to-female are often used to describe a person assigned male at birth who identifies as female Sexual Assault 

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Over the course of their lifetimes, 43.9% of women and 23.4% of men experience sexual violence, which is defined as unwanted sexual experiences, unwanted sexual contact, and sexual coercion. A further 19.3% of women and 1.7% of men are raped Only a small number of sexual assaults are reported to authorities. The most common reasons victims cite for not reporting are a prior relationship with the attacker, reluctance to see the attacker incarcerated, and fear that the authorities would blame the victim for the attack

Evaluation 

A trained provider should evaluate a victim of a sexual assault within 72 hours after the crime. In the United States, specially trained nurses often carry out these evaluations. o This model is referred to as sexual assault nurse evaluation

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History taking is critical to the evaluation of a survivor of sexual assault. It is often helpful to have a sexual assault advocate from a rape crisis organization present during history taking. The advocate does not answer for the victim but helps guide the victim through the process.

History

Examination 

Items frequently used during the course of an examination after a sexual assault include a camera to document injuries, a colposcope to identify microinjuries, an ultraviolet light source to identify semen and other foreign objects, and specimen collection tools such as swabs and evidence bags, a ruler or other easily sized item for photographs, and a

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speculum. The nurse or other healthcare provider should not take any samples or pictures or conduct any physical examination without the explicit consent of the victim. The nurse should closely examine any body parts the victim identifies as having been subjected to trauma. The TEARS categorization (tears, ecchymoses, abrasions, redness, and swelling) is often used to help organize and describe examination findings

Forensic Evaluation 

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As with all aspects of a sexual assault evaluation, the nurse or other healthcare provider must obtain patient consent before conducting a forensic examination. A forensic evaluation requires the collection of numerous samples for evaluation by a laboratory if indicated. Special kits are used for this purpose. A victim is under no obligation to pursue police reporting even after specimen collection. At times the nurse may have to conduct a forensic examination of the perpetrator, as well, using a similar methodology.

Laboratory Testing and Prophylactic Medications 

Sexually transmitted infections (STIs) and pregnancy are both concerns for many victims of sexual assault. A pregnancy or STI test taken at the time of the initial evaluation is unlikely to detect a pregnancy or STI resulting from the assault because of incubation periods.

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The risk of pregnancy after a single act of unprotected intercourse varies according to a woman’s cycle. The overall risk for pregnancy after rape is approximately 5% A woman who is using contraception is clearly not at any greater risk for pregnancy from nonconsensual sex than she would be from consensual sex, although her anxiety about pregnancy may be heightened. The woman should take a follow-up pregnancy test if she misses her period or 2 to 3 weeks after the assault.

Pregnancy

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Sexually Transmitted Infections  

The risk of contracting chlamydia or gonorrhea after a sexual assault is as high as 15% and 5%, respectively. Patients who initially present for evaluation and treatment after a sexual

Hepatitis B Virus 

Women who are sexually assaulted have been vaccinated for the hepatitis B virus, most have not been tested for immunity against this virus. Like all vaccinations, the vaccination for hepatitis B does not guarantee immunity after the completion of a vaccine series.

Human Immunodeficiency Virus 

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The risk of contracting human immunodeficiency virus (HIV) after a single episode of consensual sex with someone who is HIV positive is approximately 0.1% for vaginal sex and 2% for receptive anal sex. These figures may be higher after a sexual assault if trauma and bleeding have created enhanced entry for the virus.

Human Papillomavirus 

Female victims of sexual assault who meet the age eligibility requirements should receive the vaccine against human papillomavirus. Patients who have already been vaccinated do not need to be revaccinated. For patients who have not been vaccinated, the series should be completed as per the recommendations for the general population

Follow Up 

The nurse should offer all victims of sexual assault access to mental health services. Potential health sequelae of a sexual assault include posttraumatic stress disorder (PTSD), anorexia, insomnia, anxiety, depression, shame, guilt, fear, anger, intrusive thoughts, p. 711 p. 712 and pain of the pelvis, abdomen, genitals, and musculoskeletal system.

Intimate Partner Violence 

is any actual or threatened psychological, sexual, or physical harm of one current or past intimate partner by the other.

Factors Contributing to the Perpetuation of IPV3 

Victims stay in IPV relationships and return to the relationships after leaving for a number of reasons. Perpetrators are controlling and often ensure they have economic control, making the victim dependent. Economic dependence is particularly acute if the victim has children. The abuser often isolates the victim from friends and family members, limiting her ability to seek help and shelter elsewhere.

Role of the Nurse 

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The dominant feature of IPV is the power one partner has over. Therefore, a critical consideration when caring for victims of IPV is patient empowerment (Box 30.2). The nurse should allow the patient to direct her own care as much as possible. It is not the role of the healthcare provider to tell the patient to leave her abuser. The role of the nurse is to build a trusting relationship with the patient and to facilitate patient decisions. Compassionate support and planning are critical to the care of IPV patients. However, little evidence supports the efficacy of interventions to prevent IPV or stop ongoing IPV. Interventions may be more effective during pregnancy or if a woman has already spent at least one night in a shelter, which indicates a readiness to leave

Offering Support 

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It often takes several encounters before a woman discloses IPV. It may take several more before a woman chooses to act. It is very common for a woman to return to an abusive relationship multiple times, and it is important that the nurse withhold judgment. Expressing empathy, validating the woman’s feelings, and offering assistance as appropriate show support. The nurse may pursue avenues for change when the patient expresses readiness The victims of IPV often have a low sense of self-worth. Depression, anxiety, and substance abuse are more common in this population. The nurse should screen the victims of IPV for psychological issues and include counseling in care, which may improve the patient’s uptake of safe behavior

Evaluating for Safety 

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Although most victims of IPV are not in immediate danger, in 2010 at least 39% of homicides of women were by intimate partners, when compared with 2.8% of homicides of men Nurses should be aware, however, that, despite the abuse, victims often downplay the danger of their situation because of denial, embarrassment, the difficulties of leaving their abuser, and fear of their abuser, as well as to protect the abuser, whom they often still love.

Support of the Victim of Intimate Partner Violence

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Helpful Statements o “I’m so sorry this is happening.” o This must be really hard.” o How can I be most helpful?” o I can help connect you with people and resources that can help you when and if you’re ready.” o “This is not your fault.” o You are a strong woman. It takes courage to tell me what you’ve told me.” o I’m so glad you told me.” o This is not an uncommon problem. You are not alone.” Unhelpful Statements o “You should leave him.” o “Just kick him out.” o “I’d never let anyone hurt me like that.” o “Why do you let him do that?” o “I don’t understand how women get themselves into these situations.” o “What did you do that made him hurt you?” o What do you think is wrong with you that you get into these situations?” o “If it’s so bad, why do you stay?”

Safety Planning 

Safety planning is an attempt to reduce the risk of escalating violence. A woman may make a safety plan with the help of a nurse and facilitation by a community domestic violence advocate or social worker. o The aspects of a safety plan include arrangements for a place to escape to, a signal to alert others to contact emergency services, the avoidance of rooms such as kitchens and bathrooms that contain potential weapons, and the preparation of an emergency kit.

Perpetrator Treatment 

Court-mandated treatment of perpetrators is a common legal intervention that decreases the rate of re-offense by approximately 5% to 7%. The dropout rate from such programs is high, and those who fail to complete the programs are most likely to reoffend

Mandated Reporting and Documentation  

Nurses are mandated reporters Only a few states mandate the reporting of IPV in all cases. More states mandate the reporting of IPV under certain conditions, such as if the abuse is of a disabled person, if a weapon is used in an assault, if the abuse is of an elder, or if a child is either the target of the abuse or a witness to the abuse.

Long- Term Consequences  

IPV victims are subject to long-term health consequences even after the victimization has stopped. Victims are more likely to have chronic and acute physical health complaints, such as pain, gynecologic issues, and infections. The experience of IPV within a year before pregnancy is associated with a higher rate of pregnancy-related complications.

Human Trafficking 

is often conceptualized as the import of humans from one part of the world to another for unpaid labor

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Among the survivors of sex trafficking, mental and physical health problems are very common. A majority report physical and sexual abuse, and approximately half attempt suicide. The rate of HIV among the victims of sex trafficking is as high as 60%. Problems associated with unprotected sex and sex with multiple partners, including STIs and unwanted pregnancies, are also common.

Identification of Victims  

Because of their frequent health problems, the victims of trafficking often have contact with healthcare providers, with a majority reporting the use of healthcare services Victims rarely self-report trafficking for various reasons. o Some may fail to recognize their situation, perceiving themselves to be in a romantic relationship with their trafficker. o Others may fear retribution against themselves, their children, or their families

Care of Victims   

The victims of human trafficking and those who care for them are at risk for harm from traffickers. Therefore, the nurse should take care to protect patient confidentiality and clinic security. The nurse should not encourage victims to leave their situation if they are unwilling or feel unsafe doing so During a physical examination, the clinician must avoid retraumatizing the patient whenever possible. Patients should guide the examination and be kept covered as much as is feasible

Human Trafficking Indicators 

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General Indicators of Human Trafficking o Shares a scripted or inconsistent history o Is unwilling or hesitant to answer questions about the injury or illness o Is accompanied by an individual who does not let the patient speak for himself or herself, refuses to let the patient have privacy, or interprets for the patient o Exhibits signs of being in controlling or dominating relationships (excessive concerns about pleasing a family member, romantic partner, or employer) o Demonstrates fearful or nervous behavior or avoids eye contact o Is resistant to assistance or demonstrates hostile behavior o Is unable to provide his or her address o Is not aware of his or her location, the current date, or time o Is not in possession of his or her identification documents o Is not in control of his or her own money o Is not being paid or has wages withheld Sex Trafficking Indicators o Is under the age of 18 y and is involved in the commercial sex industry o Has tattoos or other forms of branding, such as tattoos that say, “Daddy,” “Property of . . .,” “For sale,” etc. o Reports an unusually high number of sexual partners o Does not have appropriate clothing for the weather or venue o Uses language common in the commercial sex industry Labor Trafficking Indicators o Has been abused at work or threatened with harm by an employer or supervisor o Is not allowed to take adequate breaks, food, or water while at work o Is not provided with adequate personal protective equipment for hazardous work o Was recruited for different work than he or she is currently doing

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Is required to live in housing provided by the employer Has a debt to the employer or recruiter that he or she cannot pay off

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The reporting of suspected trafficking of minors is mandated. The reporting of trafficking of mentally and physically abled adults is not mandated. However, if a nurse suspects or has knowledge of trafficking, the nurse can report it and seek guidance from the National Human Trafficking Resource

Reporting

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Eating Disorders 

The most commonly identified eating disorders in adults are anorexia nervosa, binge eating disorder, and bulimia nervosa. They are collectively defined as a disturbance in eating with a negative impact on physical or mental health

Anorexia Nervosa 

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is made when the patient exhibits each of the three following criteria: o Calorie restriction below that required for weight maintenance. o A fear and profound anxiety about being overweight despite being underweight. o A perception of body weight that is distorted and disproportionately important to the patient. Sufferer may deny medical significance of perception and behavior. The severity of the disease is classified in accordance with the patient’s body mass index (BMI). o The condition is considered mild if the patient’s BMI is 17 to 18.49 kg/m2, o moderate with a BMI from 16 to 15.99 kg/m2, o severe with a BMI from 15 to 15.99 kg/m2, o extreme with a BMI less than 15 kg/m2 Patients may lose or maintain weight by restricting the categories of food, calories, fasting, excessive exercise, vomiting, and the use of laxatives, enemas, or diuretics. The mortality rate for people diagnosed with anorexia nervosa is 4% to 14% higher than for the general population, with approximately 60% of deaths resulting from medical complications stemming directly from the anorexia People with anorexia often hide their illness, making the prevalence of the illness challenging to assess. The treatment of anorexia usually consists of a combination of psychotherapy and nutritional rehabilitation, either inpatient or in the community. In some situations, medication may also be used to promote weight gain, but rarely as a first-line intervention. Antipsychotic medications are used most frequently for this purpose

Binge Eating Disorder   

is frequent binging—or bouts of overeating—without inappropriate compensatory behaviors, such as purging or excessive exercise. the lifetime prevalence of binge eating disorder in women is 3.5% and the median age of onset is 23 years old Treatment goals for patients with binge eating disorder include reducing the number of binge eating episodes and weight loss if indicated. Patients with poor body image may have an additional treatment goal of self-acceptance.

Bulimia Nervosa 

is defined as recurrent binge eating with inappropriate compensatory behaviors (purging, excessive exercise, and the use of medications such as laxatives and diuretics) in an attempt to control weight gain at least once weekly for a minimum of 3 months

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As with patients with other eating disorders, patients with bulimia nervosa often try to hide their illness. It is estimated that the lifetime prevalence of the condition in the United States is approximately 1%, and the condition is three times as common in women as it is in men. o The median age for developing bulimia nervosa is 18 years Bulimia nervosa frequently co-occurs with depression, anxiety, body dysmorphic disorder, PTSD, substance use disorder, specific phobias, social anxiety disorder, and other mental disorders. Personality disorders, including borderline personality disorder, are also more common in this population Bulimia nervosa is associated with an increase in the all-cause mortality of up to eight times that is observed in people without the condition

Pregnancy Care for Incarcerated Patients 

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Common challenges are related to transportation, communication, timely follow-up, and care of the neonate if the patient gives birth while incarcerated. All incarcerated individuals are legally entitled to care per the Eighth Amendment of the United States Constitution, although specific policies regarding the care of inmates in pregnancy vary according to state. On-site medical staff, including nurses and other healthcare providers, often do not provide any prenatal care or provide only limited prenatal care, with ultrasounds and the management of high-risk pregnancies occurring off-site. When an off-site provider sees a patient, to ensure patient confidentiality, visit r...