12-11-2008, 04:50 PM
Please,anyone help me with specific qs about it??????????????
exam is very soon..............
exam is very soon..............
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rape case??? - zeta_nyc
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12-11-2008, 08:39 PM
Thanks to ramri for posting this a few days back................
Rape Miz according to the nurse chart I realized you have been sexually assaulted. so sorry about that can understand the emotional trauma that you are going through. I deeply regret for what has happened to you. I will not force you to reveal the information but I need to know certain things which can help you in turn. I assure that the information would be kept confidential and would not be disclose to any one without your consent and against your will. Would you like to share your problems with me? Would you like to tell me about it. I understand how difficult and tough for you to talk about this issue in particular but I want to assure you that I'm here to help you get through this and everything you will say will be kept confidential even the medical exams and all lab tests Now Mrs. I would like to ask you some questions about this issue if you don't mind. It will help in clarifying the problem in helping you. Can you tell me what happened exactly? Miz please take your time So where did it happen? was there any physical assault like beating hitting biting. Was the perpetuator drunk? Or drugged (just if she knows) Did u get any bleeding after the assault Do u know who assaulted you? Was it vaginal, anal, oral, or all? Anyone who witnessed it? Any pain in stomach. Any headache Do u feel angry with rapist or other peoples around you? Do u feel contaminated, degraded or dirty? How is your mood most of the day? DO u easily startled or frightened Do u still get the Flashbacks of the event Any Upsetting dreams about the traumatic event , night mares? Do u feel emotionally numb Do u feel sad all the time? Do u blame youself for what happened? DO u think about the people, and places that are connected with this event? How is your concentration? Do u have difficulty remembering things? DO u lack of interest in activities that used to be enjoyed (anhedonia) Do u have any plan for future? I mean about career or whatever u plan to do? How is your sleep? Do u have trouble falling asleep or staying asleep? DO u get recurrent flashback of event? Do u forget things frequently or do u feel that you are losing your memory? Do you or have you ever thought about killing yourself? Is there any gun at home? How is your energy level? Do u feel tired easily? Have u changed to daily physical activities? I mean do you still do things you were once interested in? like going out with friends or hobbies?-- Do u have anyone to talk to when you r in distress Could u describe to me a typical day in your life? What are your hobbies? DO they give u the same kind of pleasure that they gave u earlier . Tell me more about your home life? Do u live by yourself ? Any boyfriend or partner? How is your family life? how do u feel about your family members? do you have friend or family near by? How is your relations them? Are they supportive? Do u try to avoid them? Have you been eating normal (no binge eating or not eating at all?) Do u drink? Is there any change in your drinking habit? How is your sexual life? Counselling Miz, I understand that you are in a lot of emotional stress.I would like to address few things. First, I want u to know that I am here to help and support you in your healing process. I would like to do vaginal examination and also some blood tests for any evidence of sexually transmitted infections and probably HIV too. Seondly, I would like to stress the fact that No woman deserves to be raped. No woman asks to be victimized, threatened, violated, frightened, humiliated, or degraded. So stop blaming yourself! Third, I would suggest u to try some of the tips to help u with sleep like --Try to lie down to sleep at the same time every night. Have a place to sleep that is dark and quiet, and has a comfortable temperature. Try not to eat within two hours of lying down to sleep. Get regular physical exercise and eat a balanced diet. Finally, We have very impressive program here that helps people in a similar situation. I would like you to talk with a counselor who can help you in getting out of this emotional stress. In the meantime I will print out information regarding the rape victim and also give you some phone number if you want to speak with them. Once again I am here to help you. You can contact me any time. I think u also need to add emmergency contraceptive counselling.
12-15-2008, 06:21 AM
Just in case anyone is looking for some additional information to read about a rape case. I found this useful. Lots of info. Included most of it so choose what you want to read.
Although legal and medical definitions vary, rape is typically defined as some oral, anal, or vaginal penetration that involves threats or force against an unwilling person. Sexual assault is rape or any other sexual contact that results from coercion, including when a child is seduced by offers of affection or bribes; it includes being touched, grabbed, kissed, or shown genitals. Rape and sexual assault, including childhood sexual assault, are common; lifetime prevalence estimates for both range from 2 to 30% but tend to be about 15 to 20%. Typically, rape is an expression of aggression, anger, or need for power; psychologically, it is more violent than sexual. Physical trauma occurs in about 50% of rapes of females. Females are raped and sexually assaulted more often than males. Rape of males is often committed by another man and often occurs in prison. Males who are raped are more likely than females to be physically injured and to be unwilling to report the crime, and multiple assailants are more likely to be involved. Overall, psychologic symptoms of rape are potentially the most prominent. In the short term, most patients experience fear, nightmares, sleep problems, anger, embarrassment, and/or shame. Immediately after an assault, patient behavior can range from talkativeness, tenseness, crying, and trembling to shock and disbelief with dispassion, quiescence, and smiling. The latter responses rarely indicate lack of concern; rather, they reflect avoidance reactions, physical exhaustion, or coping mechanisms that require control of emotion. Anger may be displaced onto hospital staff members. Friends, family members, and officials often react judgmentally, derisively, or in another negative way. Such reactions can impede recovery after an assault. Eventually, most patients recover; however, long-range effects of rape may include posttraumatic stress disorder (PTSD”see Anxiety Disorders: Posttraumatic Stress Disorder), particularly among women. PTSD is an anxiety disorder; symptoms include re-experiencing (eg, flashbacks, intrusive upsetting thoughts or images), avoidance (eg, of trauma-related situations, thoughts, and feelings), and hyperarousal (eg, sleep difficulties, irritability, concentration problems). Symptoms last for > 1 mo and significantly impair social and occupational functioning. Goals of rape evaluation are medical (assessment and treatment for injuries; assessment, treatment, and prevention of pregnancy and STDs), collection of forensic evidence, and psychological evaluation and support. A form (sometimes part of a rape kit) is used to record legal evidence and medical findings (for typical elements in the form, see Table 1: Medical Examination of the Rape Victim: Typical Examination for Alleged Rape ); it should be adapted to local requirements. Because the medical record may be used in court, results should be written legibly and in nontechnical language that can be understood by a jury. History and examination: Before beginning, the examiner asks the patient's permission. Because recounting the events often frightens or embarrasses the patient, the examiner must be reassuring, empathetic, and nonjudgmental and should not rush the patient. Privacy should be ensured. The examiner elicits specific details, including the type of injuries sustained (particularly the mouth, breasts, vagina, and rectum); whether the patient or assailant had any bleeding or abrasions (to help assess the risks of transmission of HIV and hepatitis); orifices penetrated and whether ejaculation occurred or a condom was used; assailant's aggression, threats, weapons, and violent behavior; and a description of the assailant. Many rape forms include most or all of these questions . The patient should be told why questions are being asked (eg, information about contraceptive use helps determine risk of pregnancy after rape; information about previous coitus helps determine validity of sperm testing). The examination should be explained step by step as it proceeds. Results should be reviewed with the patient. When feasible, photographs of possible injuries are taken. The mouth, breasts, genitals, and rectum are examined closely. Common sites of injury include the labia minora and posterior vagina. Examination using a Wood's lamp may reveal semen on the skin. Colposcopy is particularly sensitive for subtle genital injuries. Some colposcopes have cameras attached, making it possible to detect and photograph injuries simultaneously. Testing and evidence collection: Routine testing includes a pregnancy test and serologic tests for syphilis, hepatitis B, and HIV; if done within a few hours of rape, these tests provide information about pregnancy or infections present before the rape but not those that develop after the rape. Vaginal discharge is examined to check for trichomonal vaginitis and bacterial vaginosis, and samples from every penetrated orifice (vaginal, oral, or rectal) are obtained for gonorrheal and chlamydial testing. If the patient has amnesia for events around the time of rape, drug screening for flunitrazepam (the œdate rape drug) and gamma hydroxybutyrate should be considered. Follow-up tests are done for gonorrhea, chlamydial infection, human papillomavirus infection (initially using a cervical sample from a Papanicolaou test), syphilis, and hepatitis at 6 wk; HIV infection at 90 days; and syphilis, hepatitis, and HIV infection at 6 mo. If the vagina was penetrated and the pregnancy test was negative at the 1st visit, the test is repeated within the next 2 wk. Patients with laceration of the upper vagina, especially children, may require laparoscopy to determine depth of the injury. Evidence that can provide proof of rape is collected; it typically includes clothing; smears of the buccal, vaginal, and rectal mucosa; combed samples of scalp and pubic hair as well as control samples (pulled from the patient); fingernail clippings and scrapings; blood and saliva samples; and, if available, semen (see Table 1: Medical Examination of the Rape Victim: Typical Examination for Alleged Rape ). Many types of evidence collection kits are available commercially, and some states recommend specific kits. Evidence is often absent or inconclusive after showering, changing clothes, douching, and as time passes, particularly > 36 h; however, evidence may be collected up to 5 days after rape. A chain of custody, in which evidence is in the possession of an identified person at all times, must be maintained. Thus, specimens are placed in individual packages, labeled, dated, sealed, and held until delivery to another person (typically, law enforcement or laboratory personnel), who signs a receipt. In some jurisdictions, samples for DNA testing to identify the assailant are collected. History and examination: Before beginning, the examiner asks the patient's permission. Because recounting the events often frightens or embarrasses the patient, the examiner must be reassuring, empathetic, and nonjudgmental and should not rush the patient. Privacy should be ensured. The examiner elicits specific details, including the type of injuries sustained (particularly the mouth, breasts, vagina, and rectum); whether the patient or assailant had any bleeding or abrasions (to help assess the risks of transmission of HIV and hepatitis); orifices penetrated and whether ejaculation occurred or a condom was used; assailant's aggression, threats, weapons, and violent behavior; and a description of the assailant. Many rape forms include most or all of these questions (see Table 1: Medical Examination of the Rape Victim: Typical Examination for Alleged Rape ). The patient should be told why questions are being asked (eg, information about contraceptive use helps determine risk of pregnancy after rape; information about previous coitus helps determine validity of sperm testing). The examination should be explained step by step as it proceeds. Results should be reviewed with the patient. When feasible, photographs of possible injuries are taken. The mouth, breasts, genitals, and rectum are examined closely. Common sites of injury include the labia minora and posterior vagina. Examination using a Wood's lamp may reveal semen on the skin. Colposcopy is particularly sensitive for subtle genital injuries. Some colposcopes have cameras attached, making it possible to detect and photograph injuries simultaneously.
12-15-2008, 12:31 PM
I would include the following in the diagnostic workup:
1. Pelvic exam and cervical culture. 2. UA including drug screen and pregnancy test. 3. Rectal exam. 4. VDRL,HBsAG,HIV-antibody. 5. KOH prep and wet mount. Would these be correct. I am glad someone brought this case up. Less surprises on the exam is better.
12-15-2008, 03:39 PM
u are very much right job, infact we can use those tests for any kind of 'personal' complaint or anykind of related case ,in case of female patients
12-16-2008, 11:55 AM
Thanks for pointing that out flanker. I´ll keep it in mind.
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