Special Needs Clients

1
Special Needs Clients

• Violence Abuse
• Domestic violence
• One of the fastest growing problems in the US
• Violence occurs in the home
• Abuse by a male partner is the single largest
  cause of injury to women in the US
• Abuser was most often abused as a child

2
Elder abuse

• Emotional, physical and sexual abuse, financial
  exploitation or neglect of older people
• Abuse of older adults is a CRIME!! They are
  vulnerable
• The most common elder abusers are adult children,
  relatives, spouses, service providers, friends,
  neighbors, grandchildren and siblings

3
Caregiver Stress

• Exhaustion and frustration of daily obligations
  related to the care of an older person
• Older adults fail to report abuse, witnesses are
  difficult to obtain and many older victims often
  fear retaliation
• See box 91-3 pg. 1449

4
Child Abuse

• Neglect, physical abuse and sexual abuse
• Fxs common-spiral
• Believe the child
• Observe the childs reactions
• Usually nurses first suspect physical abuse
• Parents, siblings, grandparents are the most
  common abusers
• Document your observations
• Teach the child inappropriate activities
• Call CPS

5
Care of the Hostile Client

• They may become physically violent
• Use the least restrictive methods of behavior
  control first
• Talk
• Encourage voluntary time-out
• Force a time-out
• Place in seclusion
• Physical or chemical restraints
• Release ASAP
• See box 93-8, pg. 1499

6
Chronic Pain

• Lasts 6 mo. or longer
• Interferes with normal functioning
• Client may be frustrated and angry if the cause
  of the pain is unknown
• When a person fails to express their feelings,
  suppressed anger may turn inward and cause
  depression

7
Substance Abuse

• Maladaptive pattern of substance use leading to
  clinically significant impairment or distress as
  defined by the APA
• Ask open ended questions during interview
  process
• Nursing care-box 94-1, pg. 1509

8
Single Mothers

• 1/3 of all children in the US are being raised in
  a single-parent home headed by a women
• Mothers face financial burdens and childcare
  demands
• New mothers
• Provide with literature about child care

9
Abortion

• Psychological impact
• 30-60 of abortions are undergone because the
  pregnant women is submitting to the pressure of
  others
• Abortion may be traumatizing and women may try to
  commit suicide
• Women may feel shameful, anger and guilt
• May abuse ETOH and drugs
• Some women experience PTSD

10
HIV/AIDS

• Transmitted through infected body fluids
• Tx-antivirals, preventing opportunistic
  infections
• What are some nursing Dxs??
• How are you going to tx this client??

11
Communication-aphasic client

• Face client, make eye contact
• Speak in a normal manner and tone
• Use short phrases with frequent pauses
• Use gestures, pictures, objects
• Keep extraneous noises to a minimum

12
RAPE SEXUAL ASSAULT

• In 2006, there was over 272,350 victims of rape,
  sexual assault or attempted rape (s do not
  include those under 12 years of age)
• Every 2 minutes in the U.S., someone is sexually
  assaulted
• Rape-forced sexual intercourse, may also be
  psychological coercion
• Sexual Assault-Completed or attempted attacks
  involving unwanted sexual contact

13
If you have been assaulted

• Seek medical attention ASAP
• Successful prosecution more likely if medical
  evidence is collected within 72 hours of the
  assault
•       Dont shower or change clothes (bring a
  change of clothes with you)
•       May feel humiliated and appear calm
• males and females

14
Nursing Considerations

• Assist with the physical exam
•       Speculum
•     Location of specimens for semen analysis
•       Pubic hair is combed for foreign hair
•       Save clothing for analysis, place in
  paper bag (plastic bags retain moisture and
  could deteriorate evidence)    

15
Nursing Considerations

• Testing for STDs and HIV
•       STD prophylaxis
•       Pregnancy prophylaxis with morning after
  pill Oval
•       Care for tissue trauma
•       Recommend counseling
• encourage to express feelings

16
  SANE nurse

•    RNs with special training to assist rape
  victims
• Provide immediate, compassionate,
  culturally-sensitive health care
•   Collect medical evidence that will assist in
  prosecution