Question

Kim is a 27-year-old woman who recently moved from a small town in Texas to work in the city of Dallas as a reporter for one of the major newspapers. She is 5’6” tall and weighs 115 lb. To keep in shape she likes to jog, which she did regularly in her hometown. She doesn’t know anyone in Dallas and has been lonely for her family since arriving. But she has moved into a small apartment in a quiet neighborhood and hopes to meet young people soon though her work and church. On the first Saturday morning after she moved into her new apartment, Kim decided to get up early and go jogging. It was still dark out, but Kim was not afraid. She had been jogging alone in the dark many times in her hometown. She donned her jogging clothes and headed down the quiet street toward a nearby park. As she entered the park, an individual came out from a dense clump of bushes, put a knife to her throat, and ordered her to the ground. She was raped and beaten unconscious. She remained in that condition until sunrise when she was found by another jogger who called emergency services, and Kim was taken to the nearest emergency department. Upon regaining consciousness, Kim was hysterical, but a sexual assault nurse examiner (SANE) was called to the scene, and Kim was assigned to a quiet area of the hospital, where the post-rape examination was initiated. Answer the following questions related to Kim: 1. What are the initial nursing interventions for Kim? 2. What treatments must the nurse ensure that Kim is aware are available for her? 3. What nursing diagnosis would the nurse expect to focus on with Kim in follow-up care?

Answer 1

1.

• Establish trust and rapport.
• Provide strict cofidentiality.
• Notify significant others who are away at her hometown.
• A staff member should be present with the patient at all times.
• Non-judgemental approach must be adopted.
• Encourage verbalization of feelings.
• Make a body map to identify size, location, colour of injuries, and take permission to take photographs.
• Carefully explain all procedures before performing them, eg., taking vaginal swabs,vaginal examination, collection of forensic evidence such as blood, pubic hairs, semen samples, skin from underneath finger nails
• Samples must be labeled, packaged and sealed along with clothing and any other evidence, and handed over directly to a police officer or stored in a secure, locked location where no tampering can take place.A specially trained advocate may be present during care if the patient gives consent for the same.
• Provide crisis counseling within an hour of admitting to the emergency deprtment. Encourage to consider treatment and evaluation for sexually transmitted diseases, and to consider prophylaxis to pregnancy.
• Provide preventive hepatitis B vaccination if full 3 serious of vaccination has not been previously taken.
• Preventive treatment for HIV and follow-up after 3 weeks, 6months and a year for testing for HIV.
• Initiate health teachings and referrals as necessary.

2.

• Explore sexual concerns with the patient
• Refer to local community resources for crisis counseling, group/ individual therapy, rape counselor, support groups, etc.
• Ensure about availability of treatment such as Stress Inoculation Training (SIT), Prolonged Exposure (PE)/ Flooding, Cognitive Processing Therapy (CPT), Multiple Channel Exposure Therapy (MCET).

3.

• Risk for infection
• Risk for trauma
• Altered nutrition less than body requirements
• Sleep pattern disturbance
• Sexual dysfunction
• Rape trauma syndrome
• Spiritual distress
• Impaired social interaction
• Powerlessness
• Body image disturbance
• ineffective individual/ family coping
• Altered family process
• Impaired verbal communication
• Phobias