Archive for July, 2008

Assessment Finding Related to Elder Abuse

July 30, 2008

Elder maltreatment is becoming an increased social problem gaining higher level of scrutiny. Medical programs have limited formal education on the recognition of the different forms of elder maltreatment. The natural changes of aging reflected in pathopysiology can make it difficult to distinguish physical changes of abuse from those of aging.
Elder maltreatment can be classified in six categories: physical abuse, sexual abuse, neglect, psychological abuse, financial and material exploitation and violation of rights. Clinician must be versed in normal pathopysiology of ageing so assessment findings will not be mistaken as trauma or neglect. The victims and perpetrators, scenarios, risk factors, common anatomic and clinical findings, the pathopysiology ageing and limitations of abuse need to be understood.
The American Medical Association defines elder maltreatment as an act or omission that results in harm or threatened harm to the health and welfare of an elderly person. The 2004 report of the National Center an Elder Abuse stated that 83 cases of abuse are reported for 1000 elder Americans. This paper will focus on physical abuse, sexual abuse and neglect.
It is important to have a knowledge base of typical victim and perpetrator characteristic to detect or prevent elder maltreatment. Common characteristics are:
• Age : >75 years old
• Dependency upon one person for ADL-IADL
• Lacks a social net work and has cognitive and physical impairment.
• Perpetrator: Transgeneration violence pattern in family. Perpetrator may be under period stress, substance abuser or have mental illness.

Physical abuse is an act carried with the intention of causing physical pain or injury. Physical abuse makes up 14% of all elder traumas. Clinicians must work to determine if assessment finding are a result of secondary or accidental trauma. Location of trauma in areas of body not commonly impacted during daily activities invite closer inspection. Such areas would be inner thigh, top or bottom of feet, inner wrists or ankle, abdomen, axilla or posterior neck. Areas that are likely non-accidental are also the eye, nose, and inner mouth. Injuries at different stages in healing would indicate repeated pattern of trauma. Imprint pattern of injury needs to be assessed for similar shape and size.
Hair loss from forehead and front temporal region is common in males and postmenopausal females. However, single or multiple patches of alopecia is a sign of traumatic alopecia. The scalp around the patch would show normal hair distribution. Scalp hemorrhage or a hematoma may be a result of hair being forcibly pulled out.

Anogentital injury vaginal hematomas should be investigated. Elderly females are prone to vaginal injury due decreased estrogen, vaginal dryness and thinning of the vaginal wall.

A nurse doing an assessment of the integumentary system should be alert to these various patterns of symptoms. Forensic nurses would be trained to these signs and social interactions between patient and care givers. This group of nurses could serve to bridge this knowledge to other members of the medical team. The medical community should anticipate an increase in elder abuse with the escalating numbers of elders in the community.

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Determining The Time of Death, comment

July 29, 2008

I found this article to be very interesting. I am aware of measuring the core temp with the outside body temp to determine the time of death of an individual. Rigor mortis sets in about 3-36 hours after death but I was not aware that the body becomes relaxed again dependent on the amount of work the muscles did prior to the time of death. This is helpful but not always an exact detector of the time of death. The most critical clue for an individual that has been dead for a while is insects. That was interesting. Being able to look at the insect that is on the corpse and determine the time of death by the age of the insect is truly amazing. It gives you a new respect for those who must try to determine the time of death of an individual. I enjoyed the article and found Forensic Science a new interest.

I had two take aways from this article. One is the possibility of relaxation of the body after death. The second one is the valuable information a small insect can tell us about the time of death.

Original Post:
January 29, 2008
Algor mortis is the first assessment in determining the time of death. The temperature of a body can be used to estimate time of death during the first 24 hours. Core temperature falls gradually with time since death, and depends on body mass, fat distribution and ambient temperature. If the body is discovered before the body temperature has come into equilibrium with the ambient temperature, forensic scientists can estimate the time of death by measuring core temperature of the body against outside temperature. The second most common assessment in the recently deceased is the presence of rigor mortis. The body muscles will normally be in a relaxed state for the first three hours after death, stiffening between 3 hours and 36 hours, and then becoming relaxed again. However, there is considerable uncertainty in estimates derived from rigor mortis, because the time of onset is highly dependent on the amount of work the muscles had done immediately before death. So, rigor mortis is helpful but not an exact detector of time. The presence of insects in a corpse is a critical clue towards estimating the time of death for bodies in longer periods of time. Because flies rapidly discover a body and their development times are predictable under particular environmental conditions, the time of death can be calculated by counting back the days from the state of development of insects living on the corpse. After the initial decay, and the body begins to smell, different types of insects are attracted to the dead body. The insects that usually arrives first is the Diptera, in particular the blow flies and the flesh flies. The theory behind estimating time of death, or rather the post mortem interval with the help of insects are very simple: since insects arrive on the body soon after death, estimating the age of the insects will also lead to an estimation of the time of death.

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Human Papillomavirus; Sexual Assault by knowingly having an STD

July 24, 2008

Being in college, there is an extreme amount of sexually transmitted infections. Human papillomavirus (HPV) I feel like is common among women in college. I even know some people who feel like it’s not that big of a deal and don’t realize the seriousness of this problem. There over 100 classified types such as benign tumors of squamous cells on the skin and warts. Some types of HPV that involve warts can progress to malignancy, particularly squamous cell carcinoma of the cervix. It shocks me that people don’t take this seriously. Many students around me that are males don’t care about HPV because they say they don’t show symptoms. This is just ridiculous because spreading this, especially without telling their partner, can be life changing. I have taken the three shots there are available now and I would also like to learn more about how they work.

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Human Papillomavirus; Sexual Assault by knowingly having an STD

July 24, 2008

Being in college, there is an extreme amount of sexually transmitted infections. Human papillomavirus (HPV) I feel like is common among women in college. I even know some people who feel like it’s not that big of a deal and don’t realize the seriousness of this problem. There over 100 classified types such as benign tumors of squamous cells on the skin and warts. Some types of HPV that involve warts can progress to malignancy, particularly squamous cell carcinoma of the cervix. It shocks me that people don’t take this seriously. Many students around me that are males don’t care about HPV because they say they don’t show symptoms. This is just ridiculous because spreading this, especially without telling their partner, can be life changing. I have taken the three shots there are available now and I would also like to learn more about how they work.

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Massage Pathology

July 23, 2008

Massage therapy is my occupational field. Forensic nursing is my educational study. I see a strong link between massage pathology and forensic nursing. I will be taking the massage pathology course that you offer online. This will help me to be more confident in identifying and handling suspicious pathology. Thank you for offering your massage pathology class.

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Documentation of Bedsores

July 16, 2008

Joint Commission and CMS (Medicare) have set a Patient Safety Goal of not allowing bedsores to occur during hospitalizations. My institution uses technology to document existing wounds at the time of admission assessment. We are a totally computerized charting hospital. When we identify an existing wound, we bring up a screen of the body and insert a photo of the wound into the patient’s medical record. This feature allows us to prevent lawsuits and receive the correct reimbursement of that patient’s hospitalization. Health assessment no longer has to rely on a verbal or hand written dictation to describe history and physical assessments!

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Informed Consent: Is It Really Understood?

July 10, 2008

It is good to see the topic of informed consent included in the text book Health Promotion Throughout the Lifespan. As a nurse, who practiced for twenty plus years in the acute care field, this topic is of vital interest to me. It was not often enough that I felt patients fully understood what they were agreeing to. Now, with mounting concerns about patient safety and lawsuits arising out of botched communications, the area of informed consent is drawing national attention. Informed consent is one aspect of patient autonomy. Informed consent occurs when with “substantial understanding” and without substantial control by others an individual authorizes a professional to do something. As a witness to the typical “informed consent” process, in the acute care setting, it is no wonder that breeches in patient autonomy are realized and being awarded financial remuneration following legal action. In my opinion, critical flaws in the current system include; the patient condition at the time information is being provided, lack of complete information including treatment alternatives, lack of patient education prior to procedures including the recovery phase, lack of time to process information, cumbersome written consent documents, language and other communication barriers. The Centers for Medicare and Medicaid Services have now called upon hospitals to design patient-friendly informed-consent processes. Theses processes are now required to include treatment alternatives and the consequences of declining recommended therapies. The Joint Commission, which accredits hospitals, is advocating the use of easy-to-read forms and the use of “teach-back” methods, which involve asking patients to repeat back what they have been told about the proposed treatment, risks and benefits. The Department of Veterans Affairs (VA) hospital system is conducting several new studies in the area of informed consent utilizing the “teach-back” method to determine patient understanding. It is the beginning of what I believe to be a long overdue focus in healthcare delivery. Hopefully, the information gained will be utilized in a standardized approach to increase patients understanding of proposed treatments with the outcome of preserving patient autonomy.

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Elder maltreatment

July 1, 2008

Elder maltreatment is becoming an increased social problem gaining higher level of scrutiny. Medical programs have limited formal education on the recognition of the different forms of elder maltreatment. The natural changes of aging reflected in pathopysiology can make it difficult to distinguish physical changes of abuse from those of aging.

Elder maltreatment can be classified in six categories: physical abuse, sexual abuse, neglect, psychological abuse, financial and material exploitation and violation of rights. Clinician must be versed in normal pathopysiology of ageing so assessment findings will not be mistaken as trauma or neglect. The victims and perpetrators, scenarios, risk factors, common anatomic and clinical findings, the pathopysiology ageing and limitations of abuse need to be understood.

The American Medical Association defines elder maltreatment as an act or omission that results in harm or threatened harm to the halt health and welfare of an elderly person. The 2004 report of the National Center an Elder Abuse stated that 83 cases of abuse are reported for 1000 elder Americans. This paper will focus on physical abuse, sexual abuse and neglect.

It is important to have a knowledge base of typical victim and perpetrator characteristic to detect or prevent elder maltreatment. Common characteristics are:
• Age : >75 years old
• Dependency upon one person for ADL-IADL
• Lacks a social net work and has cognitive and physical impairment.
• Perpetrator: Transgeneration violence pattern in family. Perpetrator may be under period stress, substance abuser or have mental illness.

Physical abuse is an act carried with the intention of causing physical pain or injury. Physical abuse makes up 14% of all elder traumas. Clinicians must work to determine if assessment finding are a result of secondary or accidental trauma. Location of trauma in areas of body not commonly impacted during daily activities invite closer inspection. Such areas would be inner thigh, top or bottom of feet, inner wrists or ankle, abdomen, axilla or posterior neck. Areas that are likely non-accidental are also the eye, nose, and inner mouth. Injuries at different stages in healing would indicate repeated pattern of trauma. Imprint pattern of injury needs to be assessed for similar shape and size.

Hair loss from forehead and front temporal region is common in males and postmenopausal females. However, single or multiple patches of alopecia is a sign of traumatic alopecia. The scalp around the patch would show normal hair distribution. Scalp hemorrhage or a hematoma may be a result of hair being forcibly pulled out.

Anogentital injury or vaginal hematomas should be investigated. Elderly females are prone to vaginal injury due decreased estrogen, vaginal dryness and thinning of the vaginal wall.

A nurse doing an assessment of the integumentary system should be alert to these various patterns of symptoms. Forensic nurses would be trained to these signs and social interactions between patient and care givers. This group of nurses could serve to bridge this knowledge to other members of the medical team. The medical community should anticipate an increase in elder abuse with the escalating numbers of elders in the community.

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