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Interventions for Domestic Violence

DMV (Domestic Violence) reports today show that many women are likely to be injured by an intimate partner than accidents or rapes, and many others go unreported. Because DMV is so prevalence many communities today have outreach programs, hospitals have specialized professionals and even work places are recognizing the need to help victims.

Early identification of abuse is key in helping a victim to be safe and providing them with the appropriate resources. When domestic violence is suspected or confirmed the nurse will want to gather resources within the community to help establish interventions that will provide for a safe environment, provide support, and offer protection. In addition the nurse wants to listen to the victims concerns and believe what the victim is telling them. The National Domestic Hotline will help the nurse find resources within the community such as safe house to protect the victim and their children, and other support systems to help meet the victim’s needs. The nurse should also offer support and reassurance that confidentiality will be protected and that the nurse will help the victim with decisions that need to be made. [1] The victim should also be reassured that intimate partner abuse is not normal and there are support groups and legal actions to help the victim not stay in an abusive situation. The best intervention for victims of intimate partner violence is to get involved and know what resources are available to help victims of domestic violence. The following links will provide the nurse with resources to aide the victim in finding the necessary resources for getting help. National Violence against women prevention research center: [2] Tool Kit to end violence: [3] Family Violence Prevention Fund: [4]

Assessment of Skin in the Elderly

With 12% of the U.S. population greater than 65 years of age and another 3 million over the age of 85 the need for health care providers to understand how to care for dermatological issues is more important than ever. In addition, it is estimated that two-thirds of this aging population have some sort of skin or dermatological complaints with a large number of these being linked to skin problems known as photoaging. Photoaged has two main concerns for the patient: The first concern involves the increase risk for skin cancer and the second concern deals with the appearance of damaged skin. In younger skin sun damage will heal faster since the cells in the epidermis have a faster turnover rate, while in the older population the skin becomes thinner and the epidermis turnover rate for cell repair is lower which may result in the dermis layer being damaged.

Chronological or Photoaged

When assessing a patient's skin the nurse should do a complete medical history to establish any current medical conditions and to determine if there are any existing skin conditions, family history, and issues that may aggravate skin problems such as medications. Patients with photoaged skin will have the appearance of their skin being coarse or pebbly. One condition seen in photaged skin is actinic purpura which can be defined as the destruction of the vascular walls in the dermis. Mildly damaged skin has a low rate of skin cancer while skin that has extensive damaged such as actinic purpura will see a increase rise in skin cancer especially in fair skin patients. In addition to skin cancer photoaged skin can affect the patient's self confidence as a result of damaged skin. Photoaged does not happen overnight but is a accumulation process that begins at childhood and affects everyone.

Clinical Features

At one time photoaging and chronological aging were considered to be the same, today they are viewed as being different and sometimes referred to as intrinsic and extrinsic aging. Chronological aged skin will lose its elasticity, develop smooth and unblemished lines or wrinkles, the epidermis changes and becomes thinner and there is a decrease in collagen. With photodamaged skin the nurse will see increased wrinkles, skin roughness, hyperpigmentation, actinic lentigines or liver spot, leathery appearance and telangiectasia. In chronologically aged skin these changes are mild but only in patients whose skin has been protected from the sun.

Education and Treatment

The patient should be educated concerning the use of sun-screen to prevent further damaged from the sun and the importance of frequent skin care inspection and reporting any skin changes as soon as possible to their physician. Recent development in treating photoaged skin damaged has come about with the development of Retinoic acid or Tretinoin also known as Retin-A. Patients under going treatment with Retin-A will also need to use a moisturizer to help with drying skin and a high SPF sun-screen to prevent further damaged. Studies are underway now showing promising results of reversing the aging process and possibly eliminating precancerous cells.

Tonsils

Tonsils can be described as functioning lymph nodes located at the entrance of the respiratory and gastrointestinal tracts. The function of the tonsils are to respond to local inflammation and aid the lymphatic systems. There are several tonsils but only three that we will focus on and they are lingual, palatine and adenoid tonsils. The palatine tonsils are more commonly refer to as the “tonsils” produce antibodies to aid the respiratory and digestive tract against infections; the palatine tonsils are visible and located on each side of the mouth. The pharyngel tonsils or adenoids are located between the hard/soft palate and can be linked to pituitary problems. The lingual tonsils are located on the upper surface of the tongue and are rarely involved in infection. As the person ages the tonsils may reach a point where they can no longer excrete toxins and the tonsils themselves create drainage into the lymph nodes of the neck, such as the superior deep jugular nodes. [5]

When assessing the tonsils the nurse will us a wooden tongue depressor to push down on the tongue, depress the tongue blade half-way back on the tongue and towards the side edge to prevent triggering the gag reflex. The nurse will examine the tonsils for color, presence of exudates or lesions. If an infection is present the tonsils may appear bright red, swollen and exudates may be present. When documenting the patient's objective data the nurse should described the tonsils appearance and then grade the tonsils on a scale that ranges from +1 to +4. With +1 showing that the tonsils are visible to +4 describing that the tonsils are touching each other. Although,tonsils may help with infections they are generally not important and can be removed.

Some diseases associated with tonsils are the following:tonsillitis,infectious mononucleosis, quinsy, tonsil stones and tonsil cancer. [6]