Rape Trauma Syndrome

Rape
Trauma Syndrome

(_)Actual (_)
Potential

Related
To:
[Check
those that apply]
Somatic
Response:
(_) Gastrointestinal irritability (N/V, anorexia)
(_) Genitourinary discomfort (pain, puritus)

(_) Skeletal muscle tension (spasm, pain)
(_) Other:___________________________
___________________________________
Sexual responses:
(_) Mistrust of men (if victim is woman)
(_) Change in sexual behavior

Other:_____________________________
__________________________________

Psychological
responses:
(_) Denial
(_) Emotional shock

(_) Anger
(_) Fear
(_) Guilt
(_) Panic on seeing assailant or scene of attack
(_) Other:_____________________________
____________________________________

____________________________________

 

As
evidenced by:
[Check
those that apply]
Major:

(
Must be
present
)
(_)
Reports or evidence of sexual asault
Minor:

(
May be
present
)
If the
victim is a child, parent(s) may experience similar
responses:
Acute Phase:
  • Somatic
    responses: Gastro-intestnal irritability (N/V,
    anorexia) Genitourinary discomfort (pain,
    pruritus) Skeletal muscle tension (spasm, pain)
  • Psychological
    responses: Denial, emotional shock, anger, fear
    of being alone or that the rapist will return [a
    child victim will fear punishment, repercussions,
    abandonment, rejection] guilt, panic on seeing
    assailant or scene of attack
  • Sexual responses:
    Mistrust of men (if victim is a woman), change in
    sexual behavior.

Long term phase:

  • Any response of
    the acute phase may continue if resolution does
    not occur.
  • Psychological
    responses: Phobias, nightmares, or sleep
    disturbances

 

Date &

Sign.

Plan and Outcome
[Check
those that apply]
Target
Date:
Nursing Interventions
[Check
those that apply]
Date
Achieved:
  The
patient will:

(_)
Experience decreased symptoms of:

 

(_) Discuss assult.

(_) Express feelings
concerning the assault and the treatment.

(_) Identify members
of support system and utilize them appropriately.

(_) Return to
pre-crisis level of functioning.

(_) Other:

 

  (_)
Assess for psychological responses:
  • Phobias
  • Denial
  • Anger
  • Depression
  • Guilt
  • Other:

 

(_) Inspect urine and
external genitalia for bleeding.

(_) Observe patient’s
behavior carefully and record objective data.

(_) Promote trusting
relationship.

(_) Provide crisis
counseling within one hour of rape trauma event.

(_) Help patient meet
personal needs of:
________________________

(_) Allow patient to
express feelings.

(_) Discuss with
patient previous coping mechanisms.

(_) Explore with
patient her/his strengths and resources.

(_) Offer feedback to
patient on feelings verbalized.

(_) Explore sexual
concerns with patient.

(_) Initiate health
teaching and referrals as necessary.

(_)
Other:________________
________________________

________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature