Viagra Vigour
By X. Arakos. Robert Morris College, Pittsburgh, PA.
Kerry and Chapman (159) have described the deliberate application of such a ligature by parents who were attempting to prevent enuresis quality 800 mg viagra vigour erectile dysfunction medications otc. After consensual sexual intercourse discount 800mg viagra vigour with mastercard erectile dysfunction treatment malaysia, lacerations of the foreskin and frenulum, meatitis, traumatic urethritis, penile edema, traumatic lymphangitis, paraphimosis, and penile “fractures” have all been described (160– 163). Accidental trauma is more common when there is a pre-existing abnormal- ity, such as phimosis (160). Skin injury may be incurred if the genitals are deliberately bitten during fellatio (160). Although the precise incidence of male genital trauma after sexual activity is unknown, anecdotal accounts suggest that it is rare to find any genital injuries when examining suspects of serious sexual assaults (164). In children the genitalia may be accidentally or deliberately injured, and the latter may be associated with sexual abuse (165). Bruises, abrasions, lac- erations, swelling, and burns of the genitalia of prepubescent males have all been described (165,166). Definitions Buggery is a lay term used to refer to penile penetration of the anus (anal intercourse) of a man, a woman, or an animal (also known as bestiality). Consensual Although anal intercourse among heterosexuals is the least common com- ponent of the sexual repertoire, it has been experienced on at least one occa- sion by 13–25% of heterosexual females surveyed (64,80,167), and it was described as a regular means of sexual gratification for 8% of women attend- ing one gynecologist (80). Among 508 men who reported having had a same- gender sexual experience at some stage in their lives, 33. Inter- estingly, in contrast to a common perception, more men had experienced both practices than had been in exclusively receptive or insertive roles (168). Nonconsensual Anal intercourse was reported by 5–16% of females who described hav- ing been sexually assaulted (6,169). Although it may be the only sexual act performed, it is more frequently combined with vaginal and oral penetration (6,169). Fewer data are available regarding sexual assaults on males, although Hillman et al. Legal Implications Under English common law, the term buggery is defined as anal inter- course by a man with another man or a woman and anal or vaginal inter- course by a man or a woman with an animal (bestiality). Although the 1967 Sexual Offences Act provided that it was not an offense for two consenting men who had attained the age of 21 to commit buggery in private, it remained an offense for a man to commit buggery with a woman, even if both parties consented, until 1994. The Criminal Justice and Public Order Act 1994 expanded the definition of rape, which had previously related to only vaginal intercourse, to include nonconsensual penile penetration of the anus independent of the gender of the recipient. The Sexual Offences (Amendment) Act 2000 reduced the minimum age at which a person, whether male or female, may lawfully consent to bug- gery to 16 years. A recent change in English law has defined nonconsensual penetration of the anus by an object or a body part (excluding the penis) as “assault by penetration,” this new offense has the same maximum sentence as rape. In some other jurisdictions, such as Australia, such acts are included in the legal definition of rape (172). Anatomy and Physiology An understanding of the normal anatomy and physiology of the perianal area and anal canal is important for the reliable description and interpretation of the medical findings after allegations of anal penetrative acts. Unfortunately, varying definitions have resulted in considerable confusion, such that there is no consensus among forensic practitioners about the nomenclature that should be used in describing injuries to this area. Therefore, a brief overview of the relevant information is given in the remaining Subheadings, together with ref- erences to more substantive texts. Anus The anus refers not to an actual anatomical structure but to the external opening of the anal canal. The skin that immediately surrounds the anus is variously referred to as the anal verge or anal margin (173). Because the anal canal can evert and invert as the anal sphincters and pelvic floor muscles relax and contract, the anal verge/margin is not a fixed, identifiable landmark. Perianal Area The perianal area is a poorly defined, approximately circular area that includes the folds of skin encircling the anus. It is covered by skin that is often Sexual Assualt Examination 103 hyperpigmented when compared with the skin on the buttocks, although this varies with age and ethnicity (174).
The following is an example of a nursing his- tory and assessment tool that may be used to gather informa- tion about the client during the assessment phase of the nursing process 800mg viagra vigour mastercard erectile dysfunction caused by low blood pressure. Family configuration (use genograms): Family of origin: Present family: Family dynamics (describe significant relationships between family members): 2 buy viagra vigour 800 mg low cost erectile dysfunction tea. This might include effects specific to gender, race, appearance, such as genetic physical defects, or any other factor related to genetics that is affecting the client’s adaptation that has not been mentioned elsewhere in this assessment. Environmental factors (family living arrange- ments, type of neighborhood, special working conditions): b. Health beliefs and practices (personal responsibility for health; special self-care practices): Nursing Process: One Step to Professionalism ● 7 c. Precipitating Event Describe the situation or events that precipitated this illness/ hospitalization: V. Anxiety level (circle level, and check the behaviors that apply): Mild Moderate Severe Panic Calm Friendly Passive Alert Perceives environment correctly Cooperative Impaired attention “Jittery” Unable to concentrate Hypervigilant Tremors Rapid speech Withdrawn Confused Disoriented Fearful Hyperventilating Misinterpreting the environment (hallucinations or delusions) Depersonalization Obsessions Compulsions Somatic complaints Excessive hyperactivity Other 2. Mood/affect (circle as many as apply): Happiness Sadness Dejection Despair Elation Euphoria Suspiciousness Apathy (little emotional tone) Anger/hostility 3. Ego defense mechanisms (describe how used by client): Projection Suppression Undoing Displacement Intellectualization Rationalization Denial Repression Nursing Process: One Step to Professionalism ● 9 Isolation Regression Reaction formation Splitting Religiosity Sublimation Compensation 4. Level of self-esteem (circle one): low moderate high Things client likes about self Things client would like to change about self Nurse’s objective assessment of self-esteem: Eye contact General appearance Personal hygiene Participation in group activities and interactions with others 5. Stage and manifestations of grief (circle one): Denial Anger Bargaining Depression Acceptance Describe the client’s behaviors that are associated with this stage of grieving in response to loss or change. Thought processes (circle as many as apply): Clear Logical Easy to follow Relevant Confused Blocking Delusional Rapid flow of thoughts Slowness in thought association Suspicious Recent memory: Loss Intact Remote memory: Loss Intact Other: 7. Interaction patterns (describe client’s pattern of interpersonal interactions with staff and peers on the unit, e. Reality orientation (check those that apply): Oriented to: Time Person Place Situation 10. Psychosomatic manifestations (describe any somatic complaints that may be stress-related): 2. Skin: Warm Dry Moist Cool Clammy Pink Cyanotic Poor turgor Edematous Evidence of: Rash Bruising Needle tracks Hirsutism Loss of hair Other c. Musculoskeletal status: Weakness Tremors Degree of range of motion (describe limitations) Pain (describe) Skeletal deformities (describe) Coordination (describe limitations) d. Neurological status: History of (check all that apply): Seizures (describe method of control) Headaches (describe location and frequency) Fainting spells Dizziness Tingling/numbness (describe location) e. Cardiovascular: B/P Pulse History of (check all that apply): Hypertension Palpitations Heart murmur Chest pain Shortness of breath Pain in legs Phlebitis Ankle/leg edema Numbness/tingling in extremities Varicose veins f. Method of birth control used Females: Date of last menstrual cycle Length of cycle Problems associated with menstruation? Medication side effects: What symptoms is the client experiencing that may be attributed to current medication usage? Activity/rest patterns: Exercise (amount, type, frequency) Leisure time activities: Patterns of sleep: Number of hours per night Use of sleep aids? Personal hygiene/activities of daily living: Patterns of self-care: Independent Requires assistance with: Mobility Hygiene Toileting Feeding Dressing Other Statement describing personal hygiene and general appearance n. Essential fea- tures of many disorders are identical, regardless of the age of the individual. Examples include the following: Cognitive disorders Personality disorders Schizophrenia Substance-related disorders Schizophreniform disorder Mood disorders Adjustment disorder Somatoform disorders Sexual disorders Psychological factors affect- ing medical condition There are, however, several disorders that appear during the early developmental years and are identified according to the child’s ability or inability to perform age-appropriate tasks or intellectual functions. It 14 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence ● 15 is essential that the nurse working with these clients understand normal behavior patterns characteristic of the infant, childhood, and adolescent years. About 5% of cases of mental retardation are caused by hereditary factors, such as Tay-Sachs disease, phenylke- tonuria, and hyperglycinemia. Chromosomal disorders, such as Down syndrome and Klinefelter syndrome, have also been implicated. Mental retardation can occur as an outcome of childhood illnesses, such as encephalitis or meningitis, or be the result of poisoning or physical trauma in childhood. The individual may experience some limitation in speech communication and in interactions with others. Systematic habit training may be accomplished, but the individual does not have the ability for academic or vocational training. There is a lack of ability for speech develop- ment, socialization skills, or fine or gross motor movements.
