A 19-year-old male presents to the Emergency Department with acomplaint of painful rectal bleeding. The triage note is otherwiseblank. The client enters the examination room alone, appearingsullen and withdrawn. The ED nurse assigned to his care becomesfrustrated during multiple attempts at a history and a physicalexam. The client is quiet, slow to answer questions, and offerslittle detail. The nurse makes several requests for the client tofully undress. Physical examination is remarkable for a bloodylaceration extending close to the ventral aspect of the analsphincter. Multiple bruises are noted on the extremities. After theexamination, the nurse shakes his head and asks, “How did all thishappen?” The patient starts to cry and states, “I can’t believe mylife has gotten so out of control.”
The social history of the client reveals client is homosexualand lives with his older boyfriend of two years. He denies tobaccouse, but drinks alcohol heavily each weekend and uses illicitdrugs. “I’m not sure what they are really called. My boyfriend getsthem for us.”
Questions:
- Why wasn’t the client immediately forthcoming about the natureof his injuries?
- How could the nurse more sensitively obtain a sexual historyfrom this client?
- What three health issues concern you about this client?
- What safety questions should be asked about possible intimatepartner violence?
