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The main ideas from this information are: - Psychosomatic complaints or chronic pain can have no identifiable medical reason. - Self-destructive behaviors such as cutting, burning, and substance abuse can be signs of underlying issues. - Neuro-symptom disorders like depression and lack of energy can be indicators of abuse or trauma. - Dementia patients in nursing homes who exhibit sudden sexual aggression may be victims of abuse themselves. - Caregivers can be perpetrators of abuse, whether physical, psychological, or orthodontic. - Injuries to the buttocks, genitals, and inner thighs in children or elderly patients are automatically considered sexual assault. - Signs of abuse can include pressure bruises, burns, and poor hygiene. - Some individuals may live in squalor due to financial limitations. - Sexual abuse is often underreported due to shame and stigma. - The least common cause of death in patients over 65 is discussed. - GEMS diamond is used to evaluate a person's activities i Psychosomatic complaints or chronic pain. I go to the hospital all the time for headaches or abdominal pains or I can't sleep, but there's no medical reason for it. There's no identifiable reason. Self-destructive behavior, cutting, burning, branding, you know, self-destructive behavior, drinking, drug use. Neuro-symptom disorders, depression or lack of energy, substance and or sexual abuse history. Dementia patients in nursing homes. A dementia patient all of a sudden becomes sexually abusive to staff or other patients and then they do some investigating and find that that patient is being abused. What happens is they're acting out the abuse on themselves. So when patients in nursing homes all of a sudden become sexually aggressive, that's the first thing they do. They investigate that patient to see if that patient is being sexually abused. More often than not, that's usually what happens. Caregivers. A category of caregivers for abuse could be physical, psychological, and orthodontic. You'll read through that table and just kind of cover all of this. Afflicted bruises usually found in the buttocks, lower back, genitals, inner thighs, face and ears. Any injury to a child or an elderly patient in the genital or buttocks region automatically considers sexual assault. May not be, but automatically consider that sexual assault and follow that group. Pressure bruises caused by human hands may be identified as global grabs of the arms or the chest, pinch marks, hand prints, point marks, lacerations with infections. Cigarette burns, matches, heated metal, forced immersion liquids. You get those circumferential or glove burns. Chemical and electrical power sources. So, look at this guy right here. Now this guy could be homeless, but look at him. Does he look healthy? Very dirty and unkempt. Look at his hair. He's got sores on his face. Probably got poor dental hygiene. He's unclean. So, these are things you want to look for because this patient may be, he might not be abused, he might be homeless. Or he might live in a squalor because he doesn't have any... He lives on $600 a month in social security, or $800 a month in social security. He can gain $130 if he's going to own social security. So, if your rent is $500 a month, then you live on $300. So, you don't have any amenities. Regarding injuries to the genitals erected, we talked about that as evidence of sexual abuse. Women, many times, don't report it for the shame. Same reason that younger women don't report it. So, in review, the least common cause of death in patients over 65 is... Least common. It doesn't mean it doesn't happen, but it's the least common. According to the GEMS diamond, a person's activities in daily living are evaluated when... Social events. Correct. Very good. Condition that causes the length of the eye is called a... Cataract. Cataract. Nystagmus is when you're checking for the pupillary... You're checking for constricted gaze and it bounces in the corners. That's a nystagmus. Astigmatism is when two eyes have different levels of vision. And glaucoma is the intraocular pressure. Glaucoma is the intraocular pressure. You are called to a neatly kept residence for any woman who does this by herself. She burned her hand on the stove and experienced a full thickness burn. So, she got a full thickness burn on the stove. Not a... Oh my god, I got a blister. A full thickness burn. That's a charring. When treating this patient, it's important to note that... She... Swallowing or reflexes causes delayed pain reaction. And she might have neuropathy, too. She may not have noticed until she smelled the smoke. The slow onset of progressive disorientation, short attention span, and loss of cognitive function. Anybody agree with that? Dementia. A 71-year-old man with a history of hypertension and vascular disease presents with tearing abdominal pain. He's got a blood pressure of 80 over 60 on the right and 160 over 90 on the left. And a heart rate of 120. Respiration is at 28. Your assessment reveals his abdomen is rigid and distended. A... An aortic aneurysm. Absolutely. AAA. It's probably ruptured. We're seeing the following. It's a physiological change that occurs during the process of aging. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C.