Reference no: EM133869852

A 19-year-old male presents to the Emergency Department with a complaint of painful rectal bleeding. The triage note is otherwise blank. The client enters the examination room alone, appearing sullen and withdrawn. The ED nurse assigned to his care becomes frustrated during multiple attempts at a history and a physical exam. The client is quiet, slow to answer questions, and offers little detail. The nurse makes several requests for the client to fully undress. Physical examination is remarkable for a bloody laceration extending close to the ventral aspect of the anal sphincter. Multiple bruises are noted on the extremities. After the examination, the nurse shakes his head and asks, "How did all this happen?" The patient starts to cry and states, "I can't believe my life has gotten so out of control."

The social history of the client reveals client is homosexual and lives with his older boyfriend of two years. He denies tobacco use, but drinks alcohol heavily each weekend and uses illicit drugs. "I'm not sure what they are really called. My boyfriend gets them for us."

Questions:

1. Why wasn't the client immediately forthcoming about the nature of his injuries?
2. How could the nurse more sensitively obtain a sexual history from this client?
3. What three health issues concern you about this client?
4. What safety questions should be asked about possible intimate partner violence?