child abuse question?

[Humaneclowninscrubs]

Hi All,

I had a question it stated a 6 year old child had bruises on knee and lower leg. What is the priority action the nurse should take? It did not state first action or last action.

The two choices that completely wanted to make me rip off my hair were as follows:

1. Assess and speak with the child alone how he got those bruises.

2. Report this to your nurse manager.

I know from content review you always report it to child protective services but that was not an answer choice. I chose 2 because you can talk to a 6 year old child and they will tell you the truth. Did I pick the correct answer?

[dsb_fam]

First of all, my 6 year old has bruises on his lower legs and knees all the time. He plays outside and is extremely active. By the way, many of his bruises are acquired at school and I don't think the school is abusing him. Secondly, if you were seeing my 6 year old, I would be present the entire time. I would not allow you to take him in another room to question him alone. This question they have given you is unfair and ridiculous. What are the other signs of abuse? Is the bruising patterned? Ask the child in front of the parent how he got the bruises. Does the story match the bruise? I have been a foster parent for over 8 years and CPS would not take bruising on the knee or legs as a legitimate abuse case unless there was more evidence. 6 year old children get bruises on their knees all the time.

[JustBeachyNurse, LPN]

Id say neither is a best choice as that is a typical bruising pattern for an active 6 year old. If the child was showing other s/s of abuse different story.

[RNsRWe, ASN, RN]

Seems like the better lesson from this question would be why it is a BAD question! Tell your instructor what dsb_fam said, and why that question is misleading at best, and dangerous (because you'd take the wrong action no matter what) at worst.

[Roman1]

I agree with all the previous posters. That is a ridiculous question. Your instructor needs to give you a more detailed scenario. I have a 4 yr old and a 15 month old. Yesterday morning my 15 month old who is a new walker did a header onto the hardwood floor and now has a bruise on his forehead (my poor little guy). As the previous posters have stated kids bruise easily from playing and that question as stated is dangerous.

[meanmaryjean, DNP, RN]

Show me an ambulatory six year old WITHOUT bruises and I'll get worried!

[dsb_fam]

I reread my post and hope I didn't sound harsh. Just wanted to say that questions like that are completely unfair.

[psu_213, BSN, RN]

What were the other choices, because, even if abuse is suspected, neither of these seem like the best course of action?

[Esme12, ASN, BSN, RN]

The best answer is ask the child if they are active in sports. Most kids can tell you details about each BooBoo. Bruises on a six year old legs is not out of the ordinary.

[TheCommuter, BSN, RN]

I know from content review you always report it to child protective services but that was not an answer choice.

If all six-year-old children in American with bruises on their lower extremities were reported to child protective services, the phone lines would not be able to handle the sheer volume.

Six-year-olds fall off bicycles and scooters. They fall off jungle gyms in the playground. Some children in this age range play sports such as baseball and soccer that have the potential for hard contact and the resultant bruises.

Real signs of physical abuse include multiple bruises on different parts of the body various stages of healing, suspicious fractures, and parents who speak for an otherwise withdrawn child.

[nurseprnRN, BSN, RN]

When I taught child abuse recognition for the Scouts the pediatrician emphasized that bruises over bony prominences like knees and shins weren't worrisome; you worried about weird places for bruises that kids would have a hard time doing to themselves, like abdomen, back, and circumferential around an arm (think: grabbing an arm or wrist hard) or patterned marks from a belt, kitchen implement, phone cord, or the like.

[mrsboots87]

Was one of the answers (you only listed two and at least for are offered) to "document findings" or something similar. Because that is what I would have chosen. Just because the question was made from the abuse lecture, does not mean that they are actually being abused. There are plenty of various types of questions that have normal findings and the answer will be to just document. Think about it. How many 6 year olds have you seen WITHOUT bruises all over their knees and legs. My 5 year old comes home with a new bruise every other day at best because she plays hard at school and is in dance and soccer. It just happens. Now if she started crying about not wanting to go to school, or had weird bruises on her back or abdomen, that would be worrisome. Same for this question, with the info provided, this appears to be normal bruising.