Homework help - child abuse?

bratmobile · Jan 25, 2012

1. trauma abc's, patient safety 2. evidence preservation, reporting, ..(?)

Esme12, ASN, BSN, RN · Jan 25, 2012

http://childlaw.sc.edu/frmPublications/treatment_114200441012.pdf

http://www.enurse-careplan.com/2010/09/nursing-care-plan-ncp-child-abuse.html

noahsmama · Jan 25, 2012

The question is worded rather vaguely. For example, it doesn't make it clear (to me, at least) if this is a case of confirmed child abuse or if child abuse is suspected but not confirmed. It also doesn't make it clear if the abuse has been reported to CPS yet?

The link provided by Esme gives some good info on physical findings that might cause you to suspect child abuse. I'll add that any kind of bone fracture in a non-ambulatory infant is a red flag for abuse -- not to say it can't happen accidentally, but any fracture in a non-ambulatory infant should be closely investigated. Also, although bruises in a non-ambulatory infant should raise concern, be aware that an abused child may not have any bruises at all. It is a misconception that even some physicians have that abusive fractures are always associated with overlying bruises -- this is simply not the case!

And, as someone who works with abused children (I work for CPS in my county), I want to really really emphasize that a mandated reporter is required to report SUSPECTED child abuse. It is not your job as a nurse (nor is it the doctor's job, unless they are a forensic pediatrician) to investigate or prove child abuse -- it is CPS's job to investigate all cases of SUSPECTED child abuse. IF YOU SUSPECT CHILD ABUSE AND DO NOT REPORT IT, YOU HAVE BROKEN THE LAW! The reason I put so much emphasis on this is that I have a case right now where clearly the doctors suspected child abuse -- "non-accidental trauma" was in the freaking differential diagnosis for pity's sake -- and yet they did not call CPS and released a child home to their parents, only to have the child return to the ED a few days later with additional injuries.

Okay, I'll get off my soap box now.......

lulain · Jan 26, 2012

Thank you for the thoughtful comments. I'm sorry to hear about your case, noahsmama. What a terrible negligence on the part of the doctor!

Constantly Surprised · Jan 29, 2012

The primary goal of any nurse regarding any patient is safety. Always safety first. Your primary goal is the safety of your patient.

Secondary to me would be a support role. An ear, a shoulder. While you wouldn't instruct your patient on what they should do (in your opinion) regarding their abuse, what you would do is provide alternatives (teach them options available to them i.e. shelters or help groups) if their choice is to leave the abuse.