Chapter 26 the abused child

Question 1

cultural differences

Answer 1

neglect/abuse versus acceptable cultural practices

Question 2

the child abuse prevention and treatment act (CAPTA)

Answer 2

• acts of comission
• acts of omission
• both are child abuse and must be reported to authorities
• unintentional abuse or injury

Question 3

acts of commission

Answer 3

intentional harm via physical, emotional, or sexual abuse

Question 4

acts of omission

Answer 4

• inadequate nutrition, shelter, warmth, appropriate seasonal clothing, safety, and education

Question 5

unintentional abuse or injury

Answer 5

occurs due to lack of education on child rearing or basic needs, or lack of resources

Question 6

types of abuse

Answer 6

physical
emotional
neglect
sexual abuse

Question 7

physical abuse

Answer 7

• acts of commission caused by parent or caregiver
• result in physical harm or have potential for physical harm

Question 8

emotional abuse or neglect

Answer 8

• failure of the parent or caregiver to provide an appropriate supportive environment
• adverse effect on emotional health and develop

Question 9

physical neglect

Answer 9

parent or caregiver who has the resources fails to provide nutrition, shelter, medical care, and safe living conditions

Question 10

sexual abuse

Answer 10

• parent, caregiver, stranger, or known family friend, relative, or neighbor uses a child for sexual gratification
• children display symptoms of infection, abdominal pain, genital injury, constipation, uti, sexually explicit behaviors, increased interest in sexuality, and emotional disturbances
• if suspected, a forensic evaluation is initiated
• nurse must maintain chain of custody/evidence —> label each photograph and specimen collected, keeping evidence within sight until given to law enforcement

Question 11

Munchausen’s syndrome by proxy

Answer 11

• parent intentionally creates an illness, fabricates the symptoms of an illness
  (also called FDIA —> factitious disorder imposed on another)
• mental illness: one has inner need for another person to be seen injured or ill
• typically mothers w/ some healthcare knowledge
• child experiencing diagnostic tests places attention on the mother
• symptoms not present when mother absent

Question 12

abuse statistics

Answer 12

• 74.9% neglect
• 8.3% physical abuse
  8.6% sexal abuse
  others include abandonment, congenital drug addiction, and threats to harm
• some children suffer multiple types of abuse

Question 13

fatal abuse

Answer 13

• infants and very young children are at greatest risk for death associated w/ abuse
• routine postmortem examinations are not always conducted globally

Question 14

most common causes of childhood deaths associated w/ abuse were

Answer 14

• head trauma
• shaking deaths
• burns
• drowning
• smothering
• suffocating
• choking
• strangulation

Question 15

prevention of child abuse

Answer 15

• preventing abuse before it occurs is ultimate goal
• community education to prevent child abuse
• readily available and affordable parenting classes
• childcare and anger management skills are taught
• programs to help improve parent child relationship
• programs to provide social support, role modeling, tools for prevention
• early reporting of suspected abuse

Question 16

medical and nursing management of child abuse

Answer 16

• protect from further abuse
• contact the authorities to begin process of identifying abuser
• careful documentation of things heard, seen, and done
• provide child w/ safety and support
• conduct assessments and diagnostics to confirm abuse
• CPS role is to identify the perpetrator and ensure continued safety

Question 17

communication: medical and nursing management of child abuse

Answer 17

child must understand that abuse was not their fault

Question 18

steps for care and protection of victim of child abuse

Answer 18

stabilization
protection from further harm
history taking
collection of lab specimens
- securing of photographs
- differentiation of child abuse from other medical conditions
- determination of spiral fractures
- rule out congenital brittle bone disease
- distinguish between abuse and cultural care practices

Question 19

labs and diagnostics for abuse

Answer 19

• skeletal bone surveys
• CAT
• ophthalmlogic examination
• color photographs
• examination of cerebrospinal fluid
• pregnancy tests
• STI screening tests
• evidentiary examinations of specimens per local coroner, CPS, or medical examiner
• do not wash/bath a child who has been a suspected sexual abuse victim
• do not use a personal cell phone for photo collection of child abuse evence
• understand cultural health practices that can cause skin markings that mimic child abuse

Question 20

nursing considerations and care

Answer 20

• observe the child for behavioral signs of abuse as well as physical signs
• be aware of institutional policies and procedures on reporting child abuse

Question 21

human trafficking

Answer 21

• recruitment, transportation, transfer, harboring, and exploitation of persons by means of threat or force or abduction, for the use of prostitution, forced labor, slavery, servitude, or removal of organs for sale