Chapter 26 the abused child Flashcards
cultural differences
neglect/abuse versus acceptable cultural practices
the child abuse prevention and treatment act (CAPTA)
- acts of comission
- acts of omission
- both are child abuse and must be reported to authorities
- unintentional abuse or injury
acts of commission
intentional harm via physical, emotional, or sexual abuse
acts of omission
- inadequate nutrition, shelter, warmth, appropriate seasonal clothing, safety, and education
unintentional abuse or injury
occurs due to lack of education on child rearing or basic needs, or lack of resources
types of abuse
physical
emotional
neglect
sexual abuse
physical abuse
- acts of commission caused by parent or caregiver
- result in physical harm or have potential for physical harm
emotional abuse or neglect
- failure of the parent or caregiver to provide an appropriate supportive environment
- adverse effect on emotional health and develop
physical neglect
parent or caregiver who has the resources fails to provide nutrition, shelter, medical care, and safe living conditions
sexual abuse
- 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
Munchausen’s syndrome by proxy
- 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
abuse statistics
- 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
fatal abuse
- infants and very young children are at greatest risk for death associated w/ abuse
- routine postmortem examinations are not always conducted globally
most common causes of childhood deaths associated w/ abuse were
- head trauma
- shaking deaths
- burns
- drowning
- smothering
- suffocating
- choking
- strangulation
prevention of child abuse
- 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
medical and nursing management of child abuse
- 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
communication: medical and nursing management of child abuse
child must understand that abuse was not their fault
steps for care and protection of victim of child abuse
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
labs and diagnostics for abuse
- 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
nursing considerations and care
- observe the child for behavioral signs of abuse as well as physical signs
- be aware of institutional policies and procedures on reporting child abuse
human trafficking
- 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
