Chapter 28: Abusive Head Trauma (Children)

Question 1

Abusive Head Trauma

Answer 1

aka shaken baby syndrome

• a non-accidental injury caused by picking up an infant or child by the shoulders or upper torso and shaking him/her
• results from major rotational forces and angular deceleration encountered when an infant is shaken forcefully
• injury may be intentional or unintentional
• most are younger than 6 months of age

Question 2

Complications of Abusive Head Trauma

Answer 2

• neuromotor impairment
• visual impairment
• developmental delays

Question 3

Signs and Symptoms of Severe Cases

Answer 3

• seizure activity
• apnea
• bulging or full fontanelles
• coma
• hemorrhage (retinal or intracerebral)
• bradycardia
• complete cardiovascular collapse

Question 4

Signs and Symptom of Less Severe Cases

Answer 4

• vomiting
• hypothermia
• poor feeding
• failure to thrive
• increased sleeping
• lethargy
• irritability
• difficult to arouse

Question 5

Diagnosis

Answer 5

CT scan or MRI used to determine if a subdural or subarachnoid hemorrhage is present
-an ocular fundoscopic exam used to assess for retinal hemorrhage

Question 6

What is a classic sign of Abusive Head Trauma?

Answer 6

Retinal Hemorrhage

-an ocular fundoscopic exam used to assess for retinal hemorrhage

Question 7

The Hallmark of Abusive Head Trauma

Answer 7

an absence of external trauma to the head, face, and neck of an infant along with massive intracranial or intraocular bleeding
-inconsistencies between health history and physical examination are further investigated

Question 8

Prevention

Answer 8

• identifying risk factors

- increasing awareness of potential stressors parents and their caregivers may experience while caring for an infant

Question 9

Nursing Care

Answer 9

• initiation and maintenance of respiratory and cardiovascular support
• upon admission, assess for increased ICP and visible injuries
• gather health history and information about the abusive event

Question 10

Long-term Impairment

Answer 10

child may have long-term impairment

• requires ongoing therapy that may consist of total care and self-care deficits, gastrostomy tube feedings, a tracheostomy, and pressure ulcer prevention
• prevention of complications such as infection, contractures, or decreased muscle tone for children in a vegetative state

Question 11

Medical Care

Answer 11

• maintaining oxygenation
• inserting a nasogastric or orogastric tube
• assessing for seizure activity and implementing seizure precautions
• maintain adequate fluid and nutritional intake

Question 12

Legal and Ethical Responsibility

Answer 12

• nurses required to report any incidences of probable abuse to the appropriate child welfare and law enforcement agencies
• health-care facilities should have relevant policy and procedural guidelines in place for a child admitted with abusive had trauma
• accurate documentation in the medical records is of great importance b/c record may be used in court

Question 13

Education/ Discharge Instructions

Answer 13

• nurse must honestly address parental concerns and questions and provide information about agencies that can provide assistance and support them
• parents need to realize the child may never return to the prior level of cognitive and physical functioning
• discharge instructions regarding home management and monitoring, indications to see the health-care provider, and follow-up appointments given to caregiver
• community resources