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NURSES ARE MANDATED TO REPORT ANY SUSPICION OF CHILD ABUSE - includes Physical, Physiological (emotional), Sexual, and Neglect many incidence of Abuse and Violence occur in families who seem to have everything usually, theres always someone w/in the family who is aware of the Abuse and not reporting it

Abuser: the abuser might have been abused as a child; hungry for power and control is likely to be an alcoholic or a drug abuser often blames victims of own wrong doing Characteristics of Abusive Parents: abusive Parents usually keep to themselves isolated from others do not invite other people into their homes most often these Parents are substance abuser themselves they have no self-control and often times they come from a family with history of Abuse/Violence the abusive husband often believes his wife belongs to him like a property they belittle and manipulate their children Victim of an Abuse: frequently suppress their anger and resentment and do not tell anyone victimized children believe that somehow they are at fault and did something to deserve or provoke the abuse as they reach adulthood they have a feeling of shame and guilt for not trying to stop the abuse Children who witness violence between their parents learn that violence is a way to resolve conflict - they feel degraded, humiliated, and dehumanized - their self-esteem is extremely low; they believe that they are unacceptable to others women who grew up in Violent families are likely to accept Violence in their own relationship - women use personal and financial dependency as a reason why they find it difficult to leave an abusive relationship adults who were victims of abuse as children frequently abuse their own children and children who are abused are likely to become an abuser and may develop a Depression Intervention: when Patient is in the ER state the facts I see you have two black eyes. Tell me how it happen know the story 1

YOUR PRIORITY IS THEIR SAFETY; DO NOT ADVISE THEM TO LEAVE THEIR RELATIONSHIP - suggest to make several copies of their ID - identify closest friend and keep set of clothing - they must have a plan if they do not have any plans ask Patient where would they go if they have no place to go they wind up staying at the hospital offer Group Therapy and work with their self-esteem REINFORCE THE VICTIM THAT IT IS NOT THEIR FAULT recognizing the signs of danger is the first step in developing a plan of care for a survival Patient of Abuse for Spousal Abuse refer the Abuser to an Anger Management program Child Abuse: serious injuries such as fractures, burn, or lacerations with no reported history of trauma bruises and cuts on the neck should always raise suspicion of strangulation bruises that are circumferential looking like a finger mark or a grab mark should also raise a red flag unusual fracture sites; emergent type burns such as perineal burns (dunken burns); burns or scalds (blisters) that have an identifiable shape such as: cigarette marks, or have a stocking and glove distribution which, indicate scalding injuries not correlating to the childs age such as: - fractured femur on a 2mnth old this baby is not old enough to walk; dislocated shoulder on a 2yr old - inner lip tear of a 3mnth old this baby is not old enough to sit up and fall which would result to have an inner lip tear - a parent reports that the infant with skull fracture rolled off the couch the infant is too you to roll over evidence of old injuries not reported, such as scars, fractures that are not treated, or multiple bruises that the parent/caregiver cannot explain Sexual Abuse: any sexual contact between an adult (over 18) and a minor Children who have been sexually abused may have high incidence of: - UTI; positive for Gonorrhea of the throat - mouth sores - bruised, red, and swollen genitals; tear or bruising of the vagina Warning Signs of Child Abuse: frequent visit to the hospital visiting a hospital that is very far away from home this indicates that the child has been to the hospital near their home many times 2

if you dont see that Mother-Child bonding when the child is brought to the ER this action should raise suspicion it is usually the child that is indifferent who is the targeted developmentally or physically disabled child; step child; a child that reminds the abuser of someone REMEMBER WE AS NURSES ARE MANDATED TO REPORT ANY SUSPICION OF CHILD ABUSE NU DX: Risk for Injury Disturbed Self-Concept r/t believing that they cause this Intervention: REPORT SUSPICION OF CHILD ABUSE your priority is the childs safety Rape any non-consenting sexual contact between two people if a person cannot give consent to the sexual intercourse it is considered rape - those who cannot give consent are people under the influence or developmentally delayed most common type of Rape is Date-Rape - raped women and children tend not to report Rape b/c of feeling shame and guilt, the fear of further injury, and the belief that they contribute to the cause of Rape Intervention: YOUR PRIORITY IS TO ENSURE THERES NO SUBSEQUENT INJURIES Patient may or may not choose to take Legal actions they have the right to refuse however even if they choose not to report police must be contacted before any examination is performed if they chose to Report: call the police do not undress or examine the Patient until the Police arrive only ensure that the Patient do not have any subsequent injuries that are life threatening if you examined the Patient w/o Police presence evidence will not stand in trial if Patient chooses to take legal actions spread a white sheet on the floor undress the Patient on the sheet then examine the Patient in the presence of the Police or Assault Nurse Examiner - examine includes: taking photographs, taking swabs and any potential DNA samples after the examination focus on the Patients safety determine where the Rape occurred if Rape occurred on a minor call the Police right away with or without the Parents consent YOU ARE MANDATED TO REPORT CHILD ABUSE 3

Patients may be given Phophylactic Antibiotics and Morning After Pill to prevent pregnancy Crisis Intervention: focus on helping the Patient define the problem; support and return them to pre-crisis level of functioning - focus on restoring the victims sense of control such as: allowing them to make decisions when possible what would she like done ensure they understand that being Rape is not their fault Neglect not providing the basic needs in life Nurses are not mandated to report Elder Abuse instead we are encourage more often occur on elderly people who have chronic mental and physical health problems where they are dependent on other for food, medical care, and various ADLs elders are often reluctant to report Neglect or Abuse b/c it usually involves the Family Indicators of Neglect: underweight, malnourished or dehydrated not related to a known illness fecal or urine smell; laying on soiled linens for long periods of time rashes, sores, lice on the elder; the elder has an untreated medical condition children with no proper immunization