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What does the broad term "child maltreatment" includes?
- intentional physical abuse (22%) or neglect (54%)
- emotional abuse or neglect (4%)
- sexual abuse (8%)
Which type of maltreatment is the most common form?
what is the definition of neglect?
failure of a parent or other person legally responsible for the child's welfare to provide for the child's basic needs and an adequate level of care.
What factors leads to child neglect?
- lack of knowledge of child's needs
- lack of resources
- caregiver substances abuse
If a mom is unaware her child needs to be feed every 3-4 hours or may not know what to feed the child or not have enough money to buy food what type of abuse is this demonstrating?
What are the two types of neglect?
- physical neglect
- emotional neglect
What type of things are considered physical neglect?
deprivation of food, clothing, shelter, supervision, medical care, and education
what type of things are considered emotional neglect?
lack of affection, attention, and emotional nurturance
What defines emotional abuse?
deliberate attempt to destroy or significantly impair a child's self-esteem or competence
What types of things are considered emotional abuse?
- verbally assaulting
What is the definition of physical abuse?
deliberate infliction of physical injury on a child, usually by the child's caregiver
"Any recent act or failure to act that results in imminent risk of serious harm, death, serious physical or emotional harm of a child < 18 yoa by a parent or caregiver who is responsible for the child's welfare." this is the definition of what?
Child Abuse Prevention and Treatment Act of 1996
What happens to an infant when they have been injured by shaken baby syndrome?
Violent shaking causes the brain to rotate within the skull, resulting in shearing forces that tear blood vessels and neurons.
Having intracranial bleeding, retinal hemorrhages, fractures of the long bones and ribs are classic signs of what type of physical abuse?
Shaken baby syndrome
What is the most important thing for a nurse to teach to parents about shaken baby syndrome prevention?
techniques to cope with inconsolable crying
What is the definition of Munchausen Syndrome by Proxy?
form of child abuse where caregivers deliberately fabricate signs/symptoms and histories of illness in the child to gain attention from medical staff
Who is most likely to be the abuser in munchausen syndrome by proxy?
biologic mother, with some degree of health care knowledge and training
What is the major problem that affects the child with Munchausen syndrome by proxy?
child may undergo painful and unnecessary treatments and procedures
What are ways to consider if a child is a victim of Munchausen Syndrome by proxy?
- Is the child's condition consistent with the reported history?
- Does diagnostic evidence support the reported history?
- Has anyone other than the caregiver witness the symptoms?
- Is treatment being provided primarily because of the caregiver's demands?
What are three factors to physical abuse?
- characteristics of the parent
- characteristics of the child
- characteristics of the environment
What types of parents are most likely to abuse their child?
- younger parents
- single parent families with an unrelated partner
- little education
- parents with substance abuse
- low self-esteem
- little knowledge of being a parent
Which type of children are more at risk of being abused?
- children from birth to 1 year of age
- disabled children
- premature children
- removing one child from the home may increase risk for other siblings
What type of environmental factors can cause child abuse?
- chronic stress (divorce, poverty, unemployment, poor housing, substance abuse, frequent relocation)
- crowded living conditions
- Any socioeconomic population (low-middle-upper class)
What is the number one factor that causes abuse between the child and caregiver?
"the use, persuasion, or coercion of any child to engage in sexually explicit conduct or simulation of such conduct for producing visual depiction of such conduct, or rape, molestation, prostitution, or incest with children." is the definition of what type of abuse?
What are the 6 types of sexual abuse?
- child pornography
- child prostitution
"Any physical sexual activity between family members; blood relationship is not required (stepparents, 1/2 siblings, grandparents, uncles/aunts, in-laws); but not sexual relations between legally sanctioned partners, such as spouses." This is what type of sexual abuse?
Which type of family is most likely not to have incest?
a healthy family
"indecent liberties," such as touching, fondling, kissing, single, or mutual masturbation, or oral-genital contact. This is what type of sexual abuse?
"Indecent exposure, usually exposure of the genitalia by an adult man to children." This is what type of sexual abuse?
"Arranging and photographing, in any media, sexual acts involving children alone or with adults or animals, regardless of consent by the child's legal guardian; also may denote distribution of such material in any form with or without profit." This is what type of sexual abuse?
"involving children in sex acts for profit and usually with changing partners." This is what type of sexual abuse."
"the sexual excitement from a young child that is the preference to an adult." This is what type of sexual abuse?
What is the difference between an assault and abuse?
- assault is from a stranger
- abuse is from a parent/caregiver
Who is most likely to be an abuser?
a male the victim knows
What are the main assessments that a nurse needs to obtain from the child about the abuse?
- identify abusive situations as early as possible
- history pertaining to the incident
- evidence of abuse
What are some physical signs that a nurse should be aware of that may alert sexual abuse?
- difficulty walking or sitting
- torn, stained, or bloody under clothing
- pain or itching in genital area
- bruises or bleeding in rectum/genital area
What are some behavioral signs that a nurse should be aware of that may alert sexual abuse?
- inappropriate sexual knowledge for their age
- abrupt change in personality
- poor peer relationships
- unwilling to change for gym/participate in physical activities
- promiscuous/seductive behaviors
- drop in school performance
- sleep disturbances
- regressive behavior
What are ways for a nurse to approach a child when talking about abuse?
- 1. provide a private time and place to talk
- 2. do not promise not to tell; tell them you are required to by law to report
- 3. do not express shock or criticize their family
- 4. use appropriate age vocabulary to discuss body parts
- 5. avoid leading statements that can alter their report
- 6. reassure them that they have done the right thing
- 7. tell them that the abuse is not their fault
- 8. determine their immediate need for safety
- 9. let the child know what will happen when you report
cultural practices, burns from metal buckles on car seats, bruising from seat belts, and spiral fractures from a twist and fall injury are these signs of physical, sexual, or neglect or neither?
What are signs from the caregiver/child interaction that there is no abuse going on?
- emotional support from the caregiver to the child
- attentiveness to the child's needs
- concern for the child's injury
What are some signs from the parent that will indicate some type of abuse is going on?
- difficult showing concern toward their child
- unable or unwilling to comfort the child
- blame child for injury
- belittle child for being clumsy or stupid
- become hostile or uncooperative to drs.
- may not participate in child's care during hospitalization
True/False. Children who have been sexually abused within the past 72 to 96 hours should be considered for forensic testing?
What are the main behavioral differences between non-abused and abused children?
- increase in sleep disorders
- temper tantrums
What is the most important factor that a nurse observes that should alarm abuse is going on?
incompatibility between the history and the physical exam
What is an important clue from the child that they have been emotionally abused?
persistent and unexplained change in child's behavior
what is the definition of elder abuse?
a single, or repeated act, or lack of appropriate action, by a caregiver or "trusted other" that causes harm or distress to an older person
what is the main type of relationship that is common in all elder abuse?
there is an "expectation of trust" between the elder and the abuser
True/False. Muggings or burglary to an older person is also considered a type of abuse.
What gender of elder people are more likely to become victims of abuse?
what type of things define physical abuse for the elders?
- false imprisonment/confinement
- giving too much or the wrong medication
What type of things define psychological abuse for the elders?
- constantly criticizing
When a person tries to coerce an older person with something that really like into doing a particular act is a prime example of what type of abuse?
What type of things define financial abuse for the elders?
- illegal or unauthorized use of a persons property, money, pension book or other valuables
- changing the person's will to name the abuser
- fraudulently obtaining power of attorney
- eviction from home
What type of things define sexual abuse for the elders?
- forcing a person to take part in any sexual activity without his or her consent
- forcing them to participate in conversations of a sexual matter
Depriving a person of food, heat, clothing or comfort or essential medication is examples of what type of elder abuse?
Denying the civil and constitutional rights of a person who is old, but not declared by court to be mentally incapacitated is examples of what type of elder abuse?
A caregiver or relative ignoring an elder person neglecting themselves by not caring about their own health or safety is an example of what type of elder abuse?
What are the three most common type of abuse that has been reported?
- 1. Psychological
- 2. Financial
- 3. Neglect
what type of people are most likely to be victims of elder abuse?
- age >80
- in a relationship
- in a long term care setting
What type of people are most likely to abuse elder people?
- between the age of 30-50
- adult child of the victim
- spouse/intimate partner of victim
- any family member of victim
What are some risk factors that make an individual an abuser?
- history of violence
- stress (unemployed)
- mental illness
- drug/ETOH use
- dependent on elder
If you as a nurse have an elder patient that is eager to eat food, hoarding, having frequent visits to the ED, refusing care because of worry that it cost to much, missing glasses/dentures/hearing aids, poorly nourished, dehydrated, and dirty. What should the nurse expect is going on with this patient?
they are victim of abuse
if your patient has symptoms of improper care of injury, injury inconsistent with explanation, bruises, welts, discoloration in different stages of healing, unexplained dehydration, and stage 3 pressure ulcers. You should expect that they are victims of what type of abuse?
If you patient has symptoms of bruises, swelling, or bleeding of external genitalia, vagina, or anal areas. you should expect that they are victims of what type of abuse?
If you have a patient that is showing signs of fear of their caregiver, confusion, disorientation, resignation, hopelessness, anger, denial, reluctance to talk, or sucking/biting. or rocking constantly, or have developed hysteria. You should expect that they are victims of what type of abuse?
If your patient tells you that they just had their title of their property changed or their will was changed, they have suspicious withdrawals of cash from their bank accounts, numerous unpaid bills. you should expect that they are victims of what type of abuse?
If your patient comes in to the ED dirty with fleas, lice, rashes, sores, smell like urine or fecal. Have no clothing, food, water, or shelter, Is malnourished and lives in dangerous conditions. Has no toilet facilities, refrigeration, heating/cooling in their home, substance abuse, isolated, and suicidal thoughts. You should expect that they are victims of what type of abuse?
self neglect abuse
What are some signs to look for in a caregiver that will suggest they are abusing the elder?
- prevent elder from speaking or seeing others without their presence
- anger, indifference, aggressive behavior toward elder
- lack of affection toward elder
- conflicting accounts of incidents
- withholds affection
- speaks of elder as a burden
When interviewing an elder person to assess for any abuse what is the best way to get information?
interview the patient alone
If you do suspect abuse what are you required to do by law and to whom?
- Adult protective service or law enforcement
If your patient is being abused by their caregiver what should the nurse do?
- Ensure their safety by keeping them away from caregiver
- educate patient about support services
- request to speak to someone else in the family
Health practitioners, MD/Nurses, dentist/hygienist, psychiatrist/Psychologist, EMT, public health personnel, coroner, law enforcement officer, financial institution, owner/employee of a place that prints photos are all type of people that should do what?
mandatory to report abuse
True/False. Anyone that reports abuse will neither be civilly or criminally liable for any report if it is made under the reporting requirements.
Removing any elder or dependent adult from their home when they lack capacity to consent to the removal across state lines is what type of abuse?
True/False. If a nurse suspects abuse with an elder patient and has no evidence they should not report the abuse to any one.
False. they should report it no matter what
What are some things that a nurse will notice that should suggest that there is a need to report abuse?
- they witness the abuse
- see physical findings
- knowledge of a reasonable suspicious event
- receive a direct report from the victim
If the patient tells the nurse that they are being abused by their caregiver when should the nurse report it?
Immediately before any other non-life threatening activity
Once the nurse reports abuse to the Adult protective services what should the nurse tell the victim what APS is going to do?
- going to accept the report
- investigate for suspected abuse
- if it is substantiated...
- provide local resources
- provide emergency services
- provide a case manager to stabilize situation
What should the nurse educate an elder patient about ways to prevent abuse?
- stay social
- stay active
- stay organized
- stay informed
The nurse should tell their elder patient that they should NEVER....
- live with anyone who has a backgroung of violent behavior or alcohol/drug abuse
- leave home unattended
- leave cash, jewelry, or prized possessions lying around
- sign any document unless someone you trust review it
- let anyone keep you in the dark about your finances or property
What type of individuals are most likely to become victims of self neglect?
- live alone
- refuse or are unable to meet their basic needs
- multiple or untreated medical/psychiatric conditions
- live in squalor