INTRODUCTION
The term child abuse is used to describe any neglect or mistreatment of infants or children including infliction of emotional pain, physical injury, or sexual exploitation. Neglect or abuse is most often inflicted by the child's biologic parents. Others who have been implicated include foster parents, babysitters, boyfriends, friends, and daycare workers. Nurses are legally and morally responsible to identify children who may be maltreated and to report findings to protect the child from further abuse.
Neglect is the most common form of abuse and may include deprivation of basic physical or emotional needs: food, clothing, shelter, health care, education, affection, love, and nurturing. Emotional abuse stems from rejection, isolation, and/or terrorizing the child. Physical abuse may result in burns, bruises, fractures, lacerations, or poisoning. Infants may suffer from "shaken baby syndrome" with severe or fatal neurologic injuries caused by violent shaking of the infant. Signs of shaken baby syndrome include retinal and subarachnoid hemorrhage. Signs of sexual abuse include bruising or bleeding of the anus or genitals, genital discharge, odor, severe itching or pain, and sexually transmitted diseases. A discrepancy between the nature of the child's injuries and the reported cause of injury is a frequent clue that abuse has occurred.
MEDICAL CARE
Complete Blood Count (CBC): reveals changes resulting from infection (increased WBC), blood loss (decreased RBC, Hgb).
Urinalysis: reveals blood, pus in urinary tract.
Vaginal/Anal Cultures: reveal sexually-transmitted disease.
X-ray: child abuse long bone series of X-rays are required to detect evidence of or to rule out healed fractures/current fractures.
C-scan: to rule out central nervous system damage caused by shaken baby syndrome.
COMMON NURSING DIAGNOSES
IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS
Related to: Inability to ingest food.
Defining Characteristics: (Specify, e.g., withholding of food by parent/caretaker, weight loss, malnutrition, lack of subcutaneous fat, failure to
thrive, provides inadequate amount of food; knowledge of deficit regarding appropriate food preparations [i.e., cleaning bottles].)
RISK FOR IMPAIRED SKIN INTEGRITY
Related to: External factor of trauma.
Defining Characteristics: (Specify, e.g., lacerations, burns, abrasions, skin trauma in different stages of healing, unclean skin, teeth, hair.)
Tuesday, May 3, 2011
NCP Child Abuse - Risk for Trauma
RISK FOR TRAUMA
Related to: Characteristics of child, caregivers, environment.
Defining Characteristics: (Specify: sexual assault of child, evidence of physical abuse of child, history of abuse of abuser, social isolation of family, low self-esteem of caretaker, inadequate support systems, violence against other members of the family.)
Goal: Child will not experience trauma by (date/time to evaluate).
Outcome Criteria
√ Absence of violence or maltreatment of the child by parents or other offenders.
NOC: Risk Detection
NIC: Risk Identification
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Has the child suffered maltreatment or violence? Provide specifics if indicated.)
(Revisions to care plan? D/C care plan? Continue care plan?)
FLOW CHART FOR CHILD ABUSE
Related to: Characteristics of child, caregivers, environment.
Defining Characteristics: (Specify: sexual assault of child, evidence of physical abuse of child, history of abuse of abuser, social isolation of family, low self-esteem of caretaker, inadequate support systems, violence against other members of the family.)
Goal: Child will not experience trauma by (date/time to evaluate).
Outcome Criteria
√ Absence of violence or maltreatment of the child by parents or other offenders.
NOC: Risk Detection
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Has the child suffered maltreatment or violence? Provide specifics if indicated.)
(Revisions to care plan? D/C care plan? Continue care plan?)
FLOW CHART FOR CHILD ABUSE
NCP Child Abuse - Impaired Parenting
IMPAIRED PARENTING
Related to: (Specify: unmet social and emotional maturation needs of parental figures, ineffective role modeling, lack of knowledge, situational crisis or incident.)
Defining Characteristics: (Specify: lack of parental attachment behaviors, verbalization of resentment toward child and of role inadequacy, inattention to needs of child, noncompliance with health practices and medical care, inappropriate discipline practices, frequent accidents and illness of child, growth and development lag in child, history of child abuse or abandonment, multiple caretakers without regard for needs of child, evidence
of physical and psychological trauma, actual abandonment of child.)
Goal: Parents will exhibit improved parenting skills by (date/time to evaluate).
Outcome Criteria
√ Demonstration of appropriate parenting behaviors.
√ Maintenance of safe environment for child.
√ Establishment of positive relationship with child and realistic expectations for self and child.
√ Acceptance of support for achievement of desirable parenting skills.
NOC: Parenting
NIC: Parent Education: Child-Rearing Family
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Provide data about outcome criteria, e.g., parent attends to child's crying; feeds child; plays game with child; attends parenting classes or self-help
groups; verbalizes child's developmental needs, etc., use quotes if possible.)
(Revisions to care plan? D/C care plan? Continue care plan?)
Related to: (Specify: unmet social and emotional maturation needs of parental figures, ineffective role modeling, lack of knowledge, situational crisis or incident.)
Defining Characteristics: (Specify: lack of parental attachment behaviors, verbalization of resentment toward child and of role inadequacy, inattention to needs of child, noncompliance with health practices and medical care, inappropriate discipline practices, frequent accidents and illness of child, growth and development lag in child, history of child abuse or abandonment, multiple caretakers without regard for needs of child, evidence
of physical and psychological trauma, actual abandonment of child.)
Goal: Parents will exhibit improved parenting skills by (date/time to evaluate).
Outcome Criteria
√ Demonstration of appropriate parenting behaviors.
√ Maintenance of safe environment for child.
√ Establishment of positive relationship with child and realistic expectations for self and child.
√ Acceptance of support for achievement of desirable parenting skills.
NOC: Parenting
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Provide data about outcome criteria, e.g., parent attends to child's crying; feeds child; plays game with child; attends parenting classes or self-help
groups; verbalizes child's developmental needs, etc., use quotes if possible.)
(Revisions to care plan? D/C care plan? Continue care plan?)
NCP Child Abuse - Anxiety
ANXIETY
Related to: Threat to self-concept, change in health status, change in interaction patterns, situational crisis.
Defining Characteristics: Increased apprehension and uncertainty, fearfulness, feeling of powerlessness, fear of consequences, repeated episodes of maltreatment, mistrust, trembling, quivering voice, poor eye contact, lacks appropriate pain response, frozen watchfulness, developmental delays/regressive behaviors (specify).
Goal: Child will experience less anxiety by (date/time to evaluate).
Outcome Criteria
√ (Specify measurable criteria, e.g., child makes eye contact, has relaxed facial features, reports decreased anxiety if age-appropriate.)
NOC: Coping
NIC: Anxiety Reduction
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Provide data about outcome criteria, e.g., does child make eye contact? Are facial features relaxed, does child report feeling "calmer," use quotes if
possible.)
(Revisions to care plan? D/C care plan? Continue care plan?)
Related to: Threat to self-concept, change in health status, change in interaction patterns, situational crisis.
Defining Characteristics: Increased apprehension and uncertainty, fearfulness, feeling of powerlessness, fear of consequences, repeated episodes of maltreatment, mistrust, trembling, quivering voice, poor eye contact, lacks appropriate pain response, frozen watchfulness, developmental delays/regressive behaviors (specify).
Goal: Child will experience less anxiety by (date/time to evaluate).
Outcome Criteria
√ (Specify measurable criteria, e.g., child makes eye contact, has relaxed facial features, reports decreased anxiety if age-appropriate.)
NOC: Coping
NIC: Anxiety Reduction
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Provide data about outcome criteria, e.g., does child make eye contact? Are facial features relaxed, does child report feeling "calmer," use quotes if
possible.)
(Revisions to care plan? D/C care plan? Continue care plan?)
NCP Hospitalized Child
INTRODUCTION
Hospitalization of the child, whether it involves a short-term hospital admission, surgery, a follow-up evaluation, or repeated hospitalizations for a chronic illness or episode, creates a crisis for the child and family. Responses to hospitalization are related to the developmental level of the child but generally include fear of separation, loss of control, injury, and pain. The ease of transition from home to the hospital depends on how well the child has been prepared for it and how the child's physical and emotional needs have been met. Supporting the family, providing them with information, and encouraging their participation in the child's care contributes to the adjustment and well-being of all concerned.
COMMON NURSING DIAGNOSES
DISTURBED SLEEP PATTERN
Related to: Physiologic factors related to illness and psychological stress, external factors of environmental changes.
Defining Characteristics: Interrupted sleep, irritability, restlessness, lethargy, disorientation, fatigue, pain, separation anxiety, side effects of
medication (nausea, vomiting, diarrhea) (specify for child).
IMPAIRED PHYSICAL MOBILITY
Related to: Pain and discomfort; neuro or musculoskeletal impairment (specify).
Defining Characteristics: Imposed restrictions of movement or activity, imposed bed rest, limited strength, endurance, weakness, fatigue, drainage tubes and IV catheters; disturbances in gait, vision, equilibrium (specify).
IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS
Related to: Loss of appetite; lack of interest in food; alteration in taste; inability to ingest, digest or absorb nutrients; nausea; vomiting; diarrhea; constipation; abdominal pain; oral ulcers (specify).
Defining Characteristics: Weakness, fatigue, anxiety, anorexia, illness, lack of interest in eating (specify behavior).
DELAYED GROWTH AND DEVELOPMENT
Related to: Separation from significant others; environmental and stimulation deficiencies; effects of repeated hospitalizations; social isolation; sensory and/or motor delays (specify).
Defining Characteristics: (Specify, e.g., inability to perform self-care or self-control activities appropriate for age; regressive behavior; fear of unfamiliar environment and treatments; feelings of inferiority; low self-esteem, or alterations to body image.)
Hospitalization of the child, whether it involves a short-term hospital admission, surgery, a follow-up evaluation, or repeated hospitalizations for a chronic illness or episode, creates a crisis for the child and family. Responses to hospitalization are related to the developmental level of the child but generally include fear of separation, loss of control, injury, and pain. The ease of transition from home to the hospital depends on how well the child has been prepared for it and how the child's physical and emotional needs have been met. Supporting the family, providing them with information, and encouraging their participation in the child's care contributes to the adjustment and well-being of all concerned.
COMMON NURSING DIAGNOSES
DISTURBED SLEEP PATTERN
Related to: Physiologic factors related to illness and psychological stress, external factors of environmental changes.
Defining Characteristics: Interrupted sleep, irritability, restlessness, lethargy, disorientation, fatigue, pain, separation anxiety, side effects of
medication (nausea, vomiting, diarrhea) (specify for child).
IMPAIRED PHYSICAL MOBILITY
Related to: Pain and discomfort; neuro or musculoskeletal impairment (specify).
Defining Characteristics: Imposed restrictions of movement or activity, imposed bed rest, limited strength, endurance, weakness, fatigue, drainage tubes and IV catheters; disturbances in gait, vision, equilibrium (specify).
IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS
Related to: Loss of appetite; lack of interest in food; alteration in taste; inability to ingest, digest or absorb nutrients; nausea; vomiting; diarrhea; constipation; abdominal pain; oral ulcers (specify).
Defining Characteristics: Weakness, fatigue, anxiety, anorexia, illness, lack of interest in eating (specify behavior).
DELAYED GROWTH AND DEVELOPMENT
Related to: Separation from significant others; environmental and stimulation deficiencies; effects of repeated hospitalizations; social isolation; sensory and/or motor delays (specify).
Defining Characteristics: (Specify, e.g., inability to perform self-care or self-control activities appropriate for age; regressive behavior; fear of unfamiliar environment and treatments; feelings of inferiority; low self-esteem, or alterations to body image.)
NCP Hospitalized Child - Risk for Trauma
RISK FOR TRAUMA
Related to: Developmental age, deficient knowledge and cognitive immaturity predisposing the child to safety hazards in the environment.
Defining Characteristics: Developmental age, developmental delays, disturbances in gait, vision, hearing, perceptual or cognitive functioning (specify).
Goal: Child will not experience any trauma by (date/time to evaluate).
Outcome Criteria
√ Child engages in appropriate play (specify) without injury.
√ Parents verbalize safety considerations related to toys/games (specify according to developmental level).
NOC: Knowledge: Personal Safety
NIC: Parent Education: Child-Rearing Family
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(List appropriate play child engaged in without injury. Provide quotes from parents verbalization of safety considerations.)
(Revisions to care plan? D/C care plan? Continue care plan?)
FLOW CHART FOR HOSPITALIZED CHILD
Related to: Developmental age, deficient knowledge and cognitive immaturity predisposing the child to safety hazards in the environment.
Defining Characteristics: Developmental age, developmental delays, disturbances in gait, vision, hearing, perceptual or cognitive functioning (specify).
Goal: Child will not experience any trauma by (date/time to evaluate).
Outcome Criteria
√ Child engages in appropriate play (specify) without injury.
√ Parents verbalize safety considerations related to toys/games (specify according to developmental level).
NOC: Knowledge: Personal Safety
NIC: Parent Education: Child-Rearing Family
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(List appropriate play child engaged in without injury. Provide quotes from parents verbalization of safety considerations.)
(Revisions to care plan? D/C care plan? Continue care plan?)
FLOW CHART FOR HOSPITALIZED CHILD
NCP Hospitalized Child - Powerlessness
POWERLESSNESS
Related to: Health care environment, illness-related regimen.
Defining Characteristics: Expression of loss of control over situation, expression or behavior indicating dissatisfaction with inability to perform activities and dependence on others, reluctance to express true feelings, fear of alienation from others in the hospital environment (specify).
Goal: Client will experience less powerlessness by (date/time to evaluate).
Outcome Criteria
√ Gains sense of control over situation
√ (Specify how child and/or parent participates in plan of care: e.g., goal-setting, scheduling of treatments.)
√ (Specify how child or parent verbalize increased sense of control—use quotes.)
NOC: Family Participation in Professional Care
NIC: Security Enhancement
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Have child/parents participated in care? Specify how. Use quotes as applicable.)
(Revisions to care plan? D/C care plan? Continue care plan?)
Related to: Health care environment, illness-related regimen.
Defining Characteristics: Expression of loss of control over situation, expression or behavior indicating dissatisfaction with inability to perform activities and dependence on others, reluctance to express true feelings, fear of alienation from others in the hospital environment (specify).
Goal: Client will experience less powerlessness by (date/time to evaluate).
Outcome Criteria
√ Gains sense of control over situation
√ (Specify how child and/or parent participates in plan of care: e.g., goal-setting, scheduling of treatments.)
√ (Specify how child or parent verbalize increased sense of control—use quotes.)
NOC: Family Participation in Professional Care
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Have child/parents participated in care? Specify how. Use quotes as applicable.)
(Revisions to care plan? D/C care plan? Continue care plan?)
NCP Hospitalized Child - Deficient Diversional Activity
DEFICIENT DIVERSIONAL ACTIVITY
Related to: Environmental lack of diversion, long-term hospitalization.
Defining Characteristics: Boredom, desire for something to do because usual hobbies and activities cannot be done in hospital (specify, use quotes).
Goal: Child will engage in diversional activity by (date/time to evaluate).
Outcome Criteria
√ Participation in age-appropriate activities within limitations imposed by illness (specify activity).
NOC: Play Participation
NIC: Activity Therapy
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Did child participate in diversional activity? Describe.)
(Revisions to care plan? D/C care plan? Continue care plan?)
Related to: Environmental lack of diversion, long-term hospitalization.
Defining Characteristics: Boredom, desire for something to do because usual hobbies and activities cannot be done in hospital (specify, use quotes).
Goal: Child will engage in diversional activity by (date/time to evaluate).
Outcome Criteria
√ Participation in age-appropriate activities within limitations imposed by illness (specify activity).
NOC: Play Participation
NIC: Activity Therapy
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Did child participate in diversional activity? Describe.)
(Revisions to care plan? D/C care plan? Continue care plan?)
NCP Hospitalized Child - Self Care Deficit
SELF-CARE DEFICIT, BATHING/HYGIENE, DRESSING/GROOMING, FEEDING, TOILETING
Related to: Impaired ability to perform ADL; pain and discomfort (specify).
Defining Characteristics: Inability to wash body, take off or put on clothing, feed self, positioning or mechanical restrictions, weakness, fatigue, imposed bed rest, inability to carry out toileting with use of bedpan or go to bathroom (specify for child).
Goal: Child will demonstrate increased ability to care for self by (date/time to evaluate).
Outcome Criteria
√ Maximum self-care capability with or without use of aids (specify for child).
NOC: Self-Care: Activities of Daily Living
NIC: Self-Care Assistance
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Describe child's ability to attain behaviors specified under outcome criteria.)
(Revisions to care plan? D/C care plan? Continue care plan?)
Related to: Impaired ability to perform ADL; pain and discomfort (specify).
Defining Characteristics: Inability to wash body, take off or put on clothing, feed self, positioning or mechanical restrictions, weakness, fatigue, imposed bed rest, inability to carry out toileting with use of bedpan or go to bathroom (specify for child).
Goal: Child will demonstrate increased ability to care for self by (date/time to evaluate).
Outcome Criteria
√ Maximum self-care capability with or without use of aids (specify for child).
NOC: Self-Care: Activities of Daily Living
 |
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Describe child's ability to attain behaviors specified under outcome criteria.)
(Revisions to care plan? D/C care plan? Continue care plan?)
NCP Hospitalized Child - Anxiety
ANXIETY
Related to: Change in health status; change in environment; threat to self-concept; situational crisis (specify).
Defining Characteristics: Increased apprehension; fear; helplessness; uncertainty; distress over hospitalization; restlessness; expressed concern
over procedures, pain, loss of control, separation from significant others; crying; clinging; refusal to interact with staff, changes in VS, financial
stresses caused by required absence from employment (specify child's behavior).
Goal: Child and family will experience decreased anxiety by (date/time to evaluate).
Outcome Criteria
√ Reduced anxiety expressed by child and family.
√ (Specify behaviors to look for: e.g., child is not crying or clinging, facial features are relaxed, parents verbalize understanding of procedures and
plan of care, etc.)
NOC: Anxiety Control
NIC: Anxiety Reduction
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Did child or family express decreased anxiety? Use quotes. Describe behavioral change associated with decreased anxiety, e.g., child is no longer
clinging to parent.)
(Revisions to care plan? D/C care plan? Continue care plan?)
Related to: Change in health status; change in environment; threat to self-concept; situational crisis (specify).
Defining Characteristics: Increased apprehension; fear; helplessness; uncertainty; distress over hospitalization; restlessness; expressed concern
over procedures, pain, loss of control, separation from significant others; crying; clinging; refusal to interact with staff, changes in VS, financial
stresses caused by required absence from employment (specify child's behavior).
Goal: Child and family will experience decreased anxiety by (date/time to evaluate).
Outcome Criteria
√ Reduced anxiety expressed by child and family.
√ (Specify behaviors to look for: e.g., child is not crying or clinging, facial features are relaxed, parents verbalize understanding of procedures and
plan of care, etc.)
NOC: Anxiety Control
NIC: Anxiety Reduction
Evaluation
(Date/time of evaluation of goal)
(Has goal been met? Not met? Partially met?)
(Did child or family express decreased anxiety? Use quotes. Describe behavioral change associated with decreased anxiety, e.g., child is no longer
clinging to parent.)
(Revisions to care plan? D/C care plan? Continue care plan?)
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