NCP Child Abuse

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.)