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.)

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

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?)

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?)