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 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.)