Child Maltreatment Flashcards

(47 cards)

1
Q

Abuse

A

Physical, sexual, or emotional injury inflicted upon a child by an adult

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2
Q

Neglect

A

failure of a caretaker to meet a child’s enviro, nutritional, or medical needs
- failure to provide for basic needs
- failure to provide adequate care
- act of ommission

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3
Q

Child at risk

A

lives in a setting known to inc likelihood of abuse or neglect

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4
Q

Pediatric abusive heat trauma

A

Injury that occurs when an infant or child receives deliberate direct blows to the head, is deliberately dropped or thrown, or is vigorously shaken

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5
Q

Child abuse prevention and treatment act (CAPTA)

A

Federal funding and guidance to states for abuse cases, grants to some organizations, provides a definition of abuse

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6
Q

Contributing factors in neglect

A
  • ignorance of needs
  • lack resources
  • poor parenting skills/edu
  • failure to recognize emo nurturing as an essential need of child
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7
Q

Consequences of global neglect

A
  • dev delay
  • neuro probs
  • poor socialization
  • parentification–kid has to act as parent (may have to happen with chronically ill parents)
  • multiple minor scarring injuries
  • death or serious injury during inappropriate supervision
  • high chance of dev personality dx assoc with criminal and abusive behaviors when combined with phys/sex abuse
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8
Q

Manifestations of neglect

A

Child
- freq absent
- beg or store food
- unhygenic and odorous
- poor clothing
- abuses alc or drugs
Parent
- appears indifferent to child
- seems apathetic or depressed
- behaves irrationally
- abusing alc or other drugs

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9
Q

Physical abuse (non-accidental trauma–NAT) family and enviro fx

A

Family
- already domestic violence
- single mom or SAHM
- poverty/limited resources
- unemployment
- single parent
- animal abuse
- inc exposure btwn parent and child
- fussy
Parental char
- sub abuse
- low self-esteem
- poor impulse control
- abused as a child
- teen parents
- neg view of child (remind of ex)
- depression
- unrealistic expectations of child’s behavior
- believe in corporal punishment

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10
Q

Risk factors for child

A
  • fussy/more challenging
  • hyperactive or perceived defiance to parent, temperament
  • cleft lip/palate
  • conditions that alter parent/child bonding
  • prolonged chronic illness
  • multiple births
  • dev delay
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11
Q

Warning signs of abuse

A
  • no injuries that are always or never caused by abuse
  • physical evidence
  • no hx to explain physical findings
  • injury inconsistent with hx or dev level
  • delay in seeking medical attn
  • hx change with repitition
  • parents blame child or sibling
  • seek medical attn far from home or in multiple places
  • reaction to injury is inappropriate
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12
Q

Behavioral char of abused kids

A
  • wary of adults
  • vacant stare or watchful
  • overly compliant, passive or w/d (esp with pain)
  • parentification
  • constantly tried to pls parent and assess parent rxn
  • doesn’t turn to parents for support
  • aggressive towards animals or small kids
  • sudden chx in behavior or school performance
  • learning prob (prob concentrating) not attributed to physical or psych causes
  • come to school early and stay late, don’t want to come home
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13
Q

Behavioral char of abusive parents

A
  • show little concern
  • deny existence of or blame child for school probs
  • ask teachers to use harsh phys discipline
  • sees child as worthless, bad
  • demands high level of phys or academia performance child can’t acheive
  • looks primarily to child for care attn, satisfaction of emo needs
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14
Q

Phys indicators of abuse

A
  • patterns of abuse
  • bruises, welts, lacerations, abrasions, broken bones
  • esp in various stages of healing
  • clustered lesions, forming regular pattern, teeth marks, handprint
  • shadow bruises–same shape as article used to injure
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15
Q

1 sign of abuse

A

Bruising, esp on buttocks, genitalia, back, inside of nose, thighs, calves

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16
Q

Rule of TEN–think abuse

A
  • Torso–lots cushion to absorb force
  • Ears–hard to bruise, not very vascular
  • Neck–protected and no structure to provide cushioning required for vascular damage/leaking
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17
Q

Mongolian spot vs bruise

A

Bluish color that does not fade/have different shades like a bruise would

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18
Q

Infancy patterns of abuse

A

More abuse than any other group
- fatal abuse, head trauma, abusive fractures, Munchausen’s, global neglect with FTT
- trigger is often crying
- can’t explain or defend self

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19
Q

Pediatric abusive head trauma (PAHT)

A
  • injury that occurs when an infant or child receives deliberate direct blows to the head, is deliberately dropped, or is shaken vigorously
  • matter of seconds from 3 violent shakes
  • includes shaken baby syndrome
  • most often 3-8M
  • fatality rate is 20%, significant disability in 2/3 kids
20
Q

Mechanism of injury from shaking

A
  • forceful shaking from more space in skull causes ruptured BVs and nerves, bruising brain tissue, bleeding and swelling
  • pressure on blood supply further exacerbates the brain injury
  • lack of blood supply to parts of the brain can cause long-term effects
21
Q

Why do kids’ heads put them at higher risk for damage?

A
  • thinner tissue
  • smaller subdural space and large subarachnoid space
  • greater volume of blood in brain
  • expandable skull
  • underdev cervical ligaments and muscles
22
Q

s/s of PAHT

A
  • unequal pupils
  • RETINAL HEMORRHAGE
  • sz or posturing
  • high pitch cry
  • pale, mottles, cold, clammy skin
  • poor feeding
  • bruising
  • vom
  • chx in LOC
  • dec in smiling or vocalizing
  • behavior chx
  • vision loss
  • chx in head control
  • bradypnea or apnea
  • bradycardia
  • bulging fontanelle
  • alopecia
  • fracture
  • scalp bruise
  • black eyes
23
Q

Perpetrator characteristics

A

Male, under 30, edu less than high school, illiterate, depression, social iso, sub abuse, low self esteem, poor impulse control

24
Q

Risk fx in child

A

Male, colic, premature, low birth wt, NAS, special needs, medically fragile, infants with NAS or cry freq, multiple births

25
Fractures of abuse
- most fractures under 1Y and under 3Y are from abuse - femur, humerus, tibia often; also skull, ulna, radius, fibula, nose, facial bones - frac in different stages of healing - scapular fracture in child w/o clear history of violent trauma - epiphyseal and metaphyseal fractures of the long bones - corner or chip fractures of the metaphyses - spiral fracture
26
Abuse of toddlers
- Triggers--toilet training probs, temper tantrums, perceived disobedience/disrespect - exacerbated by unrealistic expectations
27
Burns; contact burns
- soles of feet, palms, back or butt - pattern burns--irons, heater grates, cigs - look like something (like heater) - rope burns
28
Accidental vs nonaccidental fluid or immersion burns
- irreg shaped burn at point of major contact vs clear delineation from unburned areas - splash vs no splash marks - depth of burns dec dramatically as distance inc - flow marks proceed down from major burn region
29
Abdominal injuries
- irregular bruising - ruptured liver or spleen - pancreatic or kidney injury - intestinal perforation - check for bleeding signs
30
Nurse's role: prevention
- educate caregivers - recognize triggers and risk fx - be a role model - hospital based programs - edu on period of purple crying (for all infants, crying increasingly more from 2W to 3-5M w/ resistance to soothing, most in evening, pain-like face and long lasting)
31
Dr Harvey Karp's five Ss
- shushing - side/stomach positioning - sucking--nonnutritive - swaddling - swinging
32
Other strategies for upset babies
- check basic needs are met - check for signs of illness - rock or walk infant - sing or talk to baby - offer pacifier or noisy toy - stroller rise - hold baby close to body and breathe calmly and slowly - call for help - take 10 minute break
33
nurse's role: recognition and common mistakes
- most physical abuse is missed in the acute care setting - non-sepcific s/s attributed to benign causes - subtle cues missed - parents are "nice people" - give the benefit of doubt to adult, not baby
34
Common assumptions/bias
- nice fam - nurse knws them - don't want to cause fam stress - don't want to expose baby to radiation for radial scan - person before you may have no idea of the abuse
35
Recognition of PAHT
lethargy, irritable, poor feeding, sx, dec appetite, odd bruises or patterned, not smile and vocalize, posturing, poor breathing, can't lift head, eyes not tracking
36
Accident or PAHT assessment
- make sure injury matches dev level of child - examine bruises carefully - does injury and age of child match? - is hx feasible? - social situation? - was it witnessed?
37
Nurse's role in child maltx
- meet phys needs - role model for parent - very good notes bc may not remember details - document fully and objectively - REPORT--not our job to figure out all the details
38
Guidelines for therapeutic inx in child maltx cases
- be nonjudgmental - provide nonthreatening enviro - ask open ended questions - avoid unprofessional attitudes that block therapeutic intx
39
Documentation of phys abuse
- date, time, place of occurence - sequence of events with times - add direct quotes and time if you can - presence of witnesses - verbal quotations from parent and child - description of parent-child intx - name, age, and condition of other kids in home - location, size, shape or lesions - distinguishing char - symm vs asymm of injuries - tenderness with palpation - degree of pain, bone tenderness - dev of child, meeting milestones?
40
Sexual abuse examples
- genital exposure - fondling - sexual penetration
41
Char of sexual abusers
- male - well known to child - all social levels - often in positions where work closely wiht kids - abuse is reptitive - use coaxing and threats
42
Char of sex abuse victims
- little physical evidence esp in males - may be bruises, bleeding, irritation of external genitalia - torn, stained underclothes - pain on urination, swelling, itching, recurrent UTIs - STDs - difficulty walking or setting - SELDOM make up abuse - possess sexual knowledge beyond what is dec appopriate - behavioral chx--stress, anx, new sex curiosity, excessive masturbation in appropriate places, seductive behavior
43
Nursing interventions in sexual abuse
- always believe - provide play opportunities for disclosure - avoid leading statements - never promise not to tell
44
Munchausen Syndrome by Proxy (MSP)
Illness that one person fabricates or induces in another person - giving child med to induce vom - feed child ketchup?
45
Child and perpetrator char for MSP
Child - under 6Y - uncooperative - anxious - fearful - negative Perpetrator - usually the mother - thrives in HC enviro - some HC knowledge - loving, cooperative, competent - suggest tests and procedures
46
Common presentations of MSP
- apnea--suffocation, drugs, poisoning - sz--drugs, poisoning, asphyxiation - bleeding--add blood to urine, vom, opening IV lines - inject products into child to give blood infx - poison with drugs that cause vom
47
When to suspect MSP
- unexplained recurrent or extremely rare illness - discrepancy btwn clinical findings and hx - unresponsive to tx, s/s occurring only in parents presence - knowledgeable parent who refuses to leave child's room - parent very interested in interacting with medical staff - family mem with similar sx