Clinical Application for Child Health Nursing

NUR 327

Child Abuse

Lecture 4-A

Types of Child Abuse

Neglect: Intentional or unintentional

omission of basic needs and support

Physical Abuse: Is non-accidental injury to a child

by an adult

Sexual Abuse: Forced involvement of children in

sexual activities by an adult

Emotional Abuse:Withholding of affection, use of cruel and degrading language towards a child by an adult

Child Abuse

Reports of violence against children has almost tripled since 1976.

Many of the abused children are infants.

NURSES ARE MANDATED NURSES ARE MANDATED REPORTERSREPORTERS

Child Abuse

Neglect Physical or emotional maltreatment Failure to thrive

Physical Abuse Minor or major physical injury (bruising,

burns, fractures) May cause death Shaken baby syndrome (SBS)

Sexual

Emotional May be suspected, but difficult to

substantiate Impairs child’s self-esteem and competence

Child Abuse

Warning Signs

Incompatibility between history of event and injuries

Conflicting stories from various people

involved

History inconsistent with developmental level of child

Repeated visits to emergency rooms

Inappropriate response from child and/or caregiver

Child Abuse

Nursing action

Assess: Physical assessment and history of event, observe and listen to caregiver’s and child’s verbal and non-verbal communication

Documentation: Contact Child Protective Services, hospital documentation

Support family and child: Social services, resources, teaching

THE CHILD’S SAFETY COMES FIRST AND IS THE PRIORITY!

Medication Administrationfor child

Lecture 4-B

Oral Medication

Hold infant with head elevated to prevent aspiration

Slowly instill liquid meds by dropper along side of the tongue

Crush pills and mix with sweet-tasting liquid if permitted, but don’t add too much liquid!

Allow choices for the child such as which med to take first

Flush following gastreostomy or NG tube

Factors to consider when selecting IM sites

Age Weight

Muscle development

Amount of subcutaneous fat

Type of drug

Drug’s absorption rate

IM and SQ Meds

Select needle length according to muscle size

• Use Z-track for iron and tissue-toxic meds •May mix medication with lidocaine

• Some medications may be need to be separated into 2 injections depending on amount

Peds IM Injection Sites

Vastus lateralis for infants

Ventrogluteal and dorsogluteal

Don’t inject into dorsogluteal until age 3 years - muscle not well developed until child walks and sciatic occupies a larger portion of the area.

Deltoid after 3 years

Vastus lateralis Site

Deltoid Site Ventrogluteal Site

Dorsogluteal Site

IV Meds

Site may be peripheral or central Administer IV fluids cautiously Always use infusion pumps with infants and small children Inspect sites frequently (Q 1-2 hours) for signs of infiltration Cool blanched skin, puffiness( infiltration) Warm and reddened skin (inflammation)

Nose Drops

Suction nare with bulb syringe prior to administration if nasal congestion

present

Ear Meds

Pull the ear down and back to instill eardrops in infants (↓3 years pull ↓)

•Pull the ear up and out to instill in older children (↑ 3 years pull ↑)

• Have medication at room temperature

The End