Read the various scenarios and answer the

Read the various scenarios and answer the questions that comes with it. Legalities: Reporting Physical Abuse Scenario: 1300 hours A 40-month-old toddler is brought to the emergency department (ED) by a parent. The child is crying vigorously and any attempt to touch or console is met with kicking and increased crying. Parent states, “I turned away for a second; I heard the screams; It happened so fast.” Upon assessment the child’s entire right hand and area extending up into the lower forearm appears redden with 3 large fluid filled blisters noted. Vital signs: Heart rate (HR): 130 beats/minute (bpm) and regular; Respiratory Rate (RR): 30 breaths/minute (bpm) Question 1: Highlight the assessment findings in the above scenario that require immediate follow-up by the nurse. Scenario: 1315 hours On further assessment the nurse notes the toddler has a tight collection of bright red contusions resembling the imprint of a thumb and two additional fingers encircling the right ankle and a similar one around left wrist. The child has a yellowish bruise on the right buttock measuring 3 cm by 2 cm. The parent states, “I was making iced tea and had just put a pot of hot water and teabags on the kitchen table to steep. The baby was across the room when I turned to get the pitcher. Then my phone rang and as I was answering it, I heard the screams. I didn’t know what to do so I grabbed the baby and came here. This baby is always getting into something and getting hurt; but this looks really bad.” The toddler is calmer but still sobs and frequently says, “Mama hurt.” Question 2: Use an X to indicate which potential assessment finding is associated with each of the listed client’s health problems. All assessment findings should be used and can be used more than once. Assessment Finding Burn Suspicious injury Yellowish bruise on buttock Crying, “Mama, hurt.” Blisters Encircling red contusions on right ankle and left wrist Continues to sob Glove-like redness on right hand Question 3: Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. Based on the toddler’s current condition, the priority need will be to prevent possible___1_____ resulting from the burn injury. In addition, the child will need interventions to prevent further injury from the parent’s suspected ___2______. Option 1 Option 2 Infection Physical abuse Scarring Neglect Impaired hand function Ineffective parenting skills Scenario: 1430 hours The toddler has been examined by the ED attending provider and orders have been written and executed for intravenous fluids, antibiotics, and pain medication. The child’s burns have been cleaned and dressed according to medical orders. Medical diagnosis: Second degree superficial partial thickness burn over 2% of the child’s body. The child who is to be admitted to the pediatric intensive care unit for observation is sleeping quietly and demonstrating no signs of physical discomfort. The child’s other parent is at the bedside. The parent who brought the child to the ED has gone home. Vital signs: HR 82 bpm; RR 20 bpm; Temp 98.8°F. (37.1°C); blood pressure (BP) 94/50 mm Hg. Child has accepted small sips of water and had tolerated that well. Output has been 110 ml of urine in one voiding since arrival to ED. In light of the child’s stable condition, the attending nurse feels it is appropriate to share concerns of potential abuse. Question 4 Use an X to indicate which initial actions listed in the left column would be considered appropriate in dealing with the suspicion of child abuse? Actions Appropriate actions Share abuse concerns with ED attending provider Collaborate with nursing supervisor Ask the parent now at the bedside to describe events leading up to the injury Prepare to notify the proper authorities as required by facility policy Deny future visitation by the suspected parent Begin arrangement for the child to be removed from the family’s custody Question 5: Use an X to indicate which actions listed in the left column would be implemented. Actions Implemented Discuss physical assessment finding relating to suspicious soft tissue trauma with ED attending provider Collaborate with supervisor regarding institutional policy related to the process for mandatory reporting of suspected child abuse Document the objective findings of the toddler’s physical assessment into the medical record Record the findings of the parental interview into the medical record using direct quotes whenever possible Share the intention to report suspicions with either or both parents Scenario: 14 hours after admission Child has been resting quietly with pain medication being administered as ordered. The dressing applied to the burn area is dry and intact. The child ate 60% of breakfast. The child accepts fluids when offered and has been urinating sufficient amount. The child is reported to be potty trained for bowel movements but has not yet defecated. Both parents are at the child’s bedside. Vital signs: HR 80 bpm; RR 20 bpm; Temp 98.6°F. (37.1°C); blood pressure (BP) 94/50 mm Hg. The nurse privately shares with the nursing supervisor that Child Protective Services was notified of the nurse’s suspicion that the child’s burn and soft tissue injuries could be a result of child abuse. The nurse followed up as required with a written report as required and was later notified that the report had been “screened in” for investigation. Question 6: Highlight the findings in the above scenario that indicate the client’s future risks for injury have been effectively and legally addressed.

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