Case study - Maltreatment (pediatric): Nursing

Nurse Angelo works in a family practice clinic and is caring for mea, a 2.5 year old who's brought in for a required wellness check before entering preschool.

In collaboration with the registered nurse, RN Rose. Nurse, Angelo goes through the steps of the clinical judgment measurement model to make clinical decisions about me care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse Angelo recognizes important cues including Maya's vital signs which are temperature 98.6 °F or 37 °C, heart rate, 100 and five BPM and respiratory rate, 23 breaths per minute.

Nurse, Angelou notes that mea has multiple circular bruises ranging in color from pale yellow to deep purple on her upper arms as well as a rounded punctate burn to the back of her left shoulder about one centimeter in diameter.

Nurse Angelou also notes maya grimaces occasionally and appears tense. So he determines Maya's pain rating is two out of 10 according to the face legs, activity, cry, and consolability or flax scale.

Nurse. Angelou also notes that when he asks me a questions, she doesn't respond or make eye contact with him.

Then he gathers additional information from Maya's mother, Josie about her injuries. I see that Maya has some bruising on her arms.

Can you tell me what happened? All those, she's clumsy, she's always bruised easily.

She probably fell down while she was playing or something. I also noticed an injury to her left shoulder that looks like a burn.

Do you know what happened there? That doesn't look like a burn to me?

Like I said, I think she probably scraped herself when she was playing nurse Angelo then analyzes these cues. He reviews Mea's electronic health record or EHR and notes that she has a history of a humerus fracture at age one year.

When asked about the fracture, Josie says it was caused by a fall when Mea was learning to walk. Nurse Angelo recalls that Children experiencing physical abuse often present with injuries that have implausible or inconsistent explanations and caregivers may downplay the seriousness of injuries recognizes that while the age of a bruise cannot be exactly determined, the varying colors of me ass bruises likely reflect different stages of healing from repeated injury.

Additionally, the location of her injuries on her upper arms and posterior shoulder aren't typical locations for childhood injuries which are commonly found on the knees, shins or forehead.

Finally, nurse Angelo understands that withdrawn behavior like avoiding eye contact can also be a symptom of physical abuse in young Children.

He determines that may have requires interventions for possible child maltreatment. Now using the information he's gathered nurse Angelo reports his findings to RN Rose.

And together they develop a priority hypothesis of risk for injury. Then they generate solutions to address Maya's risk for injury and they establish the expected outcome that after intervening Maya will be discharged to a safe environment.

Nurse Angelo then takes action to implement these solutions. He reports his findings to the healthcare provider who determines that mea's injuries are likely consistent with physical abuse.

The healthcare provider works together with nurse Angelo and RN Rose to contact the designated child protection services and the clinical social worker.

While they wait for the representative from child Protective Services to arrive, the clinical social worker escorts Josie to a different room to conduct an initial interview while nurse Angelou enters Maya's room with a teddy bear and a picture book using a calm and reassuring voice.

Nurse Angelou shows mea her new teddy bear and reads a story with her. Then nurse Angelo asks mea about her injuries.

Maya does any part of your body hurt right now? Maya nods.

Yes. Can you show me where youre hurting by pointing to the same spot on your teddy bear.

Mea points to the teddy bear's shoulder. Oh, I'm sorry, is it ok?

If I look at your shoulder and put a bandage on the part that hurts, may a nod her head. Yes, I want you to know it's not your fault you were hurt.

Mea nods her head. Yes.

Then nurse Angelo applies a non adhesive dressing to Maya's shoulder and he gives me a bandage to put on the teddy bear in the same place.

The representative from Child Protective Services arrives interviews Josie and determines that Mea's home environment may not be safe and removes Mea from Josie's care until a formal investigation can be completed.

The social worker explains to Mea that her aunt is going to come pick her up. Nurse Angelo remains in the room until me ass aunt arrives.

Then nurse Angelo evaluates the outcomes of his actions. He takes Mea's vital signs which are temperature 98.6 °F or 37 °C heart rate, 100 and one BPM, respiratory rate, 21 breaths per minute and pain.

One out of 10. After meeting with nurse Angelou and the social worker, me ass aunt takes me at home.

All right. As a quick recap, nurse Angelou recognized and analyzed cues related to Maya's risk for injury and in collaboration with RN Rose prioritized hypotheses and generated solutions to address this problem.

Nurse Angelo and RN Rose then implemented measures and evaluated Maya's outcomes comparing them to the expected outcome.

Since Mayo was discharged to a safe environment, they determined that the plan of care was successful.