Mental Health Nursing

Children and Families
Good Mental Health for an Adolescent
 Ability

to trust others and to view the world as
generally safe and supportive.
 ...
Good Mental Health/Adolescent contd
 Mastery

of developmental tasks-remember
Erickson’s stages of development!
 Ability...
Why Children Develop Mental
Disorders
 Result

from interactions between genetics
and life experiences
 Children more li...
Manifestations of Dysfunctional
Families








Failure to develop sense of trust
Excessive fears
Misdirected ange...
Effect of Mental Disorders on
Development
 The

child’s developmental stage at the onset
of a mental disorder determines ...
Question:
A

child that develops Major Depressive
Disorder during the developmental task of
Identity vs Role Confusion
–
...
Developmental Disorders
 Autism
 Aspergers’s

Disorder
 Rett’s Disorder
 Childhood Disintegrative Disorder
Autism
 Manifested

by motor sensory, cognitive, and
behavioral dysfunctions
 Involves
–
–
–

Impaired social interactio...
Causes of Autism







May be caused by a defect in neurogenesis in early
weeks of fetal life
May involve an abnormal...
5 Signs of Autism
Significant signs noticed by 1 year of age;
–
–
–
–
–

Failure to make eye contact,
poor attention behav...
Cognitive Delays
 No

interest in other children and play
 Difficulty engaging in pretend play
 Solitary play is prefer...
Autism
 Single

most common symptom is impaired
social interaction.
 Learning disabilities, avoiding eye contact,
inabil...
Autism Treatment
 Usually

diagnosed by 4 years of age,
although symptoms may appear earlier
 Early identification and i...
Autism Treatment/Nursing
Considerations








Specific drugs to deal with specific behavioral
problems.
Drug therap...
Asperger’s Disorder
 Also

a developmental disorder
 Compared to those with autism, children with
this are less disabled...
Asperger’s Disorder
 Characterized
–
–
–

•

by the following;

Severe impairment in social interactions
Repetitive and s...
Asperger’s Disorder
 May

be able to function independently as
adults
 Continue to have impaired social behavior
and hav...
Nursing Considerations
 Decrease

environmental stimulations
 Decrease anxiety by decreasing and
managing stressors
Rett’s Disorder











Developmental disorder
Observed only in females
The essential feature is the developmen...
Childhood Disintegrative Disorder






Developmental disorder
More common in males
In this disorder there will be a p...
Anxiety Disorders
 Separation

anxiety
 Post traumatic stress disorder (PTSD)
Separation Anxiety
 Characterized

by excessive anxiety about

separation
 More severe than expected for the child’s
dev...
Features of Separation Anxiety










Recurrent excessive stress when separating
Persistent and excessive worry ...
Separation Anxiety
 May

manifest because of a stressor such as
the loss of a loved one, pet, illness,
immigration, or a ...
PTSD
 Affects

children differently than it does adults
 Adults tend to relive the event
 Children tend to react with b...
PTSD
 Behaviors
–
–
–
–
–
–
–
–

of PTSD

Irritability
Temper tantrums
Sleep difficulties
Agitation
Disorganized behavior...
Nursing considerations with PTSD
 Have

child draw or talk about their fears
 Nurse may have to provide for the child’s
...
Mental Retardation
Difference Between Mental
Retardation and Down Syndrome
 Mental

retardation is a side effect of Down
Syndrome.
 Down sy...
Mental Retardation
 Characterized

by significantly below average
intellectual functioning which begins before
the child ...
Causes of Mental Retardation
 Genetics
 Alterations

in embryonic development
 Problems during pregnancy and the perina...
Learning Disorders









Reading disorder
Mathematics disorder
Disorder of written expression
Developmental Coo...
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder
(OCD)
 Differences

between OCD in children and

adults
 Symptoms are not usually part of ...
OCD Causes
 Related

to depression and other psychiatric
disorders such as Tourette’s syndrome
 Suicidal behavior is a h...
OCD Behaviors
 Behaviors

that may be evident in the child

with OCD
–
–

Children often become withdrawn and isolate
fro...
OCD Treatment
 Treatment

–Behavioral therapy combined
with medication is the best approach.
 For behavioral therapy to ...
Depression (Mood Disorder) and
Suicide
Depression in Children
 How

do children usually express depression?
 Depression is an emotion common to
childhood
 The...
Signs of Depression
–
–
–
–
–
–
–
–
–
–
–

loss of appetite
sleep problems
lethargy
social withdrawal
sudden drop in grade...
Depression in Children
 Factors

associated with adolescent
depression –
–
–
–
–
–
–
–

physical or sexual abuse or negle...
Depression in Children










Like adults, life happenings, death, bad grades,
break ups, etc happen.
Adolescents ...
Suicide
 Factors

that indicate a potentially successful
suicide – Same as adult –
 Plan of action, a means to carry out...
Suicide
 Suicide

ideation vs. suicide attempt:
 Suicide ideation involves the thoughts about
suicide
 Suicide gesture ...
Suicide
 Rates

increasing in children and adolescents
 Third leading cause of death in adolescents
 Sad – sometimes th...
Suicide
 When

adolescent opens up to a nurse about
feelings of hopelessness an talks about
feeling useless or worthless,...
Suicide








Maternal child book – Review table ---characteristics
of abused drugs and their reactions in adolescen...
Attention Deficit and Disruptive
Behavior Disorders
 ADHD-

Attention Deficit Hyperactivity
Disorder
 Conduct Disorder
...
ADHD
 Characterized

by a developmentally
inappropriate degree of gross motor activity,
impulsivity and inattention in sc...
ADHD Symptoms






Inattention – easily distracted, needs calm place to
work, fails to complete work, does not appear ...
Health Promotion for ADHD
 Health
–
–
–
–
–
–
–

promotions

increase positive interactions
provide tutoring
computer ass...
Nursing Considerations with
ADHD
 Establish

a nurse client relationship
 Explain expected behavior
 Give positive feed...
ADHD Medication
 Usually

treated with Ritalin
 Acts as a stimulant to enhance the activity of
the brain-Dopamine and No...
New Med for ADHD
 Strattera-

non stimulating medication for

ADHD
 Inhibits the transport of norepinephrine in the
CNS
...
Conduct Disorder
 Repetitive

and persistent pattern of behavior
in which the basic rights of others or major
societal ru...
4 Types of Behavior with Conduct
Disorder
 Aggressive

conduct that causes or threatens
physical harm to other people or ...
Diagnosis of Conduct Disorder
 Three

or more of these behaviors must have
occurred in the past 12 months and the
behavio...
Conduct Disorder











Children may use bullying and intimidating behavior
May start frequent fights
Might us...
Oppositional Defiant Disorder
 This

might be common and normal in some
children
 This behavior cannot be diagnosed unle...
Behaviors in Oppositional Defiant
Behavior









Loses his/her temper
Argues with adults
Actively defies or ref...
Oppositional Defiant Disorder
 More

common in males
 More common in males before puberty and
equally common in both mal...
HEADSSS Psychosocial behavior
interview technique








H – home environment relations/ parents and siblings
E-ed...
Family and Community Violence


1
2
3
4
5

Child abuse – Many types
Emotional abuse –intentional verbal attacks
Emotional...
Child Abuse
Child Maltreatment
Child

maltreatment is the general
term used to describe all forms of
child abuse and neglect.
Abuse Statistics CDC 2010
 More

than 740,000 children and youth are
treated in hospital emergency departments
as a resul...
Abuse Statistics CDC 2010




In 2010 est 1560 children died from maltreatment
– 40.8% experienced multiple maltreatment...
Victims and Perpetrators of
Childhood Abuse
 Most

victims were maltreated by a parent
(84%)
 Relatives (6.1%)
 Unmarri...
Child Abuse
 Temperaments

of child/parent can be casual
factor in child abuse.
 Children that are “different” in any wa...
Physical Assessment of a Suspected
Abuse Victim Would Include:
 Shaken
–
–
–
–
–
–

baby syndrome-

intracranial hemorrha...
Assessment For Abuse
Preschoolers/Adolescents









Assess unusual bruising (abd, back, buttocks).
Assess mechanis...
Other Assessments
 Bruising

or bleeding
 Absence from school
 Depression
 Withdrawal from friends/social activities
...
Mandatory reporting
 Mandatory

to report suspected cases.
 Most states have penalties for failure to
report suspected a...
Elder Abuse/Violence
Definition
 Abuse:
–
–

To use (something) to bad effect or for a bad
purpose; misuse
The improper use of something

 Vi...
Elder Abuse/Violence
 Can

include the same types of abuse as with
child abuse.
 Physical abuse commonly includes slappi...
Elder Abuse/Violence






Physical
– Physical restraints
– Chemical- giving them medications they don’t need to sedate...
Elder Abuse/Violence
 Nurses

need to assess for bruises,
lacerations, abrasions, or fractures in which
the physical appe...
Violence
 Violence

from one person toward another is
a social act involving serious abuse of power
 Violence is common ...
Violence
 Specific
–
–
–

types of behaviors may include:

Physical violence which causes pain or harm
Sexual violence
Em...
Violence
 Neglect

which includes failure to provide
physical care, emotional care, or education
for a child
 Economic v...
Cycle of Violence
 Tension
–

building phase-

abuser has minor episodes of anger and may be
verbally abusive or physical...
Cycle of Violence
 Honeymoon
–

phase-

situation is defused for awhile after episode.

 Abuser

becomes loving, promise...
Violence
 Victim
–

characteristics –

demonstrates low self esteem and feelings of
helplessness, hopelessness, powerless...
Violence (Perpetrator characteristics)
 May

use threats and intimidation to control
victim
 Usually an extreme discipli...
Nursing History and Interventions
 Conduct

interviews in private
 Be direct, honest and professional
 Use language cli...
Nursing History and Interventions
 Open

ended questions/require descriptive
responses
 Make a safety plan for fast esca...
Nursing History and Interventions
 Teach

strategies to manage stress
 Refer to support groups and community
resources
...
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10.children and families

  1. 1. Mental Health Nursing Children and Families
  2. 2. Good Mental Health for an Adolescent  Ability to trust others and to view the world as generally safe and supportive.  Ability to interpret reality correctly and interpret surrounding environment correctly  Positive self concept  Ability to cope with stress and anxiety in age appropriate way.
  3. 3. Good Mental Health/Adolescent contd  Mastery of developmental tasks-remember Erickson’s stages of development!  Ability to express self spontaneously and creatively  Ability to develop satisfying relationships
  4. 4. Why Children Develop Mental Disorders  Result from interactions between genetics and life experiences  Children more likely to develop mental disorders (but not all)- due to – – Abuse Hardships  Dysfunctional families
  5. 5. Manifestations of Dysfunctional Families        Failure to develop sense of trust Excessive fears Misdirected anger manifested as behavioral problems Depression Low self esteem Lack of confidence Feelings of lack of control over themselves and their environment
  6. 6. Effect of Mental Disorders on Development  The child’s developmental stage at the onset of a mental disorder determines how the disorder affects him/her  Mental disorders make it more difficult for children to achieve developmental tasks  Example: Industry vs Inferiority- (depression) may be unable to participate in group activities with his/her peers or to accomplish school projects.
  7. 7. Question: A child that develops Major Depressive Disorder during the developmental task of Identity vs Role Confusion – What happens if there is no intervention during this time?
  8. 8. Developmental Disorders  Autism  Aspergers’s Disorder  Rett’s Disorder  Childhood Disintegrative Disorder
  9. 9. Autism  Manifested by motor sensory, cognitive, and behavioral dysfunctions  Involves – – – Impaired social interactions Impaired Communication Preoccupation with odd interests
  10. 10. Causes of Autism     May be caused by a defect in neurogenesis in early weeks of fetal life May involve an abnormal neurochemical status with abnormalities in catecholamine pathways and increased serotonin levels. Causes are not confirmed but genetics, viral infections, and chemicals found in environment are suspected causes or contributors Other theories include a reaction to early childhood immunizations, but at this time there is no evidence based research that supports this theory.
  11. 11. 5 Signs of Autism Significant signs noticed by 1 year of age; – – – – – Failure to make eye contact, poor attention behavior, poor orientation to one’s name. baby not babbling, baby performing gestures like pointing or grasping at objects
  12. 12. Cognitive Delays  No interest in other children and play  Difficulty engaging in pretend play  Solitary play is preference for autistic child
  13. 13. Autism  Single most common symptom is impaired social interaction.  Learning disabilities, avoiding eye contact, inability to make friends or respond to others emotions  May rock back and forth, twirl their hair, perform self hurtful and mutilating behaviors such as biting themselves or hitting their head on object
  14. 14. Autism Treatment  Usually diagnosed by 4 years of age, although symptoms may appear earlier  Early identification and intervention  Providing well structured home and school environment  Behavior modifications
  15. 15. Autism Treatment/Nursing Considerations      Specific drugs to deal with specific behavioral problems. Drug therapy is not a cure all rather the goal is to reduce behavioral symptoms Multidisciplinary approach is essential Nurses need to provide a safe environment Need a highly structured environment with few distractions and a normal homelike routine.
  16. 16. Asperger’s Disorder  Also a developmental disorder  Compared to those with autism, children with this are less disabled  Those who suffer from Asperger’s have no significant delays in thinking or language development
  17. 17. Asperger’s Disorder  Characterized – – – • by the following; Severe impairment in social interactions Repetitive and stereotyped behaviors Significant impairment in social, school, or occupational functioning This disorder is usually apparent between the ages of 3 and 5 years of age
  18. 18. Asperger’s Disorder  May be able to function independently as adults  Continue to have impaired social behavior and have difficulty understanding the feelings of others
  19. 19. Nursing Considerations  Decrease environmental stimulations  Decrease anxiety by decreasing and managing stressors
  20. 20. Rett’s Disorder         Developmental disorder Observed only in females The essential feature is the development of multiple deficits following a period of normal functioning Rate of head growth decreases Previously acquired hand skills are lost Gait is slow and poorly coordinated This disorder persists throughout life and the lost of skills is progressive Usually associated with mental retardation
  21. 21. Childhood Disintegrative Disorder     Developmental disorder More common in males In this disorder there will be a period of regression in multiple areas of function followed by a period of at least 2 years of normal development This child will have significant loss of skills in at least two of the following areas: – – – language and social skills bowel or bladder control play or motor skills
  22. 22. Anxiety Disorders  Separation anxiety  Post traumatic stress disorder (PTSD)
  23. 23. Separation Anxiety  Characterized by excessive anxiety about separation  More severe than expected for the child’s developmental level  Lasts for more than 4 weeks, begins before age 18 and causes significant distress or impairment in social, school, or other functioning
  24. 24. Features of Separation Anxiety        Recurrent excessive stress when separating Persistent and excessive worry about losing or about harm coming to parental figures Excessive worry that something will lead to separation from parental figures- being lost or kidnapped Fear of going to school Fear of being alone without parent Repeated nightmares about separation Repeated complaints about physical symptoms- HA’s, nausea, stomachaches
  25. 25. Separation Anxiety  May manifest because of a stressor such as the loss of a loved one, pet, illness, immigration, or a move to a new neighborhood.  Periods of exacerbations and remissions
  26. 26. PTSD  Affects children differently than it does adults  Adults tend to relive the event  Children tend to react with behaviors of internalized anxiety
  27. 27. PTSD  Behaviors – – – – – – – – of PTSD Irritability Temper tantrums Sleep difficulties Agitation Disorganized behavior Regression Nightmares Withdrawl
  28. 28. Nursing considerations with PTSD  Have child draw or talk about their fears  Nurse may have to provide for the child’s most basic physical needs while the child is experiencing sever or panic anxiety  Nurses have to help children make choices and decisions  Improve self esteem and hope
  29. 29. Mental Retardation
  30. 30. Difference Between Mental Retardation and Down Syndrome  Mental retardation is a side effect of Down Syndrome.  Down syndrome or trisomy 21 is a chromosomal disorder caused by the presence of all or part of an extra twenty-first chromosome.  Down Syndrome also causes mild to moderate mental retardation.
  31. 31. Mental Retardation  Characterized by significantly below average intellectual functioning which begins before the child is 18 years of age  Accompanied by impairment in adaptive functioning which is the ability of the individual to cope with the demands of everyday life  Can vary in degree from mild to profound
  32. 32. Causes of Mental Retardation  Genetics  Alterations in embryonic development  Problems during pregnancy and the perinatal period  Environmental influences  Mental disorders  General medical conditions acquired in infancy or childhood
  33. 33. Learning Disorders         Reading disorder Mathematics disorder Disorder of written expression Developmental Coordination Disorder Expressive language disorder Mixed receptive expressive language disorder Phonological disorder Stuttering
  34. 34. Obsessive Compulsive Disorder
  35. 35. Obsessive Compulsive Disorder (OCD)  Differences between OCD in children and adults  Symptoms are not usually part of an obsessive personality  May start as early as 4 yrs of age displaying symptoms but can go unnoticed until 10 yrs of age. Children are usually aware of their behaviors and may even voluntarily control them while in school or with peers.
  36. 36. OCD Causes  Related to depression and other psychiatric disorders such as Tourette’s syndrome  Suicidal behavior is a high risk for adolescents with OCD  OCD has a genetic origin
  37. 37. OCD Behaviors  Behaviors that may be evident in the child with OCD – – Children often become withdrawn and isolate from their peers and family Poor school performance rather than a deficit in intelligence
  38. 38. OCD Treatment  Treatment –Behavioral therapy combined with medication is the best approach.  For behavioral therapy to be successful, the child must be motivated and capable of following directions.  Parent and total family involvement are essential
  39. 39. Depression (Mood Disorder) and Suicide
  40. 40. Depression in Children  How do children usually express depression?  Depression is an emotion common to childhood  They have difficulty expressing their feelings and often “act-out” instead
  41. 41. Signs of Depression – – – – – – – – – – – loss of appetite sleep problems lethargy social withdrawal sudden drop in grades or dropping out of school substance abuse and other high risk behaviors suicide irritability aggressiveness feelings of hopelessness nonspecific complaints to health
  42. 42. Depression in Children  Factors associated with adolescent depression – – – – – – – – physical or sexual abuse or neglect homelessness disputes among parents conflict with peers or family and rejection by peers or family engaging in high risk behavior learning disabilities having a chronic illness
  43. 43. Depression in Children      Like adults, life happenings, death, bad grades, break ups, etc happen. Adolescents depression for a short period of time is normal. If depressed for a prolonged period of time causing interference with school, family life or age-specific activities occur, action should be taken. Treatment -Prozac is only FDA approved SSRI for children under 18. Cognitive behavior therapy is also useful.
  44. 44. Suicide  Factors that indicate a potentially successful suicide – Same as adult –  Plan of action, a means to carry out the plan, and an absence of obvious resources to turn to for help  Manifestations of suicidal behavior – – – – – – – flat affect deterioration in school performance isolation from friends and family changes in physical appearance giving away cherished possession talk of death
  45. 45. Suicide  Suicide ideation vs. suicide attempt:  Suicide ideation involves the thoughts about suicide  Suicide gesture is an attempt to commit suicide that does not result in injury  Suicide attempt is an action that is seriously intended to cause death
  46. 46. Suicide  Rates increasing in children and adolescents  Third leading cause of death in adolescents  Sad – sometimes they exhibit rage behavior or emotional outburst that result in an impulsive act that can result in accidental death  EVERY THREAT OF SUICIDE MUST BE TAKEN SERIOUSLY
  47. 47. Suicide  When adolescent opens up to a nurse about feelings of hopelessness an talks about feeling useless or worthless, do not contradict what they are saying, LISTEN.  Encourage them to talk and let them know you care and want to help.  Nurses need to educate, prevent and identify children and young adults that are at risk
  48. 48. Suicide     Maternal child book – Review table ---characteristics of abused drugs and their reactions in adolescents Other risky factors – sex, guns, not wearing seatbelts or helmets, dieting, etc. EDUCATE as a nurse. Adolescents feel more comfortable talking to people not directly in their lives. Primary prevention- involve social workers, support groups, eventually family members.
  49. 49. Attention Deficit and Disruptive Behavior Disorders  ADHD- Attention Deficit Hyperactivity Disorder  Conduct Disorder  Oppositional Defiant Disorder
  50. 50. ADHD  Characterized by a developmentally inappropriate degree of gross motor activity, impulsivity and inattention in school or home.  Begins before age of 7, lasts more than 6 months  Not related to existence of any other CNS illness.  More common in boys than girls.
  51. 51. ADHD Symptoms    Inattention – easily distracted, needs calm place to work, fails to complete work, does not appear to listen, difficulty concentrating unless instructions are 1 on 1, needs info r repeated Impulsivity-disruptive with other children, talks out in class, extremely excitable, cannot wait turn, overly talkative, requires lot of supervision Hyperactivity-climbs on furniture, fidgets, always on the go, cannot stay seated, does things in a loud and noisy way
  52. 52. Health Promotion for ADHD  Health – – – – – – – promotions increase positive interactions provide tutoring computer assistance behavioral management strategies minimize any distractions remind child to focus his or her attention give clear instructions
  53. 53. Nursing Considerations with ADHD  Establish a nurse client relationship  Explain expected behavior  Give positive feedback for positive behavior  Help child to consider alternate behavior  Divide complicated tasks into smaller parts  Provide low stimulation environment  Keep goals and instructions simple and realistic
  54. 54. ADHD Medication  Usually treated with Ritalin  Acts as a stimulant to enhance the activity of the brain-Dopamine and Norepinephrine  Giving a stimulant will not increase risk of drug abusing- actually the opposite is true  Common side effects are loss of appetite and insomnia – – Give med 6 hours before bedtime Have a regularly scheduled bedtime
  55. 55. New Med for ADHD  Strattera- non stimulating medication for ADHD  Inhibits the transport of norepinephrine in the CNS  This med has been shown to improve attention and reduce hyperactivity
  56. 56. Conduct Disorder  Repetitive and persistent pattern of behavior in which the basic rights of others or major societal rules are violated
  57. 57. 4 Types of Behavior with Conduct Disorder  Aggressive conduct that causes or threatens physical harm to other people or animals  Nonaggressive conduct that causes property loss or damage  Deceitfulness or theft  Serious violations of rules
  58. 58. Diagnosis of Conduct Disorder  Three or more of these behaviors must have occurred in the past 12 months and the behavior must cause significant impairment in social, academic, or job functioning  Usually present in a variety of settings – – – School Home Community
  59. 59. Conduct Disorder         Children may use bullying and intimidating behavior May start frequent fights Might use a weapon to cause serious harm Might by physically cruel to humans and animals Physical violence might take the form of assault or rape Might start fires or cause vandalism Might stay out all night and spend all day away from home More likely to have ADHD, or Antisocial Personality Disorder
  60. 60. Oppositional Defiant Disorder  This might be common and normal in some children  This behavior cannot be diagnosed unless there is repeated behavior lasting more than 6 months
  61. 61. Behaviors in Oppositional Defiant Behavior         Loses his/her temper Argues with adults Actively defies or refuses to comply with adults Deliberately annoys people Blames others for his/her mistakes Is easily annoyed by others Is angry or resentful Is spiteful or vindictive
  62. 62. Oppositional Defiant Disorder  More common in males  More common in males before puberty and equally common in both males and females after puberty  Disorder becomes apparent at the age of 8 and has a gradual onset
  63. 63. HEADSSS Psychosocial behavior interview technique        H – home environment relations/ parents and siblings E-education/employment, school performance A-activities, sports, after school activities, peer relations D-Drug, alcohol or tobacco use S-Sexuality S-Suicide Risk/symptoms of depression/ other mental disorders S- “savagery” violence/abuse in home environment or in neighborhood
  64. 64. Family and Community Violence  1 2 3 4 5 Child abuse – Many types Emotional abuse –intentional verbal attacks Emotional neglect – omission of actions for development Sexual abuse Physical neglect-Failure to provide basic needs Physical abuse-Deliberate infliction of injury
  65. 65. Child Abuse
  66. 66. Child Maltreatment Child maltreatment is the general term used to describe all forms of child abuse and neglect.
  67. 67. Abuse Statistics CDC 2010  More than 740,000 children and youth are treated in hospital emergency departments as a result of violence each year—that’s more than 84 every hour.  The total lifetime cost of child maltreatment is $124 billion each year.  More than 3 million reports of child maltreatment are received by state and local agencies each year—that’s nearly 6 reports every minute.
  68. 68. Abuse Statistics CDC 2010   In 2010 est 1560 children died from maltreatment – 40.8% experienced multiple maltreatment types – 32.6 experienced neglect only – 22.9% experienced physical abuse only Of the fatalities in 2010 – 79.4% were younger than 4 – 11.1% 4-7 years of age – 3.6% 8-11 years of age – 1.8% 16-17 years of age
  69. 69. Victims and Perpetrators of Childhood Abuse  Most victims were maltreated by a parent (84%)  Relatives (6.1%)  Unmarried partners of parents (4.4%)  Other (3.8%)  45.2% perps were men  53.6% perps were women
  70. 70. Child Abuse  Temperaments of child/parent can be casual factor in child abuse.  Children that are “different” in any way are at particular risk (child sick or disabled, unattractive child, unwanted, illegitimate infant or stepchild)  Child under the age of 3 years of age is also at risk
  71. 71. Physical Assessment of a Suspected Abuse Victim Would Include:  Shaken – – – – – – baby syndrome- intracranial hemorrhage respiratory distress bulging fontanel’s and increased head circumference retinal hemorrhage may be present as well. any bruising on an infant before age 6 months is suspicious as well high pitch cry
  72. 72. Assessment For Abuse Preschoolers/Adolescents      Assess unusual bruising (abd, back, buttocks). Assess mechanism of injury. Numerous bruises at various stages, shape of bruises or welts should be investigated. Assess for burns, Burns with specific patterns, like “glove” with no splash burns are signs of immersion. Small round burns, think cigarettes. Assess for fractures with unusual features, forearm spiral fractures or multiple fractures. Assess for human bite marks/head injury
  73. 73. Other Assessments  Bruising or bleeding  Absence from school  Depression  Withdrawal from friends/social activities  Frequent bladder infections (Sexual abuse)  Frequent visits to ED
  74. 74. Mandatory reporting  Mandatory to report suspected cases.  Most states have penalties for failure to report suspected abuse.  It is Imperative that documentation be complete and objective.  Including measuring sizes of bruises or wounds, staging bruises, describe how the child acts and reacts, remember not to be judgmental and not in include your opinion
  75. 75. Elder Abuse/Violence
  76. 76. Definition  Abuse: – – To use (something) to bad effect or for a bad purpose; misuse The improper use of something  Violence: – – Behavior involving physical force intended to hurt, damage, or kill someone or something Strength of emotion or an unpleasant or destructive natural force
  77. 77. Elder Abuse/Violence  Can include the same types of abuse as with child abuse.  Physical abuse commonly includes slapping, hitting and striking with objects, resulting in bruised, sprains, abrasions, skeletal fractures, burns and other injuries.  Elder abuse takes place in private homes and in established health care facilities
  78. 78. Elder Abuse/Violence    Physical – Physical restraints – Chemical- giving them medications they don’t need to sedate them etc. – Denying them food, medicine, and water – Sexual Emotional – Threats – Intimidation – Harassment Financial – Taking control over finances/hiding money – Making them sign documents pertaining to their finances
  79. 79. Elder Abuse/Violence  Nurses need to assess for bruises, lacerations, abrasions, or fractures in which the physical appearance does not match the history or mechanism of injury.  Again accurate and concise documentation is imperative.
  80. 80. Violence  Violence from one person toward another is a social act involving serious abuse of power  Violence is common with family groups, and most violence is aimed at family and friends rather than strangers  Family violence occurs across all economic and educational backgrounds and racial and ethnic groups
  81. 81. Violence  Specific – – – types of behaviors may include: Physical violence which causes pain or harm Sexual violence Emotional violence which includes minimizing an individual’s feelings of self worth or humiliating, threatening, or intimidating a family member.
  82. 82. Violence  Neglect which includes failure to provide physical care, emotional care, or education for a child  Economic violence includes depriving family members of resources or support
  83. 83. Cycle of Violence  Tension – building phase- abuser has minor episodes of anger and may be verbally abusive or physically violent.  Victim is tense and tends to accept blame for what is happening  Serious battering phase– tension becomes too much to bear and a serious incident takes place
  84. 84. Cycle of Violence  Honeymoon – phase- situation is defused for awhile after episode.  Abuser becomes loving, promises to change, and is sorry for the behavior.  Know that victims are at greatest risk for violence when they try to leave the relationship.  Pregnancy tends to increase the likelihood of violence toward domestic partner.
  85. 85. Violence  Victim – characteristics – demonstrates low self esteem and feelings of helplessness, hopelessness, powerlessness, guilt and shame  May attempt to protect the perpetrator and accept responsibility for the abuse  May deny severity of situation and feelings of anger and terror
  86. 86. Violence (Perpetrator characteristics)  May use threats and intimidation to control victim  Usually an extreme disciplinarian who believes in physical punishment  May have history of substance abuse problems  Likely to have experienced family violence as a child
  87. 87. Nursing History and Interventions  Conduct interviews in private  Be direct, honest and professional  Use language client understands  Be understanding and attentive  Tell them a referral must be made  Assess safety and help reduce danger for victim
  88. 88. Nursing History and Interventions  Open ended questions/require descriptive responses  Make a safety plan for fast escape  Teach victim to recognize behaviors and situations that may trigger violence  Teach empowerment skills  Stabilize home situation
  89. 89. Nursing History and Interventions  Teach strategies to manage stress  Refer to support groups and community resources  Individual psychotherapy, family therapy and group therapy should be considered
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