4 Child Abuse Nursing Care Plans

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The term child abuse is used to describe any neglect or mistreatment of infants or children including infliction of emotional pain, physical injury, or sexual exploitation. Neglect or abuse is most often inflicted by the child’s biological parents. Others who have been implicated include foster parents, babysitters, boyfriends, friends, and daycare workers. Nurses are legally and morally responsible to identify children who may be maltreated and to report findings to protect the child from further abuse.

Neglect is the most common form of abuse and may include deprivation of basic physical or emotional needs: food, clothing, shelter, healthcare, education, affection, love, and nurturing. Emotional abuse stems from rejection, isolation, and/or terrorizing the child.

Physical abuse may result in burns, bruises, fractures, lacerations, or poisoning. Infants may suffer from “shaken baby syndrome” with severe or fatal neurologic injuries caused
by violent shaking of the infant. Signs of shaken baby syndrome include retinal and subarachnoid hemorrhage. Signs of sexual abuse include bruising or bleeding of the anus or genitals, genital discharge, odor, severe itching or pain, and sexually transmitted diseases. A discrepancy between the nature of the child’s injuries and the reported cause of injury is a frequent clue that abuse has occurred.

Nursing Care Plans

The major nursing care planning goals for the child experiencing abuse includes ensuring adequate nutrition, safety of the abused child, relief from anxiety, improving parenting skills and building parental confidence.

Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for child abuse:

  1. Imbalanced Nutrition: Less Than Body Requirements
  2. Anxiety
  3. Impaired Parenting
  4. Risk for Trauma

Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis

May be related to

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  • Inability to ingest food
  • Parental neglect on nutritional status

Possibly evidenced by

  • Loss of subcutaneous fat
  • Inadequate amount of food
  • Weight loss
  • Malnutrition
  • Withholding of food by parent/caretaker
  • Failure to thrive

Desired Outcomes

  • Child will manifest no further weight loss and, if malnourished, will gain 2.2 lb (1 kg)
    per week.
Nursing Interventions Rationale
Assess for signs and symptoms of malnutrition. A child with nutritional deficiency manifest decreased attention span, confused, pale and dry skin, subcutaneous tissue loss, dull and brittle hair, and red, swollen tongue and mucous membranes.
Monitor intake and output and food intake; Weigh client daily. Allows the evaluation of the number of calories being consumed per day and progress of nutritional therapy.
Assess and record the amount, consistency, and color of stools and emesis. Provide a guide on the absorption of nutrients in the body.
Maintain good oral hygiene prior meals. Promotes good appetite and enhances the taste of foods/fluids.
Encourage parents to assist the child during feeding. Eating as a self-care activity enhances self-esteem.
Encourage small, frequent feedings high in carbohydrates and protein. Small meals decrease fatigue and are easier to tolerate.
Encourage adequate rest periods. Minimizes fatigue and improve the child’s appetite.
Consider the possible need for enteral or parenteral nutritional support as indicated. Nutritional support may be recommended for those who are unable to maintain nutritional intake by the oral route.
Consult and refer to a dietitian or nutritional support team for dietary counseling. A dietitian or nutritional support team can
individualize the child’s diet within prescribed restrictions

Anxiety

Nursing Diagnosis

  • Anxiety

May be related to

  • Change in health status
  • Change in interaction patterns
  • Situational crisis
  • Threat to self-concept

Possibly evidenced by

  • Developmental delays/regressive behaviors
  • Fearfulness
  • Feeling of powerlessness
  • Fear of consequences
  • Frozen watchfulness
  • Increased apprehension and uncertainty
  • Lacks appropriate pain response
  • Mistrust, trembling, quivering voice, poor eye contact
  • Repeated episodes of maltreatment

Desired Outcomes

  • Child will make eye contact, has relaxed facial features, reports decreased anxiety if age-appropriate.
Nursing Interventions Rationale
Assess level of anxiety and fear in the child and how it is manifested; Determine the source of anxiety and note reactions to staff and parents at each contact. Provides information about the source and level of anxiety and what might relieve it and basis to judge improvement.
Encourage expression of concerns and fears of child regarding environment and management; Grant questions and provide honest explanations and communication at the level of child’s age. Provides an opportunity to release feelings that can decreases anxiety.
Demonstrate affection and acceptance of
the child even if not returned or ignored; avoid reinforcing any negative behavior.
Promotes trust of staff and positive behavior of the child.
Provide consistent staffing for the child, preferably those who seem to relate well to child. Promotes familiarity and trusting relationship with staff.
Provide a play program with other
children; set aside time to be alone with child or quiet time for the child as well; praise child or reward with a special treat when appropriate.
Modifies negative behavior by promoting interactions with others and rewarding desired behaviors; promotes self-esteem.
Use therapeutic play kit to instruct the child in any procedure to be done (dolls, syringe, tubing, dressing, other articles, specify). Reduces anxiety by familiarizing child with what to expect to reduce anxiety.
Provide treatment of injuries; avoid treating the child as a victim, asking too many questions, or forcing any discussion. Prevents increased anxiety and stress in child by discussion of abuse.
Explain all treatments and procedures
to be done and the purpose for them
and that someone will accompany them to a different department if needed.
Provides preparation and information that will assist in preventing fear or anxiety.
Refer for counseling services for the
child as indicated.
Reduces anxiety and supports child in dealing with abuse and negative behavior.

Impaired Parenting

Nursing Diagnosis

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  • Impaired Parenting

May be related to

  • Unmet social and emotional maturation needs of parental figures
  • Ineffective role modeling
  • Lack of knowledge
  • Situational crisis or incident

Possibly evidenced by

  • Lack of parental attachment behaviors
  • Verbalization of resentment toward the child and of role inadequacy
  • Inattention to needs of the child
  • Noncompliance with health practices and medical care
  • Inappropriate discipline practices
  • Frequent accidents and illness of child
  • Growth and development lag in child
  • History of child abuse or abandonment
  • Multiple caretakers without regard for needs of child
  • Evidence of physical and psychological trauma, actual abandonment of child

Desired Outcomes

  • Parent will demonstrate appropriate parenting behaviors.
  • Parent will provide a safe environment for child.
  • Parent will establish positive relationship with child and realistic expectations for self and child.
Nursing Interventions Rationale
Assess parents for the achievement of  developmental tasks of self and
understanding of child’s growth and
development; how they are bonded and
attached to the child; how they interpret
and respond to the child; how they accept
and support child; how they meet child’s social, psychological and physical needs.
Provides information about parent-child relationship and parenting styles that may lead to child abuse; identifies parents at risk for violence or other abusive behavior.
Provide an opportunity for parents to express their feelings, personal needs, and goals; avoid making judgmental remarks or comparing them to other parents. Supports parents in meeting their own needs.
Praise parents for their participation in child’s care, tell them that they are giving good care to the child. Reinforces positive parenting behaviors and increases a feeling of adequacy.
Provide a child nurturing role model for parents to emulate. Promotes the development of parenting skills by imitation.
Include parents in planning care and setting goals. Promotes participation of parents in meeting child’s needs.
Discuss with parents methods to reduce conflict, to be consistent in approach to child’s behavior and needs, to avoid siding with the child or other parents. Promotes a more positive child-parent relationship.
Teach parents developmental tasks for
child and parents, difference in developmental level between child and parents, and appropriate tasks for age levels.
Provides information that assists parents in responding realistically and appropriately to child’s needs at different age levels.
Instruct parents to maintain their own health by getting adequate rest, nutrition, and exercise; and to participate in leisure activities and make social contacts. Provides information on the importance of parents meeting their own needs to enable them to better care for and cope with their children.
Refer to community agencies that offer
parenting classes and support groups.
Provides education in parenting skills.
Initiate referrals to social services,
parenting classes, or counseling as
appropriate. Inform parents that child protection services have been contacted to investigate the child’s health status and safety; keep the parents informed of the child’s health status (unless or until
custody of the child is removed from
the parents.
Provides options if parenting is unsatisfactory or inadequate.

Risk for Trauma

Nursing Diagnosis

  • Risk for Trauma

May be related to

  • Characteristics of child, caregivers, environment.

Possibly evidenced by

  • Sexual assault of child
  • Evidence of physical abuse of child
  • History of abuse of abuser
  • Social isolation of family
  • Low self-esteem of caretaker
  • Inadequate support systems
  • Violence against other members of the family

Desired Outcomes

  • Child will not experience maltreatment or abuse by parents or other offenders.
Nursing Interventions Rationale
Assess the abuser for violent behavior or
other abusive patterns, use of alcohol
or drugs, or other psychosocial problems.
Provides information to determine warning signs of child abuse.
Assess behavior of parents toward the child, including responses to the child’s behavior, ability to comfort the child, feelings, and perceptions toward the child, expectations for the child,over-protective or concern for the child. Reveals characteristics that may indicate risk for abuse.
Maintain factual and objective
documentation of all observations,  including child’s physical condition, child’s behavioral response to parents, health care workers, other visitors, parent’s response to child, and interviews
with family members.
Provides information that may be used in legal action regarding abuse.
Communicate information and needs of the child to those on the abuse team (or to new caretakers if the child being placed with a foster parent or someone other than parents); provide written instruction for care and child’s needs. Provides care plan for the child based on the court decision to caretakers working with the family based on the court decision for child’s care.
Instruct parents in identifying events that
lead to child abuse and in methods to deal with behavior without harming the child.
Prevents further abusive behavior directed at the child.
Inform parents of follow-up care and needs of the child, need to evaluate child’s progress. Promotes emphasis on child’s care and prevention of recurrence of abuse.
Inform parents of child’s placement in
a foster home, allow them to meet and speak to a new caretaker.
Prepares parents for court order of alternate placement to ensure a safe environment.
Inform of Parents Anonymous and other child protective groups to contact for assistance. Provides self-help group activities, information, and support based on the type of abuse and parental needs.
Initiate referral to a social worker,
public health nurse, psychological counselor before discharge to home.
Provides support to child and family, and monitors behaviors following discharge.

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See Also

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Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.

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