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
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Anxiety

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

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 InterventionsRationale
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.
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See Also

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