1. Clinical Application for Child Health Nursing NUR 327 Child Abuse Lecture 4-A

2. Types of Child Abuse  Neglect: Intentional or unintentional omission of basic needs and support  Physical Abuse: Is non-accidental injury to a child by an adult  Sexual Abuse: Forced involvement of children in sexual activities by an adult  Emotional Abuse: Withholding of affection, use of cruel and degrading language towards a child by an adult

3. Child Abuse  Reports of violence against children has almost tripled since 1976.  Many of the abused children are infants. NURSES ARE MANDATED REPORTERS

4. Child Abuse Neglect  Physical or emotional maltreatment  Failure to thrive Physical Abuse  Minor or major physical injury (bruising, burns, fractures)  May cause death  Shaken baby syndrome (SBS) Sexual Emotional  May be suspected, but difficult to substantiate  Impairs child’s self-esteem and competence

5. Child Abuse Warning Signs  Incompatibility between history of event and injuries  Conflicting stories from various people involved  History inconsistent with developmental level of child  Repeated visits to emergency rooms  Inappropriate response from child and/or caregiver

6. Child Abuse Nursing action  Assess: Physical assessment and history of event, observe and listen to caregiver’s and child’s verbal and non-verbal communication  Documentation: Contact Child Protective Services, hospital documentation  Support family and child: Social services, resources, teaching THE CHILD’S SAFETY COMES FIRST AND IS THE PRIORITY!

7. Medication Administration for child Lecture 4-B

8. Oral Medication Hold infant with head elevated to prevent aspiration Slowly instill liquid meds by dropper along side of the tongue Crush pills and mix with sweet-tasting liquid if permitted, but don’t add too much liquid! Allow choices for the child such as which med to take first Flush following gastreostomy or NG tube

9. Factors to consider when selecting IM sites  Age  Weight  Muscle development  Amount of subcutaneous fat  Type of drug  Drug’s absorption rate

10. IM and SQ Meds Select needle length according to muscle size Use Z-track for iron and tissue-toxic meds May mix medication with lidocaine Some medications may be need to be separated into 2 injections depending on amount

11. Peds IM Injection Sites  Vastus lateralis for infants  Ventrogluteal and dorsogluteal Don’t inject into dorsogluteal until age 3 years - muscle not well developed until child walks and sciatic occupies a larger portion of the area.  Deltoid after 3 years

12. Vastus lateralis Site

13. Deltoid Site Ventrogluteal Site

14. Dorsogluteal Site

15. IV Meds  Site may be peripheral or central  Administer IV fluids cautiously  Always use infusion pumps with infants and small children  Inspect sites frequently (Q 1-2 hours) for signs of infiltration  Cool blanched skin, puffiness( infiltration)  Warm and reddened skin (inflammation)

16. Nose Drops  Suction nare with bulb syringe prior to administration if nasal congestion present

17. Ear Meds Pull the ear down and back to instill eardrops in infants (↓3 years pull ↓) Pull the ear up and out to instill in older children (↑ 3 years pull ↑) Have medication at room temperature

18. The End