Psychiatric Mental Health, part 10: Abuse: Signs of Abuse, Nursing Care

July 30, 2021 Updated: December 29, 2021 6 min read

In this article, we'll continue our discussion on abuse, including signs of different types of abuse and the nursing care of patients who have been abused. These topics are important to understand as part of your psychiatric mental health nursing education and practice.

If you missed it, check our previous article on aggression, violence, types of abuse, and abuse risk factors.

This series follows along with our Psychiatric Mental Health Nursing Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Signs of abuse

There are different signs of abuse to look for depending on the type of abuse. Here, we'll explain the varying signs of abuse for physical abuse, emotional abuse, sexual abuse, and neglect.

Signs of physical abuse

Injury story inconsistency

If there is an inconsistency between the story of how an injury happened, and the injury itself, then that is suspect for abuse. For example, if a parent says, "My three-month-old crawled over to the stairs and fell down the stairs," that is highly unlikely because a three-month-old would not have reached the crawling stage yet. Infants usually begin to crawl between 8-10 months. You can learn more about the developmental stages of babies in our Pediatric Nursing Flashcards.

Multiple injuries

If you see multiple injuries in various stages of healing, that is also suspect for abuse, as are bruises on the cheeks, neck, genitals, buttocks, or back. Bruises in the shape of a causative object (e.g., a belt) are also a red flag.

Burns

Burns in the clear shape of a hot object (e.g., a cigarette burn) or forced-immersion burn patterns are also red flag signs of abuse. A forced-immersion burn would occur from someone having their hand dipped in something scalding.

Spiral fractures

Spiral fractures occur when a long bone (e.g., the femur, humerus) is broken by a twisting force, and the accidental causes of these are usually injuries from skiing, snowboarding, soccer, football, wrestling, or motorcycle accidents. A spiral fracture in a small child or infant is unlikely to be from these and can be a sign of abuse, like if the arm or leg was forcibly twisted.

Normal childhood bruises vs. Bruises as a result of abuse

Accidental bruises are often found on the extremities, like the elbows or knees, in children who are up and walking or running around. These are fairly common.

But bruises in unusual locations like the cheeks, neck, genitals, buttocks or back, are suspect for abuse.

Shaken baby syndrome

Signs and symptoms of shaken baby syndrome include poor feeding, irritability, lethargy, vomiting, seizures, periods of apnea, and retinal hemorrhage.

This is a serious form of abuse inflicted on a child, usually occurring when a parent or other caregiver shakes a baby out of anger or frustration.

Babies have very weak neck muscles, which is why you are supposed to support their head when you hold them. Shaking would cause the baby's head to move dangerously back and forth, which could cause brain injury and head trauma.

Signs of emotional abuse

Signs of emotional abuse can include extreme behavior, like if a child is overly compliant, overly demanding, extremely passive, or extremely aggressive.

Delayed physical and emotional development in a child may require additional assessment for emotional abuse.

Signs of sexual abuse

Signs of sexual abuse include difficulty walking or sitting, children that exhibit strange or advanced sexual behavior or understanding for their age, a child with sexually transmitted infections, frequent urinary tract infections, or new onset of bed-wetting.

Signs of neglect

Signs of neglect include if a child is frequently absent from school, begs for food or steals food or money, comes to school with unclean clothes, has body odor or poor dental health, or is dressed in a way that is inappropriate for the weather (e.g., wearing shorts in the middle of winter).

Nursing care for patients who have been abused

Assess the patient as soon as possible after the incident and provide immediate care for any physical injuries.

Clearly identify and count injuries. Take measurements, pictures, and full descriptions in the patient's record.

Interview the patient and caretaker separately. This can help identify story inconsistency as well.

Nurses are mandated reporters. Mandated reporters are required to report suspicion of abuse. You do not have to provide proof, you just have to provide the facts and circumstances that lead you to suspect abuse. The documentation that you do can be of assistance to the patient for legal purposes.

To learn more about mandatory reporting, check out our Fundamentals of Nursing Flashcards.

Help the patient develop a safety plan. You can provide information on shelters and safe houses as well as a plan for escape if abuse reoccurs.


Full Transcript

Hi, I'm Cathy with Level Up RN. In this video, I'm going to talk about the signs of abuse and nursing care of abuse victims. At the end of this video, I'm going to give you guys a little knowledge check, a little quiz to see if you have picked up on some of the key concepts that I'll be covering in this video. So be sure to stay tuned for that.

So let's start with the signs of physical abuse.

If there is an inconsistency between the story and the injury, then that is suspect for abuse. So for example, if a parent says, "My three-month-old crawled over to the stairs and fell down the stairs," that is highly unlikely because a three-month-old would not be crawling by that point. So you want to look for that inconsistency.

If you see multiple injuries in various stages of healing, that is also suspect for abuse, as are bruises on the cheeks, the neck, the genitals, buttocks, or back. Accidental bruises are often found on the extremities, so like the elbows or knees, in children who are up and walking or running around. Those can happen.

But if you find these bruises in these unusual locations, then those are more suspect. If you see bruises in the shape of a causative object, such as a belt, then that's obviously a red flag.

Burns in the clear shape of a hot object, such as a cigarette, or forced-immersion burn patterns are also going to be a red flag. So if it looks like somebody had their hand dipped in something scalding, that's obviously suspect for abuse.

Spiral fractures, like in the arms, are usually indicative of a twist injury. So those would also be suspect for abuse.

And then, finally, you also want to be looking for signs and symptoms of shaken baby syndrome, which can include poor feeding, irritability, lethargy, vomiting, seizures, periods of apnea, as well as retinal hemorrhage.

Now, let's talk about the signs of possible emotional abuse.

If a child is exhibiting extreme behavior, if they're overly compliant or overly demanding, if they're extremely passive or extremely aggressive, then that would be suspect.

If we see delayed physical and emotional development in a child, it may require additional assessment to see if emotional abuse could be at play.

In terms of the signs of sexual abuse, if a child has difficulty sitting or walking, that is suspect for sexual abuse.

Also, if they exhibit strange or advanced sexual behavior or understanding for their age, that is also suspect.

If they present with sexually transmitted infections or frequent urinary tract infections, that is definitely a red flag, as is a new onset of bed-wetting.

In terms of the signs of neglect, if a child is frequently absent for school or begs or steals food or money and comes to school maybe with unclean clothes, body odor, and poor dental health, and if they dress inappropriately for the weather, like just wearing shorts in the middle of the winter, then those are signs of neglect.

Let's now talk about nursing care in an abuse situation.

You want to assess the patient as soon as possible after the incident and provide immediate care for any physical injuries.

You want to clearly identify and document injuries. So you want to take measurements, pictures, full descriptions in the patient's record.

You want to interview the patient and caretaker separately.

And as a mandated reporter, which all nurses are, you have to report suspicion of abuse. You do not have to provide proof. You just have to provide the facts and circumstances that lead you to suspect abuse.

You'll also be collecting and preparing evidence for legal purposes, and you want to help the patient develop a safety plan. So you can provide information on shelters and safe houses as well as a plan for escape if abuse reoccurs.

All right. Time for a quiz. I have three questions for you. First question, scratches and bruises on the knees of a five-year-old are indicative of abuse, true or false? The answer is false. Bruises and scratches on the extremities of a child who is able to walk are pretty common. However, if you see bruises on the child's buttocks, back, neck, cheeks, those are more indicative of abuse.

Number two, difficulty walking or sitting is indicative of what type of abuse? The answer is sexual abuse.

And then number three, when reporting abuse, you need to provide proof to the authorities, true or false? The answer is false. You just have to report suspicion of abuse, the facts and circumstances that lead you to suspect abuse. You do not have to provide proof. All right. I hope this video's been helpful. Good luck with studying, and I will be making more videos soon.


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