ren service agency to further investigate whether abuse or neglect has occurred.In obtaining data in suspected abuse or neglect, the nurse must conduct a thorough health assessment including a history and physical exam as well as a developmental assessment. The nurse should assess the childs immediate medical needs, obtain the past medical and social history of the child and family members, assess the credibility of the history being provided in light of any pre-existing medical conditions, determine the level of risk to the child if he/she returns home. The following physical findings may be indicative of physical abuse: Bruises and welts, which form regular or symmetrical patterns, will resemble the shape of the article used to inflict the injury. Burns- cigarette, immersions burns, or patterned burns resembling an electrical appliance. Lacerations or abrasions- rope burns, palate, mouth, and external genitalia. Fractures- skull, ribs, or long bones. Abdominal Injuries- Bruises, hematomas, intestinal perforations, ruptured liver or spleen, ruptured blood vessels, kidney or bladder injury, pancreatic injury. Central Nervous System Injuries- Subdural hematoma, retinal hemorrhage, subarachnoid hemorrhage, cerebral infarction secondary to cerebral edema. Other injuries or signs- Munchausen syndrome by proxy, symptoms of suffocation, or chemical abuse.Findings of neglect may include: Lack of appropriate well-child care, lack of appropriate medical care of chronic illnesses, absence of necessary health aides, such as glasses, absence of appropriate dental care, undernutrition, poor hygiene, developmental delay, untreated medical conditions, and rampant dental caries. Behavioral findings may include: Depression, anxiety, enuresis, excessive masturbation, impaired interpersonal relations, discipline problems, poor school performance, role reversal in which child assumes caretaker role, or excessive household duties including child ca...
