when to suspect fracture is abuse no bruise do i report adult patient

by Grover Miller 8 min read

You suspect a patient is being abused. What should you do?

14 hours ago  · Even if you’re not sure, you are required by law to report suspected abuse or neglect. Anonymous calls are accepted. Kentucky: Call (877) KYSAFE1 (1-877-597-2331) Indiana: (800) 800-5556. If a child is in immediate danger, call … >> Go To The Portal


Depending on the state, nurses may be required to report suspicious injuries to law enforcement whether or not the patient consents or wishes to press charges. Depending on the type of abuse, the nurse is required to call Adult Protective Services or Child Protective Services and follow it up with a written report.

Full Answer

How to tell if a bruise is from abuse?

How to tell if a bruise is from abuse Examples of suspicious bruises can include: Bruising on babies or children who are not independently mobile Bruising in clusters, that occur multiple times in similar shapes and sizes

How common are bruises in older adults who have been abused?

A study of older adults who had been physically abused within 30 days of the examination revealed that 60 percent of the bruises were inflicted, 14 percent were accidental, and 26 percent were of an unknown cause.

Should physician reports of bruising in children be based on current literature?

Physicians are required by law to report situations that may indicate child abuse. Current medical literature and recently published evidence-based guidelines can best inform the challenging decision-making process that might lead to reporting. Bruising in children poses a diagnostic challenge to health care providers.

Does your loved one have bruises in a nursing home?

While not all bruising is caused by abuse or neglect, if your loved one lives in a nursing home and has continual unexplained bruises, it’s a cause for concern – especially if they aren’t able to tell you how they got them.

What is your initial responsibility if you suspect that a patient has been abused?

If a nurse suspects abuse or neglect, they should first report it to a physician, nurse practitioner, or physician assistant. Notifying a supervisor may also be required, depending on the workplace. If the victim is with a suspected abuser, the exam should take place without that person in the room.

What do doctors do if they suspect abuse?

Discuss any suspicion of abuse sensitively with the patient, whether or not reporting is legally mandated, and direct the patient to appropriate community resources. Report suspected violence and abuse in keeping with applicable requirements.

What are the 4 types of abuses?

The four different main types of child abuse are physical abuse, emotional abuse, neglect, and sexual abuse.Physical Abuse. Physical Abuse is the deliberate intention to inflict pain. ... Emotional Abuse. ... Neglect. ... Sexual Abuse. ... Long Term Effects of Child Abuse.

How many types of abuse are there?

There are different types of abuse that perpetrators use against their victims, most abuse will overlap. Types of abuse include; physical, sexual, psychological, verbal, emotional and mental, financial and spiritual.

What is the nurse's role in reporting the suspected abuse?

For nurses being a mandated reporter means that it is a nurse's responsibility to report any suspicions of child or adult abuse or neglect. If the story just doesn't fit, the nurse needs to be suspicious. If the child or adult suggest they have been abused, the nurse needs to report.

What is considered patient abuse?

Patient abuse or neglect is any action or failure to act which causes unreasonable suffering, misery or harm to the patient. Elder abuse is classified as patient abuse of those older that 60 and forms a large proportion of patient abuse. Abuse includes physically striking or sexually assaulting a patient.

How soon would you report any concerns about abuse?

An evaluation of the risk of harm to the adult must take place on the same day as the concern is identified. Adult safeguarding concerns should be reported to the Adult Helpdesk without delay. The indicative timescale for reporting the concern is within the same working day.

What are the five signs of abuse?

Signs of physical abusebruises, black eyes, welts, lacerations, and rope marks.broken bones.open wounds, cuts, punctures, untreated injuries in various stages of healing.broken eyeglasses/frames, or any physical signs of being punished or restrained.laboratory findings of either an overdose or under dose medications.More items...

What are the four signs of abuse?

Common signsunexplained changes in behaviour or personality.becoming withdrawn.seeming anxious.becoming uncharacteristically aggressive.lacks social skills and has few friends, if any.poor bond or relationship with a parent.knowledge of adult issues inappropriate for their age.running away or going missing.More items...

What is classed as adult abuse?

Identifying adult abuse It is abuse when someone misuses their power or control over another person, causing harm or distress. The abuser could be in a close relationship with the adult at risk. They could be someone the adult at risk depends on and trusts.

Which type of abuse is the hardest to detect?

Emotional or psychological abuse Emotional abuse often coexists with other forms of abuse, and it is the most difficult to identify.

What is neglectful abuse?

'Neglect' means negligent treatment or maltreatment of a child, including the failure to provide adequate food, clothing, shelter, medical treatment, or supervision. Sexual Abuse/Exploitation.

How many bruises are accidental?

A study of older adults who had been physically abused within 30 days of the examination revealed that 60 percent of the bruises were inflicted, 14 percent were accidental, and 26 percent were of an unknown cause.

Why do elderly people get bruises?

Bruises can be caused by many things. Elderly people are more susceptible to bruising due to medications, thinning skin, diseases, and injuries. While not all bruising is caused by abuse or neglect, if your loved one lives in a nursing home and has continual unexplained bruises, it’s a cause for concern – especially if they aren’t able ...

How many elderly people are abused in Georgia?

It’s estimated that about 5 million elders are abused each year in the U.S. , and only one in 14 cases of abuse are reported to authorities.

What does it mean when you have a bruise on your wrist?

Unusually shaped bruises (in the shape of knuckles or fingers) Patterned bruises on the ankles, wrist, or hips can be a sign of bed rails or cuffs used as restraints. Bruises on the neck, face, lateral arms, and torso. Bruises due to serious falls or other injuries. Large bruises.

What to do if you suspect someone is being abused?

If you suspect abuse and fear your loved one may be in immediate danger, call 911 and file a report of the incident with police.

Why are bones brittle in nursing homes?

As people age, their bones can become brittle due to diseases like arthritis. It’s crucial caregivers take extra steps to protect nursing home residents from falls, and follow protocol when transporting or dressing residents.

What does it mean when a child has a bruise?

A bruise means that a child is just rambunctious, right? Possibly, but some bruising can signify something much more serious: child abuse . Bruises are a commonly overlooked sign of abuse. Many people have the misconception that bruising is obvious and matches the size of an adult hand. In reality, the damage from abuse can manifest in a variety of different ways, including small, subtle bruises.

How to help a child who is being abused?

Take a few deep breaths, listen to your favorite song or do a few exercises. You also can call a trusted friend or relative, or the Childhelp National Child Abuse Hotline at (800) 4-A-CHILD / (800) 422-4453. Finally, spend time with the people who are caregivers for your children.

What are some examples of bruises?

Examples of suspicious bruises can include: 1 Bruising on babies or children who are not independently mobile 2 Bruising in clusters, that occur multiple times in similar shapes and sizes 3 Bruising on areas of the body such as the torso, ears, neck, eyes, cheeks and buttocks

What is the phone number to call Norton Children's?

Anonymous calls are accepted.Kentucky: (877) KYSAFE1 (597-2331) Indiana: (800) 800-5556. If a child is in immediate danger, call 911. Norton Children’s Pediatric Protection Specialists, affiliated with UofL School of Medicine.

What is bruising on a baby?

Bruising on babies or children who are not independently mobile. Bruising in clusters, that occur multiple times in similar shapes and sizes. Bruising on areas of the body such as the torso, ears, neck, eyes, cheeks and buttocks. Other warning signs can be detected from caregiver behavior such as:

Where do bruises come from?

Not all bruising comes from abuse; children can bruise from everyday activities such as playing. It’s important to know that for toddlers and older children, bruises usually occur on the front of the body. Normal bruising also usually occurs over bony areas such as the forehead, elbows, knees and shins. Kids will be kids and get bruises ...

What are the warning signs of a caregiver?

Other warning signs can be detected from caregiver behavior such as: A delay in seeking medical attention for the child. Being inconsistent or unconvincing in describing the details of the accident. Showing a lack of concern for their child’s injuries.

Should a nurse report abuse?

The nurse should notify law enforcement as soon as possible, while the victim is still in the care area. However, this depends on the victim and type of abuse. Adults who are alert and oriented and capable of their decision-making can choose not to report on their own and opt to leave. Depending on the state, nurses may be required ...

Do nurses have a responsibility to care for victims of abuse?

Employers are typically clear with outlining requirements for their workers, but nurses have a responsibility to know what to do in case they care for a victim of abuse.

Do nurses have to be able to connect victims of abuse?

While not required by law, nurses should also offer to connect victims of abuse to counseling services. Many times, victims fall into a cycle of abuse which is difficult to escape.

What is abusive bruising?

Abusive bruising may be the result of a victim being punched, kicked, choked, squeezed or held down. Or, they may have been struck with a firm or flexible object ranging from a stick or bat to a belt or electrical cord (or any other striking implement you can think of).

What does a bruise on a shoe mean?

A.) A bruise may form reflecting the imprint of the sole of a shoe if it is distinct, as in a lugged pattern on a boot#N#B.) May leave a curved imprint bruise

What are the areas of bruising that police officers see?

Conversely, in abuse cases, police officers will typically see bruising to the face, mouth, lips, neck, back, ribs, buttocks, thighs, and genitals. Naturally, other areas of bruising may be observed, but those listed are commonly found in intentional injury cases. Abusive bruising may be the result of a victim being punched, kicked, choked, ...

What is bruising in medical terms?

Bruising involves the escape or hemorrhage of blood from ruptured blood vessels into the surrounding tissue. The resulting discoloration can usually be seen beneath the surface of the skin but, bruising is an injury that has many variables for investigators to consider. 1.) Location.

Why are victims reluctant to share information with investigators?

Some may be fearful of retaliation or further abuse as in a domestic violence case. Others may be unable to tell you what happened due to a loss of consciousness or in the case of an elderly victim, dementia.

What are the most common injuries police officers see?

In abuse cases, there is no limit to the injuries a police officer or investigator might encounter, and one of the most common injuries seen is bruising. Police officers and detectives frequently investigate abuse cases. In child abuse, elder abuse, and/or domestic abuse cases it’s not uncommon to deal with victims who are scared, unwilling, ...

Does force vary when an injury is inflicted?

• Force will vary at the time an injury is inflicted#N #• The body moves to deflect and/or absorb force#N#• Clothing can absorb and diffuse force#N#• The mark left from an object will vary according to its rigidity, flexibility and the force applied

What is a bruise after a fall?

Bruises can result after an injury, a fall, or even bumping into something. A bruise (contusion) is an injury to the soft tissue that results in broken capillaries which leak red blood cells. As the heart pumps, the blood escapes to the surrounding tissues, creating a bruise. Bruises can surface hours or even days after an injury ...

How long do bruises last?

In addition, bruises in older adults can last longer than the usual 1-2 weeks, sometimes lasting for months. Certain drugs can also make you more susceptible to bruises, many of which are common medications for older adults.

Why should nursing home staff pay particular attention to bruises that occur on a resident’s face, arm, and

Therefore, nursing home staff should pay particular attention to bruises that occur on a resident’s face, arm, and back because these areas have been shown to have the greatest incidence of bruising in cases of mistreatment.

Why do older people bruise more?

Bruising in the Elderly. Older adults bruise more easily and heal more slowly than younger adults because they have fragile capillaries and thinner skin. This is because as you age, your skin becomes thinner and you lose some of the protective fatty layer that helps cushion your blood vessels. In addition, bruises in older adults can last longer ...

What does it mean when you have bruises on your wrists?

Bruises in patterns can indicate the use of restraints (bruises on hips and arms can indicate the use of bed rails, and bruises on the wrists can indicate the use of cuffs). Frequent or serious falls are another common cause of bruising, and can indicate improper supervision of a resident. In order to provide the best possible care, nursing homes ...

Why do nursing homes have bruises?

Bruises are one of the most common indicators of nursing home abuse and neglect. This is important to note because elder abuse, including physical abuse, is on the rise. Elderly nursing home residents are vulnerable to injuries and abuse because of weakness, illness, and decreased mental cognition. Many times the elderly residents who are victims ...

How do bruises heal?

How bruises heal. Bruises fade gradually as your body reabsorbs the blood that leaked from your blood vessels. After an injury, you can take steps to prevent or minimize bruising. This includes applying a cold compress to the injured area, elevating the injured area, and avoiding blood thinning medications if possible.

What are the signs of a fractured bone?

Signs of a bone fracture. Broken bones are most common in the upper and lower extremities (limbs). The upper extremities include the arms, elbows, wrists and fingers and the lower extremities include the legs, knees, ankles and feet. Tendon and ligament injuries ( sprains and strains) can occur in these areas as well, ...

What is an open fracture?

An open fracture, also known as a compound fracture, is a relatively rare occurrence in children and happens when the bone breaks through the skin.

How to tell if a child has a deformity?

A child should be seen ASAP if: 1 The extremity has a deformity (may look like a bump or change in shape around the bone). 2 There is a break in the skin and bone is showing. 3 The child cannot bear weight on or use the extremity 15 minutes after the injury occurred 4 The child’s pain is not being controlled and the child is crying with rest, elevation, ice and over-the-counter pain medication.

What is non displacement fracture?

Non-displaced fracture: Occurs where there is a crack in the bone, but the bone hasn’t shifted out of place. Stress fractures (that occur when tiny cracks form in the bone) or buckle fractures (when one side of the bone buckles upon itself) are two common non-displaced fractures.

How long does it take for a broken bone to be recognized?

Most broken bones will be recognized immediately or within a day if a child is still not able to use the extremity as usual. If after a day this is the case, the child should be seen in an outpatient clinic, either with the primary care doctor or an orthopaedic surgeon.

What is growth plate fracture?

Growth plate fracture: Growth plates refer to the softer pieces of developing cartilage tissue, which form the length and shape of the bone. Left untreated, a growth plate fracture can lead to issues with growth and bone development.

What is the most common area for bone bruising?

The most common areas for bone bruising occur are the knee and ankle. If your child is experiencing severe pain, swollen or tender area near the injury, swollen or stiff joints near the injury or changes in skin color over the injury, it might be bruised.

How to tell if someone is being abused?

While bruising alone may not tell you whether or not a loved one has been abused, there are other signs to look out for. Look for other red flags to narrow down the cause. Common signs of elder abuse include the following: 1 Poor hygiene 2 Additional physical injuries, like burns or broken bones 3 Bed sores 4 Nervousness or withdrawal 5 Dehydration or malnutrition 6 Strange cash withdrawals from bank accounts, like ones that are larger or more frequent than normal 7 Clothing that’s dirty or torn 8 Anxiety 9 Depression

How do you know if you are being abused by an elder?

Common signs of elder abuse include the following: Poor hygiene. Additional physical injuries, like burns or broken bones. Bed sores. Nervousness or withdrawal. Dehydration or malnutri tion. Strange cash withdrawals from bank accounts, like ones that are larger or more frequent than normal.

What are the signs of elder abuse?

Knowing the Signs of Abuse. Bruises are a common indicator of neglect or abuse, and the features of the bruising can tell you a lot. Bruises that appear in clusters or patterns or that tend to reappear after they’ve healed, may be a sign of elder abuse. If the pattern of the bruise matches that of knuckles or fingerprints, ...

Why do older people bruise more easily?

As people age, their skin is bruised and discolored more easily. This happens because aging causes blood vessels to break down and reduces the amount of muscle tissue that protects the skin from the bones.

How long does it take for a bruise to heal?

Most bruises will fully heal within two weeks, but very serious bruises can take longer as can regular bruises on the elderly. It’s possible for a bruise to show up several hours or even several days after an injury, and they may occur on a place that wasn’t directly affected by the injury.

Why are people in nursing homes vulnerable?

Vulnerability of the Elderly. People in nursing homes are particularly vulnerable to abuse because they tend to be ill or weak. If they’re experiencing a decrease in mental cognition, they may not even fully realize what’s going on. Sometimes, a person may say that bruising happened a certain way when really it was the result of abuse.

Why is context important in elder abuse?

Context plays a big role in elder abuse. And if the person can’t explain the situation surrounding the injury, it’s difficult to pinpoint the cause of the bruising. It’s also important to realize that if one person is being abused in a nursing home, chances are good that other people are victims as well. Elderly abuse is not usually confined ...

How rare are bruises in children?

The majority of the skin injuries were bruises, but children also exhibited abrasions and scratches. Labbe and Caouette concluded that it was rare to find 15 or more skin injuries in any child, and it was especially rare to find any bruises in an infant under 9 months of age. Patterned or clustered bruises.

What to do if you find bruises on your child?

In cases where bruising is found, the clinician should obtain a complete medical history and document all findings from a thorough physical examination. Physicians are required by law to report situations that may indicate child abuse.

What does a linear bruise mean?

It is well accepted that bruising on the skin that depicts an object or pattern is highly suspicious for inflicted trauma. [ 11-13] For example, a linear bruise may indicate that the child was hit with a stick-like object, and parallel linear bruises may indicate that the child was slapped with a hand.

How many skin injuries did Labbe and Caouette find?

Labbe and Caouette studied almost 1500 children from age 0 months to 17 years and found that 17% of children had 5 skin injuries and 4% had 10 or more skin injuries. [ 3] . Less than 1% of the total sample of children had 15 or more skin injuries.

What is sentinel injury?

They defined such a “sentinel” injury as “a previous injury reported in the medical history that was suspicious for abuse because the infant could not cruise or the explanation was implausible.”. Bruising was the most common sentinel injury and was found in almost 25% of infants with abusive head trauma.

Why do kids get bruises?

Bruising can be caused by an underlying medical condition, accidental injury, or physical abuse. It is estimated that over 50% of children older than 1 year will have bruising from minor accidental injury. [ 1-4] However, bruising is also the most common injury in children who have been physically abused.

What can a child abuse physician do?

The child abuse physicians can support health care providers who are concerned about a child and can offer advice regarding specific laboratory testing and medical imaging. Reporting to child protection services. Physicians are required by law to report situations that may indicate child abuse.