Abuse and Neglect

Definition/Etiology:

• Abuse – most common in elderly and children due to inability for independent care. Physical, sexual, or psychological abuse most common.
• Neglect = Think NEED injury. The breach of duty that occurs in the negligent act must be the proximate cause of the injury in the case of healthcare neglect.
  In caregiver neglect, it simply means to pay little or no attention.
• Battery – harmful or offensive touching of one person by another.
  (example – nurses can be accused of this by giving a patient a medication against their will)

Pathophysiology:

Abuse may occur in various ways and are often experienced by those with a caregiver:

• Withholding of food
• Limiting financial freedom
• Physical harm
• Controlling and limiting of social circle
• Inappropriate managing or medication or withholding medication

Clinical Presentation:

Abuse:

• Physical abuse –
  • Bruising in various stages of healing
  • Bruises in infants less than 6 months
  • Retinal hemorrhages
  • Burns (cigarette common, evidence of scalding)
  • Frequent fractures
• Sexual abuse –
  • Genital bleeding/bruising
  • Inappropriate sexual behavior for age
  • Caregiver answers for the patient and won’t leave the patient during examination, even during more private portions of the examination
• Neglect –
  • Malnutrition
  • Developmental delays due to lack of interaction
  • Poor hygiene

Collaborative Management:

• R/o any underlying injury from possible trauma
• CT scan for possible underlying brain injury (especially in petechial hemorrhaging)
• Labs, EKG, fluid replacement may be needed in the cases of malnutrition
• Pharmacological interventions may include pain management of correction of electrolyte imbalances.
• Non-pharm interventions include involvement of social work and mandated reporting
• May need to collaborate with social services per department’s protocol

Evaluation | Patient Monitoring | Education:

• Is this person safe to discharge back to their home environment?
• Do we need law enforcement involvement?
• Have we reported appropriately according to our organization/state’s laws and regulations?
• Follow up and possible rehab
• Discharge with any available resources including abuse or neglect hotlines

Linchpins: (Key Points)

• Various types of abuse – think physical bodily harm. Abuse to the body.
• Neglect – failure to act which resulted in harm. Neglected to pay appropriate attention to.
• Bruises in various stages of healing is a key finding
• Suspect closed head injury with any petechial hemorrhage
• Suspect sexual abuse with a caregiver that is extremely smothering and does not allow the patient to speak or leave