💓 Savvy NurseOpen the app

🧠 Psychosocial Integrity · Lesson 4 of 6 · 6 min

Recognizing Abuse: What You Document and Whom You Tell

🩹 A 4-year-old has a spiral fracture of the arm. Dad says she fell off the couch. Spiral fractures come from twisting, not falling. Your next steps have a legal shape, and the exam knows it exactly.

💡 Key idea

Injury that does not match the story, delays in care and a controlling caregiver are red flags. Interview alone, document objectively, and report suspicion to protective services.

🧠 Why it matters

Red flags for ABUSE: injuries inconsistent with the explanation, injuries in various stages of healing, patterned injuries (belt marks, cigarette burns, immersion burns with clear lines), spiral fractures in children, delay in seeking care, a caregiver who answers for the client or refuses to leave, and a client who is fearful, withdrawn or overly compliant. NEGLECT shows as poor hygiene, malnutrition, untreated conditions, missing aids like glasses or dentures, and pressure injuries in a dependent person. Interview the client ALONE, in private, with open-ended questions. Document OBJECTIVELY: direct quotes, measurements, locations on a body map, and photographs per policy. Do not confront the suspected abuser or express judgment. Nurses are MANDATORY REPORTERS for suspected abuse of children, older adults and dependent adults; reasonable suspicion is enough, you do not need proof, and you report to the appropriate protective services agency, not just the supervisor. Intimate partner violence in a competent adult is reported according to state law and the client's wishes; the priority is a safety plan and resources.

🏥 In the real world

🧮 The spiral fracture, a healing bruise on the back, and a father who will not let the child speak. The nurse examines the child alone, charts 'spiral fracture left humerus; 3 cm yellow-green bruise right scapula; child states "Daddy was mad"', and files a report with child protective services. She does not accuse the father, and she does not need to be certain. Suspicion is the legal threshold.

📌 Takeaways

  • Mismatch between injury and story is the classic sign
  • Interview alone; quote, measure, map; no editorializing
  • Report suspicion to protective services; proof is not required

📖 Terms in this lesson

Mandatory reporter: A professional, including every nurse, legally required to report suspected abuse of children, elders and dependent adults.

✅ Test yourself

Which finding most strongly suggests physical abuse in a toddler?
  1. Multiple bruises on the back and buttocks
  2. A scraped knee after playing outside
  3. A single bump on the forehead
  4. A bruise on the shin after a fall at the playground

Answer: A · Multiple bruises on the back and buttocks

Multiple bruises on protected areas such as the back and buttocks, especially in various stages of healing, are inconsistent with normal childhood injuries, which occur over bony prominences like shins and foreheads.

A nurse suspects an older client is being neglected by a home caregiver. What is the nurse's legal obligation?
  1. Report the suspicion to adult protective services
  2. Discuss it only with the client's family
  3. Wait until proof is obtained
  4. Confront the caregiver

Answer: A · Report the suspicion to adult protective services

Nurses are mandated reporters, and reasonable suspicion triggers the duty to report.

Which documentation is appropriate for a suspected abuse case?
  1. '4 cm purple bruise left upper arm; client states, "He grabbed me."'
  2. 'Client appears to be lying about her injuries.'
  3. 'Client is a victim of domestic violence.'
  4. 'Client was obviously beaten by her husband.'

Answer: A · '4 cm purple bruise left upper arm; client states, "He grabbed me."'

Objective measurements, locations and direct quotes. Conclusions and labels do not belong in the chart.

Start this lesson free →

NCLEX-style questions, XP and streaks in the app. No sign-up needed.

More in Psychosocial Integrity

🔗 Related lessons