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Case #1:
Corey Corey is an 8 year old
boy who was brought into the emergency department where
you work, by emergency medical services (EMS) personnel
after he was hit by a softball during physical education
class at school. Corey lost consciousness for several
minutes. During the physical exam, you note that he
has bilateral bruises to his shoulders, arms and abdomen.
Crying, Corey reports that he was "beaten up" by classmates.
When his father arrives at the ED, Corey becomes visibly
fearful and stops crying. The father is clearly angry;
he begins to shout at Corey about having to leave work
early during an important business meeting; he was shouting
at Corey about not paying attention to the game, about
being a lousy ball player and acting like a baby. As
the physician in the ED, you note the dad's behavior
and how Corey is responding to it.
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Case #2:
Juanita You are a family nurse
practitioner working in a primary care office. Juanita's
mother comes to the office in follow-up to the hypertension
noted at the last visit. She brings 9-year old Juanita
with her to the appointment, as she usually does. Today
you note that Juanita is withdrawn and has bruises on
her face and arms. She looks like she's been crying.
Juanita is typically a chatty girl who usually engages
you in talking about her love of dancing, often showing
off her latest moves for the staff. Her mother appears
irritable and distracted. You ask her what's wrong and
she says she's fine. You mention that Juanita is so
quiet and looks upset today, to which she replies that
Juanita has been "bad". What would you do if you were
the nurse practitioner this situation?
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Case #3:
Sam Twelve year old Sam comes
to school wearing only a short sleeved t-shirt and jeans
on days when the temperature is in the 30s. Sam is a
quiet, slender young man. He often seems nervous; he
is easily startled. Sam is a C student. He never seems
to be paying much attention during class; he looks preoccupied.
Sam doesn't make much eye contact. He spends most of
his time alone; he doesn't really have any friends at
school. Indeed, often Sam is the focus of harassment
and teasing from his classmates. About 2 weeks ago Sam
came to class limping. He said he sprained his left
ankle. The ankle didn't get better after a week, so
you sent a note home to have Sam's family get medical
attention for Sam. That was last week and there has
been no change. As the teacher in this 7th grade classroom
you wonder if Sam might be really injured.
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Case #4:
Alicia and Martin The visiting
nurse comes to the home to follow-up on 10 week old
Alicia. The baby was born to a 19 year old mother with
a history of cocaine addiction. Alicia weighed 6 lbs.
2 oz. at birth and was not drug addicted. Today, the
first day you have been able to get into the home since
the referral was made 6 weeks ago, you note that Alicia
weighs 4 lbs. 6 oz. The mom tells the nurse that she
ran out of formula yesterday and hasn't had a chance
to get to the store yet today. Alicia is fretful, but
does not cry. Also, during the home visits the nurse
notes that 3 year old Martin has circular burn marks
on his arms and legs. He is a lethargic child who cries
frequently and is very shy and fearful of adults. The
nurse examines Martin and finds that he also has a patterned
bruise on his back which looks much like a wooden spoon.
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Case #5:
Tisha 5 year old Tisha has been
to see her primary care provider almost weekly for the
past month. Each week Tisha has complained to her mother
that her stomach hurts, so her mother brings her in
to be examined. Tisha's only symptom is abdominal pain.
She has no nausea, vomiting or diarrhea. She is well
nourished and developmentally appropriate for her age;
she clearly has been well cared for. Multiple diagnostic
tests have been run over the past month. As the family
nurse practitioner in this practice, you must inform
Tisha's mother that Tisha has tested positive for syphyllis.
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Case #6:
Marcus, Amber and Isaiah Sometimes,
the Shaw children come to school appearing to be hungry.
You are the school nurse who comes to this school most
afternoons, usually getting to the school at lunchtime.
You note that the Shaw children often don't have any
lunch. When they do bring a lunch, it is often not enough
food. Other than this, the children seem well-groomed
and well-behaved. The children are generally quiet,
rather private. As the nurse, you begin talking to them
and learn that their father does seasonal work and is
often between jobs. How would you handle this if you
were the school nurse?
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Case #7:
Tim At a residential treatment
center for boys age 13-16, recently some of the boys
have alleged that they were sexually abused by staff.
The internal investigations at the facility have never
supported these claims. One of the registered nurses,
Jean, suspects that what she is being told by the boys
is correct; she has noted how some of the aides, mostly
males, treat the boys so roughly on the one hand and
then at other times are often way too familiar. She
has often felt uncomfortable with their behavior. 15
year old Tim showed Jean his bloody underwear. He also
told Jean that one of the aides, Joe, was forcing him
to have sexual relations with some of the other aides
and that Joe was recording these sessions and making
money by selling the DVDs. Jean complains to the facility
administration about these allegations, but was told
that an internal investigation has occurred and there
is no evidence that these allegations are based in fact.
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Ken Hammond, USDA
These situations are real, or at least they
could be real; several are based on real situations. If you
were faced with these situations, what would you do? Do you
know what child abuse looks like? Would you recognize child
abuse if signs and symptoms were presented to you? Would you
know what to do ethically if you suspect child abuse? Do you
know what you must do legally if you suspect child abuse?
What if you are not sure? Do you know what you might face
legally if you did not report your suspicions? Would you face
repercussions if you did report? How should you proceed?
Continue to The
Disturbing Statistics
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