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Difficulty: MediumAbuse or Neglect

A practical nurse (PN) on a medical-surgical unit is admitting a 67-year-old client for severe dehydration. The PN notes that the client has matted hair, soiled clothing, and multiple fading contusions on the upper arms. The client's adult child is present and aggressively attempts to answer all questions for the client. Which of the following actions should the PN take? (Select all that apply.)

  1. Document objective characteristics of the contusions, including size, color, and location.Answer
  2. Ensure the client is interviewed privately by asking the adult child to step out of the room.Answer
  3. Report the suspected abuse and neglect immediately to the nursing supervisor and adult protective services.Answer
  4. D
    Postpone filing a formal report until the healthcare provider can definitively prove the abuse occurred.
  5. E
    Ask the client directly, "Why didn't you tell anyone that your child was hurting you?"
  6. F
    Discuss the suspected abuse with the client's neighbors who are waiting in the public lobby to gather more background information.

Answer

The nurse should document objective findings of the injuries, arrange to interview the client privately without the family member present, and immediately report the suspected abuse to the appropriate authorities.
Appropriate nursing actions for suspected abuse involve ensuring client safety through private assessment, meticulously documenting objective physical evidence, and fulfilling the legal obligation of mandated reporting immediately based on reasonable suspicion.

Step-by-Step Solution

1
Analyze the clinical findings and family dynamics.
The client displays signs of physical neglect (poor hygiene, dehydration) and physical abuse (fading contusions), while the caregiver exhibits controlling behavior.
Recognizing clustered indicators of abuse or neglect is the first step in initiating protective measures for vulnerable adults.
2
Determine immediate safety and assessment priorities.
The nurse must separate the client from the potential abuser to safely gather an accurate history.
Victims of abuse often fear retaliation and will rarely disclose trauma if the suspected abuser is present in the room.
3
Identify legal and documentation responsibilities.
The nurse must document all physical findings objectively and immediately report the suspicion.
Practical nurses are mandated reporters who must act on reasonable suspicion to ensure client safety, and objective documentation provides critical evidentiary support.

Key Concept

Prioritizing client safety, objective documentation, and immediate mandated reporting when elder abuse or neglect is suspected.
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Topics

Abuse or Neglect

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