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Question

Difficulty: MediumAbuse and Neglect

A 10-year-old child with a cognitive disability is brought to the emergency department by a caregiver. The child has an actively bleeding scalp laceration, and the nurse observes patterned, defensive bruising on the child's forearms. The caregiver's explanation of the injuries is inconsistent with the physical findings. Arrange the following nursing actions in the correct order of priority from first to last.

  1. 1Apply direct pressure to the actively bleeding scalp laceration.
  2. 2Separate the caregiver from the child using a facility-approved protocol.
  3. 3Complete a full physical assessment and interview the child privately.
  4. 4Document the objective characteristics of the wounds and the child's exact statements.
  5. 5Report the suspected child abuse to the designated local child protective services agency.

Answer

The correct sequence prioritizes physiological stability, then immediate safety, followed by assessment, factual documentation, and finally mandatory reporting.
Nursing prioritization follows a strict clinical hierarchy: physiological needs (circulation and bleeding control) must be addressed first, followed immediately by physical safety (separating the suspected abuser). Once the client is medically stabilized and safe, the nurse can conduct a thorough, uncoerced assessment. Objective documentation of these findings must precede external reporting to ensure accurate and factual information is provided to child protective services.

Step-by-Step Solution

1
Apply direct pressure to the actively bleeding scalp laceration.
The active hemorrhage is controlled, achieving physiological stability.
According to the ABCs of resuscitation, physiological survival (circulation) takes immediate precedence over all other interventions.
2
Separate the caregiver from the child using a facility-approved protocol.
The child is placed in a secure environment away from potential intimidation or further harm.
Once medically stable, ensuring the client's immediate physical safety and security is the next priority in Maslow's hierarchy of needs.
3
Complete a full physical assessment and interview the child privately.
Comprehensive clinical data and the client's perspective are gathered safely.
A thorough assessment can only yield accurate, uncoerced information if the suspected abuser is no longer present.
4
Document the objective characteristics of the wounds and the child's exact statements.
An objective legal medical record of the abuse suspicion is created.
Factual documentation provides the essential evidence base required before initiating external communications.
5
Report the suspected child abuse to the designated local child protective services agency.
The legal obligation as a mandated reporter is fulfilled.
External reporting relies on the objective data gathered during the assessment phase and must be completed once safety and stability are ensured.

Key Concept

Prioritization of Care in Suspected Abuse
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Topics

Abuse and Neglect

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