A nurse is assisting with the care of a 45-year-old female client who is in the emergency department.

Exhibits

Click to highlight the findings from the nurses’ notes that indicate partner violence and should be reported to the provider.

Nurses’ Notes for Highlighting:
Bruises noted in various stages of healing to the face, bilateral arms, and abdomen. Laceration to the left cheek cleansed and covered with an adhesive bandage. Left shoulder cleansed, antiseptic ointment applied, and covered with gauze dressing. Client states, “I fell getting out of the shower and scraped my face and shoulder on the bathroom counter. I tried to catch myself when I fell, and that is how I broke my arm.” Client has been married for 22 years and has two children. Client works part-time and volunteers at a community center. Client is tearful, does not make eye contact, and only speaks when spoken to. Client requests not to notify their partner because they do not want them to have to miss work or worry. Client reports poor appetite and difficulty sleeping.

Choice A rationale

Loss of a job is a situational crisis, stemming from an external event that disrupts a person's life. This type of crisis is usually unexpected and can lead to significant emotional distress due to financial strain and loss of identity associated with employment. Situational crises are often linked to specific life circumstances rather than developmental stages.

Choice B rationale

Divorce is also classified as a situational crisis. It is a disruptive life event that involves significant emotional upheaval, changes in social roles, and potential financial difficulties. The crisis arises from the loss of the marital relationship and the adjustments required in living arrangements and family dynamics, not from a predictable stage of life.

Choice C rationale

A child leaving for college represents a maturational crisis, a normal transitional phase in the family life cycle. This stage involves adjustments for parents as their role shifts and the family structure changes. While it can evoke feelings of loss or pride, it is a predictable developmental milestone that requires adaptation.

Choice D rationale

A motor-vehicle crash is a traumatic and unexpected event, classifying it as an adventitious crisis. This type of crisis is not a normal part of life or development and is often characterized by suddenness, violence, and potential for significant physical and emotional harm. It is an external event that overwhelms coping mechanisms.

Choice A rationale

While a bruise on the shin could indicate abuse, it could also result from an accidental bump or fall, which are common in older adults due to factors like impaired balance or decreased bone density. A single bruise alone is not definitive evidence of caregiver abuse or neglect and requires further assessment to determine the cause.

Choice B rationale

Being 9 kg (20 lb) over the recommended weight is indicative of potential overeating or a sedentary lifestyle, both of which are health concerns but not direct indicators of caregiver abuse or neglect. Weight management is related to dietary habits and physical activity levels, not necessarily the actions of a caregiver.

Choice C rationale

A caregiver paying a client's bills is not necessarily indicative of abuse or neglect. It could be a sign of assistance and support, especially if the client has difficulty managing their finances. Financial arrangements between a client and caregiver need to be assessed within the context of their relationship and the client's capacity.

Choice D rationale

Wearing soiled clothing suggests a lack of proper hygiene and care, which could be a sign of neglect by the caregiver. Inadequate attention to basic needs like cleanliness can lead to skin breakdown, infections, and a decline in the client's overall health and well-being. This warrants further investigation into the care provided.