An acute care nurse is caring for a pediatric client diagnosed with diabetes mellitus who receives insulin injections. Which of the following actions by the nurse demonstrates atraumatic care?

Potential Condition: Child maltreatment

Actions to take:

Interview the child separately from the parents

Ask a parent, away from the child

Parameters to monitor:

Signs of fear or apprehension from the child when either parent is present

Negative comments about child from either parent.

Rationale:

Potential Condition: Child Maltreatment

The client’s history of multiple injuries (bloody nose, sutures from hitting cabinet, and spiral fracture) in the context of the parent’s alcohol intoxication, slurring, and aggressive behavior raises concern for possible child maltreatment. The child’s statement about being "clumsy" and the observed scars also support the need for further investigation into possible abuse.

Actions to Take

Interview the child separately from the parents: To ensure the child can speak freely and report any concerns without the influence or presence of the parents, especially when maltreatment is suspected.

Ask a parent, away from the child: The parent should be interviewed privately to assess their behavior and any possible stressors or issues that could indicate abuse or neglect, especially considering their appearance and actions when visiting the child.

Parameters to Monitor

Signs of fear or apprehension from the child when either parent is present: This could indicate emotional distress or fear related to the parent’s behavior. It is important to observe how the child reacts to the presence of each parent during assessments.

Negative comments about the child from either parent: Verbal abuse or negative comments can be a red flag for emotional abuse or neglect. Careful attention should be paid to any signs of verbal maltreatment.

Potential Diagnoses: Incorrect Choices

Muscular Dystrophy: While this could explain a pattern of injury due to muscle weakness, it does not align with the history of multiple injuries caused by trauma or the current family dynamics.

Constipation: No evidence or symptoms supporting constipation were observed in the current assessment.

Strabismus: No direct evidence to suggest strabismus in the child’s history or exam.

A. Oxygen saturation levels typically decrease, not elevate, in cystic fibrosis due to scarring and impairment of lung function, leading to difficulty with gas exchange.

B. Cystic fibrosis primarily affects the lungs and digestive system but does not directly impact blood glucose levels unless diabetes develops as a complication.

C. Cystic fibrosis affects mucus production in the lungs, but potassium levels are not typically affected in the way described. Potassium imbalance would be more related to renal function or other factors.

D. Cystic fibrosis affects the movement of sodium and water across cell membranes, leading to thickened mucus and an increased risk of electrolyte imbalances, such as low sodium levels (hyponatremia).