A nurse is assisting with teaching a class about the effects of spirituality for clients who are near the end of life. Which of the following information should the nurse include?

Explanation:

A. A 6-year-old child with a spiral fracture of the tibia and fibula, reportedly occurring while riding a bicycle:

While a spiral fracture can be concerning, it is also a common injury seen in children due to falls or accidents during physical activities such as riding a bicycle. Without further evidence or suspicion, this may not immediately indicate physical abuse.

B. A 14-month-old toddler reportedly learning to walk and has several bruises on bony prominences of the lower legs and elbows:

Bruises on bony prominences can be common in toddlers who are learning to walk and explore their environment. These bruises are often seen on areas such as the lower legs and elbows. Without additional concerning signs or patterns, this may not indicate physical abuse.

C. A 9-month-old infant who sustained near drowning when he reportedly climbed into the tub and turned on the water:

Near drowning incidents can occur accidentally, especially in curious and mobile infants who may explore their surroundings. While this is a serious event, it does not necessarily suggest physical abuse unless there are other suspicious findings or a history of non-accidental injuries.

D. A 3-year-old toddler with scalding burns over the face and chest reportedly sustained when the child pulled on a tablecloth, spilling a cup of tea on himself:

Scalding burns, especially over sensitive areas like the face and chest, can raise concerns about physical abuse, especially when the reported mechanism of injury (spilling a cup of tea) seems inconsistent or disproportionate to the severity of the burns. The pattern and location of burns may not align with accidental spillage, leading to suspicion of abuse.

Explanation:

A. The child was brought to the facility 30 minutes after the injury occurred:

The timing of seeking medical attention alone may not necessarily indicate abuse. However, if there are inconsistencies in the reported mechanism of injury or if there is a delay in seeking medical care without a valid explanation, it can raise suspicion and warrant further investigation.

B. The parents report that the child injured herself by falling off the couch:

While falls are common causes of fractures in toddlers, spiral fractures are more commonly associated with twisting or torsional forces, which can raise concerns about non-accidental trauma. If the reported mechanism of injury does not align with the type of fracture or if there are inconsistencies in the history provided, it may indicate potential abuse.

C. The child begins to cry when her arm is examined by the provider:

It is common for children to cry or show discomfort during a physical examination, especially if they are in pain or feeling anxious. While this finding alone may not indicate abuse, it is essential to assess the child's behavior, pain response, and overall presentation for any additional signs or patterns of abuse.

D. The child's examination shows a single injury:

The presence of a single injury does not necessarily rule out abuse. Abusive injuries can be single or multiple, and the absence of other injuries does not negate the possibility of abuse. It is crucial to consider the context, history, and clinical findings comprehensively when evaluating for abuse.