CHILD ABUSE

A. DEFINITIONS Child abuse or wrong treatment of the child is defined as any child abuse or adolens by a parent, guardian, or other person who sought to preserve, maintain, and care for them. Child abuse is an act or acts of negligence or the parents who care for children who cause children to be mentally and physically, emotional development, and development in general. Meanwhile, according to the U.S. Department of Health, Education and Wolfare provides definitions Child abuse as physical or mental violence, sexual violence and neglect against children under the age of 18 by people who should be responsible for the welfare of the child, so the child's safety and well-being is threatened.

B.

CLASSIFICATION There are two major categories, namely: 1. In the family Physical abuse, Non Accidental "injury" ranging from mild "Bruiser laceration" to the severe neurological trauma and death. Physical injury caused by corporal punishment out of bounds, or the cruelty of the poisoning. Child neglect / negligence, namely: direct action or behavior that may cause deleterious effects on the child's physical condition and psychological development. Negligence can be: Inadequate maintenance. Cause failure to thrive, children feel loss of love, psychiatric disorders, developmental delay Inadequate supervision. Cause children to fail at risk for physical and mental trauma Failure to get treatment Failure to properly care for the child

Negligence in education, including the failure to educate children to be able to interact with the environment, or have failed to send their children to earn a living for the family so that children were forced to drop out of school.

Emotional maltreatment Marked with criticism / words are demeaning the child, does not recognize as a child. Persecution like this are almost always followed by other forms of persecution. Sexual abuse using persuasive approach. Corecion of a child to engage in behavior / conduct real sexual activity, that describes activities such as: sexual activity (oral-genital, genital, anal, or sodomy), including incest.

2. Outdoors in institutions / agencies, at work, on the road, on the battlefield.

C.Etiology There are several factors that lead to children being abused. Both physical and psychological violence, such as: Stress comes from children a. Different physical, is a physical difference is the physical condition of the child is different from other children. An example of this is the child has a physical disability. Children have physical abnormalities and different from other children who have a perfect physique. b. Mentally different, ie mentally retarded child so the child has developmental problems and difficult to interact with the environment around it.

c. Different temperaments, children with weak temperament tend to experience a lot of violence when compared with children who had harsh temperament. This is because children who have a hard temperament tend to fight when compared to the weak-tempered child. d. Behave differently, that child has a behavior that is not reasonable and different to other children. For example, children behaving and acting weird in the family and the neighborhood. e. Adopted child, foster child tends to get rough treatment because parents assume that the adopted child is not a baby of the marriage itself, so instinctively no strong emotional ties between the child and the adoptive parents. Family Stress a. Poverty and unemployment, two factors are the strongest factors that cause violence in children, because these two factors are strongly associated with survival. So anything will be done by parents, especially after earning his living including sacrificing family. b. Mobility, isolation, and inadequate housing, these three factors also significantly affect the occurrence of child abuse, because the environment the biggest factor in shaping the child's personality and behavior. c. Divorce, divorce cause stress to the child, because the child will lose the love of both parents. d. Children are not expected, it will also lead to the emergence of violent behavior in children, because children are not in accordance with what is desired by the parents, such as physical handicaps, mentally weak, and so on. Stress comes from the parents, namely: a. Low self-esteem, children with low self-esteem will often get violent, because children always felt he was useless and always disappointing others. b. As a child gets misbehave, parents who experienced mistreatment in childhood will do the same thing to other people or their children as a form of release for the incident ever happened.

c. Hope the kids are not realistic, unrealistic expectations will make parents experiencing severe stress so that when not able to meet the needs of infants, parents tend to the children in a rebound frustration with violent conduct.

D. MANIFESTATION CLINIC Due to the child's physical a. Abrasions, hematoma, bite wounds, burns, fractures, retinal hemorrhages result of subdural hematoma and damage other internal organs.

b. Sequel / disabled as a result of trauma, such as scarring, nerve damage, hearing loss, eye damage and other defects. c. Death. Due to the growth and development of children The growth and development of children who experienced mistreatment, generally slower than normal children, namely: a. Physical growth of children in general less than other children who do not receive treatment either. b. The development of psychiatric disorders as well, namely: Intelligence Various studies have reported there is a delay in cognitive development, language, reading, and motor. Mental retardation can be caused by direct trauma to the head, as well as malnutrition. In some cases this delay is reinforced by the absence of adequate stimulation or due to emotional distress.

 Emotion There is emotional distress on: the development of a positive self kosnep, or hostile in dealing with aggression, the development of social relationships with others, including the ability to be confident. Occurred pseudomaturitas emotion. Some children become aggressive or hostile with adults, while others become withdrawn / away socially. Children like wetting, hyperactivity, bizarre behavior, learning difficulties, failing schools, sleeplessness, tempretantrum, etc. The concept of self Children who misbehave felt ugly, unloved, unwanted, sad, and unhappy, unable to enjoying the activities and some even attempt suicide. Aggressive Kids get the wrong treatment in body, more aggressive towards their peers. Often these aggressive actions to imitate their parents' actions or divert aggressive feelings to their peers as a result of poor self-concept. Social relations In these children are often less able to get along with their peers or with adults. They have few friends and likes to annoy adults, such as throwing rocks or other criminal acts. As a result of the sexual abuse Signs of sexual abuse include: Sign of trauma or local infection, such as perianal pain, vaginal discharge, and bleeding anus. Signs of emotional disturbance, such as reduced concentration, enuresis, enkopresis, anorexia, or changes in behavior. Sexual behavior or knowledge that is not in accordance with the child's age. Dilakuak genital examination with attention to the vulva, hymen, and anus child.

 Munchausen Syndrome Preview this syndrome consists of symptoms: Symptoms are unusual / non-specific. Symptoms appear only if there are parents Getting treatment by his parents tremendous Excessive parental behavior

E. EVALUATION Diagnostic misconduct can be established based on history, physical examination, through, complete documentation psychological history, and laboratory. Medical history and physical examination. Physical abuse Signs patogomonik result of child abuse can be : Bruises, especially on the face, lips, mouth, ears, head, or back. Patogomonik burns and frequent : cigarettes, immersion foot-hands in hot water, or circular burns on the buttocks. Electric burns like an oven or dryer. Head trauma, such as skull fractures, intracranial trauma, retinal hemorrhages, and multiple long bone fractures with different levels of healing. Abdominal and thoracic trauma less frequent than head trauma and bone on child abuse. Physical abuse more prevalent in children over 2 years of age. Neglect Neglect of non-organic failure to thrive, a condition that resulted in the failure to follow the pattern of growth and development should be, but responds well to meet the food and the emotional needs of children. Medical neglect, which did not receive adequate treatment in children with chronic illness because the parents deny the child has a chronic illness. Not able to immunization and other health care. Failure of the willful negligence of parents also include oral health care for children so damaged teeth.

Sexual abuse Sign and symptoms of sexual abuse include : Pain vagina, anus, and penis and the presence of bleeding or vaginal secretions. Chronic dysuria, enuresis, constipation or encopresis. Premature Puberty in women. Specific behavior: sexual activity with peers, animal, or object. Not according to the age of the child sexual knowledge and behavior that excites. Unspecified behavior: suicide attempts, feelings of fear in adults, nightmares, sleep disturbances, withdrawal, low self-esteem, depression, post-traumatic stress disorder, prostitution, eating disorders, etc.. Laboratory If found bruises, bleeding should dilakuak screening. In sexual abuse, examined: Swabs for analysis of acid phosphatase, spermatozoa within 72 hours after sexual abuse. Culture specimens from oral, anal, and vaginal sex for genokokus

Tests for syphilis, HIV, and hepatitis B.Analysis of pubic hair Radiology There are two role of radiology in the diagnosis of abuse in children, namely to: a. Identification focus of lesion b. Documentation Radiological examinations in children under the age of 2 years should be conducted to examine the bones, whereas children over 4-5 years need only be done if there is bone pain, limitation in movement during physical examination. The existence of multiple fractures to the level of healing the physical country persecution. CT-scan is more sensitive and specific for acute and chronic cerebral lesions, only indicated in pengniayaan child or a baby who suffered severe head trauma. MRI

(Magnetic Resonance Imaging) is more sensitive to the subacute and chronic lesions such as subdural and sub-arachnoid haemorrhage.Ultrasound is used to diagnose the presence of visceral lesions Colposcopy to evaluate children who experience sexual abuse.

F. MANAGEMENT Prevention and management of abuse and violence against children is through: Health services Health services can do a variety of activities and programs aimed at individuals, families, and communities. a. Primary-prevention objectives: promotion parenting and family welfare. Individual Family life education in schools, places of worship, and community Education to children on how to conflict resolution Sexual education in adolescents at risk Infant care education for youth who care for babies Reference service life care Training for professionals for early detection of violent behavior. Family Preparation classes to parents in hospitals, schools, public institutions Facilitating the fabric of the new parents love Refer new parents on nurses health center for follow-up (follow-up) Social services for families Community Health education about family violence Reducing that violent media Developing community support services, such as crisis services, shelters children / family / elderly / women who are persecuted Holder control firearms and sharp

b. Secondary-prevention Individual

goals:

diagnosis

and

action

for

families

who

stress

- Complete assessment of each incident of violence in the family in every health care - Plan escape for victims adequately - Knowledge of the sentence to ask for help and protection - Care or "Foster home" for victims

Family - Community services for individuals and families - Refer to support groups in the community (self-help-group). Example: family welfare watchdog group - Refer to the agencies / institutions in the community that provide services to victims Community - All skilled health professionals to provide services to victims of the standard procedure in helping victims - And emergency service units 24 hours to respond, report, service cases, coordination with law enforcement / social service for immediate service. - Tim coroner accident / injury especially infants and children. - The role of the government: police, courts, and local governments - Epidemiological approach to the evaluation - Holder control firearms and sharp c. Tertiary prevention-goal: redukasi and rehabilitation of families with violence Individual - Recovery strategies strength and confidence to victims - Professional counseling to individuals

Family - Re-education of parents in parenting - Professional counseling for families - Self-help-group (group care) Community - "Foster home", a refuge - The role of the government - "Follow up" on cases of abuse and violence - Holder control firearms and sharp Education Schools have the privilege of teaching a very personal part of the body, the penis, vagina, anus, mammary biology class. It should be emphasized that they are very personal and kept harud no one else. Schools also need to improve the safety of children in school. Attitude or way of educating children also need to be considered in order to avoid emotional mayhem. Teachers can also help detect signs of physical persecution and neglect in child care. Law enforcement and security Should the Act no.4 year 1979, about child welfare enforced consistently fast. This will protect the child from all forms of abuse and violence. Chapter II, Article 2 states that "children have the right to protection of the environment that can harm or inhibit the growth and development of natural causes.

 Mass media The preaching of abuse and violence against children should be followed by the articles of prevention and mitigation. The impact on children both short and long term prevention program reported that over emphasized.

G. NURSING CARE 1. Assessment The focus of the overall assessment for nursing diagnosis related to child abuse, among other things: Psychosocial 1) self neglect (neglect), clothes and hair dirty, smelly 2) Failure to thrive 3) Delay in the development of the level of cognitive, psychomotor, and psychosocial 4) With drawl (split) of the adults Musculoskeletal 1) Fracture 2) Dislocation 3) Sprain (sprain) Genito urinary 1) urinary tract infection 2) bleeding per vagina 3) Injury to the vagina / penis 4) Painful micturition time 5) laceration on external genetalia organs, vagina, and anus.

Integumentary 1) circulation lesions (usually in the case because of cigarette burns) 2) burns to the skin, bruising and abrasion 3) The human bite marks that can not be explained 4) Swelling. 2. Nursing Diagnosis a. Damage bd parenting a young age, especially teens, lack of knowledge regarding the fulfillment of child health and child care settings ketidakadekuatan. b. Adaptive Capacity: decreased intracranial brain injury bd c. Imbalance nutrition less than body requirements include the inability bd, digest, and absorb food due to psychological factors. d. Risk of developmental delay bd damage was caused by violence. 3. Intervention Dx I: Damage Rt nurturing young age, especially teens, lack of knowledge regarding the fulfillment of child health and child care settings adequate. NOC: After nursing care so parents will address the constructive discipline, identify effective ways to express anger or frustration that does not harm the child, and actively participate in counseling or parenting classes. Intervention: - Encourage disclosure of feelings - Assist parents to identify deficits or changes in parenting - Provide frequent opportunities for interaction that a parent or child

Dx II: Adaptive Capacity: decreased intracranial brain injury NOC: After nursing care then the client will show an increase in intracranial adaptive capacity indicated by fluid balance, electrolyte balance and acid-base balance. Neurological status, and neurological status: consciousness. Intervention: - Monitor intracranial pressure and cerebral perfusion pressure - Monitor neurological status at regular intervals - Note the events that stimulate change in ICT wave - Determine baseline vital signs and cardiac rhythm and monitor changes during and after activity - Teach caregivers about the signs that indicate increased ICP (eg, increased seizure activity) - Teach caregivers about specific situations that stimulate ICT on the client (eg, pain and anxiety);

Dx III: Imbalance nutrition less than body requirements r.t inability to incorporate, digest, and absorb food due to psychological factors. NOC: After nursing care then the client will show the status Nutrition ; intake of food , fluid and nutrition, characterized by the following indicators (value range 1-5: inadequate, mild, moderate, strong, or inadequate total). Oral feeds through tube feeding, or total parenteral nutrition. Intake of oral fluids or IV Intervention: - Identification of factors that can affect the patient's loss of appetite - Monitor laboratory values, particularly transferrin, albumin and electrolytes - Nutrient management: know the client's favorite foods, monitor your nutrition and calorie intake on the mold, weigh the client at appropriate intervals

- Teach methods for planning meals - Teach clients / families about nutritious food and not expensive - Nutritional management: provide the right information about the nutritional needs and how to fulfill them.

REFERENCES

Soetjiningsih. 1995. Growth. Jakarta: EGC. The situation of children World, 1991. UNICEF Fair, Chairul. 1994. Child Abuse, Medika 3. http://aneka-wacana.blogspot.com/2012/03/asuhan-keperawatan-child-abuse aplikasi.html#ixzz2QVOpi8uX has been accessed on Saturday, April 13th 2013 at 16.13 WITA. http://mercusuarku.wordpress.com/2008/08/10/perkembangan-manusia/ has been accessed on Saturday, April 13th 2013 at 16.15 WITA.

https://esmet-yulia.googlecode.com/files/ASKEpANAKDenganCHILD.doc has been accessed on

Saturday, April 13th 2013 at 16.17 WITA.

http://repository.usu.ac.id/bitstream/123456789/3586/1/keperawatan-nur2.pdf has been accessed on

Saturday, April 13th 2013 at 16.19 WITA.

http://downloadaskep.blogspot.com/2012/05/download-askep-anak-dengan-child-abuse.html has been

accessed on Saturday, April 13th 2013 at 16.21 WITA.

PEDIATRIC NURSING CHILD ABUSE

By : Muhammaad Nurmajid Sitti Chairun Nissa Wahtuti Jemi

BANJARMASIN MUHAMMADIYAH HEALTH COLLEGE INTERNATIONAL CLASS OF NURSING DIPLOMA PROGRAM 2013/2014