A nurse working in an emergency department is caring for an 89-year-old woman who was brought to the hospital by her daughter for a fracture of the right arm

Question

The woman is wheelchair dependent and lives with her widowed daughter who is the primary caregiver. The daughter states that her mother got up out of the wheelchair unassisted to go to the bathroom and fell. The patient cannot recall the circumstances of the fall. The patient is weeping and cradling her right arm. The patient's history reveals two previous wrist fractures over the course of the past year. The nurse notes several large ecchymotic areas on the right hand and left arm and on the left side of the body and the back. The ecchymoses are in various stages of healing. Upon assessment, the patient is non-weight-bearing (NWB). The nurse suspects phys-ical abuse based on which of the following findings? (Select all that apply.)
a. Bruises are in various stages of healing.
b. The fracture is inconsistent with the pa-tient's functional ability.
c. Caregiver suffering stress from caring for a functionally-dependent individual.
d. Patient is crying.
e. Patient has a history of previous wrist fractures.

Answer 1

ANS: A, B
Specific signs of physical abuse include unexplained bruising or lacerations or those in unusual areas in various stages of healing, and fractures inconsistent with functional ability. This patient has many bruises in different areas all in various stages of healing, which leads one to believe that they were sustained at different times. The patient is NWB, so the daughter's statement that she fell while getting out of the wheelchair to go the bathroom does not match the patient's func-tional abilities. While there could be caregiver stress in this situation, the scenario does not men-tion it. While the patient's crying is concerning, it could be due to many other factors, including pain. A previous history of wrist fractures is concerning as well, but there are many other possible reasons for repeated fractures.