Abnormal Motor Behaviors

Abnormal motor behaviors are activities displayed by the mentally ill patient and occur as a result of a psychiatric disorder.

There are types of abnormal motor behaviors as I mention here:

Akathisia

• Displaying motor restlessness and muscular quivering
• Patient is unable to sit or lie quietly

Echolalia
Repeating the speech of another person

Echopraxia
Repeating movement of another person

Parkinson-like Symptoms
Making masklike faces, drolling, and having shuffling gait, tremors, and muscular rigidity

Waxy Flexibility
Having one’s arm or legs place in a certain position and holding that same position for hours

Dyskinesia
Impairment of the power of voluntary movement

Abuse and Neglect: Shaken Baby Syndrome

Shaken baby syndrome (SBS) is a form of physical abuse that mostly caused by rigorous shaking. There are three risk factors of shaken baby syndrome: gender, financial stress, and mental-health problems.


Sign and Symptoms:

• Poor feeding
• Bulging fontanels
• Lethargy
• Seizures
• Apnea
• Retinal detachment

Nursing Interventions:
Assure and teach parent about age-appropriate play of the infants that will not cause injuries

Abuse and Neglect: Child Abuse

Signs of Physical Child Abuse:

• Unexplained bruise or welts
• Unexplained burns
• Unexplained fractures (multiple or in various stages of healing)
• Unexplained lacerations or abrasions (mouth, eyes, and external genitalia)
• Expresses fear of going home
• Appears frightened of parents
• Reports of being injured by parents
• Exhibits extreme aggressiveness or withdrawal
• Acts wary of contact with adults
• Becomes apprehensive when other children cry

Signs of Physical Child Neglect:

• Inappropriate dress
• Always hungry
• Poor hygiene
• Uncared for medical or physical problems
• Begging or stealing food
• Abandonment
• Early arrival and late departure from school
• Fatigue
• Listlessness
• Reports lack of a caretaker
• Delinquency

Why the parent becomes an abusive parent? Here are the risk factors that parent become an abuser:

1. Under significant stress
2. Abused as a child
3. Deficient in social and financial resources
4. Lack of impulse control
5. Uses inappropriate coping skills
6. Anger and hostility
7. Ambivalent toward parenthood
8. Mental illness
9. Marital problems
10. Lack of knowledge regarding children development
11. Substance abuser

Nursing Interventions:

• Assess the patient, family, and significant others about the signs of an impending crisis and effective problem solving techniques to manage crisis
• Assess the patient, family, and significant others about the signs of abuse and neglect, and to access help immediately if abuse or neglect are suspected
• Assess caregivers about coping strategies to prevent abuse and neglect

Abuse and Neglect: Sexual Abuse

The case of sexual abuse may range from sexual harassment to molestation and rape.

Patients with rape usually deal with the consequences from physical injury, pregnancy and sexually transmitted disease, and rape trauma syndrome. The rape trauma syndrome includes high level of anxiety, difficulty making decision, flashbacks, violent dream, preoccupation with future danger, and problems with intimate relationships.

In the long-term, the victims of sexual abuse may experience posttraumatic stress disorder (PTSD). In this case, the sexual abuse victims:

• Uses denial, repression, and suppression to cope with anxious feelings
• Shows symptoms including flashback, intrusive memories of the event, hopelessness, depression, night-mares, and outbursts of anger and rage.

Nursing Interventions:

• In children sexual abuse, assess for sexualized behavior characteristic: seductive behavior used to gain affection, unusual curiosity regarding genitalia, decreased personal boundaries, extreme reaction to bathing, extraordinary fear of the opposite sex, unwillingness to participate in age appropriate physical or social activity.
• In the emergency department: gather evidence with permission of the victim following policies of facility and low enforcement.
• Give the victim a control as much as possible during the assessment.
• Treat physical injuries appropriately
• Advice patient about potential for pregnancy and STDs
• Encourage patient to discuss feeling about the assault
• Provide the information about community services

Abuse and Neglect: Elder Abuse

Elder abuse is the term that includes both abuse and neglect. It may be physical harm, sexual or verbal intimidation, emotional, or physical neglect, and or economic exploitation.

Elder victims are often reluctant to reveal abuse out of fear of abandonment or retaliation from abuser. The abusers are usually family member.

Signs and Symptoms of Elder Abuse:

• Dehydration and malnutrition
• Unexplained bruising, burns, or injuries
• Oversedation
• Unmet physical and medical needs
• Bruises, wounds, and pressure ulcers
• Fearfulness
• Report of restraints or being locked in a room
• Conflicting stories from client and caregiver or family member

Nursing Interventions:

• Assess for signs of abuse or neglect
• Treat and manage the existing injuries
• Report abuse to appropriate authorities
• Refer to community agencies (respite for caregivers, support groups for caregiver)

Abuse and Neglect: Spouse / Partner Abuse

Spouse or partner abuse occurs as emotional, physical, economic, sexual, or combination. This abuse happens most frequently that a male on a female.

Victims of spouse or partner abuse are more likely to abuse alcohol or drugs and to commit suicide.

Attacks escalate in severity and frequency over time.

This kind of abuse usually follow a cycle or pattern: escalating tension, abuse, and then remorse (honeymoon period). In remorse pattern, the abuser apologizes and promises that it will never happen again, professes low for partner, often engages in romantic behaviors, and tension-building phase begins again.

The victim may leave the abuser, and this condition is most dangerous to both of them.

Nursing Interventions:
1. Identify possible victims, use SAFE question:

• Stress/safety: Do you feel safe:
• Afraid/abused: Are you ever afraid in your relationship?
• Friend/family: Are they aware you have been hurt?
• Emergency plan: Do you have a safe place to go and the resources you may need?

2. Refer to the appropriate resources such as police or legal aid, local shelters, and support groups.

Abuse and Neglect: Assessment Questions Guide

When caring patient with abuse or neglect, this Assessment Questions Guide will help you to give care properly.

1. Sometimes women (or men or children) are forced into sexual activity. Has this ever happened to you? Has anyone ever suggested they wish to engage you in sexual activity even when you’ve resisted?
2. If the client is pregnant—Since you have been pregnant, have you been hit, slapped, kicked, or physically hurt in any other manner by someone?
3. Has anyone failed to help you when you needed help?
4. I noticed that you have a number of bruises. Can you tell me how they happened? Has anyone hurt you?
5. You seem anxious. Has anyone ever hurt you or threatened to do so? Are you ever afraid of anyone close to you, such as your
6. partner, caretaker, or any other family member?
7. Sometimes clients tell me that they have been hurt by someone at home or work. Is this happening to you?
8. Has anyone ever prevented you from seeing your friends or family members?
9. Have you ever been pressured to sign papers you did not understand or did not wish to sign?

Care With Abused / Neglected Patient: Key Concepts

Here are the key concepts in caring patient with abuse or neglect:

• Both of abuse and neglect can occur as physical, sexual, and psychological. They can come to all ages and affect both genders from all socioeconomic, ethnic, and cultural groups.
• The nurse should ask direct questions during assessment and should be in private.
• All disabled and elderly clients should be asked for possible abuse or neglect.
• Domestic violence: child abuse, elder abuse, and abuse of women and men.
• Abuse or neglect is rarely a one-time occurrence, it usually continues and escalates in severity.
• Sexual abuse in female: have more health problem and undergo more surgeries than nonvictims
• Sexual abuse in childhood: they will experience more chronic depression, posttraumatic stress disorder, morbid obesity, marital instability, gastrointestinal problems, headaches, and greater reliance on health care services than nonvictims
• Abused risk factors are high levels of stress or alcoholism in caregivers, high emotions, evidence of violence, financial dependency or physical dependency
• Symptoms of client with abuse: suicide attemps, drug and alcohol abuse, frequent emergency department visits, multiple injuries, unexplained injuries, vague pelvic pain, depression, and insomnia



• Symptoms of client with neglect: poor hygiene, hunger, dehydration, pain, unkempt appearance, inadequate clothing or shoes, unfilled medication prescriptions, missed appointments with healthcare provider, and lack of ancillary devices
• Nurse roles in caring patient with abuse: documents the event, provides drawings or photos of injuries, examine the entire surface of patient's body, assessess patient's interactions with others, and performs a mental status examination
• Nurse's primary attention is the safety of the patient: separated from abuser, support the patient, and collaboration with interdisciplinary team
• The nurse should evaluates the response of patient, family and significant others to every interventions and do updates if necessary