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. 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 nonweight-bearing. The nurse suspects physical abuse based on which of the following findings? (Select all that apply.)

A. Patient has a history of previous wrist fractures: Recurrent fractures in an older adult, especially when the reported causes are vague or inconsistent, raise concern for possible abuse. Multiple injuries over time suggest repeated trauma rather than isolated accidental falls. B. Patient is crying: Emotional distress such as crying is expected when experiencing pain or fear, but it does not specifically indicate abuse. While the behavior warrants empathy and support, it is not sufficient evidence of mistreatment on its own. C. The fracture is inconsistent with the patient’s functional ability: The daughter’s report that her wheelchair-bound mother stood unassisted to walk to the bathroom is inconsistent with the patient’s physical limitations. Injuries that do not match the client’s functional capacity are a strong indicator of possible physical abuse. D. Bruises are in various stages of healing: The presence of bruises in multiple healing phases suggests repeated injury over time rather than a single fall. This pattern is a classic sign of ongoing physical abuse and requires immediate reporting and investigation. E. Caregiver suffering stress from caring for a functionally dependent individual: Caregiver stress can increase the risk of abuse but does not confirm it. While caregiver burden should be assessed, it is a risk factor not direct evidence of physical abuse.