nursing pediatric Well Child Developmental Assessment Paper

Bowie State University Bowie, MD 20715 College of Professional Studies Department of Nursing Well Child

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Developmental Assessment Paper Guidelines Students will conduct a developmental assessment met in a home setting to identify factors influencing a child’s development. WELL CHILD DEVELOPMENTAL ASSESSMENT PAPER (20%) Each student will conduct a pediatric developmental assessment in order to facilitate his/her learning of the multiple, predictable aspects of a child’s growth and development. The student will also assess the child’s home environment to identify some of the factors influencing the child’s development. Following the visit, a written paper will be due which will include physiologic and psychosocial assessment data, goals for the child and family, interventions, and recommendations. I. PROCEDURE FOR THE VISIT Identify a well child (1 month – 10 years of age) either in a home or school environment. The child should not be a member of the student’s immediate family. For home visits, you will be conducting a developmental and a home assessment for a child birth to 10 years of age. For school students, you may conduct a systematic assessment of their developmental status and identify environmental factors located in the school which are aimed at stimulating their development. Some suggested parameters to include: a) birth date, age, and gender b) growth parameters – use growth charts based on the ➢ For children < 2 years, use the Birth to 36 months 3rd-97th percentile forms and plot the following on the chart: o length for age o weight for age o head circumference for age o weight for length ➢ For children > 2 years, use the 2-20 years 3rd-97th percentile forms and plot the following on the chart: o stature for age o weight for age o BMI for age c) nutritional status d) development – remember the different aspects of development e) family ➢ Who lives in the home and what are their roles with the child? ➢ What influences do they have on the child’s development? ➢ Is the child cared for outside of the home and what impact does that have on the child and his/her family? f) home environment or school assessment– ➢ include safety issues that may not be covered by this tool, i.e.: guns in home, helmets w/ bikes, harmful chemicals within reach, etc. 2) ANALYSIS OF DATA Bowie State University Bowie, MD 20715 College of Professional Studies Department of Nursing a) Interpret the child’s growth percentiles. b) Describe and interpret child developmental findings. Select at least two developmental theorists and compare the child’s development. c) Assess the child’s environment in the areas of cognitive and social emotional support, safety, nutrition, and list factors that facilitate or inhibit the child’s growth and development. Or, if school based, describe environmental factors you have identified that are stimulating the child’s development d) Discuss problems to be addressed, nursing diagnoses, and needs. If there are no problems, discuss anticipatory guidance needs. 3) GOALS – for child and family 4) INTERVENTIONS OR RECOMMENDATIONS – to maintain and promote growth, development and health of the child. Include documented rationale. 5) REFERENCE LIST – Use APA format. Bowie State University Bowie, MD 20715 College of Professional Studies Department of Nursing SECTION POSSIBLE POINTS ASSESSMENT: Collection of Subjective and Objective Data 1. Growth Chart 2. Nutritional Status (24-hour food diary) 3. Family Assessment 5. Pediatric Home Environment 5pts 5pts 5pts 5pts Total points 20pts ANALYSIS OF DATA 1. Child’s Growth and Development (must reference two developmental theorist) 2. Child’s Home Environment 10pts 3. Factors that facilitate/inhibit G&D 4. Discussion of identified problems 15pts 10pts 15pts Total Points 50pts GOALS: 1. 2. 2 for Child 2 for Family 4pts 4pts Total Points 8pts INTERVENTIONS/RECOMMENDATIONS: 1. 2. Maintenance of current Health Practices Promotion of health, growth & development 10pts 10pts Total Points 20pts APA FORMATING: 2pts TOTAL POSSIBLE POINTS: 100pts Running head: WELL CHILD PAPER 1 Kiara Hooker Well Child Paper Bowie State University Professor Danielle Artis December 8, 2017 WELL CHILD PAPER 2 Introduction M. B., the initials of the young lady, who became the focus of this paper. M. B. is a 5year-old African-American child, who comes from a single parent home. My paper take a look into her growth and development, with assessments based on the influences of her home environment, nutrition, health, and family. In response to the information gathered, my goal is to plan a course of action to promote the overall health and development for M. B. and other children in her age range. Well Child Home Visit M.B is a 5-year-old African American female. She was born on December 3, 2012. She lives with her mother along with her roommate, boyfriend and son in District Heights Maryland. M.B is the only child from both her mother and father. Her mother who is now 21 is a new police officer for Washington DC, and her father works in retail. She sees her father about 10 times a year. On weekends, she stays with her grandparents, they live 20 minutes away. Her aunt who is 9 years old lives at her grandparents’ house. Assessment M.B was born vaginally at 38 weeks gestation. She weighed 6 pounds 8 ounces and was 19.3 inches long. She did not have any complications when she was born. She was breastfeeding until she was 1 years old. She is allergic to penicillin and she has mild eczema. She has been to the doctor for her eczema and now uses Eczema Therapy Aveeno moisture cream. This has been very helpful in managing her eczema. When first entering the home, I observed the environment. M.B lived in an apartment on the fifth floor. It was a two bedroom. M.B stays in the room with her mother where they share a WELL CHILD PAPER 3 bed. The television in the room is a flat screen placed on a folding table. It is not secured and wires are hanging off the side. In the bathroom, the cleaning supplied in in cabinet under the sink easily accessible to the children. Also, the kitchen has cleaning supplies under the sink with no lock and knives are in a drawer that M.B can reach. The apartment has carpet all throughout except for in the kitchen and bathroom. The living room and dining room is furnished. In the bathroom, there were medications in the mirror cabinet where M.B would not be able to reach. There are windows throughout the home. They have screens in them and they were all locked. Due to M.B’s mother being a police officer there is a gun in the home. Her mother hand a talk with her letting her know that she is never to touch the gun or show anyone the gun. The gun is also locked in a safe at the top of a closet. While doing a home visit I was able to observe and discuss her eating habits and nutritional status. For lunch M.B had a chicken nugget happy meal from McDonalds. The meal included chicken nuggets, french fries, sliced apples and a chocolate milk. She did not sit in one place while eating. She would take a bite of food go play and come back for another bite. She never finished her meal completely. While with her mother most of her meals consist of fast food. There are times where she eats fruits and vegetables but it is rare. When she does she eats broccoli and apples. When she is with her grandparents she eats more nutritious meals but she does not finish her food. As we progress in age there are milestones that are accomplished dealing with growth and development. M.B has been successful through her first four years of life. By 1 years old she was able to sit up on her own, crawl, pull up on furniture to stand, make a few steps without holding on to things, respond to simple request, say mama and dada, shake, bang and grow things, put things in a container and play games like peek-a-boo. At the age of 2 M.B was able to WELL CHILD PAPER 4 play make believe games, repeat words that she overheard, copy others, throw balls over hand, walk up the stairs holding onto rails, build block towers, run, kick balls, name things that she saw such as different animals and she was showing more independence. By 3 she could say her name and age, follow instructions more, play make believe with toys, climb well, show different emotions, walk up and down stairs one foot at a time, name her friends and have conversations with 2 to 3 sentences. Because M.B is now 5 years old she expected to speak clearly, want to please and be like friends, count 10 or more things, stand on one foot for 10 seconds or longer, swing and climb, print some letters and numbers, copy geometric shapes, say her name and address, show more independence along with several other things. According to the CDC these are the milestones children should meet by that specific age. While in her home and her grandparents’ home M.B I taught about right from wrong. She is disciplined by using time outs, taking away tv and phone privileges as well as spankings. She has positive influences around her. When she is at her grandparents’ home her aunt who is in elementary school influences her to participate in educational games although they may be on the computer. They go over letters and number as well as writing the alphabet and spelling her first and last name. When talking to M.B’s mother I was told that she normally brushes her teeth once a day, sometimes she doesn’t brush at all. She has been to the dentist and had to receive caps because when she was younger she slept with a bottle in her mouth causing some type of tooth decay or cavity. Even though she has gone to the dentist to correct this problem her mother does not continue practices to prevent the same issue from happening again. Analysis M.B weighs 54 pounds and is 3 feet 8 inches tall. According to the CDC she is in the 97th percentile in weight and 75th percentile in height. Also, her BMI is 19.6. This puts her in the 97th WELL CHILD PAPER percentile. Being in the 97th percentile means that she is above the average, she is what they would consider obese. This could be due to her eating habits along with how active she is on a daily basis. View Appendix B for stature and weight percentile chart and Appendix C for BMI chart. Nutrition is very important for growth and development. A 5 year old’s diet should consist of all the food groups in healthy portions. M.B’s diet is not an example of a healthy diet. According to Healthy Children a typical day’s diet should consist of 2 to 3 servings of fruit, 2 to 3 servings of vegetables, 6 to 11 servings of grains, 2 servings of meats or other protein and 2 to 3 servings of dairy. Having a healthy diet will help reduce her likelihood of having childhood obesity and other conditions that are related to that. To view M.B’s 24 hour diet recall view Appendix A. At 5 years old M.B is in Erikson initiative vs guilt stage. in the prior stages M.B was gaining trust and independence. In this stage of life Erikson believes that will either develop initiative, meaning she will “plan activities, accomplish task and face different challenges.” The parent is expected to encourage the child to explore different things rather than being stuck in a bubble. This will allow M.B to learn to make the right choices. The parent should not be discouraging because it may cause the child to feel ashamed of themselves and to become dependent on help from others (Hockenberry, 2015, p.524) According to Kohlberg M.B would be in the self-interest stage also known as instrumental orientation. This stage is for children who are in preschool. They are interested in what benefits them. Their behavior is based on rewards that may be given if they are well behaved. In the prior stage of Kohlberg’s theory M.B was learning good from bad based on punishment (Sincero, 2010). With these two stages M.B is obeying the rules that adults put into 5 WELL CHILD PAPER 6 place as well as helping others an expecting to be helped in return. This may be thought of as if you scratch my back ill scratch yours. Goals and Interventions Goal 1: M.B will begin to brush her teeth 2 times a day. This will help to prevent cavities and promote healthy routines for the future. Goal 2: M.B will limit time watching tv and paying video games on the cell phone to 2 hours per day. She will use this time to explore books appropriate for her age. Goal 3: The family will include healthier food options during meal time. This will allow M.B to grow at a rate that will keep her healthy and prevent childhood obesity. Goal 4: The family will schedule active play time in order for M.B to maintain a healthy weight for her age and prevent childhood obesity. As a 5-year-old I believe M.B is developing well. There are a few things in the house hold that should be changed. First, there should be some type of locks on the cabinets with cleaning supplies, or the supplies should be placed in an area where M.B cannot reach them. Next, M.B should have a diet consisting of more fruits and vegetables. Having these food in her diet will promote healthy growth and development and prevent childhood obesity. Many of the foods that she eats are unhealthy and she mostly has fast food. Her mother should limit the amount of juices and sweets she eats. This will prevent the start of cavities and the need for dental work. Technology plays a very important role in the lives of many people. At the age of 5 it should not consume majority of a child’s time. Tv time should be limited to two hours, this should include the use of cell phones. M.B could use this time to explore books and her imagination. WELL CHILD PAPER 7 Reference American Academy of Pediatrics. (2010). Bright Futures Parent Handout 5 and 6 Year Visit. Retrieved from https://brightfutures.aap.org/Bright%20Futures%20Documents/C.MCh.PH.5,6yr.pdf CDC. (2012). Milestone Check List. Retrieved from https://www.cdc.gov/ncbddd/actearly/pdf/checklists/Checklists_WithParentTips_FNL5yr.pdf Healthy Children. (2015, November 21). Portions and Serving Sizes. Retrieved from https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Portions-andServing-Sizes.aspx Henry, N. J. (2016). RN nursing care of children: review module. Stilwell, KS: Assessment Technologies Institute. Hockenberry, M. J., & Wilson, D. (2015). Wongs nursing care of infants and children. St. Louis, MO: Elsevier. Sincero, S. M. (2010). Theory of Moral Development by Lawrence Kohlberg. Retrieved from https://explorable.com/theory-of-moral-development WELL CHILD PAPER 8 Appendix A 24 hour diet recall Time Food Completion 7:00 am Granola bar Capri Sun Slice of peperoni pizza Sweet corn Apple juice Chocolate milk 3/4th 2:00pm Cheese curl chips Capri sun ½ of a bag 4:00pm Capri sun Brownie whole brownie Mcdonalds happy meal Chicken nuggets French fries Apple slices Gogurt Chocolate milk 3 nuggets All fries 2 apple slices None All milk Cup of milk All milk 11:00am (school lunch) 6:00pm 8:45pm N/A WELL CHILD PAPER 9 Appendix B WELL CHILD PAPER 10 Appendix C WELL CHILD PAPER 11 Developmental Influences on Child Health Promotion Danielle Artis, MSN, RN, CPN . Changes in body proportions occur dramatically during childhood Foundations of Growth and Development Growth is increase in number and size of cells as they divide and synthesize new proteins; results in increased size and weight of whole or any of its parts Development is gradual change and expansion; advancement from lower to more advanced stage of complexity; increased capacity through growth, maturation, and learning Biologic Growth and Physical Development External proportions Biologic determinants Skeletal growth and maturation Neurologic maturation Lymphoid tissue Organ systems Theoretic Foundations of Personality Development—cont’d Psychosocial development (Erikson) – Trust vs. mistrust (birth to 1 year) – Autonomy vs. shame and doubt (1 to 3 years) – Initiative vs. guilt (3 to 6 years) – Industry vs. inferiority (6 to 12 years) – Identity vs. role confusion (12 to 18 years) Theoretic Foundations of Mental Development Cognitive development (Piaget) – Sensorimotor (birth to 2 years) – Preoperational (2 to 7 years) – Concrete operations (7 to 11 years) – Formal operations (11 to 15 years) Moral Development Moral development (Kohlberg) – Preconventional level – Conventional level – Postconventional, autonomous, or principled level Development of SelfConcept Body image Self-esteem – – – – Competence Sense of control Moral worth Worthiness of love and acceptance Role of Play in Development Classification of play Content of play – – – – – Social-affective play Sense-pleasure play Skill play Unoccupied behavior Dramatic or pretend play – Games Role of Play in Development—cont’d Social character of play – – – – – Onlooker play Solitary play Parallel play Associative play Cooperative play Fig. 33-8. Role of Play in Development—cont’d Functions of play – Sensorimotor development – Intellectual development – Creativity – Self-awareness – Therapeutic value – Moral value Role of Play in Development—cont’d Toys – Toy safety is a joint effort between children and parents – Government agencies do not police and inspect all toys on market – Evaluation of safety is always adult’s responsibility Selected Factors That Influence Development Heredity Neuroendocrine factors Nutrition Interpersonal relationships Socioeconomic level Disease Selected Factors That Influence Development—cont’d Environmental hazards Stress in childhood – Coping Influence of mass media – Reading materials – Movies – Television – Internet and video games Chapter 36 The Infant and Family Promoting Optimal Growth and Development Biologic development Proportional changes – 5- to 7-oz weight gain per week – Double birth weight by age 6 months – Triple birth weight by age 1 year – Height increases by 1 inch per month x 6 months – Growth in “spurts” rather than gradual pattern Maturation of Systems Respiratory Immunologic system Cardiovascular Hematopoietic changes Digestive processes Thermoregulation Renal function Sensory Fine Motor Development Grasping object: ages 2 to 3 months Transfer object between hands: age 7 months Pincer grasp age: 10 months Remove objects from container: 11 months Build tower of two blocks:12 months http://media.atitesting.com/R M/07_NCC/Media_02/RM_NCC _Ch03_Fine_Gross_Mot_Medi a2/index.html Gross Motor Development Head control Rolling over: ages 5 to 6 months Sitting: 7 months Move from prone to sitting position: 10 months Gross Motor Development— cont’d Locomotion – Cephalocaudal direction of development – Crawling age: 6 to 7 months – Creeping age: 9 months – Walk with assistance: 11 months – Walk alone: 12 months Psychosocial Development Erikson Acquiring sense of trust while overcoming sense of distrust – Birth to 1 year – First 3 to 4 months’ food intake is most important social activity – Next modality reaching out through grasping – More active phase that follows includes biting Cognitive Development Piaget Sensorimotor phase – Birth to 1 month: reflex stage – 1 to 4 months: primary circular reactions – 4 to 8 months: secondary circular reactions – Imitation – Play – Affect Development of Body Image Concept of object permanence By end of first year recognize that they are distinct from parents Social Development Attachment Reactive attachment disorder Separation anxiety Stranger fear Language development Play Promoting Optimum Health During Infancy First 6 months of life – Breast milk should be only food Second 6 months Selection and preparation of solid foods Introduction of solid foods Weaning from breast or bottle Dental Health Maternal dental health Cleaning begins when primary teeth erupt Fluoride at 6 months Prevention of dental caries Fig. 36-15. Safety demonstration board. Clockwise from lower left: Two types of cabinet latches, a shock guard for an electrical outlet in use, and two types of outlet covers (the one with the white cover has passive devices that automatically cover the outlet when a plug is removed). Injury Prevention Aspiration of foreign objects Suffocation Motor vehicle injuries Falls Poisoning Burns Drowning Bodily damage The Toddler and Family Promoting Optimal Growth and Development “The terrible twos” Ages 12 to 36 months Intense period of exploration Temper tantrums/obstinacy occur frequently Biologic Development Weight gain slows to 4 to 6 lb/year Birth weight should be quadrupled by 2½ Height increases about 3 inches/year Growth is steplike rather than linear Sensory Changes Visual acuity of 20/40 acceptable Hearing, smell, taste, and touch increase in development Uses all senses to explore environment Maturation of Systems Most physiologic systems relatively mature by the end of toddlerhood Upper respiratory infections, otitis media, and tonsillitis are common among toddlers Voluntary control of elimination – Sphincter control: ages 18 to 24 months Gross and Fine Motor Development Locomotion Improved coordination: between ages 2 and 3 Fine motor development – Improved manual dexterity: ages 12 to 15 months – Throw ball: by 18 months Psychosocial Development Erikson; developing sense of autonomy Autonomy vs. shame and doubt Negativism Ritualization provides sense of comfort Id, ego, superego/conscience Preoperational Phase Begins about age 2 Transition between self-satisfying behavior and socialized relationships Preconceptual phase is a subdivision of the preoperational phase Preoperational thought implies children cannot think in terms of operations Development of Body Image Refer to body parts by name Avoid negative labels about physical appearance Recognize sexual differences by age 2 Development of Gender Identity Exploration of genitalia is common Gender roles understood by toddler Playing “house” Social Development Differentiation of self from mother and significant others Separation Individualization Language Increasing level of comprehension Increasing ability to understand Comprehension is much greater than the number of words a toddler can say At age 1 uses one word sentences By age 2 uses multiword sentences Personal Social Behavior Toddlers develop skills of independence Skills for independence may result in tyrannical, strong-willed, volatile behaviors Skills include feeding, playing, dressing, and undressing self Play Magnifies physical and psychosocial development Interaction with others becomes more important Parallel play Related to emerging linguistic abilities Tactile play Selection of appropriate toys Coping with Concerns Related to Normal Growth and Development Toilet training Sibling rivalry Temper tantrums Negativism Regression Assessing Readiness for Toilet Training Voluntary sphincter control Able to stay dry for 2 hours Fine motor skills to remove clothing Willingness to please parents Curiosity about adult’s or sibling’s toilet habits Impatient with wet or soiled diapers Promoting Optimum Health During Toddlerhood Nutrition – Phenomenon of “physiologic anorexia” – Dietary guidelines Sleep and activity Dental health – Regular dental examinations – Removal of plaque – Fluoride Injury Prevention Motor vehicle injuries: car seat safety Drowning Burns Poisoning Falls Aspiration and suffocation Bodily damage Anticipatory guidance The Preschooler and Family Promoting Optimal Growth and Development The preschool period: ages 3 to 5 years Preparation for most significant lifestyle change—going to school Experience brief and prolonged separation Use language for mental symbolization Increased attention span and memory Biologic Development Physical growth slows and stabilizes Average weight gain remains about 5 lb/year Average height increases 2½ to 3 inches/year Body systems mature and stabilize; can adjust to moderate stress and change Gross and Fine Motor Behavior Gross motor: walking, running, climbing, and jumping well established Refinement in eye-hand and muscle coordination – Drawing, artwork, skillful manipulation Psychosocial Development Erikson; developing sense of initiative – Chief psychosocial task of preschool period – Feelings of guilt, anxiety, and fear may result from thoughts that differ from expected behavior – Development of superego (conscience) – Learning right from wrong/moral development Cognitive Development Readiness for school Readiness for scholastic learning Typically ages 5 to 6 years Cognitive Development—cont’d Piaget; preoperational phase – Spans 2 to 7 years – Divided into two stages – Preconceptual phase: ages 2 to 4 – Intuitive thought phase: ages 4 to 7 – Shifts from egocentric thought to social awareness – Able to consider other viewpoints Cognitive Development—cont’d Language continues to develop Concept of causality beginning to develop Concept of time incompletely understood Use “magical thinking” frequently Moral Development Kohlberg; preconventional or premoral level – Basic level of moral judgment – Punishment and obedience orientation – Naïve instrumental orientation – Very concrete sense of justice and fairness Development of Body Image Increasing comprehension of “desirable” appearances Aware of racial identity, differences in appearances, and biases Poorly defined body boundaries – Fear that if skin is “broken” all blood and “insides” can leak out – Intrusive experiences are frightening Development of Sexuality Form strong attachment to opposite-sex parent while identifying with same-sex parent Modesty becomes a concern Sex role limitation, “dressing up like Mommy or Daddy” Sexual exploration more pronounced Questions arise about sexual reproduction Social Development Separation-individuation process is completed Overcome stranger anxiety and fear of separation from parents Still need parental security and guidance Security from familiar objects Play therapy beneficial for working through fears, anxieties, and fantasies Language Major mode of communication and social interaction Vocabulary increases dramatically between ages 2 and 5 Complexity of language use increases between ages 2 and 5 Personal-Social Behavior Self-dressing Willing to please Have internalized values and standards of family and culture May begin to challenge family’s code of conduct Play Associative play Imitative play Imaginative play— imaginative playmates Dramatic play Coping with Concerns Related to Normal Growth and Development Preschool and kindergarten – Developmental screening tool to assess readiness for school – Importance of infection control in school setting – Introduction of child to school Sex Education Find out what children know and think Be honest Avoid “over-answering” question Sexual exploration/sexual curiosity Fears Dark Being left alone Animals (e.g., snakes, large dogs) Ghosts Sexual matters Objects or people associated with pain Stress Minimum amounts of stress can be beneficial Parental awareness of signs of stress in child’s life Prevention of stress Schedule adequate rest Prepare child for upcoming changes to maximize coping strategies Stress Minimum amounts of stress can be beneficial Parental awareness of signs of stress in child’s life Prevention of stress Schedule adequate rest Prepare child for upcoming changes to maximize coping strategies Aggression Behavior that attempts to hurt person or destroy property May be influenced by biologic, sociocultural, and familiar variables Factors that increase aggressive behavior: gender, frustration, modeling, and reinforcement Promoting Optimal Health During the Preschool Years Nutrition – Caloric requirements approximately 90 kcal/kg – Fluid requirements approximately 100 ml/kg, depending on activity and climate – Food fads, strong tastes common Sleep and Activity 12 hours of sleep per night, infrequent naps Free play encouraged Emphasis on fun and safety Sleep Problems Thorough assessment of sleep problems Nightmares Sleep terrors Encourage consistent bedtime routine Dental Health Eruption of deciduous teeth is complete Professional care and prophylaxis Fluoride supplements Injury Prevention Safety education Pedestrian motor vehicle accidents increase Development of long-term safety behaviors – Bike helmets Anticipatory Guidance— Care of Families Child care focus shifts from protection to education Children begin questioning previous teachings of parents Children begin to prefer companionship of peers
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