NCM 107 Lesson 4-5 Midterm Reviewer PDF

lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT Prof. Lizcir Panelo || 2022-2023 BSN – 2ND YEAR Made by: ShionIsHere NURSING CARE OF A FAMIL...

lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT Prof. Lizcir Panelo || 2022-2023 BSN – 2ND YEAR Made by: ShionIsHere NURSING CARE OF A FAMILY WITH A SCHOOL- Growth and Development of a School-Age Child AGE CHILD Physical Growth Legend: School-age children’s annual average weight gain is Remember Lecturer Book Previous Trans approximately 3 to 5 lb (1.3 to 2.2 kg); the increase in height (Exams) Trans Comm is 1 to 2 in (2.5 to 5 cm).      Children who did not lose the lordosis and knock-kneed appearance of toddlers during the preschool period lose Introduction these now. The term “school age” commonly refers to children between By 10 years of age, brain growth is complete, so fine the ages of 6 and 12. 10 years motor coordination, becomes refined. Train Although these years represent a time of slow physical growth, As the eye globe reaches its final shape about this same cognitive growth and development continue to proceed at time, an adult vision level is achieved. rapid rates. Because of this, there are many differences If the eruption of permanent teeth and growth of jaw do among children from one year to the next. not correlate with final head growth, malocclusion with For example, 7- and 10-y10-year-old children have teeth malalignment may be present (El-Dawlatly, very different needs and outlooks, as do 11- and 12- Fayed & Mostafa, 2012). year-old children. The immunoglobulins IgG and IgA reach adult levels, Because of these big differences, always assess children as and lymphatic tissue continues to grow up until about individuals to understand the particular developmental needs age 9. of each child based on what developmental status has been Because the lymphatic system grows so rapidly, achieved, not on what stage you think the child should have this results in an abundance of tonsillar and reached (Lowe, Godoy, Rhodes, et al., 2013). adenoid tissue in the early school years, which is often mistaken for disease during respiratory Assessment illness as the tonsils seem so enlarged in the Use both history and physical examination to assess the back of the throat. growth and development of a school-age child. The appendix is also lined with lymphatic tissue, so Include questions about school activities and progress. swelling of this tissue in the narrow tube can lead to School-age children are interested and able to contribute to trapped fecal material and inflammation (appendicitis) in their own health history; to allow for this, it is useful to interview the early school-age child. children 10 years or older at least in part without their Frontal sinuses develop at about 6 years, so sinus parents present. headache becomes a possibility (before then, headache During the physical examination, show your respect for in children is rarely caused by a sinus infection). children’s adult-level modesty by furnishing a cover gown. The left ventricle of the heart enlarges to be strong Parents of school-age children often mention behavioral enough to pump blood to the growing body. issues or conflicts during yearly health visits. Innocent heart murmurs may become apparent because of the extra blood crossing heart Some parents feel they are losing contact with their children send - valves. The pulse rate decreases to 70 to 80 during these years. This can cause them to misinterpret a age normal change in behavior, especially if they are not prepared beats per minute; blood pressure rises to about for what to expect from their child. 112/60 112/60 mm Hg. Nursing Diagnosis Sexual Maturation At a set point in brain maturity, the hypothalamus transmits Common nursing diagnoses pertinent to growth and an enzyme to the anterior pituitary gland to begin production development during the school-age period are: of gonadotropic hormones, which activate changes in testes a. Health-seeking behaviors related to normal school-age and ovaries and produce puberty. growth and development Timing of the onset of puberty varies widely, between 10 and b. Readiness for enhanced parenting related to improved 14 years of age (Edmonds, 2012). The length of time it takes family living conditions to pass through puberty until sexual maturity is complete also c. Anxiety related to the slow growth pattern of child varies. d. Risk for injury related to deficient parental knowledge Sexual maturation in girls usually occurs between 12 and 18 about safety precautions for a school-age child years; in boys, between 14 and 20 years. e. Imbalanced nutrition, more than body requirements, related to frequent consumption of snack foods f. Delayed growth and development related to speech, girls-12-18 M-20 motor, psychosocial, or cognitive concerns boys. Page 1 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS 2. If they do not know testicular development precedes penis growth, they can worry that their growth will be inadequate. 3. Boys should also be informed that hypertrophy of breast tissue (gynecomastia) can occur in prepuberty (most often in stocky or obese boys). 4. Some boys also become concerned because, although they have pubic hair, they cannot yet grow a beard or do not have chest hair—outward, easily recognized signs of maturity. o You can assure them that pubic hair normally appears first and that chest and facial hair may not Sexual and Physical Concerns grow until several years later. The changes in physical appearance that come with puberty 5. As seminal fluid is produced, boys begin to notice can lead to concerns for both children and their parents. ejaculation during sleep, termed nocturnal emissions. School age is a time for parents to discuss with children the 6. Preadolescent boys may believe an old myth that loss of physical changes that will occur and the sexual responsibility seminal fluid is debilitating; also, boys may have heard the these changes dictate. term “premature ejaculation” and worry this is a forewarning This is also a time to reinforce previous teaching with children of a problem in years to come. Both are fallacies. that their body is their own, to be used only in the way they choose. Teeth Deciduous teeth are lost and permanent teeth erupt during Concerns of Girls the school-age period. 1. Prepubertal girls are usually taller, by about 2 in (5 cm) or Because of this, the average child gains 28 teeth between 6 more, than preadolescent boys because their typical growth and 12 years of age. spurt begins earlier. o The central and lateral incisors; first, second, and 2. Sometimes a girl notices the change in her pelvic contour third cuspids; and first and second molars when she tries on a skirt or dress from the year before and realizes her hips are becoming broader. o She may misinterpret this finding as a gain in weight and attempt a crash diet. 3. Girls are usually conscious of breast development, and whether they are overdeveloped or underdeveloped. o Also, breast development is not always symmetrical, so it is not unusual for a girl to have breasts of slightly different sizes. 4. Early preparation for menstruation is important for future childbearing and for the girl’s concept of herself as a woman. o In addition to an explanation of the reason for menstrual flow, girls need an explanation of good hygiene and reassurance they can bathe, shower, and swim during their periods. o They can use either sanitary napkins or tampons; if they choose tampons, they must take precautions to avoid toxic shock syndrome. ↳ years o The average age at which menarche (the first menstrual period) occurs is 12-years. o Most girls have some menstrual irregularity during the first year or two after menarche. o This occurs primarily because a girl’s cycles are anovulatory at first. With maturity and the onset of ovulation, cycles become more regular. 5. Girls also need to know that vaginal secretions will begin to be present. If this is not explained, a girl may fear needlessly Developmental Milestones that she has contracted an infection. Explain that any Gross Motor Development secretions that cause vulvar irritation should be evaluated at a health care facility, because this does suggest infection. At the beginning of the school-age period (age 6), children nopI endlessly jump, tumble, skip, and hop. ↓ Concerns of Boys They have enough coordination to walk a straight line. Many can ride a bicycle. They can skip rope with practice. 1. Just as girls are keenly aware of breast development, boys are aware of increasing genital size. Page 2 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 pati CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS A 7-year-old appears quiet compared with a rough-and- By 7 years of age, children require more props for play than tumble 6-year-old. when they were younger, which indicates the start of a decline o Gender differences usually begin to manifest in play: in imaginative play. morts bor there are “girl games,” such as dressing dolls, and “boy games,” such as pretending to be pirates. & o This may continue unless a child receives adequate encouragement to use imagination. The movements of 8-year-olds are more graceful than those By age 8, collections may become increasingly structured as of younger children, although as their arms and legs grow, children develop skills for sorting and cataloging. they may stumble on furniture or spill milk and food. o Competitive behaviors can develop and cause sports o They ride a bicycle well and enjoy sports such as children to change the rules in the middle of a game Headline gymnastics, soccer, and hockey. to keep from losing. Nine-year-olds are on the go constantly, as if they always At about 10 years of age, children become very interested in have a deadline to meet. They have enough eye–hand rules and fairness in competitive play situations. coordination to enjoy baseball, basketball, and volleyball. o Music and artistic expression also become athletic By 10 years of age, they are more interested in perfecting their athletic skills than they were previously. important during this time. During preteen years, listening to music and learning popular skills At age 11, many children feel awkward because of their dances take the place of earlier simple games. growth spurt and drop out of sports activities rather than look o Both boys and girls seem to feel they are on the verge ungainly in their attempts. of something great and anxiously wait to turn 13 and o They may channel their energy into constant motion be a teenager. instead: constantly drumming fingers and tapping pencils or feet. Language Development Twelve-year-olds plunge into activities with intensity and Six-year-olds talk in full sentences, using language easily concentration. They often enjoy participating in sports and with meaning. They no longer sound as though talking is events for charities such as walk-a-thons. an experiment but appear to have incorporated language o They may be refreshingly cooperative around the permanently. house, able to handle a great deal of responsibility, Most 7-year-olds can tell the time in hours, but they may and complete given task. have trouble with concepts such as “half past” and “quarter to,” especially with the prevalence of digital clocks and watches. Fine Motor Development As children discover “dirty” jokes at about age 9, they like 6-year-olds can easily tie their shoelaces. They can cut and to tell them to friends or try to understand those told by adults. paste well and draw a person with good detail. o They use swear words to express anger or just to They can print, although they may routinely reverse letters. show other children they are growing up. 7-year-olds concentrate on fine motor skills even more than they did the year before. This has been called the “eraser year” Emotional Development because children are never quite content with what they have Ideally, children enter the school-age period with the ability to done. trust others and with a sense of respect for their own By 8 years of age, children’s eyes are developed enough so worth. They can accomplish small tasks independently read they can read regular-size type. o This can make reading a greater pleasure and school because they have gained a sense of autonomy. They should have practiced or mimicked adult roles and had more enjoyable. They are able to write script in the opportunity to explore at preschool or other social addition to print. mature environments. By age 9, their writing begins to look mature and less awkward. Developmental Task: Industry Versus Inferiority Older school-age children begin to evaluate their teachers’ During the early school years, children attempt to master yet ability and may perform at varying levels, depending on each another developmental step: learning a sense of industry or teacher’s expectations. accomplishment (Erikson, 1993). o This may be a child’s first exposure to reading as a If gaining a sense of initiative can be defined as learning fulfilling and worthwhile experience rather than just how to do things, then gaining a sense of industry is as an assignment and may be the time a child is learning how to do things well. “turned on” to reading. If children are prevented from achieving a sense of industry or do not receive rewards for accomplishment, they can develop Play a feeling of inferiority or become convinced they cannot do Play continues to be rough at age 6. things they actually can do. However, when children discover reading as an enjoyable The best type of book for school-age children has many short activity that opens doors to other worlds, they can begin to chapters; children feel a sense of accomplishment when they spend quiet time with books. finish each chapter, rather than having to wait until the end of o Many children spend hours playing increasingly the book. challenging video games, an activity that can either o Small chores that can be completed quickly also give foster a healthy sense of competition or create this type of reward. isolation from others. Page 3 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS Hobbies and projects also are enjoyed best if they are small c. Conservation, the ability to appreciate that a change in and can be finished within a short time. shape does not necessarily mean a change in size. o Most school-age children, for example, prefer putting o If you pour 30 mL of cough medicine from a thin glass together two or three fairly simple model-car kits to into a wide one, the preschooler will say that one assembling one extremely complicated kit. glass holds more than the other; a school-age child will say both glasses hold an equal amount. Socialization d. Class inclusion, the ability to understand that objects Six-year-old children play in groups, but when they are tired can belong to more than one classification. or under added stress, they prefer one-to-one contact. o A preschooler can categorize items in only one way, o In a first-grade classroom, students compete actively for example, such as stones and shells are found at for a few minutes of special time with their teacher. the beach; a school-age child can categorize them in o At the end of a day, they enjoy time spent individually many ways such as stones and shells are both found with parents. You may have to remind parents this is at the beach but are made of different materials, are not babyish behavior but that of a typical 6-year-old. different in sizes, etc. Seven-year-olds are increasingly aware of family roles and responsibility. Promises must be kept, because 7-year-olds Moral and Spiritual Development view them as definite, firm commitments. These children tattle School-age children begin to mature in terms of moral because they have a strong sense of justice (Loke, Heyman, development as they enter a stage of preconventional & Forgie, 2011). This tattling may dissolve play groups quickly. reasoning, sometimes as early as 5 years of age (Kohlberg, Eight-year-olds actively seek the company of other children. 1984). Most 8-year-old girls have a close girlfriend; boys have a close o During this stage, if asked, “Why is it wrong to steal boyfriend. from your neighbor?” school-age children will Nine-year-olds take the values of their peer group very answer, “The police say it’s wrong,” or “Because if seriously. They are much more interested in how other you do, you’ll go to jail.” children dress than in what their parents want them to wear. They concentrate on “niceness” or “fairness” and cannot see Although 10-year-olds enjoy groups, they also enjoy yet that stealing hurts their neighbor, the highest level of moral privacy. They like having their own bedroom or at least their reasoning. own dresser, where they can store a collection and know it is Because they are still limited in their ability to understand free from parents’ or siblings’ eyes. other’s views, they may interpret something as being right Girls become increasingly interested in boys and vice because it is good for them, not because it is right for humanity versa by 11 years of age. Favorite activities are mixed-sex as well. rather than single-sex ones. Children of this age are Remember that school-age children are rule-oriented; particularly insecure, however, and girls tend to dance with when they ask for something, because they were good, they girls while boys talk together in corners. expect to receive what they are asking. Twelve-year-olds feel more comfortable in social situations than they did the year before. Boys experience Promoting School-Age Safety erections on small provocation so may feel uncomfortable School-age children are ready for time on their own without being pushed into boy–girl situations until they know how to direct adult supervision. This means they need good education control their bodies better. on safety practices. School age is not too early for parents to look at the effect of Cognitive Development carrying heavy backpacks on children posture. The period from 5 to 7 years of age is a transitional stage o A backpack is that weighs more than 10% of the where children undergo a shift from the preoperational thought child’s body weight is enough to cause a child to they used as preschoolers to concrete operational thought or have to lean forward chronically to bear the weight. the ability to reason through any problem they can actually o This can lead to chronic back pain (Kistner, visualize (Piaget, 1969). Fiebert, & Roach, 2012). Children can use concrete operational thought because they Sexual maltreatment is an unfortunate, and all-too-common learn several new concepts, such as: hazard for children. a. Decentering, the ability to project oneself into other people’s situations and see the world from their viewpoint Establishing Healthy Patterns rather than focusing only on their own view. School-age children need breakfast to provide enough energy b. Accommodation, the ability to adapt thought processes to get them through active mornings at school. to fit what is perceived such as understanding that there They eat best if parents get up in the morning and eat some can be more than one reason for other people’s actions. themselves. Children react badly to the instruction, “Do as o A preschooler might expect to see the same nurse I say, not as I do.” in the morning who was there the evening before; a Ideally, children should receive guidance from school school-age child can understand that different nurses personnel, but this often is impossible in a busy lunchroom. work different shifts. Healthcare personnel, therefore, should play an active role in nutrition education at health maintenance visits. Page 4 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS Many children qualify for a free or reduced-price school lunch active exercise. Exercise need not involve organized sports. It and breakfast (Hirschman & Chiqui,2012) can come from neighborhood games, walking with parents or o A government regulated school lunch (type A) a dog, or bicycle riding. provides milk (8 oz), protein (2 oz), one starch serving, vegetable (3 ⁄4 cup), and fruit (3 ⁄4 cup). 4. Hygiene Serving sizes vary according to age to provide one third of a Children of 6 or 7 years of age still need help in regulating child’s nutrition requirements for a day. bath water temperature and in cleaning their ears and o Check that children are actually eating school fingernails. lunches, not trading items they do not want, so they By age 8, children are generally capable of bathing receive the full benefit of the program. themselves but may not do it well because they are too busy Alert the children with allergies such things as eggs or to take the time or because they do not find bathing as peanuts that they need to ask how food is prepared (Robinson important as their parents. & Ficca, 2012). o Both boys and girls become interested in showering as they approach their teens. This can be Recommended Dietary Intakes encouraged as perspiration increases with puberty, Although parents may have less to say about what a along with sebaceous gland activity. school-age child eats, it is important that the increasing When girls begin to menstruate, they may be afraid to take energy requirements that come with this age (often in baths or wash their hair during their period if they have heard spurts) are met daily with foods of high nutritional value. this is not safe. Because school-age children typically dislike vegetables, o They need information on the importance and safety their intake may be deficient in fiber. of good hygiene during their menses. Both girls and boys require more iron in prepuberty Boys who are uncircumcised may develop inflammation than they did between the ages of 7 and 10. under the foreskin from increased secretions if they do not Adequate calcium and fluoride intake remain important wash regularly (Meng & Tanagho, 2013). to ensure good teeth and bone growth. 5. Care of Teeth Promoting Development of a School-Age With proper dental care, the average child today can expect to Child in Daily Activities grow up cavity free. To ensure this happening, school-age 1. Dress children should visit a dentist at least twice yearly for a checkup, cleaning, and possibly a fluoride treatment to Although school-age children can fully dress themselves, they strengthen and harden the tooth enamel (Tubert-Jeannin, are not good at taking care of their clothes until later in the school-age years. Auclair, Amsalem, et al., 2011). o This is the right age, however (if not started already), Some children develop a fear of dentists and, if a dentist visit to teach children the importance of caring for their is painful, want to avoid going at all. The advantage of frequent visits is that if cavities are filled when they are small, the drilling own belongings. required is minimal and little pain is involved. School-age children have definite opinions about clothing School-age children have to be reminded to brush their teeth styles, often based on the likes of their friends or a popular sports or rock star rather than the preferences of their parents. daily. If brushing becomes an area of conflict for the family, Help parents be aware that a child who wears different clothing brushing well once a day may be more effective than brushing more often but doing an inadequate job. than others may become the object of exclusion from a school o For effective brushing, a child should use a soft club or group. toothbrush, fluoride-based toothpaste, and dental floss to clean between teeth to help remove plaque. 2. Sleep Sleep needs vary among individual children. Younger school-age children typically require 10 to 12 Common Health Problems of the School-Age Period hours of sleep each night, and older ones require about 8 to 1. Dental Caries 10 hours. Caries (cavities) are progressive, destructive lesions or Most 6- year-olds are too old for naps but do require quiet decalcifications of the tooth enamel and dentin. time after school to get them through the remainder of the day. When the pH of the tooth surface drops to 5.6 or below Nighttime terrors may continue during the early school years (which happens after children eat readily fermented and may actually increase during the first-grade year as a child carbohydrates, such as table sugar), acid microorganisms reacts to the stress of beginning school. (acidogenic lactobacilli and aciduric streptococci) found in dental plaque attack the organic cementing medium of teeth 3. Exercise and destroy it. School-age children need daily exercise. Although they go As stated earlier, dental caries are largely preventable with to school all day, they do not automatically receive much proper brushing and use of fluoridated water or fluoride exercise because school is basically a sit-down activity. application. Children who are bussed or driven by a parent to school may therefore return home without having spent much time in Page 5 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS When caries do occur, it is important they be treated quickly Children who resist attending school this way may develop and the child’s dental hygiene practices be evaluated and physical signs of illness, such as vomiting, diarrhea, improved if necessary. headache, or abdominal pain on school days. o This lasts until after the school bus has left or the 2. Malocclusion child is given permission to stay home for the day. The upper jaw in children matures rapidly in early childhood A particular child may be reacting to a situation such as a along with skull growth; the lower jaw forms more slowly, harsh teacher, having to shower in gym class, or facing a class forcing teeth to make a prolonged series of changes until they bully every day. In these instances, the child’s fear may be well reach their final adult alignment and position. grounded. Counseling may help the child manage the Good tooth occlusion, in which the upper teeth overlap the situation better. lower teeth by a small amount and teeth are evenly spaced School refusal may occur from fear of separation from and in good alignment, is necessary for the optimal formation parents. of teeth, the health of the supporting tissue, optimal speech o The child may be overly dependent on the parents or development, and what most people view as a pleasant may be reluctant to leave home because of worry that physical appearance. younger siblings will usurp the parents’ affection. Malocclusion (a deviation from the normal) may be The anxiety of separation may also result because the congenital and related to conditions such as cleft palate, a parent is overprotective of the child or is the one having the small lower jaw, or familial traits tending toward malocclusion. most difficulty separating. Common Fears and Anxieties of a School-Age Child 3. Homeschooling Because of religious or personal preference or because of 1. Anxiety Related to Beginning School disillusionment with the school system, a growing number of children are homeschooled today (Anthony & Burroughs, Adjusting to grade school is a big task for 6-year-olds. Even if 2010). they attended preschool, grade school is different: the rules Because their main contact has been with well-educated are firmer, and the elective feeling (“If I don’t like it, I can quit”) parents at home, the vocabulary of homeschooled children is gone. may be advanced or may suggest they are older than their o School is for keeps until age 16 or longer, a time actual age. span too long for a young child to even imagine. Ask if they receive exposure to other cultures or families so Whereas preschool learning was carried out through fun they can better adjust to people different from themselves at activities, part of every day in grade school involves obvious college or a first work position. work. Because school is an adjustment, a health assessment of all 4. Children Who Spend Time Independently school-age children should include an inquiry about progress in school. Children whose parents both work outside the home may You can obtain information by asking a parent, “How is Susan spend time alone without adult supervision for a part of each doing in school?” followed by a second question, “How does day. her teacher say she is doing?” If there is a discrepancy A major concern of children staying alone is that they will between the answers, the situation bears study. develop an increased tendency toward accidents, o The answer to the first question reveals the parent’s delinquent behavior, alcohol or beginning drug abuse, or attitude toward the child’s progress. decreased school performance from lack of adult o The answer to the second may indicate a child who supervision. is having trouble adjusting to a structured school For children who feel safe in their community, however, a short environment. period of independence every day may actually be beneficial; Some parents have to alter their expectations of how much it encourages problem-solving in self-care. their child should be achieving to conform to their child’s actual ability. This can be difficult. 5. Sex Education o One of the biggest tasks of the first year of school is It is important that school-age children be educated about learning to read. pubertal changes and responsible sexual practices so they are It is best if parents have prepared children for this by reading well prepared for these. to them since infancy, pointing to the words and pictures as Also, preteens should have adults to whom they can turn for they go along. This helps children realize sentences flow from answers to questions about sex. Ideally, these should be their left to right and the words, not the pictures, tell the story. parents, but because sex is an emotionally charged topic, some parents may be extremely uncomfortable discussing it 2. School Refusal or Phobia with their children. As a result, healthcare personnel often School refusal is fear of attending school. It is a type of “social become resource persons. phobia” similar to agoraphobia (fear of going outside the Sex education should be incorporated into health education home) or separation anxiety disorder (SAD). throughout the school years in a manner that is appropriate to age and development. Page 6 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS Topics to teach and discuss in a sex education course for both d. Parents who typically resort to physical punishment preadolescent boys and girls include: e. There is the presence of a child who is a natural victim a. Reproductive organ function (e.g., small, insecure, with low self-esteem) b. Secondary sexual characteristics, so children will know what is going on in their bodies Suggestions for school personnel to deal with bullies are: c. Physiology of reproduction, so they understand what a. Supervise recreation periods closely. menstruation is and why it occurs b. Intervene immediately to stop bullying. d. Male sexual functioning, including why the production of c. Insist that if such behavior does not stop, both school and increased amounts of seminal fluid leads to nocturnal parents will become involved. emissions d. Therapy may be needed to correct bullying behavior if it e. The physiology of pregnancy and the possibility of is ingrained. unintended pregnancies, which will come with sexual e. Advise parents to discuss bullying with their school-age maturity. child and help them understand that it should be reported f. Responsibilities of sexual maturity to allow adults to intervene. g. Reproductive life planning measures and the principles of safer sex if appropriate to the cultural setting. 8. Violence or Terrorism Children basically view their world as safe, so it is a shock 6. Stealing when violence such as a school shooting or reports of During early school age, most children go through a period terrorists enter their lives (Dowdell, 2012). during which they steal loose change from their mother’s purse or father’s dresser. Common recommendations for parents to help children feel This usually happens at around 7 years of age, when children safe are: first learn how to make a change and also discover the a. Assure children they are safe; even if the violence is in importance of money. their community, their parents are actively involved in Occurs because, although a child is gaining an appreciation being certain they are not in danger for money, this appreciation is not yet balanced by strong b. Observe for signs of stress such as sleep disturbance, moral principles. fatigue, lack of pleasure in activities, or signs of beginning substance abuse. Parents should explore the reason for the stealing: c. Do not allow children or adolescents to view footage of a. Do other children on the block receive an allowance and traumatic events over and over, because this decreases so have money for small items? their ability to be safe. b. Did their child make a bet that must be paid? d. Watch news programs with children so it can be explained c. Is a child buying a bully’s friendship by purchasing gum or that the situation portrayed is not near them and that their candy for that child? child is safe. d. Does a child need more security and view money as e. Explain there are bad people in the world, and bad people security? do bad things but help children appreciate not all people in a particular group or who look a particular way are bad. As a rule, early childhood stealing is best handled without Lashing out at people who resemble them only causes a great deal of emotion. A parent should tell the child the more harm. money is missing. The importance of property rights should be f. Prepare a family disaster plan, including such things as reviewed: mother’s and father’s money is theirs; the child’s bottled water, blankets, toiletries, pet supplies, money is the child’s; they are not interchangeable. appropriate clothing, flashlights, and information such as Youngsters who continue to steal past 9 years of age may what immunizations their children have had (particularly require counseling because they should have progressed tetanus) and, if a child is ill, a history of medical needs or beyond this normal developmental step by this age. care so that in an emergency, these items are ready. 7. Bullying A frequent reason school-age children cite for feeling so Nursing Care of a Family With An Adolescent unhappy that they turn guns on classmates is that they were Introduction ridiculed or bullied to the point they could no longer take such abuse (Cooper, Clements,& Holt, 2012). Adolescence is generally defined as the period between 13 Alert parents that Internet or texting bullying are both also and 18 or 20 years, a time that serves as a transition between possible and that a bully doesn’t have to be in face-to-face childhood and young adulthood. contact with their child to be harmful. It can be divided into an early period (13 to 14 years), a middle period (15 to 16 years), and a late period (17 to 20 Traits commonly associated with school-age bullies are: years). a. Advanced physical size and strength for their age During all periods, adolescence is defined not so much by b. Aggressive temperament (both male and female) chronologic age as by physiologic, psychological, and c. Parents who are indifferent to the problem or are sociologic changes. permissive with a child Page 7 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS The drastic change in physical appearance and the change in expectations of others (especially parents) that occur during Teeth the period can lead to both emotional and physical health Adolescents gain their second molars at about 13 years of age problems. and their third molars (wisdom teeth) between 18 and 21 years of age Assessment Third molars may erupt as early as 14 to 15 years of age. Parents rarely bring adolescents for routine health The jaw reaches adult size only toward the end of maintenance visits the way they did when their children were adolescence, however. younger, and adolescents generally do not come to health As a result, adolescents whose third molars erupt before the care facilities on their own unless they are ill. lengthening of the jaw is complete may experience pain and Unless adolescents need a physical examination for athletic may need these molars extracted because they do not fit their clearance, therefore, they are often not seen for health jawline (Marciani, 2012) assessments. o When adolescents are accompanied by their parents Puberty at health visits, it is best to obtain a health history Puberty is the time at which an individual first becomes separately from parents to promote independence capable of sexual reproduction. A girl has entered puberty and responsibility for self-care. when she begins to menstruate; a boy enters puberty when he When performing physical examinations on adolescents, be begins to produce spermatozoa. These events usually occur aware they may be very self-conscious. between ages 11 and 14 years. o They also need health assurance and appreciate The age of first menstruation in girls is gradually decreasing comments such as “Your hair has a nice, healthy feel,” or from a mean of 13 years to 12.4 years, probably related to “This is an accessory nipple. more weight gain in girls (Ledger, 2012; McDowell, Brody, & o Have you ever wondered about it?” so they can learn Hughes, 2007). more about their rapidly changing bodies. Puberty creates many questions for early teenagers about what is normal and what is not (Marvan & Molina-Abolnik, 2012). Nursing Diagnosis Health-seeking behaviors related to normal growth and Secondary Sex Change development: Secondary sex characteristics such as body hair configuration a. Low self-esteem related to facial acne and breast growth are those characteristics which distinguish b. Anxiety related to concerns about normal growth and the sexes from each other but play no direct part in development reproduction. The secondary sex characteristics that began in c. Risk for injury related to peer pressure to use alcohol and the late school-age period continue to develop during drugs adolescence. d. Readiness for enhanced parenting related to increased Sexual maturity in males Sexual maturity in males and females knowledge of teenage years is classified according to Tanner stages, named after the original researcher on sexual maturity (Tanner, 1962). Growth and Development of an Adolescent Physical Growth The major milestones of development in the adolescent period are the onset of puberty at 9 to 12 years of age, and the cessation of body growth at 16 to 20 years (Sass, & Kaplan, 2013) Between these milestones, physiologic growth and development of adult coordination occur. At first, the gain in physical growth is mostly in weight, leading to the stocky, slightly obese appearance of prepubescence; later comes the thin, gangly appearance of late adolescence. Most girls are 1 to 2 in (2.4 to 5 cm) taller than boys coming into adolescence but generally stop growing within 3 years from menarche and so are shorter than boys by the end of Developmental Milestones adolescence. Play or Recreation Boys typically grow about 4 to 12 in ( 10 to 30 cm) in height Thirteen-year-old children change from school-age activities and gain about 15 to 65 lb (7 to 30 kg) during their teenage of active games to more adult forms of recreation such as years. listening to music, chatting on computers, or following a sports Girls grow 2 to 8 in. (5 to 20 cm)in height and gain 15 to 55 lb team’s wins and losses. (7 to 25 kg). Team (or school) loyalty is intense, and following a coach’s Growth stops with closure of the epiphyseal lines of the long instructions becomes mandatory. This attitude is similar to the bones, which occurs at about 16 or 17 years of age in females loyalty 6-year-old children show toward their first-grade and about 18 to 20 years of age in males. teacher. Page 8 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS Most adolescents spend a great deal of time just talking with c. Changes in social relationships (including relationships peers as social interaction, either face-to-face or through with both family and friends) electronic media. d. Changes in family and school expectations Beginning at age 16, most adolescents want part-time jobs to earn money. Such jobs can teach young people how to work Help parents understand how important it is for adolescents to with others, accept responsibility, and spend money wisely. have immediate success such as making the high school Many adolescents engage in charitable endeavors during the basketball team or having a date for the senior prom. middle to late adolescence as a form of recreation. Parental comments, such as “When you’re older, these things o They do well organizing and supervising swimming won’t be so important,” are not likely to erase the hurt that or gym programs for physically challenged children comes from being 16 years old and not being included in such or participating in marathons. major events. These activities fulfill an adolescent’s need for satisfying o Compassionate understanding (“It’s hard to be left interaction with others as well as indicators of maturity and out”) is a better communication technique. willingness to accept adult roles. Value System Emotional Development Adolescents develop values through talking to peers. Developmental Task: Identity Versus Role Confusion They also need an attentive adult ear, someone who will listen According to Erikson (1993), the developmental task in early to their fears, hopes, dreams, and the pressure they feel to be and mid-adolescence is to form a sense of identity or decide somebody, the pressure of wanting to do something and yet who they are and what kind of person they will be. not knowing what or how to do it. In late adolescence, it is to form a sense of intimacy versus isolation. Career Decisions Part of the feeling of knowing what kind of person you are is The four main areas in which they must make gains to achieve a knowing what kind of occupation will be a fit. Because of the sense of identity include: thousands of opportunities available today, making a career a. Accepting their changed body image decision becomes more and more difficult. b. Establishing a value system or what kind of person they Many adolescents are encouraged to wait until they have been want to be. in college for 2 years before choosing a major. c. Making a career decision o This delay may be an advantage because of the wide d. Becoming emancipated from their parents range of available options. It delays settling on a concrete goal until about 20 years of If young people do not achieve a sense of identity, they age, however, and therefore puts off a choice that strengthens develop a sense of role confusion or can have little idea what an adolescent’s sense of identity. kind of person they are (Erikson, 1993). o This can lead to their having difficulty functioning Emancipation from Parents effectively as adults, because they are unable, for Emancipation from parents can become a major issue during example, to decide what stand to take on a particular the middle and late adolescent years for two reasons. issue or how to approach new challenges or situations. o Some parents may not yet be ready for their child to be totally independent, and some adolescents may Body Image not yet be sure they want to be on their own. Adolescents who developed a strong sense of industry during Encourage parents to give adolescents more freedom such as their school-age years have learned to solve problems and are allowing them to buy their own clothes, use their own judgment best equipped to adjust to the new body image that comes about allotting time for studying, choose their friends, join with adolescence. clubs, or choose afterschool activities. Nurses can do much to educate adolescents about their At the same time, help parents continue to place some bodies and help them to accept the changes that mark restrictions on adolescent behavior (“You must drive the car maturity. safely or you can’t use it,” “You must continue to take Some adolescents, for example, are disappointed with their responsibility for household chores,” “We must know where final height; they had hoped to be 6 ft tall and are only 5 ft 6 in you go after school”). tall. In other instances, they have seen themselves as “ugly ducklings” and dreamed they would emerge as beautiful Late Adolescent Developmental Task: Intimacy Versus swans. Isolation Developing a sense of intimacy means a young adult is able Self-Esteem to form long-term, meaningful relationships with persons of the Like body image, self-esteem may undergo major changes opposite sex as well as their same-sex (Erickson, 1993). during the adolescent years and can be challenged by all the Those who do not develop a sense of intimacy are left feeling changes that occur during adolescence, including: isolated; in a crisis situation they have no one whom they feel a. Changes in one’s body and physiologic functioning they can turn to for help or support. b. Changes in feelings and emotional focus Page 9 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS A sense of intimacy is closely related to the sense of trust envisioning a department store or a large corporation as learned in the first year of life because without the feeling that capable of suffering economic loss from stealing, a concept one can trust others, building a sense of intimacy is difficult. that can contribute to the frequent practice of petty shoplifting at this age. Socialization Almost all adolescents question the existence of God and any Early teenagers may feel more self-doubt than self- religious practices they have been taught (Kohlberg, 1984). confidence. They want to look grown up, but they still look like o This questioning is a natural part of forming a sense children. of identity and establishing a value system at a time The voices of most boys have not yet dependably deepened; in life when they draw away from their families. this makes them unable to trust their voices to carry the serious tone they wish to convey. Promoting Adolescent Safety Most girls’ bodies have not yet fully developed; they may look Unintentional injuries, most commonly those involving motor at themselves in a mirror and compare their profiles with those vehicles, are the leading cause of death among adolescents. of models in popular magazines and feel inadequate. o Although teenagers are at the peak of physical and o Both male and female early adolescents tend to be sensorimotor functioning, their need to rebel against loud and boisterous, particularly when peers of the authority or to gain attention leads them to take opposite sex whose attention they would like to foolish chances while driving, such as speeding or attract are nearby. driving while intoxicated. o They are impulsive and very much like 2-year-old Drowning is another chief accident of adolescence, even children in that they want what they want though it is largely preventable. immediately, not when it is convenient for others. o Teaching all children to swim is not the only Many 13-year-olds begin to experience “crushes”, or preventive measure, because some drownings occur infatuations with schoolmates. when good swimmers go beyond their capabilities on o At this age, however, they may spend more time dares or in hopes of impressing friends. longing for someone than they do instituting an in- Other common causes of death in adolescents are depth and rewarding relationship. homicide and suicide, related to the easy accessibility of guns Adolescents watch adults carefully during this period, to teenagers. Gang violence and the desire to protect searching for good role models with whom they can identify. themselves from this can add to this problem. o They usually have a hero—a film star, writer, o Accidental gunshot injuries increase in early scientist, doctor, or athlete—whom they want to grow adolescence, often for the same reason that up to be like. drowning increases: youngsters want to impress Fourteen-year-olds often form a friendship with an older friends. Some teenagers play gunshots in Russian adolescent of the same sex, trying to imitate that person in roulette to prove to friends they are courageous. everything from thoughts to clothing. If the older adolescent has dropped out of school or plays a Promoting Nutritional Health for an Adolescent particular sport, the younger person may express a wish to Adolescents are experiencing so much growth they may drop out or train for that sport, too. Idolization of fam. always feel hungry. If adolescents’ eating habits are unsupervised, they tend to eat faddish or quick snack foods Cognitive Development rather than more nutritionally sound ones. The final stage of cognitive development, the stage of formal Some adolescents turn away from the basic My Plate food operational thought, begins at age 12 or 13 years and grows groups to eat sweets, soft drinks, or empty-calorie snacks and in depth over the adolescent years (Piaget, 1969). so are left poorly nourished. This step involves the ability to think in abstract terms and o This type of eating pattern, combined with a lack of use the scientific method to arrive at conclusions. exercise, also leads to obesity. (Wengle, Hamilton, The problems that adolescents are asked to solve in school Manlhiot, et al., 2012). depend on this type of thought such as a boy rowing upstream at 5 miles per hour against a current of 2 miles per hour will go Recommended Dietary Reference Intake how far in 1 hour? An adolescent needs an increased number of calories to o Problem-solving in any situation depends on the support the rapid body growth that occurs. ability to think abstractly and logically. Males grow more than females during this period. One of the most important things adolescents can learn is that just Moral and Spiritual Development filling their stomachs will not provide adequate nutrition. Because adolescents enlarge their thought processes to o Foods that supply the necessary carbohydrates, include formal reasoning, they are able to respond to the vitamins, protein, and minerals are essential. question, “Why is it wrong to steal from your neighbor’s Increased calcium plus physical exercise is necessary for house?” with “It would hurt my neighbor by requiring him to rapid skeletal growth as well as to “stockpile” calcium to spend money to replace what I stole,” rather than with the prevent osteoporosis later in life (Chouinard, Randall immature response of the school-age child, “The police will Simpson, & Buchholz, 2012). punish me.” Some adolescents, however, may have difficulty Page 10 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS Zinc is necessary for sexual maturation and final body growth. Common Health Problems of an Adolescent Good sources of iron are meat and green vegetables. 1. Hypertension Calcium is abundant in milk and milk products; meat and milk It is present if blood pressure is above the 95th percentile, or are also high in zinc. 127/81 mm Hg for 16-year-old girls and 131/81 for 16-year- old boys for two consecutive readings in different settings. Promoting Development of an Adolescent in Daily Activities Adolescents who are obese, who eat a high in salt, or who 1. Dress and Hygiene have a family history of hypertension are most susceptible to Adolescents are capable of total self-care and, because of developing the condition. their body awareness, may even be overly conscientious This is particularly important for adolescents because new about personal hygiene and appearance. medication plus education can help to greatly reduce the They often wash their hair every day but then grow dissatisfied incidence of cardiovascular disease as they reach adulthood because their hair has lost so much natural oil it is dull and (Blake & Davis, 2011). stringy. o Both sexes try many types of shampoo, deodorant, 2. Poor Posture breath fresheners, and toothpaste. Many adolescents demonstrate poor posture, a tendency to They may take seriously (without admitting it) the content of round shoulders, and a shambling, slouchy walk. ads showing toothpaste or deodorants can help win an o This is due in part to the imbalance of growth that attractive person or gain instant success. arises from the skeletal system growing a little more Remember this when caring for hospitalized adolescents. rapidly than the muscles attached to it. Providing time for self-care, such as shampooing hair, is Poor posture particularly seems to develop in adolescents who important to include in an adolescent’s nursing care plan. reach adult height before their peers. They slouch to appear no taller than anyone around them. 2. Care of Teeth Girls, especially, may slouch so as not to appear taller than Adolescents are generally very conscientious about boys in the belief that boys only like girls shorter than toothbrushing because of a fear of developing bad breath. themselves. They should continue to use a fluoride paste rather than a o Girls may also slouch to diminish the appearance brand advertised as providing white teeth. They should of their breast size if they are developing more continue to drink fluoridated water to ensure firm enamel rapidly than their friends. growth (Armfield, 2010). They tend to snack a great deal, so their teeth are always 3. Body Piercing and Tattoos exposed to bacterial erosion, and so some may develop These are a strong mark of adolescence (Armstrong, 2007). cavities for the first time during this period. o Both sexes have ears, lips, chins, navels, and Teens with braces must be extremely conscientious about breasts pierced and filled with studs, or tattoos toothbrushing to prevent plaque buildup on hidden tooth applied to arms, legs, or their central body. surfaces. These acts have become a way for adolescents to make a statement that they are different from their parents. 3. Sleep Be certain they know the symptoms of infection at a piercing Although it is widely believed that everyone needs 8 hours of or tattoo site (redness, warmness, drainage, swelling, mild sleep a night, some need more and others can adjust to pain) and to report these to a health care provider if they occur considerably less. as serious staphylococcal or streptococcal infections can Because protein synthesis occurs most readily during sleep occur at piercing sites. and adolescents are building so many new cells, adolescents Caution adolescents that sharing needles for piercing or may need proportionately more sleep than any other age tattooing carries the same risk as sharing needles for group. intravenous drug use. o In addition, because this is a stress period similar to first grade, adolescents may sleep restlessly as their 4. Fatigue mind reworks the day’s tensions; even long periods So many adolescents comment they feel fatigued to some of sleep, therefore, may not leave them feeling degree that this can be considered normal for the age group. refreshed o Because fatigue may be a beginning symptom of disease, however, it is important it be investigated as 4. Exercise a legitimate concern and not underestimated. Just as with younger children, adolescents need exercise Assess an adolescent’s diet, sleep patterns, and activity every day both to maintain muscle tone and to provide an schedules, because all can contribute greatly to fatigue. Note outlet for tension. when the fatigue began. Unlike younger children, although they are constantly on the A short period of extreme tiredness is more likely to suggest go, adolescents often receive little real exercise. They ride a disease than a long, ill-defined report of always feeling tired. bus to school, sit for classes, sit at a mall after school and talk to friends. They have put in a full day, yet most of their time was spent sitting. Page 11 of 14 Downloaded by Jj Bear ([email protected])  lOMoARcPSD|48000704 CARE OF MOTHER, CHILD, AND ADOLESCENT LEC– MIDTERMS 5. Menstrual Irregularities Because of this, as part of routine health assessment of Menstrual irregularities can be a major health concern of adolescents and preadolescents, ask if they are sexually adolescent girls as they learn to adjust to their individual body active or are concerned about sexual risk behaviors. cycles. Adolescents are usually interested in discussing sexuality concerns with a health care provider because they are 6. Acne concerned they are exposing themselves to HIV infection or It is a self-limiting inflammatory disease that involves the other sexually transmitted diseases and to pregnancy. sebaceous glands that empty into hair shafts (the For adolescents who want to have intercourse, the primary pilosebaceous unit). reasons given are sexual curiosity (50% of boys; 24% of It is the most common skin disorder of adolescence, girls) and affection for their partner (25% of boys; 48% of girls). occurring in as many as 80% to 95% of adolescents (Morelli o For adolescents who agree to have intercourse but & Prok, 2012). do not really want to, the primary reasons given are It occurs slightly more frequently in boys than in girls. peer pressure (about 30%), curiosity (50% of boys; The peak age for the lesions to occur in girls is 14 to 17 25% of girls), and