Preschool Child Care PDF

Care of the PRESCHOOL CHILD LEARNING OBJECTIVES: On completion of this unit, you are expected to demonstrate understanding of the concepts related to the care of a family with a preschooler. Specifically, you are able to: 1. Describe the normal g...

Care of the PRESCHOOL CHILD LEARNING OBJECTIVES: On completion of this unit, you are expected to demonstrate understanding of the concepts related to the care of a family with a preschooler. Specifically, you are able to: 1. Describe the normal growth and development of a preschool child and associated parental concerns. 2. Distinguish each milestone achieved by the preschooler and its implication. 3. Use critical thinking to analyze methods of a family-centered care of a preschooler.  GROWTH & DEVELOPMENT OF A PRESCHOOL CHILD LESSON 11 LEARNING OBJECTIVES On completion of this lesson, you are expected to demonstrate understanding of the concepts related to the care of a family with a preschool child. Specifically, students are able to: 1. Identify key terms that are significant in the care of a preschool child and the family. 2. Discuss the preschool child’s biologic-proportional changes and their implications. 3. Evaluate the relationship among the motor, language, psychosocial, cognitive and temperament milestones of a preschool child.. INTRODUCTION Preschoolers are fascinating creatures. As their social circles enlarge to include peers and adults outside the family, preschoolers’ language, play patterns, and appearance change markedly. Their curiosity about the world around them grows, as does their ability to explore that world in greater detail and see new meanings in what they find. At 3 years of age, the child still has the chubby, baby-face look of a toddler; by age 5, a leaner, taller, better-coordinated social being has emerged. The child works and plays tirelessly, “making things” and telling everyone about them. In children this age, exploring and learning go on continuously. According to Erikson, the developmental task of the preschool age is initiative versus guilt. Preschoolers often try to find ways to do things to help, but they may feel guilty if scolded when they fail because of inexperience or lack of skill. Our main role as nurses is understanding the process of their growth and development so that we can aid the family as they raise their child. Moreover, being adept with the concept of their growth and development allows us to device health teachings and do assessments and interventions that are child and family centered which is unique to their characteristic.  ACTIVITY 11.1 INSTRUCTION: Match the presented preschool concepts (column 1) based on the different child development theories (column 2). Place your answer on the left side of each number. ANSWER COLUMN 1 COLUMN 2 1. Phallic Stage A. Erik Erikson’s Theory 2. Preconceptual Intuitive B. Moral and Spiritual Development 3. Play C. Mutilation and castration 4. Level 1 preconventional D. Simple jigsaw puzzle, dolls, color- ing books, pencils, pens 5. Preconceptual preoperational E. Cognitive Development 6. Initiative VS Guilt F. (5-7 years old) Child learns through asking questions 7. Fear G. Sigmund Freud’s Theory 8. Centration H. Perceiving that one’s thoughts and needs are better or more im- portant than those of others 9. Toys I. Focused on the characteristic of an object or person and based their de- cision on that one characteristic. 10. Egocentrism J. Associative play and imitation play  CONCEPT DISCUSSION PRESCHOOL STAGE Age: 3 to 6 years Erikson: Initiative vs Guilt Freud: Phallic Cognitive Development: Preconceptual Preoperational (3-4 years old) Preconceptual Intuitive (5-7 years old)  learn by asking questions  Centration: focused on the characteristic of an object or person and based their decision on that one characteristic  not aware of the Law of Conservation Moral and Spiritual Development Level 1 Preconventional: Individualism & Exchange determines right and wrong based on their parents’ rules Fear: Mutilation and castration Play: Associative Play, Imitation Play Toys: simple jigsaw puzzle, dolls, coloring book, pencils, pens & crayons EXPECTED GROWTH AND DEVELOPMENT Physical Growth slimmer, taller, and much more childlike proportions. Contour changes are so definite that future body type—ectomorphic (slim) or endomorphic (large)—becomes apparent. Handedness begins to be obvious. Lymphatic tissue begins to increase in size, particularly the tonsils, and levels of IgG and IgA antibodies increase PR= 85 bpm, BP= 100/60 mmHg bladder – easily palpable at symphysis pubis (9-10 times voiding daily) well formed arch in the foot Weight, Height, BMI & Head Circumference Slight weight gain (4.5 lg or 2 kg/ year) Appetite is the same with toddler years Height gain- minimal (2-3.5 inches or 6-8 cm) Teeth 20 deciduous teeth by 3 years old Teeth needs to be preserved because: 1. permanent teeth erupts by school-age period 2. deciduous teeth hold the position for permanent teeth as the jaw grows larger Gross and Fine Motor Development AGE FINE MOTOR GROSS MOTOR MILESTONE MILESTONE 3 years old undress self; stack tower runs; alternates feet on stairs; of blocks; draws a cross rides tricycle; stands on one foot 4 years old can do simple buttons constantly in motion; jumps; skips 5 years old can draw a six part figure; throws overhead laces shoe Language 3 y.o – vocabulary of 900 words 4 y.o – vocabulary of 1500 words 5 y.o – vocabulary of 2100 words Play 3 y.o – able to take turns; very imaginative 4 y.o – pretending is a major activity; roughhousing and imitative play 5 y.o – likes games with number or letters; interested in group games and reciting songs they have learned Language Development uses vocabulary to ask questions Egocentrism is strong *** Egocentrism: perceiving that ones thoughts and needs are better or more important than those of others defines objects mainly in relation to themselves 4-5 years old: children enjoy participating in mealtime conversation & can describe an incident from their day in great detail Emotional Development Initiative: like to explore because they have discovered that learning new things is fun Guilt: develops when children are punished/ criticized for attempts at initiative *** Implication: children may have difficulty later in life making decisions about everything; they can’t envision their capability to solve problems that may come with change How to promote initiative?  Expose children to a wide variety of experiences and play materials so they can learn how things work  Explore outside homes  Provide materials that encourage creative play (Free form play) Imitation: role modeling; imitate activities best they see their parents performing; introduce child to parents’ work environment to let child learn words such as photocopi- er, assembly line, fax machine, etc. Fantasy: differentiation starts; magical thinking; deal with fantasy by supporting the imitation but present reality at the same time Oedipus Complex: strong emotional attachment a preschool boy demonstrates toward his mother Electra Complex: attachment of a preschool girl to her father *** Assure parents that these are normal phenomena Gender Roles awareness of the difference between sexes Preschoolers need exposure to an adult of the opposite gender so they can become familiar with opposite gender roles Children’s gender-typical actions are strengthened by parents, strangers, preschool teachers, other family members, and other children. Socialization exposure to other playmates makes preschoolers relate to other people easily than those raised in an environment where they rarely see other children of the same age (Paulus & Moore, 2012) 4-year-old children may be involved in arguments because of their awareness of their role in the group 5-year-old children begin to develop best friendship on the basis of who they walk to school or who lives closest to them  ASSIGNMENT 11.1 INSTRUCTION: Answer the questions below pertaining to the preschool development stage. Write your answers on the space provided in a concise yet substantial manner. This is a graded exercise. Each question will be graded according to the short answer rubric. 1. Differentiate the gross motor milestone and fine motor milestone of the preschool developmental stage. 2. Explain the language development and emotional development of preschool stage. 3. Define the emotional attachments which normally occurs during the preschool stage: Oedipus complex and Electra complex. Also relate the concept of preschool gender roles in the normal emotional attachments.  FEEDBACK Let us look into how well you fared. If you answered all questions correctly, congratulations! It shows that you are already familiar with the topics discussed in lesson 11. If your answers are quite not close to the discussion, you have some ideas about the topics covered but need to learn more. Now, you have a glimpse of the Growth and Development of a Preschool child. Read on and continue exploring this topic. Read further on your textbook pages _______ to _________ and on other Maternal and child health nursing references. Quiz 11.1 Congratulations! You are done with Lesson 11. In order to see how much you have learned, an online quiz has been prepared for you to answer. Follow the steps stated herewith. 1. Log in to your NDMU Academic Learning Management System Account. 2. Go to My Courses and click NCM 107 A. 3. Look for the online quiz prepared under Week 12 entitled Growth & Development of a Preschooler. 4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM. 5. Your are expected to finish the quiz within the time set in the system. 6. Only 1 attempt is allowed unless reasons such as poor internet connection would have affected your access to the quiz. Best of luck and well done! Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott Williams & Wilkins, Philadelphia. 2011. Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017. McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs- ing, 6th Edition. Elsevier, Singapore. 2014. Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018. Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https:// teach.its.uiowa.edu Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make- your-own/crossword/crossword.php Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/ pdfs /classes/rubric-reflections.pdf  WELLNESS PROMOTION & INJURY PREVENTION FOR THE PRESCHOOL CHILD LESSON 12 LEARNING OBJECTIVES On completion of this lesson, you are expected to demonstrate understanding of the concepts related to coping with preschool concerns, wellness promotion and injury prevention. Specifically, students are able to: 1. Discuss various parental concerns related to a preschooler’s growth and development. 2. Manage parental concerns related to preschooler’s growth and development through formulation of health teachings suited for each concern. 3. Recognize important safety issues for the preschooler. 4. Formulate interventions and health teachings for the prevention of injury. INTRODUCTION Preschoolers can be said to soak up information “like a sponge.” “Why?” and “how?” are favorite words. This curiosity also means that accidents are still a serious concern. They sometimes have problems separating fantasy from reality. Routine checkups, family teaching, as well as accident and infection prevention are all important aspects of health promotion and maintenance for the preschool child. These are significant in assuring the optimum health of these children as they discover their environment and continue to achieve milestones. These are also important areas wherein family health teachings must be given according to the unique characteristics of the preschooler and family. In this lesson, you will get familiar with the wellness promotion and injury prevention measures to ensure that you are competent enough to promote the safety and overall functioning of the preschool through formulation of well though of health teachings for the family.  ACTIVITY 12.1 An activity has been prepared in the Learning Management System to kickstart this lesson. Follow the steps stated herewith. 1. Log in to your Learning Management System Account. 2. Go to My Courses and click NCM 107 A. 3. Look for the activity prepared under Week 13 entitled Wellness Promotion & Injury Prevention for Preschoolers. 4. The activity is published only on _____(date)______, between ____ AM to ____ AM. 5. Your are expected to finish the activity within the time set in the system and in order to proceed to the succeeding activities. CONCEPT DISCUSSION HEALTH PROMOTION OF A PRESCHOOLER AND FAMILY Daily Activities Dressing: they prefer bright colors or prints; needs the experience of choosing their clothes Sleep: resistance in taking naps; refuses to sleep at night due to fear of the dark Exercise: Roughhousing Hygiene: must not be left unsupervised at bath time; discourage bubble bath especially to girls to avoid vulvar irritation and bladder infection Care of teeth: start independent brushing; floss; fluoride water or supplement for children; encourage fruits and protein for snacks instead of sweets; 1st visit to dentist is not later than 2 years old; dental services at 3 years old, teeth grinding (bruxism) may begin  Promoting Safety Motor vehicle & Bicycle Safety  buckle children into car seats or booster seat in the back seat  stress the importance of seatbelts  let children wear safety helmets approved for their age and size Common Fears 1. Fear of the Dark - leave a dim night light - reassure children that they are safe when they woke up terrified & screaming 2. Fear of mutilation 3. Fear of separation or Abandonment - due to their distorted sense of time Behavior Variations - due to their keen imagination and immature reasoning 1. Telling Tall Tales - stretching stories to make them seem more interesting *** may lead to chronic lying if not manage accordingly *** help child separate fact from fiction  2. Imaginary Friends - assure parents that this normal and that they just have to ensure that the child has exposure to real playmates and imaginary friends should not prevent the child from so- cializing - pretend friends can encourage language development and provide means for the child to express their feelings - accommodate imagination at the same time present reality 3. Difficulty Sharing - already have a concept that some things are theirs, some belong to others and some can belong to both - can stand in line to wait for their turn - assure parents that sharing is a difficult concept to grasp and needs practice to understand and learn it (Sutherland & Friedman, 2012) - parents must teach property rights as part of learning to share 4. Regression - in relation to stress, revert to behavior they previously outgrew - help parents understand that regression is normal - remove stress to discontinue this behavior 5. Sibling Rivalry - jealousy may become evident because preschoolers have enough vocabulary to express themselves and because they are more aware of family roles Preparing for a New Sibling - Introduction should be before the child begins to feel the difference the new baby will make (mother first begins to look pregnant) - Children can be sent to school before the baby is born to let them perceive it as part of maturity - Include them in the preparation for the upcoming baby Sex Education - Give factual but simple answers to questions related to genitals - Do not convey that these body parts are never to be talked about but rather leave an open line of communication - masturbation: explain that certain thins are done in some places but not in others - Teach how to avoid sexual maltreatment: not allowing anyone to touch their body unless they and their parents agree that it is alright (Perez-Fuentes, Olfson, Villegas, et al, 2012) Broken Fluency: repeating words or syllables; repetition and prolongation of sounds, sylla- bles and words (secondary stuttering) - Do not discuss in the child’s presence that he/she is experiencing difficulty of speech - Listen with patience rather than interrupting or asking the child to speak slowly or start over - Always talk to the child in a calm, simple way to role model slow speech - Do not force a child to speak if she/ he does not want to - Do not reward or punish a child for fluent or non fluent speech respectively  PRESCHOOL Play is associative Regular dental care is essential Elektra complex Sibling rivalry Castration and mutilation fears Has Imaginary friends Oedipus complex Often asks questions Listen with patience (broken fluency)  EXERCISE 11.1 NOT PRESCHOOL Play is associative Regular dental care is essential Elektra complex Sibling rivalry Castration and mutilation fears Has Imaginary friends Oedipus complex Often asks questions Listen with patience (broken fluency) INSTRUCTION: Create your own learning abbreviation related to the concepts discussed about the preschool stage, similar on the above presentation. You can make use of the same terminolo- gy PRESCHOOL or other related terminologies. Just provide one learning abbreviation only.  FEEDBACK Let us look into how well you fared. If you answered all questions correctly, congratulations! It shows that you are already familiar with the topics discussed in lesson 12. If your answers are quite not close to the discussion, you have some ideas about the topics covered but need to learn more. Now, you have a glimpse of the Wellness promotion and injury prevention of a Preschool child. Read on and continue exploring this topic. Read further on your textbook pages _______ to _________ and on other Maternal and child health nursing references. Quiz 12.1 Congratulations! You are done with Lesson 12. In order to see how much you have learned, an online quiz has been prepared for you to answer. Follow the steps stated herewith. 1. Log in to your NDMU Academic Learning Management System Account. 2. Go to My Courses and click NCM 107 A. 3. Look for the online quiz prepared under Week 13 entitled Wellness promotion and Injury prevention of a Preschooler. 4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM. 5. Your are expected to finish the quiz within the time set in the system. 6. Only 1 attempt is allowed unless reasons such as poor internet connection would have affected your access to the quiz. Best of luck and well done! Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott Williams & Wilkins, Philadelphia. 2011. Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017. McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs- ing, 6th Edition. Elsevier, Singapore. 2014. Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018. Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https:// teach.its.uiowa.edu Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make- your-own/crossword/crossword.php Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/ pdfs /classes/rubric-reflections.pdf  Care of the SCHOOLAGE CHILD LEARNING OBJECTIVES: On completion of this unit, you are expected to demonstrate understanding of the concepts related to the care of a family with a school-age child. Specifically, you are able to: 1. Describe the normal growth and development of a school-age child and associated parental concerns. 2. Distinguish each milestone achieved by the school-age child and its implication. 3. Use critical thinking to analyze methods of a family-centered care of a school-age child.  GROWTH & DEVELOPMENT OF A SCHOOL-AGE CHILD LESSON 13 LEARNING OBJECTIVES On completion of this lesson, you are expected to demonstrate understanding of the concepts related to the care of a family with a school-age child. Specifically, students are able to: 1. Identify key terms that are significant in the care of a school-age child and the family. 2. Discuss the school-age child’s biologic-proportional changes and their implications. 3. Evaluate the relationship among the motor, language, psychosocial, cognitive and moral milestones of a school-age child. INTRODUCTION The middle years is also referred as the school-age or school years. In this period, the school environment plays a vital role, giving a significant impact on the growth and develop- ment of the child. In terms of the physiologic changes, the school-age years begin with the shedding of the deciduous teeth and would end with the transition into the teenage years. During this stage, progress becomes evident as children are seen to have grown and developed into sturdy, complicated individuals with the capacity to communicate, conceptualize in a limited way, and become involved in complex social and motor behavior (Hockenberry, 2019). In terms of biologic development, anthropometric measurements assumes a slower but steady pace compared with the earlier years. In terms of proportional changes, this period is characterized by more graceful movements as compared with the preschool years. On the context of psychosocial and cognitive development, a leap of improvement can be seen. With these changes, our role as a nurse is important especially in guiding the family as they go through caring for the child during this stage.  ACTIVITY 13.1 INSTRUCTION: Fill-in the missing letters in the blank to complete the key terms. You can utilize the presented definition to easily identify the needed key terms in each number. 1. Develops when a child does not receive rewards for accomplishment; implications later in life will be difficulty in tackling new situations (can’t envision successful way of handling them). ANSWER: _NF_RI_RI_Y 2. Ability to project one’s self into other people’s situation ANSWER: D_CEN_ER_N_ 3. Ability to adapt thought process to fir what is perceived ANSWER: _CC_M_ _DA_ _ON 4. Ability to understand that objects can belong to more than one classification. ANSWER: CL_SS I_CL_SI_N 5. Hypertrophy of the breast tissue can occur in prepubescent boys usually in obese children. ANSWER: G_NE_OM_S_IA  ACTIVITY 13.2 Instruction: Identify the specific development theory for each of the following statements. Indicate ‘P’ for PSYCHOSOCIAL, ‘C’ for COGNITIVE and ‘M’ for MORAL. _____ 1. Child needs a supportive/ loving environment to achieve sense of industry. _____ 2. The school-age child begins to relate external events to mental representations and can express those representations verbally and symbolically. _____ 3. Can develop classification skills (sort objects according to object qualities). _____ 4. Peer approval is a strong motivator. _____ 5. Motivated by rewards and punishments. _____ 6. Children with physical/ mental limitations may be at greater risk, but all children will have some tasks that they cannot master. _____ 7. Children know rules but do not understand reasons for them. _____ 8. Do not tend to have personal judgement when it comes to “good” and “bad” but rather judge these based on what they are told by others. _____ 9. Can use memories of past experiences to evaluate and interpret the present. _____ 10. A sense of independence grows, children want to complete tasks successfully on their own.  CONCEPT DISCUSSION SCHOOL-AGE CHILD Age: 6 to 12 years of age Height increases from an average of 45.5 (115 cm) at 6 years to 59 (150 cm) at 12 years Weight increases from 46 lb (21 kg) to 88 lb (40 kg) By age 12, girls are taller and heavier than boys One of the healthiest periods of life Fear: displacement from school Proportional Changes of School-age Children Compared with preschoolers… Longer legs and lower center of gravity A lanky appearance up to 10 to 12 years Less body fat; greater percentage of muscle in body mass Improved posture and coordination Much greater strength (but muscles are still immature) Bone development that precedes muscular development A decreased ratio of head circumference and waist circumference compared with height EXPECTED GROWTH AND DEVELOPMENT(MATURATION OF SYSTEMS) Urinary System  Girls have greater bladder capacity than boys Cardiopulmonary system  Heart grows more slowly and is smaller compared with the body than at any other period  Heart rate and respiratory rate decreases  Blood pressure increases  Blood volume increases  Frontal sinuses develop at about 6 years old (sinus headaches become possible)  Maturation of respiratory system leads to increase gas exchange increasing exertion ability and stamina  TEMPERATURE PULSE RATE RESPIRATORY BLOOD RATE PRESSURE RANGE 36.4 C– 37 C 70-110 bpm 16-22 Girls: Systolic: 102-115 Diastolic: 60-74 Boys: Systolic: 102-115 Diastolic: 61-75 * After 12 years of age, a boy’s pulse is 5 beats/min slower than a girl’s Immune System  More competent in ability to localize infections and produce an antibody-antigen response  However, more infections increase in the first years of school because of exposure to other children  IgG and IgA reach adult levels and lymphatic tissue continues to grow in size until 9 years old  Abundance of tonsillar and adenoid tissue in early school children  Appendix is lined with lymphatic tissue Musculoskeletal System  deciduous teeth are lost and permanent teeth erupt  Average child gains 28 teeth between 6 & 12 years of age  Central and lateral incisors first, second and third cuspids and first and second molars  Refinement of coordination, balance and control  Motor development is primary; necessary for competitive activity Sensory and Nervous System  By 10 years old, brain growth is complete (refined fine motor coordination)  Adult level vision is achieved Sexual Maturation  Timing of onset of puberty varies widely between 8 and 14 years of age due to genetic and cultural differences  Both genders (10-12 years): pubescent changes begin to appear; earlier in females than in males  Androgen: Low in childhood (until 7-9 years)  Estrogen: Low in childhood; In males, increasing gradually until maturity; In females, increasing gradually until onset of ovarian function, then greatly increasing until approximately 3 years after first menstruation  Sexual and Physical Concerns Concerns of Girls - Prepubertal Girls: 2 in or 5 cm taller than preadolescent boys; earlier growth spurt for girls - Change in pelvic contour: assure the child that it is part of an adult female profile - Breast development not always symmetrical - Early preparation for menstruation is important for the following reasons: a. to have a positive attitude towards the occurrence of menstruation b. girls need an explanation of proper hygiene & reassurance they can bathe, shower or swim during periods - Girls need to know that vaginal secretions will begin to be present - 1st year or two after menarche: menstrual irregularity is normal PUBERTY Sexual and Physical Concerns Concerns of Boys - Boys become aware of increasing genital size - Gynecomastia or hypertrophy of breast tissue can occur in prepubescent boys usually in obese children *** assure that this is a transitory phenomenon and will fade as soon as male hormones become more mature and active - Concerned about pubic hair growth but not yet able to grow a beard and o not have chest hair yet *** assure that pubic hair appears first and facial and chest hairs grow several years later - Nocturnal emissions start (increased seminal fluid) and ejaculation during sleep  DEVELOPMENTAL THEORIES Emotional Development  Inferiority: develops when a child does not receive rewards for accomplishment; implications later in life will be difficulty in tackling new situations (can’t envision successful way of handling them)  8-9 years old: spends less time with family and more time with peers  Before engaging in competitive sports, they must learn how to avoid devastation when losing  The good time to teach children compassion and thoughtfulness  Spite clubs or exclusion is evident especially at 9 years old  Interest in opposite sex at 11 years old MILESTONE Psychosocial Development Theory: Sense of Industry Mastery of Erikson’s first three stages of psychosocial development is important to healthy development Child needs a supportive/ loving environment to achieve sense of industry Stage of accomplishment (sense of industry) occurs sometime between 6 years and adolescence; learning how to do things well Children wish to learn skills and participate in meaningful tasks; they have a desire to contribute A sense of independence grows, children want to complete tasks successfully on their own Children gain satisfaction from being able to do so independently Successful task completion may help children achieve status in social activities Recognition and rewards reinforce this desire Children develop ability to both cooperate and compete with others Peer approval is a strong motivator Sense of reward is often based on mastery of skills; Children needs reassurance that they are doing things correctly immediately after the task is completed Potential difficulty in this stage is a situation that makes the child feel inferior Children with physical/ mental limitations may be at greater risk, but all children will have some tasks that they cannot master Sense of industry is achieved when children have tasks that are necessary and that they are able to complete well Adjusting and achieving in school are two vital tasks for this age group Give children small but frequent rewards (Merit badge system) Activities: reading books with short chapters, small chores that can be quickly com- pleted, hobbies and projects that are small and can be finished within a short time   Play  Decline in imaginative play  Interest in collecting items  Boys and girls play separately  Interest in rules and fairness Mental abilities of the school-age child  Readiness for learning, especially in perceptual organization  Understands rules and reasons for them  Solves trial-and-error problem conceptually rather than through action  Greater understanding and use of language Cognitive Development: concrete operational thought 1. Decentering: ability to project one’s self into other people’s situation 2. Accommodation: ability to adapt thought process to fir what is perceived 3. Conservation 4. Class inclusion: ability to understand that objects can belong to more than one classification MILESTONE Cognitive Development Theory: Concrete Operations The school-age child begins to relate external events to mental representations and can express those representations verbally and symbolically Can use thought to process events and actions Can understand outside/external viewpoints Develop an understanding of relationships between things and ideas Make judgements based on what can be reasoned (conceptual thinking) Can master symbols (eg, the alphabet representing sounds and words) and abstract mathematical concepts, such as conservation Can use memories of past experiences to evaluate and interpret the present Is able to understand quantity remains the same even when appearance may change (mass, weight, volume) Can develop classification skills (sort objects according to object qualities) Can enjoy arranging/ ordering the environment Can understand relative differences in concepts (eg, larger, smaller, darker, lighter, etc) Understands reciprocity of familial relationships (eg, a mother must have a child; a child has a mother) Begins to appreciate economics and finances Can follow several instructions at once Language Development -Talks in full sentences -Defines object by their use -Can tell the time in hours, months, holidays and can add or subtract by 7 years old -Discovers dirty jokes and uses swear words when angry by 9 years old -Can carry adult conversation by 12 years old  MILESTONE Moral Development Theory Level II: Conventional Orientation to interpersonal relations of mutuality *SEEKS CONFORMITY & LOYALTY * FOLLOWS RULES *MAINTAINS SOCIAL ORDER Ages 6-7 years Children know rules but do not understand reasons for them Motivated by rewards and punishments “Good” is something that obeys a rule and is rewarded “Bad” is something that breaks a rule and is punished May believe that something unfortunate was actually a punishment of something bad Do not tend to have personal judgement when it comes to “good” and “bad” but rather judge these based on what they are told by others Ages 8-12 years Children begin to be aware of intentions as a factor in “good” and “bad” Rules are less absolute; children begin to understand that these may be based on others’ preferences As they age, children start to consider context for any rule infractions Children are able to consider alternative points of view and temper their judge- ments accordingly  ASSIGNMENT 13.1 INSTRUCTION: Complete the Venn diagram by filling all the spaces inside the circle. Specify the growth and development of the school-age child: boys and girls, based on the different systems. Also provide the similar growth and development in the middle space. BOYS GIRLS  FEEDBACK Let us look into how well you fared. If you answered all questions correctly, congratulations! It shows that you are already familiar with the topics discussed in lesson 13. If your answers are quite not close to the discussion, you have some ideas about the topics covered but need to learn more. Now, you have a glimpse of the Growth and Development of a School-age child. Read on and continue exploring this topic. Read further on your textbook pages _______ to _________ and on other Maternal and child health nursing references. Quiz 13.1 Congratulations! You are done with Lesson 13. In order to see how much you have learned, an online quiz has been prepared for you to answer. Follow the steps stated herewith. 1. Log in to your NDMU Academic Learning Management System Account. 2. Go to My Courses and click NCM 107 A. 3. Look for the online quiz prepared under Week 14 entitled Growth & Development of a School-age Child. 4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM. 5. Your are expected to finish the quiz within the time set in the system. 6. Only 1 attempt is allowed unless reasons such as poor internet connection would have affected your access to the quiz. Best of luck and well done! Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott Williams & Wilkins, Philadelphia. 2011. Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017. McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs- ing, 6th Edition. Elsevier, Singapore. 2014. Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018. Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https:// teach.its.uiowa.edu Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make- your-own/crossword/crossword.php Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/ pdfs /classes/rubric-reflections.pdf  WELLNESS PROMOTION & INJURY PREVENTION FOR THE SCHOOL-AGE CHILD LESSON 14 LEARNING OBJECTIVES On completion of this lesson, you are expected to demonstrate understanding of the concepts related to coping with school-age concerns, wellness promotion and injury prevention. Specifically, students are able to: 1. Discuss various parental concerns related to a schooler’s growth and development. 2. Manage parental concerns related to schooler’s growth and development through formulation of health teachings suited for each concern. 3. Recognize important safety issues for the schooler. 4. Formulate interventions and health teachings for the prevention of injury. INTRODUCTION The progression of skills and the evident growth among school-age children can also bring out some concerns. These concerns include the nutrition, daily activities, discipline , safety and common ,s health problems that need to be attended to since it can have a significant impact on the over-all growth and development of these children. Our role as nurse usually would involve formulation of care plans that suits these con- cerns. Interventions are being selected for implementation according to the identified needs of the child and the family. One of the most important intervention for nurses to include is the health teachings which are formulated with a sense of individuality. This entails that these teachings are done in relation to the situation of the child and family. Hence, our responsibility entails not only a clinical eye but also the ability to build effec- tive communication in order to extract important cues which will be our basis for a care plan that is patient and family centered.  CONCEPT DISCUSSION HEALTH PROMOTION Nutrition  Caloric needs are decreased from earlier years  Eating away from parent’s influence for the first time, though family patters still have influ- ence  Begin to try and develop tastes for new things  Encourage eating of breakfast (parents must model this behavior)  Eating habits during school age persists through adulthood  Fostering Industry & Nutrition ***Allow children to help plan meals and assist during preparation ***Allow them to prepare simple meals ***Teach about proper etiquette  Dietary Intake ***Boys need more calories than girls ***Both boys and girls require more iron ***Adequate calcium and fluoride ***Major deficit during this age is fiber Daily Activities  Dress: Style is based on their friends’ or those that are popular to avoid exclusion  Sleep : Younger school age: 10-12 hours; Older children: 8-10 hours  Exercise: Encourage daily exercise to avoid obesity and osteoporosis later in life  Hygiene: teach the importance of hygiene during menstruation and educate boys that are uncircumcised to regularly wash genitals to avoid inflammation from secretions that lodges under the foreskin  Care of teeth: visit dentist twice a year Safety  Avoid carrying heavy backpacks that weighs more than 10% of the child’s weight; causes chronic back pain (Kistner, Fiebert & Roach, 2012)  Teach about sexual maltreatment  Limit-Setting and Discipline  Intended to help children learn to control their own behavior  Corporal punishment can have negative outcomes  School-age child is old enough to understand basic reasoning  Discipline should  Define forbidden actions  Provide an alternative (acceptable) course of action  Provide reasoning regarding unacceptable and acceptable actions  Teach child empathy (if her or she has wronged someone)  Effective strategies may include withholding treats or privileges, requiring child to fix problem (if possible), etc. Safety  Avoid carrying heavy backpacks that weighs more than 10% of the child’s weight; causes chronic back pain (Kistner, Fiebert & Roach, 2012)  Teach about sexual maltreatment Promoting Health Family Functioning  6 years old- teacher as the final authority in all subjects; friends are guides for their behavior *** emphasize rule without criticizing the friend’s behavior *** avoid negative remarks COMMON HEALTH PROBLEMS Dental Caries Caries: progressive, destructive lesions or decalcification of the tooth enamel & dentin Malocclusion: deviation of tooth position from the normal Problems with Language Development  Articulation: difficulty pronouncing s,z,th,l,r & w or substitutes w for r or r for l  Speech therapy is needed if it persists COMMON FEARS AND ANXIETIES HOW TO DEAL WITH BULLIES  Anxiety related to beginning school 1. Supervise recreation periods closely  School refusal or phobia  Homeschooling 2. Intervene immediately to stop bullying  Children who spend time independently 3.Insist school and parents become  Sex Education  Stealing involved if it persists  Violence or terrorism 4. Advise parents to discuss it with their  Recreational drug use  Obesity child and help them understand that it  Bullying must be reported INJURY PREVENTION Source of Unintentional Injury Preventive Measure Motor Vehicle  Encourage children to use seat belts and a booster seat if needed; role model seat belt use  Teach street-crossing safety; stress that streets are no place for roughhousing, pushing or shoving  Teach parking lot and school bus safety (eg, do not walk in back of parked cars, wait for crossing guard) Bicycle  Teach bicycle safety, including wearing a helmet and not giving “passengers” rides Community  Teach to avoid unsafe areas  Stress to not go with strangers (parents can establish a code word with child; child does not leave school with anyone who does not know the word)  Teach children to say “no” to anyone who touches them if they do not wish it, including family members (most sexual maltreatment is by a family member, not a stranger)  Teach children not to arrange a meeting with people they meet on the internet Source of Unintentional Injury Preventive Measure Burns  Teach safety with candles, matches and campfires and that fire is not fun. Also teach safety with begin- ning cooking skills  Teach safety with sun exposure; use sun block  Teach to not climb electric poles Falls  Educate that roughhousing on fences or climbing on roofs is hazardous.  Teach skateboard, scooter and skating safety. Sports Injuries  Teach that wearing appropriate equipment for sports is not babyish but smart management  Stress not to play to a point of exhaustion or in a sport beyond physical capability Drowning  Teach how to swim; dares and roughhousing when diving or swimming are not appropriate. Stress not to swim beyond limits of capabilities. Drugs  Help child to avoid all recreational drugs; prescription medicine should only be taken as directed. Teach to avoid tobacco and alcohol.  Young school-age children may mistake drugs/ vitamins for candy Firearms  Teach firearm safety. Keep firearms in locked cabinets with bullets separate from gun. Source of Unintentional Injury Preventive Measure General  School-age children should keep adults informed as to where they are and what they are doing; cell- phones can help with this  Be aware the frequency of unintentional injuries in- creases when parents are under stress and therefore less attentive. Special precautions must be taken at these times.  Caution that some children are more active, curious and impulsive and therefore more vulnerable to unin- tentional injuries than others. SCHOOL-AGE ame sex grouping chool phobia & bullying ix years: ties shoe laces with ease ense of Industry tart of articulation problem  EXERCISE 13.1 INSTRUCTION: Write 'T' for 'true' and 'F' for 'false' for the following statements. _____________a. Caloric needs are constant since early stages of the child development. _____________b. The school-age children are recommended to avoid carrying heavy back- packs that weighs more than 20% of their weight because it can cause chronic back pain. _____________c. One of the common health problem encountered during the school-age stage is Malocclusion, which defines as the deviation of tooth position from the normal. _____________d. Intended to help children learn to control their own behavior. _____________e. To promote healthy teeth to children, advise the family to allow their child visit the dentist once a year only. _____________f. Parents can establish a code word with child; child does not leave school with anyone who does not know the word. _____________g. School-age children should keep adults informed as to where they are and what they are doing; cellphones can help with this. _____________h. Caution that some children are more active, curious and impulsive and therefore more vulnerable to unintentional injuries than others. _____________i. Be aware the frequency of unintentional injuries increases when parents are under stress and therefore less attentive. Special precautions are not neces- sary. ______________j. Corporal punishment can have negative outcomes.  EXERCISE 13.2 INSTRUCTION: Please list down at least 5 common fears and anxieties among school-age children, and provide each related nursing interventions to overcome those common problems. COMMON FEARS AND ANXIETIES NURSING INTERVENTION 1 2 3. 4. 5.  FEEDBACK Let us look into how well you fared. If you answered all questions correctly, congratulations! It shows that you are already familiar with the topics discussed in lesson 14. If your answers are quite not close to the discussion, you have some ideas about the topics covered but need to learn more. Now, you have a glimpse of the Wellness promotion and injury prevention of a School-age child. Read on and continue exploring this topic. Read further on your textbook pages _______ to _________ and on other Maternal and child health nursing references. Quiz 14.1 Congratulations! You are done with Lesson 14. In order to see how much you have learned, an online quiz has been prepared for you to answer. Follow the steps stated herewith. 1. Log in to your NDMU Academic Learning Management System Account. 2. Go to My Courses and click NCM 107 A. 3. Look for the online quiz prepared under Week 15 entitled Wellness promotion and Injury prevention of a School-age Child. 4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM. 5. Your are expected to finish the quiz within the time set in the system. 6. Only 1 attempt is allowed unless reasons such as poor internet connection would have affected your access to the quiz. Best of luck and well done! Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott Williams & Wilkins, Philadelphia. 2011. Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017. McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs- ing, 6th Edition. Elsevier, Singapore. 2014. Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018. Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https:// teach.its.uiowa.edu Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make- your-own/crossword/crossword.php Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/ pdfs /classes/rubric-reflections.pdf  Care of the ADOLESCENT LEARNING OBJECTIVES: On completion of this unit, you are expected to demonstrate understanding of the concepts related to the care of a family with an adolescent. Specifically, you are able to: 1. Describe the normal growth and development of an adolescent and associated parental concerns. 2. Distinguish each milestone achieved by the adolescent and its implication. 3. Use critical thinking to analyze methods of a family-centered care of an adolescent.  GROWTH & DEVELOPMENT OF AN ADOLESCENT LESSON 15 LEARNING OBJECTIVES On completion of this lesson, you are expected to demonstrate understanding of the concepts related to the care of a family with an adolescent. Specifically, students are able to: 1. Identify key terms that are significant in the care of an adolescent and the family. 2. Discuss the adolescent’s biologic-proportional changes and their implications. 3. Evaluate the relationship among the motor, language, psychosocial, cognitive and moral milestones of an adolescent. INTRODUCTION Adolescence is a period of transition between childhood and adulthood. It is a time of profound biologic, intellectual, psychosocial and economic change. In this period, physical and sexual maturity are developing into a more sophisticated manner along with their reasoning abilities. They become more capable of making decisions of their own but becomes too aggressive at times that they overlook the implications of their decisions. Having these characteristics, it is important that nurses would guide the adolescent and family as this period is a very challenging time for them. Health teachings and understanding the growth and development are ways to help them through with this phase and these can be facilitated by us, nurses.  ACTIVITY 15.1 READING ACTIVITY Read in advance the topic on Nursing Care of A Family with An Adolescent in your textbook, Maternal and Child Health Nursing by Adele Pillitteri, pages 885 to 913. CONCEPT DISCUSSION ADOLESCENCE Is the period between 13 and 18 to 20 years, a time that serves as a transition between child- hood and adulthood. 3 Periods of Adolescence: 1. Early Period– 13 to 14 years 2. Middle Period– 15 to 16 years 3. Late Period– 17 to 20 years PHYSICAL GROWTH The major milestones of development in the adolescent period are the onset of puberty and the cessation of the body growth. The gain in physical growth is mostly in weight, leading to the stocky, slightly abuse appearance of prepubescence then thin and gangly appearance of late adolescence. Most girls are 1 to 2 inches taller than boys coming into adolescence but generally stop growing withing 3 years from menarche.  Girls who started menstruating at 10 years of age, may reach adult height by age 13. Girls grow 2 to 8 inches in height and gain 15 to 55 pounds. Boys grow about 4 to 1 2inches in height and gain 15 to 65 pounds during adolescence. Growth stops with the closure of the epiphyseal lines of long bones. This occurs at about 16 to 17 years of age in females and about 18 to 20 years of age in males. The increase in body size does not occur in all organ systems at the same rate. These differences in growth rates make adolescents appear long-legged and awkward during a rapid growth spurt because their extremities elongate first, followed by trunk growth. Because the heart and lungs increase in size more slowly than the rest of the body, blood flow and oxygen availability are reduced. This means adolescents may have insufficient energy and become fatigued trying to finish the various activities that interest them. During adolescence, androgen stimulates sebaceous glands to extreme activity, some- times resulting in acne, a common adolescent skin problem. Apocrine sweat glands (glands present in the axillae and genital area) form shortly after puberty producing a strong odor in response to emotional stimulation. Teeth Adolescents gain their second molars at about 13 years of age and the third molar (wisdom teeth) between 18 to 21 years old. Third molars may erupt as early as 14 to 15 years of age Jaw reaches adult size by the end of adolescence Puberty Puberty is the stage at which the individual first become capable of sexual reproduction A girl has entered puberty when she begins to menstruate (menarche). A boy enters puberty when he begins to produce spermatozoa These events occurs between ages 11 and 14 years. Secondary Sex Changes Secondary sex characteristics such as body hair configuration and breast growth are those characteristics which distinguish the sexes from each other but play no direct part in reproduction. secondary sex characteristics that began in the late school-age period continue to develop during adolescence. DEVELOPMENTAL MILESTONES PLAY OR RECREATION  Thirteen-year-old children change from school-age activ- ities of active games to more adult forms of recreation such as listening to music, chatting on computers, or fol- lowing a sports team’s wins and losses.  Team (or school) loyalty is intense, and following a coach’s instructions becomes mandatory.  Urge parents to encourage youngsters to play sports for their own health and well-being and the companionship involved, however, even though they do not excel.  If they do not excel in sports, encouraged to try other activities in which they can excel, such as science, music, or art. Overuse injuries from athletics occur in early ado- lescence.  Fifteen-year-old children may spend a great deal of time in their room or, in a quiet corner of the home away from traffic and conversation areas. If they cannot find privacy some- where in the house, they tend to spend time elsewhere.  Activities fulfill an adolescent’s need for satisfying interaction with others and are indications of maturity and willingness to accept adult roles. EMOTIONAL DEVELOPMENT Developmental Task: Identity Versus Role Confusion  The developmental task in early and middle adolescence is to form a sense of identity or decide who they are and what kind of person they will be.  In late adolescence, the task is to form a sense of inti- macy or form close relation- ship with persons of the op- posite as with as the same sex.  4 main areas to make gains to achieve a sense of identity 1. Accepting their change body image 2. Establishing a value system or what kind of persons they want to be 3. Making career decisions 4. Becoming emancipated from their parents If young people do not achieve a sense of identity, they develop a sense of role confusion or can have little idea what kind of persons they are. This can lead to their having difficulty functioning effectively as adults. Some adolescents may become delinquent or exhibit acting-out (attention-getting) behavior because they believe it is better to have a negative image than to be nobody at all. BODY IMAGE Adolescents who developed a strong sense of industry during their school-age years have learned to solve problems and are best equipped to adjust to their new body image. Role of Nurses educate adolescents about their bodies and help them to accept the changes that mark maturity. Adolescents are usually their own worst critics, never pleased with any aspect of their bodies. Those with low self-esteem may need parental or health care provider support to understand that a person’s worth is based on more than physical appearance. SELF-ESTEEM Changes in Adolescence that challenges self-esteem: A. Changes in one’s body and physiologic functioning B. Changes in feelings and emotional focus C. Changes in social relationships (including relationships with both family and friends) D. Changes in family and school expectations  All of these factors can have an effect on adolescents’ feelings about themselves, some- times resulting in crisis.  Help parents understand how important it is for adolescents to have immediate success- es such as making the high school basketball team or having a date for the senior prom. VALUE SYSTEM  Adolescents develop values through talking to peers. Adolescents develop values through talking adult ear who will listen to their fears, hopes, dreams and pressures they feel to be somebody. early adolescence: girls tend to band together with girls and boys with boys. They dress identically with other members of their group Adolescents who are different for any reason often are excluded from groups. This behavior may seem immature, but it is necessary establishing a sense of identity. How to address exclusion: Helping adolescents to appre- ciate that it is not fair to ex- clude others on the basis of su- perficial characteristics helps them move more quickly through this stage. CAREER DECISIONS  Part of the feeling of knowing what kind of person you are is knowing what kind of occupation will be a fit. Many adolescents are encouraged to wait until they have been in college for 2 years before choosing a major. EMANCIPATION FROM PARENTS Emancipation from parents can become a major issue during the middle and late adolescent years for 2 reasons: 1. Some parents may not be ready for their child to be totally independent, and 2. Some adolescent may not be sure they want to be on their own.  Both parents and adolescents may need help to understand that emancipation does not mean severance but a change in a relationship. SENSE OF INTIMACY Once adolescents have achieved a sense of identity is early or mid-adolescence, they are ready to work on second developmental task, that of achieving a sense of intimacy. The ability to form intimate relationship is strongly correlated with the sense of trust. Some adolescents require help from parents or other adults to differentiate between sound relationships and those that are based only on sexual attraction. Intimacy involves this deeper level of relationships or developing a sense of compassion or concern for people of both sexes. Empathy, is feeling for another or a developed sense of intimacy in its finest form. SOCIALIZATION Early teenagers may feel more self-doubt than self-confidence. They want to look grown up, but they still look like children. Both male and female 13 years old tend to be loud and boisterous, particularly when pure of the opposite sex whose attention they would like to attract are nearby. They are impulsive and very much like 2 years old children in that they want immediately, not when it is convenient for others Many 13 years old face being in love. Fourteen-year-olds are often quieter and more introspective than they were the year be- fore. They are becoming used to their changing bodies, have more confidence in them- selves, and feel more self-esteem. Adolescents watch adults carefully during this period, searching for good role models with whom they can identify. Idolization of famous people or older adolescents fades as adolescents become more interested in forming reciprocal friendships. Most 15 years old face being in love five or six times a year. COGNITIVE DEVELOPMENT Adolescents reach a point of cognitive development termed FORMAL OPERATIONAL THOUGHT. It begins at age 12 or 13 years and grows on dept over the adolescent years. Involves the ability to think in abstract terms and use the scientific method to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis and think through the probable consequences. Thinking abstractly is what allows adolescents to project themselves into the minds of others and imagine how others view them or their actions (display compassion). MORAL AND SPIRITUAL DEVELOPMENT Almost all adolescents question the existence of God and any religious practice they have been taught This questioning is a natural part of forming a sense of identity and es- tablishing a value system at a time when they draw away form their families Diagnoses: 1. Health seeking behaviors related to normal growth and development 2. low self-esteem related to facial acne 3. anxiety related to concerns about normal growth and development 4. risk for injury related to peer pressure to use alcohol and drugs 5. readiness for enhanced parenting related to increased knowledge of teenage years.  WELLNESS PROMOTION & INJURY PREVENTION FOR THE ADOLESCENTS LESSON 16 LEARNING OBJECTIVES On completion of this lesson, you are expected to demonstrate understanding of the concepts related to coping with adolescent concerns, wellness promotion and injury prevention. Specifically, students are able to: 1. Discuss various parental concerns related to an adolescent’s growth and development. 2. Manage parental concerns related to adolescent’s growth and development through formulation of health teachings suited for each concern. 3. Recognize important safety issues for the adolescent. 4. Formulate interventions and health teachings for the prevention of injury. INTRODUCTION Adolescence is one of the most challenging stages. Concerns emerge as part of the complexities that happen in the growth and development denoting progress and start of maturation. These concerns may be somehow difficult to a family but with the right information through health teachings and right approaches towards the adolescent and family, this phase can be experienced in a more exciting way. Nurses then play an important role to make this transition period from childhood to adulthood a smooth-sailing one by means of identifying cues and formulating interventions and teachings that address the concerns in a child and family centered manner.  CONCEPT DISCUSSION HEALTH PROMOTION 1. Adolescent Safety Accidents, most commonly those involving motor vehicles, are the leading cause of death among adolescents. Theirneed to rebel against authority or to gain attention leads them to take foolish chances while driving, such as speeding or driving while intoxicated. parents need to have the courage to insist on emotional maturity rather than age as the qualification for obtaining a driver’s license. motorcycles, motorbikes, and motor scooters: wear safety helmets to prevent head injury; long pants to prevent leg burns from exhaust pipes; and full body covering to prevent abrasions in case of an accident. Drowning is another chief accident of adolescence, even though it is largely preventable. Teaching water safety, such as not swimming alone or when tired, is as important as teaching the mechanics of swimming. Other common causes of death in adolescents are homicide and suicide. It is important that both water and firearm safety be taught creatively to adolescents by encouraging problem solving rather than by lecturing Athletic injuries tend to increase in number during adolescence 2. Nutritional health  If adolescents’ eating habits are unsupervised, they tend to eat faddish or quick snack foods rather than more nutritionally sound ones  For obese adolescents, a weight-loss diet may be appropriate during adolescence, but it must be supervised to ensure that an adolescent consumes sufficient calories and nutrients for growth.  Foods that supply the necessary carbohydrates, vitamins, protein, and minerals are essential.  CONCEPT DISCUSSION  The nutrients that are most apt to be deficient in both male and female adolescent diets are iron, calcium, and zinc.  Iron– for iron-deficiency anemia  Calcium– for rapid skeletal growth Zinc- necessary for sexual maturation and final body growth.  Good sources of iron are meat and green vegetables; calcium is abundant in milk and milk products; meat and milk are also high in zinc. 3. Daily Activities Adequate sleep, hygiene and exercise are important and should become the adolescent’s responsibility rather than that of the parents. Provide adolescents the time for self-care, such as shampooing hair, etc. It is important to include this in the nursing care plan especially when they are hospitalized. Remembering how important clothing is for adolescents also helps you plan care for them during a hospitalization. Most teenagers seem to improve markedly when allowed to wear their own clothing rather than a hospital gown. In care of their teeth, they should continue to use a fluoride paste and drink fluoridated water to ensure firm enamel growth Because protein synthesis occurs most readily during sleep and adolescents are building so many new cells, adolescents may need proportionately more sleep than any other age group. Adolescents need exercise every day both to maintain muscle tone and to provide an outlet for tension. 4. Healthy Family Functioning Early adolescents may have many disagreements with parents partly from wanting more independence and partly from being disappointed in their bodies. It may be helpful to counsel parents to appreciate that although it is not easy to live with a teenager, it is equally difficult to be the teenager. 5. Common Health Problems A. Hypertension Is present if blood pressure is above the 95th percentile (127/80) for 16 years old girls and 131/81 for 16 year-old boys for two consecutive readings in different settings. Family history is most susceptible factor in developing this disease All children over 3 years of age should have their blood pressure taken routinely. new medication plus education in risk factors makes treatment at this age successful B. Poor Posture Most adolescents demonstrate poor posture, a tendency to round shoulders and a shambling, slouchy walk due to imbalance of growth, the skeletal system growing a little more rapidly than the muscle attached to it. Girls may slouch so as not to appear taller than boys in the belief boys will only date girls shorter than themselves. Girls may slouch to diminish the appearance of their breast size if they are devel- oping more rapidly than their friends. C. Body piercing and tattoos Body piercing and tattoos are becoming a mark of adolescence Both sexes have ears, lips, chins, navels and breasts pierced and filled with ear- rings or tattoos applied to arms, legs or their central body These acts have become a way for adolescents to make a statement different from you D. Fatigue Adolescents comment they feel fatigued to some degree that this can be consid- ered normal for the age group. Assess an adolescents diet, sleep pattern and activity schedule, because all can contribute greatly to fatigue E. Menstrual irregularities Can be a major health concern of adolescents girls as they learn to adjust to their individual body cycles F. Acne Is a self-limiting inflammatory disease that involves the sebaceous glands that empty into hair shafts mainly of the face and shoulders. The peak age for the cession to occur in girls is 14-17 years, for boys 16-19 years The goal of therapy for acne is threefold: (a) decrease sebum formation, (b) pre- vent comedones, and (c) control bacterial proliferation. G. Obesity Most overnight adolescents have obese parents, suggesting that both inheritance and environment play a part in the development of adolescent obesity. H. Sexuality and sexual activity Because of increasing exposure to and acceptance of pre-marital sexual relation in society, more adolescents than ever before engage in sexual intercourse. Counseling can help adolescents improve their perspective and learn how to say no. Falsehoods about sex must be explored through discussion, because adolescents who believe them may never be comfortable with sexual relationships. Be certain to provide information on date rape and rape prevention as well when discussing sexual behaviors, because adolescents are in a high-risk age group for date rape. I. Stalking It refers to repetitive, intrusive and unwanted actions directed at an individual to gain the individuals attention or evoke fear. Stalking behavior can occur in adolescents either males or females can become stalker or victim. Measures to help avoid being stalked are the same as those for avoiding rape, such as advising adolescents not to put themselves in positions where they will be vulnerable to being alone with a stalker J. Hazing It refers to the demeaning or humiliating rituals that prospective members have to undergo to join sororities, fraternities or adolescents gangs. Parents need to be aware of what clubs or organizations their adolescent is attempting to join and what the requirements for membership will be. Health care providers can help adolescents make sound decisions about what type of hazing their organization advocates by asking teenagers about the subject at health assessments. K. Substance abuse Refers to the use of chemicals to improve a mental state or induce euphoria This is common among adolescents that as many as 50% of high school seniors report having experimented with some form of drugs. Types of abused substance are Tobacco, Alcohol, Steroid, Marijuana, Cocaine and Hallucinogens L. Attempted Suicide Is deliberately self-injury with the intend to end one life Successful suicide occurs more frequently in males than in females, although more females apparently attempt suicide than males. M. Runaways Defined as an adolescents between the ages of 10 and 17 years who has been absent from home at least overnight without permissions of a parent or guardian. Runaway adolescents are most likely to be from low and high income families. Unemployment alcoholism, sexual abuse, attempted suicide and poverty are the frequent characteristics.  EXERCISE 16.1 NOTRE DAME OF MARBEL UNIVERSITY MOVIES AND REFLECTION: Watch the movie “Mean Girls” through this link: https:// drive.google.com/file/d/1KaD8SBelmdW5Bgn8lhIYtz1f8ckpP5Yt/view?usp=sharing. Make a reflection paper composed of not less than 400 words. The reflection paper must con- tain your thoughts and realizations about our discussion on the nursing care of a family with an adolescent. Point out the details on our lesson that you have identified in the movie and relate them into your personal experiences as an adolescent. The reflection paper must be in a short-sized document, using the following format: an Arial 12 font style and size , 1.5 spacing, justified paragraph format. FEEDBACK Let us look into how well you fared. If you answered all questions correctly, congratulations! It shows that you are already familiar with the topics discussed in lesson 15 and 6. If your answers are quite not close to the discussion, you have some ideas about the topics covered but need to learn more. Now, you have a glimpse of the Wellness promotion and injury prevention of an Adolescent. Read on and continue ex- ploring this topic. Read further on your textbook pages _______ to _________ and on other Maternal and child health nursing references.  Quiz 14.1 Congratulations! You are done with Lesson 16. In order to see how much you have learned, an online quiz has been prepared for you to answer. Follow the steps stated herewith. 1. Log in to your NDMU Academic Learning Management System Account. 2. Go to My Courses and click NCM 107 A. 3. Look for the online quiz prepared under Week 17 entitled Wellness promotion and Injury prevention of an Adolescents. 4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM. 5. Your are expected to finish the quiz within the time set in the system. 6. Only 1 attempt is allowed unless reasons such as poor internet connection would have affected your access to the quiz. Best of luck and well done! Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott Williams & Wilkins, Philadelphia. 2011. Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017. McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs- ing, 6th Edition. Elsevier, Singapore. 2014. Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018. Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https:// teach.its.uiowa.edu Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make- your-own/crossword/crossword.php Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/ pdfs /classes/rubric-reflections.pdf