Week 14 Nursing Process for Promotion of Normal Growth and Development (NCMA217 Finals PDF)

1ST SEMESTER A.Y. 2022-2023 NCMA217-FINALS IMPLEMENTATION WEEK 14: NURSING PROCESS FOR One of the most important interventions of the infant period is PROMOTION OF NORMA...

1ST SEMESTER A.Y. 2022-2023 NCMA217-FINALS IMPLEMENTATION WEEK 14: NURSING PROCESS FOR One of the most important interventions of the infant period is PROMOTION OF NORMAL GROWTH AND teaching new parents about how to care for their infant and keep the infant safe. Whenever possible, this information should be DEVELOPMENT anticipatory so parents can prepare for ways to care for and protect THE FAMILY WITH AN INFANT their infant as the infant grows. ASSESSMENT OUTCOME EVALUATION Nursing assessment of an infant begins with an interview Evaluate expected outcomes at each visit to detect changes in with the primary caregiver. Important areas to discuss parents’ understanding of caring for their infant. Help parents include nutrition, growth patterns, and development. understand all aspects of infant care, not just a single element. An infant’s height, weight, and head circumference are Examples of expected outcomes include: important indicators of growth, so they should be Mother states she feels fatigued but able to cope with measured and plotted on standard growth charts sleep disturbance from night waking. (Brayden, Daley, & Brown, 2008). These charts represent Parents state five actions they are taking daily to average growth and can determine if the baby’s growth encourage bonding. remains within the same relative percentile at each Father states both he and spouse are adjusting to new checkup. roles as parents. Physical assessment of an infant must be done quickly yet Parents verbalize appropriate techniques they use to thoroughly because a baby can tire or become hungry, stimulate infants. making it difficult to judge overall behavior and Infants demonstrate age-appropriate growth and temperament. development. The primary caregiver should be present to make a child Infant exhibits weight, height, and head and chest feel comfortable. Using a calm approach helps the infant circumference within acceptable norms. remain calm as well. THE FAMILY WITH A TODDLER NURSING DIAGNOSIS Much of your assessment of an infant and family will focus on basic ASSESSMENT needs such as sleep, nutrition, and activity and the parents’ Whether a child is seen for a routine checkup or has come to a adjustment to their new role. Examples of nursing diagnoses are: health care center because of a specific health concern, assessment Ineffective breastfeeding related to maternal fatigue begins with taking a careful health history. Asking parents about a Disturbed sleep pattern (maternal) related to baby’s need toddler’s ability to carry out activities of daily living offers assessment to nurse every 2 hours information not only on the child’s developmental progress but also Deficient knowledge related to normal infant growth and important clues about the child–parent relationship. Careful development observation is another crucial element of nursing assessment of a Imbalanced nutrition, less than body requirements, related toddler. This is because parents may become so emotionally to infant’s difficulty sucking involved in a health concern they may not describe it with complete Health-seeking behaviors related to adjusting to objectivity. On the other hand, parents see their children daily and so parenthood are the best source of information and opinion on when a child Delayed growth and development related to lack of seems to be acting “out of sorts” or “different” (a typical sign a child stimulating environment may not be feeling well). Risk for impaired parenting related to long hospitalization of infant NURSING DIAGNOSIS Readiness for enhanced family coping related to increased financial support Nursing diagnoses related to normal growth and development of Social isolation (maternal) related to lack of adequate toddlers usually focus on the parents’ eagerness to learn more about social support the parameters of normal growth and development or issues of Ineffective role performance related to new responsibilities safety or care. Examples are: within the family Health-seeking behaviors related to normal toddler development OUTCOME IDENTIFICATION AND PLANNING Deficient knowledge related to best method of toilet training Outcomes established for infant care need to be realistic based on Risk for injury related to impulsiveness of toddler the family’s new circumstances. Interrupted family process related to need for close Parents of infants, especially first-time parents, must do a supervision of 2-year-old lot of adjusting, and this takes time. Try to suggest Readiness for enhanced family coping related to parents’ activities that can be easily incorporated into the family’s ability to adjust to new needs of child lifestyle. Readiness for enhanced parenting related to increased If your assessment data indicate that a child needs more awareness for poison prevention exposure to language and you know both parents work Disturbed sleep pattern related to lack of bedtime routine during the day, for example, you might suggest the parents ask their child’s caretaker to talk their infant more. OUTCOME IDENTIFICATION AND PLANNING Encourage parents to spend additional time each evening reading or reciting nursery rhymes to their baby. The To help parents resolve a concern during the toddler period, focus combined interventions should increase the baby’s largely on family education and anticipatory guidance. Urge them to language skills. establish realistic goals and outcomes so they can meet the rapidly changing needs of their toddler and learn to cope with typical toddler behaviors. Otherwise, parents can expect too much of a toddler and grow frustrated instead of enjoying being a parent of a child this age. 1st Semester | NCMA 217 (LECTURE) Parental anxiety related to lack of IMPLEMENTATION understanding of childhood When teaching about typical toddler behavior, teach parents a good development rule is to think of a toddler as a visitor from a foreign land who wants Imbalanced nutrition related to child’s to participate in everything the family is doing but does not know the many food dislikes customs or the language. They need to help their toddler learn these the same as they would that stranger. Also teach parents not only OUTCOME IDENTIFICATION AND PLANNING how to approach a current problem but also how to learn adequate For many parents, preschool is a difficult time because a child is at methods for resolving similar situations that are sure to arise in the an in-between stage: no longer an infant, although not yet ready for future. If parents do not learn methods that can be applied formal school. throughout their child’s growing years, they may win battles but lose Planning and establishing expected outcomes for care of the wars. For instance, parents may find that promising children a treat preschooler often begin with establishing a schedule for discussing when they are in the middle of a temper tantrum will stop the normal preschool development with the parents (this should be done tantrum, but it will not prevent other tantrums from occurring in the at all health maintenance visits). future (and, in fact, may encourage them). Planning for accident prevention such as how to cross streets safely Health visits provide opportunities to help parents learn healthy becomes increasingly important as children begin to enjoy coping techniques. In addition, demonstrating good communication experiences away from home. It is important to plan opportunities for skills with toddlers can serve as a model for healthy communication adventurous activities or messy play. When asking parents to behavior with them. incorporate adventurous activities or messy material into a preschooler’s play, you may be asking them to do something they do OUTCOME EVALUATION not personally enjoy. Expected outcomes must be evaluated frequently during the toddler Most parents do initiate these activities with their child if they believe period because children change so much and learn so many new they are important, but some are able to do this better than others. skills during this time that their abilities and associated parental Allowing children choices may also be difficult for parents because concerns can change from day to day. Examples of expected they want to protect them from making errors. outcomes are: Parents state child maintains a consistent bedtime routine IMPLEMENTATION within the next 2 weeks. Preschool children imitate moods as well as actions. An important Parents state they have childproofed their home by putting nursing intervention, then, is role playing a mood or attitude you a lock on kitchen cupboard by next clinic visit. would like a child to learn. To project an attitude that health Grandmother states she has modified usual activities to assessment is an enjoyable activity, you might suggest preschoolers conserve strength to care for toddler granddaughter by 1 participate by listening to their heart or coloring the table paper. weeks’ time. Accident prevention is also best taught by role modeling (a parent always crosses streets at the corner and does not start the car until THE FAMILY WITH A PRESCHOOLER seatbelts are in place). ASSESSMENT OUTCOME EVALUATION Regular assessment of a preschooler includes obtaining a Evaluation of expected outcomes needs to be continuous and health history and performing both a physical and frequent. Because growth during this period is more cognitive and developmental evaluation. Preschoolers speak very little emotional than physical, parents may report little growth. Evaluating during a health assessment; they may even revert to baby specific areas helps them to see that progress has occurred. talk or babyish actions such as thumb-sucking if they find Examples of expected outcomes might be: a health visit stressful. A history that details their usual Child states importance of holding parent’s hand while performance level is therefore very important for accurate crossing streets. evaluation. Parent states realistic expectations of 3-year-old’s motor Assess a child’s weight and height according to standard ability by next visit. growth charts. Keep in mind these charts are based on Mother reports she has prepared 4-year-old for new baby average weights and heights of white American children, by next visit. so those for children from other ethnic or cultural backgrounds may not completely agree with these norms. THE FAMILY WITH A SCHOOL AGE CHILD Also assess a child for general appearance. Does the child appear alert? Happy? Active? Healthy? Ask whether ASSESSMENT a child can play actively without becoming exhausted. Use both history and physical examination to assess Assess the teeth for presence of cavities. Evaluate for a growth and development of a school-age child. Include symmetrical gait. As preschoolers develop frequent upper questions about school activities and progress. respiratory infections (the average preschooler may have School-age children are interested and able to contribute 6 to 12 a year), assess for these as well. to their own health history; to allow for this, it is useful to interview children 10 years or older at least in part without NURSING DIAGNOSIS their parents present. Nursing diagnoses for preschoolers typically concern health During the physical examination, show your respect for promotion. Examples are: children’s adult-level modesty by furnishing a cover gown. Health-seeking behaviors related to developmental Parents of school-age children often mention behavioral expectations issues or conflicts during yearly health visits. Some Readiness for enhanced parenting related to parent’s parents feel they are losing contact with their children pride in child during these years. This can cause them to misinterpret a ○ Other nursing diagnoses include: normal change in behavior, especially if they are not Risk for injury related to increased prepared for what to expect from their child. Other parents independence outside the home may consider children who behave differently from their Delayed growth and development siblings as “abnormal” when children are just expressing related to frequent illness their own personality. Risk for poisoning related to When problems are discussed in the health care setting, maturational age of child take the history from the parent but also allow the child to express the problem. It may be necessary to obtain the  opinion of school personnel (with the parents’ permission) their parents a health visits, it is best to obtain a health history regarding the problem or even just determine whether separately from parents to promote independence and responsibility school personnel feel a problem exists. In some instances, for self-care. When performing physical examinations on a counselor’s opinion may be necessary. If the problem is adolescents, be aware they may be very self-conscious. They also related to a medical condition, its effect on the family need health assurance and appreciate comments such as “Your hair should also be assessed, because the illness of a child has a nice, healthy feel,” or “This is an accessory nipple. Have you affects the functioning of the entire family. ever wondered about it?” so they can learn more about their rapidly changing bodies. NURSING DIAGNOSIS Common nursing diagnoses pertinent to growth and development NURSING DIAGNOSIS during the school-age period are: Nursing diagnoses for adolescents cover a wide range. Frequently Health-seeking behaviors related to normal school-age used diagnoses related to adolescents and their families are: growth and development Health-seeking behaviors related to normal growth and Readiness for enhanced parenting related to improved development family living conditions Low self-esteem related to facial acne Anxiety related to slow growth pattern of child Anxiety related to concerns about normal growth and Risk for injury related to deficient parental knowledge development about safety precautions for a school-age child Risk for injury related to peer pressure to use alcohol and Imbalanced nutrition, more than body requirements, drugs related to frequent consumption of snack foods Readiness for enhanced parenting related to increased Delayed growth and development related to speech, knowledge of teenage years motor, psychosocial, or cognitive concerns Outcome Identification and Planning OUTCOME IDENTIFICATION AND PLANNING When planning care with adolescents, respect the fact they have a When identifying expected outcomes and planning care, keep in strong desire to exert independence or do mind that school-age children tend to enjoy small or short-term things their own way. This means they are not likely to adhere to a projects rather than long, involved ones. A child with diabetes, for plan of care that disrupts their lifestyle or example, in her early school years may gain a feeling of makes them appear different from others their age. Including them in achievement by learning to assess her own serum glucose level, but planning is essential so the plan will be agreeable and accepted. she may have difficulty continuing glucose assessment on a regular Establishing a contract such as asking an adolescent to agree to basis. take medication daily may be the most effective means to reach a mutual understanding. Adolescents are very present oriented, so a Behavior problems need to be well defined before outcomes are program that provides immediate results, such as increased identified and interventions planned. Often, it is enough for parents respiratory function, will usually be carried out well. In contrast, a to accept the problem as one consistent with normal growth and regimen oriented toward the future, with long-term goals such as development. preventing hypertension, may not be as successful. This does not mean it is not important to teach adolescents about the necessity of IMPLEMENTATION reducing future health risks—by eating well, not smoking, and School-age children are interested in learning about adult roles, so generally taking care of their bodies—but that information will be this means they will watch you to see your attitude as well as your best accepted if geared as much as possible to specific, short-term actions in a given situation. When giving care, keep in mind children benefits to their health. this age feel more comfortable if they know the “hows” and “whys” of actions. They may not cooperate with a procedure until they are IMPLEMENTATION given a satisfactory explanation of why it must be done. Adolescents do poorly with tasks that someone tells them they must do. If they help to plan tasks, however, they can typically carry them OUTCOME EVALUATION out successfully. Adolescents have little patience with adults who do Yearly health visits covering both physical and psychosocial not demonstrate the behavior they are being asked to achieve; a development are important at this age. It may be useful for parents parent or nurse who smokes and asks an adolescent not to smoke, to look back on problems identified at the last visit and discuss if and for example, will probably not be successful. For best results, how they were resolved. Often, some problems and conflicts fade evaluate how an intervention appears from an adolescent’s away without anyone really noticing. As some problems recede, standpoint before beginning teaching. however, others may emerge. At times, the same concerns of parents and the child may appear to be unresolved at each visit. OUTCOME EVALUATION Make sure no underlying problem exists that prevents resolution. Evaluation of expected outcomes should include not only whether Examples of expected outcomes are: desired outcomes have been achieved but whether adolescents are Parent states he allows child to make own decisions about pleased with their success. Individuals will have difficulty how to spend allowance. accomplishing desired goals as adults unless they have high Child lists books she and her parents have read together self-esteem that includes feeling secure in their new body image. in past 2 weeks. Child states he understands his growth is normal, even Examples of outcome criteria that might be established are: though he is the shortest boy in his eighth-grade class. Client states she is able to feel good about herself even Child does not sustain injury from sports activities during though she is the shortest girl in her class. the summer recess. Client states he has not consumed alcohol in 2 weeks. Parents state they feel more confident about their ability to THE FAMILY WITH AN ADOLESCENCE parent an adolescent. Client states she feels high self-esteem despite persistent ASSESSMENT facial acne. Parents rarely bring adolescents for routine health maintenance visits the way they did when their children were younger, and adolescents generally do not come to health care facilities on their own unless they are ill. Unless adolescents need a physical examination for athletic clearance, therefore, they are often not seen for health assessments. When adolescents are accompanied by Maria Alyssa Jimenez | 3