Children’s functional health pattern assessment

A toddler is dependent on their parents for their health management. They are not capable of making decision and 100% rely on their parents to manage their health. They will preform task like brushing their teeth. They may also participate in activities such as bedtime rituals because their parent taught them to do the task. They do not understand that these tasks are preventative measures. Preschool age children will start to be aware of the internal makeup of their body and not just the external parts of the body. They are more aware of the function of their body and start to understand how things work. Children who are preschool age will have curiosity about the opposite sex. Health management is also greatly influenced by teachings of the child’s parents. School age children have the ability to participate in health promotion and prevention. They have a better understanding of concepts of brushing their teeth to prevent cavities or washing their hands to prevent getting sick. Understanding measures to prevent illness is a concept that early in childhood they did not comprehend. School age children can develop health patterns that prevent illness and disease.

One of the potential problems a nurse may come across in a toddler is the child is dependent upon what their parent’s perception of health may be. Parent’s health perception influences the child’s management. Another problem that may arise regarding health management is compliance. If the parent is noncompliant in their own health management then they will most likely be noncompliant with their child’s health management. A nurse can provide the parent with education regarding importance of health management. The children in this age group only understand cause and effect. The do not understand the concept that are needed to comprehend prevention of injury. Health perception is greatly influenced by the parent’s health perception. Preventative task need to be taught by the parent. Examples of health management teachings are brushing teeth regularly; sleep routines, and healthy diet intake. School age children understand they will get sick but they do not understand how it works. The parents should reinforce encouragement of good health promotion and prevention to the child. Development level must be considered when teaching a child health promotion and management. Development varies greatly between the ages of 6 years old and puberty. The teaching provided to the child should be catered to the developmental level of the child. Nutritional-Metabolic Pattern:

List two normal assessment findings that would be characteristic for each age group.

List two potential problems that a nurse may discover in an assessment of each age group.

(Edelman, 2014)

A toddler is normally weaned from the bottle. They are able to eat foods and nutrition is no longer only provided by breast milk, formula, or milk through a bottle. It is normal for a toddler to have fluctuations in growth and appetite during this developmental stage of their life. Preschool age children often refuse new introduced foods. A parent should encourage their child to have healthy eating habits. The meals provided should be a well-rounded healthy diet. The parent’s food choices also influence the child’s food selection. If a parent doesn’t like certain food the child my not be given those food selections. A nurse should encourage the parent to keep in mind the dietary needs for healthy growth development. School aged children should have dietary intake that consist of 1200 to 1800 calories. They should have 3 meals and at least 1-2 snacks included in their diet. The meals and snacks should include calcium, iron, vitamin C, low fat, and low sodium foods. A well-rounded healthy diet is needed to promote growth and healthy eating habits for the future.

A toddler can have problems with tooth decay. One way to prevent tooth decay is to encourage parents to limit juice and milk in bottles especially at bedtime. Toddlers also can be very picky eaters. A nurse can encourage the parent to keep a record of food intake. This will help the parent assess the nutritional need for the child. Another great way to help with picky eaters is to involve the child in food preparation. The active participation may help increase the toddler’s nutritional intake. Preschool age children should consume large amounts of carbohydrates and calcium for the needs of bone growth. Parents should encourage meals that include these types of foods. Fat content should be high in preschool children. The burn energy and sugar quickly with the activity level and dietary intake should be provided to enhance growth. Parents should provide meals that help the child promote optimal health. The average child’s diet does not meet dietary recommendations for the age group. Parents need to play an active role in providing healthy and recommended food the child needs for healthy development. Health concerns such as obesity, childhood diabetes, and hypertension are seen in children due to poor nutritional intake. Parents can help the child prevent future complications by providing healthy choices for the child and display healthy eating habits. Pattern of Elimination:

List two normal assessment findings that would be characteristic for each age group.

List two potential problems that a nurse may discover in an assessment of each age group.

(Edelman, 2014)

A toddler will toilet train usually around 3 years old. It is common for toddlers to have constipation issues. They want to play and will not take the time out of play to go to the restroom. They are busy little people and are afraid they will miss something by going to the restroom for a few moments. By preschool age a child is capable of independent toileting. They are more independent at this age and able to control bladder and bowel. Even thought the children are more independent with toileting they still may struggle with physical task like remembering to flush or wash hands. Parent should help reinforce these good hygiene behaviors. School age children are able to control their bowels and bladder similar to adults. They are also able to communication concerns to parents such as burning with urination, diarrhea, or constipation. They are able to flush, wash hands, and dress themselves. There involvement is more independent.

Problems may arise for the toddler regarding readiness for toilet training. Every child is different. Some children toilet train early and some do not. The parent should attempt toilet training their child at the appropriate age for the child by assessing the cognitive and understanding level of the specific child. A nurse may see frustration in both parent and child during toilet training. It is a daunting task. It is important to encourage the parent to be consistent. Encourage the parent to talk to other parents who have found things that have worked for them to help ease the pains of the learning process for both child and paren. Nighttime bedwetting may continue to be a problem. Parents who struggle with this should be reminded that is not uncommon for a child this age to have problems with bedwetting. Most children outgrow bedwetting. If the problems persist, the parent should explore medical conditions that may be contributing to the problem.

Preschool age children may be teased or criticized by others. They may experience feelings of shame and doubt for being a “bed wetter”. Parents should provide comfort and understanding with child in the matter of bed-wetting. A child should not be punished for wetting the bed. The child should know this is problem many children their age have. Nighttime bedwetting may still persist in some cases. The child may become embarrassed and develop low self-esteem. The parent should encourage the child and provide positive reinforcement. It is import to protect modesty. If the problems persist the parent may need to explore a medical condition causing the problem. Some children can also “dribble”. Small amounts of incontinent urine may be an indication of holding behaviors. If the child waits to long it can result in the dribbling. The parent should encourage the child to use the bathroom when sign such as crossing legs or bouncing around are noted. If problem persist medical causes should be explored. Pattern of Activity and Exercise:

List two normal assessment findings that would be characteristic for each age group.

List two potential problems that a nurse may discover in an assessment of each age group.

(Edelman, 2014)

(Edelman, 2014)

A toddler is always busy. They are always into something and constantly on the go. A child this age likes to have a ritual or pattern to routine. The use the rituals as a safety net or security. Rituals may include eating, sleeping, and playtime. The patterns or routines help them feel secure. Preschool children will explore and show increased coordination and fine motor skills. The child will be seen as less clumsy. They will also separate from the parents with greater ease at this age. This is the age a child starts going to school and ability for the separation is achievable with play or distractions. School aged children foster and acquire regular physical activity patterns. They start to develop activity patterns they will take into adulthood. They develop strength and coordination. Sports are common activities school age children will begin to participate in. They enjoy the challenge of the activity and the socialization it provides.

Problems that may be displayed in a child this age are inability for sharing. Toddles tend to parallel play. They do not share well. Toddlers also are known for temper tantrums. Tantrums stem from frustration. They may get frustrated because they cannot perform a task. The most important thing a parent needs to be aware of during a tantrum is safety. The parent should maintain safety during this trying time of development. Children in this age group will mimic the activity and exercise behaviors of their parents or role models. They are greatly influenced by the people in their lives. If the parent is not active then the child may follow suit. Positive role models will help the child become an active individual. Video games and computers are the current entertainment for our youth.

No activity or exercise are involved in these play times. Parents should limit “inactive time” and encourage active play. School age children of today are a computer generation. This can lead to inactivity. The inactivity can lead to health concerns for the child. Parents should encourage participation in activities and limit computer and video game time for their children. School age children develop socialization skills through activity and sports participation. By not being active the child may be at a disadvantage for developing the much-needed social skills needed for later in life. Parents should display encouragement and positive reinforcement toward an active lifestyle. Cognitive/Perceptual Pattern:

List two normal assessment findings that would be characteristic for each age group.

List two potential problems that a nurse may discover in an assessment of each age group.

(Edelman, 2014)

Toddlers will want to perform task on their own. They don’t want help. This independent phase can be frustrating to parents. They also will use gestures instead of language because of their limited vocabulary. This can also cause frustration for the parent and the child because of lack of communication. Preschool age children are concrete thinkers. They are black and white thinkers. School age children do not think outside the box. It is also common for children this age to have imaginary friends. They are very imaginative at this age and parents should be reminded that it is very common for a child to start making up stories at this age. School aged children can master new concepts or ideas. They able to acquire needed thinking skills for the future. School age children begin to use intellect and logic to problem solve. They are able to handle challenges and problems presented at school and home by thinking through the problem and developing an answer to the problem through reasoning.

Children this age are not as easily distracted by toys, blankets, or parents as they once were. The parent may have a problem trying to redirect the toddler’s attention. This is also the age of the “terrible two’s”. They will test their parents through trial and error. It is important for the parent to be consistent and clear during this phase. Positive reinforcement for good behavior will reinforce the good behavior. Children in this age group are unable to consider more then one fact at a time when making a decision. The parents of these children should be reminded to consider this when presenting a decision making process with the child. Parents can become concern when the child’s imagination is running wild. The nurse should educate the parents that this is a common occurrence with children this age. School age cognitive ability will emerge and grow with experience and maturity. Developmental level varies greatly in cognitive ability. The developmental level of the specific child should be taken into consideration when assessing a child’s cognitive pattern. A parent may assume the child’s cognitive level is the same as their siblings was at that age. It is important for the parent to remember every child develops differently. Pattern of Sleep and Rest:

List two normal assessment findings that would be characteristic for each age group.

List two potential problems that a nurse may discover in an assessment of each age group.

(Edelman, 2014)

A toddler requires about 12 hours of sleep a day. They may nap 1-2 times a day depending on the specific child. Nap routines are essential for a happy child. Disturbances in the child’s sleep pattern can wreak havoc on a household. Preschool age children require 8-12 hours of sleep a day. They may or may not require naps. The fatigue and irritability of the child should be monitored by the parent to ensure the child is getting the amount of rest need for healthy development during this phase of child growth. Children this age need to have bedtime rituals. This helps the child “wind down” before going to bed. The routines help promote rest and healthy sleep patterns. Most school age children have no difficulty with sleep disturbance. Their sleep pattern is similar to adults. They need to continue to have sleep routines to get good sound rest needed for growth and development. Sleep is also needed for concentration and learning. School grades will decline if the child is not resting well at night.

The child may be unaware of their fatigue when enthralled in play. They may fight the parent regarding nap time or bedtime. The toddler may become overtired in some cases. They can have difficulty sleeping because of being overtired. The parent should be encouraged to keep the child on the sleep schedule established to prevent the sleep disturbance.

Preschool age children will become irritable and cranky when not resting the time needed. Frustration between the parent child relationships can suffer due to loss of sleep and fatigue. Parents should be encouraged to keep their child on a sleep routine to ensure the child is getting the required sleep needed for their age group. Even if the child does not take naps a rest time or quiet time can be implemented. School age children can suffer from night terrors. TV programs, video games, or movies can cause the child to have night terrors. The parent should monitor what the child is viewing. Night terrors can be seen in some cases of abuse. The parent should be aware of that fact if night terrors persist and intensify. Sleepwalking is also a sleep problem a child can develop. Safety for the child is the most important educational concept the parent should be instructed on. Pattern of Self-Perception and Self-Concept:

List two normal assessment findings that would be characteristic for each age group.

List two potential problems that a nurse may discover in an assessment of each age group.

(Edelman, 2014)

A toddler will acquire a sense of autonomy. They want to be independent. They may think they can do things by themselves even though they are unable. Toddlers also love to climb, crawl, taste, and smell. Senses are all used at this age. They are exploring their environment and learning everyday through the use of smell, touch, and taste. Self-perception in a preschool aged child is increased. The child starts to understand the results of their actions and the impact their actions cause. By contributing the child will increase their self-esteem. School age children start to relate to older siblings or children. This is a normal part of the development of a school age child. School aged children will focus on success to enhance their self-perceptions in a positive way. The children in this age group will develop their self-concept through relationships. How others portray the child will affect how the children see themselves.

Exploring phase can be a dangerous time for a toddler. The child’s environment should be made as safe as possible during this phase of the child’s development. The parent should also encourage autonomy at this age. Not encouraging autonomy at this phase of development can result in shame and doubt in the child. Children can struggle with autonomy at this stage. They want to be independent but are also used to relying on parents for needs. Parents should encourage autonomy for the child’s development growth and better understanding of self-perception. Parent’s self-perception can negatively affect their child. Influence can have a large impact on a child and the parents should be aware. If a school age child receives very little encouragement they will see their self-perception in a negative way. This will cause low self-esteem and behavioral problems. Negative relationships can cause negative self-concept for the children in this age group. Role-Relationship Pattern:

List two normal assessment findings that would be characteristic for each age group.

List 2 potential problems that a nurse may discover in an assessment of each age group.

(Edelman, 2014)

A toddler will begin to understand the roles of siblings and parents in a family unit. This is a very limited understanding at this age. Toddlers normally will think of the roles of a family member by the actions they display. An example of this is a mother comforts injury. A sibling takes away toys. A father enforces rules. Their perception is not this is my mother, father, or brother but defined in their minds as actions the individual displays. Peers play a significant role in a preschool age child’s life. They can influence the behaviors and actions of the child in a positive or negative way. Parents or role models in preschool aged children influence role perception. Parents should be cautious of the examples they are showing to their child regarding role relationship. A school age child will begin to feel a sense of security with their family in a healthy family setting. They will show love and compassion to others around them. Children this age will follow rules and respect the role models in their lives. Healthy role relationships are formed from positive influences around them.

Sibling rivalry is a common problem at this age. The toddler will be interested in everything the older sibling is doing or toys they have. This will frustrate the older sibling causing fighting and rivalry. Another problem that may occur is parents taking side during this development stage. If a parent does not reward or punish the satisfaction by the children becomes less. They haven’t gotten the other child in trouble so the thrill and satisfaction is not there. You cannot make stop children from fighting but by the parent not taking sides may reduce the occurrences of the fighting. Caution should be taken by the parents to have positive role models surrounding their children. The child develops their role by modeling examples of others around them. A child at this age wants to start playing a role in relationships. Encourage positive role models to develop this need in preschool age children. School age children have a significant influence on self-perception from their siblings. This fact can have a negative effect on the child. If the sibling is not a good role model for the child the child will act out as the older sibling does. Praising good behavior by the parent can help gear the child to a positive self-perception. Children in this age group can also test parents with violent or bad behavior. Steps should be taken to deter this type of behavior.

Sexuality – Reproductive Pattern:

List two normal assessment findings that would be characteristic for each age group.

List two potential problems that a nurse may discover in an assessment of each age group.

(Edelman, 2014)

Parents may see exploration of genitals during toilet training. They have discovered and are more aware of this part of their body. Another action you might see in a toddler is masturbation. They are exploring and curious about the genitalia area of the body. Parents can have multiple concerns during this phase of development but education on normal patterns for toddlers can help ease their concerns. Preschoolers will recognize male and female genders. They know there is a difference between the sexes. Positive reinforcement when displaying differences between sexes needs to per reinforced. Preschool children will ask questions about the physical differences between woman and men. They are inquisitive and want to know absorbing everything the adults in their lives tell them. School age children will learn and exhibit gender specific behaviors and roles. The people who influence them most in their lives define the concept of gender role. They will have increased curiosity about sexual function.

Parent will have worry and concerns how to address issues with child. It is important for the parent to use correct terminology and be clear with child. Confusion for the child can happen very easily at this stage. The child may also be unaware of appropriate and inappropriate behaviors regarding exploration. The parent will need to communicate appropriate behaviors to the child. Communication will help the parent and child get through this phase of growth. Some problems may arise from preschooler’s questions regarding differences between male and female. A parent should be simple and factual in their responses. This will help alleviate confusion in the preschooler. Preschoolers may get negativity from their curiosity about gender and differences between the sexes. This can cause low self-esteem. Parents should be cognitive of this fact want responding to questions asked by the preschooler. Stereotypes can influence a child by instilling a negative view of gender roles and behaviors. They hear things from parents, friends, and siblings that may contribute to this problem. Sexual issues and curiosity may cause inappropriate behaviors. Children will also accept what children tell them about sexuality as fact. The child they are getting information from may be no more informed then they are. Pattern of Coping and Stress Tolerance:

List two normal assessment findings that would be characteristic for each age group.

List whom potential problems that a nurse may discover in an assessment of
each age group.

(Edelman, 2014)

Toddlers cope differently depending on the child. Temperament of the child fluctuates in every child. Temperament impacts the child’s ability to cope. A toddler will also imitate the behaviors and coping mechanism of their parents. They observe how their parents cope with stress and display the same coping mechanisms. Preschool age children express their coping and stress tolerance through tone and expression. You can assess physical symptoms from the child by the face they are making or the tone they use with you. Children this age also will follow the lead of the adult they look up to. The child absorbs the coping and stress tolerance in the parent or role model they look up to. Stress will physically affect a school-aged child. They may have symptoms such as their heart is racing or they can get and upset stomach. A school age child should develop healthy coping mechanisms to get them through stressful situations.

Difficult temperaments can cause stress and frustration within family dynamics. Patents and understanding by the parents can help transition the child through stressful situations. A problem may occur when parents themselves don’t have health coping mechanisms. The parent can negatively affect their child’s stress tolerance and coping skills. The nurse should have the parents evaluate their coping ability and consider how it affects their child. Negative role models influence a preschoolers coping mechanism. Parents should be cautious to show good example of coping and stress management to their child. Preschoolers can sometimes struggle with their emotions and feelings. They act out or display bad behavior that stems from their stress. A parent should be learning the stress expression of their child so they can help the child cope with the stress in a positive way. A child in this age group can have complications such as anxiety and feelings of hopelessness. Depression or suicidal thought or actions can result from ineffective coping mechanisms. Parents should monitor children for sign and symptoms of depression. Pattern of Value and Beliefs:

List two normal assessment findings that would be characteristic for each age group.

List two potential problems that a nurse may discover in an assessment of each age group.

(Edelman, 2014)

Toddlers feel that rules are absolute. They will not question if a rule is reasonable or not. They fear punishment. The fear in a toddler may promote good behavior but the parent must be careful not to instill too much fear in their child. A toddler will also be able to learn prayers, songs, or rituals of family beliefs but they do not understand the meaning of them. Preschoolers have thoughts of guilt and conflict. They begin to rationalize and think through negative or positive behaviors. The thoughts of what is negative or positive are produced by the values and beliefs the child’s parents teach them. Children will pick up on values and beliefs portrayed in movies and on TV. Careful monitoring by parents of child’s exposure should be implemented. School age children have moral development forming. They are quick to let an adult know if someone did something wrong. Beliefs are usually the parents beliefs at this age. They have not yet begun to question what they are told. What a parent says in their eyes is what they truly believe.

A nurse may see unhealthy fear of wrong doing in a toddler. The nurse should make sure no abuse has taken place. Monitoring and reporting signs of abuse in a child with unhealthy fear by nurse will help keep the child safe. The parent may also not understand the child ability to understand the values and beliefs taught to them for their developmental level. The parent may just need education on cognitive development in a toddler. Preschooler’s values can change in an instant. One minute they are sweet and kind to a friend and the next they are yanking their friend’s toy out of their hands.

Children want to do the right thing but sometimes values they had go to the back of their mind. It is important for the parent to encourage and reward good values and positive displays of beliefs. Negative role models that teach children about values and belief can be a problem. Preschoolers are like “little sponges”. They absorb what they hear and what they are taught. Parents should try to surround their children with positive influence to promote positive values and beliefs. School age children will behave badly by lying, exaggerating, or give inaccurate account to make them look better to the adult. Influences from values and beliefs instilled by the parents will help deter these bad behaviors. A child wants to “look good” in their parents eyes. Parent’s values can have a negative effect on a child. The parents have to instill good values in their child for a positive outcome. (Edelman, 2014)

Short Answer Questions

Address the following based on the above assessment findings. Expected answers will be 1-2 paragraphs in length. Cite and reference outside sources used.

1) Compare and contrast identified similarities as well as differences in expected assessment across the childhood age groups.

Children have many different similarities and differences depending on their age and development level of the child. The most consistent assessment finding in all age groups is that the parents of children have a significant role in the health function patterns of all children. The parents or role models that are involved in raising the child influence every functional pattern discussed. The parents influence their children through their teaching, education, discipline, values, examples shown, and beliefs. A child in an unhealthy family environment will be influenced by the people and environment and repeat the bad behaviors and belief displayed by the people they look up too. Positive influences will result in positive outcomes for the children.

Differences are based on the developmental level of the child. Children who are toddler and preschool age are growing and learning and need more sleep and have different nutritional requirements then a school age child. The School age child can logically think through situations where as a younger child would display more concrete type thinking when presented with a problem or situation. The development level of the school age child varies greatly and education or teaching should be catered to the specific child’s level. Teaching approached with children will have a large variety in the delivery of information. A toddler or preschooler may learn best with puppet shows, stories, or play. A school age child might learn more effectively with discussion, examples, or diagrams. A nurse should take into consideration the differences and similarities in the child’s assessment when educating children and parent on functional health patterns.

2) Summarize how a nurse would handle physical assessments, examinations, education, and communication differently with children versus adults. Consider spirituality and cultural differences in your answer.

Physical assessment and examination cannot be approach in the same way you would approach and exam and assessment on an adult. Children may be scared of the nurse or the strange equipment. A child can be intimidated by the situation and may cling to their parent. A great way to complete your exam with a child is to let the child be held by the parent during the exam. If a nurse wishes to listen to the child’s lung the best way is to have the child held by the parent and listen from behind. If a nurse attempts to separate the child from the parent the child may scream. The nurse will not hear any lung sounds with the child upset and crying. Play can be used for a successful assessment and examination of a child. Let the child use the stethoscope to listen to the nurse first. Touching and feeling the “scary equipment” will help ease the child’s fears. A nurse can learn a lot of information from just observing a child.

Observing skin color, breathing effort, and the actions or domineer of a child can tell a nurse a large amount of information during his or her assessment. Education to a child should be presented in a manor that fits the child’s developmental level. A toddler or preschool child my learn best with pictures or other tactile teaching tools. A school age child can understand at a higher level but still do not have the capability of understanding that an adult does (Faria, Gidden, 1997). The nurse should be aware of cultural considerations during assessment of child. Cultures such as Chinese may use cupping to promote healing. The process will leave bruises on a child. A nurse may note bruises on a child during assessment and think that child abuse may be a problem. Cultural competent nurses can help alleviate unwarranted accusations (Gavrilla, Palicia, 2010).

References
Edelman, C. (2014). Health Promotion Throughout the Life span (8th ed.). Retrieved from VitalBook Faria, S., & Glidden, C. (1997). Patient assessment. Assessment of the child: what’s different? Home Care Provider, 2(6), 282-285. Gavrila, C., & Palicica, M. (2010). Reserving the rural cultural heritage: a few considerations. Agricultural Management, 12(1), 1-6.