Childrens Fubctional Health Pattern

Functional Health Pattern Assessment (FHP) Toddler
Erickson’s Developmental Stage:
Autonomy vs. Shame and Doubt Preschool-Aged
Erickson’s Developmental Stage:
Initiative vs. Guilt: School-Aged
Erickson’s Developmental Stage:
Industry vs. Inferiority
Pattern of Health Perception and Health Management:

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. The overall growth rate slows significantly, and the increasingly active toddlers begin the process of shedding baby fat and straightening their posture (Edelman & Mandle, 2010).

Interviewing the caregiver and watching the reaction of the child will give clues of trust. Child should appear fearful of their environment, clinging to the caregiver (Arlene F Harder MA, 2012). Because children in this age group are often seeking independence, they are likely to learn to accept personal responsibility for their actions; however, parental involvement is crucial at this time in order to fully meet the child's needs (Edelman & Mandle, 2010). Growth and development within normal range Dietary needs, eating habits and dental hygiene provided (Edelman, C.&Mandle,2010) School-age children must be aware of their surroundings in order to prevent harmful situations. They should have knowledge of where and how to go or help (Arlene F Harder MA, 2012).

They should have school etiquette for colds; flu and bathroom use (Arlene F Harder MA, 2012). Toddlers are prone to injury inside the home and out, physical assessment of the child’s body to look for injury or possible physical abuse vs. cultural markings. (Arlene F Harder MA, 2012). Children need to develop a sense of personal control over physical skills and a sense of independence. Toilet training should have been initiated (Erik H. Erikson2012).

How is the discipline handled at home? The child should be able to speak to this. Notice the interaction between the primary caregiver and child during this phase. Is the child fearful or anxious of doing something wrong, extreme behavior i.e. extremely compliant or extremely demanding, extremely passive or extremely aggressive (Erik H. Erikson2012).
Nurses assess whether the child is receiving preventive dental care. Parents should be encouraged to begin or maintain this care. Suggestions for promoting good oral hygiene as part of general health-promotion teaching (Edelman & Mandle, 2010). A natural disaster or the death of a parent can be devastating for a child this age. One of the most common reasons for death in a school-age child is from firearms, trauma, and cancer. (University of Illinois, 2012). Note reaction to touch and questions especially if child shields or flinches at sudden movements, afraid to go home (Melinda Smith, M.A., and Jeanne Segal, Ph.D.2012).
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.
Toddler should be weaned from the breast to milk (Edelman, C.&Mandle,2010)

Toddler within normal range for growth chart (Edelman, C.&Mandle,2010)

Child eating 3 meals a day at least five serving of fruits and vegetables and 2 snacks (Edelman & Mandle, 2010).
Child should consume approximately half of their diet in carbohydrates, with the other half consisting of protein (5% to 20%) and fat (30% to 40%) (Edelman & Mandle, 2010). Some school-age children willingly try new foods, many continue to dislike vegetables, fruits, casseroles, spicy foods, and iron-rich foods and prefer a small range of foods (Edelman & Mandle, 2010).
School age children should consume 1200-1800 calories per day (Edelman & Mandle, 2010). |

Toddler should eat food rich with Iron (Edelman & Mandle, 2010).

Toddler still using bottle causing dental caries (Edelman & Mandle, 2010). Iron deficiency results in behavioral and cognitive deficits (Edelman & Mandle, 2010).
Salt and sugar intake should be moderate. Marshall's study group (2007) provides support for limiting nonmilk sugar intake in order to limit carcinogenicity (Edelman & Mandle, 2010). Cultural factors as well as food access influence poor nutrition among the homeless and children in child care centers and contribute to the high level of obesity, especially among Hispanic, Black, and Native American children(Edelman & Mandle, 2010).
Children frequently make their own after-school snacks and need supervision regarding the content. Foods high in vitamins A and C, fruits, and vegetables should be encouraged daily (Edelman & Mandle, 2010).
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. Toddler should now begin to be toilet trained (Edelman, C.&Mandle,2010)

Toddler should have a normal bowel group (Edelman & Mandle, 2010). Child should be expected to change their clothing if it becomes wet or soiled (Edelman & Mandle, 2010).

Child should be developing independence with toilet habits (Edelman & Mandle, 2010). School age children should have pattern of 1-2 bowel movements daily, and should void at least 6-8 times daily (Edelman & Mandle,2010 p.514) Child should have bowel control by the age of 5, along with being able to dress wash and wipe their hands (Edelman & Mandle, 2010). Toddler frustrated with toilet training. Always refuses to go to the bathroom (Edelman, C.&Mandle,2010)

The toddler may soil in their clothes, and the parent should no scold the child, but ignore the behavior (Edelman & Mandle, 2010).

Child should have a bowel movement after every meal (Edelman & Mandle, 2010).

Child may have anxiety with toilet performance and should not be teased or punished when they are unable to perform independently (Edelman & Mandle, 2010). Involuntary urination at an age when control should be present or enuresis (Edelman & Mandle, 2010).

Child may have a problem with day dribbling or bedwetting (Edelman & Mandle, 2010).
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. Toddler should engage in play (Edelman & Mandle, 2010).

Toddler should develop rituals around their eating and sleeping (Edelman & Mandle, 2010).

Toddlers will engage in parallel play and will not share with others (Edelman & Mandle, 2010). Preschooler does modeling and activity of play which involves other children (Edelman & Mandle, 2010).

During play the preschooler mimics the role of the adult and involves dramatic play, sometimes imaginary fantasy (Edelman & Mandle, 2010). School age children play with peers as their exercise (Edelman & Mandle, 2010).

School age children exercise by group as in organized sports and clubs (Edelman & Mandle, 2010). Toddlers under the age of 2 should not have any screen or TV time to encourage exercise and exploration of their environment (Edelman & Mandle, 2010).

Problems can arise when the preschooler chooses spend more time in front of the TV than in play (Edelman & Mandle, 2010).

Preschooler which watches television of adult’s which are violent, and contain moral decision making (Edelman & Mandle, 2010). Problems can arise with the school age child if the parent uses psychological and physical pressure to manipulate them in the organized sports or activities (Edelman & Mandle, 2010).

Too much computer and electronic time decreases activity and family interaction (Edelman & Mandle, 2010).
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. Toddlers learn by the use of objects (Edelman & Mandle, 2010).

Toddlers should have mastered the basics of language function, form and content by age of 3 (Edelman & Mandle, 2010).

The preschooler is now able to be oriented in space, and develops an awareness of the location of and understanding of the home with the neighborhood (Edelman, C. & Mandle, 2010). The preschooler is now able to structure daily activities, and has a sense of value for activities, objects, and people. (Edelman, C. & Mandle, 2010). School age child should master new ideas which requires intact senses and should understand concepts regarding objects and concept of observation of substances (Edelman, C. & Mandle, 2010).
School age child should be able to understand classifying and ordering. (Edelman, C. & Mandle, 2010).

Toddler may appear to be acting out, called the terrible twos, but they are learning by repetition (Edelman & Mandle, 2010).

Toddlers who withdraw from interactions, and has impaired communication may need to be evaluated for Autism (Edelman & Mandle, 2010). Preschooler could have problems with amblyopia (Edelman, C. & Mandle, 2010).

Preschool has difficulty with discriminating right images due to visual sensory deficits and left mirror images, such as confusing letters (Edelman & Mandle, 2010). School age child may have problems with learning by not having intact hearing, and this deficit compromises learning in school and important socialization with peers (Edelman. & Mandle, 2010).
School age child may have problems learning due to sensory deficits such as being hyperopic, or farsighted (Edelman. & Mandle, 2010).
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. Toddler should be sleeping 12 hours a day with 1or 2 naps lasting 1-2 hrs. Toddler should have bedtime rituals which consisting of activities or rituals for going to bed (Edelman, C.&Mandle,2010)

Preschool should sleep from 8-12 hours during the night without naps (Edelman, C.&Mandle,2010)

Preschool should have quiet time daily prior to going to bed (Edelman, C. &Mandle, 2010). School age children should sleep 8-12hrs. without naps (Edelman, C. &Mandle,2010).

School age children do not have a problem going to bed alone (Edelman, C. &Mandle, 2010). Toddler tries to prevent getting rest by attention seeking behavior with numerous requests (Edelman, C. &Mandle, 2010).

Toddler may have a problem with night terrors (Edelman, C. &Mandle, 2010).

Preschooler makes have problems with night waking (Edelman, C. &Mandle, 2010).

Preschooler may have problems sleeping in their own bed (Edelman, C. &Mandle, 2010). School age children may have disturbances such as night terrors and sleep talking (Edelman, C. &Mandle, 2010).

School age children may have Enuresis or bed wetting interfering with sleep (Edelman, C. &Mandle, 2010).
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.
Toddler should have a sense of their personality (Edelman, C. &Mandle, 2010).

Toddler should overcome the sense of doubt and shame (Edelman, C. &Mandle, 2010).

Preschooler’s self-esteem is built by reinforcing skill, and accomplishing tasks (Edelman, C. &Mandle, 2010).

Develops a sense of initiative by their motor activity, and active imagination (Edelman, C. &Mandle, 2010). School age child focus is on their personality development, and the child should have a sense of industry (Edelman, C. &Mandle, 2010). The school age child focus should master personal tasks, and social tasks (Edelman, C. &Mandle, 2010). As a result of the toddler seeking autonomy could result in a conflict with the parent when the toddler refuses to obey (Edelman, C. &Mandle, 2010).

Toddler may have a temper tantrum in order to establish autonomy (Edelman, C. &Mandle, 2010).

If the preschooler is not allowed to try new experiences by parents this delays promotion of development of initiative (Edelman, C. &Mandle, 2010).

If preschooler is criticized they will feel guilty and inadequate (Edelman, C. &Mandle, 2010). Problems with inferiority will result if child fails at attempted tasks (Edelman, C. &Mandle, 2010).

School age child self-concept is viewed by as others see them, and their self-esteem also is viewed by as how others see them (Edelman, C. &Mandle, 2010).
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. Toddler knows the roles of parents and sibling by how the roles relate to the toddler (Edelman, C. &Mandle, 2010).

Toddler tends to expect certain roles from parents (Edelman, C. &Mandle, 2010).

Preschoolers understandings the gender expectations regarding jobs, activities, and competencies of people in the environment (Edelman, C. &Mandle, 2010).

Values ideas and information from their peers, and does role play to learn about new roles to relieve stress (Edelman, C. &Mandle, 2010). School age child learn about behaviors which are acceptable through limit setting (Edelman, C. &Mandle, 2010).

School age child will have school, and peer group relationship as a priority to promote socialization (Edelman, C. &Mandle, 2010). Toddlers can regress to regain a sense of mastery, when dealing with sibling rivalry (Edelman, C. &Mandle, 2010).

Toddler can get into fights with sibling in order to get rewards (Edelman, C. &Mandle, 2010).

Preschoolers can be negatively influenced if inaccurate roles of male and female are depicted (Edelman, C. &Mandle, 2010).

Preschooler may react to changes by displaying regression, confusion, or irritability especially when they don’t understand (Edelman, C. &Mandle, 2010). School age child may have problems with discipline (Edelman, C. &Mandle, 2010).

School age child have may experience child abuse which leads to problems later on in life such as anxiety (Edelman, C. &Mandle, 2010).
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. Toddler will now explore their genital area by touching it (Edelman, C. &Mandle, 2010). Toilet training leads to the toddler being curious about their genitals (Edelman, C. &Mandle, 2010).

Preschooler knows that there are two genders which they identify with their own gender (Edelman, C. &Mandle, 2010).
Preschoolers have body image as part of gender identity which they are curious about their body and sexual functions (Edelman, C. &Mandle, 2010). The school age child identifies their sexuality with the parent of the same gender (Edelman, C. &Mandle, 2010).
School age child will learn the concept of gender and expected behavior which is about their sexual function of their body, so they engage in exploration of body parts of others (Edelman, C. &Mandle, 2010). Toddler may engage in masturbation from exploration of their genitals (Edelman, C. &Mandle, 2010).

Toddler exploration could lead to discomfort or embarrassment from the parent (Edelman, C. &Mandle, 2010). Preschooler who seeks sexual information can sometimes be viewed as naughty or promote negativity for the child (Edelman, C. &Mandle, 2010).

Preschool may get a negative gender role model by the media (Edelman, C. &Mandle, 2010). The school age child which explores a child of the same gender is viewed as wrong by their peers (Edelman, C. &Mandle, 2010).

School age children have to deal with stressors as a result us a variety of coping skills defense, mechanisms of regression, denial, repression, projection, displacement, and sublimation (Edelman, C. &Mandle, 2010).
Pattern of Coping and Stress Tolerance:
List two normal assessment findings that would be characteristic for each age group.

List wo potential problems that a nurse may discover in an assessment of each age group. Toddler copes by using temperament (Edelman, C. &Mandle, 2010).

Toddler will imitate parent’s means of coping (Edelman, C. &Mandle, 2010).

Preschooler copes with stressors by fantasy play (Edelman, C. &Mandle, 2010).

Preschooler uses coping mechanisms like those of a toddler such as separation anxiety, regression (Edelman, C. &Mandle, 2010). School age children have to deal with stressors as a result us a variety of coping skills (Edelman, C. &Mandle, 2010).

The school age child may also use humor as a means to cope (Edelman, C. &Mandle, 2010). Toddler can regress when feeling over whelmed with stressors (Edelman, C. &Mandle, 2010). Toddler will have a problem with coping if not allowed to time to rehearse before the stressor comes (Edelman, C. &Mandle, 2010).

Preschooler may at times display temper tantrums as a means to communicate to adults (Edelman, C. &Mandle, 2010).

When the preschooler uses projection and fantasy this can cause the parents not to trust the child (Edelman, C. &Mandle, 2010). School age child who does not cope will have after effects such as juvenile behavior (Edelman, C. &Mandle, 2010).

The child who is exposed to stressors can develop depression (Edelman, C. &Mandle, 2010).
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. Toddler relies on their parents to establish values and beliefs for them (Edelman, C. &Mandle, 2010).

Toddlers belief that there are rules and that you will be punished if you misbehave (Edelman, C. &Mandle, 2010).

Preschooler’s values are done by modeling, and induction explanation which influence moral behavior (Edelman, C. &Mandle, 2010).

Preschoolers will express their values by stating what they want to be when they grow up (Edelman, C. &Mandle, 2010). The school age child will base their decisions on moral development (Edelman, C. &Mandle, 2010).

The child’s values come from cultural, religion and parental values, and the concept of right and wrong (Edelman, C. &Mandle, 2010).

Toddlers tend not to get attention when they are good only when they misbehave (Edelman, C. &Mandle, 2010).

Toddlers may have a problem because religion beliefs which are passed on by the family do not mean that child will end up being a good child (Edelman, C. &Mandle, 2010).

Preschoolers who experience the death of a loved one may have behavioral, and sleep deficits (Edelman, C. &Mandle, 2010).
Disciplinary approaches vary from culture to culture. Uncertainty also results when parents integrate their cultural background into the community standards, but the grandparents adhere to traditional cultural practices, rituals, and child-rearing ideas (Edelman, C. &Mandle, 2010). The school age child may engage in lying, stealing and cheating with disregard for moral beliefs (Edelman, C. &Mandle, 2010).

Television facilitates negative attitudes and values among children, increases their aggressive behavior, decreases their emotional sensitivity when aggressive acts occur, and leads them to accept aggressive behavior (Edelman, C. &Mandle, 2010).

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.
There is not whole lot of difference between the assessment of the toddler and the pre schooled. The gap is between the preschool and the school age. Caregivers are the primary mainstay for the development and implementation of the child’s values and beliefs. The primary concern for the nurse is to assess the developmental task and periods of where the child is developmentally. If the development is accurate, the child should be happy and healthy. The main concern for all age levels is the parent interaction and safety. The nurse needs to provide the family with current education and resources.

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 for the school aged child includes allowing the child to undress themselves with or without the parent present. Allow for cover gown, have the parent present for physical examination. Explain everything you are about to do. Direct all questions to the child. Ask them if they have any concerns about themselves or their body. Be matter of fact when examining genital areas. Note reaction to touch and questions especially if child shields or flinches at sudden movements, afraid to go home (Melinda Smith, M.A., and Jeanne Segal, Ph.D.2012). Clothing is inappropriate in order to hide injuries or displays interest in sexual or seductive behavior and won’t participate in physical activities (Melinda Smith, M.A., and Jeanne Segal, Ph.D2012). Ask how they are doing in school, do they have a group of friends from school they hang out with, what do they do in their free time? Are they involved in sports? Do they sit in the back seat of the car and do they wear a helmet when riding a bike or skateboard Talk to them about safety. Inquire if they know the hazards of firearms and the importance of seat belts.

Lastly, ask them if they have any questions or concerns for you. Address their spiritual and cultural needs .Offer to escort the caregiver out of the room for a minute to provide privacy. Provide education material for upcoming stages of puberty smoking and drugs if appropriate. Assess for educational needs for dietary, hygiene and safety. Follow up with caregiver for any questions or concerns they may be having with the child. Review immunization list if current.
In summary the assessment across the childhood age groups differ dramatically. The toddler has little interaction with the nurse whereas the preschooler is encouraged to interact and the school aged child has full interaction. The parent participation varies as well but not as dramatically. The parent involvement is a must. It is important for the parent to show a positive, trusting relationship with the nurse. Safety, hygiene, dietary, spiritual, emotional and physical attributes are a must for all age groups. The difference is the method in which the nurse utilizes in order to obtain the necessary information to perform a complete and effective assessment.

Resources:

ArleneFHarder,MARevised2012MFT http://psychology.about.com/library/bl_psychosocial_summary.htm

Edelman, C., & Mandle, C. (2010). Health promotion throughout the life span (7th ed.). St.Louis, MO: Mosby Elsevier.

Erikson,2012http://currentnursing.com/nursing_theory/theory_of_psychosocial_development.html Theory of Psychosocial Development Erik H. Erikson, last updated on January 31, 2012.

Melinda Smith, M.A., and Jeanne Segal, Ph.D.http://www.helpguide.org/mental/child_abuse_physical_emotional_sexual_neglect.htm Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: July 2012.