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Children's Functional Health Exam

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Children’s Functional Health Pattern Assessment
|Functional Health Pattern Assessment |Toddler |Preschool-Aged |School-Aged |
|(FHP) |Erickson’s Developmental Stage: |Erickson’s Developmental Stage: |Erickson’s Developmental Stage: |
|Pattern of Health Perception and Health |Toddlers can recognize not feeling well |Preschoolers have a concept of their |Understands health but the understanding |
|Management: |but are unable what health means (Edelman|outer bodies and the functions. |is still not developed. Adolescents feel |
| |& Mandle, 2010) | |invisible (Edelman & Mandle).Work on |
|List two normal assessment findings that | |Able to state a few of the inner parts |health promoting like eating well and |
|would be characteristic for each age |Toddlers will partake in health |to the body (Edelman & Mandle). |teeth brushing. |
|group. |promotions that they have seen their | | |
| |parents do such as, brushing teeth at bed|Can jump and kick a ball, feed self | |
| |time (Edelman & Mandle, 2010). | | |
|List two potential problems that a nurse | | | |
|may discover in an assessment of each age| | | |
|group. | | | |
| |Not talking or words that are jumbled may|A child that is unable to speak |Does not self-promote care or understand |
| |be from a hearing impairment. |clearly, or unintelligible to strangers|health in relation to their body or |
| | |may show speech or hearing difficulties|others. |
| |Amblyopia or Strabismus are early vision |(Edelam & Mandle). | |
| |problems that may be seen when a toddler | | |
| |is being assessed These two early vision |Has a huge fear of loss of control. | |
| |problems may be caused by lack of use of | | |
| |the eye or muscle weakness (Edelman & | | |
| |Mandle). | | |
| | | | |
| | | | |
|Nutritional-Metabolic Pattern: |Toddlers are able to start feeding |Eat a variety of foods and consume half|Average caloric intake 1200-1800 a day. |
| |themselves and start learning to use |their diet in carbs and the other half |Usually 3 meals a day and a few snacks. |
|List two normal assessment findings that |utensils (Ricci & Kyle). |of protein and fat (Edelman & Mandle). | |
|would be characteristic for each age | |Ask about sugar intake. | |
|group. |Toddlers become pickier eaters and will |Bone growth: calcium intake of 470 mg/d| |
| |mimic their parents. Healthy snacks and |a day. | |
| |foods with enough calcium and iron should| | |
|List two potential problems that a nurse |be provided. | | |
|may discover in an assessment of each age| | | |
|group. | | | |
| |Iron-deficiency anemia can lead to |Iron deficiency can lead to behavioral |Poor intakes can possible chronic illness|
| |developmental and psychomotor delays in |and cognitive deficits (Edelman & |or disease. DMII can also play a role in |
| |toddlers (Ricci & Kyle, 2009). |Mandle). |diet concerns. |
| | | | |
| |Toddlers not gaining weight according to |Lack of growth, may be | |
| |age appropriate gains could show a |Ca+ deficiency. | |
| |nutritional deficiency. |Refusal of all foods. May be | |
| | |intolerance to a specific food. | |
| |Dental caries are a sign of excessive | | |
| |bottle use and possible bedtime milk or | | |
| |juice. | | |
|Pattern of Elimination: |Toddlers are ready for bowel and bladder |Self-toileting. |Full bowel and bladder control (Edelman &|
| |training when myelinization has occurred |Physically able to toilet and able to |Mandle). Able to dress and toileting |
|List two normal assessment findings that |and the child starts having regular bowel|take care of them if clothing becomes |cares including wiping and washing hands |
|would be characteristic for each age |movements and can understand when they |soiled (Edelman & Mandle) | |
|group. |are wet (Ricci & Kyle). |How they mentally feel about toileting.| |
| | |A positive response is good | |
| |Toddlers start grabbing at diapers, | | |
| |asking to be changed and/or hiding behind| | |
|List two potential problems that a nurse |stuff when having elimination (Ricci & | | |
|may discover in an assessment of each age|Kyle). | | |
|group. | | | |
| |Issues that may arise from a toddler |No self-toileting or unable to go a |Bed wetting can be a physiological or |
| |during potty training are the concern of |reasonable time without soiling |physical problem. |
| |a toddler not understanding why they |themselves. Look for internal physical |Overweight/Underweight. Need to encourage|
| |cannot hold their bowel and bladder. |development. |exercise. |
| | | | |
| |Excessive masturbation that a toddler | | |
| |does in public can become a stressor | | |
| |(Ricci & Kyle). | | |
|Pattern of Activity and Exercise: |Toddlers enjoy playing along others with |Love to play with increased |Regular physical activity is important. |
| |the same or similar toys and doing the |coordination and confidence. Motor |This decreases with age (Edelman & |
|List two normal assessment findings that |similar motions as those that they are |skills continue to improve. Can play |Mandle). |
|would be characteristic for each age |playing with. This is called parallel |without having parent or caregiver |Having a safe place for them to play. |
|group. |play (Edelman & Mandle). |close by Edelman & Mandle). |Socially able to engage with others in |
| | | |play. |
| |Toddlers have short attention spans and | | |
| |should be allowed to use their | | |
|List two potential problems that a nurse |imagination and explore new toys (Ricci &| | |
|may discover in an assessment of each age|Kyle). | | |
|group. | | | |
| |Toddlers having too much screen time can |Unable to separate from parents to |Physical deficit and unable to ride a |
| |lead to a decrease in vocabulary (Edelman|play. |bike or run. |
| |& Mandle). |Lack of motor skills to play. |Lack social skills to play with others. |
| | | | |
| |The lack of motor skills or the desire to| | |
| |not paly could be a sign of a | | |
| |developmental delay. | | |
| | | | |
|Cognitive/Perceptual Pattern: | |Can understand yesterday and today with|Learning to master new ideas and |
| |Toddlers who have a sense of security are|the events that took place on or in |concepts. Able to continue learning. |
|List two normal assessment findings that |able to explore. |these days (Edelman & Mandle). |Continue learning from parents and |
|would be characteristic for each age | | |caregivers (Edelman & Mandle). |
|group. |Books are a favorite with words and |Understands the future. | |
| |pictures. They are ready at this age to | | |
| |continue brain growth. | | |
| | | | |
|List two potential problems that a nurse | | | |
|may discover in an assessment of each age| | | |
|group. | | | |
| |Toddlers that don’t have an interest in |Unable to think of the past or future. |Slow cognitive development-look for |
| |books or learning can be a concern. |Has a hard time structuring the day. |hearing delays with lack of speech. |
| | | |Routine physicals are important to rule |
| |They should be repeating items and able | |out any physical disorder. |
| |to repeat learned items back to | | |
| |teacher/parent. If not developmental | | |
| |delay could be an issue. | | |
|Pattern of Sleep and Rest: |Toddlers should be sleeping a minimum of |Preschoolers sleep 8-12 hours at night |Adolescents need at least 8 hours of |
| |12 hours through the night and taking one|and may or may not nap (Edelman & |sleep per night (Edelman & Mandel). |
|List two normal assessment findings that |nap a day (Ricci & Kyle). |Mandle). Quiet time can be asked for |Usually no sleep issues. Sleep more than |
|would be characteristic for each age | |with rest times for music and books. |adults and varies on activity. |
|group. |Toddler should have a set bedtime and | |Continue with regular bedtimes. |
| |ritual to help them sleep. | | |
| | | | |
| | | | |
| | | | |
|List two potential problems that a nurse | | | |
|may discover in an assessment of each age| | | |
|group. | | | |
| |Night time awakening whether for |Night terrors and night mares become |Sleep deprivation can occur if an |
| |attention or due to a schedule/ritual |more profound causing sleep to be |adolescent had too much going on. |
| |change (Ricci & Kyle). |disrupted. |Sleepwalking |
| | |Unable to concentrate to play and |Sleep talking |
| |Night terrors can start in the toddler |learn. |Enuresis |
| |years. These are dreams that a child will| | |
| |not completely awaken from and will cry | | |
| |out (Edelman & Mandle). | | |
|Pattern of Self-Perception and |They have the ability to take control of |Basic self-concept comes alive. They |Process of self-discovery to create their|
|Self-Concept: |their action. Toddlers like to do well. |are more able to understand self. |own personalities and start to build |
| |May try to take control with the word |Esteem building with simple task of |relationships with others. |
|List two normal assessment findings that |“No” (Edelman & Mandle). |picking up toys when asked. |Masters what they are doing ( Edelman & |
|would be characteristic for each age |Toddler’s stile like to be cuddle and |Understand what it is to be a sibling |Mandle). |
|group. |held. |or friend. | |
| | | | |
| | | | |
|List two potential problems that a nurse | | | |
|may discover in an assessment of each age| | | |
|group. | | | |
| |Toddlers lashing out and controlling |Not wanting to have a friend or being |Unable to develop friends. |
| |their parents. |distant. Not able to follow simple |No self-concept. No responsibility for |
| | |directions |items. |
| |Toddlers not wanting love and attention | | |
| |from loved ones/parents. | | |
|Role-Relationship Pattern: |They are interested in all the roles of |Enjoy friends and gain information from|Increasing independence. Enjoys school |
| |the family. |them. They understand gender roles in |and peers. |
|List two normal assessment findings that |Ask parent how they get along with |their life and base play on those |Look to new interests and exploring them.|
|would be characteristic for each age |siblings. This is the start of the |roles. Environment plays a huge impact(| |
|group. |rivalry (Edelman & Mandle). Parents need |Edelman & Mandle). | |
| |to not reward or punish or take side and | | |
| |the battle will diminish. | | |
|List 2 potential problems that a nurse | | | |
|may discover in an assessment of each age| | | |
|group. | | | |
| |A toddler trying to harm a sibling is a |Preschoolers acting out negative |Lack of friends or interest in school. |
| |sign something is seriously wrong and the|actions with play. |Lack of responsibility. |
| |child should be seen by a therapist. |Not wanting to be social. | |
| | | | |
| |A disruptive toddler that is seeking out | | |
| |to be in trouble is time to take action. | | |
|Sexuality – Reproductive Pattern: |Masturbation is common. Help parents be |Understand the two genders and follow |Continue to model their gender. |
| |aware of this phase (Edelman & Mandle). |their own gender (Edelman & Mandle). |Identifies with parent of the same sex. |
|List two normal assessment findings that | |Recognize the difference between gender|Aware of own body. Exploratory behavior. |
|would be characteristic for each age |Using proper terms for genitalia as not |body parts. |Ask questions regarding sexual matters. |
|group. |to confuse the toddler. | |Fantasize about relationships and sexual |
| | | |acts (Edelman & Mandel) |
|List two potential problems that a nurse | | | |
|may discover in an assessment of each age| | | |
|group. | | | |
| |Inappropriate touching of other. |Over curious about their bodies or |Obsessed with own or others bodies. |
| | |others. |Increased sexual questions or behaviors. |
| |Inappropriate touching of themselves in |Low self-esteem (Edelman & Mandle). | |
| |public (Edelman & Mandle). | | |
| | | | |
| |Confusion of words for genitalia. | | |
|Pattern of Coping and Stress Tolerance: |The child can calm themselves after a |Watching for positive play. Looking at |Learning to cope with stress. Can |
|List two normal assessment findings that |stressor (Edelman & Mandle). |how they interact with dolls or puppets|identify with body stress symptoms like |
|would be characteristic for each age | |(Edelman & Mandle). |butterflies or pounding heart (Edelman & |
|group. |Does the child react appropriately to a |Storytelling with props or books for |Mandle). |
| |stressor? |feelings and meaning. | |
|List two potential problems that a nurse | |Improved protest behavior. | |
|may discover in an assessment of each age| | | |
|group. | | | |
| |Look for the less affectionate or hard to|Continued tantrums or behaviors. Unable|Unable to deal with stress, signs of |
| |manage child. |to calm down when upset (Edelman & |depression occur (Edelman & Mandle). |
| | |Mandle). |Exhibits signs of anxiety. No coping |
| |Excessive temper tantrums. | |strategies learned |
|Pattern of Value and Beliefs: |Toddlers are taught values and religious |Continue to learn consciences. Have |Decision making related to moral and |
| |beliefs from the parents. Toddlers should|some internal control of a situation. |ethical issues (Edelman & Mandle). |
|List two normal assessment findings that |be able to repeat some of the words to |Look for parental approval and love. |Can share with others. |
|would be characteristic for each age |prayers (Edelman &Mandle). | | |
|group. | | | |
| | | | |
| | | | |
|List two potential problems that a nurse | | | |
|may discover in an assessment of each age| | | |
|group. | | | |
| |Parents expecting toddlers to understand |No regard for moral actions or sharing.|Unable to share and makes poor choices. |
| |the words of songs and prayers. (Edelman | |Lying, stealing or cheating. |
| |& Mandle). |Unable to express feelings. | |
| | | | |
| |Child misbehaving or rebelling for | | |
| |attention. | | |
| | | | |

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.

Across the childhood age groups the assessments are similar in that the nurse needs to be aware of the child’s actions. They need to be present in the assessment and be able to ask the appropriate questions to the parent or to the child. By asking these questions the nurse will be able to identify any issues. Some parents may not remember what they were going to discuss at the health exam so the observant nurse may be able to answer some development questions for each growing age. With assessment being similar there are differences as well. Each age group has milestones that are mostly seen in that age group. The nurse must be familiar with the different stages of development for each age group to complete a proper assessment of the child.

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.

Each physical assessment must be handled differently. When the nurse enters the room they must be able to do a quick scan of the environment. Depending on the culture they may need to shake the parent’s hand, or just sit down at their level. The nurse needs to know what religions have different values and beliefs than the nurse’s religion. When doing the assessment and educating parents and patients the nurse needs to take all aspects of a patients beliefs, and values into account. The way the nurse interacts with the child is also taken into consideration. They must develop a relationship with all age groups and be able to ask age appropriate questions to the parent or directly to the child. Building rapport is very important.

References

Edelman, C. L., & Mandle, C. L. (2010). Health Promotion: Throughout the Life Span (7th ed.). St. Louis, MO: Mosby.
Ricci, S. S., & Kyle, T. (2009). Maternity and Pediatric Nursing. Philadelphia, PA: Lippincott Williams & Wilkins.

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