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Nursing

Children’s Functional Health Pattern Assessment

 

Functional Health Pattern Assessment (FHP)

 

Toddler

Erickson’s Developmental Stage:

Autonomy versus

Shame and Doubt

15-36 months

 

Preschool-Aged

Erickson’s Developmental Stage:

Initiative Versus Guilt

 

 

School-Aged

Erickson’s Developmental Stage:

Industry versus 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.

 

1. Toddlers rely on their parents for health management, and are willing to participate in health promotion.

2. They develop habits such as brushing teeth at night before sleeping.

 

 

1.      Preschoolers contribute to health management by wearing weather appropriate clothing, taking medication, etc.

2.      They become inquisitive about their opposite sex.

1.      Child may believe that an illness is caused by a misdeed or bad behavior.

2.      Child shows concern about their growth, weight, time of menarche and final height.

 

1. Safety issues such as playing with water, toys, and strangers may cause injury become apparent.

2. As a result of their desire to explore, toddlers will climb furniture or fixtures which may lead to injuries such as scuffs, bruises, and head injuries.

 

1. Dental caries are apparent.

2. Group activity increases the likelihood of infection which eventually helps with the development of their immune system

 

1. Child is not taught healthy behaviors in the home.

2. Most acute, life-threatening diseases of a hereditary nature become evident

 

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.

 

1. Toddlers experience a transition from breast milk to regular milk. (Edelman & Mandle, 2006, p. 419)

2. Toddlers have great appetite. They enjoy meal time and are exposed to varieties of food if adults prepare and eat different kinds of food.

 

1. Preschoolers learn the taste of food and become selective as they have developed strong likes and dislikes relating to food preferences.

2. They eat variety of food with emphasis on a healthy diet.

 

1. School age children can help their parents plan family meals and eat better for their overall health.

2. They eat three regular meals a day with two snacks and drink plenty of water

1. Toddlers may lack iron intake due to transition from bottle and breast feeding to regular meals. This may result to anemia in the child.

2. Drinking bottled milk at bed time may cause dental caries.

 

1.There is a tendency to develop anemia due to selective eating habit

2. Consumption of fat and processed foods along with lack of inactivity may result to  health problems such as juvenile diabetes.

1. School age children are likely to develop obesity  by eating junk foods .

2. They do not enjoy drinking water.

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.

 

1. Toddlers express signs of readiness to be potty trained by either pointing to the toilet or pulling their panty down.

2. They are likely to have a bowel movement after meals because of the gastro colic reflex. (Edelman & Mandle, 2006, p. 421)

 

1. Preschoolers try to use the toilet by themselves.

2. Their stools are semi solid.

 

1. School age children have control of bladder and bowel movement, and are able to move their bowels about twice a day, urinating also about 8 times in a day.

2. They are able to undress, dress, wipe, flush, and clean hands when they use the toilet.

1. Toddlers may experience delay with toilet training. Parents can try potty seat and initial toileting every two hours and after meal time.

2. They may be irritated if toilet training is introduced earlier than it was supposed to.

 

1. Preschoolers may not practice good hygiene such as hand washing after using the toilet which can expose them to illness.

2. They become incontinent when afraid.

1. School age children may experience enuresis known as unintentional urination on self. They bed wet.

2. They may also experience encopresis, which is defined as an unintentional fecal soiling in children who have been toilet trained. Children with encopresis often leak stool into their underpants.

 

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.

1. Toddlers are very active physically. They enjoy dressing and undressing, kicking, building and destroying towers, throwing and chasing after balls.

2. They like exploring their environment, and trying out activities that most times are beyond their abilities like trying to move heavy furniture.

 

1. Preschoolers involve other children in playing mostly in group setting.

2. They like to mimic the behaviors of people familiar to them by rehearsing what was demonstrated to them (Edelman & Mandle, 2006, p. 443).

1. School age children may be very active in sports like softball, basket ball etc. It helps them develop stronger muscles, strength and promotes good health and body image.

2. They engage in playful activities which enhance social, personal, and cognitive development.

 

1. Toddlers play alongside with other children and do not like to share their toys.

2. As they start learning more skills and explore their environment, they are at risk for several injuries.

 

 

 

1. Preschoolers tend to excessively attach to television which can interrupt communication with other children as well as parents and can result to lack of physical activity.

2. They practice behavioral patterns learnt from watching movies, like kicking the wall because they saw somebody doing it on TV. This may result to injury.

1. These children prefer interacting with friends rather than family members.

2. Excessive attachment to computer and television may distract them from physical activities. This should be monitored by parents.

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.

1. Toddlers babble words and try to make sentences. They can express up to 270 words (Edelman & Mandle, 2006, p. 424).

2. They learn and master skills by repetitive and ritualistic behavior.

 

 

1. Preschoolers are able to know about 2,100 words by age 5.

2. They understand rules and apply them during their play time (Edelman & Mandle, 2006, p. 445).

 

1.

School age children learn by rehearsing a word, which helps their retentive memory, meaning they are able to remember the word easily.

2.  Perception in school age children is remarkably improved, especially in the temporal lobe. Good functioning of the sensory organs like vision and hearing have to be intact for better learning ability.

 

1. Toddlers may experience delay with language development which may be related to hearing problem.

2. They may be noted as acting out especially around age 2 which is referred to as terrible twos.

1. Preschoolers find it difficult to distinguish the quantity of fluid a glass contains to the size of the glass.

2. The existence of imaginary friends can make a child set up chairs at while eating.

 

1. These children may have problems with mastering and learning due to sensory deficit such as vision.

2. They tend to be anti-social due to fear of not being accepted in the group.

 

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.

 

1. Toddlers establish a sleeping pattern which requires sleeping for 12 hours a day, and takings a few naps.

2. They usually develop a nap and bedtime rituals like having a snack, bathing, brushing their teeth, and listening to night time story.

 

1. Preschooler’s sleeping time during the day is reduced and will usually sleep between 8-12 hours at night.

2. They like sleeping with the night light on, and also with a treasure item like their favorite toy.

 

1. With school age children, school and play time adjust hours of sleep and rest.

2. They enjoy sleeping during the night and they rest well.

 

1. Toddlers may stay awake at nights and sleep more during daytime.

2. They find it difficult falling asleep without cuddling.

 

 

 

1. Preschoolers experience delay falling asleep and will repeatedly call for parents’ attention.

2. They experience night terror and nightmares that come in form of frightening dreams which interrupt with sleep.

 

1. Child is hyperactive and does not rest.

2. They experience shorter sleeping time than normal.

 

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.

 

1. Toddlers become more independent and wanting to take control.

2. They learn to express personal feelings, rejection, and acceptance.

 

 

1. The preschooler builds self esteem by successfully accomplishing a task.

2. By praising a preschooler, it provides opportunity for new experience, improves their mental and physical health, and makes them feel good about themselves.

 

1. They participate in competitive and collaborative activities in school and play groups with their age mates.

2. They pay more attention to their body image because they want to be accepted by fellow peers.

 

Child learns to free self from effects of separation from parents.

 

1. Toddlers may become regressive if a new baby is introduced in the family with little or no attention given to them by parents.

2. They may become frustrated as a result of restriction from their independent attitude when parent feel the environment is not safe enough to explore.

 

1. Preschoolers may lose their self esteem and feel less important when their parents criticize them for wrong acts. For example throwing their toys all over the room.

2. Feeling of guilt and inadequacy may result to withdrawal.

 

1. Child could respond with tantrum towards adults and peers for restraining their expressions.

2. Girls experience greater competition and are faced with pressures about personal appearance.

 

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.

 

1. Toddlers tend to imitate adults, parents, and older siblings around.

2. They become knowledgeable about what the roles of their parents and sibling are in the home.

 

1. They admire their older sibling and want to do things just like them.

2. They play out their mother and father role like praising, punishing, and setting limits on an invented child.

 

1. As they mature, they are able to pick up house chores like feeding the pet and making the bed.

2. School age children model their behavior after a person they love or admire like their parent, teachers, friends and other adults.

 

1. Their behavior towards possessions of things that belong to others creates sibling rivalry.

2. They do not want to relate to people who are non-family members.

 

 

 

1. They have difficulty playing with peers especially, games, which require switching roles.

2. They are emotionally affected by parental divorce, so is left to the parent to let the child know that regardless of the separation, the child is still loved.

 

1. They may be exposed to child abuse, if not identified, may cause anxiety, depression, confusion and irritability in the child. (Edelman. & Mandle, 2006, p. 483).

2. They do not acknowledge authority.

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.

 

1. Toddlers express curiosity with their sex organs by touching or playing with it.

2. They explore their gender mostly during toileting.

 

 

1. Preschoolers are able to recognize and identify with their own gender.

2. By watching television show, they are able to identify gender role like working mother that helps them able to identify their own roles more realistically (Edelman & Mandle, 2006, p. 452).

 

 

1. Children tend to be closer with parent of same gender.

2.  Becomes fully aware of their sexuality as it pertains to gender orientation.

 

 

1. Toddlers may engage in masturbation due to exploration of their genital.

2. They may be exposed to sexual molestation by family members.

 

1. Preschoolers may be confused regarding sexuality.

2. They do not know how to behave according to social gender norms.

 

1. May become much attached to same gender and explore one another sexual organ.

2. School age children discuss questions about sex with their peers.

Pattern of Coping and Stress Tolerance:

 

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.

 

1. Toddlers try to cope with stress by responding with tantrum.

2. They try to imitate their parent’s way of coping with stress.

 

 

1. Preschoolers can tolerate being alone more often and for longer periods.

2. They can use a doll to act out their own life stories in a form of play.

 

 

1. They are able to identify symptoms associated with stress such as fast heart beat, anxiety, and sweaty hands.

2. They have to handle the pressure of meeting targets for submitting homework, and competitions in school among school mates.

 

1. Toddlers tend to be aggressive if under emotional strain.

2. Their tantrum most times, may lead to injury.

 

 

 

1. Preschoolers attempt to be violent when not allowed to do what he/she wants.

2. They respond adversely to discipline

 

 

1. Their functional ability and success may be affected when they are being bullied by fellow peers. Some children may end-up committing suicide.

2. They suffer a feeling of loss when parents go through divorce.

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.

 

1. Toddlers belief in the concept of right and wrong, therefore acting to behave to abstain from chastisement.

2. They rely on their parents to instill values and beliefs in them.

 

 

 

 

1. The preschooler may enjoy community activities such as their enrollment in special that teach them moral principles.

2. They may start expressing their values by saying what they want to be as adult. (Edelman & Mandle, 2006, p. 452)

 

 

 

 

1. The child starts developing an appreciation for the importance of rules when they start benefiting from it, for example, a child is chastised for stealing from other kids.

2. The child’s moral development enhances their ability to make the right decisions that will affect them in a positive way like submitting home work timely, and avoiding problems. (Edelman & Mandle, 2006, p. 486).

 

 

1. Toddlers over react to attitudes of non-acceptance.

2. They become remorseful when corrected.

 

 

 

1. When preschoolers experience disapproval from parent, it affects their self esteem and makes them feel less important.

2. May become aggressive (fighting other children) as a result of losing a loved one.

 

 

1. Lying, stealing, or cheating are some moral problems that are very common amongst school age children.

2. Because of their desire for success, they may cheat. For example in a competition with fellow friends, a game and even with class work.

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

According to Gordon (2009) functional patterns of assessment across childhood age groups, nutrition shows consistence within the toddler, preschool and school aged child. Once the taste for food was established during the toddler years, this developed into a food preference and ultimately into a great appetite. A similarity was also identified across patterns of values and beliefs. Value is a component of socialization; it encompasses a wide range of artifacts which are all associated with the child’s perception of belief. Once belief developed, it emerged from a premise of value which takes the child throughout life. However, patterns of elimination and cognition showed marked differences which might be closely linked to biological factors (Gordon, 2009).

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.

When handling a physical assessment, examination, education, and communication with children versus adults, the nurse is expected to first consider the age and culture/spiritual differences. Unlike the adult, toddlers and preschoolers like to explore their environment so the nurse should let the child feel and play with the medical instruments, such as pen light, etc. The nurse should be prepared to respond to the questions of the preschooler because they are usually inquisitive and multiple questions can be directed to dietary and health practices such as dental hygiene, beloved activities, and friends. The toddler’s parent needs to be around during assessment for improved interaction between the nurse and the toddler. However, the nurse can help the school age child develop a healthy educational environment by promoting a comprehensive and age-appropriate health education program focused on children taking responsibility for their own health (Edelman & Mandle, 2006, p. 498).

The nurse should assess the children immunization record and make sure their physical examinations are current, considering their ages at the time of communication, also putting into consideration their spiritual practices (Islam, Christianity, Jehovah witness, Hinduism, etc),  cultural practices and belief (like who makes decisions for the family, what are their views towards health promotion and illness prevention) in the family. For instance, a kind of religion does not believe in blood transfusion. While an adult can easily make the decision to abide by his/her religious belief, it might not be that easy to make such a determination for a child when the illness is life threatening and requires a blood transfusion because babies and toddlers cannot verbalize their feelings. As such the nurse is expected to take all these differences into consideration during assessment.

References

Crain, W. (2011). Theories of Development: Concepts and Applications (6th ed.) Upper Saddle River, NJ: Pearson Education, Inc.

Edelman, L., & Mandle, C. (2006) Health Promotion Throughout the Lifespan. St. Louis, Missouri: Mosby.

Gordon, M. (2009). Manual of Nursing Diagnosis (12th Edition). Boston: Jones & Bartlet Learning.

Jarvis, C. (2012). Physical Examination & Health Assessment (6th ed.). St. Louis, MO: Saunders.