Development focused care school and adolescence PDF

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Exam notes for adolescence. ...

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6 YEARS TO 12 YEARS (GRADE SCHOOL) MILESTONES: first day of school is a big milestone, development of the thinking process, development of attitudes, development of first permanent teeth. ERIKSON'S STAGE industry vs. inferiority. This is the stage where children learn to read, write, do sums, and establish a sense of independence in regards to completing tasks on their own. Teachers begin to play a large role in the child's life, as they act as a caregiver throughout daylight hours. It is immensely important for the teacher and parents to praise the child for their accomplishments when they do things well. If their accomplishments go unnoticed, or they are even scolded for making a mistake while trying to complete an accomplishment, the child will gain a sense of inferiority. When this happens, the child most likely will not attempt to accomplish an activity of that caliber again. Children are also able to engage and finish projects. They want to learn to do things well, and be praised for a job well done. Girls and boys also begin to play with toys and activities within their gender. For example girls will play with dolls while boys will play with trucks. Are there different stages of childhood. If so how do these compare? Consider Early, Middle and Late here PHYSICAL GROWTH- School age children have a slowed and steady physical development. They are expected to gain 5-6 pounds per year as well as grow 2-3 inches per year. It is at this time that they begin to lose their deciduous teeth and replace them with permanent teeth. GROSS MOTOR: Increase strength, speed, perception, and coordination needed to play games and sports FINE MOTOR: writing styles are developed and content has flow (Big block writing to small letter cursive). Drawing detailed pictures occurs and there is more refinement with using tools and utensils. With these skills their perception and coordination increase greatly. LANGUAGE- child will know about 2500 words and will use every form of sentence structure at age 6. By ten years old the child uses language to convey thought and to figure out what others are thinking. Can use all sentence structures. By 10 years old, a child is able to convey a thought through language, and now has the ability to look at others point of view. PERSONAL SOCIAL: rewards with accomplishment are necessary to aid in self-esteem. Understands possibility of more than one reason for others actions (accommodation). Classification system becomes developed and child understands objects can belong to more than one classification (ie by color or by size). Rules and fairness are paramount, and frequent reassurance is necessary. School-age children tend to play in sexually segregated groups based on gender play preference. Children no longer give objects life like qualities, they decrease their egocentric qualities, and also understand there is reversibility of actions. They

have now developed decentration and can see/complete different elements of a project at the same time. For the first time the parents are no longer the primary influence on child's development. Who are the influences and how does the nurse use this information to influence development? The primary influences are the child's peers and teachers. Most relationships stem from school, and conformity becomes evident. Peer pressure begins to play a role in the child's decision making. Bullying can became an issue, and is related to a child's poor relationships and difficulty identifying with a group. The nurse should ask about the child's friend group and what activities they like to do in order to gain insight as to what kind of environment the child is subject to. Since peers have such a large influence over a child's decisions, it is important to make sure the child's peers are acting appropriately for their age and are creating a safe environment to promote healthy growth and development.

Describe the characteristics of PLAY in the school aged child Describe the components of an effective school health program. This should be a reflection of your school health experience The grade school-aged child has a remarkable amount of freedom and responsibility compared to the previous growth and development periods. They are able to verbalize when they don't feel well, go to the nurse by themselves, and explain their concerns without the help of their parents by their side (as would happen in a provider's office). An effective school health program would foster their independence in a healthy, safe way. This can be done in a variety of ways that may vary depending on the child. For example, a child with a chronic condition, such as diabetes, or a child that needs to take a daily medicine would have the responsibility of going to the nurse's office in order to receive care. Having a set routine or time for them to come in, as well as making teachers aware of their medical needs, would help them get into a self-care routine. When it comes to taking daily medications, the nurse I work with for clinical asks for the child's full name, DOB, and the name of the medication (if they are cognitively able). She says it's good to get them to understand what medications they're on, because if anything happened where they were hospitalized they would be able to say their pharmaceutical histories. Having the child be responsible for visiting the nurse for daily treatments promotes independence, because even though they are taking a pill or doing something under the supervision of the nurse, they as an individual are responsible for prompting that action towards managing their health. Another component that would be very important would be providing educational resources and outreach to the children, especially those in at-risk communities. With the freedom that comes with being able to choose a lunch/snack to purchase or what activities to participate in, it's critical that we are encouraging children to make healthy decisions. It is wonderful to have healthy foods available for kids in school, but if they are not choosing to eat them then they are not reaping the health benefits or developing a healthy lifestyle. Teaching these kdis about what foods to eat and the importance of exercise in a fun way can set the child up for a lifelong

healthy lifestyle; conversely, the opposite can have a very negative effect, with childhood obesity at 17% (from the CDC website, http://www.cdc.gov/obesity/data/childhood.html). Rewarding positive choices/behavior instead of berating for not-so-good choices would be the best way to accomplish this. This website does a good job of providing an explanation of the specific needs of school-aged children and would be a good resource for parents to utilize in order to meet their needs: https://www.healthychildren.org/English/agesstages/gradeschool/nutrition/Pages/default.aspx. COGNITIVE DEVELOPMENT: Develops accommodation: understand that there could be more than one reason for others’ actions, progress from an animism way of thinking to realism, sophisticated classifying systems: i.e. can be organized by color or shapes, conservation of length or number, understand cause and effect relationships, no longer attribute living qualities to nonliving objects, increase in empathy. HEALTH PROMOTION-ILLNESS PREVENTION -Continuing immunizations is very important in this age range (diphtheria, tetanus toxoids, pertussis. IPV, MMR and Varicella) -Screening should be completed for scoliosis in this age group (often done in schools or at health facilities) - Proper nutrition should be promoted, by the end of the school age years children should be able to eat adult portions of food and should be able to identify nutritious food versus unhealthy food - Obesity is a growing concern for this age group, to help prevent obesity, parents should avoid using food as a reward, emphasize physical activity, teach children to make healthy snack choices, avoid fast food, avoid skipping meals, and model heathy behaviors themselves - To increase dental health, school age children should taught to brush after meals, snacks, and at bedtime. They should floss daily, have regular checkups at the dentist, and if it is necessary, have regular fluoride treatments - To help prevent drowning children should be supervised while swimming or when they are at play near a body of water. Parents should also encourage breaks to prevent the child from becoming over tired -Educate children and families about safety during sports and activities, such as helmet use -Promote development of empathy by asking children to view situations from another's point of view -help child feel sense of accomplishment by rewarding them. "everyone gets a medal" at this age. -Encourage the child to participate in his or her plan of care

The middle school aged child (7-10) fear bodily harm and destruction as a result of pain. Why? How do you manage pain in the school aged child? 12 YEARS TO 18 YEARS (ADOLESCENTS) ERIKSON'S STAGE: identity v. role confusion. Adolescents are interested in what their role is going to be going into adulthood, answering the question, "who am I." Erikson stresses the importance of overcoming earlier conflicts, such as trust v. mistrust, in order for the child to reach this stage. The adolescent must make a search for his/her identity in order to be successful. If he/she cannot make important choices, such as sexual orientation or vocation, this can cause role confusion, which can be a threat for adulthood. (2) GROSS MOTOR- Many adolescents engage in sports and athletic activities, which improves gross motor skills necessary for success. (3) FINE MOTOR- Fine motor skills continue to develop with engagement in sports and athletic activities. (3) LANGUAGE- Adolescents develop the ability to think abstractly and can analyze hypothetical situations using imaginative symbols. Therefore, they have the ability to have thoughtful conversations and take a variety of perspectives. (3) PERSONAL SOCIALPeer relationships act as a support system, and best friend relationships become more stable and long lasting. In early adolescence, friendships are primarily with the same sex, and views of oneself are based on similarities with these peers. In middle adolescence intimate relationships with the opposite sex form. By late adolescence sexual identity is formed. This is based upon sexual experiences, feelings, and knowledge. Views on oneself are now based on unique characteristics. Throughout adolescence, relationships with parents change to allow for a greater level of independence.

Because of increased independence, the adolescent's social relationship focus shifts from parents to peers. As a young adolescent, the peer group is small, similar and of the same sex. As adolescence progresses, the social group shifts to become more diverse. Adolescents prefer to rely on parents or responsible and trusted adults for guidance on making big decisions (jobs, finances, college, etc.). While trying to develop self-identity, adolescents often rely on peers for support and peer's opinions often influence decisions. Therefore, adolescents tend to engage in impulsive, risky behaviors. Additionally, adolescents begin to develop moral reasoning, altruism and caring for others. Emotions are exaggerated in adolescent years, which in combination with self-identity conflict can lead to a variety of self-esteem issues. Yet, the adolescent begins to develop emotional intelligence which gives them the ability to better relate with peers and

develop relationship skills. The development of sexuality also takes place at this stage. Adolescents tend to engage in dating and sexual activities between the ages of 14 and 16. (3)

HEALTH PROMOTION-ILLNESS PREVENTIONIt is important to engage in conversation with the adolescent using open-ended questions to allow them to express their thoughts and feelings. It is important to listen without judgment to gain the trust of the adolescent. To promote identity development, ask non-threatening questions to guide them (Example: what are your hopes for the future? Who do you admire? etc.). With exaggerated emotions, it is important for the healthcare professional to identify low self esteem thoughts and behaviors through asking guiding questions regarding depression, expectations of self, energy, insecurities and doubtfulness. To assist in developing self-esteem, assist the adolescent in identifying strengths and abilities. It is important to maintain adolescent safety by encouraging thought out decisions rather than impulsive decisions. Teaching adolescents to think about positive and negative consequences of a decision may reduce engagement in risky behavior. With hormones and impulsive behaviors at this age, it is also important to provide sexual education to prevent risky behaviors. As a healthcare professional, it is important to be non-judgmental and open to conversation with adolescents with sexuality conflicts. It is important to use listening and non-judgmental conversation to assess the adolescent's sexuality development and assist in health promotion if necessary. (3)

http://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/childrens-health/art20044948?pg=2

PATHOPHYSIOLOGY Define Adolescence and what period of time encompasses adolescence:  

ADOLESCENCE is the period of time between puberty and adulthood, growing into maturity. AGE RANGES: 12-20 years

Physical, Mental, and Social Changes During Adolescence

What does Erikson identify as the developmental stage of adolescence and how would that affect the adolescent with special health care needs 

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Identity vs Role Confusion o Development of personal, unique identity o Group Identity- become part of a peer group that influences behavior o Retrieved from: ATI: RN Nursing Care of Children Other Developmental Milestones in Adolescence o Piaget: Formal Operations  able to think about more than two variables, capable of evaluating their own thinking, imaginative and idealistic, able to use logic, think beyond current situation, understand influence of actions on others o Sexual Identity- close same sex relationships and transitions into intimate relationships o Health Perceptions - view self as "invincible" o Moral Development- Question relevance of existing moral values to society and individuals and solve dilemmas by using their morals o Self-Concept Development- View self in relation to similar peers and transitions to viewing self according to unique characteristics o Social Development- peer relationships develop and act as support system, bestfriend relationships become stable and parent-child relationships change allow more independence o Retrieved from ATI: RN Nursing Care of Children Adolescents with Special Health Care Needs and Psychosocial/Cognitive Development o The transition from adolescence to adulthood is complex for adolescents with special healthcare needs o Adolescents with special health care needs need a variety of services for healthy development and functioning. As they grow into an adult, they continue to need developmentally appropriate services, but a variety of factors influence this transition:  Lack of adult Health insurance and loss of additional government funded services provided during childhood  The Medicaid “adult” package is much less comprehensive than those for adolescents  Transfer of care providers from pediatric to adult  Park, M., & Irwin CE, J. (2008). Youth with special health care needs: facilitating a healthy transition to young adulthood. Journal of Adolescent Health, 43(1), 6-7 2p. o Identity, self-image and ego development are all affected by chronic illnesses in adolescence, especially when illness is more severe and verbal IQ is higher  Body image and sexual development are distorted- treatments or bodily changes may be embarrassing  Adolescents with chronic health conditions have lower self-esteem and higher body dissatisfaction than peers (this may later affect sexual function)

From the World Health Organization: The Adolescent with a Chronic Condition -http://apps.who.int/iris/bitstream/10665/43775/1/9789241595704_eng.pd f o These limitations may influence identity development. Because adolescents with special health care needs may not be able to identify with a group of peers, their cognitive development may be delayed. Additionally, increased reliance on family/parents for medical support in adolescents with chronic health conditions may impact a change in parent-child relationships that allows more independence (they may rely on parents even through adolescents which will impact social development) o Developmental disabilities may impact cognitive development and ability to process variables, use logic, think beyond current situation and understand influence of actions on others o Body image and low self-esteem problems (as discussed above) may impact sexual identity development 

What is overuse syndrome and how is it treated? Overuse syndrome is the result of an accumulation of trauma injuries that exceed the amount of time that is needed for them to heal. Typically, stresses placed on tendons, ligaments, soft tissues etc can be overcome by the healing process. When a child is participating in sports or performing an activity that always places stress onto particular muscles, tissues, ligaments , tendons, then the muscle area fatigues and deformation, swelling, redness, crepitus, pain and decreased ROM can occur. In addition to muscles, ligaments, tendons, and other soft tissues, nerve tissue can also be affected leading to nerve pain/damage. Retrieved from: http://www.aafp.org/afp/2006/0315/p1014.html Treatment: Depending on the site of overuse exacerbation, most of these injuries can be managed conservatively by mechanisms such as rest and ice. As the syndrome progresses, recovery time increases and there is an inability to participate in the sport for a longer duration of time. For More Information See: Overuse Syndrome in Adolescents Discuss mononucleosis in teens: Mononucleosis itself is not severe, but it may impact daily life for several weeks. It commonly affects adolescents between 15-17 and the impact on daily life can have affects on adolescent development. Adolescents commonly present with the classic symptoms, but 85% of adults show antibodies to the Epstein-Barr virus by 40 years old, meaning that they were infected at some point in their life. Many children are infected but have very mild symptoms. Cause:

Mononucleosis is caused by the Epstein-Barr virus and is spread through saliva or mucous of someone infected. The incubation period is usually 4-6 weeks. Symptoms: Fever, sore throat, swollen lymph glands in neck/arm/groin, fatigue, muscle aches/weakness, white patches on throat, skin rash, headache, loss of appetite The spleen also becomes enlarged in some people. This usually becomes enlarged for 2-3 weeks. Symptoms usually last for 1-4 weeks but can last up to 2 months before engagement in normal activities. Diagnosis: Diagnosed based on symptoms (fever, sore throat, swollen lymph glands) and blood tests (mono spot test) but it can detect antibodies to Epstein-Barr virus and is sometime inaccurate during the first week of infection. CBC reveals high lymphocytes. Titers of antibodies against virus confirms diagnosis. https://my.clevelandclinic.org/health/diseases_conditions/hic-mononucleosis

Discuss Acne in teens: Almost 8 in 10 teens have acne and is a normal part of puberty. Acne vulgaris is acne of the "common type" and usually appears on the face, neck, shoulders, upper back and chest. Hair follicles contain sebaceous glands which make sebum, an oil that lubricates the hair and skin. As the body begins to develop, hormones stimulate the sebaceous glands to create more sebum which clogs pores. This causes bacteria to enter the pores which causes swelling and redness. Whiteheads: White dots that are pores impacted with oil and skin covered by skin layers. Blackheads: Black bumps that are impacted pores in which material pushes out through the follicles. The black color is not from dirt. It may be from bacteria, dead skin cells, and matter that react with oxygen. P...