Children’s Functional Health Pattern Assessment Functional Health Pattern Assessment (FHP) | Toddler Erickson’s Developmental Stage: Autonomy vs. Shame (McLeod, 2013) | Preschool-Aged Erickson’s Developmental Stage: Initiative vs. Guilt (McLeod, 2013) | School-Aged Erickson’s Developmental Stage: Industry vs. Inferiority (McLeod, 2013) | Pattern of Health Perception and Health Management: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Able to express feeling bad/sick but have little understanding of the meaning of health. Depend on the caregiver for health management. Ready for independent activities. Often imitate parents or caregivers. Ex. brushing teeth on their own but unaware of the health benefits. | Able to verbalize when in pain or not feeling well. Curious about their body and its functions. View the internal body to be hollow. | Aware of how their body functions and when it is sick or not functioning properly. Have abstract thought and understand the definition of health and factors causing illness. Cultural influences contribute to their perception of illness. | | Risk for injury r/t accidental exposure and environmental dangers. Risk for poor health maintenance r/t caregiver knowledge deficit. | Risk for disturbed body image r/t body image issues, size or deformities producing sense of vulnerability and fear. Risk for infection r/t up to date immunizations. | Risk for self-neglect r/t poor hygiene and show of no interest in their appearance. Risk for ineffective health maintenance r/t learning poor health habits by imitating their caregivers. | Nutritional-Metabolic Pattern: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Transitions from breast milk or formula to whole milk. Begins to learn how to self-feed, using spoons, hands and sipping from a cup. | Food preferences emerge as early childhood progresses. Able to prepare simple food tasks, such as washing fruit, vegetables and helping prepare a family meal. | Understand the difference between healthy and unhealthy foods. Have sense of good nutrition and will choose a well-balanced diet if given freedom to do so. | | Risk for imbalanced nutrition r/t drinking milk from a bottle affecting appetite and iron absorption. Risk for impaired swallowing r/t foods offered that may be a choking hazard | Risk for imbalanced nutrition: more than body requirements r/t eating excessive junk foods. Risk for imbalanced nutrition r/t frequently eating meals away from home and may not be nutritious meals. | Risk for ineffective health maintenance r/t children and their families living busy lives and potential for skipped meals, fast food and poor food choices which increase the risk for obesity and metabolic disorders. Risk for obesity and anorexia r/t access to food and cultural factors, especially if living in poverty. | Pattern of Elimination: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Start exploring toilet training and interest in awareness of bowel and bladder elimination; often imitating same sex. Diapers dry for more than 2 hours which indicate readiness for beginning toilet training. | Capable of and responsible for independent toileting. Aware of basic hygiene after toileting. May forget to flush the toilet and may not have adequate motor skills for proper genital hygiene. | Full bowel and bladder control. Ability to undress, wipe, flush, dress, wash hands and very modest about hygiene and toileting. | | Risk for toileting self-care deficit r/t frustration d/t caregivers beginning activity before readiness. Risk for situational low self-esteem r/t poor caregiver communication explanation and teaching. | Risk for low self-esteem r/t not yet being toilet trained and emotional scarring d/t not being able to perform activity independently. Risk for infection r/t not washing hands after toileting and improper hygiene d/t inadequate motor skills. | Risk for impaired urinary elimination r/t enuresis. Risk for constipation r/t diet or other health issues. | Pattern of Activity and Exercise: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Developing physically and more mobile. Discovers new skills and activities by repetition. Advances from taking their first steps to running and stair climbing to eventually pedaling, illustrating growth of independence and autonomy. | Explore independently, and able to demonstrate increase coordination. Begin planning activities, make up games and initiate activities with others. May have imaginary friend. | Naturally and physically active. Develops strength, balance and coordination. Many motor skill changes, allowing engagement in many activities such as sports. | | Risk for impaired communication r/t too much television and not enough exploration and interaction with caregivers and others. Risk for injury r/t lack of knowledge of their limits and exploring activities beyond their abilities. Risk unintentional injury r/t drowning and poisoning d/t exploring their new environment. | Risk for social isolation r/t playing by themselves. Risk for ineffective activity planning r/t expressing anger in play which may transfer to real life situations. | Risk impaired physical mobility r/t lack of physical activity and playing non-physical video games and watching TV all day. Risk for activity intolerance r/t poor nutrition and unhealthy diet, leading to obesity. | Cognitive/Perceptual Pattern: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Developing egocentrism, advancing their thought process and abilities to use language. Understands object permanence. Receptive and expressive language is developing rapidly. | Develops interpersonal skills through initiating activities. Develops more secure sense of self and play is more related to real life events. | Begin to feel industrious and feel confident in their ability to achieve goals. Understands other people’s feelings and has the basic understanding of morality and ethics. | | Risk for developmental problems r/t caregiver knowledge deficit in psychosocial development. Risk of injury r/t various developmental and physical changes. | Risk for impaired verbal communication r/t difficulty developing sentences and conveying meaning. Risk for impaired memory r/t rapid developing brain and poor memory skills | Risk for impaired verbal communication r/t difficulty reading, writing and speaking. Risk for low self-esteem r/t learning disabilities affecting inability to function satisfactory. | Pattern of Sleep and Rest: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Twelve hours of sleep is needed per day this includes 1-2 naps in the daytime. Require rituals to encourage sense of security and maintains a healthy schedule. | Eight to 12 hours during the night is needed and naps become less frequent. Require bedtime rituals to move from play to falling asleep alone. | Eight to 12 hours of sleep is needed and they do not need daytime naps. Bedtime becomes more flexible and does not require rituals. | | Risk for impaired health maintenance r/t sleeping more than recommended 12 hours daily which can cause health problems or developmental delays. Risk for disturbed sleep pattern r/t night terrors | Risk for disturbed sleep pattern r/t frequent nightmares and night terrors; some nightmares may be recurring Risk for fatigue r/t staying up late and awakening frequently throughout the night. | Risk for disturbed sleep pattern r/t sleepwalking and sleep talking and enuresis. Risk for injury r/t sleepwalking. Risk for developmental or socialization issues r/t sleeping with caregivers or siblings. | Pattern of Self-Perception and Self-Concept: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Learns to exert autonomy by surrendering their dependence on others. Thoughts are subject to what they see, hear and experience. | Begin to express likes and dislikes of clothing and start to prefer to dress themselves. Continues to develop their sense of self through task-oriented and social experiences. | Self-discovery; explore and grow through physiological growth, cognitive and social development. Competitive and good self-esteem. | | Risk for disorganized behavior r/t caregiver criticism, knowledge deficit and emotions. Risk for sensory deficit if not responding to own name. | Risk low self-esteem r/t guilt and inadequacy if unable to perform tasks or contribute to the family. Risk for disturbed personal identity r/t unable to complete basic needs, embarrassed by their actions and sensitivity to criticism. | Risk for low self-esteem r/t peer groups affect the feelings of self-worth and sense of belonging in a negative way. Risk disturbed personal identity r/t poor hygiene and may not care about their appearance. | Role-Relationship Pattern: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Fear strangers and know their family members. Gravitate to their caregivers and interested in their activities and processions. | Show affection to loved ones but peers become increasingly important and desire to play with other children. Understand gender expectations regarding jobs and activities. | Develop more friendships and relationships outside the family circle. Understands their role within the family and takes on more responsibilities and interacts well within the family unit. | | Risk for regression r/t new sibling joining the family. Risk for separation anxiety r/t strong attachment to one caregiver. | Risk for impaired social interaction r/t relating to older peers and may not play well with peers in their own age group. Risk for negative influences r/t inaccurate portrayals of male and female roles in society. | Risk for impaired attachment r/t spending time with friends more satisfying than spending time with the family. Risk for ineffective role performance r/t caregivers not engaging in setting limits and defining expected behaviors. | Sexuality – Reproductive Pattern: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Masturbation and genital exploration. Touch genitals during diaper changes or during toilet training. | Able to recognize that there are two genders and identifies self and usually desires same-sex friends. Develops curiosity toward the opposite gender. | Increased awareness of the body; may have breast development, pubic hair, and other signs of puberty onset. Curious about opposite sex | | Risk for sexual dysfunction r/t touching themselves in front of others or inappropriately trying to touch others. Risk for injury r/t frequent cries when having bowel movement or voiding; may indicate a medical issue | Risk for potential problem if teased about their interest in sexual information. Caregivers should be there to answer any questions simply and accurately. Risk for role confusion and gender identity r/t dislike in certain gender and negative body image. | Risk for knowledge deficit r/t caregivers unwilling to discuss sexual matters. Risk for ineffective sexuality pattern r/t dressing inappropriately to get sexual attention and gender role challenges. | Pattern of Coping and Stress Tolerance: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Will cope to any situation because they are temperament. May throw tantrums to control a situation or attach to caregivers out of fear. | Displays coping mechanisms similar to toddlers; separation anxiety, regression, denial, repression and projection. May use a doll/teddy bear or special blanket for sense of security. | Use defense mechanisms; controlling behavior, use of repetition, humor and exercise. Cope by listening to music, talking to friends, engaging in sports or activities. | | Risk for ineffective coping r/t difficult temperament Risk for caregiver role strain r/t distressing behaviors of child causing them to feel ineffective in their roles | Risk for impaired coping r/t regressive behavior, refusing to follow directions. Risk for developmental problem r/t daydreaming or may indicate sensory problem. | Risk for anxiety r/t competition, homework and family issues overloading stress. Risk for depression r/t homelessness, death of a loved one, long-term hospitalization, chronic illness, and learning problems. | Pattern of Value and Beliefs: (Edelman, 2010) (Jarvis, 2012) (McLeod, 2013) 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. | Responds with good behavior reflected by positive feedback. Learns right from wrong from positive family values and beliefs. | Demonstrates some internal control over actions and behaviors. Learn religious beliefs from their caregivers, church and express their values frequently. | Moral development influenced by cultural, religious and caregiver values. Able to make moral and ethical decisions; knowing right from wrong. | | Risk for moral distress r/t caregivers only attending to misbehavior and not rewarding good behavior. Risk for impaired parenting r/t caregivers not using positive reinforcement or do not discipline bad behavior | Risk for moral distress r/t peers and inappropriate television content influencing behavior. Risk for decisional conflict r/t rule breaking and disrespect to others. | Risk for moral distress r/t peer pressure. Risk for spiritual distress r/t frequent lies d/t fantasy exaggerations and inaccurate understanding. May show disrespect to other people. |

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.

As a child becomes a toddler, preschooler and school-age, they share many of the same challenges. They all develop an ego by successfully completing Erikson’s stages of development (McLeod 2013). Developmental growth is reflected by their environment and influence of caregivers directly involved by shaping them by their family’s culture, religion and value/belief system (Edelman 2010).

There are many differences in how each age group responds within each health pattern. Toddlers and preschoolers need more structure and guidance from caregivers as well as the opportunity to be autonomous. The school-age child need support from their caregivers but practice the values and learned behaviors to build on and move toward self-concept and identity. Thought process changes over these age groups from magical, concrete, to abstract.

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.

When the nurse is assessing a child, the nurse must understand that they are predominantly caring for two patients, the child and the caregiver (Jarvis, 2012). For a nurse, the assessment, examination and interaction with a child patient offer its own set of challenges and require a different approach from that of an adult. When dealing the toddler and preschooler, the nurse should interact with the caregiver, giving the child the opportunity to see the nurse’s interaction with their caregiver. This allows the child to see that the caregiver has accepted and trusts the nurse. For the toddler and the preschooler, the caregiver will be providing the health history for the most part. (Jarvis, 2012).

The nurse should interview and examine the child with the caregiver always present (Jarvis, 2012). The nurse should be familiar with the child’s way of communicating prior to the exam or treatment. Cultural competence should always be considered. The nurse needs to ensure that the caregiver and the child feel comfortable with and during the interview, assessment, examination and educational/patient teaching phases of the visit (Jarvis, 2012).

Some strategies that the nurse might incorporate include awareness of the various developmental stages that a child faces. When performing a physical assessment of a child the nurse should be at eye level and when talking to the child and explaining concepts the nurse should use simple language that they child can understand (Jarvis, 2012). The nurse can allow the child to hold instruments, like a stethoscope, during the physical exam to help them feel like they are involved in their own care or reduce fear (Jarvis, 2012). Diverting their attention away from the nurse by sharing reading materials or media to look at may help (Jarvis, 2012).

References

Edelman, C., & Mandle, C., (2010). Health Promotion Throughout the Life Span. 7th ed. St. Louis, MI: Mosby.

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

McLeod, S. A. (2013). Erik Erikson. Retrieved from www.simplypsychology.org/Erik-Erikson.html