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Question Description

Pediatric Health Promotion

The client is a 17-year-old and is in the adolescent stage. She has met the developmental milestones of adolescents such as: having more interest in romantic relationships, showing more independence from parents, having a deeper capacity for caring, spending more time with friends, and shows concern about future school and work plans (The Centers for Disease Control and Prevention [CDC], 2020). She can determine the difference between right and wrong and can make her own choices.

Erik Erikson was a psychologist that developed a theory for the stages of psychosocial development. Erikson’s theory is comprised of 8 stages and believed that personality would develop in each stage. In adolescence, the psychosocial stage is identity vs role confusion. Identity vs. role confusion is the fifth stage of Erik Erikson’s theory of psychosocial development. This is a pivotal stage in the growth of an adolescent, and typically occurs between the ages of about 12-18 (McLeod, 2018). The maturity from child to adulthood in this stage is especially important because the adolescent must determine which role, he/she will play as an adult. The mind and body will also change during this stage, potentially leaving the adolescent uncomfortable in their own skin, and may also lead them to explore different social roles, which can cause “role confusion” (Ragelien? T, 2016). When the adolescent grows to be comfortable with themselves both physically and mentally, they will achieve a sense of fidelity. Fidelity is crucial for the adolescent for them mesh well with others who may have different values and beliefs (McLeod, 2018). On the other hand, an identity crisis can occur when the adolescent is searching for themselves from a “who am I” standpoint. During this phase one might experiment with different lifestyles including hobbies, career paths, and style in general.

In Maslow’s Hierarchy of Needs, the pyramid consists of five components of survival. At the bottom of the pyramid stands basic needs, as an adolescent, they need food and water in order to grow, be healthy, and comprehend information (McLeod, 2020). The second component of the pyramid is safety needs. It is necessary for an adolescent to be living in a safe and comfortable environment in order to grow as a responsible, mature adult. Regarding social needs, an adolescent needs to feel loved and have a belongingness to their peers and loved ones. The adolescent years is when they start to initiate intimate relationships which can often lead to unhappy endings. The fourth component, esteem needs, can either negatively or positively affect the adolescent by creating a toxic or fair environment with their peers (McLeod, 2020). Adolescents often feel the need to fit in, to attract friends; which can lead to bad decisions and mental health issues. The last component of the pyramid is self-actualization. Adolescents at this stage try to find their own identity and to be fulfilled in their actions of their capabilities.

Adolescents are motivated by watching others and are influenced by behaviors of others, this is called social learning theory. In the social learning theory, learning comes from observational learning by watching other people (Pearson, 2019). It is important to repeat skills and to model positive, healthy behavior.

Proper communication is a very important skill when completing a health promotion assessment for an adolescent client. The use of effective communication can help keep the client engaged, gain their trust, and respect, and promote preventative health. It is essential that the client knows that the examination room is a judgement free zone, and all the information is confidential. The client should be aware on why they are being asked personal questions, and that they do not have to answer if they are not comfortable with doing so. The client should have an opportunity to be able to communicate without their parent present, because they might not be comfortable speaking about certain topics in front of their parents. Speaking to the client alone also helps them to have some autonomy to talk about any questions or concerns that they may have and provides the client with some privacy.

Client:

The client is a 17-year-old female, and will be referenced as A.J. The interview included the mother as the informant. Client has completed the following documents:

Guidelines for Adolescent Prevention Survey

Bright Futures Previsit Questionnaire-15 to 17-year visits

Health History:

Biographic Data:

Informant: R.J., mother of the client, the client was given the option to choose if she wanted her mother present.

A.J., Female, 17 years, DOB 04/22/2003, Asian Indian American.

Reason for Seeking Care: Well visit

History of Present Illness: Not included in a well visit

Present Health Status: Medications for the client include multivitamins which are taken once a day. Client is lactose intolerant. Interventions include using alternatives to dairy such as almond milk.

Past Health History: The client has no history of chronic illnesses, surgeries, or any hospitalizations. Clients immunizations are all up to date.

Last physical exam: October 5, 2018

Last vision exam: April 17, 2019

Last dental exam: January 6, 2020

Family History:

Sister: 24 years old, seasonal allergies

Sister: 22 years old, Hashimoto Thyroiditis

Brother: 16 years old, Diabetes Mellitus Type 1

Father: 54 years old, Seasonal Allergies, Inguinal Hernia

Mother: 53 years old, Coronary Artery Disease, Diabetes Mellitus Type 2, Osteoarthritis, Hypertension

Paternal Grandfather: Deceased (100 years old) Alzheimer’s

Paternal Grandmother: Deceased (60 years old) health history unknown

Maternal Grandfather: Deceased (40 years old) Alcohol abuse

Maternal Grandmother: 76 years old, Diabetes Mellitus, Vision Loss

Personal Status:

Client is described by mother as “very intelligent, empathetic, and funny”. When client was asked “how do you think life is going?” she replied, “I think it’s ok. I’m worried about my mom because she has heart disease, and she is high risk for coronavirus, and she has close contact because she is a nurse”. Client was asked “what do you like about yourself?” She responded, “I like my humor, I’m organized, and I can handle constructive criticism”. Client was also asked “what could you work on”? She responded, “I could work on my anger, sometimes I cannot control it. I also wish I had more patience”.

Client is part of her high school’s marching band and enjoys playing Fortnite with her friends. On the Guidelines for Adolescent Prevention Survey, client indicated that she spends a lot of time thinking of ways to be skinny and exercises at least three times a week.

Family and Social Relationships:

Client lives with her father, mother, grandmother, two older sisters, and one younger brother. The father, mother, and two sisters all share caregiving duties. The father is a full-time surgical assistant, mother is a full-time registered nurse. The client has health insurance through her father. The parents can meet the child’s basic physical needs. Client states that she is close to her brother who is 16 years old, one year younger than him. Client states that she has two close friends who are also 17 years old. Client enjoys baking with her friends, shopping, and going on walks with friends. There is no known gang activity or violence in her school, and the client has not started dating.

Diet and Nutrition:

Clients is lactose intolerant. The client stated that she usually eats each meal by herself at home. The clients typical breakfast includes a croissant with an egg and strawberries. Lunch is typically rice with chicken, and the client also has this for dinner. The client states that she does not drink any soda but does consume fast food about once a week. When the client was asked, “what is your perception of your current weight?”, client replied “fat”. Client states that she does not like her body and would like to lose weight.

Sleep:

Client states that her sleep pattern has changed because of the quarantine, client usually goes to bed at 0500. Client states that she usually goes to bed late at night as a result of playing video games and talking to her peers. Client sleeps between 7 and 9 hours per night and uses her cellphone alarm to wake up.

Mental health:

Client states that she feels depressed sometimes but has no suicidal thoughts. Client states that she does not like her body. Client states that she can talk about her feelings and problems with her best friends who she can trust. Client states that her current stresses are coronavirus and school and stated that exercising and listening to music have been effective for stress relief. Client states that she has not been feeling angry recently, but when she does, she verbally expresses her feelings when she has calmed down.

Sexuality:

Client states that she was 9 years old when she started her menstrual cycle. Clients usual menstrual interval is every 30 days and usually lasts 8 days. The flow is heavy for the first three days of menstruation using two pads in one hour and on the 4-8th day the flow is moderate using one pad an hour. Client is heterosexual and states that she is not in a sexual relationship.

Development:

According to the Bright Futures Pre-Visit Questionnaire client,

Engage in behaviors that support a healthy lifestyle, such as eating healthy foods, being active, and keeping themselves safe

Has a strong support system, and has friends that she is comfortable with

Has the ability to bounce back from life’s disappointments

Makes own decisions, and has become more independent

Good at doing a certain thing, which is baking

Health Promotion activities:

Client gets adequate sleep every night. Client goes on an hour walk every day with friends or siblings at least 5 times a week. Client denies tobacco and alcohol use. Client has a strong, positive connection in her life. Client is part of her high school marching band.

Home Environment:

The client lives in a safe neighborhood with a very low crime rate. The client has a running track for the community right next to her house. The house has running water, adequate space, smoke detectors, carbon monoxide detectors, heat, and cooling.

General Survey:

Client is tall and slender. Client appears to be reported age. Skin color is appropriate to ethnicity. Client is alert and oriented x3. Client maintains eye contact and is cooperative. The facial features appear symmetric. No signs of acute distress. The client appears clean and is wearing clothing appropriate to climate. The client’s gait is coordinated with full mobility in all joints, and she sits and stands comfortably.

Vital signs:

Temperature: 97.4 F, Oral

Blood pressure: 117/69 sitting.

Pulse: 76 beats/min. Regular rhythm, amplitude is 2+, and it is smooth and round.

Respiratory rate: 14 breaths/min on room air. Clients breathing is quiet, effortless, and posture is relaxed.

Weight: 61.2 kg

Height: 66 inches

BMI: 21.9 kg/m², normal weight

Pain: Client was asked to rate her pain on a scale from 0 having no pain to 10 which would be the worst pain that she has ever been in. The client stated that her pain level is a 0.

Analysis of Data:

The pre-visit questionnaire, GAPS, health history interview, vital signs, and general survey provided data for this health promotion. During the GAPS, the client stated that she thinks of ways to be skinny often. The clients BMI is 29 kg/m², which indicated normal weight. The mother was asked to develop or implement ways to improve the client’s self-confidence. It is important to recognize the effects of low self-esteem on the client, as it could lead to depression, which can put them at risk for various things. The care plan will address the problem of low self-esteem.

Nursing Diagnosis: Situational Low Self-Esteem r/t body image as evidenced by verbal reports of insecurity

Goal: Improved self esteem by verbalizing positive statements about themselves by the next clinical visit.

Objective 1: Client lists things to do build self-esteem, and implements them by next visit

Objective 2: Client will identify positive traits of herself and how she views her body by

next visit.

Objective 3: Client will present a journal containing one positive statement each day by next visit.

Interventions:

1.Spend enough time with the client to avoid the feeling of being rushed and to encourage client to verbalize thoughts and feelings

2.Use active listening, and provide full attention to the client

3.Discussions should be held in a private setting so client feels like they will not be overheard, and so they can talk openly

4.Provide the client with continuous positive feedback

5.Use open ended questions, this guides the client to be more open

6.Help client identify what is causing low self-esteem, it is important to identify the problem

7.Help the client find resources that will aid with low self esteem

Evaluation:

1.Will review journal with client on next visit, if the client is comfortable, journal should have at least one positive attribute from each day until next visit.

2.Client can verbalize positive characteristics about themselves and their body

References

Center for Disease Control and Prevention. (2020). Teenagers (15-17 years of age). Retrieved from https://www.cdc.gov/ncbddd/childdevelopment/positi…

McLeod, S. (2018). Erik Erikson’s Stages of Psychosocial Development. Retrieved May 1, 2020, from https://www.simplypsychology.org/Erik-Erikson.html

Ragelien? T. (2016). Links of Adolescents Identity Development and Relationship with Peers: A Systematic Literature Review. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent, 25(2), 97–105.

McLeod, S. (2020). Maslow’s Hierarchy of Needs. Retrieved May 1, 2020, from https://www.simplypsychology.org/maslow.html

Pearson. (2019). Nursing: A concept-based approach to learning (3rd ed.). Boston, MA: Pearson Education, Inc.

Wilson, S. & Giddens, J (2016). Health Assessment for Nursing Practice (6th ed). Mosby, Inc.

Ackley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Mosby.