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NR602 Week 3: Homework- MyEvaluations Log
NR602 Week 3: Homework- MyEvaluations Log
Perform clinical activities under the guidance of a clinical preceptor and document all your patient encounters and practicum hours on the clinical documentation log and submit before the end of Week 3.
Week 3 References
Burns, C.E. (2020). Pediatric Primary Care (7th ed.). Saunders Elsevier
Centers for Disease Control and Prevention (CDC). (2019). Growth charts.
Savage, M. N., & Bouck, E. C. (2017). Predictors of Risky Behavior and Offending for Adolescents with Mild Intellectual Disability. Intellectual & Developmental Disabilities, 55 (3), 154-166
Caring for the Pediatric Patient Within a Family
There are some important tips that all NPs should remember when caring for a child in a primary care setting.
- Make everyone in the exam room comfortable and safe.
- Provide privacy.
- Be at eye level with the child.
- Speak to the child no matter his or her age or developmental level.
- Be observant of parent and child interaction.
- Always carry a calculator with you. Be able to quickly calculate kilograms to inches and centimeters to inches.
- Separate adolescents from the parent during the exam to ask questions about emotional well-being, safety and social determinants of health. Explain this is routine upon the first adolescent health visit. Adolescents are more likely to reveal more information without parent present.
- Be prepared to unclothe your patient at some point in all well child exams. Visualization of symmetry and skin is critical in pediatric patients.
Indicators of Child Health
There are globally agreed upon child health indices. Additional health indicators are examined in primary care practice in the United States. As an NP in family practice, you should stay current on indicator statistics and strive to improve your practice. You should also be aware of state and local trends that affect your patients and monitor their health based on indicators.
U.S. Child Health Indicators
The current list of U.S. child health indicators includes but is not limited to measurement of the following:
- Family structure, living arrangements
- Births to unmarried women
- Language spoken at home
- Health insurance coverage
- Usual source of healthcare
- Low birth weight infants
- Infant mortality
- Child deaths
- Teen deaths
- Infant births to teenage mothers
- Immunization rates
- Oral care
- Limitations in physical activity
- Rates of cigarette smoking, alcohol use, illicit drug use
- Sexual activity among adolescents
- Rates of homicide, suicide, and injuries among children and adolescents
- Violent crime arrest rates
- Percentage of adolescents dropping out of high school
- Percentage of children living below the federal poverty level
For more information on current child health indicators and to read statistics for the states go to Federal Interagency Forum on Child and Family Statistics website.
For global health indicators of child health, as measured by the World Health Organization website.
Family Assessment by the Nurse Practitioner: Assessment of the Infant, Child and Adolescent Review of Pediatric Development
The fundamental objective of pediatric patient care is to optimize growth and development in order to enhance quality of life and minimize injury, illness, and death. The nurse practitioner (NP) must comprehend and frequently apply basic growth and development theories and concepts to the treatment of children and their families. The following are some fundamental human growth and development concepts.
- Human growth is cephalocaudal (head to tail) and from the center of the body to the periphery.
- Human growth is linear and should follow established patterns for physical, cognitive, and motor growth and development.
- Physical growth during childhood should follow a smooth curve if measured every 6 to 12 months.
- Growth or height velocity per year can and should be calculated when there are concerns in linear growth. The formula for growth velocity = change in height since last visit times 12 months divided by months since last visit.
- The process of physical growth and development takes almost 2 decades to complete.
- Development depends on psychosocial maturation and cognitive learning.
- Cognitive development occurs from simple to complex (concrete to abstract).
- Each child is unique, with different environments, history, exposures, and genetic make-up that will affect growth and development.
- No single measure should be a concern for growth, but serial measures for at least 6 to 12 months should be recorded.
This week’s readings will cover growth and management in pediatric primary care, including newborns, toddlers/preschoolers, school-age children, and adolescents. Developmental milestones are divided into several areas, including social, emotional, linguistic, and cognitive growth. As a nurse practitioner, it is critical to be aware and experienced in screening for red flags in children.
Review (Burns et al., 2020)
- Table 10.4 Developmental Red Flags: Newborns and Infants
- Table 11.12 Red Flags of Early Childhood Development
For more information on developmental milestones, review American Academy of Pediatrics’ Bright Futures website. Also download the Centers for Disease Control and Prevention’s (CDC) Milestones Tracker app from the CDC website.
Normal Growth and Development (NR602 Week 3: Homework- MyEvaluations Log)
Routine measurement and tracking of growth and development cannot be emphasized enough. In the primary care setting, not only should charts and graphs be kept of children’s weight and height gains, but also of BMI and head circumferences. Children should always be measured more than once to confirm results when there are concerns about accelerated or delayed growth. Shoes and extra clothing, such as coats and accessories should be taken off during weighing and measuring children. Office personnel should be trained in proper weighing and measurement of children. A diagnosis of growth problems should not be made on a single measure at a single visit. When children are referred for delay or acceleration in height or weight to the pediatric specialist best suited based on associated symptoms, then all measures of height and weight along with plotted growth charts of several visits should be sent to the specialist.
The growth curve is more than just a chart that compares a child’s height, weight, head circumference, and/or BMI to population norms; it also helps the primary care practitioner to anticipate development trajectories. For example, a patient with premature puberty may be taller than others at a younger age, but may cease developing shortly after puberty, making him or her shorter than expected. One rationale for medically interfering and postponing puberty is to reach maximum potential height.
To accurately assess growth at each visit, key principles must always be employed.
- Each child must be weighed and measured at each visit.
- For infants, clothing must be removed.
- Recumbent height measurement (when the child is lying down) is utilized until 2 years of age.
- Head circumference should be measured until age 3.
- Infants should be weighed with no clothes or diaper.
- In older children, height must be with shoes off, against a wall, and with heels to the wall at every visit.
- Height and head circumference should be measured three times for congruence and the highest number used.
- Physical growth parameters should be plotted at each visit and an ongoing record kept.
- For premature infants born at less than 36 weeks’ gestation, height and weight documentation should be corrected for by a documented gestational age assessment, completed in the first 24 hours.
Review growth charts within your Burn’s Pediatric Primary Care textbook. The same age appropriate growth charts are also available at the Centers for Disease Control and Prevention’s (CDC) website, under National Center for Health Statistics.
Review the Growth Curves video at: https://www.youtube.com/watch?v=lNE8jSL7WQk
Measuring Development at Each Visit
Childhood growth and development should be measured and observed at each yearly well-child exam and periodically at other visits. Be sure to read the course text for specifics of measures that should be taken at each visit and are dependent on age and development. Keep in mind that children who were born prematurely may have delays in growth and development, but by 24 months post birth, they should be caught up to peers.NR602 Week 3: Homework- MyEvaluations Log
Adolescence is a period of rapid physical, emotional, cognitive, and social growth and development. In westernized nations, the period of adolescence begins somewhere around the age of 11 years, with females beginning earlier than males and can take as long as age 18 years to complete in females and age 21 years to complete in males.
Females show physical signs of puberty with either the larche (breast budding) or adrenarche (development of pubic hair). Menarche signified the primary event in female puberty and is associated with changes in self-identity. Girls experience menarche at different ages. However, on average, menarche occurs at 12 ½ years of age (Burns, et al., 2019)
What is the purpose of adolescence? Adolescence serves as a time period when individuals pass from childhood into adulthood and it is marked by more than simply physical changes. Peers and outside activities become critical to adolescents and mark normal social development. The struggle for independence between parents or guardians and adolescents is also normal but should be monitored for qualities that hinder development in other areas or the achievement of closure to adolescence.
The following are goals of adolescence:
- Completion of puberty and growth
- Development socially, emotionally, and cognitively
- Abstract thinking
- Establishment of independent identity
- Preparation for career or life work
Contributors to adolescent morbidity include:
- unintentional pregnancy;
- substance use and abuse;
- sexually transmitted diseases;
- dropping out of school;
- running away;
- physical violence; and
- juvenile delinquency.
Adolescent engagement in risky behaviors has increased in recent years. These risky behaviors include smoking, alcohol consumption, and sexual activity. Continued involvement of these behaviors tends to result in negative health outcomes such as sexually transmitted infections or committing an illegal offending act. Research has shown that adolescents who engage in one risky behavior are more likely to engage in multiple risky behaviors which places them at a higher risk for long-lasting negative health outcomes (Savage & Bouck, 2017).
The HEADSS assessment is an adolescent psychosocial assessment used to quickly obtain historical data. During this interview portion, you may ask the parent or guardian to leave the room. Remember to be sensitive culturally while also ensuring patient privacy and confidentiality with the adolescence. As the nurse practitioner, it is imperative to provide open-ended questions to elicit responses from adolescents about categories regarding home environment, eating habits, education, employment, peer related activities, drug use or awareness, sexuality, suicide and depression factors, and safety. In-depth discussion can warrant further physical or emotional assessment for the adolescent.
Also, during adolescent visits, the US Preventative Services Task Force (USPSTF) recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.NR602 Week 3: Homework- MyEvaluations Log
Tanner Staging, also known as Sexual Maturity Rating (SMR), is an objective classification system used to assess and track the physical development and sex characteristics associated with pubertal growth and maturation of children (Emmanuel & Bokor, 2018). Review (Burns et al., 2020)
- Figure 13.3 Normal female breast development
- Figure 13.4 Normal female genitalia development
- Figure 13.5 Normal male genitalia development