Ncma217 Lec Final

Bachelor of Science in Nursing 2YA
NCMA217 LEC: BSN 2ND YEAR 1ST SEMESTER FINAL 2021
Coverage for Final Exam: hospitals starting in New York city to promote comprehensive
• Growth and Development care to children.
- 1889 – open of first milk distribution center providing
• Nursing process for promotion of normal pasteurized milk. At nakatulong ito sa pagbaba ng infant
growth and development mortality rate.
• Health promotion and disease prevention in Importance of growth and development assessment
different stages of growth and development 1) Knowing what to expect of a particular child at any given age.
• Ethical Scope and Standards (will help us anticipate their needs.)
• Filipino Culture, Values and Practices in 2) Gaining better understanding of the reason behind illnesses.
(bakit sila nagkakasakit, ano ung mga contributing factors)
Relation to Maternal and Child Care
3) Helps in formulating the plan of care.
4) Helps in parents’ education in order to achieve optimal growth
INTRODUCTION TO GROWTH & DEVELOPMENT
and development.
- Growth – quantitative increase, measurable, in weight, height,
Principles of growth and development
circumferential diameters. If you are alive and eating, you will
1) Innate in every person – innate is u don’t need to decide, its
grow. Growth is the measurable increase in the physical
natural and part of us to grow and develop.
changes of the whole body and any of its parts.
2) Predictable and follows pattern
- Growth occurs as cells divide and synthesize new proteins.
3) People have different pacing or rate in growth and
- Nutrition represents the most important variable influencing
development
child’s growth.
4) Heredity sets limit in growth and development – chromosomal
- growth starts conception but ends some age. (18-21 years old)
abnormalities (down syndrome can set limit in growth and
- Circumferential diameters are head, chest and abdominal.
development)
• Weight – kg, pounds 5) Environment affects growth and development – kung ano
• Height – cm, ft. inches, meters nakikita sa paligid nila
• Circumferences – cm, inches 6) Nutrition affects growth and development – starts at during
• Walang mg, ml pregnancy of mother
- Development – qualitative increase in the capacity to function. 7) Development is continuous throughout life
If you are alive, eating, interacting with your environment, you 8) There are critical periods in growth and development
will develop. Development is a progressive increase in skill (developmental milestones) it is predictable
and capacity to function. (Maturation) 9) There are upper limits of growth and development that cannot
- Nursing responsibility: teach the parents on how to care and be surpassed. (Ex: kapag ung IQ mo ay 90, hanggang doon lng
interact with their children. ang kaya. Hindi na pwede lumagpas)
- Development can be measured by observing the child’s ability
to perform a specific task. Mam Jhal:
- Parenting style and competence are also major influences on 1) Principle of continuity
the behavioral and mental health development of the children. 2) Principle of integration – development that involves a
- Parameters: movement. It enables the child to develop satisfactory in
• Speech and language – how many words can child speak relation to various aspects or dimension of this personality.
• Body language – gestures, facial expression (Orderly sequence)
• Self-esteem – self-worth, self-valuing 3) Principle of lack uniformity – hindi pareparehas (not exhibits
• Motor development – movements, using extremities steadiness and uniformity)
• Sensory development – visual, auditor, olfactory, 4) Principle of individual differences (walang magkamukha,
gustatory, tactile, cognitive hindi dapat pinagcocompare)
- The child will develop self esteem as the child is growing up 5) Principle of uniformity pattern
because the child will be able to experience the different 6) Principle of proceeding from general to specific
theories of growth and development. 7) Principle of interaction between heredity and environment
1) Psychosocial development (Eric Erickson) (environmental influences provides space for multi-
2) Psychosexual development (Sigmund Freud) dimensional development through interaction with family,
3) Cognitive development (Jean Piaget) peers and society)
4) Moral development (Lawrence Kohlberg) 8) Principle of interrelation (kapag may ginawa kang isa,
- As nurses, the early recognition of growth and developmental maapektuhan un susunod na gagawin mo)
failures helps for effective nursing intervention in managing 9) Principle of cephalocaudal
our client’s problem. (Early detection) 10) Principle of proximodistal
- Growing up is a complex phenomenon because of the many 11) Principle of predictability (it will help the uniformity of the
interrelated facets involvement. pattern and sequence of development) pwede mo i-anticipate
- Abraham Jacobi (1870) – known as Father of Pediatrics. He na at this particular age, ganito na kaya nyang gawin
was awarded the first pediatric professorship in the US. Hew 12) Principle of spiral vs linear advancement
was able to promote establishments of pediatric departments in 13) Principle of association of maturation and learning.
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CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE– BSN 2ND YEAR 1ST SEMESTER FINAL 2021
Adolescent Peer group (kabarkada) Loss of privacy, rejection
Stages Play Toys Question

Rattles (brightly
Solitary (naglalaro
Infant colored, None
mag isa)
tumutunog)
Parallel (dahil Push and pull
What (object
Toddler selfish ang mga (increase motor
orientation)
toddler) ability)
Preschool Associative Make believe Why (reasons)
How
School age Cooperative (procedural
stage)
What if (life
Adolescent Competitive
situations)
Different patterns of growth and development
Stages of Moral Development
a) Cephalon-caudal
Level 1: Preconventional
- Head to toe
- Throughout the preconventional level, a child’s sense of
- Ex. Lifting the head before the body. (pababa)
morality is externally controlled. Children accept and believe
b) Proximodistal
the rules of authority figures, such as parents and teachers.
- From center to periphery (Ex. Arms before hands)
- A child with pre-conventional morality has not yet adopted or
c) Gross to refine
internalized society’s conventions regarding what is right or
- Gross anatomy – palm
wrong, but instead focuses largely on external consequences
- Refine – fingers
that certain actions may bring.
- Ex. Palmar grasp before pincer grasp
d) Simple to complex Stage 1: Obedience-and-Punishment Orientation
- Easy task to difficult task - Child’s desire to obey rules and avoid being punished.
- Gross to refine and simple to complex are interrelated - For example, an action is perceived as morally wrong because
e) General to specific the perpetrator is punished; the worse the punishment for the
- Example: nouns – common name before proper name act is, the “worse” the act is perceived to be.
Stages Age Psychosocial Psychosexual Stage 2: Instrumental Orientation
Infant 0–1 Trust vs Mistrust Oral - Expresses the “what’s in it for me?” position, in which right
Toddler 1–3
Autonomy vs Shame
Anal behavior is defined by whatever the individual believes to be
and Doubt in their best interest.
Preschool 3–6 Initiative vs Guilt Phallic - Stage two reasoning shows a limited interest in the needs of
School age 6 – 12 Industry vs Inferiority Latency others, only to the point where it might further the individual’s
Identity vs Role
Adolescent 12 – 18 Genital own interests. As a result, concern for others is not based on
Confusion
loyalty or intrinsic respect, but rather a “you scratch my back,
o Phallic and genital magpinsan
and I’ll scratch yours” mentality.
- An example would be when a child is asked by his parents to
Cognitive Moral
Stages Age do a chore. The child asks, “what’s in it for me?” and the
development development
Sensory motor (more parents offer the child an incentive by giving him an
Infant 0–1 Amoral allowance.
on senses)
Sensory motor (more Preconventional Level 2: Conventional
Toddler 1–3 - A child’s sense of morality is tied to personal and societal
on motor) stage 1
Pre-operation (pre- Preconventional relationships. Children continue to accept the rules of authority
Preschool 3–6
conceptual) stage 2 figures, but this is now due to their belief that this is necessary
School age 6 – 12 Concrete operational Conventional to ensure positive relationships and societal order. Adherence
Post operational/ Post- to rules and conventions is somewhat rigid during these stages,
Adolescent 12 – 18
formal operational conventional and a rule’s appropriateness or fairness is seldom questioned.
Stage 3: Good Boy, Nice Girl Orientation
Most significant
Stages Fear - Children want the approval of others and act in ways to avoid
person
disapproval. Emphasis is placed on good behavior and people
Infant Primary care giver Stranger anxiety being “nice” to others.
Toddler Parents Separation anxiety
Stage 4: Law-and-Order Orientation
Ghost, dark, monster, - The child blindly accepts rules and convention because of their
Preschool Family/ neighbors castration/ mutilation importance in maintaining a functioning society.
(imaginative) - Rules are seen as being the same for everyone, and obeying
School age Peers (kaidad)
Death, intimidating teacher, rules by doing what one is “supposed” to do is seen as
failure in school valuable and important.
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- Moral reasoning in stage four is beyond the need for - Toy – rattle
individual approval exhibited in stage three. If one person - GOATS
violates a law, perhaps everyone would—thus there is an • Grows very fast
obligation and a duty to uphold laws and rules. • Oral
- Most active members of society remain at stage four, where • Amoral
morality is still predominantly dictated by an outside force. • trust
Level 3: Postconventional o Infant and adolescent stage has a most rapid rate of growth and
- A person’s sense of morality is defined in terms of more development. (Growth spurt)
abstract principles and values. People now believe that some o Infant grows very fast because Birth weight x2 by 6 mos, x4
laws are unjust and should be changed or eliminated. by 12mos, and x3 by 2y/o
- This level is marked by a growing realization that individuals o Trust – primary care giver
are separate entities from society and that individuals may o Trust is established if needs of the infant are consistently met
disobey rules inconsistent with their own principles. by the PCG.
- Post-conventional moralists live by their o Since infant cannot communicate verbally, he/ she will cry to
own ethical principles — principles that typically include such convey his/her needs. (Hunger, pain, discomfort, attention)
basic human rights as life, liberty, and justice—and view rules o Mistrust is established if the needs of the infant are not
as useful but changeable mechanisms, rather than absolute constantly met.
dictates that must be obeyed without question. Because post- o Fear – stranger anxiety = mistrust = object permanence – the
conventional individuals elevate their own moral evaluation of infant can already remember starting 6 months.
a situation over social conventions, their behavior, especially o Below 6mos, the concept of the infant is “he and his primary
at stage six, can sometimes be confused with that of those at care giver are the same persons”
the pre-conventional level. Some theorists have speculated that o And starting 6 mos. They will have object prominence; the
many people may never reach this level of abstract moral infant can remember the face/ image of the primary care giver
reasoning. then he realizes that he is separate person from the PCG.
Stage 5: Social-Contract Orientation o Peak 8th mos. (9th mos.)
- The world is viewed as holding different opinions, rights, and o Stranger anxiety begins to fade at 12 mos.
values. Such perspectives should be mutually respected as o According to EE, if the PCG is not meeting the needs of the
unique to each person or community. infant, sometimes the infant will be the one to meet his own
- Laws are regarded as social contracts rather than rigid edicts. needs. Example is solitary play, naglalaro magisa. Body parts
Those that do not promote the general welfare should be o Since ang kanyang psychosexual ay oral, lahat ng body parts
changed when necessary to meet the greatest good for the or ung nilalaro nya ay nilalagay nya sa bibig nya.
greatest number of people. o By 3mos. He can discover his hands. He uses his hands as toy.
- This is achieved through majority decision and inevitable o By 7mos. The infant will start sucking his feet.
compromise. Democratic government is theoretically based on o The best toy for infant is rattle. (Rattle is something the infant
stage five reasoning. is holding and its colorful specifically red color. And the rattle
Stage 6: Universal-Ethical-Principal Orientation produces sounds.
- Moral reasoning is based on abstract reasoning using universal o Maganda ung rattle kasi it promotes motor development. This
ethical principles. Generally, the chosen principles are abstract is given 4-5 mos. Specially when the palmar/ grasping reflex
rather than concrete and focus on ideas such as equality, fades.
dignity, or respect. o Hindi pa pwede ibigay ung rattle sa 3mos kasi meron syang
- Laws are valid only insofar as they are grounded in justice, reflex, once na nahold nya yon. Hindi na nya mabibitawan.
and a commitment to justice carries with it an obligation to (Parang ikaw, alam mo ng niloloko ka na, nasasaktan ka na at
disobey unjust laws. may mahal na syang iba pero hindi mo pa rin sya mabitawan,
- People choose the ethical principles they want to follow, and if ano tawag dyan? Hehe)
they violate those principles, they feel guilty. In this way, the o 2mos – crib/ musical mobile (more on auditory)
individual acts because it is morally right to do so (and not o Hindi masyado naappreaciate ng 1mos old baby ang musical
because he or she wants to avoid punishment), it is in their mobile kasi most of the time natutulog lng sila. Average 17-18
best interest, it is expected, it is legal, or it is previously agreed hours in a day, as much as 20 hrs. gigising lang sila pag
upon. Although Kohlberg insisted that stage six exists, he nagugutom, natatae.
found it difficult to identify individuals who consistently o Ung sleep ng 1-2mos ay importante kasi it promotes brain
operated at that level. development.
o Choice of toy – best answer: safe to play (it must be age
INFANT appropriate, size appropriate and nontoxic, so it will consider
- From birth to 1 year-old as safe to play) global effect/ umbrella effect.
- Psychosocial task – trust vs mistrust a) Age appropriate
- Psychosexual stage – oral b) Size appropriate – not too small (aspiration of foreign
- Cognitive stage – sensory motor bodies/ object and this results to choking) and not too big
- Stage of moral development – amoral (suffocation/ asphyxia)
- Most significant person – primary care giver c) Non-toxic – no detachable parts
- Fear – stranger anxiety d) Safe to play
- Play – solitary play
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o The infant learns using his senses and motor skills, pero o 6-7 y/o the teeth will start to fall off. Kasi ang lalabas na dito
limited pa ang motor skills ay permanent teeth = 32.
• Infant can communicate by means of crying o Teething should not be accompanied by fever and diarrhea.
• Infant can talk (between 10-12mos) 2 syllabus, same Pero kung may kakilala kayo na nagkakalagnat or nag-
vowels. diarrhea, kasi habang nag eerupt ung ngipin ng baby,
o According to Kohlberg, the infant has no moral development nagakakroon ng discomfort ung gums nya or makati. Kaya
yet. maghahanap sya ng ikakagat nya. so kung ang nakuha ni baby
o According to Freud, the infant is still in the oral stage. ay madumi at kinagat nya yon. That causes fever and diarrhea.
o To remove the habit of thumb sucking of your child (6- o Solid foods:
7yrsold), do not focus on thumb sucking but give attention to 1) Iron-fortified cereals
your child. (iisipin ng bata na, nakukuha nya pa rin ung 2) Veggies then fruit (ung fruits kasi matamis. So pag inuna
attention ng magulang kahit hindi sya nag ta-thumb sucking, mo ung fruit at sinunod mo ung veggies, hindi na nya
so gradually, mawawala ang thumb sucking) kakainin ung veggies)
o Nag ta-thumb sucking pa rin sila sa advance age nila kasi 3) Meat – chicken, pork, fish, and chicken liver should be
meron silang unmet oral needs during infancy na nakatago shredded and chopped. (Wag muna beef bcz it’s hard to
saknyang subconscious at nama-manifest nila yan of attention digest)
seeking behavior pagdating ng advance age.
o Causes of accidents: aspiration of foreign bodies – toys, fall, TODDLER
- 1-3 years old
burns
Developmental milestones - PRAISE (best reward for the toddler)
o Important events/ task/ ability of a child expected to be • P – parents, parallel, push and pull toys
performed on a specific age. • R – ritual, routines, regression, rivalry
o Lifting his head of the bed: • A – anal, autonomy vs shame & doubt
• 0 mos. – 0 degree • I – involve the parents in the care of the toddler
• 1 mo. – 15 degrees • S – sensory-motor, separation anxiety, selfish
• 2 mos. – 30 degrees • E – egocentric environment, explore, elimination.
• 3 mos. – 45 degrees o Most significant = parents – omnipotent (in authority) (para sa
• 4 mos. – more than 45 degrees (pwede na sya mag roll toddlers, ang mga magulang nila ay perfect, hindi sila
over) nagkakamali)
• 6 mos. – sits with support o For toddler, ate and kuya are rivals. (Gusto nya kasi sya lang)
so the child tend to be selfish.
• 8 mos. – sits without support
o The toddler will pattern his morality towards the parents. Kaya
• 9 mos. – crawling and creeping
ang kanyang moral stage ay preconventional stage 1.
• 10 mos. – standing with support o Lahat ng gnawa or pinapakita ng magulang ay tama para
• 11 mos. – cruising sakanila.
• 12 mos. – walking with support o Egocentric – selfish, self-centered.
• 15 mos. – walking without support o Do not force the toddler to share because toddlers are normally
• 18 mos. – running and jumping selfish but instead encourage the toddler to share.
• 2 yrs old – feet are at the same level o If the toddler is able to share, praise them to reinforce their
• 3 yrs old – can alternate his feet on the stairs good behavior. Like “ang bait bait ng baby ko”, “ang galing
o When the child can alternate his feet on the stairs, you can galing ng baby ko” (hays sanaol tlg may baby)
provide them a bicycle. Meron na syang sense of balance. o Behavioral indicators of toddlers: Selfish, egocentric, self-
• 6 mos. – introduction of solid foods centered, negativistic, manipulative, ritualistic.
o During the 6 mos. of life, the hemoglobin of infant is still the o Negativistic – they always say no but they don’t want to
fetal hemoglobin na mataas sa iron kasi nagbigay ng iron si receive an answer of no. “What’s mine is mine, what’s yours
nanay during pregnancy. are also mine”
o Starting 6 mos. the bone marrow will produce adult o Theme: holding on and letting go (on food, toys)
hemoglobin, so kukuha sila ng iron sa solid foods. - Toddler A and Toddler B (visitor), so para kay toddler A,
o Signs that infant is ready for solid foods: there is a threat, kasi may dumating na bata. At syempre,
• Sit with support – maturation of the cardiac sphincter i-hohold nya un mga laruan nya na parang “akin lang to,
(nasa dulo ng esophagus at nasa buka na ng stomach) to madamot ako”. Eh itong toddler B bisita, Nakita nya ung
prevent regurgitation of gastric content. Backflow. Kaya toys ng toddler A, so ung nanay ng toddler A, kinuha nya
during the 6mos of life, kapag dinede mo si baby at hiniga un toys nya para ibigay sa toddler B na bisita. And that is
mo agad, lalabas ung milk sa bibig nya, nagsusuka sya. forcing to share.
Kaya dapat binuburp muna si baby bago pahigain. - Hindi natin dapat finoforce un bata, dapat ineencourage
• Fading of extrusion reflex (spiting reflex) – anything that like “baby pahiramin mo na sya ohh kawawa naman.
is not sweet, the tongue of the baby will push it out. Hiram lang, ibabalik din naman sayo. Sige na oh, love na
• Teething – milk teeth/ primary/ temporary/ deciduous = love ka ni mami kapag nagsheshare ka ng toys yieee”
20, lower - So itong nanay ni toddler B. dapat kausapin din nya un
o 8 teeth at 1 yr. old anak nya “anak hiram lang to ahhh, ibabalik din natin to”
o 20 teeth present at 2 ½ - 3 yrs old (first dental checkup)
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- Ung toddler A and B, naglalaro sila sabay pero hindi sila - Wants to please his parents
magkasama. Parallel lane – they are playing side by side o Bowel training
but not playing together. - Start at 1 ½ to 2 years old
- Uwian time – so si nanay ni toddler B, sasabihan nya anak - Control gained at 2 ½ to 3 years old
nya na ibalik na ung toys kay toddler A. so ang gagawin - No distraction during bowel training (no food, no TV, no
ng B, iiyak muna yan, gusto nya sakanya nlng un toy. So toys, and no playmates.
un nanay ni toddler A, sasabihin nya “nak ibigay mo nlng - Same time of the day.
saknya yon, bibilhan nlng kita ng bago bukas” - Potty chair
- So syempre kinabukasan, sisingilin ka na ng anak mo. o Bladder training
Dapat when u make a promise, fulfill the promise. - Start at 2 ½ - 3 years old
Ganyan para sa mga toddler dapat tinutupad mo un - Control gained at 3-4 years old
promise. (hindi yung sasabihin mo saknya “hindi kita iiwan - No fluid going to bed
PROMISE” puro ka promise promise, tas wala, iniwan ka na o Ritualistic – kapag nakikita mo na sya ng ganyan, may
bigla sa ere HAHAHAH) opportunity ka na to teach the toddler about healthy rituals like
- Any broken promises it has an impact with the behavior hand washing, toothbrushing.
of the toddler. o The no. 1 defense mechanism of action is regression.
o You need to know how to read between the line. (Sometimes o Push and pull toys to promote motor development.
the no of the toddler means yes) o Since ate and kuya is rival for toddler, the toddler doesn’t want
- Example, may bumisita, at bibigyan sana sa toddler ung to left in the house without any 1 of his parent.
chocolate. Pero ayaw nya tanggapin. Nun kinuha na ng
o Separation anxiety
nanay nun toddler at tinago, maya maya hihingi na un
anak nya. So, ang bata ay gusto ng chocolate pero may - Protest
stranger anxiety sya kaya hindi nya tinatanggap kanina un - Despair
chocolate. (Stranger anxiety = infant to 18months) - Denial
o You will be able to establish autonomy if you: - Recovery
- Allow the toddler to choose and make simple decision. o Most the question of the toddler begins with what. – object
- Allow to explore the environment (Ang gusto ng toddler orientation
ay lapag sa sahig) but with limitation. (Safety of the o Causes of accidents: AFB, fall, burns, drowning, poisoning
toddler) child- lock container
o Dapat madevelop muna un trust bago autonomy (kasi kung
binibigay natin un needs ng infant at inaallow mo sya mag PRE-SCHOOL
explore during toddler, madali na ung sense of initiative ng o 3-6 years old
preschool) o MAGIC
o Toddlers are manipulative. Tinetest nya ang patient ng parents • M – Mutilation/ Castration
nya. • A – Associative play
- Tinanong mo anak mo “Chicken or hotdog?”, at chicken • G – Guilt
pinili nya. pero maya maya pag kakain na kayo, nilalaro • I – Initiative, imagination, imitator
nlng ng bata at ayaw nyang kainin ung chicken, gusto nya • C – Curiosity
raw ng hotdog. So, hindi natin pwede sundin un gusto nya o One is the most exciting, because according to Erick Erikson
na hotdog, kasi pinapili natin sya nun una tas magbabago psychosocial stage of development, the preschooler is under
na nun nilabas na un chicken. Ang number one rule sa initiative vs guilt.
discipline ay consistency. o Initiative – kusa (try)
- So since ayaw ng toddler makareceive ng NO, iencourage o Theme: to make, to try, to play, (everything is part of play)
mo nlng un bata na “bukas nlng un hotdog nak” kaya o Try a certain task is part of his play kasi meron silang curiosity.
magkakaroon ng frustration un bata. o Hindi pa maaasahan sa mga gawain bahay.
o Frustration: temper tantrums – more on nonverbal because o Nangangapit bahay na.
toddlers lack verbal skills. Nagwawala. So kapag pinansin mo o Significant others: playmates, everyone in the family,
yan, lalo yan magwawala mag iingay kasi nakuha na nya ung neighbors
attention mo at imamanipulate ka nya hanggang sa makuha o He learns how to share.
nya un desire nya. o Role modeling – Preschoolers learn morality and behaviors
o Management: ignore temper tantrums, hayaan mo sya umiyak, from family and neighbors.
mapapagod din sya except if toddler is hurting himself. o Favorite question: Why
o If the toddler hurting himself, put your child in your lap prone o He keeps asking why because of curiosity and he wants to try.
position and embrace. While u restraining the child, do not o Give positive reinforcement: praise
talk. Then after the temper tantrums, provide personal hygiene o Pag na satisfy na un curiosity ng preschool, mawawalan na sya
and talk to the child. ng interest doon sa bagay.
o To develop sense of independent = toilet training – o Sense of guilt – sample “ayaw ko na magtanong sa nanay ko,
nagkakaroon na syang anal sphincter control. ayoko na itry ung gnagawa ng nanay ko kasi nagiging trabaho
o The toddler is ready for toilet training when ko sya”
- He walks well. (Around 15-18 mos)
- Remains dry for long hours
- Can identify dry from wet diaper
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o Dapat isupport lng natin ung initiative ng bata. (kapag na o Most of the school age, if they failed to attend the school
satisfy na ung curiosity at nawalan na sya ng interest, okay they’re worried. (baka mapagalitan sya, missing the topics,
lang yon atleast na support mo un pagiging initiative nun bata) catching with the school activities)
o Sense of initiative can develop a confidence. At dapat isupport o To develop sense of industry – the child has developed trust,
ung initiative kasi next magiging school age na sya at marami autonomy, initiative and then industry. He will be able to
na syang makikilala na tao. perform in the class because he has sense of confidence and
o They are telling tall tales – exaggerated stories. (Partly true, independence.
partly lies.) o Kaya bilang magulang, para madevelop ung sense of industry
o Kapag nag sabi ng lies un anak mo, kailangan mo syang at maprevent ung inferiority ng bata, you will act as a teacher
icorrect pero hindi mo pwede icorrecy ung anak mo sa harap but you don’t have to be strict. Kasi kapag strikto ka sa anak
ng playmates nya. wag mo ipapahiya. Kausapin mo sya kapag mo, hindi nya madedevelop ung industry, inferiority ang
tapos na sila maglaro at kayong dalawa lng. madedevelop nya.
o Kapag hindi mo kinokorek un anak mo, makakasanayan nya o You can set rules and schedules in the house (sample: 8am-
na magsinungaling hanggang sa pagtanda. 3pm ang klase ng bata, tas 3:30 dapat nakauwi na sa bahay, tas
o Type of play: associative – role modeling/ make believe pahinga muna sya, laro laro ganern, pag 5pm na dapat gawin
(kunya kunyarian) na nya yung assignments nya, at habang gnagawa nya ung
o Imaginary friend – to satisfy the emotional needs of the assignment nya dpaat walang tv or phone. sanaol organize, pag
preschool. Mawawala na ung imaginary friend kapag na ako sabihin ko 5mins scroll muna ako sa fb, tas umabot na ng apat
satisfy na sya or na distract sya sa ibang bagay. oras at wala akong natapos na activities hehe dats mah lyf)
o Mahilig mag daydreaming o You can compromise (sample: sabi ng nanay walang tv
o Imitator – gaya gaya hanggat d pa natatapos ung assignment nya, pero sabi ng bata
o Moral development – preconventional stage 2 na may gusto sya panoorin sa gantong oras, icompromise mo
o We have to support sense of initiative to prevent sense of guilt. nlng like “osige basta promise mo sakin tatapusin mo ung
Kasi kung puro guilt un bata, mawawalan ng confidence. assignment mo ah” ganern)
o Genital stage: phallic – gender orientation, start of o School age child get to become modest; they want to become
masturbation (frequent touching) helpful, obedient, and respectful to please they’re teacher.
• Kapag nilabas ng anak mo un genital nya, wag ka o Loss of self-control – napipikon
magpaka hysterical like “ay anak bakit mo nilalabas yan. o The child oriented to the concept of competition, you have to
Bastos ka” teach sportsmanship
• Dapat tanungin mo muna, at turuan na wag basta basta o Favorite question: How? That’s why explain the procedure.
nilalabas kapag may tao, dapat sa kwarto lng o sa banyo. o Play of school age: cooperative
o Fear: dark, ghost, monster, mutilation and castration o Causes of fear: Death, failure in school or intimidating teacher
o Mutilation/ castration – cutting of an organ. o For preschool, ang death ay temporary lng, para saknila tulog
o Normal ito sa early preschool pero dapat mabago ito sa late lng. Pero sa school age, alam na nila ung meaning ng death.
preschool o School phobia – specially pag first time (this will not
• Oedipal complex – son to mother attachment disappear kung hindi mo sya pinapaattend sa school everyday)
• Electra complex – daughter to father attachment o Latchkey children – who are going to school and both parents
o Marereverse sya kapag nagbobonding. are working. They have own keys for they house. They tend to
o Kapag hindi nareverse, pwede ito maging possible cause ng become independent.
identity crisis o Role development: latency
o Death – hindi pa natatakot ung preschool dyan kasi para o Causes of accidents: fall, fracture (rapid long bone
sakanila tulog lang un tao. development) drowning motor accident.
o Cognitive development: pre-conceptual, he wants to find ADOLESCENT
meaning or reason in everything. (Why) o 12 – 18 years old
o Causes of accidents: Fall, burns, drowning poisoning o PAIRS (kasi andito ung first love)
• P – peer group
SCHOOL AGE
• A – acceptance of bodily changes
o 6 – 12 years old
• I – identity vs
o DIMPLE (tries to please his teacher) • R – role confusion/ role diffusion/ rejection
• D – death
• S – separation from peer groups
• I – Industry vs inferiority
o Play: competitive
• M – modesty
• P – peers
o The adolescent will be able to establish identity – acceptance
• L – loss of self-control of bodily changes
• E – explain the procedure o According to Sigmund Freud, the sexual stage of adolescent is
o Psychosocial task: industry vs inferiority genital. (nung preschool, gender orientation “flower girl; bird
o Significant person: peers, teachers (teacher is the most boy”, ngayon naman genital – sexual orientation what for is
significant person but also a source of fear for a school age) penis, what for is vagina, Sexual activity)
o Sense of industry – participation, perform to the class to be o If you are not able to accept your bodily changes, there will be
able to please his teacher. pressure on sexual activity.
J.A.K.E 6 of 21
o For the person to be able to avoid identity, he must be able to Outcome Identification and Planning
choose his friends, he must be able to allow to choose his - Outcomes established for infant care need to be realistic based
future career. on the family’s new circumstances.
o Role confusion – what is your role in the house (ex: single • Parents of infants, especially first-time parents, must do a
mother, at hindi sapat ang kinikita nya, at may lima syang lot of adjusting, and this takes time. Try to suggest
anak, ung panganay na lalaki, magtatrabaho din sya para activities that can be easily incorporated into the family’s
matulungan nya ung pamilya nya, so may role confusion sya, lifestyle.
“am I child? Or father already” • If your assessment data indicate that a child needs more
o Role diffusion – you cannot become what you want to become exposure to language and you know both parents work
because your parents always dictating what you should do or during the day, for example, you might suggest the
become. Ex: ma I want to become engineer. But the mother parents ask their child’s caretaker to talk to their infant
will say, No, you will become nurse kasi ikaw ang bubuhay more.
samin at magpapa aral sa mga kapatid mo. (relate na relate ang mga • Encourage parents to spend additional time each evening
ate kuya dyan yoohooo) reading or reciting nursery rhymes to their baby. The
o Identity crisis – you must accept who you are and what you combined interventions should increase the baby’s
are. If you cannot accept that how other people accept you. language skills.
o Causes of accidents: motor/ vehicular accidents, substance Implementation
abuse - One of the most important interventions of the infant period is
teaching new parents about how to care for their infant and
NURSING PROCESS FOR PROMOTION OF NORMAL keep the infant safe. Whenever possible, this information
GROWTH AND DEVELOPMENT should be anticipatory so parents can prepare for ways to care
The family with an infant for and protect their infant as the infant grows.
Assessment Outcome Evaluation
- Nursing assessment of an infant begins with an interview with - Evaluate expected outcomes at each visit to detect changes in
the primary caregiver. Important areas to discuss include parents’ understanding of caring for their infant. Help parents
nutrition, growth patterns, and development. understand all aspects of infant care, not just a single element.
- An infant’s height, weight, and head circumference are • Mother states she feels fatigued but able to cope with
important indicators of growth, so they should be measured sleep disturbance from night waking.
and plotted on standard growth charts (Brayden, Daley, & • Parents state five actions they are taking daily to
Brown, 2008). These charts represent average growth and can encourage bonding.
determine if the baby’s growth remains within the same • Father states both he and spouse are adjusting to new roles
relative percentile at each checkup. as parents.
- Physical assessment of an infant must be done quickly yet
• Parents verbalize appropriate techniques they use to
thoroughly because a baby can tire or become hungry, making
stimulate infants.
it difficult to judge overall behavior and temperament.
• Infants demonstrate age-appropriate growth and
- The primary caregiver should be present to make a child feel
development.
comfortable. Using a calm approach helps the infant remain
• Infant exhibits weight, height, and head and chest
calm as well.
circumference within acceptable norms.
Nursing Diagnosis
- Much of your assessment of an infant and family will focus on The family with a Toddler
basic needs such as sleep, nutrition, and activity and the Assessment
parents’ adjustment to their new role. - Whether a child is seen for a routine checkup or has come to a
• Ineffective breastfeeding related to maternal fatigue health care center because of a specific health concern,
• Disturbed sleep pattern (maternal) related to baby’s need assessment begins with taking a careful health history.
to nurse every 2 hours - Asking parents about a toddler’s ability to carry out activities
• Deficient knowledge related to normal infant growth and of daily living offers assessment information not only on the
development child’s developmental progress but also important clues about
• Imbalanced nutrition, less than body requirements, related the child–parent relationship.
to infant’s difficulty sucking - Careful observation is another crucial element of nursing
• Health-seeking behaviors related to adjusting to assessment of a toddler. This is because parents may become
parenthood so emotionally involved in a health concern, they may not
• Delayed growth and development related to lack of describe it with complete objectivity.
stimulating environment - On the other hand, parents see their children daily and so are
• Risk for impaired parenting related to long hospitalization the best source of information and opinion on when a child
of infant seems to be acting “out of sorts” or “different” (a typical sign
• Readiness for enhanced family coping related to increased a child may not be feeling well).
financial support Nursing Diagnosis
• Social isolation (maternal) related to lack of adequate - Focus on the parents’ eagerness to learn more about the
social support parameters of normal growth and development or issues of
• Ineffective role performance related to new safety or care. Examples are:
responsibilities within the family • Health-seeking behaviors related to normal toddler
J.A.K.E 7 of 21
development - Assess a child’s weight and height according to standard

• Deficient knowledge related to best method of toilet growth charts. Keep in mind these charts are based on average
training weights and heights of white American children, so those for
• Risk for injury related to impulsiveness of toddler children from other ethnic or cultural
• Interrupted family process related to need for close backgrounds may not completely agree with these norms.
supervision of 2-year-old Also assess a child for general appearance. Does the child
• Readiness for enhanced family coping related to parents’ appear alert? Happy? Active? Healthy? Ask whether a child
ability to adjust to new needs of child can play actively without becoming exhausted. Assess the
• Readiness for enhanced parenting related to increased teeth for presence of cavities. Evaluate for a symmetrical gait.
awareness for poison prevention As preschoolers develop frequent upper respiratory infections
• Disturbed sleep pattern related to lack of bedtime routine (the average preschooler may have 6 to 12 a year), assess for
Outcome Identification and Planning these as well.
- To help parents resolve a concern during the toddler period, Nursing Diagnosis
focus largely on family education and anticipatory guidance. - Nursing diagnoses for preschoolers typically concern health
- Urge them to establish realistic goals and outcomes so they promotion. Examples are:
can meet the rapidly changing needs of their toddler and learn • Health-seeking behaviors related to developmental
to cope with typical toddler behaviors. expectations
- Otherwise, parents can expect too much of a toddler and grow • Readiness for enhanced parenting related to parent’s pride
frustrated instead of enjoying being a parent of a child this age. in child
Implementation - Other nursing diagnoses include:
- When teaching about typical toddler behavior, teach parents a • Risk for injury related to increased independence outside
good rule is to think of a toddler as a visitor from a foreign the home
land who wants to participate in everything the family is doing • Delayed growth and development related to frequent
but does not know the customs or the language. They need to illness
help their toddler learn these the same as they would that • Risk for poisoning related to maturational age of child
stranger. • Parental anxiety related to lack of understanding of
- Also teach parents not only how to approach a current problem childhood development
but also how to learn adequate methods for resolving similar • Imbalanced nutrition related to child’s many food dislikes
situations that are sure to arise in the future. If parents do not Outcome Identification and Planning
learn methods that can be applied throughout their child’s - For many parents, preschool is a difficult time because a child
growing years, they may win battles but lose wars. For is at an in-between stage: no longer an infant, although not yet
instance, parents may find that promising children a treat when ready for formal school.
they are in the middle of a temper tantrum will stop the - Planning and establishing expected outcomes for care of the
tantrum, but it will not prevent other tantrums from occurring preschooler often begin with establishing a schedule for
in the future (and, in fact, may encourage them). discussing normal preschool development with the parents
- Health visits provide opportunities to help parents learn (this should be done at all health maintenance visits).
healthy coping techniques. In addition, demonstrating good - Planning for accident prevention such as how to cross streets
communication skills with toddlers can serve as a model for safely becomes increasingly important as children begin to
healthy communication behavior with them. enjoy experiences away from home. It is important to plan
Outcome Evaluation opportunities for adventurous activities or messy play. When
- Expected outcomes must be evaluated frequently during the asking parents to incorporate adventurous activities or messy
toddler period because children change so much and learn so material into a preschooler’s play, you may be asking them to
many new skills during this time that their abilities and do something they do not personally enjoy.
associated parental concerns can change from day to day. - Most parents do initiate these activities with their child if they
• Parents state child maintains a consistent bedtime routine believe they are important, but some are able to do this better
within the next 2 weeks. than others. Allowing children choices may also be difficult
• Parents state they have childproofed their home by putting for parents because they want to protect them from making
a lock on kitchen cupboard by next clinic visit. errors.
• Grandmother states she has modified usual activities to Implementation
conserve strength to care for toddler granddaughter by 1 - Preschool children imitate moods as well as actions. An
weeks’ time. important nursing intervention, then, is role playing a mood or
attitude you would like a child to learn.
The family with a Preschooler - To project an attitude that health assessment is an enjoyable
Assessment activity, you might suggest preschoolers participate by
- Regular assessment of a preschooler includes obtaining a listening to their heart or coloring the table paper.
health history and performing both a physical and - Accident prevention is also best taught by role modeling (a
developmental evaluation. Preschoolers speak very little parent always crosses streets at the corner and does not start
during a health assessment; they may even revert to baby talk the car until seatbelts are in place).
or babyish actions such as thumb-sucking if they find a health Outcome Evaluation
visit stressful. A history that details their usual performance - Evaluation of expected outcomes needs to be continuous and
level is therefore very important for accurate evaluation. frequent. Because growth during this period is more cognitive
J.A.K.E 8 of 21
and emotional than physical, parents may report little growth. Implementation
- Evaluating specific areas helps them to see that progress has - School-age children are interested in learning about adult roles,
occurred. Examples of expected outcomes might be: so this means they will watch you to see your attitude as well
• Child states importance of holding parent’s hand while as your actions in each situation.
crossing streets. - When giving care, keep in mind children this age feel more
• Parent states realistic expectations of 3-year-old’s motor comfortable if they know the “hows” and “whys” of actions.
ability by next visit. - They may not cooperate with a procedure until they are given
• Mother reports she has prepared 4-year-old for new baby a satisfactory explanation of why it must be done.
by next visit. Outcome Evaluation
- Yearly health visits covering both physical and psychosocial
The family with a School age Child development are important at this age. It may be useful for
Assessment parents to look back on problems identified at the last visit and
- Use both history and physical examination to assess growth discuss if and how they were resolved. Often, some problems
and development of a school-age child. Include questions and conflicts fade away without anyone really noticing. As
about school activities and progress. School-age children are some problems recede, however, others may emerge.
interested and able to contribute to their own health history; to - At times, the same concerns of parents and the child may
allow for this, it is useful to interview children 10 years or appear to be unresolved at each visit. Make sure no underlying
older at least in part without their parents present. problem exists that prevents resolution. Examples of expected
- During the physical examination, show your respect for outcomes are:
children’s adult-level modesty by furnishing a cover gown. • Parent states he allows child to make own decisions about
- Parents of school-age children often mention behavioral issues how to spend allowance.
or conflicts during yearly health visits. Some parents feel they • Child lists books she and her parents have read together in
are losing contact with their children during these years. This past 2 weeks.
can cause them to misinterpret a normal change in behavior, • Child states he understands his growth is normal, even
especially if they are not prepared for what to expect from though he is the shortest boy in his eighth-grade class.
their child. Other parents may consider children who behave • Child does not sustain injury from sports activities during
differently from their siblings as “abnormal” when children the summer recess.
are just expressing their own personality.
- When problems are discussed in the health care setting, take The family with an Adolescence
the history from the parent but also allow the child to express Assessment
the problem. It may be necessary to obtain the opinion of - Parents rarely bring adolescents for routine health maintenance
school personnel (with the parents’ permission) regarding the visits the way they did when their children were younger, and
problem or even just determine whether school personnel feel adolescents generally do not come to health care facilities on
a problem exists. In some instances, a counselor’s opinion may their own unless they are ill.
be necessary. If the problem is related to a medical condition, - Unless adolescents need a physical examination for athletic
its effect on the family should also be assessed, because the clearance, therefore, they are often not seen for health
illness of a child affects the functioning of the entire family. assessments. When adolescents are accompanied by their
Nursing Diagnosis parents a health visits, it is best to obtain a health history
- Health-seeking behaviors related to normal school-age growth separately from parents to promote independence and
and development responsibility for self-care. When performing physical
- Readiness for enhanced parenting related to improved family examinations on adolescents, be aware they may be very self-
living conditions conscious.
- Anxiety related to slow growth pattern of child - They also need health assurance and appreciate comments
- Risk for injury related to deficient parental knowledge about such as “Your hair has a nice, healthy feel,” or “This is an
safety precautions for a school-age child accessory nipple. Have you ever wondered about it?” so they
- Imbalanced nutrition, more than body requirements, related to can learn more about their rapidly changing bodies.
frequent consumption of snack foods Nursing Diagnosis
- Delayed growth and development related to speech, motor, - Nursing diagnoses for adolescents cover a wide range.
psychosocial, or cognitive concerns Frequently used diagnoses related to adolescents and their
Outcome Identification and Planning families are:
- When identifying expected outcomes and planning care, keep • Health-seeking behaviors related to normal growth and
in mind that school-age children tend to enjoy small or short- development
term projects rather than long, involved ones. A child with • Low self-esteem related to facial acne
diabetes, for example, in her early school years may gain a • Anxiety related to concerns about normal growth and
feeling of achievement by learning to assess her own serum development
glucose level, but she may have difficulty continuing glucose • Risk for injury related to peer pressure to use alcohol and
assessment on a regular basis. drugs
- Behavior problems need to be well defined before outcomes • Readiness for enhanced parenting related to increased
are identified and interventions planned. Often, it is enough for knowledge of teenage years
parents to accept the problem as one consistent with normal
growth and development.
J.A.K.E 9 of 21
Outcome Identification and Planning - A 1-inch (3.2-cm) cylinder, such as a carrot or hot dog, is
- When planning care with adolescents, respect the fact they particularly dangerous because it can totally obstruct an
have a strong desire to exert independence or do things their infant’s airway. A deflated balloon can be sucked into the
own way. This means they are not likely to adhere to a plan of mouth, obstructing the airway in the same way. Educate
care that disrupts their lifestyle or makes them appear different parents who feed their infant formula not to prop bottles. By
from others their age. Including them in planning is essential doing this, they are overestimating their infant’s ability to push
so the plan will be agreeable and accepted. Establishing a the bottle away, sit up, turn the head to the side, cough, and
contract such as asking an adolescent to agree to take clear the airway if milk should flow too rapidly into the mouth
medication daily may be the most effective means to reach a and an infant begins to aspirate.
mutual understanding. - Other instances of aspiration occur because parents
- Adolescents are very present oriented, so a program that underestimate their infant’s ability to grasp and place objects
provides immediate results, such as increased respiratory in their mouth. Even a newborn can wiggle to a new position
function, will usually be carried out well. In contrast, a to reach an attractive object such as a teddy bear with small
regimen oriented toward the future, with long-term goals such button eyes. Newborns’ grasp and sucking reflexes
as preventing hypertension, may not be as successful. This automatically cause them to grasp and pull the object into their
does not mean it is not important to teach adolescents about mouth.
the necessity of reducing future health risks—by eating well, - Caution parents to be certain nothing comes within an infant’s
not smoking, and generally taking care of their bodies—but reach that would not be safe to put into the mouth. Using
that information will be best accepted if geared as much as clothing without decorative buttons, and checking toys and
possible to specific, short-term benefits to their health. rattles to ensure they have no small parts that could snap off or
Implementation fall out, are good steps for parents to follow. A test of whether
- Adolescents do poorly with tasks that someone tells them they a toy could be dangerous if an infant puts it inside the mouth is
must do. If they help to plan tasks, however, they can typically whether it fits inside a toilet paper roll. If it does, it is small
carry them out successfully. enough to be aspirated.
- Adolescents have little patience with adults who do not - When solid foods are introduced, encourage parents to offer
demonstrate the behavior they are being asked to achieve; a small pieces of hot dogs or grapes, not large chunks for this
parent or nurse who smokes and asks an adolescent not to reason. Children under about 5 years should not be offered
smoke, for example, will probably not be successful. For best popcorn or peanuts because of this danger of aspiration.
results, evaluate how an intervention appears from an Fall Prevention
adolescent’s standpoint before beginning teaching. - Falls are a second major cause of infant accidents. As a
Outcome Evaluation preventive measure, no infant, beginning with a newborn,
- Evaluation of expected outcomes should include not only should be left unattended on a raised surface. Normal wiggling
whether desired outcomes have been achieved but whether can bring a baby to the edge of a bed, couch, or table top,
adolescents are pleased with their success. resulting in a fall.
- Individuals will have difficulty accomplishing desired goals as - Teach parents to be prepared for their infant to roll over by 2
adults unless they have high self-esteem that includes feeling months of age. From that time on, they must be especially
secure in their new body image. vigilant not to leave the baby unattended on a changing table
- Examples of outcome criteria that might be established are: or counter. If the child sleeps in a crib, the mattress should be
• Client states she is able to feel good about herself even lowered to its bottom position so the height of the side rails
though she is the shortest girl in her class. increases; rails should be 23⁄8 inches apart, narrow enough so
• Client states he has not consumed alcohol in 2 weeks. children cannot put their head between them. Two months is
• Parents state they feel more confident about their ability about the maximum length of time infants can safely sleep in a
to parent an adolescent. bassinet; they need the protection of a crib and high side rails
• Client states she feels high self-esteem despite persistent before they turn over.
facial acne. - All of these safety precautions apply to the hospital
environment as well as to the home. Be sure crib sides are
HEALTH PROMOTION OF AN INFANT raised and secure before anyone walks away from the crib,
Promoting Infant Safety even for just a moment. Also ensure that the space between the
- Accidents are a leading cause of death in children from 1 mattress and headboard is small enough an infant’s head could
month through 24 years of age. They are second only to acute not become trapped. Make sure cords from nursing call bells
infections as a cause of acute morbidity and physician visits or safety pins are out of an infant’s reach.
(National Vital Statistics System [NVSS], 2009). Car Safety
- Most accidents in infancy occur because parents either - Teaching car safety for infants (as well as for the whole
underestimate or overestimate a child’s ability. Nursing family) is a vital preventive health measure.
interventions that help parents become sensitive to their - Car seats should continue to be used without interruption
infant’s developmental progress not only help establish sound through the preschool age, or until the child reaches 40 to 60
parent–child relationships but also guard infant safety. lb. If parents are firm about keeping infants in car seats even
Aspiration Prevention when they get fussy or impatient, children will eventually
- Aspiration is a potential threat to infants throughout the first become more comfortable in seats than outside them. Infants
year. Round, cylindrical objects are more dangerous than up to 20 lb and 1 year old should be placed in rear-facing seats
square or flexible objects in this regard.
J.A.K.E 10 of 21
in the back seat because an inflating front-seat airbag could objects that could be swallowed. Some of an infant’s toys are
suffocate an infant (AAP, 2009). now also 10 months old and need to be checked to be certain
Safety with Siblings they are still intact and safe.
- As infants become more fun to play with at about 3 months, - Children who can walk may venture into the street or a
older brothers and sisters grow more interested in interacting swimming pool if not carefully supervised. Although they
with them. seem very independent and able to take care of themselves,
- You may need to remind parents that children under 5 years of their judgment about what is dangerous is immature. In a
age, as a group, are not responsible enough or knowledgeable hospital setting, a 12-month-old child can wander onto an
enough about infants to be left unattended with them. elevator, out of the hospital, or into a laboratory area, or fall
- They might introduce an unsafe toy or engage in play that is down a flight of stairs if not supervised.
too rough for an infant. Some preschoolers may be so jealous
of a new baby they will physically harm an infant if left alone. Promoting Nutritional Health of an Infant
Bathing and Swimming Safety Recommended Dietary Reference Intakes for an Infant
- As babies begin to develop good back support, many parents - Because children’s nutritional needs vary from infancy
begin to bathe them in an adult tub. Caution parents never to through adolescence, the recommended allowances of calories,
leave an infant unattended in a tub, even when propped up out protein, vitamins, and minerals also vary with each period of
of the water or sitting in a bath ring or bath seat. Normal development.
wiggling can easily cause a baby to slip down under the water. - The entire first year of life is one of extremely rapid growth,
This applies to a hospital setting as well. so a high-protein, high-calorie intake is necessary. Both
- Many communities offer infant swim programs for babies as commercial formulas and breast milk contain 20
young as 6 months. If their child is enrolled in one of these calories/oz.Calorie allowances can be gradually reduced
programs, parents may become overconfident about their during the first year from a level of 120 per kilogram of body
infant’s ability to operate safely in water. Because children can weight at birth to approximately 100 per kilogram of body
dog-paddle momentarily in a swimming pool does not mean weight at the end of the first year to prevent babies from
they can sustain that position for any length of time in a becoming overweight.
bathtub or pool. Being able to swim momentarily may also - Although heredity plays a role, a baby who is overweight
cause children to lose their instinctive fear of water and so be during the first year of life is more likely to become an obese
in more danger when around water than children who are still adult than one whose weight is within normal limits as, once
naturally more cautious. Such programs may also cause formed, fat cells (adipocytes) remain for life. Breastfed infants
hypothermia and spread microorganisms because infants this gain less weight than those who are formula fed. Delaying the
age are not yet toilet-trained. Exposure to chlorinated water introduction of solid food until 4 to 6 months and avoiding
can damage lung epithelium that may be a precursor to sweet drinks for infants can help avoid obesity in formula fed
childhood asthma. infants.
Childproofing Introduction of Solid Food
- When infants begin teething at 5 to 6 months, they chew on - From a nutritional standpoint, a normal full-term infant can
any object within reach to lessen gum-line pain. Remind thrive on breast milk or a commercial iron-fortified formula
parents to check for possible sources of lead paint, such as without the addition of any solid food until 4 to 6 months
painted cribs, playpen rails, or windowsills (Keefe, 2007). (Gomella & Haist, 2007). Delaying solid food until this time
Paints safe for baby furniture should be marked “Safe for use helps prevent overwhelming an infant’s kidneys with a heavy
on surfaces that might be chewed by children.” If an infant is solute load that can occur when protein is ingested. Although
going to be allowed to play on the floor, parents should move difficult to document, it also may delay the development of
furniture in front of electrical fixtures or buy protective caps food allergies in susceptible infants and be another way to help
for outlets. Infants are especially fascinated by the holes and prevent future obesity (Sass, 2007).
will probe them with (often wet) fingers. Parents may need to - Generally speaking, infants are physiologically ready for solid
install safety gates at the top and bottom of stairways as other food when they are nursing vigorously every 3 to 4 hours and
safety measures. do not seem satisfied or taking more than 32 oz (960 mL) of
- Urge parents to move all potentially poisonous substances formula a day and do not seem satisfied. Infants are not ready
from bottom cupboards and store them well out of their to digest complex starches until amylase is present in saliva at
infant’s reach. Infants of any age should not be left unattended approximately 2 to 3 months. Biting movements begin at
in carriages, highchairs, grocery shopping carts, or strollers. approximately 3 months. Chewing movements do not begin
Baby walkers are extremely dangerous because infants can until 7 to 9 months. Therefore, foods that require chewing
maneuver them near stairways and fall the length of the stairs. should not be given until this age.
- When infants begin creeping, remind parents to recheck Techniques for Feeding Solid Food
bottom cupboards and stairways for safety. When the child - Teach parents to offer new foods one at a time and allow a
begins to walk, higher areas, such as coffee tables, need to be child to eat that item for about 1 week before introducing
cleared of dangerous items. In a hospital setting, assess low another new food. This system helps parents to detect possible
counter areas for dangerous objects. Do not leave possibly food allergy. For example, if they start egg yolk on Monday
dangerous supplies in an infant’s room. and by Tuesday evening the child is breathing noisily or has a
- By 10 months, achievement of a pincer grasp makes infants rash, they could suspect the child is allergic to eggs. If two
able to pick up very small objects. Remind parents to check new foods had been started on Monday, it would be hard to
play areas or areas such as table tops for pins or other sharp know which one was suspect. Introducing foods one at a time
J.A.K.E 11 of 21
also helps to establish a sense of trust in infants, because it crying (Bolte, 2007). An infant cries loudly and pulls the legs
minimizes the number of new experiences in any one day. up against the abdomen. The infant’s face becomes red and
- Babies have distinct taste preferences even at young ages and flushed, the fists clench, and the abdomen becomes tense. If
may spit out a food because they do not like the taste. Even offered a bottle, the infant will suck vigorously for a few
after the extrusion reflex has faded (at approximately 4 minutes as if starved, then stop as another wave of intestinal
months), infants may appear to be spitting out food. This is pain occurs.
because infants drink from a bottle or breast by pressing their - The cause of colic is unclear. It may occur in susceptible
tongue and the nipple against their hard palate. When an infant infants from overfeeding or from swallowing too much air
tries to eat solid food using the same technique, it appears that while drinking. Formula-fed babies are more likely to have
the child is spitting it out with the tongue. colic than breastfed babies, possibly because they swallow
- Infants take different quantities of food according to their more air while drinking or because formula is harder to digest.
preferences and needs. A newborn’s stomach can hold - Changing formula bottles to the type with disposable bags that
approximately 2 tablespoons (30 mL). By 1 year, a stomach collapse as the baby sucks may help minimize the amount of
can hold no more than about 1 cup (240 mL). For this reason, air swallowed. Taking infants for car rides is often reported as
when they begin eating solid food, infants rarely take more being helpful in soothing colicky babies. Some music boxes
than 2 tablespoons (30 mL) at a time. simulate the sound of a heartbeat, which also may be helpful.
Antiflatulent agents such as simethicone have not been shown
Parental Concerns and Problems Related to Normal Infant to be helpful but may be tried (Srinivasan & Middleton,2008).
Development Diaper Dermatitis
Teething - Some infants have such sensitive skin that diaper dermatitis
- Most infants have little difficulty with teething, but some (diaper rash) is a problem from the first few days of life. It
appear very distressed. Generally, the gums are sore and occurs for several reasons.
tender before a new tooth breaks the surface. As soon as the - When parents do not change a child’s diaper frequently, feces
tooth is through, the tenderness passes. is left in contact with skin, and irritation may result in the
- Because of this pain, infants can be resistant to chewing for a perianal area. Urine that is left in diapers too long breaks down
day or two and be slightly cranky, possibly because they are a into ammonia, a chemical that is extremely irritating to infant
little hungry from not eating as much as usual. High fever, skin. Ammonia dermatitis of this type is generally a problem
seizures, vomiting or diarrhea, and earache are never normal in the second half of the first year of life, when an infant is
signs of teething. An infant with any of these symptoms has an producing a larger quantity of urine than before. For some
underlying infection or disease process requiring further infants, however, it is a problem from the first week.
evaluation. - Frequent diaper changing, applying A&D or Desitin ointment,
- Many over-the-counter medicines are sold for teething pain. and exposing the diaper area to air may relieve the problem.
As a rule, their use should be discouraged if they contain Some infants may have to sleep without diapers at night to
benzocaine, a topical anesthetic, because if applied too far control the problem.
back in the throat, this could interfere with the gag reflex. - If a diaper area is covered with lesions that are bright red, with
- Acetaminophen (Tylenol), 10 to 15 mg/kg every 4 hours, up to or without oozing, last longer than 3 days, and appear as red
four times a day, may be used for teething discomfort but pinpoint lesions, suspect a fungal (monilial or candidiasis)
parents should check with their infant’s health care provider infection.
before giving any over-the-counter drug this way. Infant Caries (Baby-Bottle Syndrome)
Sleep Problems - Putting an infant to bed with a bottle of formula, breast milk,
- Sleep problems develop in early infancy because of colic or orange juice, or glucose water can result in aspiration. It also
because an otherwise healthy infant takes longer than usual to can lead to decay of all the upper teeth and the lower posterior
adjust to sleeping through the night. Breastfed babies tend to teeth. Decay occurs because while an infant sleeps, liquid from
wake more often than those who are formula fed because the propped bottle continuously soaks the upper front teeth and
breast milk is more easily digested, so infants become hungry lower back teeth (the lower front teeth are protected by the
sooner. In late infancy, the problem of waking at night and tongue).
remaining awake for an hour or more becomes common. - The problem, called baby-bottle syndrome, occurs because
Although an infant may be content and not cry during this time, the carbohydrate in solutions such as formula or glucose water
parents are reluctant to sleep while the child is awake, so they ferments to organic acids that demineralize the tooth enamel
may become extremely fatigued. until it decays.
- Suggestions for eliminating or at least coping with night - To prevent this problem, advise parents never to put their baby
waking are: to bed with a bottle. If parents insist a bottle is necessary to
• Delay bedtime by 1 hour allow a baby to fall asleep, encourage them to fill it with water
• Shorten an afternoon sleep period and use a nipple with a smaller hole to prevent the baby from
• Do not respond immediately to infants at night so they can receiving a large amount of fluid. If the baby refuses to drink
have time to fall back to sleep on their own anything but milk, the parents might dilute the milk with water
• Provide soft toys or music to allow infants to play quietly more and more each night until the bottle is down to water
alone during this wakeful time. only.
Colic Obesity in Infants
- Colic is paroxysmal abdominal pain that generally occurs in - Obesity in infants is defined as a weight greater than the 90th
infants under 3 months of age and is marked by loud, intense to 95th percentile on a standardized height/weight chart.
J.A.K.E 12 of 21
Obesity occurs when there is an increase in the number of fat (such as windowsills, paint chips, or furniture) that are covered
cells because of excessive calorie intake. Preventing obesity in with lead-based paint.
infants is important because the extra fat cells formed at this • Soil around the exterior of the house and potentially
time are likely to remain throughout childhood and even into contaminated food grown there
adulthood. If a child becomes obese because of over ingestion • Dust or fumes created by home renovation
of milk, iron-deficiency anemia may also be present because • Pottery made with lead glazes
of the low iron content of both breast and commercial milk. • Jewelry made from lead or lead alloys
Once infant obesity begins, it is difficult to reverse, so • Colored print in newspapers
prevention is the key (Farrow & Blissett, 2008). • Old water pipes
- This occurs most often with formula-fed infants whose parents
• Lead-based gasoline—children who live in high-traffic
urge them to empty their bottle or finish a cereal serving. It
areas are at high risk for contamination by lead fumes
can occur any time parents automatically feed an infant when
• Lead dust brought home on the clothing of parents who
the child cries rather than investigating what the cry might
work with lead products such as batteries
really mean.
• Toys or cribs that were painted with lead-based paint
- As a general rule, an infant should take no more than 32 oz of
formula daily. When solid food is introduced, a bottle of water • Sources in other countries (pertains to immigrant
can be substituted for formula at one feeding. Nonfat milk children)
should not be given because it contains so little fat that Toddler Nutrition
essential fatty acid requirements may not be sufficient to - Parents may become frustrated when trying to provide
ensure cell growth. adequate nutrition for their toddler because of a toddler’s
- Another way to help prevent obesity is to add a source of fiber, varying and unpredictable appetite and food preferences.
such as whole-grain cereal and raw fruit, to an infant’s diet. Although a toddler’s daily food consumption may vary greatly,
These prolong the stomach-emptying time, so they can help energy needs are generally met when sufficient food is
reduce food intake. Caution parents about giving obese infants supplied in a positive environment. Sedentary children ages 1
foods with high amounts of refined sugars, such as pudding, to 3 years should consume 1000 kcal daily; active children in
cake, cookies, and candy. Encourage parents to learn more this age group may need up to 1400 kcal daily.
about balanced nutrition and to provide this for their entire - Calories are best supplied by a variety of foods spaced into
family. three meals a day (Krebs & Primak 2008). Protein and
carbohydrate needs are often those most easily met during the
HEALTH PROMOTION OF AN TODDLER toddler period; diets high in sugar should be avoided.
Promoting Toddler Safety - Fats should generally not be restricted for children under 2
- Accidents are the major cause of death in children of al ages. years old; however, children over 2 years old should have a
Accidental ingestions (poisoning) are the type of accident that total fat intake between 30% and 35% of calories, with most
occurs most frequently in toddlers (Dart & Rumack, 2008). fat coming from sources of polyunsaturated and
Although poisoning can involve medicine such as monounsaturated fatty acids, such as fish, nuts, and vegetable
acetaminophen, it most often occurs from ingestion of oils—the same as for adults.
cleaning products. Aspiration or ingestion of small objects - Trans–fatty acids should be kept to a minimum. Adequate
such as watch or hearing aid batteries, pencil erasers, or calcium and phosphorus intake is important for bone
crayons is also a major danger for children of this age. Urge mineralization. Milk should be whole milk until age 2 years
parents to childproof their home by putting all poisonous after which 2% milk can be introduced
products, drugs, and small objects out of reach by the time Parental Concerns Associated With the Toddler Period
their infant is crawling, and certainly by the time their infant is Toilet Training
walking. - Toilet training is one of the biggest tasks a toddler tries to
- Other accidents that occur frequently in toddlers include motor achieve. There are so many theories concerning toilet training
vehicle accidents, burns, falls, drowning, playground injuries. that understanding the procedure can become one of the
These occur because toddlers’ motor ability jumps ahead of biggest tasks of this period for parents. Most first-time parents
their judgment. To prevent serious injury, a toddler must be ask when to start, when training should be completed, and how
supervised at all times. Toddlers can walk surely and swiftly to go about it. The answer is that toilet training is an
enough so that if they are left outside to play, they can very individualized task for each child. It should begin and be
quickly travel a block away. Because they have no judgment completed according to a child’s ability to accomplish it, not
concerning moving cars, they walk across streets with no according to a set schedule.
regard for oncoming cars. - Before children can begin toilet training, they must have
Lead Screening reached three important developmental levels, one physiologic
- The Centers for Disease Control and Prevention (CDC) has set and the other two cognitive:
as a goal the elimination of elevated blood lead levels in • They must have control of rectal and urethral sphincters,
children (CDC, 2008). All children between the ages of 6 usually achieved at the time they walk well.
months and 6 years who live in communities with buildings • They must have a cognitive understanding of what it
built before 1950 should be tested periodically for the presence means to hold urine and stools until they can release them
of too much lead in their body (lead poisoning). Elevated lead at a certain place and time.
levels are caused by eating, chewing, or sucking on objects • They must have a desire to delay immediate gratification
for a more socially accepted action.
J.A.K.E 13 of 21
- Toilet training need not start this early, however, because repeats the behavior, parents select an area that is non-
cognitively and socially, many children do not understand stimulating, such as a corner of a room or a hallway. The child
what is being asked of them until they are 2 or even 3 years is directed to go immediately to the “timeout” space. The child
old. The markers of readiness are subtle, but as a rule children then sits there for a specified period of time. If the child cries
are ready for toilet training when they begin to be or shows any other disruptive behavior, the timeout period
uncomfortable in wet diapers. They demonstrate this by does not begin until there is quiet. When the specified time
pulling or tugging at soiled diapers; they may bring a parent a period has passed, the child can return to the family.
clean diaper after they have soiled so they can be changed. Separation Anxiety
- Some toddlers smear or play with feces, often at about the - Fear of being separated from parents begins at about 6 months
same time that toilet training is started. This occurs because of age and persists throughout the preschool period. For this
they have become aware of body excretions but have no adult reason, toddlers have difficulty accepting being separated from
values toward them; stools seem little different from the their primary caregiver to spend the day at a day care center or
modeling clay they play with. This activity can be minimized if they or their primary caregiver is hospitalized.
by providing toddlers with play substances of similar texture - Most toddlers react best to separation if a regular babysitter is
and by changing diapers immediately after defecation. Teach employed or the day care center is one with consistent
parents to accept this behavior for what it is: enjoyment of the caregivers. Many are more comfortable if they are cared for in
body and of the self, and the discovery of a new substance. their own home. It helps if they have fair warning that they
After a child is fully toilet trained, this activity rarely persists will have a babysitter.
Negativism - It helps if parents say goodbye firmly, repeat the explanation
- As part of establishing their identities as separate individuals, they will be there when the child wakes in the morning, and
toddlers typically go through a period of extreme negativism. then leave. Prolonged goodbyes only lead to more crying.
They do not want to do anything a parent wants them to do. Sneaking out prevents crying and may ease the parents’ guilt,
Their reply to every request is a very definite “no.” but it can strengthen fear of abandonment so should be
- It is easy for parents to believe their authority is being discouraged. This applies to hospital visits as well.
questioned when this happens and to worry children are Temper Tantrums
becoming so disrespectful they will have difficulty getting - Almost every toddler has a temper tantrum at one time or
along in the world. They can be baffled by the extreme change another. The child may kick, scream, stamp feet, shout “No,
from happy, cooperative infants who lived to please them to no, no,” lie on the floor, flail arms and legs, and bang the head
irritating, uncooperative toddlers. They may need some help to against the floor. Children may even hold their breath until
realize this is not only a normal phenomenon of toddlerhood they become cyanotic. If breath holding, the child develops a
but also a positive stage in development. This change indicates distended chest (a halt after inspiration), often air-filled cheeks,
that toddlers have learned they are separate individuals with and increasing distress as the child’s body registers oxygen
separate needs. It is important that toddlers do this if they are want. This is harmless breath holding; ignoring it will make it
to grow up to be persons who are independent and able to take ineffective and the child will give it up.
care of their own needs and desires. - True breath holding is a neurologic problem in which children,
- A toddler’s “no” can best be eliminated by limiting the under stress, appear to “forget” to breathe in or halt breathing
number of questions asked of the child. A father does not after expiration, usually at the peak of anger. They become so
really mean, for example, “Are you ready for dinner?” He short of breath that they slump to the floor. Breath holding can
means, “Come to the table. It’s dinnertime.” A mother asks, be mistaken for seizures because of the fall to the floor
“Will you come take a bath now?” She means, “It’s time for - Temper tantrums occur as a natural consequence of toddlers’
your bath.” Making a statement instead of asking a question development (Taylor, 2007). They occur because toddlers are
can avoid a great many negative responses. independent enough to know what they want, but they do not
Discipline have the vocabulary or the wisdom to express their feelings in
- Some parents ask during the last part of the infant year or the a more socially acceptable way.
early toddler period when they should start to discipline their - Tantrums may occur if parents are saying “no” too frequently
child or when toddlers are old enough to be punished. Remind in regard to such things as touching the coffee table, getting
parents that “discipline” and “punishment” are not dirty, using a spoon, or running and jumping so that children
interchangeable terms. Discipline means setting rules or road feel constantly thwarted.
signs so children know what is expected of them. Punishment - A tantrum may be a response to difficulty making choices or
is a consequence that results from a breakdown in discipline, decisions or to pressure from activities such as toilet training.
from the child’s disregard of the rules that were learned. Such children need to express feelings in some way and do so
- Parents should begin to instill some sense of discipline early in with temper tantrums. These episodes are taxing for the
life because part of it involves setting safety limits and parents; they are also energy-consuming for children.
protecting others or property: for example, a child must stay
away from the fireplace or heater; she must not go into the
street; she must not hit other children
- “Timeout” is a technique to help children learn that actions
have consequences. To use “timeout” effectively, parents first
need to be certain their child understands the rule they are
trying to enforce: for instance, “If you hit your brother, you’ll
have timeout.” Parents should give one warning. If the child
J.A.K.E 14 of 21
HEALTH PROMOTION FOR A PRESCHOOLER AND - Since children this age have sense of initiative or are learning
FAMILY to do things, allowing a child to prepare simple foods, such as
Promoting Preschooler Safety making sandwich or spreading jelly on a toast.
- By 4 years of age, children may demonstrate an attitude of - To prevent childhood obesity, urge parents to offer snacks
independence and the ability to take care of their own needs. such as fruit, cheese, or milk rather than cookies and a soft
However, they still need supervision to be certain they do not drink or juice.
injure themselves or other children while roughhousing and to - If a child is eating foods from all five groups and meets the
ensure that they do not stray too far from home. criteria for a healthy child such as being alert and active with
- Their interest in learning adult roles may lead them to explore height ang weight within normal averages, additional vitamins
the blades of a lawn mower or an electric saw, or a neighbor’s are probably unnecessary.
pool. They may also imitate adults taking medicine. - Caution parents not to give more vitamins than the
- Gun safety must also be ensured. recommended daily amount or poisoning from high doses of
- Preschoolers must be reminded repeatedly to buckle their fat-soluble vitamins or iron can result.
booster seat and no to walk behind or in front of automobiles. - If a child consumes a vegetarian diet, it is usually deficient in
Keeping Children Safe, Strong, and Free calcium, Vit B12, and vitamin D. Check to be sure that the
- Educating children about the potential threat of harm from child is ingesting a variety of calcium and Vit D sources.
strangers or how to address bullying behavior from children or - Vit B12 is found almost exclusively in animal products, so a
adults may begin at this stage through these measures: child on a vegetarian diet may need a supplemental source
- Never talk with strangers or accept a ride from a stranger. (Whitney & Rolfes, 2013).
- How to call for help in an emergency such as yelling or
running to a designated neighbor’s house if outside, dialing Promoting Preschooler Development in Daily Activities
emergency hotlines if near a phone. Dressing
- Describing what police officers look like and explaining that - One way for parents to solve problems of clothes mismatching
police can help in an emergency. is to fold together matching shirts and slacks so a child sees
- Explaining that if children or adults ask them to keep secrets them as a set instead of individual pieces.
about anything that has made them uncomfortable, they should - If children insist on wearing mismatched clothes, urge parents
tell their parents or another adult, even if they promised to to make no apologies for their appearance. A simple statement,
keep the secret. “Mark chose his own clothes today” explains the situation. It
- Explaining that bullying behavior from other children is not to would mean that the child is given autonomy to select their
be tolerated and should be reported so they can receive help own clothing and is worth more than a perfect appearance by
managing it. adult standards.
- If these measures are presented in a calm and everyday Sleep
manner, children can use it to begin to build safe habits that - Preschoolers are more aware of their needs than toddlers.
will help them later when they are old enough to walk home When they are tired, they often curl up on a couch or soft chair
from school alone or play with their friends unsupervised. and fall asleep.
Motor Vehicle and Bicycle Safety - On some occasions, even though they may be tired, refused to
- Because of front seat airbags, preschoolers need to be buckled sleep because of fear of the dark and may wake up terrified by
into car seats or booster seats in the back seat (AAP, 2012). a bad dream.
- Urge parents to stress the importance of seat belts in - Preschoolers may need a night-light turned on. Screening out
preventing injury and to make a rule that the car does not frightening stories or TV watching just before bedtime may
move until seat belts are fastened. help.
- Remind parents to check the position of shoulder harness in Exercise
car seats or booster seats so the belt does not cross a child’s - Roughhousing helps relieve tension and should be allowed if it
face or throat. does not become destructive.
- To promote bicycle safety and prevent falls from bicycles, - Promoting active games and reducing TV watching can be
preschoolers need age- and size-appropriate safety helmet. steps toward helping children develop motor skills as well as
- Encourage parents to demonstrate safe riding habits by preventing childhood obesity (Hodges, Smith, Tidwell, et al.,
wearing helmets as well. 2012; Mitka, 2012).
Possible Unintentional Injuries to Preschoolers Hygiene
• Motor vehicles - Preschoolers can wash and dry their hands adequately if the
• Falls faucet is regulated for them. Parents should turn down the
temperature of the water heater in their home to under 120 deg
• Drowning
F to help prevent scalds.
• Animal bites
- They should not be left unsupervised at bath time in case they
• Poisoning decide to add more hot water or practice swimming and then
• Burns be unable to get their head out of the water again.
Promoting Preschooler Nutrition - Some girls develop vulvar irritation (and perhaps bladder
- Preschool years are not a time of fast growth, they are not irritation) from exposure to bubble bath so parents shouldn’t
likely to have ravenous appetite. add such products to the water.
- Children may not clean their ears and fingernails during bath
time and often need “touching up” by a parent or older sibling.
J.A.K.E 15 of 21
Care of Teeth Fear of Mutilation

- Electric or battery-operated toothbrushes can be used safely if - Fear of mutilation is also significant during preschool age, as
the child is taught not to use it or any other electrical appliance revealed by the intense reaction of a preschooler to even a
near a basin of water. simple injury such as falling and scraping a knee or having a
- Parents should also floss the child’s teeth because this is a skill needle inserted for immunization.
beyond a preschooler’s motor ability. - According to Freud, boys develop a fear of castration because
- Preschoolers should continue to drink fluoridated water or developmentally, they are more in tune of their body parts and
receive a prescribed oral fluoride supplement if fluoride is not are starting to identify with the same-sex parent as they go
provided in the water supply. through he Oedipal phase.
- Encourage children to eat apples, carrots, chicken, or cheese - Preschoolers dislike procedures such as needlesticks, rectal
for snacks rather than candy or sweets to prevent tooth decay. temperature assessments, otoscopic examinations, or having
If allowed to chew a gum, it should be the sugar-free variety. an NGT passed into their stomach.
- A first visit to a dentist should be arranged no later than 2 - They need good explanations of the limits of healthcare
years of age for an evaluation of tooth formulation because procedures, such as clarifying a tympanic thermometer does
deciduous (baby) teeth must be preserved to preserve the not hurt or a finger prick heals quickly as well as distraction
dental arch. techniques to feel safe
- Dental services can be performed at 3 years of age. Initial Fear of Separation or Abandonment
visits usually reveal no cavities and should be a pain-free - Fear of separation is yet another major concern for
experience for the preschooler. preschoolers.
- Teeth-grinding (bruxism) may begin at this age as a way of - Their sense of time is still distorted that they cannot be
“letting go”, similar to body rocking. If grinding is extensive, comforted by assurances such as “Mommy will pick you up
the crowns of the teeth can become abraded. If damage is from preschool at noon.” Their sense of distance is also
evident, refer the family to a pediatric dentist so the teeth can limited, so making a statement such as “I work only a block
be evaluated, repaired (capped), and conserved. away” is not reassuring.
- Relating time and space to something a child knows better,
Promoting Healthy Family Functioning such as meals, TV shows, or a friend’s house is more effective.
- An important role of preschooler parent is to respect creativity. For example, stating, “Mommy will pick you up from
Part of encouraging creativity is encouraging vocabulary preschool after you had your snack” is apt to be more
building by reading aloud to their child and by answering comforting than “Mommy will pick you up at 3 PM.”
questions, so the child sees language as an organized system of - A hospital admission or going to a new school often bring a
communication. child’s fear of separation to the forefront. Help parents
- Discipline thoroughly prepare preschoolers for these experiences so they
• Time-out – useful for parents to correct behavior can survive them in sound mental health.
throughout the preschool years. 3 to 5 minutes is
appropriate for preschoolers. Behavior Variations
Telling Tall Tales
Common Health Problems of the Preschooler - Stretching stories to make them seem more interesting is a
- Major cause of death (CDC, 2012) phenomenon frequently encountered in preschoolers.
• Automobile accidents - For example, after a trip to the zoo, if you ask a preschooler,
• Poisoning “What happened today?”, a child perceives you want
• Falls something exciting to have happened, and so might answer,
- Higher incidence of ear infections and respiratory infections “A bear jumped out of his cage and ate the boy next to me.”
among children whose parents are smokers. This is not lying, but merely supplying an expected answer.
- Increased incidence of gastrointestinal disturbances and upper - Caution the parents not to encourage this kind of storytelling
respiratory infections among children who attend childcare but instead help the child separate fact from fiction.
and preschool programs from the exposure to other children Imaginary Friends
unless frequent handwashing is performed. - Imaginary friends are a normal, creative part of the preschool
years and should not pose a problem and often leave as
Common Fears of the Preschooler quickly as they come.
- Because preschoolers’ imaginations are so active, this leads to - Pretend friends can encourage language development, may
a number of fears such as fear of the dark, mutilation, and provide an outlet for the child to express feelings or serve as a
separation or abandonment. handy scapegoat for behavior about which the child has some
Fear of the Dark conflict.
- The tendency to fear the dark is an example of a fear Difficulty Sharing
heightened by a child’s vivid imagination. - Sharing is a concept that the child would come to understand
- Parents should monitor the stimuli their children are exposed by the age of 3. Before this, the child engages in parallel play.
to especially before bedtime, such as TV, adult discussions, - Around 3 years of age, children begin to understand some
and frightening stories. things are theirs, some belong to others, and some can belong
- Leaving on a dim night-light can solve the problem. to both.
- Children who awake terrified and screaming need reassurance - Assure parents that sharing is a difficult concept to grasp and
that they are safe and that whatever was chasing them was a preschoolers need practice to learn and understand it.
dream and is not in their room.
J.A.K.E 16 of 21
- Defining limits and exposing children to the concepts of mine, - Poor eating habits developed at this stage may last through
yours, ours helps them determine which objects belong to adulthood and lead to an increased risk of type 2 diabetes,
which category. hypertension, cardiovascular disease, and obesity.
Regression - Proper etiquette is important in the school- age years. Parents
- Some preschoolers, in relation to stress, revert to behavior they can model this behavior for their child and encourage meals to
previously outgrew, such as thumb-sucking, negativism, loss be eaten at the table rather than while watching TV.
of bladder control, and inability to separate from their parents. - Boys require more calories and other nutrients than girls at this
- Help parents understand that regression in these circumstances time.
is normal. - Both girls and boys require more iron in prepuberty than they
Broken Fluency did between the ages 7 to 10.
- Broken fluency is the repetition or prolongation of sounds, - Calcium and fluoride are important to ensure good teeth and
syllables, and words, such as “I-I-I want a n-n-new spoon- bone growth.
spoon-spoon.” - A major deficit may be fiber because they dislike vegetable.
- It is often referred to as secondary stuttering because the child
began to speak without these problems and then, during the Promoting School-Age Child Development in Daily Activities
preschool years, develops it. Dress
- Remind parents that this is a part of normal development, and - This is the right age to teach children the importance of caring
if accepted as such, will pass. for their own belongings.
- School-age children often base their clothing styles on the
HEALTH PROMOTION FOR A SCHOOL-AGE CHILD likes of their friends or their idols rather than their parent’s
AND FAMILY preferences
Promoting School-Age Safety Sleep
- Advise parents to look at the effect of carrying heavy - Younger school-age children typically require 10 to 12 hours
backpacks on children’s posture. A backpack that weighs more of sleep each night. Older children require 8 to 10 hours.
than 10% of the child’s body weight is enough to cause a child Exercise
to have to lean forward chronically to bear the weight and can - Increasing time spent in exercise need not involve organize
lead to chronic back pain. sports. It can come from neighborhood games, walking with
- Sexual maltreatment is an unfortunate and all-too-common parents or a dog, or bicycle riding.
hazard for children. Educate the school-age child about these - Urge them to participate in some form of daily exercise or
safety measures: obesity or osteoporosis can result later in life
• Your body is your property, and you can decide who Hygiene
looks at it or touches it. - Children 6 to 7 years of age still need help in regulating bath
• It’s all right to tell someone about something that was water temperature and in cleaning their ears and fingernails.
- By age 8 years, they are generally capable of bathing but may
done to you that you didn’t like,
not do it well because they are too busy or may not find
• Don’t go anywhere with a stranger.
bathing important.
• You don’t have to allow anyone to touch you in a way
- Showering must be encouraged because perspiration increases
you don’t like
with puberty, along with sebaceous gland activity.
• Avoid meeting with people you talk on social media and Care of Teeth
the internet. - School-age children should visit a dentist at least twice yearly
• A “private part” is the part of you a bathing suit touches. for a checkup cleaning, and possibly a fluoride treatment to
If anyone asks you to show them a private part or touches strengthen or harden the tooth enamel or sealants on secondary
a private part, tell them to stop, and tell someone what teeth.
happened. - School-age children have to be reminded to brush their teeth
• If the person you tell doesn’t believe you, keep telling daily using a soft toothbrush, fluoride-based toothpaste, and
people until someone does believe you. dental floss.
- Possible Unintentional Injuries to School-Age Children
• Motor vehicles Common Health Problems of the School-Age Period
• Bicycle - School-age children may have small health concerns such as
• Drowning head lice or ringworm.
• Burns - The two causes of death seen most frequently are more from
• Falls unintentional injury and cancer.
• Sports injuries - Minor illness is largely due to dental caries, GI disturbances,
and upper respiratory infection.
• Drugs
Dental Caries
• Firearms
- Dental caries is largely preventable with proper brushing and
Promoting Nutrition of a School-Age Child use of fluoridated water or fluoride application.
- School-age children should be encouraged to eat a healthy - Dental visits are recommended every 6 months.
breakfast to ensure the ability to concentrate during the school Malocclusion
day. - Malocclusion is a deviation of tooth position from the normal
- Nutritious after-school snacks are important. and may be congenital due to conditions such as cleft palate, a
small lower jaw, or familial traits tending toward malocclusion.
J.A.K.E 17 of 21
- Children with a malocclusion should be evaluated by an - Preteens should have adults they can turn to for answers
orthodontist to see if orthodontic braces or other therapy is to questions about sex.
necessary. - Nurses can take steps to improve health outcomes for
LGBT youth by providing care that is affirming and
Concerns and Problems of the School-Age Period inclusive.
Problems Associated with Language Development b) Stealing
- The most common problem of a school-age child is - Stealing occurs because, although a child is gaining an
articulation. The child has difficulty pronouncing s, z, th, l, r, appreciation for money, this appreciation is not yet
and w or substitutes w for r (“westroom” instead of balanced by strong moral principles or an understanding
“restroom”) or r for l (“radies’ room” instead of “ladies’ of ownership.
room”). - As a rule, early childhood stealing is best handled without
- This is noticeable during the first and second grades; it usually a great deal of emotion.
disappears by the third grade. - Shoplifting must be taken seriously because it is a
Common Fears and Anxieties of a School-Age Child punishable crime and should be confronted immediately
Anxiety Related to Beginning School to prevent children who succeed once form taking
- Adjusting to grade school is a big task for 6-year-olds (AAP, something even bigger the second time.
Council on early childhood, Council on School Health, 2016). c) Violence or Terrorism
Also, where preschool learning was carried out through fun - Assure children they are safe.
activities, part of everyday in grade school involves obvious - Observe for signs of stress such as sleep disturbances,
work. fatigue, lack of pleasure in activities, or signs of
- Many first graders are capable of mature action at school but beginning substance abuse.
appear less mature when they return home. They may bite - Do not allow children or adolescents to view footage of
their fingernails, suck their thumb, or talk baby talk. traumatic events over and over.
- Urge the parents to spend some time with the child after - Watch news programs with children so it can be explained.
school or in the evening so the child continues to feel secure in - Prepare a family disaster plan.
the family and does not feel pushed out by seeing sent to - Designate a “rally point” where the family will meet if
school. ever separated by a disaster or evacuation.
School Refusal or Phobia d) Bullying
- School refusal is a fear of attending school. - A frequent reason school-age children cite for feeling so
- Children who resist attending school this way develop unhappy that they turn guns on classmates or commit
physical signs of illness, such as vomiting, diarrhea, headache, suicide is because they were ridiculed or bullied to the
or abdominal pain on school days. point they can no longer take such abuse (Cooper,
- As a rule, once it has been established that the child is free of Clements, & Holt, 2012).
any illness and the resistance stems from separation or phobia, - Alerts parents that Internet or text bullying are both also
the child should be made to attend school. possible and that a bully doesn’t have to be in fact-to-face
Homeschooling contact with their child to be harmful (D’Auria, 2014).
- Because the main contact of homeschooled children is with e) Recreational Drug Use
well-educated parents at home, their vocabulary may be - Illegal drugs such as marijuana, cocaine, and
advanced or may suggest that they are older than their actual amphetamines are now available to children as early as
age. elementary school and certainly by the time they reach the
- Assess if children have peer experiences such as participation seventh and eighth grades.
in community sports teams or clubs. Ask if they receive - Children who report being happy and can communicate
exposure to other cultures or families, so they can better adjust with their family are less likely to be regular users than
to people different from themselves later at college or at a job. others (Farmer & Hanratty, 2012).
Children Who Spend Time Independently - Parents should suspect recreational drug use if their child
- Both parents work outside the home and children may spend regularly appears irritable, inattentive, or drowsy.
time alone without adult supervision for a part of each - Cigarette smoking also begins in school-age children.
weekday. Caution children against experimenting with smokeless
- A major concern is that they will experience an increased tobacco as well because this can lead to mouth and throat
number of unintentional injuries, delinquent behavior, alcohol cancer, the same as smoking.
or substance abuse, or decreased school performance from a - To discourage use of tobacco by school-age children,
lack of adult supervision. healthcare professionals and parents need to be role
- Safety points for children, safety responsibilities for parents, models of excellent nonsmoking health behavior.
parental actions to prevent loneliness, parental actions to
socialization, and parental actions to increase self-esteem must
be discussed at health visits.
a) Sex Education
- It is important that school-age children be educated about
pubertal changes and responsible sexual practices.
J.A.K.E 18 of 21
HEALTH PROMOTION FOR AN ADOLESCENT AND not overdo it and consequently develop sprains or other
FAMILY overuse injuries (Huang, Coel, Vidal, et al., 2012).
Promoting Adolescent Safety
- Unintentional injuries, most commonly those involving motor Common Health Problems of an Adolescent
vehicles, are the leading cause of death among adolescents. Hypertension
- Some adolescents dismiss seat belts as childish and that safety - Hypertension is present if the blood pressure is above the 95th
precautions must be used. percentile, or 127/81 for 16-year-old girls and 131/81 for 16-
- Wear safety helmets to prevent head injury, long pants to year-old bo0ys for two consecutive readings in different
prevent leg burn, and a full body covering to prevent abrasions settings.
in case of an accident. - Adolescents who have a family history, who are black, who
- Teaching water safety, such as not swimming alone or when eat a high salt diet, or have a family history if hypertension are
tired, is as important as teaching the mechanics of swimming more susceptible to develop the condition.
(CDC, 2016b). - All children older than 3 years old must have their BOP
- Other common causes of death in adolescents are homicide checked at all health visits.
and self-harm such as suicide (Swahn, Ali, Bossarte, et al., - New medications plus education can help to greatly reduce the
2012). incidence of cardiovascular diseases when they reach
- Athletic injuries, especially overuse from poor conditioning, adulthood.
tend to increase in number during adolescence because of the Poor Posture
vigorous level of competition that occurs in organized sports - Urge children of both sexes to use good posture during these
(Khan, Thompson, Blair, et al., 2012) rapid-growth years.
- Assess posture at all adolescent health visits to detect
Promoting Nutritional Health for an Adolescent differences between simple poor posture and the beginning of
- Adolescents tend to eat faddish or quick snack foods rather spinal dysplasia or scoliosis.
than more nutritious foods. This type of eating pattern, Body Piercing and Tattoos
combined with a lack of exercise, also leads to obesity - Body piercing and tattoos are a strong mark of adolescence
(Wengle, Hamilton, Manlhiot, et. al., 2012). (Stein & Jordan, 2012).
- Giving an adolescent some responsibility for food planning or - Be certain they know the symptoms of infection at a piercing
meals can teach some important lessons about nutrition or tattoo site.
without conflict. - Caution that sharing needles for piercing and tattooing carries
- A weight-loss diet is appropriate during adolescence, but it the same risk for contracting a blood-borne disease.
must be supervised to ensure the adolescent is consuming Fatigue
sufficient calories and nutrients for growth. - Always assess the diet, sleep patterns, and activity schedules
- Some adolescents may find it difficult to follow a vegetarian of fatigued adolescents.
diet because that makes them different from their peers and - Be aware that if fatigue begins as a short period of extreme
limits the food they can eat. tiredness, it suggests disease more than a long, ill-defined
report of always being tired.
Promoting Development of an Adolescent in Daily Activities - Blood tests may be indicated to rule out anemia and common
Dress and Hygiene infections in adolescents.
- Adolescents are capable of total self-care and may even be Acne
overly conscientious about personal hygiene and appearance. - Acne is a self-limiting inflammatory disease that involves the
- When caring for hospitalized adolescents, providing time for sebaceous glands, which empty into hair shafts.
self-care, such as shampooing hair, is important to include in - It is the most common skin disorder of adolescence and occurs
an adolescent’s nursing care plan. slightly more frequently in boys than girls.
- When hospitalized, most teenagers seem to improve markedly - The goal of therapy for acne is threefold: decrease sebum
when allowed to wear their own clothing rather than a hospital formation, prevent comedones (blocked hair follicle), and
gown. control proliferation.
Care of Teeth Obesity
- Adolescents are generally very conscientious about tooth - Inheritance and environment play a part in the development of
brushing because of fear of developing bad breath. adolescent obesity.
- They should continue to use a fluoride toothpaste and drink - Health teaching with these adolescents may need to begin with
fluoridated water to ensure firm enamel growth. a discussion of normal weight and standard food portion.
- Teens with braces must be extremely conscientious about - In addition to reducing calories consumed, encourage
tooth brushing to prevent plaque buildup on hidden tooth activities that burn calories, such as swimming, gym classes or
surfaces. walking their dog.
Sleep and Exercise
- This age group may need proportionately more sleep than any ETHICAL SCOPE AND STANDARDS
other age group because adolescents are building new cells • Ethics – The branch of philosophy concerned with the
during protein synthesis. distinction between right and wrong on the basis of the body
- Adolescents need exercise every day to maintain muscle tone knowledge, not only on the basis of opinions.
and to provide an outlet for tension. • Morality – Behavior in accordance with customs or traditions,
- If they have not participated in competitive sports before, they usually reflecting personal or religious beliefs.
may need advice on increasing exercise gradually, so they do
J.A.K.E 19 of 21
• Ethical Principles: Codes that directs or governs nursing Client’s Rights

actions - The client’s rights document, also called the Client’s Bill of
a) Autonomy – respect for an individual’s right to self Rights, reflects acknowledgement of client’s right to
determination participate in her or his healthcare with an emphasis of client’s
b) Nonmaleficence – The obligation to do or cause no harm autonomy.
to another - The document provides a list of rights of the client and
c) Beneficence – The duty to do good to others and to responsibilities that the hospital cannot violate.
maintain a balance between benefits and harm. Client’s Right When Hospitalized
Paternalism is an undesirable outcome of beneficence, in 1) Right to considerate and respectful care
which the health care provider decides what is best for the 2) Right to be informed about diagnosis, possible treatments,
client and encourages the client to act against his/her own likely outcome, and to discuss this information with the health
choices. care provider
d) Justice – The equitable distribution of potential benefits 3) Right to know the names and roles of the persons who are
and task determining the order in which clients should be involved in care
cared for 4) Right to consent or refuse a treatment
e) Veracity – The obligation to tell the truth 5) Right to have an advance directive
f) Fidelity – The duty to do what one has promised 6) Right to privacy
• Values: Beliefs and attitudes that may influence behavior and 7) Right to expect that medical records are confidential
the process of decision making 8) Right to review the medical record and to have information
• Values Identification: The process of analyzing one’s own explained
values to understand oneself more completely regarding what 9) Right to expect that the hospital will provide necessary health
is truly important. services
• Ethical Codes 10) Right to know if the hospital with outside parties that may
- Ethical codes provide broad principles for determining influence treatment or care
and evaluating client care. 11) Right to consent or refuse to take part in research
- These codes are not legally binding, but the board of 12) Right to be told of realistic care alternatives when hospital
nursing has authority in reprimand nurses for care is no longer appropriate
unprofessional conduct that results from violation of 13) Right to know about hospital rules that affect treatment, and
ethical codes. about charges and payment methods
• Ethical Dilemma Ethical Considerations of Practice on Maternal and Child Care
- An ethical dilemma occurs when there is a conflict Some of the most difficult ethical quandaries in health care today
between two or more ethical principles. are those that involve children and families. Examples include:
- No correct decision exists, and the nurse must make a • Conception issues, especially those related ton invitro
choice between two alternatives that are equals a result of fertilization, embryo transfer, ownership of frozen oocytes or
differences in culturally unsatisfactory.
sperm, and surrogate motherhood
- Such dilemma may occur as a result of differences in
• Pregnancy termination
cultural or religious beliefs.
• Fetal rights versus the rights of the mother
- Ethical reasoning is the process of thinking through what
one should do in an orderly and systematic manner to • Stem cell research
provide justification for action based on principles; the • Resuscitation (and length of continuation)
nurse should gather all information to determine whether • Number of procedures or degree of pain a child should be
an ethical dilemma exists, examine his or her own values, asked to endure to achieve a degree of better health
verbalize the problem, consider possible courses of action, • Balance between modern technology and quality of life
negotiate the outcome, and evaluate the action taken. • Difficulty maintaining confidentiality of records when there
• Advocate are multiple care givers
- An advocate is a person who speaks up for or acts on
behalf of the client, protects the client’s right to make his FILIPINO CULTURE, VALUES AND PRACTICES IN
or her own decisions, and upholds the principle of fidelity. RELATION TO MATERNAL AND CHILD CARE AND
- An advocate represents the client’s viewpoint to others. MATERNAL AND CHILD CARE ENTREPRENEURIAL
- An advocate avoids letting personal values influence OPPORTUNITIES
advocacy for the client to support the client’s decision, Health related beliefs and practices
even when it conflicts with the advocate’s own • In the Philippines, biomedical services may be supplemented
preferences or choices. by herbalists and other healers who specialize in herbal
remedies, massage or healing by spiritual means, through
• Ethics Committees power derived from devotion to Christian saints.
a. Ethics committees takes a multidisciplinary approach to • People may use the concepts of ‘hot’ and ‘cold’ to classify and
facilitate dialogue regarding ethical dilemmas. explain illnesses. Foods, medicines and temperature/weather
b. These committees develop and establish policies and conditions are classified according to their hot or cold qualities
procedures to facilitate the prevention and resolution of and their effects on the body. Sudden changes in body
dilemmas. temperature may be perceived as harmful.
J.A.K.E 20 of 21
• Beliefs about the relationship of water and bathing to health - Some women perform various practices for the purpose of
can differ substantially. Bathing can be associated with a ‘drying out’ the womb. For example, ‘mother roasting’ can
draining of strength from the body, particularly if a person is involve lying beside a stove for up to 30 days, squatting over a
already ill. burning clay stove, sitting on a chair over a heated stone or a
Pregnancy pot with steaming water, or bathing in smoke from smoldering
- According to some Filipino beliefs, cravings for food during leaves.
pregnancy should be satisfied.
- Some pregnant women may avoid eating black foods to avoid Maternal and Child Care Entrepreneurial Opportunities
the birth of an infant with a dark skin tone. - According to Vanucci (2017), a nurse entrepreneur is defined
- Some pregnant women may place great emphasis on being as a proprietor of a business that offers nursing services of a
tidy and beautiful, believing that these practices will influence direct care, educational, research, administrative or
the beauty of their child. consultative nature.
- Unpleasant emotions experienced by pregnant women may be - Nurse entrepreneurs may build their businesses to develop and
blamed for causing birthmarks. distribute medical products or devices, offer direct patient care
Birth or patient advocacy, educate or train other professionals or
- The most common birthing position is to lie down. Some community members, or provide health care-related
women may prefer a squatting position. consultation, among other functions. As more nurses move
- In some regions of the Philippines, it is believed that putting beyond the bedside to explore entrepreneurship, it is important
squash leaves on the abdomen of a laboring woman can to identify best practices and the skill sets that are transferable
facilitate labor. from direct caregiving to business leadership.
- Some women believe that drinking coconut water can - The following are the Entrepreneurial Opportunities that a
facilitate a fast labor. Maternal and Care Nurse can venture:
- Some fathers may prefer to be close to their laboring wife, so 1) Childcare services provide care for children when parents
they can bury the placenta. and family members are unavailable. Many parents feel
After birth more confident leaving their children in the care of
- In some regions a father is responsible for the burial of the someone with proper medical training. The nurse may
placenta. He usually buries the placenta very quickly, because open their own childcare center or simply offer in-home
the burial of the placenta indicates the end of the labor, and childcare.
therefore the end of pain and blood loss experienced by the 2) Doulas services provide guidance and support for mothers
laboring woman. The placenta should be offered to the through the pregnancy and childbirth process. The doula
postpartum woman or the father. assists the mother by providing physical comfort through
- Traditional custom in the Philippines dictates that women techniques such as touch and massage and assistance with
should not bathe for about ten days after giving birth and proper breathing during labor and birth.
during menstruation. Bathing during these times is seen as a 3) Childbirth Education Service – The nurse may offer
cause of ill health and rheumatism in old age. Sponge baths classes or training programs designed to help expecting
and steam baths could be used as alternatives. Women may parents prepare for childbirth.
object to having a shower immediately after giving birth. 4) Lactation Consulting – The nurse may help or assist
- Traditionally, after labor, women wear heavy clothes or wrap new mothers on lactation and breastfeeding practice
themselves in blankets to prevent exposure to ‘cold’ and 5) Fertility consultant care for couples and families who seek
‘wind’. counseling or treatment options related reproductive
- Some Filipinas bind their abdomen tightly, believing that this health. The nurse could provide consulting and guidance
practice helps to prevent bleeding and helps the uterus to to couples who wants to be parents aimed at helping them
retract. overcome certain fertility issues.
- New and lactating mothers are often given rice porridge (rice 6) Birthing clinics is a health care facility for childbirth
boiled soft to a consistency halfway between soup and puree). where care is provided by nurse and midwives. The
This may be served with sweet, salty or spicy accompaniments. birthing clinic is freestanding and not a hospital.
Soup made of meat and vegetables is also believed to help
promote lactation.
- Women fear what is referred to as a ‘relapse’ if they become
active too soon. This involves extreme tiredness, weakness
and chronic headache.
- In the Philippines when a woman has a baby, she usually rests
while her relatives do all the housework and cooking. Many
women can have difficulty coping with the daily routine of Yung week 14-17 kinopy paste ko lang un module heheh kasi 6
looking after a baby in a country where they may not have the pages lng nagawa ko sa buong discussion ni sir v sa finals. Eh
support of an extended family. feeling ko ang onti kaya dinagdagan ko nlng ng module sa canvas,
- Postpartum women may be massaged with coconut oil, with tutal pinapabasa din saten hehehe Goood luckkk pipol – Aki
the aim of restoring their lost health, expelling blood clots
from the uterus, returning the uterus into a normal position,
and promoting lactation.
J.A.K.E 21 of 21

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Bachelor of Science in Nursing 2YA

NCMA217 LEC: BSN 2ND YEAR 1ST SEMESTER FINAL 2021

Adolescent Peer group (kabarkada) Loss of privacy, rejection

Stages Play Toys Question

development - Assess a child’s weight and height according to standard

Care of Teeth Fear of Mutilation

• Ethical Principles: Codes that directs or governs nursing Client’s Rights

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