Bachelor of Science in Nursing 2YA

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

Coverage for Final: objects
• Care of Client during Infancy period Transfer object Able to explore small
5.5
• Care of Client during Toddler period hand to hand objects
• Care of Client during Preschool age Thumbs pages of Increasing autonomy
8
• Care of Client during School age books during book time
• Care of Client during Adolescent period Visuomotor
• Types of Complementary and Alternative Medicine Scribbles 13 coordination

Read Canvas Modules Week 13-17 Build tower of 2 Uses objects in

13
cubes combination
GROWTH AND DEVELOPMENT MILESTONE Requires visual, gross
Builds tower of 6
Discussed by Prof. Donato Mirador and Prof. Pam Pablo 22 and fine motor
cubes
1) Cognitive Development – ability to learn and solve problems coordination
2) Social and Emotional Development – ability to interact with
others, including helping themselves and self-control Communication and Language
3) Speech and Language Development – ability to both - Ability to both understand and use language
understand and use language Average Age of
4) Fine Motor Skill Development – ability to use small muscles, Milestone Attainment Objects use
specifically their hands and fingers (months)
5) Gross Motor Skill Development – ability to use large Smiles in
muscles More active social
response to face 1.5
participant
and voice
Gross Motor
- Ability to use large muscles Mono syllabic Experimentation with
6
Average Age of babble sound, tactile sense
Developmental Response to tone
Milestone Attainment Inhibits to “no” 7
Implication (nonverbal)
(months)
Holds head while Allows more visual Follows one step
2 Nonverbal
sitting interaction command with 7
communication
Pulls to sit with no gesture
3 Muscle tone Follows one step Verbal receptive
head lag 10
Brings hands Self-discovery of without gesture language (give it to me)
3 Says “mama” or
together in midline hands 10 Expressive language
Asymmetric tonic Can inspect hand in “dada”
4
neck reflex gone midline Interactive
Points to objects 10
Sits without communication
6 Increasing exploration
support Speaks first real
Truncal flexion, risk 12 Beginning of labeling
Rolls back to word
6.5 of falls
stomach Acquisition of object
Speaks 4-6 words 15
Exploration, control and personal names
Walks alone 12 of proximity of Speaks 10-15 Acquisition of object
18
parents words and personal names
Supervision more Beginning
Runs 16 Speaks 2-word
difficult grammaticization
sentences 19
corresponds with 50-
(mommy shoe)
Fine Motor word vocabulary
- Ability to use small muscles, specifically their hands and
fingers Cognitive
Average Age of - Ability to learn and solve problems
Milestone Attainment Objects use Average Age of
Developmental
(months) Milestone Attainment
Implication
Visuomotor (months)
Grasps Rattle 3.5 Stares Lack of object
Coordination
Reaches for momentarily at permanence (out of
4 Voluntary Release 2
Objects spot where object sight, out of mind ex:
Palmar Grasp gone 4 Comparison of disappear yarn ball dropped)

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 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021

Self-discovery, cause - How baby communicates

Stares at own hand 4
and effect • Uses body language to tell you how she feels about what
Active comparison of is going on when she smiles at you, she is inviting you to
Bangs 2 cubes 8
objects play with her
Uncovers toy • Baby’s cries are becoming easier to identify.
(after seeing it 8 Object permanence
hidden) 3 – 6 months
Egocentric - Baby will smile more often and begin to laugh.
symbolic play Beginning symbolic - What baby can see
12 • Focus on objects as far ways as three feet.
(pretends to drink thought
in a cup) • Can look back and forth at two different things.
Uses stick to reach Able to link actions to - How baby eats
17
toy solve problem • Begin introducing solid goods
Pretend to play - How baby moves
with doll (gives 17 Symbolic though • Learns to hold her head up on her own
doll bottle) • May start to roll over.
- How baby uses her hands
1st 6 weeks • Can reach and grab things
- Newborns are totally dependent on us for their basic needs - How baby communicates
- What baby can see • Begin using different vowel sounds
• Vision is not fully developed - How baby growing emotionally
• enjoy seeing bright colors or large black and white • More active in getting attention
pictures • Begin to smile at herself in the mirror
- What baby can hear - Loving and playing with baby
• Already recognizes his mother's voice when he is born • Enjoy playing peek-a-boo
• Changes in your baby's body movements when there are • Give lots of opportunities to reach for things with
new or loud sounds around him. different textures.
- What baby can feel
• Babies enjoy gentle massages 6-9 months
- How baby eats - beginning to move his body into different positions.
• Only tolerate liquids - How baby eat
- How baby moves • Explore the world by putting things in his mouth.
• Need a lot of support to hold his head up - How baby uses her hands
- How baby communicates • Enjoys learning about his surroundings.
• Cry is her way of communicating her needs. • Can move a toy easily from one hand to the other.
• When baby makes eye contact with you, he is - How your baby moves
communicating his interest • Learning to sit by herself
• Baby may pull back from you to show that he needs a • Babies love to stand when you hold them u
break. • She is getting ready to crawl.
• Baby may make cooing sounds, particularly when you - How baby communicates
talk to her. • May turn his head when you call his name.
• He enjoy blowing "bubbles" and makes "bbb" sounds.
1 ½ - 3 months - How your baby explores
- Awake for a good part of the day and sleeping most of the • If you hide baby's bottle and she sees where you put it,
night. she may try to reach for it
- What baby can see • Enjoys repeating an action over and over.
• Vision is improving - How baby responds to others
• Starting to look in the direction where sounds are coming • Communicate with you by using gestures.
from. • Baby is picking up on feelings by the tone of voice.
• He sees your smile and learns to smile back.
- What baby can hear 9-12 months
• Likes to listen to music - Very curious and explores his surroundings.
• Baby loves to hear your voice - How baby eats
- What baby can feel • Begin spoon-feeding
• Baby’s hands are opening up more • Introduce more solid foods but cut them into tiny,
• Enjoy the feeling of her hand in the mouth. - How your baby uses her hands
- How baby moves • Learn how to use his thumb and index finger to pick up
• Strengthening the muscles in his neck so that he may be small objects
able to hold his head up on his own • Learning to voluntarily let go of things and will "practice"
• Learning to control the muscles in arms and legs be dropping objects

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 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021
- How baby moves
• Baby will pull himself up from the floor to stand against a
sofa, table
• Preparing himself to take his first step by himself.
- How baby communicates
• Starts to use her pointer finger to show interest in
something
• When you say "no," baby may stop what she is doing and
may even look at you.
• May recognize a few familiar words.
- How baby growing emotionally
• Understand the word "no,“
• Try to imitate some of the things that you do
• Baby will only want her mother to take care of her needs
and is more hesitant around strangers.
1-2 years
- Learning to walk and talk is your child's biggest job in this
year.
- How child eats
• Child should be on an eating schedule and can join the
family at the dinner table 3 times a day.
- How child uses his hands
• Trying to use a spoon
• Enjoy making marks on paper with crayons.
- How your child moves
• Use lots of energy to learn to walk.
• Learn how to roll and kick a ball.
- How child communicates
• Child is putting two and three words together to make
simple sentences
- How your child explores
• More interested in turning pages of her favorite books
• Learn how to match two objects together by color, shape
or size.
• Paying more attention to the actions of others
- How your child is growing emotionally
• Earning how to communicate his wants, needs, and
feelings by using words and facial expressions
• Begin to recognize herself in the mirror.
• Child may show jealousy when he isn't the center of
attention.
2-3 years
- They want to do things for themselves
- How child eats
• Start the habit of washing his hands before meals.
• Capable of helping with some meal preparation
- How child uses his hands
• More interested in scribbling with crayons
• Enjoy learning to cut with safety scissors.
- How child moves
• Learn to jump on both feet
• To walk up and down stairs independently.
- How your child explores
• Child will understand simple stories.
• Child's imagination will become more vivid
• Learn to count "1-2-3“
- How child growing emotional
• Showing more interest in other children
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• "mine" is a word often used
• Child will know that he is a boy, or that she is a girl
3-5 years
- Child believes that everything resolves around her
- How child eats
• Capable of helping with some meal preparation
- How child uses his hands
• Learn to hold his crayon better
• Learn how to button his clothes and zip and unzip by
himself
• Offer to help with household chores
- How child moves
• Learn to throw and catch a large ball
• Prone to accidents because she may be more adventurous
• Learn to pedal a tricycle
- How your child communicates
• Asking “why” is a favorite activity
• Kaya kailangan lagi kang handa sa kapag nag tanong sya
at obligation mon a sagutin yun para ma yung curiosity
nila is masagot at hindi magkaroon ng effect doon sa bata.
• Learn to listen to the explanations of others with interest
• Can recite familiar stories
- How child explores
• Learn to know different shapes by name and colors
• Know how to tell a story with a beginning, middle and
end
- How child growing emotionally
• Develop fears especially about unfamiliar sights and
sounds
• Easily influenced by what he watches on tv
• Kaya wag hahayaan na manood nila ng mga pang adult na
genre kase magkakaroon din to ng bad effect sakanila
dahil madali sila ma impluwensyahan at pwedeng trauma
ito sa bata
• Earn to follow simple rules in games like “hide and seek”
5-7 years
- Each day becomes an adventure and a time of discovery
- How child eats:
• Capable of measuring ingredients and using simple
kitchen utensils
- How child uses his hands
• Learn how to make letters, words and sentences.
• Will be able to tie his shoes
- How child moves
• Be able balance on one foot for 10 seconds.
- How your child communicates
• Recognize opposites, define objects by their use
• Understands the rules of conversation
- How child explores
• Be able to follow two-step directions
• Know his full name, age and address
• Be able to answer who, what, when, where, why questions.
- How child growing emotionally
• Developing self-esteem is a central issue
• Child is a wonderful mimic
• Child is becoming aware that she is one of many people in
the world
 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021

• Become very interested in the difference between truth - More argumentative

and lies - Teens may not want to be seen with parents in public
School Age PRE-SCHOOL GROWTH AND DEVELOPMENT
- Describes the expected physical, emotional, and mental Discussed by Prof. Melanie Cambel and Prof. Jacqueline Gabiana
abilities - 3-5 years old
- Peer acceptance become increasingly important - Physical growth slows during this period, personality and
- Friendship with members of same sex lying, cheating and cognitive growth also continues at rapid rate and most of them
stealing are all examples of behaviour are independent.
- Learn how to deal with failure w/ out losing self-esteem (ay - Setting limits to protect children from harming themselves and
naol djk) others is important
- They are highly active
- They know right from wrong Nursing Assessment
- Able to accept moderate responsibilities Physical growth
- Ex. Household chores - A change in body contours occurs
- Has sense of humor - Contour changes are so definite that future body type –
- Has self confidence and a sense of pride and competence automorphic body build (slim body build) or endomorphic
- Has dramatic, artistic or musical talent body build (large body build) – becomes apparent.
- Takes appropriate responsibility for homework with little - Lymphatic tissue begins to increase in size.
podding - Physiologic splitting of heart sounds may be present for the
- Assumes responsibility for his or her own health first time on auscultation.
- Is comfortable is asking parents questions Weight, height, body mass index, and head circumference
- Generally cooperative and considerate, although at time is - The average child gains only about 4.5 lb. (2 kg) a year.
inconsistent and unpredictable - In height only 2 to 3.5 in. (6 to 8 cm) a year on average.
- Children generally have all 20 of their deciduous teeth by 3
Adolescent years of age; permanent teeth don’t replace these until school
- A time of many transitions for both teens and their families age.
Physical Development - The extent of a 3-year-old child’s vocabulary varies depending
- Rapid gains in height and weight on how much the child has been encouraged to ask questions
- Development of secondary sex characteristics e. Menarche or participate in conversations.
- Continued brain development Fine Motor
Age Gross Motor Language Play
- Teens frequently sleep longer Skills
- Maybe more clumsy bec. Of growth spurts Undressed Runs;
- Overly sensitive about their weight self; stacks alternates feet Vocabulary Able to take
- Concerned bec. They are not physically developing at the 3 tower of on stairs; rides of 900 turns; very
same rate as their peers blocks; tricycle; stands words imaginative
- Feel awkward about demonstrating affection to the opposite draw a cross on one foot
sex parent Can do Vocabulary Pretending
Constantly in
- Ask more direct questions about sex 4 simple 1,500 is major
motion jumps
Cognitive Development buttons words activity
- Developing advanced reasoning skills Can draw a Likes
Vocabulary
- Developing abstract thinking skills six-part Throws games with
5 2,100
Demonstrate a heightened level of Self Conscious figure; can overhand number or
words
- They believe that no one else has ever experienced similar lace shoes letters
feelings and emotions teens tend to exhibit the “it can’t happen
to me” syndrome also known as “personal fable” Emotional development
- Tends to become very cause – oriented • Developmental task: initiative vs. Guilt
- Tend to exhibit a “justice” orientation • Initiative
Psychosocial Development - Discovered that learning new things is fun
- Establishing an identity - If children are criticized or punished for attempts at
- Establishing autonomy initiative, they can develop a sense of guilt for wanting to
- Teens begin to spend more time with their friend more than try new activities or to have new experiences.
their families (kase nga iniisip natin mas naiintindihan tayo ng - Those who leave the preschool period with a sense of
mga kaibigan natin kesa sa pamilya natin) guilt can carry it with them to school situations.
- May have more questions about sexuality - To gain a sense of initiative, preschoolers need exposure
- May begin to keep a journal (mahilig gumawa ng mga diaries) to a wide variety of experiences and play materials so they
- When they are in their rooms, they begin lock their bedroom can learn as much about how things work as possible
doors (privacy) • Guilt – developed if child was criticized or punished for
- May become involved in multiple hobbies or clubs attempts to try new activities or experiences
- May become elusive about where they are going or with • Imitation
whom - Role playing

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 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021

- Children generally imitate those activities best that they Common safety measures to prevent unintentional injuries to
see their parents performing at home. preschooler
• Fantasy Possible
- Begin to differentiate fantasy and reality Unintentional Prevention Measure
- They may become so engrossed in a fantasy role, that they Injury
become afraid they seem to have lost their own identity Teach safety w/ tricycles. teach the child to
• Oedipus and Electra complexes always hold hands w/ an adult bef. crossing a
Motor
- Oedipus complex – strong emotional attachment a street. Teach parking lot safety. Teach children
vehicles
preschool boy demonstrates toward his mother to consistently wear helmets when beginning
- Electra complexes – attachment of a preschool girl to her bicycle riding
father Always supervise a preschooler at a
• Gender roles playground. Remove drawstrings from hooded
Falls
- Preschoolers begin to be aware of the difference between clothing. Help the child to judge safe distances
sexes and so need to be introduced to both gender for jumping or safe heights for climbing
• Socialization Drowning Teach beginning swimming
- 3-year-olds are capable of sharing. Do not allow the child to approach strange
Animal bites
- 4-year-olds continue to enjoy play groups dogs. supervise the child’s play w/ family pets
- 5-year-olds begin to develop “best” friendships Never present medication as a candy. never
take medication in front of the child. never
Cognitive development store food or substances in containers other
- Intuitional thought (centering) – they lack the insight to view than their own. post the tel. no. of the poison
themselves as others see them or to put themselves in Poisoning
control center by the telephone or as a cells
another’s place conversation. phone contact no. teach the child that
- This means that if they have two balls of clay of equal size, medications are a serious substance and not for
but one is squashed wider than the other, they will insist the play
flatter one is bigger (because it is wider) or the intact one is Store matches in closed containers. do not
bigger (because it is taller). Burns allow the preschooler to help light birthday
- Not aware of the property of conservation candles, or fireplaces; fire is not fun
Teach the preschooler that not all people are
Moral and Spiritual development
friends. define a stranger as someone the child
• Determine right from wrong based on their parents’ rule Community does not know, not someone odd looking. teach
• Begin to have element concept of God safety the child to say “no” to people whose touching
Health Promotion he or she does not enjoy; including family
• Promoting Preschooler Safety member
o Keeping children safe, strong, and free Know the whereabouts of the preschooler at all
- The preschool years are not too early a time to times. be ware the frequency of unintentional
educate children about the potential injuries increases when parents are under
- Threat of harm from strangers or how to address General stress. Special precautions must be taken at
bullying behavior from people these times. Some children are more active,
o Motor vehicle and bicycle safety curious, and impulsive and therefore more
vulnerable to unintentional injuries than others
- Urge parents to stress the important role of seat belts
in preventing injury.
- Preschool is also the right age to promote bicycle Immunization
safety because falls off bicycles are a major cause of Diphtheria, pertussis,
DTaP 5 Bef. start of school
severe head injuries and tetanus
• Promoting the nutritional health of a preschooler and MMR MMR #2 Bef. start of school
nutrition requirements IPV IPV #4 Bef. start of school
- To prevent childhood obesity, urge parents to offer snacks
such as fruit, cheese, or milk rather than cookies and Varicella VAR #2 Bef. start of school
parents do give vitamins, remind them that a child will influenza IIV Yearly
undoubtedly view a vitamin as candy rather than medicine
so they must be stored out of reach. Anticipatory Guidance
- Vegetables, fruits, and grains are also healthy
Preschool Care Active litening and health teaching
• Promoting the development of the preschooler in daily
Expected Growth and
activities Active listening and health
developmental milestones
- Dressing teaching
before next visit
- Sleep
Unintentional injury Counseling about street and
- Exercises
prevention personal safety
- Hygiene
- Care of teeth

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 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021
Parental Difficulties Evaluating Health Problems in the
Preschool Child
1) Evaluating seriousness of illness or condition
2) Evaluating bowel and bladder problems
3) Evaluating nutritional intake
4) Evaluating bed-wetting
5) Evaluating activity versus hyperactivity
6) Evaluating activity versus hyperactivity
Common Fears of the Preschooler
• Fear of the dark
• Behavior variations – Stretching stories to make them seem
more interesting phenomenon frequently encountered in by
preschoolers.
• Fear of separation or abandonment
• Imaginary friends
• Difficulty sharing
• Regression
• Sibling’s rivalry
• Sex education
• Broken fluency
• Bathroom language
SCHOOL AGE
Discussed by Prof. Melanie Cambel and Prof. Jacqueline Gabiana
- School age refers to children ages 6 to 12.
- These represent slow physical growth but cognitive, growth
and development progress at different rates, differences in
height and weight and built are prominent.
For healthy development of a school-age child
1) Assessment
2) Outcome identification and Planning
3) Implementation
4) Outcome evaluation
Assessment
- Use both history and physical examination to assess growth
and development of school-age children.
- Include questions about school activities and progress.
- School-age children are interested and able to contribute to
their own health history.
- During a physical examination, show your respect for
children’s adult-level modesty by furnishing a cover gown.
- If the problem is related to a medical condition, its effect on
the family should also be assessed, because the illness of a
child affects the functioning of the entire family.
Nursing Diagnosis
Common nursing diagnoses pertinent to growth and development
during the school-age period include:
• Health-seeking behaviors related to normal school-age
growth and development
• Readiness for enhanced parenting related to improved
family living conditions
• Anxiety related to slow growth pattern of child
• Risk for injury related to deficient parental knowledge
about safety precautions for a school-age
Outcome Identification and Planning
- When identifying expected outcomes and planning care, keep
in mind that school-age children tend to enjoy small or short-
term projects.
J.A.K.E 6 of 15
- Behavior problems need to be well defined before outcomes
are identified and interventions planned. Often, it is enough for
parents to accept the problem as one consistent with normal
growth and development.
Implementation
- School-age children are interested in learning about adult roles,
so this means they will watch you to note your attitude as well
as your actions in a given situation.
- When giving care, keep in mind that children this age feel
more comfortable if they know the “how’s” and “whys” of
actions. This means that they may not cooperate with a
procedure until they are given a satisfactory explanation of
why it must be done.
Outcome Evaluation
- Yearly health visits covering both physical and psychosocial
development are important at this age. It may be useful for
parents to look back on problems, identify the last visit and
discuss if and how they were resolved.
- Parent states that he allows the child to make his own
decisions about how to spend an allowance.
• Child lists books she and her parents have read together in
the past 2 weeks.
• Child states he understands his growth is within the usual
guidelines, even though he is the shortest boy in his
eighth-grade class.
• Children do not sustain injuries from sports activities
during the summer recess.
Physical Growth
- The average annual weight gain for a school-age child is
approximately 3 to 5 lb (1.3 to 2.2 kg); the increase in height is
1 to 2 in. (2.5 to 5 cm).
- By 10 years of age, brain growth is complete, so fine motor
coordination becomes refined.
- As the eye globe reaches its final shape at about this same time,
an adult vision level is achieved.
- If the eruption of permanent teeth and growth of the jaw do
not correlate with final head growth, the immune globulins
IgG and IgA each reach adult levels, and lymphatic tissue
continues to grow in size until about age 9 years.
- The pulse rate decreases to 70 to 80 beats/min; blood pressure
rises to about 112/60 mmHg.
- Maturation of the respiratory system leads to increased
oxygen–carbon dioxide exchange
Sexual Maturation
- Timing of the onset of puberty varies widely, between 8 and
14 years of age.
- The school-age period is a time for parents to discuss with
children the physical changes that will occur and the sexual
responsibility these changes dictate. In both sexes, puberty
brings changes in the sebaceous glands.
- Under the influence of androgen, glands become more active,
setting the stage for acne Vasomotor instability commonly
leads to blushing; perspiration also increases.
- Girls are usually conscious of breast development. Prepubertal
girls are usually taller by about 2 in. (5 cm) or more than
preadolescent boys because their typical growth spurt begins
earlier. Early Preparation for menstruation is an important
preparation for future childbearing and for a girl’s concept of
herself as a woman
 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021

- Boys are becoming aware of increasing genital size. If they do CHRONOLOGIC DEVELOPMENT OF SECONDARY SEX
not know testicular development precedes penis growth, they CHARACTERISTICS
can worry that their growth will be inadequate. Hypertrophy of Age Boys Girls
breast tissue (gynecomastia) can occur in prepubescent boys, Breasts: elevation of
most often in those who are stocky or obese. Some boys can Prepubertal weight gain papilla with breast bud
also become concerned because, although they have pubic hair, 9-11
occurs. formation; areolar diameter
they cannot yet grow a beard or do not have chest hair, As enlarges
increased seminal fluid begins to be produced, boys begin to 11–12 Sparse growth of Straight hair along the
notice ejaculation during sleep, termed nocturnal emissions straight, downy, slightly labia; vaginal epithelium
pigmented hair at base of becomes certified. pH of
Teeth
penis. Scrotum becomes vaginal secretions becomes
- Deciduous teeth are lost and permanent teeth erupt during the
11-12 textured, growth of penis acidic; slight mucous
school-age period Because of this, the average child gains 28
and testes begins. vaginal discharge is
teeth between 6 and 12 years of age
Sebaceous gland present. Sebaceous gland
Developmental Milestones secretion. Perspiration secretion increases.
Gross Motor Development increases. Dramatic growth spurt
- They have enough coordination to walk a straight line, many Pubic hair grows darker;
Pubic hair present across
can ride a bicycle and they learn to skip rope with practice. spreads over the entire
pubis. Penis lengthens.
- A 7-year-old child appears quiet compared with a rough-and- pubis. Breasts enlarge, still
12-13 Dramatic linear growth
tumble 6-year-old. no protrusion of nipples.
spurt. Breast
- Gender differences usually begin to manifest themselves in Axillary hair present.
enlargement may occur.
play. Menarche occurs
- 8-year-olds are more graceful than those of younger children,
Nine-year-olds are on the go constantly, as if they always have Fine Motor Development
a deadline to meet. They have enough eye–hand coordination - Six-year-olds can easily tie their shoelaces. Seven-year-olds
to enjoy baseball, basketball, and volleyball. concentrate on fine motor skills even more than they did the
- By 10years of age, children are more interested in perfecting year before. By 8 years of age, children’s eyes are developed
their athletic skills than they were previously. enough so they can read regular-size type. Older school-age
- At 11 years of age, many children feel awkward because of children begin to evaluate their teachers’ ability and may
their growth spurt and drop out of sports activities perform at varying levels depending on each teacher’s
Psychosocial and cognitive expectations.
Age Physical development - Play
development
First-grade teacher becomes - Play continues to be rough and tumble at age 6 years; By
authority figure; adjustment to 7 years of age, children require more props for play. Nine-
A year of constant year-olds play hard. Many schools begin music lessons
all-day school may be difficult
motion; skipping is a for children at about 9 years of age. By 12 years of age,
6 and may lead to nervous
new skill; first molars children can carry on an adult conversation,
manifestations of fingernail
erupt. Language Development
biting, etc. Defines words by
their use - Six-year-olds talk in full sentences, using language easily and
Central incisors erupt; A quiet year; striving for with meaning.
difference between perfection leads to - Most 7-year-olds can tell the time in hours,
7 - 9 years, they like to tell them to friends or try to understand
sexes become apparent This year is called an eraser
in play year. Learns conservation those told by adults.
Coordination definitely Best friends develop; - By 12 years of age, children can carry on an adult
improved; eyesight whispering and giggling begin; conversation.
8 fully develops; playing can write in cursive as well as Emotional Development
with friends becomes print; understands concepts of - Children enter the school-age period with the ability to trust
important. past, present, and future. others and with a sense of respect for their own worth
Friend or club age; a 9-year-old Developmental Task
All activities done with club is formed to spite • Industry Versus Inferiority
9 - Children attempt to master their new developmental step:
friends someone, has secret codes, is
all boy or all girl; learning a sense of industry or accomplishment (Erikson,
Ready for camp away from 1993).
home; collecting age; likes - If gaining a sense of initiative can be defined as learning
10 Coordination improves how to do things, then gaining a sense of industry is
rules; ready for competitive
games learning how to do things well.
Insecure with members of - If children are prevented from achieving a sense of
Active, but awkward industry or do not receive rewards for accomplishment,
11 opposite sex; repeats off-color
and ungainly they can develop a feeling of inferiority or become
jokes.
A sense of humor is present; is convinced they cannot do things they actually can do.
12 Coordination improves.
social and cooperative
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 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021
These children can have difficulty tackling new situations
later in life
• Home as a Setting to Learn Industry
- Parents of a school-age child may need to take a step
forward in development along with their child.
• Problem Solving
- An important part of developing a sense of industry is
learning how to solve problems.
- Parents and teachers can help children develop this skill
by encouraging practice
• School as a Setting to Learn Industry
- Adjusting to and achieving in school are two of the major
tasks for this age group.
- Child’s teacher will think of learning as fun and will
encourage a child to plunge into new experiences.
• Learning to Live with others
- School-age children are sometimes so interested in tasks
and in accomplishing physical projects that they forget
they must work with people to achieve these goals.
- A good time to urge children to learn compassion and
thoughtfulness toward others is during the early school
years.
• Socialization
- Six-year-old children play in groups, but when they are
tired or under stress, they usually prefer one-to-one
contact
- Eight-year-olds actively seek the company of other
children. Most 8-year-old girls have a close girlfriend;
boys have a close boyfriend.
- 9-year-oldare ready for activities away from home, such
as a week at camp. Although
- 10-year-olds enjoy groups, they also enjoy privacy. Girls
become increasingly interested in boys and vice versa by
11 years of age.
Cognitive Development
- The age period from 5 to 11 years is a transitional stage where
children undergo a shift from the preoperational thought they
used as preschoolers to concrete operational thought or the
ability to reason through any problem they can actually
visualize.
- Children can use concrete operational thought because
Children can use concrete operational thought because they
learn several new concepts during school age.
- Decentering
- The ability to project one’s self into other people’s
situations and see the world from their viewpoint rather
than focusing only on their own view.
- Accommodation
- The ability to adapt thought processes to fit what is
perceived such as understanding that there can be more
than one reason for other people’s actions. A preschooler
might expect to see the same nurse in the morning who
was there the evening before, whereas a school-age child
will understand that.
- Conservation
- The ability to appreciate that a change in shape does not
necessarily mean a change in size. If you pour 30 ml of
cough medicine from a thin glass to a wide one, the
preschooler will say that one glass holds more than the
other; a school-age child will know that both glasses hold
an equal amount.
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- Class inclusion
- The ability to understand that objects can belong to more
than one classification.
- A preschooler is able to categorize items in only one way,
for example, stones and shells are found at the beach; a
school-age child can categorize them in many ways.
Moral and Spiritual Development
- School-age children begin to mature in terms of moral
development as they enter a stage of preconvention reasoning,
sometimes as early as 5 years of age.
- They concentrate on “niceness” or “fairness” and cannot see
ye that stealing hurts their neighbor, the highest level of moral
reasoning. Because they are still limited in their ability to
understand others’ views, they may interpret something as
being right because it is good for them, not because it is right
for humanity as a whole.
Common safety measures to prevent unintentional injuries to
school years
Possible
Unintentional Prevention Measure
Injury
Encourage children to use seat belts and a
booster seat if needed; role model seat belt use.
Teach street-crossing safety; stress that streets
Motor vehicle
are no place for roughhousing, pushing, or
shoving. Teach parking lot and school bus
safety
Teach bicycle safety, including wearing a
Bicycle
helmet and not
Teach to avoid unsafe areas, such as train
yards, grain silos, and back alleys. Stress to not
go with strangers (parents can establish a code
word with the child; child does not leave
school with anyone who does not know the
word). Teach children to say “no” to anyone
who touches them if they do not wish it,
Community
including family members (most sexual
maltreatment is by a family member, not a
stranger). Teach children not to arrange a
meeting with people they meet on the Internet.
For older school-age children, teach rules of
safer sex so they know these rules before they
need to use them
Teach safety with candles, matches, and
campfires and that fire is not fun. Also teach
safety with beginning cooking skills (e.g., be
certain to include microwave oven safety,
Burns
such as closing firmly before turning on the
oven; not using metal containers).Teach safety
with sun exposure; use sun block. Teach to not
climb electric poles
Educate that roughhousing on fences or
Falls climbing on roofs is hazardous. Teach
skateboard, scooter, and skating safety
Teach that wearing appropriate equipment for
sports is not babyish but smart management.
Stress not to play to a point of exhaustion or in
Sports injury a sport beyond physical capability (no pitching
baseballs or toe ballet for an early grade-school
child). Use trampolines only with adult
supervision
 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021

Teach how to swim; dares and roughhousing 11 or 12 years; second

Drowning when diving or swimming are not appropriate. Human papillomavirus (HPV or injection 2 months later;
Stress not to swim beyond limits of capabilities vaccine HPV4) third injection 6 months
Help your child avoid all recreational drugs; after last dose
Drugs prescription medicine should only be taken as Inactivated If four doses not
directed. poliomyelitis (IPV) previously
Teach firearm safety. Keep firearms in locked vaccine administered
Firearms
cabinets with Influenza vaccine (IIV) Yearly
School-age children should keep adults Meningococcal
informed as to where they are and what they conjugate (MCV4) 11–12 years
are doing; cell phones can help with this. vaccine
Beware the frequency of unintentional injures Pneumococcal vaccine (PPSV) To children at high risk
increases when parents are under stress and Measles, mumps, If two doses not
General (MMR)
therefore less attentive. Special precautions rubella vaccine previously
must be taken at these times. Caution that some At any age after 1 year if
children are more active, curious, and not
impulsive and therefore more vulnerable to Varicella vaccine
(VAR) previously immunized,
unintentional or at
11–12 years if lacking
Promoting Nutritional Health of A School-Age Child
1) Establishing Healthy Eating Patterns Homeschooling
2) Fostering Industry and Nutrition - When discussing homeschooling with parents, assess if
3) Recommended Dietary Intakes children have peer experiences, perhaps through participation
4) A Vegetarian Diet in community sports teams or clubs.

Promoting Development of A School-Age Child In Daily
Activities
1) Dress - This is the right age to teach children the importance
of caring for their own belongings
2) Sleep - Sleep needs vary among individual children. Younger
school-age children typically require 10 to 12 hours of sleep
each night,
3) Exercise
4) Hygiene- Perspiration increase during this period so hygiene
should be encouraged. They need information that bathing and
hygiene are safe during their menses. Boys who are
uncircumcised may develop inflammation under the foreskin
from increased secretions if they do not wash regularly
5) Care of Teeth /dental visit -Dental visits are recommended
every month. With the eruption of the permanent teeth,
sealants can be applied at dental visits to lessen the
development of dental decay.
6) Malocclusion - Malocclusion (a deviation of tooth position
from the normal) may be congenital due to conditions such as
cleft palate, a small lower jaw, or familial traits tending toward
malocclusion. The condition can result later on from constant
mouth breathing or abnormal tongue position (tongue
thrusting). Thumb sucking is still another possibility if it
persists past the time of eruption of the permanent front teeth
(6 to 7 years). The loss of teeth due to extraction or an
unintentional injury may lead to malocclusion if not properly
treated so that alignment is maintained.
Immunization
Diphtheria, tetanus,
(DTaP) 11–12 years
and pertussis vaccine
If not previously
Hepatitis A vaccine (HepA)
administered
If not administered in
infancy
Hepatitis B vaccine (HepB)
or three injections were
not
Children Who Spend Time Independently
- A major concern of children staying home alone is that they
will experience an increased number of unintentional injuries,
delinquent behavior, alcohol or substance abuse, or decreased
school performance from a lack of adult supervision. For
children who are responsible and feel safe in their community,
however, a short period of independence every day may
actually be beneficial because it encourages problem solving
in self-care (Mack, Dellinger, & West, 2012).
- Many communities and schools offer special after-school
programs so children do not have to be home alone. Nurses are
in a position to educate parents about such services so their
children can feel both safe and stimulated creatively during
this time. Both Boy and Girl Scouts, the Boys & Girls Clubs
of America, and Camp Fire USA are examples of
organizations that offer programs in many neighborhoods to
help children adjust to being home alone.
Sex Education
- It’s best if sex education is incorporated into health education
classes throughout the school years in a manner that is
appropriate to age and development.
Stealing
- Stealing occurs because, although a child is gaining an
appreciation for money, this appreciation is not yet balanced
by strong moral principles or an understanding of ownership.
- As an overall principle, parents should set good examples if
they expect their child to be honest. If one parent takes money
from the other without permission, neither should be surprised
to find their child attempting to do the same

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Violence or Terrorism
Common recommendations for parents to help children feel safe
when they hear of these instances include:
• Assure children they are safe; even if the violence is in
their community, their parents are actively involved in
being certain they are not in danger.
• Observe for signs of stress such as sleep disturbances,
fatigue, lack of pleasure in activities, or signs of
beginning substance abuse.
• Do not allow children or adolescents to view footage of
traumatic events over and over because this decreases
their ability to feel safe.
• Watch news programs with children so it can be explained
that the situation portrayed is not near them and that their
child is safe.
• Explain that there are bad people in the world, and bad
people do bad things, but not all people in a particular
group or who look a particular way are bad. Lashing out
at people who resemble them only causes more harm.
• Prepare a family disaster plan, including such things as
bottled water, blankets, toiletries, pet supplies, appropriate
clothing, flashlights, and information such as what
immunizations their children have had (particularly
tetanus) and, if a child is ill, a history of medical needs or
care so that such items are ready in an emergency.
Bullying
- A frequent reason school-age children cite for feeling so
unhappy that they turn guns on classmates or commit suicide
is because they were ridiculed or bullied to the point they
could no longer take such abuse (Cooper, Clements, & Holt,
2012).
- Alert parents that Internet or texting bullying are both also
possible and that a bully doesn’t have to be in fact-to-face
contact with their child to be harmful (D’Auria, 2014).
- Traits commonly associated with school-age bullies include:
• Advanced physical size and strength for their age
• Aggressive temperament (both male and female)
• Parents who are indifferent to the problem or are
permissive with an aggressive child
• Parents who typically resort to physical punishment
• There is the presence of a child who is a “natural victim
- Bullying can be done face to face or through social media
and/or texting.
- Suggestions for school personnel to deal with bullies include
• Supervise recreation periods closely.
• Intervene immediately to stop bullying.
• Insist if such behavior does not stop, both the school and
parents will become involved.
• Advise parents to discuss bullying with their school-age
child and help them understand that it should be reported
to allow adults to intervene.
• Parents should monitor their child’s social media and
texting interactions.
• If bullying behavior is ingrained, therapy may be needed
to correct the behavior.
J.A.K.E 10 of 15
Concerns of the School-Age Child and Family with Unique
Needs
The Child of Alcoholic Parents
- Children who live with an alcoholic parent are at greater
risk for having emotional problems than others because of
the frequent disruption in their lives (Allen, Garcia-
Huidobro, Porta, et al., 2016).
The Child With a Long-Term Illness or Physical Cognitive
Challenge
- Urge parents of children with physical or cognitive
challenges to assign them household chores just like other
children and to allow them to participate in peer activities,
such as Girl or Boy Scouts, in which accomplishment is
encouraged.
- It is important for such children to develop a sense of
industry or accomplishment so they can persevere in
measures that will help them to be as independent as
possible in the future
ADOLESCENT GROWTH AND DEVELOPMENT
- Adolescence is a period of transition between childhood and
adulthood between ages 13 up to 20 years old. The drastic
change in physical appearance and the change in expectations
of others that occur during the period can lead to both
emotional and physical health concerns
- Adolescents invariably feel a sense of pressure throughout this
period because they are mature in some respects but still
young in others.
Assessment
- When performing physical examinations on adolescents, be
aware they may be very self-conscious of their body. They
need health assurance and appreciate comments such as “Your
blood pressure is 120/70, which is healthy, “so they can learn
more about their rapidly changing bodies.
Nursing Diagnosis
- Frequently used diagnoses related to adolescents and their
families include:
• Health-seeking behaviors related to normal growth and
development
• Low self-esteem related to facial acne
• Anxiety related to concerns about normal growth and
development
• Risk for injury related to peer pressure to use alcohol and
drugs
• Risk for disease related to sexual activity
• Readiness for enhanced parenting related to increased
knowledge of teenage
Outcome Identification and Planning
- When planning care with adolescents, respect the fact that they
have a strong desire to exert independence or do things their
own way.
Implementation
- Adolescents tend to do poorly with tasks someone tells them
they must do.
- Integrating the adolescents in their plan of care typically helps
them be successful.
Outcome Evaluation
- An evaluation of expected outcomes should include not only
whether desired outcomes have been achieved but also
whether adolescents are pleased with the outcome.
 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021

Growth and Development of an Adolescent Play or Recreation

- Between these milestones, physiologic growth and - Most adolescents spend a great deal of time just talking with
development of adult coordination occur. peers as social interaction, either face-to-face or through
- Most girls are 1 to 2 in. (2.4 to 5 cm) taller than boys coming electronic media.
into adolescence but generally stop growing within 3 years - Conflict can arise if parents disapprove of the number of hours
from menarche and so are shorter than boys by the end of spent in this activity, afraid their children are wasting
adolescence. important hours, or at least exchanging a great deal of trivial
- Boys typically grow about 4 to 12 in. (10 to 30 cm) in height conversation.
and gain about 15 to 65 lb (7 to 30 kg) during their teenage - Beginning at age 16 years, most adolescents want part-time
years. Girls grow 2 to 8 in. (5 to 20 cm) in height and gain 15 jobs to earn money. Such jobs can teach young people how to
to 55 lb (7 to 25 kg). Growth stops with closure of the work with others, accept responsibility, and how to save and
epiphyseal lines of the long bones, which occurs at about 16 or spend money wisely.
17 years of age in females and about 18 to 20 years of age in
males. Emotional Development
Teeth Early Adolescent Developmental Task:
- They gain second molars at about 13 years of age and their Identity Versus Role Confusion
third molars (wisdom teeth) between 18 and 21 years of age. The four main areas in which they must make gains to achieve a
Third molars may erupt as early as 14 to 15 years of age sense of identity include:
Puberty 1) Accepting their changed body image
- Puberty is the time at which an individual first becomes 2) Establishing a value system or what kind of person they
capable of sexual reproduction. want to be
- A girl has entered puberty when she begins to menstruate; a 3) Making a career decision
boy enters puberty when he begins to produce spermatozoa. 4) Becoming emancipated from parents
These events usually occur between ages 11 and 14 years. The - If young people do not achieve a sense of identity, they can
age of first menstruation in girls is gradually decreasing from a have little idea what kind of person they are or may develop a
mean of 13 years to 12.4 years, which is probably related to sense of role confusion (Dunkel & Harbke,2017). This can
more weight gain in girls (Ledger,2012). lead to difficulty functioning effectively as adults because they
are unable, for example, to decide what stand to take on a
Secondary Sex Changes particular issue or how to approach new challenges or
Age Male Female situations.
Growth spurt continuing; Pubic hair thick and Body Image
pubic hair abundant and curly, triangular in - Adolescents who were able to develop a strong sense of
curly; testes, scrotum, and distribution; breast industry during their school-age years learned to solve
penis enlarging further; areola and papilla form problems and are best equipped to adjust to the changing body
13-15 image that comes with adolescence. This adjustment to
axillary hair present; facial secondary mound;
hair fine and downy; voice menstruation is changes is not always easy, however, because adolescents can
changes happen with ovulatory, making feel disappointed with their final height or general appearance.
annoying frequency pregnancy possible Self-Esteem
Genitalia adult; scrotum Pubic hair curly and - Although the turmoil of adolescence can be just as confusing
dark and heavily rugated; abundant; may to boys as it is to girls, Gilligan (Gilligan, 1982; Taylor et al.,
facial and body hair extend onto medial 1995) hypothesized boys may feel less pressure as they
present; sperm production aspect of become adults because they learn more easily to be
mature thighs; breast tissue competitive, independent, and separated from feelings.
15-16 appears adult; nipples - Girls, because they are encouraged to maintain their concern
protrude; areolas no for people throughout their lives, are caught in a conflict
longer project as between that and being independent and competitive. This
separate ridges from makes girls at risk for more conflicting feelings throughout
breasts; may have some adolescence.
degree of facial acne Value System
Pubic hair may extend End of skeletal growth - Adolescents develop their values throughout their childhood as
along medial aspect of they interact with their family.
thighs; testes, scrotum, and Social Coupling
penis adult in size; may - In early adolescence, individuals tend to dress and behave
16-17 have some degree of facial similarly to other members of their peer group.
acne; - Bullying behavior may be directed at individuals who don’t
gynecomastia (enlarged conform to or associate with a peer group.
breast - Bullying behaviors should be identified, and the appropriate
tissue), if present, fades interventions should be initiated.
17-18 End of skeletal growth - Encourage an open dialogue with adolescents to assist them to
process their feelings and establish their own identity.
Counseling may be helpful to assist with family
communication if the family is not accepting.
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Career Decisions - Some adolescents turn away from the basic My Plate food
- The adolescent may identify an educational and career groups to eat sweets, soft drinks, or empty-calorie snacks and
trajectory during self-discovery of personal positive attributes so are left poorly nourished. This type of eating pattern,
Emancipation from Parents combined with a lack of exercise, also leads to obesity. Some
- Both parents and adolescents may need help to understand that diet so excessively they develop eating disorders such as
emancipation does not mean severance of a relationship but bulimia or anorexia nervosa
rather a change in a relationship because people who are - The nutrients that are most apt to be deficient in both male and
independent of one another can have even better relationships female adolescent’s diets are iron, calcium, and zinc. Iron is
than those who are dependent on one another. necessary to meet expanding blood volume requirements.
Late Adolescent Developmental Task: Females require a high iron intake not only because of this
Intimacy Versus Isolation increasing blood volume but also because iron begins to be
- Developing a sense of intimacy means a late adolescent is able lost with menstruation.
to form long-term, meaningful relationships with persons of Promoting Nutritional Health with a Varied Diet
the opposite as well as their same sex (Erikson, 1950, 1968). • Vegetarian Diets
Those who do not develop a sense of intimacy are left feeling • Glycogen Loading is a procedure used to ensure there is
isolated; in a crisis situation, they have no one to whom they adequate glycogen to sustain energy through an athletic event.
feel they can turn to for help or support. With the renewed carbohydrate intake, muscle glycogen is
Socialization stored at two to three times the usual level, which supplies
- Early teenagers may feel more self-doubt than self-confidence them with up to twice the glucose needed for sustained energy
when they meet another adolescent with whom they would (Bagnulo, 2006).
like to begin a lasting relationship.
- The voices of most boys have not yet dependably deepened; Promoting Development of an Adolescent in Daily
this makes them unable to trust their voices to carry the serious Activities
tone they wish to convey. - Adequate sleep, hygiene, and exercise are important health
- Most girls’ bodies have not yet fully developed; they may look education topics for adolescents as these become an
at themselves in a mirror, compare their profiles with those of adolescent’s responsibility
models in popular magazines, and feel inadequate. Dress and Hygiene
- Adolescents are capable of total self-care and, because of their
Cognitive Development body awareness, may even be overly conscientious about
- The final stage of cognitive development, the stage of formal personal hygiene and appearance.
operational thought, begins at age 12 or 13 years and grows Care of Teeth
in depth over the adolescent years, although it may not be - Adolescents are generally very conscientious about tooth
complete until about age 25 years (Piaget, 1969). brushing because of a fear of developing bad breath.
- This step involves the ability to think in abstract terms and use Sleep
the scientific method (i.e., deductive reasoning) to arrive at - Although it is widely believed everyone needs 8 hours of sleep
conclusions. a night, some need more and others can adjust to considerably
- The problems that adolescents are asked to solve in school less. Because protein synthesis occurs most readily during
depend on this type of thought. sleep and adolescents are building so many new cells, this age
- Problem solving in any situation depends on the ability to group may need proportionately more sleep than any other age
think abstractly and logically. With the ability to use scientific group (Short, Gradisar, Lack, et al.,2013).
reasoning, adolescents can plan their future Exercise
- Just as with younger children, adolescents need exercise every
Promoting Adolescent Safety day both to maintain muscle tone and to provide an outlet for
- Unintentional injuries, most commonly those involving motor tension.
vehicles, are the leading cause of death among adolescents. Sun Exposure
Other common causes of death in adolescents are homicide
- Encourage teenagers to use sunscreen, avoid tanning beds, and
and self-harm (i.e., suicide) (Swan, Ali, Bossarte, et al., 2012). report to their primary healthcare provider any skin mole that
- These are related to the easy accessibility of guns when added changes in shape or color.
to depression, binge drinking, and impulsivity.
- Gang violence and the desire to protect themselves are Immunization:
additional factors. Unintentional gunshot injuries increase in Check history and past records; inform caregiver about any risks
early adolescence, often for the same reason that drowning and side effects; administer vaccines in accordance with healthcare
increases: Youngsters want to impress friends by showing they agency policies.
can handle guns. Area of Focus Method Frequency
Hepatitis A If not previously
Promoting Nutritional Health for an Adolescent Hepa A
vaccine immunized
- Adolescents experience such rapid growth that they may
Hepatitis B If not previously
always feel hungry If their eating habits are unsupervised, Hepa B
vaccine immunized
because of peer pressure and when in a hurry to get to other
Human
activities, they tend to eat faddish or quick snack foods rather If not previously
papillomavirus HPV
than more nutritionally sound ones. immunized
vaccine
Influenza vaccine LAIV Yearly
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TIV (trivalent • Leakage of fatty acids causes a dermal inflammatory

influenza vaccine reaction.
If not previously • Bacteria (generally, Propionibacterium acnes) lodge and
Measles, mumps,
MMR vaccinated; do not give thrive in the retained secretions and ducts.
rubella vaccine
to pregnant adolescent
MPV4 Concerns Regarding Sexuality and Sexual Activity
Meningococcal (meningococcal - When discussing sexuality with adolescents, the nurse should
Booster at 16 years
Vaccine polysaccharide avoid assumptions about the gender of the adolescent’s partner.
vaccine) Ask open-ended questions when providing education on health
PCV promoting behaviors. This will also help the adolescent feel
To high-risk groups if
Pneumococcal (pneumococcal more open to asking questions.
not previously
vaccine conjugate - Counseling can assist adolescents improve their perspective
vaccinated
vaccine) and also learn how to say no. For adolescents who agree to
Tetanus and have intercourse but who do not really want to, the primary
If not previously
Diphtheria Tdap reasons given are peer pressure, curiosity, and affection for
immunized
vaccine their partner (Fuzzell, Fedesco, Alexander, et al., 2016;
If not previously Katsufrakis & Nusbaum, 2011).
Varicella vaccine VAR
vaccinated Stalking
- Stalking refers to repetitive, intrusive, and unwanted actions
Hypertension such as constant and threatening pursuit directed at an
- Hypertension is present if blood pressure is above the 95th individual to gain the individual’s attention or to evoke fear.
percentile, or 127/81 mmHg for 16-year-old girls and 131/81 - Electronic media can be used for cyberstalking, Internet
for 16-year-old boys for two consecutive readings in different harassment, andInternet bullying to embarrass, harass, or
settings. threaten adolescents (CDC, 2017c).
Poor Posture
- This is also due to the imbalance of growth that arises from the Concerns Regarding Hazing or Bullying
skeletal system growing a little more rapidly than the muscles - The bullied child has the ability to retaliate through self-
attached to it. destructive behavior or school violence.
- Girls, especially, may slouch so as not to appear taller than - Hazing, a form of organized bullying, refers to degrading or
boys or to diminish the appearance of their breast size if they humiliating rituals that prospective members have to undergo
are developing more rapidly than their friends. Yet another to join sororities, fraternities, adolescent gangs, or sports teams
reason may be related to carrying backpacks that are too heavy (Diamond, Callahan, Chain, et al., 2016).
(Kistner,Fiebert, & Roach, 2012). - Most rituals are secret and in the past were accepted as “rites
Body Piercing and Tattoos of passage.” In recent years, hazing has become so extreme the
- Body piercing and tattoos are a strong mark of adolescence practice has moved out of the “just fun” category into
(Stein & Jordan, 2012). Both sexes may have ears, lips, chins, activities that can cause physical and certainly psychological
navels, and breasts pierced and filled with studs or tattoos harm, such as being forced to wear demeaning clothing or
applied to arms, legs, or their central body. engaging in crude or lewd skits.
- Body piercings and tattoos have become a way for adolescents - They can be extended to such an extreme that adolescents may
to make a statement of who they are and that they are different be punched or kicked, sodomized, left out in the cold so long
from their parents It is important to caution adolescents that that frostbite develops, or forced to drink alcohol until they
sharing needles for piercing or tattooing carries the same risk vomit, pass out, or even die from alcohol intoxication.
for contacting a blood-borne disease as sharing needles for - Initiation for street gangs can require prospective members to
intravenous drug use. steal or destroy property or even kill another person.
Fatigue - To help prevent this from happening to their child, urge
- Always assess the diet, sleep patterns, and activity schedules parents to be aware of what clubs or organizations their
of fatigued adolescents. adolescent joins and what the requirements for membership
- Be aware that if the fatigue began as a short period of extreme are.
tiredness, it suggests disease more so than a long, ill-defined
report of always feeling tired. Concerns Regarding Substance Use Disorder
Acne Types of Abused Substances
Changes associated with puberty that cause acne to develop - Prescription and Over-the-Counter Drugs Adolescents may
include: first begin drug experimentation by taking drugs prescribed for
• As androgen levels rise in both sexes, sebaceous glands another family member or a pet such as sedatives, pain
become active. medication, ketamine (an anesthetic used in veterinary
• The output of sebum, which is largely composed of lipids, medicine), or cough syrup containing codeine or
mainly triglycerides, increases. dextromethorphan (DXM). Called “pharming,” adolescents
• Trapped sebum causes whiteheads, or closed comedones. who use drugs this way can easily overdose because they are
fatty acid components on exposure to air, blackheads, or unaware of usual dosages (Storck, Black, & Liddell,2016).
open comedones, form. - Methylphenidate (Ritalin) is a drug frequently prescribed for
attention deficit hyperactivity disorder. Because

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 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021
methylphenidate (Ritalin) is a stimulant, when oral tablets are
crushed and injected intravenously, they produce a feeling of
giddiness and extreme well-being.
- Alcohol -Once adolescents admit they have come to rely on
alcohol as a way to feel popular or reduce stress, an
organization such as Alcoholics Anonymous can be invaluable
in helping them stop drinking; innovative online programs
geared especially for adolescents are also available
- Tobacco Adolescents usually begin smoking because the habit
conveys a stamp of maturity; One of the strongest
determinants of whether adolescents will smoke a first
cigarette is whether their friend’s smoke. They are also
influenced to begin smoking by advertising
Nursing actions that encourage a sense of identity in the
physically challenged or chronically ill adolescent
Category Action
If an adolescent is on a special diet, discuss the
Nutrition
role of food preferences with dietitian. Respect
food preferences in all ways possible
Allow adolescents to order supplies. Ask for
suggestions as to the final appearance of
Dressing
dressing. If soaks are included, have adolescent
Change
time the treatment. Allow adolescent to choose
time for dressing change
Offer the adolescent a choice of site for injection
or intravenous insertion to encourage a sense of
Medicine
control. Teach name, action, and possible side
effects of medicine
Contract with adolescent for time and length of
Rest
rest periods
Hygiene Contract with adolescent for extent of self-care
Encourage adolescent to express pain and teach
distraction technique for
sharp pain, such as deep breathing and counting
Pain
backward from 100.
Encourage adolescents to ask for analgesics as
needed.
Provide favorite music with earphones. Provide
a radio to listen to talk shows to foster active
involvement. Encourage schoolwork. Provide
crossword puzzles or card games to increase
Stimulation socialization
Encourage adolescents to network with one
another.
Encourage adolescents to keep in contact with
friends
J.A.K.E 14 of 15
TYPES OF COMPLEMENTARY AND ALTERNATIVE
MEDICINE
Traditional alternative medicine
- This field includes the more mainstream and accepted forms of
therapy, such as acupuncture, homeopathy, and Oriental
practices.
- These therapies have been practiced for centuries worldwide.
• Acupuncture – the practice of penetrating the skin with
thin, solid, metallic needles which are then activated
through gentle and specific movements of the
practitioner's hands or with electrical stimulation.
• Ayurveda – The term Ayurveda is derived from the
Sanskrit words ayur (life) and veda (science or
knowledge). Based on the idea that disease is due to an
imbalance or stress in a person's consciousness, Ayurveda
encourages certain lifestyle interventions and natural
therapies to regain a balance between the body, mind,
spirit, and the environment. Ayurveda treatment starts
with an internal purification process, followed by a
special diet, herbal remedies, massage therapy, yoga, and
meditation.
• Homeopathy – or homeopathic medicine, is a medical
philosophy and practice based on the idea that the body
has the ability to heal itself.
• Naturopathy – based on the belief that the body can heal
itself. It aims to improve health, prevent disease, and treat
illness through the use of organic foods and exercise; a
healthy, balanced lifestyle; and the use of treatments from
other areas of complementary medicine.
• Chinese or Oriental medicine – Chinese herbs,
combinations of herbs, roots, powders, or animal
substances to help restore balance in the body.
Body
- Touch has been used in medicine since the early days of
medical care. Healing by touch is based on the idea that illness
or injury in one area of the body can affect all parts of the
body. If, with manual manipulation, the other parts can be
brought back to optimum health, the body can fully focus on
healing at the site of injury or illness.
- Body techniques are often combined with those of the mind.
• Chiropractic and osteopathic medicine – an alternative
health profession concerned with the diagnosis, treatment,
and prevention of mechanical disorders of the
musculoskeletal system, especially of the spine.
• Massage – Massage may be helpful in reducing tension
and pain, improving blood flow, and encouraging
relaxation.
• Body movement therapies – practices that exert their
effect primarily on the flow and balance of the body's
subtle energy system and, to a greater or lesser extent, on
the biomechanics of the body in terms of flexibility,
coordination, balance, and strength.
• Tai chi – a series of movements done either very slowly
or quickly to help move the body's chi. People use tai chi
as a way to combine meditation and movement and to
improve and maintain health.
• Yoga – mind and body practice that involves movement,
breathing exercises, and a focus on thoughts and feelings
as they happen (mindfulness). It began in ancient India as
a spiritual practice, based on the idea that the mind and
 NCMA217 RLE – BSN 2ND YEAR 1ST SEMESTER FINAL 2021

body are one. But today, more people practice yoga for Senses
overall health, including flexibility, stress relief, and - Some people believe the senses, touch, sight, hearing, smell,
physical fitness. and taste, can affect overall health. Examples of therapies
incorporating the senses include:
Diet and herbs • Art, dance, and music – Music therapy is the use of
- Over the centuries, man has gone from a simple diet consisting music to gain physical and emotional healing and
of meats, fruits, vegetables, and grains, to a diet that often wellness. A trained and certified music therapist can
consists of foods rich in fats, oils, and complex carbohydrates. provide music therapy. It helps people express themselves,
- Nutritional excess and deficiency have become problems in find new memories, and calm the body and mind through
today's society, both leading to certain chronic diseases. Many its rhythm, order, and predictability.
dietary and herbal approaches attempt to balance the body's • Visualization and guided imagery – a program of
nutritional well-being. Dietary and herbal approaches may directed thoughts and suggestions that guide your
include:
imagination toward a relaxed, focused state. Using all of
• Dietary supplements – products intended to supplement your senses, your body seems to respond as though what
the diet. Most dietary supplement products are extractions you are imagining is real.
from plants, animals, or it can be of synthesized enzymes
that the body cannot create on its own.
• Herbal medicine – the use of plants and plant extracts to
treat disease.
• Nutrition/diet – use of specific intake of nutrition for
health or weight-management reasons.
External energy Lahat po ito galing lang sa canvas module, kase un mga ppt din ng prof
binase lng nila sa canvas. Reviewhin nyo rin maigi ung lectureee kase
- Some people believe external energies from objects or other
minsan, un lecture lumalabas din sa exam ng RLE eh hahaha Goooddd
sources directly affect a person's health. An example of
luccck guys!! Last daaay naaa – Aki
external energy therapy is:
• Electromagnetic therapy – Practitioners of magnetic
field therapy believe that interactions between the body,
the earth, and other electromagnetic fields cause physical
and emotional changes in humans. They also believe that
the body's electromagnetic field must be in balance to
maintain good health.
• Reiki – Reiki means "universal life energy" and is an
ancient healing method that manipulates energy flow in
the body. It is thought that reiki releases energy flows and
allows the body's own natural healing ability to work.
Reiki focuses on seven main energy centers, called
chakras, in your body. The energy should flow freely
through your chakras in order for you to be spiritually,
physically, and mentally healthy.
• Qigong – which uses movement, breathing techniques,
and meditation.
Mind
- Even standard or conventional medicine recognizes the power
of the connection between mind and body. Studies have found
that people heal better if they have good emotional and mental
health. Therapies using the mind may include:
• Meditation – the practice of focusing your attention to
help you feel calm and give you a clear awareness about
your life. Eastern philosophies have recognized the health
benefits of meditation for thousands of years.
• Biofeedback – a method that uses the mind to help
control a body function that the body normally regulates
automatically, such as skin temperature, muscle tension,
heart rate, or blood pressure.
• Hypnosis – a state of focused concentration during which
a person becomes less aware of his or her surroundings.
Hypnotherapy is the use of hypnosis to treat physical or
psychological conditions.

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