Final Nursing Care Process - GRP 1

Far Eastern University
Institute of of Health Science and Nursing

Department of Nursing
Imbalanced Nutrition: Less than body requirements, related to insufficient

dietary intake, as evidenced by below normal BMI and food/fluid intake less than the
recommended daily allowance
Presented By:
Abanilla, Lani Mae

Abogado, Andrea Hope
Alfonso, Gabriel Joseph
Añonuevo, Janica Mavi
Aquino, Lorraine Jazmine
Buhawe, Marianne Mae
Castillo, Mc Kenneth
Cruz, Alliah Nicole
Daileg, Allyza
Delos Reyes, Jaimee
Group 1 – Section 206
Presented To:
Ms. Loida Getizo
Mr. Edgar Pineda
Submitted on:
May 20, 2023

I. DEMOGRAPHIC PROFILE
Demographic Data
Name: J.R.D
Address: Brgy. 205, Tondo, Manila
Age: 9 Birth Date: March 08, 2014 Birth Place: Candijay, Bohol
Gender: Male
Religion: Catholic Race/Ethnic Origin: Filipino
Occupation: None Educational Attainment: Grade 3
Marital Status: Single Name of Spouse: N/A
Number of Children: N/A
Chief Complaint: Underweight
Date of Admission: May 13, 2023
Room & Bed Number: N/A
Attending / Admitting Physician: N/A
Admitting / Final Diagnosis: Imbalanced nutrition: less than body requirements, related to
insufficient dietary intake, as evidenced by a below normal BMI and food/fluid intake less than
the recommended daily allowance.
Medical Insurance: None
III. NURSING HEALTH HISTORY
A. History of Present Illness
The client's mother verbalized, "Wala naman po siyang sakit, hindi naman po siya masakitin,
pero kapag may sakit siya naglalaro naman." But it was found that the client's body weight is off, and
that this might lead to health problems in the future. The client has inadequate nutrition due to having
fewer body requirements. His height and weight were measured, and it was discovered that he has an
underweight BMI of 13.1. The client is specifically 117 cm (3 feet 10 inches) in height or length and
weighs 18 kg (39.6 lbs). He was observed to seem lethargic, have poor growth, and have thinning skin.
On May 17, 2023 the student nurses delivered a health education intervention. The client gains
information that increases his awareness of the effects of eating unhealthily.
B. Past Health History
The client’s mother stated that her son’s medical record revealed that there is no history of major
illnesses, injuries, or accidents in the past that have had a significant impact on his present health. There
are no records of unusual childhood infections, such as chicken pox, mumps, or measles. Moreover, the
client is not hypertensive, anemic, diabetic, or asthmatic and does not have a history of heart or lung
disease. Additionally, the client is fully immunized against the COVID-19 vaccine, with Pfizer as both the
primary and secondary dose. Lastly, he has a history of traveling locally from Bicol to Manila since he
was born in the said province.
C. Pediatric History
a. Birth History
TYPE OF VACCINE RECEIVED NOT RECEIVED DATE: (mm/dd/yyyy)
BGC 03/09/14
Hepatitis B Infection/ 03/08/14

Liver Cancer
Diphtheria, Pertussis,
Pneumonia, Hepatitis
B, Meningitis
DPT-HepB-hib1 06/10/14
Oral Polio Vaccine
OPV1 06/10/14
OPV2 07/08/14
OPV3 08/12/14
BOOSTER 01/27/20
Pneumonia,
Meningitis,
Bacteremia, Middle
Ear Infection, Sinusitis
PCV1
PCV2
PCV3
Severe Diarrhea caused

by Rotavirus
Rotavirus1
Rotavirus2
Rotavirus3
Measles 12/06/14
Measles, Mumps and 03/17/15

German Measles
Other Vaccines:
MR SIA 05/16/18
MR BOOSTER 02/18/16
Vitamin A 03/23/19
COVID -19 Vaccine

Type of Vaccine:
Pfizer
1st dose
2nd dose
Booster 06/09/22
07/04/22
Interpretation: All babies and young children should receive pneumococcal conjugate vaccine (PCV13
or PCV15). PCV13 or PCV15 should be given to children 2 through 4 years old who are unvaccinated or
unable to receive a complete pneumococcal vaccine series (CDC - Pneumococcal Disease and the
Vaccine (Shot), 2022). According to the Center for Disease Control and Prevention (2018), children
should receive all doses of rotavirus vaccine before they turn 8 months old. The best defense against
rotavirus disease for your child is the rotavirus vaccine. Most children (about 9 out of 10) who get the
vaccine will be protected from severe rotavirus disease. About 7 out of 10 children will be protected from
rotavirus disease of any severity ((Rotavirus Vaccination | CDC, 2018.)
Reference:
Pneumococcal Disease and the Vaccine (Shot). (2022, September 15). Centers for Disease Control and
Prevention.
https://www.cdc.gov/vaccines/parents/diseases/pneumo.html#:~:text=All%20babies%20and%20y
oung%20children,depends%20on%20the%20medical%20condition.
Rotavirus Vaccination | CDC. (n.d.). https://www.cdc.gov/vaccines/vpd/rotavirus/index.html
Medications: The client is currently not taking any medications or supplements.

Allergies: The client doesn’t have any allergies.
b. Social History
The client lives with his parents, along with his brother and sister. His mother works as a vendor,
and his father works as a jeepney driver. His brother is in Grade 5, and his sister is in Grade 6. Their
residence contains no pets. His father is the only one who smokes in their family.
c. Developmental Milestones
I. Gross Motor Development
Age Milestone
Newborn Limbs flexed,

symmetrical pattern Marked head lag on pulling
up
6-8 weeks Raises head to 45 degrees in prone (tummy-time)
6 - 8 months Sits without support (initially with a round back,

then eventually with a straight back by 8 months)
8 - 9 months Crawling
10 months Stands independently

Cruises around furniture
12 months Walks unsteadily – a broad gait, with hands apart
15 months Walks steadily
2.5 years Runs and jumps
3 years Walk backwards

Pedals a tricycle
Alternates feet on stairs
4 years Constantly in motion

Jumps and skips
5 years Throws overhand
6 years Endlessly jump, tumble, skip,and hop

Walk a straight line
Can ride a bicycle
8 years Movements are more graceful

Enjoy sports
9 years Constantly on the go

Have enough hand-eye coordination to enjoy
sports like basketball
II. Vision and Fine Motor development
Age Newborn
6 weeks Follows moving object or face by turning the

head (fixing and following)
4 months Reaches out for toys
4 - 6 months Palmar grasp
7 months Transfers toys from one hand to another
10 months Mature pincer grip
16 - 18 months Makes marks with crayons
14 months - 4 years old Tower of three – 18 months

Tower of six – 2 years
Tower of eight or a train with four bricks – 2.5
years Bridge (from a model) – 3 years
Steps (after demonstration) – 4 years
Handedness - 4 years
2 years old - 5 years old Line – 2 years

Circle – 3 years
Cross – 3.5 years
Square – 4 years
Triangle – 5 years
6 years Can easily tie shoelace

Cut and paste
Draw a person with good detail
8 years Eyes developed enough to read, making reading a

greater pleasure and school more enjoyable
9 years Writing begins to look mature and less awkward.
III. Hearing, speech and language development
Age Milestones
Newborn Limbs flexed,

symmetrical pattern Marked head lag on pulling
up
3 - 4 months Raises head to 45 degrees in prone (tummy-time)
7 months Sits without support (initially with a round back,

then eventually with a straight back by 8 months)
7 - 10 months Crawling
12 months Two to three words other than ‘Dada’ or ‘Mama’
18 months 6-10 words

20 - 24 months Joins two or more words to make simple phrases
2.5 - 3 years Talks constantly in 3 – 4-word sentences

Understands 2 joined commands
4 years Has a vocabulary of 1,500 words
5 years Has a vocabulary of 2,100 words
6 years Talk in full sentences

Define objects by their use
7 years Can tell time in hours

Know months of year and name months in which
holiday falls
Know simple arithmetic
9 years Bathroom language
IV. Social, emotional and behavioral development
Age Milestone
6 weeks Smiles responsively
6 - 8 months Puts food in their mouth
10 - 12 months Puts food in their mouth
12 months Drinks from a cup with two hands
18 months Holds spoon and gets food safely to mouth
18 - 24 months Symbolic play
2 years Symbolic play

Pulls of some clothing
2.5 - 3 years Parallel play

Interactive play
4 years Enjoy play groups
5 years Develop “best” friendships
6 years Play in groups
7 years Aware of family roles and responsibility

Promises must be kept
Tattling due to strong sense of justice
8 years Seeks company of other children

Have secrets with close friends
9 years Club age

They take the values of their peer group very
seriously
D. Family History
According to J.R.D., his father drives jeepneys, and his mother works as a vendor. The client has
three elder siblings who are currently in school; his older brother is in grade five, and his older sister is in
grade six, he also has a 20 year old maternal half-sister who is residing in Mindanao. "Hikain po talaga
ang kuya niya since birth, wala naman po sa amin ng asawa ko ang may asthma, lahi lang po ang high
blood pressure or stroke sa father side ko po Noong maliit pa po ang kuya niya, sa isang buwan po,
dalawang beses po siya hinihika. Kapag mauntog lang po ulo niya noong baby pa siya nangingitim siya
at hindi na gumagalaw. Si J.R.D., naman po hindi po nagkakasakit ng malala, kung magkakasakit man po
siya, kinabukasan naglalaro na kapag nakainom ng gamot." According to the client's mother, they are
simply living in Manila alone, without any nearby relatives or family members. It was additionally stated
that the siblings are close and do not fight with each other, with the exception of the oldest brother and
older sister, who occasionally argue.
IV. GORDON’S HEALTH ASSESSMENT
A. Health Perception – Health Management Pattern
As the student nurse begins the interview with the client, he admits to being a little nervous, but
he also looks lethargic. Upon questioning the client about whether he was in any pain at the moment, he
replied, "Wala po kahit noon po," implying that he had never had any health issues. The client stated that
he does not take any drugs, medications, or supplements. When being questioned by the client about
whether he consumed breakfast on the day that the nurse performed the interview, his response was "Wala
po." On the other hand, the client claims that he takes care of himself by eating on time. The client had no
bad incidents or accidents, but whenever he gets a wound while playing outdoors with friends, his sister is
the one who assists him in washing and treating his wounds. When one of the family members became ill,
he stated, "Inaalagaan po kami ni mama, kapag may sakit." Furthermore, he exercised by walking from
their house to the school because it was just a short distance away. According to the client's parents, he
already received the Hepa B vaccine, pentavalent vaccine, oral polio vaccine, and COVID-19 vaccine
(Pfizer).
Analysis: Vaccines decreased the number of diseases that killed individuals of all ages. Vaccines are vital
for ensuring safety after obtaining immunizations for disease prevention. Pharmacovigilance plays an
essential role in ensuring the safety and effectiveness of each vaccination and reducing the risk of adverse
effects on human health. This will reduce the potential undesirable influence on the person's
immunization. (Al-Worafi, Ming, & Al-Shami, 2023). Lethargy is a state of fatigue which involves a lack
of energy, motivation, and strength for physical and mental activities. Lethargic is also a sign of being
underweight. Underweight can be an indication of health problems, just as being overweight is. When a
person is underweight, the body is deprived of the nutrients needed to maintain healthy bones, skin, and
hair. Underweight individuals have or are at risk of having issues with their skin, hair, dental problems,
osteoporosis, slow pace or delayed development, being slow to catch up, anemia, and feeling exhausted at
all costs. According to the journal BMC Public Health Trusted Source, being underweight has been
associated with an increased risk of mortality, and this is most likely caused by a family history, frequent
physical activity, and a high metabolism (Nall, MSN, & CRNA, 2018).
Interpretation: DEVIATION FROM NORMAL
Reference:
Al-Worafi, Y. M., Ming, L. C., & Al-Shami, A. M. (2023). Vaccines safety case studies. In Y. M.
Al-Worafi
(Ed.), Clinical Case Studies on Medication Safety (pp. 487–497). Elsevier.
Nall, R. (2018, April 25). Underweight health risks: Causes, symptoms, and treatment.
Medicalnewstoday.com. https://www.medicalnewstoday.com/articles/321612
B. Cognitive – Perceptual Pattern
The client is coherent and oriented. The student nurse asked questions that would examine the
client’s consciousness, such as "Alam mo ba kung anong oras at araw ngayon?" His answers were
"Wednesday, 10:35 a.m.," which is correct. Moving on, the client doesn’t have the ability to retain
information. The client shows difficulties in understanding what is happening in his environment and said
that he often experiences difficulty focusing on his schoolwork and that he is having a hard time learning
new tasks. He stated, "Hindi ko po masyadong maalala ‘yung mga ginawa ko kahapon." Moreover, the
client can speak; however, the words are not clear because his voice is weak. He also reported that he has
intact hearing and visual senses. He has no visual impairment and has 20/20 vision. The patient does not
have any problems with his hearing. He can hear clearly in both of his ears and has the ability to
recognize both whispered sounds and a normal voice.
Analysis: The client was conscious during the interview. However, based on what he has said, he doesn’t
have the ability to retain information. This shows that his cognition is working properly since senses are
stimulated or aroused when one is in a stimulating situation; those sensations are then transmitted to the
cerebral cortex, where they are recognized (perceived) and interpreted (cognized) by the brain. The
cognitive-perceptual health pattern is concerned with how people obtain information from their
surroundings, as well as how they interpret and use that knowledge. The gathering, interpretation, and
acknowledgment of stimuli, including pain, are all part of perception. Intelligence, memory, language,
and decision making are all aspects of cognition. Perception and cognition are intricately related to the
functioning of the central nervous system, as well as the specific senses of hearing, taste, smell, and
vision (Cognition and Perception, 2020).
Reference:
Cognition and perception. (2020, July 11). Nurse key. https://nursekey.com/cognition-and-perception/
C. Self-perception – Self-concept Pattern
According to the client, he maintains a positive attitude, rarely loses his temper, and isn't upset
over anything. This is evident in how the client interacts with his friends and the people around him. The
client described himself as playful and gleeful when asked how he would describe himself. He also stated,
"Masaya po ako sa pamilya ko saka sa school," when asked if he is happy about his environment.
Moreover, the client said that it is okay for him if he doesn’t get what he wants and that he is content with
whatever he has at the moment. However, when the client was asked if he was having an identity crisis
and what he thought about his appearance, he explained that he didn’t know what it was all about.
Analysis: Happiness can be defined as a complex emotional state that arises from the confluence of
various positive emotions. It is characterized by a subjective sense of well-being that is contingent upon
the predominance of positive emotions over negative ones and a high degree of life satisfaction (Diener,
2000), whereas the client showed a positive attitude towards himself. As per the research conducted by
Fredrickson in the domain of positive psychology, it has been established that positive thinking plays a
pivotal role in expanding one's sense of possibility and facilitating cognitive flexibility. This, in turn,
enables individuals to acquire novel skills and enhance their resilience, which can be particularly
beneficial for children (Cullins, 2022).
Interpretation: NO DEVIATION FROM NORMAL

Reference:
Cullins, A. (2022, May 17). 7 Activities to Help Your Child Develop a Positive Attitude. Big Life Journal.
https://biglifejournal.com/blogs/blog/children-positive-attitude#:~:text=According%20to%20posi
tive%20psychology%20researcher,(and%20adults)%20more%20resilient
Diener, E. (2000). Subjective well-being: The science of happiness and a proposal for a national index.
American Psychologist, 55(1), 34–43. https://doi.org/10.1037/0003-066x.55.1.34
D. Role – Relationship Pattern
According to the client, when it came to his schoolwork, both of his parents and siblings helped
him. The client verbalizes, "Hindi po kami namamasyal nila mama at papa", but he enjoys playing
Roblox with his siblings, but with regards to his school friends, he does not play with them, but he enjoys
his friends company because, according to him, after his classes he goes home immediately. After the
family’s school and work activities all day, the client verbalizes that he eats with his brother and sister
because both of their parents are busy with their work. Additionally, sometimes with their bare hands
while employing any hand hygiene techniques.
Analysis: Close interactions that your child develops at school will be advantageous to their sense of
self-worth (Fowler et al., 2011). According to the findings of several studies, the risk that a child may
have mental or emotional disorders as an adult is enhanced when the child lacks a strong social network.
Children who have a strong network of close friends are better prepared to deal with the challenges they
will experience as adults, such as getting along with others, resolving arguments, and taking charge in
difficult situations.
As your child navigates the ups and downs of making new friends and saying goodbye to old
ones, having solid, safe relationships within the family will benefit them. Indeed, the love and affection
you offer your child on a regular basis at home will help them become better at managing their
interactions with others. Children grow socially and emotionally as a result of their interactions and
relationships with others during their childhood. As a result, studying children's social development
within the framework of their families makes perfect sense. McCollum and Ostrosky (2008) proposed
three separate approaches for parents to assist their young children in forming healthy relationships with
their peers in their research: (1) through positive interactions between parent and child; (2) through
parental involvement in the form of supervision, coaching, and guidance during children's play; and (3)
by providing opportunities for children to interact with other people.
One of the most important responsibilities of parenting is supervision, which refers to the efforts
that parents take to ensure that their children's basic physical and emotional requirements are addressed
(Butler et al., n.d). Parental engagement refers to measures taken by parents to improve their child's
academic performance as well as their emotional and social well-being. Parental supervision includes
meeting the child's physical and safety needs, whereas parental involvement includes those activities. The
level of supervision required to keep school-age children safe may vary depending on both the child's
chronological age and the distance between the child's home and the facility where they are educated.
This is due to the fact that the amount of supervision required to keep children of school age safe can
vary.

Reference:
Butler, D., Christensen K., & Scheider, B. (n.d.). Families with School-age Children.
https://rhyclearinghouse.acf.hhs.gov/sites/default/files/docs/20206-Families_with_School.pdf
Fowler, S. A., Ostrosky, M. M., & Yu, S. (2011) Children’s Friendship Development: A Comparative
Study.
https://files.eric.ed.gov/fulltext/EJ931228.pdf
McCollum, Jeanette A., & Ostrosky, Michaelene M. (2008). Family roles in young children's emerging
peer-related social competence. In William H. Brown, Samuel L. Odom, & Scott R. McConnell
(Eds.), Social competence of young children: Risk, disability, and intervention (pp. 31- 60).
Baltimore, MD: Paul H. Brookes.
E. Sexuality – Reproductive Pattern
The client has the right to decline any questions being asked. He disclosed this part because he
didn’t want to talk about his sexuality or reproductive patterns because he is only 9 years old.
F. Coping – Stress Tolerance Pattern
The client specifically stated that he does not usually get stressed or upset. Moreover, when the
client does get upset, he does not resort to any coping strategies. The client also added that he looks
forward to playing with his friends in his local neighborhood, which makes him feel happy.
Analysis: In an attempt to cope with stress, the use of strategies such as self-comfort, help seeking, and
distraction may assist the child in managing early frustrations or responding to fear. These kinds of
behavioral strategies begin to develop during the school age phase of a child, which enables the child to
develop proper social skills and coping strategies (Calkins, 2020).
Reference:
Calkins, S. (2020). Self-regulatory processes in early personality development: A multilevel approach to
the study of childhood social withdrawal and aggression.
https://www.researchgate.net/publication/11106222_Self-regulatory_processes_in_early_personal
ity_development_A_multilevel_approach_to_the_study_of_childhood_social_withdrawal_and_a
ggression
G. Value – Belief Pattern
The client mentioned that he is not particularly spiritual and often forgets to pray, but he and his
older sister never miss attending mass every Sunday. Moreover, he always remembers to pray when he
wishes for something from God or when he or a family member is ill. He added that his goal of
becoming a police officer kept him going and motivated him to study hard. In addition, there are no
restrictions in his religion or its traditions that would prohibit him from getting any medical interventions
or procedures. His parents do not believe in superstitious beliefs such as albularyos or other forms of
folk medicine, so if he falls ill, he is given over-the-counter medication immediately.
Analysis: Seeing the family as the primary unit of care necessitates taking into account the child's
culturally-specific psychosocial requirements, building trust, and being familiar with the child's social
context outside of the medical setting. A family’s reliance on their cultural references was noted with
regards to the beliefs, values, and practices of families in the care of children in a medical context, such
as how prayers complement medical treatments and manifest themselves as a cultural expression. A
person's religious views and ideals may serve as a source of strength during his or her treatment (Swihart
et al., 2022).
Reference:
Swihart, D. L., S. Yarrarapu, S. N., & Martin, R. L. (2022, November 14). Cultural Religious
Competence In
Clinical Practice - StatPearls - NCBI Bookshelf. Cultural Religious Competence in Clinical
Practice - StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK493216/
H. Nutritional- Metabolic Pattern
The client is 18 kg (39.6 lbs) in weight and is 117 cm (3 ft 10 inches) in height or length, with a
BMI of 13.1. The client’s mouth is moist and pink and has no lesions. The client stated that he doesn’t
have any food allergies or food restrictions. When asked about what he usually eats, he answered
"Hotdog, itlog, at kanin po pagkain ko palagi". The client also verbalized, “3 o 4 na beses po ako
umiinom ng tubig araw-araw “. Moreover, when the client was asked about what type of supplement or
vitamins he takes, the client answered, “Hindi po ako umiinom non eh”. The client also stated that he
usually eats his meal three times a day and doesn’t experience any difficulties in chewing or swallowing
food.
FOOD RECALL (3 Days)
MONDAY (May 15)
TIME FOOD & BEVERAGE AMOUNT
Breakfast Fudgee Bar 1 pc
Milo 1 glass
Lunch Rice ½ cup
Hotdog 1 pc
Water 1 glass
Dinner Rice 1 cup
Fish 1/2 pc
Water 2 glasses
TUESDAY (May 16)
Breakfast Bread 1 pc
Milo 1 glass
Lunch Rice ½ cup
Egg (Sunny side up) 1 pc
Water 2 glasses
Dinner Rice 1 cup
Fried Chicken 1 pc
Water 1 glass
WEDNESDAY (May 17)
Breakfast Milo 1 glass
Inipit (Bread) 1 pc
Lunch Rice ½ cup
Hotdog 1 pc
Water 1 glass
Dinner Rice 1 cup
Longganisa 2 pcs
Water 2 glasses
Analysis: Children must consume water throughout the day to keep their bodies hydrated, maintain body
temperature, and do daily tasks. Ages 9 to 13 years old must drink 5 to 6 glasses of water everyday. BMI
is the measurement of weight in relation to height (Health Direct, n.d). This figure aids medical
professionals in determining whether a patient is at risk for health problems due to being underweight,
overweight, or obese. The BMI of a healthy weight should be 5th percentile to less than the 85th
percentile (CDCP - About Child and Teen BMI, 2022). Children need vitamins and minerals for good
health, growth, and development, if the child doesn’t get enough vitamins or minerals, it can result in
growth and development problems. Vitamins A, B, C, D, E, and K are essential for the growth and
development of your child (Raising Children Network, 2022).

References:
About Child and Teen BMI. (2022, September 24). Centers for Disease Control and Prevention.
https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
Healthdirect Australia. (n.d.). Hydration tips for children. Healthdirect.

https://www.healthdirect.gov.au/hydration-tips-for-children
Vitamins and minerals. (2022, August 26). Raising Children Network.

https://raisingchildren.net.au/teens/healthy-lifestyle/nutrients/vitamins-minerals#:~:text=Children
%20need%20vitamins%20and%20minerals,to%20growth%20and%20development%20problems
I. Elimination Pattern
The client claimed that he urinates four times each day. His urine has a yellowish color. He
added that he does not hold his urine and does not experience any pain while urinating. Moving on, the
client stated that he only pooped once every day and that it was brown in color. His bowels are soft and
easy to pass. The client added that he doesn't have any pain while he is pooping. Lastly, the client said
that he did not sweat frequently.
Analysis: Healthy bowel habits comprise at least four times per week of consistent bowel movements that
are soft and simple to pass. Researchers refer to the period of time it takes for food to leave the body as
feces as the intestinal transit time. A child's body typically produces waste in between 24 to 36 hours,
which is a little quicker than an adult's body does (Galan, 2017). However, the majority of people urinate
six to seven times per day. If the frequency does not affect the person's quality of life, urinating four to ten
times a day may be considered healthy. The individual, how much fluid they ingest, and other variables
will also play a role in this (Leonard, 2023).
Reference:
Galan, N. (2017, November 1). How often should you poop each day?
https://www.medicalnewstoday.com/articles/319879
Leonard, J. (2023, February 14). How many times a day should a person pee?
J. Activity – Exercise Pattern
The client is a Grade 3 pupil with a schedule of Monday to Tuesday asynchronous class,
Wednesday 9:00 a.m. to 12:00 p.m. class, and every Thursday and Friday 6:00 a.m. until 12:00 p.m. He
stated that he usually walks to school and home, as verbalized, "hindi naman po masyadong malayo yung
bahay mga 15 minutes ko lang po nilalakad." Aside from walking and playing "habulan" with his
siblings, there are no other exercises that the client is engaged in. His favorite pastimes are playing
Roblox, watching television, and watching YouTube videos. As verbalized by the client, "naglalaro lang
po ako sa cellphone pag walang ginagawa o kaya po nakahiga lang, wala po kasi akong bike para mag
bike-bike." In addition, the client rarely plays with his friends and siblings outside; most of the time he is
using his cellphone to play and entertain himself. Aside from the above, the client claims that he has the
ability to bathe, feed, and dress himself. The client also claims that he can assist with household chores
assigned by his mother. However, the client stated that "isang beses lang po ako naliligo sa isang araw,
hindi rin po ako nagtutoothbrush." .
Analysis: The average day for a child of school age (ages 6 to 12) consists of short bursts of physical
activity ranging from moderate to vigorous intensity, alternating with periods of lighter activity or rest
throughout the day. Any action that ranges from moderate to vigorous counts toward the goal of sixty
minutes of physical activity (CDC, 2022).
References:
Centers for Disease Control and Prevention (2022, June 3). How Much Physical Activity Do Children
Need?
https://www.cdc.gov/physicalactivity/basics/children/index.htm
ACTIVITY RECALL
MAY 11, 2023 - THURSDAY
5:00 AM Time woke up
5:15 AM Ate breakfast
5:30 AM Took a bath
5:40 AM Walking on the way to school
5:55 AM Arrived at school
6:00 AM Start of face to face class
9:30 AM Ate snack
12:00 NOON End of face to face class
12:15 PM Ate lunch
12:30 PM Rest
2:00 PM Playing roblox on cellphone
3:00 PM Lying on the bed watching Youtube videos
4:00 PM Went outside to play “habulan” with siblings
5:00 PM Help his mother do household chores
5:30 PM Rest
6:00 PM Ate dinner
6:30 PM Wash hands and feet, change clothes

7:00 PM Watching youtube videos
8:00 PM Time to sleep
MAY 12, 2023 - FRIDAY
5:30 AM Took a bath
5:40 AM Walking on the way to school
9:30 AM Ate snack
12:15 PM Ate lunch
12:30 PM Rest
3:00 PM Lying on the bed watching Youtube videos
4:00 PM Went outside to play “habulan” with siblings
5:00 PM Help his mother do household chores
5:30 PM Rest
6:00 PM Ate dinner
MAY 13, 2023 - SATURDAY

MAY 13, 2023 - SATURDAY
8:00 AM Playing roblox on cellphone
9:30 AM Helped his mother fold their clean clothes
10:00 AM Ate snack
10:30 PM Rest
11:00 PM Took a bath
11:30 PM Watching television
12:30 PM Ate lunch
2:00 PM Relaxing in the bed
3:00 PM Ate snacks
3:30 PM Went outside to play with siblings
4:30 PM Rest
6:00 PM Ate dinner
6:30 PM Wah hands and feet, change clothes
8:00 PM Lying in the bed preparing to sleep, still watching

youtube videos
MAY 14, 2023 - SUNDAY
10:00 AM Ate snack
10:30 PM Rest
MAY 14, 2023 - SUNDAY
11:00 PM Took a bath
11:30 PM Watching television
12:30 PM Ate lunch
2:00 PM Relaxing in the bed
3:00 PM Ate snacks
3:30 PM Went outside to play with siblings
4:30 PM Rest
6:00 PM Ate dinner
8:00 PM Lying in the bed preparing to sleep, still watching

youtube videos
MAY 15, 2023 - MONDAY
7:00 AM Took a bath
7:30 AM Doing his modules
9:00 AM Ate snack
9:15 AM Rest
10:00 AM Watching youtube videos
11:00 AM Play roblox on cellphone
12:00 NOON Ate Lunch

MAY 15, 2023 - MONDAY
12:30 PM Relaxing while watching television
1:30 PM Continue doing his module
3:00 PM Rest
3:30 PM Went out to play with his siblings
4:00 PM Sweeping the floor
4:15 PM Play roblox on cellphone
5:00 PM Watch youtube videos
6:00 PM Ate dinner
6:30 PM Wash hand and feet, change clothes
MAY 16, 2023 - TUESDAY
7:00 AM Took a bath
7:30 AM Doing his modules
9:00 AM Ate snack
9:15 AM Rest
10:00 AM Watching youtube videos
12:00 NOON Ate Lunch
12:30 PM Relaxing while watching television
1:30 PM Continue doing his module
3:00 PM Rest
MAY 16, 2023 - TUESDAY
3:30 PM Went out to play with his siblings
5:00 PM Watch youtube videos
6:00 PM Ate Dinner
6:30 PM Wash hand and feet, change clothes
MAY 17, 2023 - WEDNESDAY
5:30 AM Ate Breakfast
7:00 AM Took a Bath
7:30 AM Brushes his teeth
7:35 AM Prepare his things and arrange his bag
8:00 AM Put on his uniform
8:30 AM Start walking going to school
10:00 AM Ate snacks
10:30 AM Resume of face to face class
12:15 PM Start walking going home
12:30 PM Arrived at their house
12:45 PM Ate lunch

MAY 17, 2023 - WEDNESDAY
1:00 PM Rest
3:45 PM Relaxing while lying on the bed
5:40 PM Doing his assignments
6:15 PM Ate Dinner
6:30 PM Wash hand and feet, change clothes for bed time
K. Sleep – Rest Pattern
The client stated that he usually gets an average of 9 hours of sleep per day. He is not using any
medications for sleeping. He usually goes to sleep at 8 or 9 in the evening and wakes up at 5:00 am. Upon
waking up, the client feels fine, stating “Okay naman po ako paggising”. He doesn’t have any trouble
sleeping either. Before going to bed, the client watches YouTube videos on his gadget. In addition, the
client takes a rest in the afternoon after his class.
Analysis: Sleep is important for a child’s mental and physical well-being. Sleep helps promote the growth
and development of children. Getting good quality sleep also helps boost a child's immune system and
decrease the likelihood of infection and illness. Research shows that sleep affects learning and memory,
mood, resiliency, vocabulary development, cognition, and mood. According to the National Sleep
Foundation, school-age children (ages 6 to 12) need an average of 9 to 11 hours of sleep each night.
However, certain kids might need more or fewer hours of sleep to feel refreshed (Hanold, 2023).
References:
Hanold, L. K. (2023, March 22). Here’s the ideal amount of sleep by age for kids and adults. Sleep.com.
https://www.sleep.com/sleep-health/how-many-hours-of-sleep
SLEEP AND REST RECALL
Schedule Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Time went
7:00 pm 7:00 pm 7:00 pm 7:00 pm 7:00 pm 8:00 pm 8:00 pm
to bed
Approxim
ate time
8:00 pm 8:00 pm 8:00 pm 8:00 pm 8:00 pm 9:00 pm 9:00 pm
went to
sleep
Wake up
period/
Not Not Not Not Not Not Not
sleep
interrupted interrupted interrupted interrupted interrupted interrupted interrupted
interruptio
ns
Time wake
up the next 5:00 am 5:00 am 5:00 am 5:00 am 5:00 am 7:00 am 7:00 am
morning
Naps (time
slept &
None None None None None None None
woke up;
duration)
Activities
Watching Watching Watching Watching Watching Watching Watching
done
YouTube YouTube YouTube YouTube YouTube YouTube YouTube
before
videos videos videos videos videos videos videos
bedtime
Bedtime Wash Wash Wash Wash Wash

Wash hands Wash hands
rituals hands and hands and hands and hands and hands and
and feet, and feet,
feet, feet, feet, feet, feet,
change change
change change change change change
clothes clothes
clothes clothes clothes clothes clothes
V. PHYSICAL ASSESSMENT
A. General Survey and Integumentary
GENERAL SURVEY
BODY PART/AREA NORMAL ACTUAL FINDINGS INTERPRETATION

TO BE ASSESSED FINDINGS AND ANALYSIS
Body build, height, and BMI and body build The BMI of the client is DEVIATION FROM
weight in relation to the are within the normal 13.1 and is less than the NORMAL
client’s age, lifestyle, range. 5th percentile range. The
and health. body build of the client is BMI is the measurement of
ectomorph. weight in relation to height.
This figure aids medical
professionals in
determining whether a
patient is at risk for health
problems due to being
underweight, overweight,
or obese. The BMI of a
healthy weight should be in
the 5th percentile to less
than the 85th percentile
(CDCP, About Child and
Teen BMI, 2022).
Reference:
About child and teen BMI.
(2022, September 24).
Centers for Disease
Control and
Prevention.
https://www.cdc.gov/h
ealthyweight/assessing/
bmi/childrens_bmi/abo
ut_childrens_bmi.html
Client's posture and Gait is smooth and can The client’s gait is NORMAL
gait, whether standing, maintain balance; it smooth and can maintain
sitting, or walking. moves all extremities balance, and the client’s
equally with good posture is a slightly
posture. forward curvature of the
spine in the neck, or
cervical lordosis.
Client’s overall hygiene Well groomed. The client does not DEVIATION FROM
and grooming. Clothing is appropriate appear well-groomed, but NORMAL
for weather was dressed appropriately
during the assessment. Analysis: Good hygiene is
The client further vital for a child’s grooming
verbalized that “Isang because it prevents the
beses lang po ako maligo spread of infectious
sa isang araw, tuwing diseases and the removal of
umaga po bago pumasok microorganisms on the
sa school.” body. Psychologically,
practicing good hygiene
will help boost a child’s
self-esteem, which keeps
them confident when
socializing with their peers.
Failure to observe good
overall hygiene will
produce visible markers of
poor health and increase
the risk of illness and
disease (Barclay, 2023).
Reference:
Barclay, T. (2023). The
impacts of personal
hygiene on your health.
https://www.innerbody.
com/impacts-of-person
al-hygiene-on-your-hea
lth
Note body and No body/breath odor There was no body odor NORMAL
breath odor in or minor body odor that was observed during
relation to activity relative to work or the assessment.
level. exercise.
Note obvious Healthy appearance. The patient seems to be DEVIATION FROM

signs of health or lethargic, and has no NORMAL
illness. difficulty in breathing.
Analysis: Lethargy is not a
symptom associated with
any one illness. Rather, it
might be a sign of a variety
of diseases and illnesses.
It's a common reaction to
things like not getting
enough sleep, stress, or
eating poorly.
Reference:
What Is Lethargy? (2021,
November 1). Verywell
Health.
https://www.verywell
health.com/lethargy-o
verview-458214
Client’s attitude. Cooperative. The client was NORMAL

cooperative with the
student nurses during the
assessment.
Client’s affect/mood; Appropriate to the The client’s mood and NORMAL
assess the situation. responses were
appropriateness appropriate to the
of the client’s situation.
responses.
Listen for Understandable, The client communicates NORMAL

quantity, quality, moderate pace, clearly, understandable,
and organization exhibits thought and has a low voice
of speech. association. volume because he is shy.
Listen for Logical sequence, The client’s answers had NORMAL

relevance and makes sense, has relevance, made sense,
organization of sense of reality. and came from an
thoughts. organization of thoughts.
INTEGUMENTARY
BODY PART/AREA NORMAL ACTUAL FINDINGS INTERPRETATION

TO BE ASSESSED FINDINGS AND ANALYSIS
Skin Color Varies from light to The client’s skin color is NORMAL
deep brown, from light brown.
ruddy pink to light
pink
Uniformity Of Skin Generally uniform The client’s skin is NORMAL

Color except in areas exposed generally uniform except
to sun; areas of lighter for those areas exposed to
pigmentation in dark the sun.
skinned
Skin Edema No edema No presence of edema NORMAL
Skin Lesions Freckles, some No presence of skin NORMAL

birthmarks, some flat abrasions and other skin
and raised nevi, no lesions
abrasion or other lesion
Skin Moisture Moisture in skin folds Smooth and the skin folds NORMAL
and the axillae, and the axillae are
affected by different moisturized.
factors
Skin Temperature Uniform; within The client’s temperature NORMAL

normal range is uniform and within the
normal range.
Skin Turgor When pinched, skin The skin returns to its NORMAL
springs back to normal position right
previous state away after being pinched.
Evenness of growth of Evenly distributed hair The client’s hair is evenly NORMAL
hair over the scalp distributed.
Hair thickness or Thick hair The client’s hair is thick. NORMAL

thinness
Hair texture and Silky, resilient hair The client’s hair is silky NORMAL
oiliness and resilient.
Presence of Infections No infections or The client has no NORMAL

or infestations infestations infections or infestations.
Amount of body hair. Variable The client’s amount of NORMAL

body hair is variable.
Fingernail plate shape Convex curvature; The nail's convex NORMAL

angle between nail and curvature at the client is
nail bed usually 160° 160°.
Fingernail and toenail Highly vascular and The client’s fingernail NORMAL
bed color pink in light skinned; and toenail bed color is
dark skinned may be highly vascular and pink.
brown or black
Fingernail and toenail Smooth texture The client’s fingernails NORMAL

texture and toenails have a
smooth texture.
Tissues surrounding Intact epidermis The client’s tissues NORMAL

nails surrounding the nails
have intact epidermis.
Blanch test of capillary Prompt return of pink Upon doing the blanch NORMAL
refill or the usual color in test of capillary refill, it
less than four seconds. took about 3 seconds to
return to its usual color.
B. Measurements (Height, Weight, BMI, Vital signs)
Height Weight Body Mass Index Vital Signs
117 cm 18 kg 13.1 Temperature: 37.1 ℃
DEVIATION FROM Pulse Rate: 90 bpm

NORMAL
Respiratory Rate: 20
Interpretation & cpm
Analysis:
UNDERWEIGHT
The client's BMI is

13.1 kg/m2 indicating
weight is in the
underweight BMI
category based on CDC
growth charts for
children and teens ages
2 through 19 years
(CDC, 2023).
Reference:
Centers for Disease

Control and Prevention.
(2023, February 9).
BMI Calculator for
Child and Teen.
https://www.cdc.gov/he
althyweight/bmi/calcul
ator.html
C. Cephalocaudal
HEAD TO NECK
HEAD
BODY PART/AREA NORMAL ACTUAL INTERPRETATION

TO BE ASSESSED FINDINGS FINDINGS AND ANALYSIS
Through inspection,
the client’s head size
Size, shape, Symmetric, erect, is symmetrical, round,
midline, NORMAL
configuration erect, in midline, and
normocephalic appropriate with her
body figure.
Through inspection,
Involuntary Still and upright there is no involuntary NORMAL
movement movement; the client's
head is still and
upright.
While palpating the

Hard and smooth; no client’s head, it is hard NORMAL
Consistency
lesions and smooth
Through inspection,
Symmetric with a the client’s face
FACE. Symmetry, round, oval, is symmetrical
features, movement, elongated, or square and round, with no
NORMAL
expression, and skin appearance. No abnormal
condition abnormal movements movements or
were noted. paralysis on either
side of the face.
Through this, the

Elastic and no client’s temporal
Temporal Artery NORMAL
tenderness artery is elastic and
not tender.
Through palpating, the
client’s
temporomandibular
joint is not swelling or
tender, and there is
No swelling, also no crepitation
Temporomandibular tenderness, or with movement. The
NORMAL
Joint (TMJ) crepitation with client was able to open
movement. and close her mouth
fully and easily, and
the lower jaw moves
1-2 cm in each
direction.
HEAD TO NECK
NECK

Symmetric, with head While inspecting the

Position, symmetry, centered and without neck, there is no
swelling, lesions, or NORMAL
and lumps or bulging masses
masses. bulging masses. It is
also symmetrical,
with the head
centered.
Thyroid cartilage, While inspecting, the

cricoid cartilage client was able to
Movement of the moves upward swallow, and the
cricoid cartilage NORMAL
neck structures symmetrically as the
client swallows moved upward
symmetrically.
Neck movement While inspecting, the

should be smooth and client was able to
controlled with 45- turn her head to the
degree flexion, 55- right and her head to
degree extension, 40- her left shoulder
degree lateral while her chin was
abduction, and touching her
70-degree rotation shoulder. She was
Range of motion also able to touch NORMAL
each ear to her
shoulder, touch the
chin to chest, and lift
the chin to the
ceiling in a smooth
and controlled
manner.
Visible and palpable While inspecting, the

client’s cervical NORMAL
Cervical Vertebrae vertebra is visible and
palpable
Midline Through palpating,

Trachea the client’s trachea is NORMAL
in the midline
No swelling or While palpating the

enlargement and no lymph nodes, there
Lymph Nodes tenderness was no swelling, NORMAL
enlargement, or
tenderness.
HEAD TO NECK
EYES

After performing the
Eye movement should position’s test, the
be smooth and client’s eyes were able NORMAL
Positions Test to follow the pen’s
symmetric throughout
all six directions movements smoothly
and symmetrically.
The client’s eyelids

are able to close and
Upright, able to close,
open. No lesions or
no redness, lesions, or
swelling can be noted.
Eyelids swelling, and eyeballs NORMAL
The client’s eyeballs
are symmetrically
appear to be
aligned in sockets.
symmetrical in the
sockets.
Through inspection, it
was observed that the
Bulbar conjunctiva is client’s bulbar
clear, moist, and conjunctiva is clear,
Bulbar Conjunctiva moist, and smooth.
smooth. Underlying NORMAL
and Sclera The underlying
structures are clearly
visible. Sclera is white structures are clearly
visible, and the sclera
is white.
was observed that the
Free of swelling, client’s lower and
Palpebral upper palpebral NORMAL
foreign bodies, or
Conjunctiva conjunctivae are clear
lesions.
and free of swelling
and lesions.
The client’s lacrimal

There is no swelling apparatus is free of
or redness; puncta are swelling, tenderness,
Lacrimal Apparatus NORMAL
visible with no or redness. The puncta
drainage. are visible, with no
drainage noted.
The cornea is was observed that the
transparent, with no client’s cornea is
opacities. The oblique transparent with no
Cornea and Lens view shows a smooth opacities; it is also NORMAL
and overall moist smooth, and has a
surface; the lens is moist surface, and the
free of opacities. lens is free of
opacities.
The client’s pupillary
Direct and consensual light reflex is direct,
Pupillary Light
pupillary response are and consensual NORMAL
Reflex
constriction pupillary responses
are constriction.
The client’s pupils

Accommodation of Accommodation and
accommodate and NORMAL
Pupils convergence
normally converge.
HEAD TO NECK
EARS

The client’s ears are

Ears are equal in size
equal in size
bilaterally; The auricle
bilaterally. The auricle
aligns with the corner
aligns with the corner
of each eye, Earlobes
of each eye. The
may be free, attached,
Auricle, Tragus and client’s earlobes are
or soldered; The skin is NORMAL
Lobule attached. The skin of
smooth, with no
both areas were
lesions, lumps, or
smooth, with no
nodules. The color is
lesions noted. The
consistent with facial
color of the ears is the
color.
same as the face.
The client’s auricle,

The auricle, tragus, tragus, and mastoid
Auricle and Mastoid
and mastoid processes process are not tender. NORMAL
Process
are not tender. No lumps, swelling, or
lesions were noted.
The client was able to

Able to correctly repeat five of the
Whisper Test repeat the two-syllable two-syllable words as NORMAL
word as whispered. they were whispered
correctly.
The client maintains The client was able to

position for 20 maintain the position
Romberg Test seconds without for the duration of the NORMAL
swaying or with test with only minimal
minimal swaying. swaying.
HEAD TO NECK
NOSE

The color is the same as The client’s external

External Nose. Nasal the rest of the face; the nose is the same color
color, shape, nasal structure is as the rest of her face,
NORMAL
consistency, and smooth and her nasal shape is
tenderness symmetrical; the client symmetrical, and no
reports no tenderness. tenderness noted.
The client was able to

sniff through each
Patency of Airflow Client is able to sniff
nostril with ease. The NORMAL
Through the Nostrils through each nostril
patency of airflow is
free and open.
The nasal mucosa is The client’s internal

dark pink, moist, and nose or nasal mucosa is
free of exudate. The moist and free of any
nasal septum is intact foreign objects or
and free of ulcers or exudate. Her nasal
Internal Nose NORMAL
perforations. septum appears to be
Turbinates are dark intact and free of
pink (redder than oral lesions. The turbinate is
mucosa), moist, and moist and free of
free of lesions. lesions as well.
The client’s frontal and

Frontal and maxillary
maxillary sinuses are
sinuses are nontender
Sinuses free of tenderness when NORMAL
to palpation, and no
palpated. No crepitus is
crepitus is evident.
evident.
HEAD TO NECK
MOUTH AND THROAT

Lips Smooth and moist Upon inspection, the NORMAL

without lesions or client has moist, smooth
swelling lips that are free of
lesions or swelling.
Teeth And Gums Thirty-two pearly The client has 16 DEVIATION FROM
white teeth with yellowish teeth. It was NORMAL
smooth surfaces and also observed that the
edges. Upper molars client has damaged
should rest directly on and incomplete teeth. Analysis: Tooth decay
the lower molars and The first and second and cavities rank among
the front upper molars of the client are the most prevalent
incisors should all absent. He also has medical conditions
slightly override the decayed teeth in his worldwide. They are
lower incisors. Some lower lateral and particularly prevalent in
clients normally have central incisors. kids, teenagers, and
only 28 teeth if the elderly people. If
four wisdom teeth do cavities are left
not erupt. untreated, they grow
larger and start to affect
your teeth's deeper
layers. They may result
in tooth loss, an
infection, and
excruciating dental pain
(Mayo Clinic, 2022).
Reference:
Cavities/tooth decay -
Symptoms and
causes - Mayo
Clinic. (2022,
March 19). Mayo
Clinic.
https://www.mayocl
inic.org/diseases-co
nditions/cavities/sy
mptoms-causes/syc-
20352892
Buccal Mucosa The buccal mucosa Upon inspection, the

should appear pink in client's buccal mucosa
light-skinned clients; appeared pink.
tissue NORMAL
pigmentation
typically increases in
dark skinned clients.
Tongue Tongue should be It was observed that the

pink, moist, a client has a pink, moist,
moderate size with and moderate size with
NORMAL
papillae (little papillae present.
protuberances)
present.
Sides of the Tongue No lesions, ulcers, or There are no lesions,
nodules are apparent. ulcers, or nodules
NORMAL
present on the client
side of the tongue.
Ventral Surface of the The tongue’s ventral The client’s tongue’s

Tongue surface is ventral surface is
smooth, shiny, pink, smooth, shiny, and
NORMAL
or slightly pale, with slightly pale, with
visible veins and no visible veins and no
lesions. lesions present.
Wharton’s Ducts The frenulum is The client’s frenulum is

midline; Wharton’s in midline, and the
ducts are visible, wharton’s ducts are
with salivary flow or visible with salivary
NORMAL
moistness in the area. flow. There are no
The client has no lesions or swellings
swelling, redness, or present.
pain.
Strength of the The tongue offers The client’s tongue

Tongue strong resistance offers strong resistance. NORMAL
Hard (Anterior) The hard palate is The patient has firm

and Soft (Posterior) pale or whitish with transverse rugae and a
Palates firm, transverse pale hard palate. The
rugae (wrinkle-like client's palatine tissues,
folds). Palatine on the other hand, NORMAL
tissues are intact; the remain intact. The soft
soft palate should be palate is pinkish,
pinkish, movable, movable, and smooth.
spongy, and smooth
Mouth Odor No unusual or foul During inspection, it DEVIATION FROM

odor is noted was found that the NORMAL
client has a slightly
unpleasant odor Analysis: The primary
because of tooth decay sign of unpleasant
breath, an oral health
and poor oral hygiene.
problem, is
foul-smelling breath.
Dental cavities, poor
oral hygiene, mouth
breathing, and
respiratory issues are
common causes of this
in children. It is usually
short-term and
disappears after
brushing their teeth
(Ewumi, 2022).
Reference:
Ewumi, O. (2022,
March 9). Causes of
bad breath in
children.
https://www.medica
lnewstoday.com/arti
cles/bad-breath-in-k
ids
Uvula The uvula is a fleshy, The client’s uvula

solid structure that hangs freely in the
hangs freely in the midline, and it has a
midline. No redness fleshy, solid structure.
of or exudate from There is no redness NORMAL
uvula or soft palate. noted on the uvula or ,
Midline elevation of soft palate. It is in the
uvula and symmetric middle.
elevation of the soft
palate.
Tonsils Tonsils may be The client’s tonsils are

present or absent. not present. They are
They are normally pink and symmetric.
pink and symmetric There are no lesions or
and may be enlarged swelling noted. NORMAL
to 1+ in healthy
clients. No exudate,
swelling, or lesions
should be present.
Posterior Pharyngeal Throat is normally Through inspection, it

Wall pink, without exudate was observed that the
NORMAL
or lesions client's throat is pink
and no lesions present.
CHEST TO ABDOMEN

Shape of the thorax The thorax is smooth, After the assessment,

rounded, and the client’s thorax is NORMAL
symmetrical. symmetrical, rounded,
Respirations should be and smooth. The
unlabored and regular client’s respiration
for all ages. From two rate is 20 breaths/min.
to ten years old,
breathing should be
between 20 and 28
breaths per minute.
Percuss the chest Hyperresonance is the

normal tone elicited in
young children
because of the
thinness of the chest NOT DONE NOT DONE
wall. This diminishes
as the child ages and
the chest wall
develops
Auscultate for Breath sounds may The client’s breath

breath sounds and seem louder and sounds are loud and
adventitious sounds harsher to young harsh. There were no
children because of adventitious sounds
their thin chest walls. heard during the
No adventitious auscultation of the
NORMAL
sounds should be lungs.
heard, although
transmitted upper
airway sounds may be
heard on auscultation
of the thorax.
Breasts Breasts are flat and The client’s breasts

symmetrical in are flat and
prepubertal children. symmetrical.
NORMAL
Obese children may
appear to have breast
tissue
Precordium. The apical pulse is in Upon inspection of the

the 4th intercostal precordium, the apical
space (ICS) until the pulse is in the 5th
age of 7 years, when it intercostal space,
NORMAL
drops to the 5th. It is located on the right of
to the right of the the midclavicular line.
midclavicular line
(MCL) at age 7.
Auscultate heart Innocent murmurs are Upon auscultation, the
sounds. common throughout heart sounds normal.
childhood and are The client’s heart rate
classified as systolic; is 90 bpm.
short duration; no
transmission to other
areas; grade III or
less; loudest in the
pulmonic area;
NORMAL
low-pitched, musical,
or groaning quality
that varies in intensity
in relation to position,
respiration, activity,
fever, and anemia.
There are no other
associated signs of
heart disease.
Shape of the In children after the After inspection, the

abdomen age of 4, the abdomen client’s abdomen
appears slightly shape is slightly
NORMAL
prominent when prominent when
standing but flat when standing.
supine until puberty.
Umbilicus The umbilicus is pink; The client’s umbilicus DEVIATION FROM

there is no discharge, is dirty and smells NORMAL
odor, redness, or sweaty. But no
herniation. discharge and no Analysis:
presence of redness or Dirty umbilicus is
herniation were noted. caused by poor
hygiene. A study
discovered that the
typical belly button
contains 67 different
species of bacteria.
Thus, a dirty
umbilicus may cause a
possible yeast
infection, a foul odor,
and other problems if
not cleansed
(Frothingham, 2019).
Reference:
Frothingham, S.
(2019, March 8).
Dirty belly button:
Why and how to
clean your navel.
Healthline.
https://www.healt
hline.com/health/d
irty-belly-button
Auscultate bowel Normal bowel sounds Upon auscultation, the

sounds occur every 10 to 30 client’s bowel sounds
seconds. They sound are normal. NORMAL
like clicks, gurgles, or
growls.
Palpate for masses Abdomen is soft to

and tenderness. palpation and free of
masses or tenderness. NOT DONE NOT DONE
Palpate liver Liver is usually

palpable 1–2 cm
below the right costal NOT DONE NOT DONE
margin in young
children.
Palpate spleen Spleen tip may be

palpable during
inspiration NOT DONE NOT DONE
Palpate kidneys The tip of the right

kidney may be
palpable during NOT DONE NOT DONE
inspiration.
Palpate bladder Bladder may be

slightly palpable in
small children. NOT DONE NOT DONE
VITAL SIGNS
BODY
PART/AREA NORMAL ACTUAL INTERPRETATION
TO BE FINDINGS FINDINGS and ANALYSIS
ASSESSED
● Babies & children The temperature of NORMAL
Temperature 97.9°F (36.6°C) to the client is 37.1°C
99°F (37.2°C) which is within the
normal range of
● Axillary babies and children.
(35.8 to 37°C)
● Age Newborn
Radial Pulse Pulse Average The client’s radial NORMAL
130 bpm pulse is within the
Range 80 -180 normal range of
bpm between 5 to 10
years old with 90
● Age 1 year bpm as recorded.
Pulse Average The client’s radial
120 bpm pulse is strong and
Range 80 -140 the intervals between
bpm pulsations are equal.
A point scale of 2+
● Age 5 to 8 years normal/strong is
old observed.
Pulse Average
100 bpm
Range 75 - 120
bpm
● Age 10 years old

Pulse Average 70
bpm
Range 50 - 90
bpm
Age ranges
Respiration The client’s NORMAL
● Newborn respiration rate is 20
30 - 80 cpm cpm which is within
the normal range
● 1 year between 5 to 10
20 - 40 cpm years old.
● 5 to 8 year old
15 - 25 cpm
○
● 10 year old
15 - 25 cpm
● NORMAL/EUP
NEA
Breaths, normal,
regular
VI. Problem Identification and Prioritization
Justification according to ABC

Nursing Diagnosis Cues Rank
or Maslows
Imbalanced nutrition: less than body 1 The nursing problem at hand has
requirements, related to insufficient been recognized as a foremost
dietary intake, as evidenced by a concern for intervention, as per
below normal BMI and food/fluid Maslow's Hierarchy of Needs,
intake less than the recommended whereby the nutritional status of
daily allowance. a child is linked to their
physiological requirements. The
provision of sustenance in the
form of food and water is
classified as a fundamental
physiological requirement.
Failure to fulfill these needs can
result in impaired bodily function
(Wahome, 2022). The
physiological needs are deemed
the most fundamental since the
satisfaction of other needs is
contingent upon their
fulfillment. At this level,
motivation is derived from an
individual's innate drive to
ensure their survival.
School-aged children between
the ages of 6 and 12 are required
to consume a diet rich in
nutritious meals and snacks.
They take food four to five
distinct times every day on
average, and their development
rate is steady but slow. Their
eating habits and food
preferences are influenced by
their families, friends, social
media, and other forms of media,
mainly via television and tablets
(CDC, 2022). Furthermore, the
nutritional state of school-age
children has an impact on their
health, cognitive functioning,
and, as a result of these factors,
academic achievement. The diet
that children of school age
consume should not encourage
them to gain an unhealthy
amount of weight; rather, it
should stimulate growth, meet
their needs for both energy and
nutrients, and complete their
requirements.
References:
Centers for Disease Control and
Prevention (2022, August
05). Childhood Nutrition
Facts.
https://www.cdc.gov/healthys
chools/nutrition/facts.htm
Wahome, C. (2022, May 13). What

is Maslow’s Hierarchy of
Needs. WebMD.
https://www.webmd.com/ment
al-health/what-is-maslow-hiera
rchy-of-needs#:~:text=Physiol
ogical%20needs%20are%20th
e%20most,your%20body%20c
annot%20function%20properl
y
Self-care deficits in hygiene and 2 This nursing problem has been

grooming, related to decreased designated as a Rank 2 priority
motivation, as evidenced by dental for intervention because the
caries, incomplete and damaged teeth, second part of Maslow's
and minimal body and mouth odor Hierarchy of Needs relates to
safety needs, which are important
to cover health. Good personal
hygiene should include clean
skin and care of the mouth, teeth,
hair, ears, hands, feet, and nails.
In addition, good body cleansing
habits such as regularly washing
of body parts and hair with soap
and water can prevent the spread
of diseases related to poor
hygiene (CDC, 2022). Personal
hygiene neglect can have a
detrimental influence on overall
health. Skin infections, oral
health difficulties, body odor, and
other health issues can result
from poor hygiene practices.
Such conditions can cause
discomfort, distress, and possible
implications, harming an
individual's physical safety and
well-being. Furthermore, those
individuals may endanger others,
undermining the community's
safety requirements (CCHOS,
2023).
References:
Canadian Centre for Occupational
Health and Safety. (2023,
April 5). Good Hygiene
Practices - Reducing the
Spread of Infections and
Viruses. CCOHS: Good
Hygiene Practices - Reducing
the Spread of Infections and
Viruses.
https://www.ccohs.ca/oshansw
ers/diseases/good_hygiene.ht
ml
Centers for Disease Control and

Prevention (2022, December
01). Personal Hygiene.
https://www.cdc.gov/hygiene/
personal-hygiene/index.html
Risk for impaired parenting related to 3

a lack of social support, as evidenced The specific nursing problem has
by the absence of parents due to work been placed as the third priority for
and other relatives to provide intervention, as the relationship of a
assistance or guidance, and support child with its parents falls under the
networks. love and belonging needs in
Maslow’s Hierarchy of Needs.
Love and belonging require a sense
of acceptance and belonging. This
hierarchy involves relationships
and connections to family and
friends. If a person fails to meet
their needs, it may lead to feelings
of loneliness and depression
(Wahome, 2022). Furthermore, a
healthy parent-child connection
fosters a child's physical,
emotional, and social growth. Each
child and parent develop, value,
and experience this special link.
The basis for the child's personality,
decisions, and general behavior is
set by the relationship. According
to studies, a good parent-child
interaction benefits the kids as well
as the family. Furthermore, it was
noted that young children who have
a strong and healthy attachment to
their parents as they grow up have a
higher likelihood of building
fulfilling connections with other
people in their lives. A child who
has a strong bond with their parents
develops the ability to control their
emotions under pressure and in
challenging situations (Kalpana,
2023).
References:
Wahome, C. (2022, May 13).
What is Maslow’s Hierarchy
of Needs. WebMD.
https://www.webmd.com/men
tal-health/what-is-maslow-hie
rarchy-of-needs#091e9c5e823
caf43-1-4
Kalpana, M. (2023, April 6).

Parent-Child relationship: Why
is it important and how to build
it. MomJunction.
https://www.momjunction.com/
articles/helpful-tips-to-strength
en-parent-child-bonding_00796
67/
IX. NURSING CARE PLAN
Cues Nursing Analysis Goal Intervention Rationale Evaluation

Diagnosis
Subjective Situational Goal: Outcome
Cues: Imbalance Analysis: Independent: Evaluation:
d nutrition: Short-Term: 1. Assess the 1.Client-centered
The client less than Client J.D. is After 15 to 30 client's care em phasizes After 30 minutes
stated, body a 9-year-old- minutes of perspective on integrating the of nursing
"Hotdog, itlog, requiremen student who nursing eating and client's values, intervention, the
nutrition.
at kanin po ts, related has an intervention, the preferences, and client was able to:
pagkain ko to insufficient client will be able 2. Look for objectives into
palagi." insufficient dietary intake. to: further physical the healthcare
dietary During the signs of poor decision-making
The client also intake, as interview, the Improve nutrient nutritional process. By Improve nutrient
verbalized, “3 evidenced client stated intake by intake. assessing the intake by
o 4 na beses by a below that he often incorporating at client's incorporating at
po ako normal eats hotdogs, least one serving 3. Assist the perspective on least one serving
umiinom ng BMI and eggs, and rice of fruits, parent in eating and from each food
tubig food/fluid for his daily vegetables, developing an nutrition, group (grains,
araw-araw .“ intake less meal. He also protein, grains, appropriate meal healthcare vegetables, fruits,
than the mentioned and dairy with plan to ensure professionals can protein, and dairy)
When the recommen that he only each meal and that the client better with each meal and
receives the
client was ded daily drinks 3 to 4 increasing fluid comprehend the increasing fluid
nutrients that his
asked about allowance. glasses of intake to meet the body requires. client's dietary intake to meet the
what type of water every recommended needs, recommended
supplement or day. Upon daily allowance motivations, and daily allowance
vitamins he assessing the within one week. 4. Assess the barriers. This within one week.
takes, the client, he parent's basic knowledge MET
client weighs 18kg, knowledge of enables the UNMET
answered, and 117 cm adequate provider to
“Hindi po ako tall, and has a nutrition and develop
umiinom ng BMI of 13.1. give the parent nutrition-related
vitamins eh.” the information plans with the
Scientific and ways for client in
Analysis: possible collaboration,
Objective techniques for thereby
Cues: A healthy Long-Term: school-age enhancing the After a month of
lifestyle is After the nursing children. overall efficacy nursing
Height: attained by intervention, of the intervention, the
117 cm maintaining a within a month, 5. Educate the intervention client was able to:
balanced diet the client will be parents’ on (Hunter et al.,
Weight: and taking able to: which 2018). The client's
18 kg. into Achieve the aim vitamin(s) to
take to boost appetite has
consideration for a weight gain 2. Inadequate effectively
the client's
BMI: the of 1 lb. per week appetite. nutrition can improved, and he
13.1 kg/m2 requirements to achieve the result in a variety was able to reach
(UNDERWEIGHT) (in terms of normal range of of complications, the target weight
nutrients) that BMI, if 6. Evaluate and including weight gain of 1 lbs per
a body needs. appropriate. document the loss, muscle week and a healthy
An cause of the atrophy,
imbalance in BMI.
imbalanced impaired MET
nutrition.
nutrition immune
occurs when a 7. Evaluate and function, and an UNMET
person’s age take note of increased risk of
does not align clients' infection. By
eating
with the recognizing the
patterns.
metabolic and Objectives: indicators of
nutritional 1. Upon 8. Evaluate the inadequate 1. After 10
needs receiving 10 etiological nutritional minutes of
required for minutes of factors that intake, health teaching,
them. In the health contribute to interventions can the client was
case of an education, the inadequate be promptly able to
nutrient
imbalanced client will made to prevent understand the
intake.
nutrition; less acquire an or reduce the significance of
than body understanding Dependent: occurrence of having adequate
requirements of the these fluid
pertain to the significance of 9. Refer to a complications consumption.
inability to improving pediatrician (Stratton et al., MET
acquire the fluid for 2018). Early UNMET
required consumption. consultation. identification and
essential action may
nutrients for 2. The client Collaborative: involve 2. The client was
that specific should take the developing able to initiate
age. This is initiative to 10. Collaborate strategies to
with a incorporating
usually due to incorporate improve eating nutritious and
the practice of healthy foods nutritionist to habits, and
help the mother adequate foods
insufficient into their daily delivering into their
dietary diet in order to learn more nutritional
about what regular diet to
intakes that improve their supplements. improve their
causes a overall foods are
providing overall
person to nutrition. 3. Based on nutrition.
become obese enough nutrients factors such as
that the client’s MET
or age, sex, weight,
body requires. UNMET
underweight growth rate, and
(Narayana 3. The client underlying health
3. The client was
Health, 2019). shall attain a conditions, every
able to achieve
Children targeted and individual has
the targeted and
should eat a suitable distinct
appropriate
varied diet weekly nutritional
weekly increase
rich in increase in requirements.
in weight.
nutrients to weight. Assisting the
avoid delays parent in MET
in growth and developing an UNMET
development, 4. It is imperative individualized
multiple for the client meal plan enables 4. The client was
health issues, to recognize the client's able to
and poor and tackle any nutritional appropriately
academic fundamental requirements to identify and
performance. factors or be met. By taking discuss any
Moreover, the obstacles that into account the underlying
body requires hinder the client's age, factors or
the right achievement weight, cultural obstacles that
quantity and of sufficient factors, financial hinder the
type of dietary intake constraints, and attainment of
nutrients to in order to any dietary sufficient
function ensure restrictions with dietary intake.
effectively sustained the help of the MET
(Vix, 2022). success. parent, the meal UNMET
plan can be
optimized to
provide the
necessary
nutrients for the
client (National
Academies of
Sciences,
Engineering, and
Medicine, 2020).
4. School-age
children have
unique nutritional
requirements and
encounter
specific
nutritional
difficulties. By
providing
information and
techniques in
addressing the
particular needs
of this age group,
which can be
determined by
assessing
parental
knowledge,
parents can
encourage
healthy eating
behaviors in
school-aged
children. This
includes
education on the
significance of
eating fruits,
vegetables, whole
grains, and lean
proteins, as well
as balanced
meals, portion
sizes, and food
variety (Kelder
et al., 2018).
Parents are better
able to create a
supportive
environment that
promotes healthy
food choices and
encourages
positive eating
behaviors when
they are equipped
with practical
techniques.
5. It is important
to educate
parents about the
right nutrition for
their children.
Gordon (2021)
asserts that
providing a
variety of
nutritious foods
and setting a
positive example
are the best ways
for parents to
make sure that
their children are
receiving the
vitamins and
minerals they
require. Their
diet should
ideally consist of
fruits, vegetables,
whole grains,
nuts, tofu,
chicken, fish,
eggs, legumes
like beans and
lentils, dairy
products, and
dairy substitutes.
Furthermore,
according to
Braverman
(2019), vitamins
are compounds
that can be found
in both plants and
animals and are
necessary for all
of the cells in the
body to function
normally. The
human body
needs all 13 of
the essential
vitamins in
sufficient
quantities to
function
effectively and
preserve
homeostasis, or
physiological
balance. Due to
this, it's critical
for parents to be
aware of the
vitamins, meals,
and supplements
that their kids
require in order
for them to have
a healthy body
and a boost in
appetite.
6. For health
maintenance and
sickness
prevention,
proper eating is
essential. In order
to give
appropriate
referrals and
interventions, it
is crucial for the
healthcare
professional to
routinely assess
the patient's
nutritional
condition and
identify any
nutritional
concerns or
possible
complications. In
particular, for
patients with
nutritional issues
and those who
are at risk for
deficiencies in
nutrition,
nutritional
assessment is a
continuous part
of daily
assessment
(Feng, n.d.).
Therefore, it's
critical to assess
and record the
underlying
reasons for
nutritional
imbalance in
order to properly
intervene,
conduct
additional
diagnostics, and
run laboratory
tests as needed to
correctly
determine the
root causes and
offer nutritional
assistance.
7. Making a
healthy food
decision requires
understanding the
client's eating
habits. Finding a
dietary pattern
might show a
stronger
relationship with
a certain health
indicator and
enable a more
thorough and
broad knowledge
of how nutrients
and other
bioactive
substances in the
food are used and
how patterns of
consumption
affect health
outcomes
(Scientific Report
of the 2020
Dietary
Guidelines
Advisory
Committee, n.d.).
In this situation,
it's crucial to
assess the client's
eating habits in
order to offer a
healthy dietary
plan.The medical
providers will
have baseline
information from
the patient's
eating habits, will
know what
interventions
might be
beneficial, and
will be better
able to identify
nutritional risk
and deteriorating
nutritional status.
8. Determining
the causes of
decreased
nutrient intake is
crucial since
doing so can
assist in
identifying the
issue's root cause
and aid in the
creation of a
suitable treatment
strategy. It is
critical to
accurately
analyze the
patient's
nutritional intake
because a variety
of factors could
have an impact.
Long-term
illnesses that
result in lack of
appetite, nausea,
vomiting, and/or
changes in bowel
habits (such as
diarrhea), as well
as poverty,
loneliness, and
social isolation,
are some
common causes
of decreased
nutrient intake
(Brazier, 2023).
Failure to thrive
(FTT) is most
frequently caused
by insufficient
calorie intake,
but inadequate
nutrient
absorption or
excessive
metabolism are
also potential
causes.
Furthermore,
some individuals
could consume a
lot of calories but
not sufficient
minerals and
vitamins
(Homan, 2023).
9. It is crucial
that the nurse
consult with the
pediatrician
before referring
the patient. A
pediatrician is a
healthcare
provider who
treats babies,
children,
adolescents, and
young adults
(Eske, 2020).
Pediatricians are
on hand to help
keep children
healthy and to
offer care if a
health issue
arises.
10. Collaboration
with a nutritionist
fosters a
continuity of care
and a
multidisciplinary
strategy. Nurses
and nutritionists
can collaborate to
assist the mother
and client in
achieving their
nutritional
objectives by
exchanging
information,
sharing
assessments and
interventions,
and working in
accordance
(Bleich et al.,
2017). This
collaboration
ensures a smooth
transition of care,
consistent
communication,
and a unified
approach to
optimizing
client’s
nutritional status.
References:
Bleich, S. N., Bandara, S., Bennett, W., Cooper, L. A., Gudzune, K. A., & Bennett, G. G. (2017). Impact
of the quality and safety of hospital food environments on eating behaviors of patients. Appetite,
116, 146-151.
Braverman, J. (2019). Vitamins to Increase the Appetite. LIVESTRONG.COM.

https://www.livestrong.com/article/293798-vitamins-to-increase-the-appetite/
Brazier, Y. (2023, January 11). Malnutrition: What you need to know.

Eske, J. (2020, February 3). What to know about pediatricians.

https://www.medicalnewstoday.com/articles/what-is-a-pediatrician
Feng, C. (n.d.). Focus Assessment: Nutritional Assessment. Pressbooks.

https://oer.pressbooks.pub/healthassessment.montgomerycollege/chapter/nutritional-assessment/
Gordon, S. (2021). Everything You Need to Know About Children's Vitamins and Minerals. Verywell
Family. https://www.verywellfamily.com/children-s-vitamins-and-minerals-5203902
Homan, G. J. (2016, August 15). Failure to Thrive: A Practical Guide. AAFP.

https://www.aafp.org/pubs/afp/issues/2016/0815/p295
Hunter, A., Boytsov, A., Malinowski, K., & Hammoud, R. (2018). Assessing and enhancing patient
satisfaction. Frontiers in Health Services Management, 34(4), 3-11.
Kelder, S. H., Hoelscher, D. M., Barroso, C. S., & Walker, J. L. (2018). Crib-to-college: longitudinal food
intake trends and their relationship to BMI percentile in a diverse sample of children. BMC
Public Health, 18(1), 1-12.
Naryana Health (2019). Importance of balanced diet in a healthy lifestyle.

https://www.narayanahealth.org/blog/importance-of-balanced-diet-for-a-healthy-lifestyle/
National Academies of Sciences, Engineering, and Medicine. (2020). Dietary reference intakes for
sodium and potassium. The National Academies Press.
Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of
Agriculture and Secretary of Health and Human Services. (2020).
https://doi.org/10.52570/dgac2020
Stratton, R. J., Green, C. J., & Elia, M. (2018). Disease‐Related Malnutrition: An Evidence‐Based
Approach to Treatment. CABI.
Vix. (2022, July 24). Balanced diet. Biology Articles, Tutorials & Dictionary Online.
https://www.biologyonline.com/dictionary/balanced-diet
THE EBN PER LEVEL REQUIREMENT
A. EBN FORMAT FOR LEVEL II UP TO LEVEL III 1st SEM

1. General Question
What intervention can be employed to enhance nutritional status and prevent its progression
towards malnutrition?
2. Reconstruction of General Question related to client’s problem identified in the RLE.
Is there greater efficacy in improving nutritional status and preventing malnutrition progression
through the administration of vitamins in addition to dietary modifications as opposed to dietary
modifications alone?
a. COPES (Client-Oriented Practical Evidence Search)
Client type & What might you do Alternate course of

What you want to accomplish
problem action
Pediatric patients Implement an In the event that the To prevent the progression of
who have an intervention like planned intervention malnutrition among pediatric
insufficient dietary health education that fails, a vitamin patients and to maintain their BMI
intake and an discusses the supplement may be at a normal level.
abnormal BMI. importance of administered. The B
increasing fluid vitamins, including B-1,
intake and eating B-2, B-3, B-5, B-6,
healthy foods such B-12, biotin, and folate,
as fruits and are essential for
vegetables to meet maintaining normal
the recommended body weight. They are
daily allowance for considered the best
well balanced vitamins for weight
nutrition. gain, as they are
involved in many
metabolic processes in
the body.
b. PICO
Patient Focus
Intervention Comparison Outcome
population
Children and adolescents Dietary modifications Administration of B vitamins and Iron
aged 9-24 years are the include nutritional vitamins and mineral supplementation have
target population, with a awareness, sufficient fluid supplements such as iron, shown promising results
particular emphasis on intake, and well-balanced calcium, and B vitamins in children in terms of
nutritional status to meals. (B-1, B-2, B-3, B-5, B-6, attention, focus, and
establish indicators of B-12, biotin, and folate) intellect, and they also
malnutrition specifically via tablets, powder appeared to influence
for school-age children. poured on drinks, or weight and mid-arm
The chosen study is snacks. circumference in children
focusing on specific age over the age of six.
groups within this cohort Calcium supplementation
to imply that dietary has been shown to have a
deficiency, and its effects small favorable influence
are common among on bone mineral density
school-age children. and bone mass in children
under the age of 18.
3. Critical Review with Summary of the Literature
Journal: Nutrition in Middle Childhood and Adolescence
Critical Review:
One of the many causes of imbalance in nutrition is the lack of consumption of essential vitamins
and minerals, also known as "micronutrient deficiency." Vitamins and minerals are the building blocks of
good health. People who do not have enough of these nutrients tend to develop nutrient malnutrition
(Center for Disease Control and Prevention, 2021). Inadequate micronutrient intake and growth failure
during the developmental stages of childhood and adolescence can result in growth delays and increase
the susceptibility to chronic diseases in adulthood. Puberty and growth spurts are frequently used in
collaboration to improve macronutrients and micronutrients (Lassi, Moin, & Bhutta, 2017). Protein,
lipids, and carbohydrates are among the examples of macronutrients. While micronutrients are small
nutritional categories that contain vitamins and minerals, such as calcium, zinc, and vitamin B-6, which
young children must consume, the majority of them are lacking (Nall, 2019). The onset of puberty is
typically associated with a period of accelerated growth, which in turn leads to an increased demand for
essential macronutrients and micronutrients. The elevated demands are counterbalanced by a heightened
efficacy in utilizing protein for growth as opposed to fuel. Numerous kids and teenagers consume diets
that are lacking in micronutrients, necessitating the use of appropriate vitamin supplements. Nutrients can
be provided via tablets, powders sprinkled on food or mixed in water, and spreads or snacks (Lassi et al.,
2017).
Given the persistence of iron deficiency anemia, vitamin A insufficiency, and iodine deficiency,
dietary changes, deworming, and malaria nets as public health and disease control interventions, as well
as food fortification with iron and iodine, may be necessary (Lassi et al., 2017). For children, women, and
adolescents, the supplementation of iron has been found to increase concentration, intelligence, and
attention (Lassi et al., 2017). Furthermore, according to Lassi et al. (2017), for children younger than 18
years old, calcium supplementation had a small positive effect on the total body and upper-limb bone
mineral density. Numerous interventions that involve dietary supplements have shown effectiveness at
different ages. However, limited evidence is available for children older than five years old.
As highlighted in Chapter 12 of the book School Feeding Programs in Middle Childhood and
Adolescence, it balanced the use of protein for the growth of these young children. When it comes to
health and nutrition, as suggested, school feeding contributes to the development of young children for
growth and nutrition (Drake et al., 2017). Another discussion that was brought out as being beneficial is
the deworming method for preventing intestinal worm infection, a condition most likely prevalent among
young children. In line with Bundy et al. (2017), the Disease Control Priorities incorporate strategies for
beneficial deworming by applying mass drug administration (MDA) programs for soil-transmitted
helminths (STHs), in which it was noted that formerly historical work reveals significant consequences of
intensive deworming infection on health. In addition, the vaccination was addressed in Chapter 15.
Vaccines have been treated as having been shown to be effective in avoiding conditions such as morbidity,
mortality, malnutrition, and developmental delay in school-age children, adolescents, and adults
(LaMontagne et al., 2017). Meningitis vaccination, measles vaccine, hepatitis B vaccine, tetanus toxoid
(TT), and human papillomavirus (HPV) are some of the immunizations available for school-age children.
There is a notable surge in growth and development, necessitating sufficient nourishment to

facilitate both physical and cognitive progress. During young adulthood, there is an increase in nutritional
requirements due to the onset of puberty and growth spurts. As mentioned above, inadequate nourishment
during these developmental phases may result in impaired physical growth, postponed cognitive
maturation, and heightened susceptibility to chronic ailments in the future.
Studies have indicated that children who adhere to a well-balanced diet consisting of fruits,
vegetables, whole grains, lean proteins, and low-fat dairy products are more inclined to sustain healthy
weight ranges and exhibit superior academic achievements (Basch, 2010). Numerous children in the
developmental stages of middle childhood and adolescence encounter challenges in maintaining healthy
dietary practices, which can be attributed to factors such as hectic schedules or inadequate availability of
nutritious food options. Yet adequate nutrition during the stages of middle childhood and adolescence is
imperative for achieving optimal growth and development. It is recommended that parents facilitate the
development of healthy eating habits in their children through the provision of nutritious meals at home
and the promotion of physical activity. It is recommended that educational institutions prioritize the
provision of nutritious food options within their cafeteria facilities while concurrently imparting
knowledge to students regarding the significance of maintaining a balanced diet.
Summary:
Emphasizing the significance of adequate nutrition during pivotal developmental phases (Lassi
et.al., 2017). The significance of sufficient consumption of fundamental nutrients for the purposes of
growth, cognitive development, and general well-being is underscored. One of the reasons for the
unbalanced diet in middle childhood and adolescence is micronutrient deficiency, which is the absence of
consumption of vital vitamins and minerals. Developmental delays and increased vulnerability to chronic
diseases in adulthood can be caused by inadequate micronutrient intake and growth failure throughout the
early stages of childhood and adolescence. On the other hand, vaccinations or immunization, deworming
procedures, a school feeding program, and parents' facilitation of the development of healthy eating
behaviors in their children through the provision of nourishing meals at home and promoting the practice
of physical activity are all necessary in order to reduce the risk of micronutrient deficiency and the
nutritional imbalance in the young ones.
Also, the paper discussed that there is a global deficiency in the focus on research and the
execution of programs that target the issue of malnutrition among adolescents. At present, the data
collected shows that there is a dearth of effective and established interventions to tackle issues such as
stunting, overweight and obesity, and micronutrient deficiencies. There is a rising concern about the dual
nutritional risks that endanger the health of children and adolescents. In order to effectively combat
malnutrition resulting from deficiencies and prevent overweight and obesity, it is imperative to implement
integrated adolescent health programs. The programs should prioritize the prevention of infections, the
improvement of dietary quality, and the promotion of physical activity. The rising prevalence of
overweight or obese adolescents, along with the negative health outcomes and healthcare costs associated
with obesity, highlights the urgent need for initiatives focused on monitoring and preventing unhealthy
weight gain in children and adolescents.
References:
Basch, C. (2010). Healthier Students Are Better Learners: A Missing Link in School Reforms to
Close the Achievement Gap (Vol. 6). Columbia University.
Bundy, D. a. P., Appleby, L. J., Bradley, M., Croke, K., Hollingsworth, T. D., Pullan, R. L., Turner, H. C.,
&
De Silva, N. (2017). Mass Deworming Programs in Middle Childhood and Adolescence. In The
World Bank eBooks (pp. 165–182). https://doi.org/10.1596/978-1-4648-0423-6_ch13
Drake, L., Fernandes, M., Aurino, E., Kiamba, J., Giyose, B., Burbano, C., Alderman, H., Mai, L.,
Mitchell,
A., & Gelli, A. (2017). School Feeding Programs in Middle Childhood and Adolescence. In The
LaMontagne, D. S., Cernuschi, T., Yakubu, A., Bloem, P., Watson-Jones, D., & Kim, J. J. (2017).
School-based delivery of vaccines to 5- to 19-year Olds. In Disease Control Priorities, Third
Edition (Volume 8): Child and Adolescent Health and Development (pp. 199–210). The World
Bank.
Lassi, Z. S., Moin, A., & Bhutta, Z. A. (2017). Nutrition in Middle Childhood and Adolescence. In The
Nall, R., (2019, December 11). Micros vs. Macros: What they are, diets, and more.
Healthline. https://www.healthline.com/health/food-nutrition/micros-vs-macros
EVIDENCE BASED NURSING

Research journals should be up-to-date (year 2010 and up) from research databases (e.g. EBSCO)
or from original sources. Writing style and citation of sources should follow the APA format.
A. Anatomy of a good clinical question consists of:
Individuals with a body mass index (BMI) below the normal range would make up a group of
underweight patients similar to the client. Usually, individuals who are underweight have a lower body
weight than expected for their height, age, and gender. Underweight patients may have various underlying
factors contributing to their low body weight. Genetic predisposition, metabolic abnormalities,
gastrointestinal issues, chronic illnesses, malnutrition, eating disorders (such as anorexia nervosa), or
certain medications are examples of these. In addition, the researchers emphasize that there are several
variables that can affect the health of a person's overall nutrition, such as the variety of food options
accessible at home, the duration of time available to prepare meals, familiarity with the nutritional value
of food, and the capacity to procure snacks. During the interview, the client confirmed that being thin and
small is within their family genetics. The client also added that he eats three times a day. It can be
possible that the client inherits it from the parents. Furthermore, in the research conducted by Lassi, Moin,
and Bhutta (2017), it was stated that during the early stages of development, stunting, which refers to a
condition of low height for age, and wasting, which refers to a condition of low weight for height, may
delay both the overall growth and the onset of puberty.
During the assessment of the client, it was noted that the client’s age, height, and weight were
known. With this information, it will be easier to compute the client's BMI. Upon computing the client’s
BMI using the CDC BMI Percentile Calculator for Children and Teens, the result is 13.1, which falls in
the underweight BMI category. Aside from that, it can be easily observed through the client’s physical
features that he is thin and small for his age. In fact, childhood undernutrition can lead to persistent
physiological and psychological stress, which can elevate the secretion of stress hormones, impair the
body's immune system, and reduce the production of thyroid hormones and insulin-like growth factor,
both of which play a crucial role in regulating growth (Rytter et al., 2014).
Reference:
Rytter M J, Kolte L, Briend A, Friis H, Christensen V B. (2014). “The Immune System in Children with
Malnutrition: A Systematic Review.” PLoS One 9: e105017. [PMC free article] [PubMed]
B. Intervention, Prognostic Factor or Exposure
The main intervention that the group is considering is to collaborate with a nutritionist to help
the mother learn more about what foods are providing enough nutrients that her body requires. When it
comes to establishing a diet that is both healthy and well-balanced, the advice and assistance of a
nutritionist can be extremely helpful. When considering prognostic factors for an underweight child, there
are several factors that may be taken into account. These factors can help assess the child's current health
status and predict potential outcomes. Here are some prognostic factors that may be considered: the
underlying cause, age, and growth and development pattern. Furthermore, aside from any evidence-based
tool that can be used in assessing the client, it is important to also know his family background, for it can
be the reason since some races are naturally born small and thin and it is hereditary.
What we want to do with the client is facilitate nursing interventions that were originally made by
the student nurses who are assigned to this case. Facilitating nursing interventions is an important part of
this nursing care process because it involves actively supporting and putting into action evidence-based
strategies to improve patient health, prevent illness, and manage their health care needs. Nursing
interventions consist of a wide range of actions that are done to provide holistic care, improve patient
outcomes, and improve general well-being.
C. One of many factors that influence the client’s prognosis is his age. At his young age, he does not
know the importance of having a healthy body. Malnutrition is the most serious effect of food insecurity
among children under the age of ten. According to Govender et al. (2021), acute malnutrition can cause
morbidity, mortality, and disability, as well as impaired cognitive and physical development and an
increased risk of concurrent infections. He also mentioned that physical and mental health development is
a fundamental right of a child, and good nutritional support can help them achieve their optimal level of
health. Other factors are economic status and familial factors. The client stated that his mother is a
vegetable vendor in a public market and his father is a jeepney driver. Given that the parents are busy
working for their daily expenses, they were not able to guide and teach the client to eat healthy foods such
as fruits and vegetables to meet the recommended daily allowance for well balanced nutrition.
D. During the interview, the client mentioned that his father is a smoker therefore, he is exposed to
cigarette smoke. Additionally, upon living in the city, he is also exposed to pollutants that are created due
to human activities such as air and water pollution. According to the World Health Organization (2022),
air pollution is one of the greatest environmental risks to health. By reducing air pollution levels,
countries can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and
acute respiratory diseases, including asthma.
E. The researchers intend to provide nutrition education to our customer in the hopes of influencing him
to change specific nutrition-related behaviors or practices in order to improve his or her health. To
achieve this goal, we will encourage in our client the desire to improve his eating and nutrition habits in
order to create a situation suitable for the development and maintenance of good health. It will be much
easier for him to obtain new nutrition information as well as the attitudes, abilities, and self-assurance that
he needs to cultivate in order to improve the nutrition practices that he already practices. In order to aid
the consumer in avoiding an incorrect diet, the following indicators will be used: 1. Reduce the amount of
sedentary time he spends. Parents should set a daily restriction of no more than two hours for their
children to spend watching television, playing video games, or surfing the internet, because our client
indicated that he spent the majority of his time playing Roblox on his mobile phone. It is important for
children to have quiet time for reading and homework, but parents should also limit their children's time
spent playing video games to no more than two hours each day. Instead, parents should encourage their
children to find pleasant pastimes that require them to walk more, which they can do alone or with other
members of their family (CDC, 2021). According to the Center for Disease Control and Prevention
(2018), children and adolescents aged 8 to 18 spend 7.5 hours per day in front of a screen for enjoyment,
with 4.5 of those hours spent watching television. It does not take into account how much time children
spend at school using computers for educational purposes or how much time they spend at home using
computers for homework. Children should engage in at least one hour of moderate-to-vigorous physical
activity every day, according to the Centers for Disease Control and Prevention (CDC). 2. Encourage your
children to engage in physical activities. Physical activity should be a daily priority for children and
adolescents aged 6 to 17, with a minimum advised quantity of one hour per day. Include aerobic activity,
which can be defined as anything that causes their heart to beat faster. Activities that strengthen bones,
such as running or jumping, are also included, as are activities that increase muscle size, such as climbing
or push-ups (CDC, 2022). 3. Establish and maintain healthy eating habits for himself. Choose lean meats,
chicken, fish, lentils, and beans as protein sources; d. urge your family to drink enough of water; e. limit
sugary drinks; and f. reduce the amount of sugar and saturated fat you consume. To help youngsters
develop healthy eating habits: a. encourage your family to drink plenty of water; b. provide plenty of
vegetables, fruits, and whole grain products; c. Consume low-fat or fat-free milk and other dairy products
such as cheese and yogurt; and d. Choose lean cuts of meat like poultry and fish. Keep in mind that even
seemingly modest changes made on a constant basis can lead to considerable improvements in
performance.
Furthermore, it is recommended that, along with planning ahead for the client’s dietary intake, an
adequate amount of vitamins and minerals be introduced into their new diet. Children require a variety of
foods that include vitamins A and B, calcium, and iron. Moreover, vitamin A promotes normal growth
and development; tissue and bone repair, and healthy skin, eyes, and immune responses. While vitamin B
aids in metabolism, energy production, and enhancing the body’s systems, calcium and iron aid in
strengthening the bones and muscles. These specific vitamins can be obtained from foods like milk and
dairy products such as cheese and yogurt, fresh fruit and green leafy vegetables, protein foods such as
pork and chicken, or whole grains like brown rice and bread (Taylor, 2023).
Patient/Problem Imbalanced nutrition

Intervention Collaborate with a certified nutritionist
Comparison, if any Developing a meal plan
Outcome/s Change unhealthy eating
habits
F. Proposed clinical question:

“In patients with imbalanced nutrition, will collaborating with a nutritionist, compared to
developing a proper meal plan, change past unhealthy eating habits?”
G. Related Literature from research databases (e.g. EBSCO) and other sources.
According to the findings of the Wolde et al. (2015) study, malnutrition is a widespread problem
in economically challenged countries, particularly among school-age children. It is likely that a variety of
factors, including prenatal malnutrition, deficits in both macro- and micronutrients, infections, and
possibly socioeconomic circumstances, contributed to its emergence. When it comes to malnutrition, the
financial toll it exacts on a society is astonishing. According to the World Health Organization (WHO),
being underweight is the single most significant risk factor contributing to the global burden of disease in
underdeveloped countries. This is especially true in countries around the world experiencing fast
population expansion. Child mortality accounts for around 15% of the total number of disability-adjusted
life years lost in nations with a high newborn mortality rate. It has also been demonstrated that reducing a
child's growth throughout childhood results in a 1% loss in adult height, which is associated with a 4%
decrease in productivity. Furthermore, the widespread existence of poor nutrition and health conditions
among the world's children is another issue that adds to the ineffectiveness of educational institutions
worldwide. The current study also revealed that children whose mothers had never received any type of
formal education had a higher likelihood of having underweight and stunted children than children whose
mothers had received any type of formal education. This was not the case for children whose mothers had
received any type of formal education. This could be because stunting is a chronic nutritional problem
that, once a kid is stunted, can be difficult to correct in late childhood. Once a child has been stunted, it
might be difficult to correct it in later childhood. This was discovered in the current study, which
discovered that the likelihood of a child having stunted growth increased as the child's age increased.
According to the findings of this study, having a large family is one of the traits that enhances one's
likelihood of wasting food. Furthermore, neither underweight nor stunted growth was shown to have a
significant relationship with any of the macronutrients or micronutrients studied. A study indicated that
stunted children had a significantly lower average calorie consumption than children of normal height for
their age category. This discovery was made public after the researchers presented their findings at a
symposium in Meghalaya. According to the conclusions of the study titled "Determinants of underweight,
stunting, and wasting among schoolchildren," schoolchildren's undernutrition might be attributable to a
range of causes. Low mother education and the status of the household's ability to access appropriate food
were discovered to be independent predictors of underweight. It was discovered that having a big family
size, inadequate carbohydrate consumption, and a home's status as food insecure were independent
predictors of a low body mass index (BMI) for an individual's age.
Malnutrition is the underlying cause of at least fifty-four percent (54%) of all child mortality
worldwide. The World Health Organization (WHO) defines malnutrition as the ingestion of insufficient,
excessive, or unequal amounts of calories or nutrients. According to a study conducted by Zamora et al.
(n.d.), there were approximately 151 million children worldwide suffering from growth failure in 2017.
Children of school age are among those most at risk of malnutrition because they have particularly high
nutritional needs to meet in order to sustain their growth and development. The fight against child
malnutrition is difficult because it is complicated by the existence of a wide range of various
circumstances. The basic causes of childhood malnutrition are, first and foremost, a lack of appropriate
food supply and, second, improper feeding of children. As a result, there has been a huge increase in the
amount of attention paid to the food consumed by school-age children, as well as the impact that diet has
on their growth.
The Philippines would continue to be one of the countries in the world bearing the greatest
burden of malnutrition (World Bank Group, 2021) . It is the seventh most stunted country in the world,
with 3.6 million stunted children. According to Laguna (2015), the Philippines has the tenth greatest
garbage burden in the world. This is due to the fact that around 769,000 children in the Philippines suffer
from moderate or severe wasting. This places the Philippines at the very top of the list of countries with
the highest burden of resource waste. According to the findings of the 2013 National Nutrition Survey
(NNS), thirty percent of children aged six to twelve were classified as underweight. Despite the fact that
the percentage of underweight children has decreased from 32.0% in 2011 to 29.1% in 2013, this is still
considered a risk to the general public's health. In contrast, a study conducted by the FNRI-DOST (2013)
discovered a 1.7 percentage point increase in the prevalence of overweight and obesity in children
between 2011 and 2013. According to the findings of a study conducted in the Philippines and published
under the title Dietary Risk Factors of Physical Growth of school-aged Children, it is critical that children
be fed a diet rich in nutrients in order for them to reach their full growth potential. Dietary risk factors for
physical growth in school-aged children was the title of the study, which was published in a journal.
According to the findings of this study, eating more sweets, grains, and cereal items was connected with a
lower risk of being underweight. The link between the two dietary categories demonstrated this. This
could be because grains include a high level of fiber as well as a higher number of other critical minerals,
such as iron, zinc, magnesium, and B vitamins, which are needed to improve one's nutritional status. This
could also be because grains have a greater range of vital elements. There is some evidence that a larger
intake of sweets is associated with a lower chance of becoming underweight. When more sugar or
sweeteners are added to foods, the calorie density of those things rises, which could explain the link
between the two. Eating sweets has a higher energy density, which is likely to have a favorable effect on
the quantity of energy that a person consumes overall (Michaelsen KF et al., 2010). While milk and milk
products are the primary sources of protein and fat. Protein and fat are both essential for maintaining a
healthy nutritional condition (Yisak H. et al., 2021). Another finding from this study revealed that
consuming milk and milk-derived products was associated with a lower chance of being underweight. It
was discovered that undernourished children of school age have a considerable protein shortage in their
bodies.
In another study by Tette et al. (2015), on the factors affecting malnutrition in children and the
uptake of interventions to prevent the condition, malnutrition is the major cause of child morbidity and
mortality. Malnutrition is regarded as the most important risk factor for illness and death globally, and it is
associated with 52.5 % of all deaths in young children. According to UNICEF, WHO, and the World
Bank, out of the 161 million under-fives estimated to be stunted globally in 2013, over a third resided in
Africa. In addition, about one-third of the 51 million under-fives who were wasted and the 99 million who
were underweight were also from Africa. Furthermore, although there has been a global decline in
underweight from 25% to 15%, Africa has experienced the smallest relative decrease in prevalence,
going from 23 % in 1990 to 17% by 2013. The researchers conducted the study by attending their local
hospital where 182 malnourished and 189 well-nourished children and their mothers participated in the
study. With this, it was found that Low birth weight, an episode of diarrhea, and the presence of
developmental delay were among the health outcomes linked to malnutrition. The multivariate analysis
showed that among the treatments, insufficient prenatal visits, stalled development, and failure to deworm
one's child were linked to malnutrition. Lastly, malnutrition was not linked to vaccinations or vitamin A
supplements. The researchers concluded that poverty remains as an underlying factor associated with
malnutrition. Additionally, specific and targeted interventions are needed to address this and must include
efforts to prevent low birth weight and diarrhea and reduce health inequalities. Regular antenatal clinic
attendance, deworming of children and growth monitoring should also be encouraged. However, further
studies are needed on the timing and use of information on growth faltering to prevent severe forms of
malnutrition.
References:
Ambient (outdoor) air pollution. (2022, December 19). World Health Organization (WHO).
https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health?gclid
=
Central of Disease Control and Prevention. (2021, October 21). Tips to Help Children Maintain Healthy
Weight. https://www.cdc.gov/healthyweight/children/index.html
Central of Disease Control and Prevention. (2018, January 29). Screen Time vs. Lean time Infographics.
https://www.cdc.gov/nccdphp/dnpao/multimedia/infographics/getmoving.html
Central of Disease Control and Prevention. (2022, January 12). Health Benefits of Physical Activity for
Children.
https://www.cdc.gov/physicalactivity/basics/adults/health-benefits-of-physical-activity-for-childre
n.html
Food and Nutrition Research Institute-Department of Science and Technology (FNRI-DOST). (2013).
Philippine nutrition facts and figures 2013: anthropometric survey. Taguig City, Metro Manila,
Philippines: FNRI-DOST; 2015.
Govender, I., Rangiah, S., Kaswa, R., & Nzaumvila, D. (2021). Malnutrition in children under the age of
5 years in a primary health care setting. South African family practice : official journal of the
South African Academy of Family Practice/Primary Care, 63(1), e1–e6.
https://doi.org/10.4102/safp.v63i1.5337
Laguna E. (2015). Sizing up: the stunting and child malnutrition problem in the Philippines. Philippines:
Save the Children Philippines.
https://resourcecentre.savethechildren.net/node/13449/pdf/save-the-children-lahatdapat-sizing-up-
the-stunting-and-child-malnutrition-problem-in-the-philippines-report-september-2015.pdf
Michaelsen K.F., Hoppe C., Ross N., Kaestel P., Stougaard M., Lauritzen L., et al. (2010). Choice of
foods and ingredients for moderately malnourished children 6 months to 5 years of age. Food
Nutr Bull; 30(3 Suppl): S343–404. doi: 10.1177/15648265090303S303
Taylor, R.B. (2023). Vitamins for Kids: Do Healthy Kids Need Supplements?
https://www.webmd.com/parenting/guide/vitamins-for-kids-do-healthy-kids-need-vitamins
Tette, E.M.A, Sifah, E.K, Nartey, E.T., (2015). Factors affecting malnutrition in children and the uptake of
interventions to prevent the condition. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653928/
World Bank Group.(2021). Undernutrition in the Philippines: scale, scope, and opportunities for nutrition
policy and programming. World Bank.
https://www.worldbank.org/en/country/philippines/publication/-keyfindings-undernutrition-in-the
-philippines
Yisak H., Tadege M., Ambaw B., Ewunetei A. (2021). Prevalence and determinants of stunting, wasting,
and underweight among school-age children aged 6–12 years in South Gondar Zone, Ethiopia.
Pediatr Health Med Ther; 12: 23–33. doi: 10.2147/PHMT.S287815
Zamora , J. A., (n.d.). Dietary risk factors for physical growth in school-aged children. Department of
Science and Technology, Food and Nutrition Research Institute.
https://foodandnutritionresearch.net/index.php/fnr/article/view/7873/14411

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Far Eastern University

Institute of of Health Science and Nursing

Imbalanced Nutrition: Less than body requirements, related to insufficient

Abanilla, Lani Mae

Group 1 – Section 206

May 20, 2023

III. NURSING HEALTH HISTORY

A. History of Present Illness

B. Past Health History

TYPE OF VACCINE RECEIVED NOT RECEIVED DATE: (mm/dd/yyyy)

Hepatitis B Infection/ 03/08/14

Oral Polio Vaccine

Severe Diarrhea caused

Measles, Mumps and 03/17/15

COVID -19 Vaccine

Medications: The client is currently not taking any medications or supplements.

I. Gross Motor Development

Newborn Limbs flexed,

6-8 weeks Raises head to 45 degrees in prone (tummy-time)

6 - 8 months Sits without support (initially with a round back,

10 months Stands independently

12 months Walks unsteadily – a broad gait, with hands apart

15 months Walks steadily

2.5 years Runs and jumps

3 years Walk backwards

4 years Constantly in motion

5 years Throws overhand

6 years Endlessly jump, tumble, skip,and hop

8 years Movements are more graceful

9 years Constantly on the go

6 weeks Follows moving object or face by turning the

4 months Reaches out for toys

4 - 6 months Palmar grasp

7 months Transfers toys from one hand to another

10 months Mature pincer grip

16 - 18 months Makes marks with crayons

14 months - 4 years old Tower of three – 18 months

2 years old - 5 years old Line – 2 years

6 years Can easily tie shoelace

8 years Eyes developed enough to read, making reading a

9 years Writing begins to look mature and less awkward.

III. Hearing, speech and language development

Newborn Limbs flexed,

3 - 4 months Raises head to 45 degrees in prone (tummy-time)

7 months Sits without support (initially with a round back,

12 months Two to three words other than ‘Dada’ or ‘Mama’

18 months 6-10 words

2.5 - 3 years Talks constantly in 3 – 4-word sentences

4 years Has a vocabulary of 1,500 words

5 years Has a vocabulary of 2,100 words

6 years Talk in full sentences

7 years Can tell time in hours

9 years Bathroom language

IV. Social, emotional and behavioral development

6 weeks Smiles responsively

6 - 8 months Puts food in their mouth

10 - 12 months Puts food in their mouth

12 months Drinks from a cup with two hands

18 months Holds spoon and gets food safely to mouth

18 - 24 months Symbolic play

2 years Symbolic play

2.5 - 3 years Parallel play

4 years Enjoy play groups