Question

fill in graph and answer questions #1-5.

Case Study 2 Toddler A 2.5-year-old girl, Mia, was seen at your clinic with her 22-year-old mother, the child's aunt, and a young cousin. She was developing normally but had not grown as expected over four months, which was concerning. The pediatrician did not find a medical basis for the growth plateau. Mia was offered appropriate foods in appropriate serving sizes, but she mostly was throwing it on the floor or refusing it with crying tantrums. She liked to drink juices from her sippy cup throughout the day. She carried the cup with her most of the time. The family was sure it was not enough for her, but did not limit her intake because she ate little else. Eventually the aunt mentioned that Mia used to eat well when living with her grandparents. With sensitive review of the child's social history, it became clear that the child had been living with her grandparents while the mother was incarcerated. Her mother had cared for Mia until eight months of age. Mia then went to live with her grandparents for 18 months until her mother's release, at which time she and her mother moved into their own apartment. Mia had not seen her grandparents for the last several months. Assessment and recommendation: After confirming that no nutritional or medical basis was involved, family disruption was considered the basis for the growth plateau, as a result of interfering with Mia's hunger and appetite. The change in Mia's eating coincided with the time of a sudden change in her life. From the child's viewpoint, her grandparents and their home were suddenly replaced by a new person and a new setting Date Magheight for lege Length oth Height Height for weight for ength height% ler Beth 175 12 months RS 3 025 114.75"

Answer 1

Age	50th percentile weight for male babies	50th percentile weight for female babies
Birth	7.8 lbs. (3.5 kg)	7.5 lbs. (3.4 kg)
0.5 months	8.8 lbs. (4.0 kg)	8.4 lbs. (3.8 kg)
1.5 months	10.8 lbs. (4.9 kg)	9.9 lbs. (4.5 kg)
2.5 months	12.6 lbs. (5.7 kg)	11.5 lbs. (5.2 kg)
3.5 months	14.1 lbs. (6.4 kg)	13 lbs. (5.9 kg)
4.5 months	15.4 lbs. (7.0 kg)	14.1 lbs. (6.4 kg)
5.5 months	16.8 lbs. (7.6 kg)	15.4 lbs. (7.0 kg)
6.5 months	18 lbs. (8.2 kg)	16.5 lbs. (7.5 kg)
7.5 months	19 lbs. (8.6 kg)	17.4 lbs. (7.9 kg)
8.5 months	20.1 lbs. (9.1 kg)	18.3 lbs. (8.3 kg)
9.5 months	20.9 lbs. (9.5 kg)	19.2 lbs. (8.7 kg)
10.5 months	21.6 lbs. (9.8 kg)	19.8 lbs. (9.0 kg)
11.5 months	22.5 lbs. (10.2 kg)	20.7 lbs. (9.4 kg)
12.5 months	23.1 lbs. (10.5 kg)	21.4 lbs. (9.7 kg)

2.

There may be genetic risk factors and a combination of environmental, social and cultural factors. It's likely that some people are more vulnerable to anorexia because of particular personality traits.

The causes that may contribute to a person developing anorexia nervosa include:

Psychological factors, such as a high level of perfectionism or obsessive-compulsive personality traits, feeling limited control in life and low self-esteem, a tendency towards depression and anxiety and a poor reaction to stress.

Environmental factors, including the onset of puberty, stressful life events and relationship problems.

Cultural pressures to be thin stemming from media and pop culture such as magazines, TV shows and movies.

Occupations that demand a thin physique may increase the risk of anorexia nervosa, such as certain sports, ballet, or the television and fashion industries.

Brain chemistry, extreme dieting can affect the balance of hormones in the body, affecting how the brain functions.

Genetic predisposition, which arises from the genes inherited from parents. Anorexia nervosa often runs in families, suggesting there may be a genetic cause.

3.

• Failure to thrive is slow physical development in a baby or child. It’s caused by a baby or child not having enough nutrition.

• A child with FTT is at risk for problems such as short height, behavior problems, and developmental delays.

• FTT has many possible causes. A baby or child may not be getting enough nutrients and calories. Or a baby or child may take in enough food, but not be able to absorb enough nutrients and calories.

• A baby or child with an ongoing (chronic) health condition may also need more calories and nutrients than normal.

• In some cases, a family may not understand what a baby needs. In severe cases, neglect or abuse may lead to FTT if food is kept from a baby on purpose.

• FTT can be prevented by seeking early help with a child’s nutritional needs.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice

4.

imbalanced nutrition: less than body requirements:

• abdominal cramping
• abdominal pain (babies express pain by crying)
• aversion to eating
• body weight 20% or more under ideal
• capillary fragility
• diarrhea
• excessive loss of hair
• hyperactive bowel sounds
• lack of food
• lack of information
• lack of interest in food
• loss of weight with adequate intake
• misconceptions
• misinformation
• pale mucous membranes
• perceived inability to ingest food
• poor muscle tone
• reported altered taste sensation
• reported food intake less than rda (recommended daily allowance)
• satiety immediately after ingesting food
• sore buccal cavity
• steatorrhea
• weakness of muscles required for mastication
• page 148, nanda-i nursing diagnoses: definitions & classification 2007-2008

nursing interventions are of 4 types:

• assess/monitor/evaluate/observe (to evaluate the patient's condition)
• care/perform/provide/assist (performing actual patient care)
• teach/educate/instruct/supervise (educating patient or caregiver)
• manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

since the child is below ideal weight, one of your interventions is going to be regular weighings. you also might want to be assessing for some of the signs and symptoms of continuing "imbalanced nutrition: less than body requirements" by looking at ones you feel are pertinent from the listing above, such as dry mucous membranes. i would have the parent start out with keeping a food diary so an analysis can be made of just how much the baby is eating which can be correlated with a weight that was taken. then, a diet can be set up for the parent to follow. perhaps the caregivers need education. perhaps you need to bring a dietician or speech therapist (if there are swallowing problems) in to consult. goals can then be figured out from that: either no further weight loss or a moderate weight gain of 1 pound in a few weeks, determination of a diet that the parents will follow by the end of a specific period of time, remaining free of specific signs and symptoms of malnutrition, etc.