Family Assessment Project

Part I: Family Health History

Family Assessment Guide

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Part II: Individual Health Needs:

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Daily health-promotional practices: 

Nutrition

(Nutrition concerns, 24-hour diet recall, food insecurity)

CB underweight at 41lbs for a 7-year-old. He is extremely picky and will not try new foods.  He typically eats a cheese sandwich, pizza, yogurt, or waffles as meals. Lunch is the priority meal whereas dinner is a smaller meal.

Exercise 

Family exercises 3-5 days a week. CAB is involved in multiple sports activities including soccer, basketball, t ball, and running club. He is involved in martial arts camp, swimming, and tennis camp during the summer. CAB is involved in many activities dues to hyperactivity but has not been diagnosed with any attention deficit. 

Hygiene

Bathes daily, brushes teeth 2xs a day. Able to dress himself appropriately for the weather.

Sleep patterns

Goes to bed at 9pm and gets up 8am on school days. Sometimes on weekends he goes to bed at 10pm and gets up at 9 or 10am. The family goes to bed at the same time.

Leisure activities

CAB plays with friends and likes to visit family at the beach. The family will take walks with the family dog and will go on bike rides with his mother. The TV is limited at the home to educational shows and books are preferred to TV. Books are challenging for CAB because he has difficulty sitting still for extended periods of time.

Childcare

CAB goes to school 5 days a week and 3 days he goes to aftercare for socialization because he is the only child. He also is involved with running club and soccer on the days he is not in daycare.

Socialization 

CAB has close friends that come over for play dates a few times a month. He attends age-appropriate birthday parties and social functions. Though CAB does not have siblings or close cousins, he often engages in playdates in the neighborhood or with children in his classroom.

Prenatal care (current and/or past)

Mother received full prenatal care during pregnancy that included doctor visits, blood work, ancillary testing, and prenatal vitamins. Pregnancy had a normal course for the baby, mother developed pregnancy tumors inside of her mouth at week 36. CAB was induced at 40 weeks due to tumors return after initial removal.

Family planning used (past or present)

Family is complete. CAB will be the only child due to the age of the parents. Mother is currently using the pill method form of birth control.

III. Resources

Financial data (sources of income, financial assistance, major expenditures): both parents work full time. Father works part-time at home and the mother works outside of the home. The family has a mortgage, currently paying one car, insurances, utilities, food and aftercare/summer camps.

Sources of medical and dental care: Mothers’ employer provides full medical and dental benefits which the family takes advantage of and utilizes for maintaining a healthy lifestyle.

Community resources: The family takes advantage of the community farmers market, summertime events, and recreation center.

IV. Interpersonal Needs

Parent-child relationships: CAB is close with both mother and father. The mother is more involved in the day to day care of the child. Father takes care of the child when the mother is working.

Spousal relationships: CAB’s parents have been married for 14 years.

Sibling relationships: CAB is the only child. CAB would like to have a sibling, but parents have completed their family.

Who is close to whom? CAB is close with the nuclear family and extended family. CAB frequently visits grandparents in Seattle and Florida. He will also take vacations in Texas, California, and Florida to visit aunts, uncles, and cousins.

Relationship Issues

Concerns about elders: Grandparents are aging but currently can care for themselves.

Are parents/grandparents caring for other dependent family members? No.

Are children responsible for other family members? No.

V. Environment

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VI. Family Needs

What needs are identified by the family?

Parents identified the need for more community-based resources including affordable daycare, aftercare and activity programs could be present or identified within their community. Additional routes to school or biking trails to promote safety within the city of Takoma Park. 

VII. Analysis (Refer to Handouts from Class 1)

A. What stage is this family in?  School-age stage. 

What data support this conclusion?  CAB is the only child at the age of 7 years. CAB’s parents are focused on his school achievements and progressing to the next grade level in school. In studying behavior, it's known that socialization both in and outside of the home is essential to the growth and development of this school-aged child, and he has ample opportunities for socialization through his involvement in sports and other extracurricular activities.  Additionally, the parents are focused on their careers but also balancing the quality and quantity of family time. They seek to provide a safe and nurturing environment for CAB so that he feels safe and can grow. 

B. At what level is this family functioning? Adult Family.

What data support this conclusion? The family is well organized, and parents provide physical and emotional security for their child.  Both parents provide income to the family unit and engage in family planning for the future which includes college for CAB. They address the family crisis in an appropriate manner that involves collaboration and will seek outside help from extended family if necessary. When problems arise, this family addresses them in an appropriate manner that resolves the problem effectively. The family assumes appropriate family roles that foster CAB to progress through developmental stages. This family is focused on guiding CAB through his development in a safe and nurturing manner.

C. What are this family’s strengths?

The family is structurally sound to provide the best environment for CAB to grow into a successful and contributing member of society and his community. The parents promote an active lifestyle while balancing the time spent with each other and extended families. They provide many opportunities for CAB to socialize and to expend his excess energy due to hyperactivity. These activities also allow CAB to grow mastery and learn to feel a sense of accomplishment.  This family lives in a comfortable, safe environment that will allow CAB to thrive. 

D. What needs are identified by the nurse?

Needs include:  

1. Healthy nutritional guidance for CAB’s excessive snacking and stressing the importance of family meals with a variety of food options for CAB. CAB is a picky eater and he requires assistance in attaining adequate nutrition for healthy growth and development.

 2. Child safety: CAB is engaged in a number of extracurricular activities such as soccer, martial arts, visiting the beach, and biking. Therefore, a few goals include using safety equipment to prevent accidents and use helmet, knee and elbow protection for biking.  Pool and Beach safety including the use of sunscreen and enrolling child in swimming lessons to prevent drowning. 

3. Discuss with the family the importance of social relationships due to extended family not in close geographical proximity and CAB being the only child in the family. CAB wishes for a sibling, but his parents have completed the family due to their age. CAB should be provided with social opportunities to expand his social skills as he is an only child. 

E. Family nursing diagnoses (NANDA format):

• Infective child feeding dynamics r/t inadequate food intake both in quality and quantity a.e.b. poor nutritional choice, and excessive snacking. 

• Impaired social interactive r/t child’s desire to have a sibling. 

• Risk for injury r/t multiple sports activities.

• Risk for fall r/t family biking activities

• Risk for delay in growth and development r/t hyperactivity and lack of concentration.

Part II Genogram/Pedigree  

I. Important life events

• Bought family home 2003

• Marriage in 2004

• Significant maternal career change 2009

• CAB born 2011

• Paternal mother death 2012

The Interview Process

To obtain the information necessary to fill out the Family Assessment Guide, I interviewed CAB and his mother KRB in their home. KRB and CAB were cooperative and open to answering questions about family history. They reacted to questions in a calm, helpful manner and KRB was very straightforward in her answers. The interview was conducted by having a conversation with KRB and CAB and pulling the necessary data from their discussion. If more information was needed, or if we needed to touch on a specific topic more explicitly, I asked questions to guide them towards the information needed. The interview was completed in a timely manner without repeating questions, being redundant, or drawing things out unnecessarily. I was able to keep KRB and CAB focused on the task at hand and we did not wander off topic into irrelevant information. CAB proved to be an avid story-teller who could follow through a story from beginning to end. He demonstrated ample verbal abilities in giving a narrative and talking about his interests.

Summary of Family

The family consists of CAB and his parents KRB and MB. KRB is 41 years old and MB is 52 years old. For this reason, the couple has completed their family with CAB. CAB’s maternal grandparents are both still living. His paternal grandfather is still living, but his paternal grandmother is no longer living. Family interactions seem to be warm and there are structure and stability in the household. CAB is aware of rules and generally follows them and his parents are reasonable, kind, and firm. 

In the family, there are some health issues that repeat throughout generations. The genogram shows a few of these issues. Hypertension is a recurrent problem, as is diabetes. Diabetes tends to run in the maternal side of the family, whereas hypertension appears on both sides, which indicates CAB may be at risk for hypertension as he ages. Osteoporosis and arthritis both show up on both sides of CAB’s family, indicating he may be at risk for bone and joint problems later in life. Dementia is present on both sides of the family as well, affecting the maternal great grandmother and the paternal grandmother, which could indicate that CAB has inherited risk for these diseases. In the family, there is also a history of fatal heart attack and liver cancer.

Family strengths include a dedication to exercise and physical activity and a limitation of screen time for CAB. Additionally, they are financially sound and living in good conditions that provide safety and security. They have no concerns about the safety of their neighborhood, the cleanliness of their water, or of any other environmental toxins. There is no abuse or violence in the home.  

Self-reflection/evaluation

I was generally confident about completing this interview. Even though I know CAB and his mother, I was somewhat apprehensive at first, but once I got into a good rhythm, the process felt more natural. Being in the position of a healthcare provider can sometimes feel awkward, as I am still getting used to how patients respond to people in positions of relative power. In terms of what I did well in the interview, I feel like I did well in prompting CAB and KRB for information without reading questions directly off the interview sheet. I tried to use the interview sheet as a guide rather than reading off each question and waiting for a response. This resulted in a much more natural conversation that put both me and my interviewees at ease. One thing I would like to do differently next time is that I would like to spend more time completing the relationship issues and interpersonal needs assessments. We only touched on those issues briefly, but I know that relationships are extremely important in family dynamics, so I would like to be better able to capture that when I am doing a patient interview. From this process, I learned how to gather information from a patient without reading directly off a worksheet. I learned how to guide the conversation, so I can get the information I need to complete my assessments. I learned how to communicate with a child and with a parent.

Pediatric Assessment

Summary of Development

Physically, CAB is small for his age. As shown in the growth charts above, he falls into the 10th percentile for both height and weight, coming in at 116 cm tall and 19.5 kg. His small stature may be related to his picky eating, as lack of adequate nutrition can lead to deficiencies in growth. Though he is small, he is otherwise healthy. As shown above, assessments indicate that he is developing in a normal and healthy way, with all exam parameters within normal limits.

CAB’s language skills are appropriate for his age. His primary language is English, and he speaks at an age-appropriate level. His syntax and grammar are developing at a normal rate. and he speaks in complete, coherent sentences without gross errors in composition. He can give a narrative that has a definitive beginning, middle, and end, indicating he understands time and is developing skills in organization and verbalizing his thoughts. 

His gross motor skills are age appropriate as are his fine motor skills; he can walk, balance, throw and catch, color, and write at a level that is appropriate for his age. He participates in multiple sports that are helping to hone his gross motor skills. He participates in soccer, martial arts, bike riding, and running, all of which are helping him develop motor skills. As noted above, his fine motor skills are age appropriate; his writing is developed to the level one would expect of a first grader, and his ability to  

CAB’s social skills are well developed. He spends time socializing with friends via playdates and school. He is close with his family and enjoys socializing with cousins, aunts and uncles, grandparents, and of course his parents.  

Social and Cognitive Development

Erikson identified eight developmental stages. At age 7, CAB is in the “Industry vs. Inferiority” stage. During this stage, children begin to take pride in accomplishments, acquire a sense of personal competence, begin to become more independent, and seek peer approval. In this stage, they need to learn that they cannot be the best at everything, and there is always more to learn. This is the industry side of the equation. On the inferiority side, children may feel inferior because they cannot master certain tasks. Inferiority may occur when a child is unprepared to assume the responsibility of having a sense of accomplishment.

CAB fits into this developmental stage. Through his participation in sports and socialization with friends, he is developing independence from his parents. In sports, he is learning that sometimes you are on the losing team, but he is also learning to feel a sense of accomplishment in winning. CAB demonstrates industry by committing to his sports. He shows pride in accomplishments such as sports victories and doing well in school. CAB shows some inclinations towards seeking peer approval as he values the opinions of his friends. For example, he wants to do well in his martial arts class so that he can impress his friends. Through his various extracurriculars, he is learning that he will not always be the best at an activity and that he can always strive for improvement to do better.

Piaget posits that there are four stages of cognitive development: the sensorimotor stage, which occurs from birth to 2 years, the preoperational stage, which occurs from age 2-7, the concrete operational stage, which occurs from ages 7-11, and the formal operational stage, which occurs from ages 12 and up. At age 7, CAB exists somewhere between the preoperational stage and the concrete operational stage. In the preoperational stage, children begin to think symbolically and learn to use words and pictures to represent objects. Children at this stage tend to be egocentric and struggle to see things from the perspective of others. In this stage, children are improving their language and thinking skills, but they are still thinking in concrete terms. Piaget suggests that significant cognitive development occurs from ages 7-11 during the concrete operational stage. During this time, children begin to use thought processes to experience events and actions, develop an understanding of relationships between things and ideas, they become able to make judgments based on reason and they become able to consider alternative solutions and solve problems. Also, during this time, conceptual abilities become flexible and children become able to see other’s points of view. They become aware that there are multiple perspectives to any situation. Finally, they begin to develop logical thought and morality. 

CAB seems to be in the early stages of the concrete operational stage. He is beginning to be able to consider alternative solutions to problems and his judgment is beginning to develop. He is beginning to understand “right” from “wrong” and he knows that some behaviors are hurtful to others. He is still not quite able to see things from another point of view, and as far as he understands things, the way he perceives reality is simply the way that reality is. In that regard, he is still in the preoperational stage. He has the beginnings of logical thought, which plays out during sports where a player must consider their options before making a move. He is beginning to be able to solve problems when they arise. CAB seems on track to fully develop the cognitive skills in the concrete operation stage within the next couple of years.

Evaluation 

I believe that CAB has met appropriate developmental milestones. While he is underweight, he is not so malnourished that he is in danger of adverse health outcomes. He is in need of healthy nutritional guidance for his excessive snacking, and it is important to stress the importance of family meals with a variety of food options for CAB, who is a picky eater. In terms of other physical milestones, his gross and fine motor skills are developed to an age-appropriate level. He can walk, run, balance, and jump without difficulty. He can write and color at a level appropriate for a seven-year-old child. 

CAB’s language skills are developed to an age-appropriate level. He can use language effectively to communicate what he wants and needs from others. His syntax and grammar are developed to an age-appropriate level as well. CAB can tell stories that have a clear narrative with a beginning, middle, and end, indicating he understands time and logical organization. He has a good sense of humor and enjoys joking around with his family and his friends, indicating an understanding of the language and subtleties of humor.

Socially, he is a very engaged child with friends in a variety of situations. He is extensively involved in sports and other activities, partly to help cope with hyperactivity. Still, this affords him ample opportunities to socialize and he is developing normally in that regard. He is exploring relationships and becoming more independent from his parents, as Erikson suggests will happen in this developmental stage. 

Cognitively, he is on track, as he is beginning to develop logical thought and the ability to see things from other perspectives. However, these abilities are just beginning to develop. Piaget suggests these developments occur between ages 7-11; at age 7, it would be expected that CAB would only be in the beginning stages of this developmental stage. However, CAB has reached all of the milestones of the previous developmental stage with Piaget says occurs from ages 2-7. In the preoperational stage, children begin to think symbolically and learn to use words and pictures to represent objects. CAB demonstrates age-appropriate symbolic thinking and he has no trouble determining the relationship between a picture of an object and an object. In that regard, I would say he has met all cognitive milestones for his age.