SCHOOL OF GRADUATE STUDIES R.N. PELAEZ Blvd., Carmen, Cagayan de Oro City
PEDIA CARE CASE STUDY: CHILD DEVELOPMENT ADJUSTMENT
SUBMITTED TO: DR. MARILU DENSING-DIZON SCHOOL OF GRADUATE STUDIES LICEO DE CAGAYAN UNIVERSITY CAGAYAN DE ORO CITY
SUBMITTED BY: RUBELLE MICAH C. SAPONG AUGUST 6, 2014
2 TABLE OF CONTENTS TITLE PAGE
I. INTRODUCTION 3
II. CLIENTS PROFILE 5
A. DEMOGRAPHIC DATA B. HISTORY C. OTHER ASSESSMENT
III. GROWTH AND DEVELOPMENT 6
A. COGNITIVE B. PHYSICAL
IV. RELATED THEORIES 7
A. ABRAHAM MASLOWS HIERARCHY OF NEEDS B. FLORENCE NIGHTINGALES ENVIRONMENTAL THEORY C. SISTER CALLISTA ROYS ROLE ADAPTATION MODEL
V. CONCLUSION 10
APPENDIX
3 I. INTRODUCTION
Autism and Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impaired social interaction, verbal and non0verbal communication, and by restricted and repetitive behavior. According to the Diagnostic and Statistical Manual for Mental Disorders (DSM IV), one of the diagnostic criteria for children with autism is that the symptoms must already be apparent before they reach the age of 3. It is one of the recognized disorders under the Autism Spectrum Disorders (also known as Pervasive Developmental Disorders) along with the other two disorders which are Retts disorder, a pervasive developmental disorder which is characterized by the development of multiple deficits after a period of normal functioning; and Aspergers disorder, which is characterized by the same impairments of social interaction and restricted stereotyped behaviors as seen in autistic disorder, but there are no language or cognitive delays in development.
Children with autism display little eye contact with and make few facial expressions towards others; they use limited gestures to communicate. They also have a limited capacity to relate to their parents and as well as towards their peers. They also lack spontaneous enjoyment, express no moods or emotional affect, and they cannot engage in play or make-believe with toys. These children engage in stereotyped behaviors such as hand flapping, body twisting, or head banging.
Research has showed that 80% cases of autism are early onset, with developmental delays starting in infancy. The other 20% of children with autism have seemingly normal growth and development until 2 or 3 years old, and then they start to have a developmental regression or loss of abilities. They stop talking and relating to parents and peers and begin to demonstrate the behaviors described previously.
Autism is linked with genetics; many children with autism have a relative with autism or autistic traits. Controversy continues about whether measles, mumps, and rubella (MMR) vaccinations contribute to the development of late-onset autism.
Autism tends to improve, in some cases substantially, as children start to acquire and use language to communicate with others. In adolescence, if the behavior starts to deteriorate, it may reflect the effects of hormonal changes or difficulty meeting increasingly complex social 4 demands. Autistic traits persist into adulthood, and most people with autism remain dependent on some degree to others.
This case analysis is focused on the diagnosis of patient P. Patient P is a patient diagnosed with Autism Spectrum Disorder. When he was around 1 year old, his parents discovered that he hasnt spoken a word. His parents wondered if there was something wrong with their child because they know a child who is the same age as their son and that child can already speak a few words but their son has always been silent. They decided to bring their child to a pediatrician. The pediatrician informed them that it is wrong to compare their childs development to another child because each childs development varies. The pediatrician told them to come back after 6 months if the child has still not spoken a word by then. After 6 months, they returned and the pediatrician referred them to a speech therapist. After 6 months of therapy, patient P showed no signs of improvement and they were referred to a psychiatrist in Cebu. Patient P was then diagnosed with autism. The parents were advised to bring patient P for regular check-up every 6 months.
At the age of 4 years the specialist Dr. VD diagnosed patient P with Autism Spectrum Disorder. This case analysis shall discuss the progress of patient P, specifically his growth and development and as well as the different theories that can be associated with Autism Spectrum Disorder. The theories that are going to be used in this case analysis are, Florence Nightingales Environmental Theory, Abraham Maslows Hierarchy of Needs, and Sister Callista Roys Role Adaptation Model .
5 II. CLIENTS PROFILE
A. DEMOGRAPHIC DATA NAME: Patient P AGE: 8 years old SEX: Male DATE OF BIRTH: November 6, 2006 HOME ADDRESS: Brgy. Carangan , Ozamis City RELIGION: Roman Catholic CURRENT EDUCATIONAL LEVEL: Elementary Level DIAGNOSIS: Autism Spectrum Disorder
B. HISTORY
When patient P was around one year old and a few months, his parents noticed that he had not spoken a word and they found it odd. The parents decided to bring patient P to a pediatrician. The pediatrician informed the parents that there are times when children have delayed language development, the pediatrician told them to observe patient P for a few more months and return for follow-up check-up after 6 months.
After 6 months of observation, the parents brought patient P back for follow-up check-up and the pediatrician referred them to a speech therapist to help patient P cope with his communication problem. After month of therapy, the therapist observed that patient P was not getting any better and the therapist asked them to visit a specialist in Cebu.
When Patient P was 4 years old, patient P was diagnosed with Autism Spectrum Disorder by the specialist Dr. VD.
C. OTHER ASSESSMENT
Patient P shows a lot of concentration when he watches television. He sometimes displays crying outbursts and temper tantrums. He is very active and is always jumping around the room. He does not have any visible lesions or other signs of disruption of his skin integrity.
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III. GROWTH AND DEVELOPMENT ASSESSMENT
A. COGNITIVE In the school age years, children are growing and developing rapidly. In terms of their cognitive abilities, they are now starting to understand the value of money. They also now have longer attention spans and they are starting to grasp the concept of space. These are examples of the normal cognitive development of a school age child. In Patient Ps case, he does not have the cognitive abilities of a normal school age child because he has Autism Spectrum Disorder which causes children who are afflicted with this disorder to have a delayed development, specially their cognitive/ adaptive development. Normal children are able to articulate their feelings well, and they also have increased number of words in their vocabulary. However, Patient P can only utter the words mama and papa despite his age. He has difficulty in communicating which is one of the reasons why he has poor tolerance towards frustration. His attention span is fleeting. He cant make eye contact for more than 3 seconds. He cant tell the time, which means that he must never be left unsupervised because he will not eat on his own accord. However, he is able to understand and perform simple tasks such as closing and opening of the windows and turning on the television. He is also able to follow simple instructions.
B. PHYSICAL In the school age years, children grow rapidly in terms of their physical attributes. They start to gain a lot of weight and they are growing taller by the day. They also have improved control over their body, especially when it comes to their hand-eye coordination and as well as their agility. Patient Ps height and weight are within the normal range of an average school age child. However his fine motor and gross motor control is not as good. He cant lift objects that are not that heavy such as plastic chairs and the like. His control over his hands is also not that good, he cant grasp objects properly; his hold is weak. His gait is slightly concentrated on the right side. He jumps all around the place, which is one of his steorotypic behaviors.
7 IV. RELATED THEORIES
A. ABRAHAM MASLOWS HIERARCHY OF NEEDS
Abraham Maslow made a theory regarding the general needs of humans. He derived a hierarchy of these needs. Basically, in order to ascend in the hierarchy, one must have met the needs of stage before that. There are 5 stages in the hierarchy; the physiological needs, safety and security needs, love and belongingness needs, self-esteem, and self- actualization.
In the case of patient P, his needs are mostly met by his family, specially by his parents. The parents have established a daily routine for him, in order to let him participate in meeting his needs. Patient P has difficulty in communication; therefore, he cannot inform his parents when he is feeling hungry. The established routine helps his parents feed him on time and it also helps Patient P meet his physiological needs. With the love and support provided by his family, he has achieved his safety and security needs, as well as his love and belongingness needs. Since patient P has difficulty in communication and social interaction, I am not quite sure if he has already achieved the other 2 stages of the hierarchy of needs.
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B. FLORENCE NIGHTINGALES ENVIRONMENTAL THEORY
Florence Nightingales environmental theory emphasizes on the manipulation of the environment in order to help patients recover fully. Back in the day, Nightingale observed that patients who were treated in a clean environment were most likely to recover faster than the ones who were treated in a dirty environment. She established the fact that the environment can greatly affect a patients health.
In the case of patient P, his primary physician Dr. VD advised his parents to manipulate his environment in order for him to maximize his potentials. The parents have established a routine for patient P to follow, in order to meet his basic needs. Certain activities were also encouraged for patient P, in order to help with his development; such as the beading therapy- which involves making patient P use beads and insert it into a thread, this activitys goal was to improve or to increase his attention span and improve his control over his hands. The manipulation of patient Ps environment has made him docile unlike other patients with the same disorder. People with ASD (Autism Spectrum Disorder) lack the ability to recognize danger and their response to pain is not normal; these people are also very hyperactive and they are very susceptible to falls and other accident-related injuries. That is why it is very important to control the childs environment to keep him safe.
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C. SISTER CALLISTA ROYS ROLE ADAPTATION MODEL
Roy's model of nursing sees an individual as a set of interrelated systems, biological, psychological, and social. The individual tries to maintain a balance between each of these systems and the outside world. However, there is no absolute level of balance. According to Roy we all strive to live within a band where we can cope adequately. This band will be unique to an individual. The adaptation level is the range of adaptability within which the individual can deal effectively with new experiences.
Input Control Processes Effectors Output
FEEDBACK Diagram 1. Roys Adaptation Model
Children who do not have developmental problems are able to cope normally whenever they experience stressors or stimuli in their daily lives. Patient P has delayed development which means that his coping is not as good as those of normal children. When he wants something, he has difficulty in expressing which makes it hard for his caregivers to understand him, his coping is manifested through his tantrums and sometimes because of the gap in communication, he ends up not getting what he wants. The next time he wants something, he might not express them anymore because he wont be able to express it anyway which makes him more agitated and restless. Frustrations also cause him to make ineffective response to stress, an example of which is his sudden outburst crying and his throwing fits and temper tantrums. Stimuli Adaptatio n Level Coping processes
Cognator
Physiological Functions
Self-concept Role Function Interdepende nce Adaptive and Ineffective Responses 10 V. CONCLUSION
Generally, studies have shown that patients with Autism Spectrum Disorder can survive with the assistance of their significant others. Studies have also shown that there are some patients who are able to function effectively that they could even get married.
Through proper management and supervision, it is highly possible for Patient P to obtain his optimal functioning. Also, it is also important to follow through the therapies and routines that have been prescribed and set-up for him. Even though his progress is slow, the important thing is he is still developing and improving even if his improvement is significantly slower than normal. It is important to continue to provide positive reinforcement and also provide a safe environment for him to exist in. Also, it is also important for him to continue to interact with new people in order to improve his social skills. The doctor has recommended that Patient P should continue to attend school as long as he can because it will help him greatly with his social skills training. It is also important to show a lot of patience in dealing with him and with other people who are also mentally or physically challenged.
The Filipino culture does not deal with disabilities well, that is why it is important for medical professionals to maintain an unbiased view of our patients. It is heartbreaking to think that the society shuns those who are different and are treated as filthy beings. We, as nurses may not be able to change the world, but in our little ways we can somehow show our patients and their families that we wont judge them no matter who they are, and that despite of all their imperfections, we will care for them.