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BSN 4B
HEALTH TEACHING PLAN FOR INFANTS, TODDLERS, PRESCHOOLERS, SCHOOLERS, AND ADOLESCENTS BASED ON THE
FOLLOWING:
GENERAL HEALTH TEACHING
1. INFANT
a. NUTRITION
(Kramer et al., 2003; Kramer & Kakuma, 2002) as well as respiratory tract
infections (Chantry, Howard, & Auinger, 2006). The breastfeeding mother
also benefits from exclusively breastfeeding her infant to six months. Her
weight loss is more rapid after birth and there may be a delayed return of
menses (Kramer & Kakuma, 2002).
How long to continue breastfeed is an individual choice, although it is
recommended through the entire first year
b. Second 6 months
Introduce solid foods while still continuing breastfeeding
The entire first year of life is one of extremely rapid growth, so a high
protein, high calorie intake is necessary.
Early weaning from breast feeding can lead to an increased incidence of
obesity.
For infants whose mothers choose not to breastfeed, a commercial iron
fortified formula will supply adequate nutrition.
Supplementation is unnecessary with iron fortified commercial formula
unless the water supply does not contain fluoride.
c.
infants kidneys with a heavy solute load that can occur when protein is
ingested.
Infants are physiologically ready for solid food when they are nursing
vigorously every 3 to 4 hours and do not seem satisfied or taking more than
32 oz (960 mL) of formula a day and do not seem satisfied.
Introduce one food at a time, waiting 5 to 7 days between new items.
Introduce the food before formula or breastfeeding when an infant is hungry.
Introduce small amounts of new food (1 or 2 tsp) at a time.
Respect infant food preferences; a child cannot be expected to like all new
tastes equally well.
Use only minimal to no salt and sugar on solid foods to minimize the number
of additives.
Remember that the extrusion reflex is present for the first 4 to 6 months of
life, so any food placed on an infants tongue will be pushed forward.
To prevent aspiration, do not place food in bottles with formula.
Introduce foods with a positive, Youll like this attitude.
e. Weaning
To wean from formula or breast milk, choose one feeding a day and then
begin offering fluid by the new method at that feeding
Choose a time of day that is not an infants fussy period
After 3 days to 1 week, when an infant has become acclimated to the one
change, change a second feeding
Should an illness such as an upper respiratory infection occur or should the
child have teething setbacks, so no set number of weeks should be
prescribed to complete weaning
Infants usually need more fluid during hot weather than cold weather
because of increased perspiration this may make it more difficult to begin
weaning during summer.
f. Self-feeding
Can be started at approximately 6 months of age
There is great deal of spilling during feeding due to underdeveloped
coordination
Spread newspapers, a plastic tablecloth, or a towel on the floor around a high
chair to catch most of the dropped food, and then let the child practice.
Let the child take in charge of the feeding
When infants no longer attempt to feed themselves at a meal but merely
begin to play with their food by squeezing it through their fingers or dabbing
it in their hair, it is time to end the meal. This behavior indicates that they
have had enough.
Sleep Problems
Nighttime Feeding
Increase daytime feeding intervals to 4 hr or more (may need to be done
gradually).
Offer last feeding as late as possible at night; may need to gradually reduce
amount of formula or length of breast feeding.
Offer no bottles in bed.
Put to bed awake.
When child is crying, check at progressively longer intervals each night;
reassure child but do not hold, rock, take to parents bed, or give bottle or
pacifier.
Developmental Night Crying
Reassure parents that this phase is temporary.
Enter room immediately to check on child but keep reassurances brief.
Avoid feeding, rocking, taking to parents bed, or any other routine that may
initiate trained night crying.
Refusal To Go To Sleep
Evaluate if hour of sleep is too early (child may resist sleep of not tired).
Assist parents in establishing consistent before bedtime routine and
enforcing consistent limits regarding childs bedtime behavior.
If child persists in leaving bedroom, close door for progressively longer
periods.
Use reward system with child to provide motivation.
Trained Night Crying (Inappropriate Sleep Associations)
Put child in own bed awake.
If possible, arrange sleeping area separate from other family members.
Nighttime Fears
Evaluate if hour of sleep is too early (child may fantasize when nothing to do
but think in dark room).
Calmly reassure frightened child; keeping night light on may be helpful.
Use reward system with child to provide motivation to deal with fears.
Avoid patterns that can lead to additional problems (e.g., sleeping with child
or taking child to parents room).
If childs fear is overwhelming, consider desensitization (e.g., progressively
spending longer time alone; consult professional help for protracted fears).
Distinguish between nightmares and sleep terrors (confused partial arousals).
c. DENTAL HEALTH
a. Oral Hygiene
Once the primary teeth erupt, cleaning should begin. The teeth and gums are
initially cleaned by wiping with a damp cloth; tooth brushing is too harsh for
the tender gingiva.
Oral hygiene can be made pleasant by singing or talking to the infant.
Infants should have an oral health examination by 6 months of age from a
qualified pediatric health practitioner.
Infants at high risk for dental caries should be seen by a dentist between 6
months and 1 year of age.
Use small, soft bristled tooth brush as more teeth erupt and the infant
adjusts to the routine of cleaning.
Fluoride is needed beginning at 6 months of age if the infant does not receive
water with adequate fluoride content.
b. Diet
Avoid propping the milk bottle or giving the milk bottle in the bed
Avoid fruit juices in a bottle, especially before 6 months of age
Foods with concentrated sugar (sucrose) are used sparingly (if at all) in the
infants diet.
The practice of coating pacifiers with honey or using commercially available
hard candy pacifiers is discouraged.
Besides being cariogenic, honey also may cause infant botulism, and parts of
d. INJURY PREVENTION
2. TODDLER
a. NUTRITION
a. Nutritional Counseling
Meal times should be enjoyable rather than times for discipline or family
arguments.
c. DENTAL HEALTH
Sit on the floor or a stool with childs head resting between adults
thighs.
With all positions, use one hand to cup the chin and the other to brush the
teeth. For easier access to back teeth, hold the mouth partially open.
For effective cleaning, a small toothbrush with soft, rounded, multitufted
nylon bristles that are short and uniform in length is recommended.
Toothbrushes should be replaced every 3 months or as soon as the bristles
are frayed or bent.
When using toothpaste, children should select the flavor they like to
encourage brushing habit.
c. Fluoride
Base recommendation on the fluoride concentration in childs drinking water,
including bottled water, filtered and well water, and processed food.
If water is fluoridated, use tap water for drinking and for preparation of
formula (except soy formula, which has twice the fluoride of regular formula),
frozen concentrated juices, powdered mixes, soups, ice, and gelatin.
If the water is nonfluoridated or contains less than 0.3 ppm (ages 6 months
to 3 years) or less than 0.6 ppm (ages 3 to 6 years) fluoride, or if child
refuses to drink tap water or refuses drinks or foods made with tap water,
consider fluoride supplements.
If the water, such as water from some wells or springs, has a concentration of
fluoride above the recommended level, encourage use of bottled
nonfluoridated water for drinking.
Encourage supervision of toddler when brushing teeth or using a fluoridated
mouth rinse to prevent overingestion of fluoridated topical supplement.
Use fluoridated toothpaste.
Consider other sources of fluoride from diet, such as tea.
d. Diet
Encourage a low cariogenic diet such as raw, fresh fruits and vegetables
Natural foods, including honey, molasses, corn syrup, and dried fruits such as
raisins, are highly cariogenic. Complex carbohydrates, such as breads,
potatoes, and pasta, also contribute to caries because they lower the plaque
pH.
Eliminate bedtime bottle completely.
Feed the last bottle before bedtime
a. NUTRITION
poisoning from high doses of fat soluble vitamins or iron can result.
c. DENTAL HEALTH
d. DRESSING
a. Sleep Problems
Preschoolers may need a night light during sleep
Screen out frightening stories or television watching just prior to bedtime
Continue familiar bedtime routines
b. Exercise
Rough housing is a good way of getting rid of tension and should be allowed
as long as it does not become destructive.
Promote love time honored games such as ring-around-the-rosy, London
Bridge, or other more structured games.
Reduce television watching.
a. Care of Teeth
A child should continue to drink fluoridated water or receive a prescribed oral
fluoride supplement if fluoride is not provided in the water supply.
One good toothbrushing period a day is often more effective than more
frequent half hearted brushings.
Check that all tooth surfaces are cleaned.
Ensure that the child floss the teeth well.
Supervise children when using an electric toothbrush and teach not to use it
or any other electrical appliance near a basin of water.
Encourage children to eat apples, carrots, celery, chicken, or cheese for
snacks rather than candy or sweets to prevent tooth decay.
1/2
Children should have made a first visit to a dentist by 2
years of age for
evaluation of tooth formation.
a. Guidelines
Preschoolers prefer bright colors or prints and so may select items that do
not match.
Children need the experience of choosing their own clothes.
One way for parents to solve the problem of mismatching is to fold together
matching shirts and pants so a child sees them as a set rather than individual
pieces.
If children insist on wearing mismatched clothes, parents should make no
apologies for their appearance. A simple statement such as Mark chose his
own clothes today explains the situation.
b. HYGIENE
4. SCHOOLER
a. Guidelines
Preschoolers can wash and dry their hands adequately if the faucet is
regulated for them so they do not scald themselves with hot water.
Parents should turn down the temperature of the water heater in their home
to under 120 F to help prevent scalds.
Preschoolers do not clean their fingernails very well, so these often need
touching up by a parent or older sibling.
Hang a mobile over the tub so they have a reason to look up for rinsing and
use a nonirritating shampoo
Although preschoolers may sit well in bathtubs, they should still not be left
unsupervised at bath time.
Do not use bubble bath with preschoolers as some girls develop vulvar
irritation (and perhaps bladder infections) from exposure to such products.
a. Keeping Children Safe, Strong, and Free
Warn a child never to talk with or accept a ride from a stranger
Teach a child how to call for help in an emergency (yelling or running to a
designated neighbor's house if outside, or dialing 911 if near a telephone)
Describe what police officers look like and explain that police officers can
help in an emergency situation
Explain that if children or adults ask them to keep secrets about anything
that has made them uncomfortable, they should tell their parents or another
trusted adult, even if they have promised to keep the secret
Explain that bullying behavior from other children is not to be tolerated and
should be reported so they can receive help managing it
b. Motor Vehicle and Bicycle Safety
Safely buckle preschoolers into car seats in the back seat
Stress the important role of seat belts in preventing injury in accidents and
should make it a rule that the car does not move until seatbelts are fastened.
Check the position of the shoulder harness so it does not go across a child's
face or throat.
Promote bicycle safety; provide a safety helmet approved for children their
age and size.
Demonstrate safe riding habits by wearing helmets as well.
a. NUTRITION
muscle mass
Activities should include both practice sessions and unstructured play; the
actual game or event should be managed in a manner that stresses mastery
of the sport and enhancement of self - image rather than winning or pleasing
others.
All children should have an opportunity to participate, and special
ceremonies should recognize all participants, not just individuals who excel in
sports or athletics.
b. Acquisition of Skills
With the tools of language and reading, children create poems, stories, and
plays.
With more advanced fine motor skills, they are able to master an unlimited
variety of handicrafts, such as ceramics, needlework, woodworking, and
beadwork.
School - age children are capable of assuming responsibility for their own
needs, although their distaste for soap and water and "dress" clothes is
legendary.
School - age children can and want to assume their share of household tasks,
which usually are related to the male and female roles that have been
defined by their culture.
Many children also assume responsibility for tasks outside the home, such as
babysitting, mowing lawns, or paper routes.
c. Exercise
Exercise can come from neighborhood games, walking with parents or a dog,
or bicycle riding.
As children enter preadolescence, those with poor coordination may become
reluctant to exercise. Urge them to participate in some daily exercise, or else
obesity, or osteoporosis later in life, can result.
One hour or more of moderate and vigorous physical activity on most or all
days.
Participate in several bouts of physical activity of 15 minutes or more each
day.
Avoid periods of inactivity of 2 hours or more.
e. DENTAL HEALTH
a. Dental Problems
Dental Caries
Dental caries are largely preventable with proper brushing and use of
fluoridated water or fluoride application.
When carries do occur, it is important they be treated quickly and the childs
dental hygiene practices to be evaluated and improved if necessary.
Most important, children must believe they have a stake in the health or
disease of their teeth so they willingly undertake the self care measures
necessary to ensure healthy teeth, with parental support rather than parental
command.
Malocclusion
Children with malocclusion should be evaluated by an orthodontist to see if
orthodontic braces or other therapy is necessary.
The time to begin correction varies with the extent of the malocclusion and
the jaw size.
Braces are expensive and painful when they are first applied and at periodic
visits when they are tightened to maintain pressure for further straightening.
Some children develop mild, shallow ulcerations (canker sores) on the buccal
membrane from friction of metal wires.
Rubbing the offending wire with dental wax dulls the surface and gives relief.
Oral acetaminophen or an agent such as Ora-Jel (an over-the-counter drug)
rubbed on the ulceration also gives relief.
Children who wear braces need to have their teeth assessed frequently to
see they are brushing properly around the braces and that they are using
dental floss to remove plaque around wires.
After removal of braces, many children must wear retainers to maintain the
correction the braces achieved.
Show appropriate sympathy and help children problem solve if they are
bothered by the appearance of braces or wearing a retainer.
b. Care of Teeth
School age children should visit a dentist at least twice yearly for a
checkup, cleaning, and possibly a fluoride treatment to strengthen and
harden the tooth enamel.
f. DRESS
g. INJURY PREVENTION
For effective brushing, a child should use a soft toothbrush, fluoride based
toothpaste, and dental floss to clean between teeth to help remove plaque.
Snacks are best limited to high protein foods such as chicken and cheese
rather than candy.
Fruits, vegetables, and cereals fortified with minerals and vitamins can all be
fun afterschool snacks for school age children.
If the child does eat candy, a type that is eaten quickly and dissolves quickly
is better than slowly dissolving or sticky candy, which stays in contact with
the teeth longer.
a. Hygiene
Children of 6 or 7 years of age still need help in regulating bath water
temperature and in cleaning their ears and fingernails.
By age 8, children are generally capable of bathing themselves but may not
do it well because they are too busy to take the time or because they do not
find bathing as important as do their parents.
Both boys and girls become interested
a. Promoting School-age Safety
Motor vehicle accidents
Educate child regarding proper use of seat belts while a passenger in a
vehicle
Maintain discipline while the child is a passenger in a vehicle (e.g., ensure
that child keep arms inside, does not lean against doors or interfere with
driver)
Remind parents and children that no one should ride in the bed of a pickup
truck
Emphasize safe pedestrian behavior
Insist that child wear safety apparel
Drowning
Teach child to swim
Teach basic rules of water safety
Select safe and supervised places to swim
Check sufficient water depth for diving
Caution child to swim with a companion
Ensure that child uses an approved flotation device in water or boat
Learn cardiopulmonary resuscitation
5. ADOLESCENT
a. NUTRITION
a. Guidelines
a.Guidelines
b. DENTAL HEALTH
a. Care of Teeth
b. PERSONAL CARE
b. STRESS REDUCTION
a. Guidelines
a. Guidelines
d. INJURY PREVENTION
3.
a. Adolescent Safety
CREATE A HEALTH TEACHING PLAN FOR AN EXPECTANT MOTHER. MUST BE MORE THAN 5 SPECIFIC HEALTH TEACHING
GENERAL HEALTH TEACHING
1. EXERCISE
2. NUTRITION
a. eat few dry crackers, toast, or sourfall before you get out to bed in the morning
to increase your carbohydrate content.
b. make up a missed meals at some other time of the day.
c. advise pregnant women not to go longer than 12 hours between meals to avoid
hypoglycemia.
d. inform the client that nutrition during pregnancy include about 300 additional
additional calories daily to provide energy.
e. inform the pt. that prenatal vitamins contains additional folic acid supplements
and iron ,so these should be used instead of OTC vitamins during pregnancy.
p.312,319-320
3. SLEEP AND REST
4. HYGIENE
5. TRAVEL
a. If a woman has trouble of falling asleep, drinking a glass of warm milk may
help.
b. Relaxation exercises (lying quietly, systematically relaxing neck muscles, arm
muscles and so on) may also helpful in promoting sleep.
c. To obtain enough sleep and rest during pregnancy, most pregnant woman
need a rest period during the afternoon as well as a full night of sleep.
d. Instruct the pt. to position oneself in Sims position with the top leg forward
to promote resting position.
e. Instruct the pregnant woman avoid resting on her back as supine
hypotension syndrome may develop in this position.p.279
a. Tub baths were restricted during pregnancy because it was feared that the
bath water may would enter the vagina and cervix and contaminate the
uterine contents.
b. Encourage pregnant women to see their dentist regularly for routine
examination.
c. Instruct the pregnant woman that douching is contraindicated
d. Recommend loose fitting, comfortable garments.
e. Encourage pregnant woman to wear firm, supportive bra with wide straps to
spread the weight across the shoulder.
a. If a woman is susceptible to motion sickness, advice pregnant women not to
take medication unless it is prescribed by the physician.
b. If a pregnant women plans to stay in the remote side caution her not to eat
uncooked food or drink unpurified water at such sites.
c. Advise woman who is taking a long trip by automobile to plan for frequent
rest periods.
d. Advise the women who is taking a long trip by an automobile to preferably
every hour or at least every 2 hours, she should get out of the car and walk in
short distances.
e. Encourage pregnant women to wear seat belts when riding a car.p.282
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