NURS 307 (Peds) Nutrition Discussion,GRADED A

NURS 307 (Peds) Nutrition Discussion This case study includes Nutrition & Growth/Development. You may use your text book Sarah Sims is here today for her one year well child check. She is at 3% of weight for length and very low on the other growth charts. She is not meeting her 1-year developmental milestones. Sarah’s mother reports that she has had to work 2 jobs to meet the needs of her family and that she is very stressed. Sarah is diagnosed with failure to thrive. 1. Is Sarah’s failure to thrive organic or inorganic? How do you know? List some causes of organic vs inorganic. Sarah’s failure to thrive (FTT) can be considered both organic and inorganic based on the provided information. Overall, we want to categorize her FTT as organic due to her diagnosis of Celiac Disease which results in her not receiving the nutrients that she needs. Organic FTT is when a medical condition is causing the lack of growth or for a child’s development to digress. Celiac Disease causes Sarah to not be able to eat gluten. In Celiac Disease, gluten can damage the intestines that could cause her to not be able to absorb all the nutrients from the food she ingests. Due to the lack of absorption, Sarah is becoming malnourished which could be causing the weight decrease. However, if we discuss this as an inorganic FTT, we can assume that Sarah’s mother is at financial hardship based on her report of working two jobs. Sarah’s mother could be working two jobs because they are economically insufficient to meet the needs of a child. We would want to discuss food availability with Sarah’s mother because the lack of financial support could be resulting in lack of food, and in Sarah’s case with Celiac Disease, she would need specific foods that typically are more costly. Also, inorganic FTT can be caused by neglect or maternal withdrawal. In this case, Sarah’s mother could be busy working her two jobs which creates a sense of withdrawal toward Sarah. We need to discuss with Sarah’s mother about her feelings toward Sarah and reassure her that if she is feeling withdrawn from Sarah, that it is common and we can help her bond better with Sarah. We also need to reassure her that there is no fault in Sarah’s FTT, but we also need to determine what could be affecting her growth. 2. What assessments are important? • Physical ▪ The things we should focus on physically in Sarah’s case is her height and weight since she is below the normal growth rate and since she has been diagnosed with celiac disease. Since she is deficient in proper nutrients for growth, her height could be affected because of the lack of bone growth. ▪ We should also measure her head circumference because bone growth also affects skull size. We also need to determine if her skull is growing at a sufficient pace to encompass Sarah’s brain. If the skull growth is not sufficient, it can cause the brain to have increased pressure, which can cause many health issues. ▪ We should also measure her vital signs to see if her organs are acting appropriate. We should especially listen to Sarah’s heart rate to determine if there are any murmurs or defects due to the altered growth pattern. Also, her blood pressure, heart rate, and respiratory rate is important in determining if Sarah is dehydrated and her body is trying to compensate. • Psychosocial ▪ Trust versus mistrust happens from birth to 1 year of age. During this stage an infant depends on an individual to meet the required needs such as food, clothing, touch, and comfort. Since Sarah is experiencing FTT she most likely experienced some mistrust during her growth. Since there was an error in food availability or absorption, this created mistrust. Therefore, we need to continue to discuss financial status and Sarah’s medical condition. During the ages 1-3 years, the child is beginning to control bodily functions, so we need to discuss toileting and how often Sarah is using the bathroom in her diapers. Due to the FTT, Sarah could have trouble with future toilet training since she experienced mistrust during the first stage of growth. She could retreat causing decreased urinary control because of the lack of autonomy skills that are learned. We should also observe if Sarah understands her name and looks when you speak it. She should also be able to stand alone for brief periods and raise her arms to be picked up. 3. What should Sarah be eating at 1 year old? Sarah should be weaned from a bottle and drinking from a cup at this stage. She can be transitioned to whole cow’s milk. She needs the whole milk because 1 and 2 % milks lack the fat content for brain development. She also requires a sufficient amount of protein and carbohydrates to provide energy. Infants need 100-116 kcal/kg/day for basic growth and development. She should also be drinking 120-150 mL/kg/day of fluids. These fluids should be mostly water. For her source of iron, she can eat red meats, fortified cereals that are gluten free due to her celiac disease, spinach, broccoli, green peas, or beans. Children that are 1-3 years old should eat about 7mg of iron and 13g of protein. Upon further assessment, it is discovered that Sarah has Celiac Disease. 4. What teaching does Sarah’s mother need? We should educate Sarah’s mother about the information regarding celiac disease. We should educate her on what foods contain gluten and alternative options that can be introduced to Sarah. We should also discuss her financial status and ability to afford the foods that are gluten free. If her mother is unaware of an item that has gluten and feeds it to Sarah, we need to educate her on the signs and symptoms that are associated with the intolerance. We need to explain that Sarah can begin to experience vomiting, diarrhea/stools that are discolored, and/or dehydration due to the fluid and electrolyte imbalance. We want to explain to Sarah’s mother that she is giving Sarah an adequate amount of fluids to keep her hydrated. Educating Sarah’s mom on how to read labels and make conscious decisions while meal planning can be affective when it comes to Celiac Disease maintenance. We should also educate her on how to talk to family members about Sarah’s condition and how to ask for family assistance and understanding. But most importantly we should explain to Sarah’s mother that having a child with Celiac Disease can be overwhelming or frustrating because not only does Sarah’s diet have to change but Sarah’s mother’s diet has to change as well. We can guide her to support groups and reassure her that she can always discuss her worries or concerns. 5. What considerations will be necessary when Sarah starts school? When Sarah starts school, discussion is the priority. Sarah’s mother will need to make arrangements with the cafeteria staff or the school of providing gluten free options or discussing that Sarah will bring her own lunch to school. Also, Sarah’s teachers need to be informed on the disease and how it can affect Sarah during class and may need to be excused to the bathroom more often than others. The school nurse or medical professional should be involved in Sarah’s case. The medical professional should keep medications prescribed to Sarah for her disease in case accidental gluten ingestion. Sarah’s mom should also talk to Sarah about what foods to avoid and if another child offers food, she should respectfully decline. What development milestones should she be exhibiting at 1 years old? At age 1 Sarah should be able to do many things. She should be able to understand her name and be able to form one worded sentences. She should also know what “no” means. For Sarah’s fine motor skills, she should be able to begin using items correctly, and she should be able to hold a crayons or markers. She should also be able to scribble and mark on paper. Sarah should be able to move objects into containers. For her gross motor skills, she should be able to stand for brief periods on her own and possibly take a few steps independently and walk completely using furniture. She should also be able to use furniture to pull herself up. During the time between 1-2 years of age, Sarah should hit a growth spurt and her height should increase about 3-5 inches and her weight should increase half a pound (8 oz).