Growth and Development: Riley Andersen (From movie Inside Out) By Quang Phan Nurs 332 CSUSM
Meet Riley! Riley Andersen is a fun-filled, loving 11 year old girl. Her age places her in the “late childhood” stage, just before entering adolescence (ATI, 2013). Her appearance includes a slim body statute, with bright blue eyes. Riley has a bright smile, with her teeth aligned. She has short, brownish-streak blonde hair, that reaches to her shoulders. Being part of a nuclear family, She is an only child whom lives with her mother (Mrs. Anderson) and father (Mr. Anderson) whom are married (cit(Kaakinen, Duff-Gedaly, Hanson, Coelho, 2015). For the most part, Riley has an up-beat, optimistic personality who simply seeks to to enjoy life, learn, and discover new adventures. She grew up happily, having a close relationship with both parents, while making the best of friends during her time in Minnesota. Throughout Riley’s entire life, her parents have been both loving and supportive. If a problem were ever to arise within Riley, both the father and mother would be appropriate to take the parent role and lift her spirits back up. Riley’s most prized hobby is ice hockey. Her father is a part time coach for the hockey team she is on, while the mother is a stay at home mom. One of her best friend’s Meg, is also on the team with her. Riley also attends elementary school, where she is eager to learn, and is no stranger to completing her homework. She spends time with her family both during outdoor activities and indoor. She has an ongoing tradition to skating with her mom and dad in the backyard every weekend.
Riley’s world takes a big turn upside-down when she is forced to move to San Francisco as a result of her father’s business work. Her emotions go into complete turmoil, and soon begins to not feel like “herself” anymore. Riley struggles to adjust to the abrupt change in setting, as she misses her beloved hometown of Minnesota. Things are not just the same for Riley; as she starts losing her joyful personality, and becoming very emotionally sensitive to certain events otherwise handled normally by simply talking to her parents. She just can’t seem to the best of her potential for playing ice hockey and has trouble socializing toward making new friends. Riley’s overall reaction to moving creates an emotional dilemma, causing her to comprehend her own feelings. The roller-coaster ride of emotions is just a part of her development as a pre-adolescent kid.
Growth and Development (School Age 6-12) Physical Development
Milestone: During the school age, a female’s physical milestones should include growing a height of 2 inches/year, and a weight of 4-6 lbs/year. Teeth should permanently erupt. Pre-adolescence occurs, having drastic physiological changes in the body. Puberty may also begin, (varying from age 9-18). (ATI, 2013). Riley: Standing at at 4 ft 4 inches and weighing 75 lbs, Riley is within a normal BMI range of 19.5,in the 50th percentile for weight, and at the 5th percentile for height for her age (Clinical growth charts, 2016). Her athleticism reflects greatly on her physical stature. Riley also shows full growth of all teeth, with a slight gap in the upper middle. Being 11, Riley is nearing the end of prepubesence stage, and has no physical signs of puberty apparent.
Psychosocial/Social Development: Milestone: During the school age, the psychosocial milestones of children deal with cooperating and competing with others. Peer pressure and friends play a huge impact on the individual's life. These individuals should also feel a sense of accomplishment, along with gaining new knowledge and skills. The mastery of skills develop through challenging tasks that arise. (ATI, 2013) Riley: Although riley has a attained strong mastery with ice hockey and cooperating with her team, her main challenge is adapting to the situational crisis due to her move to San Francisco. She continue to grow skills by learning to handle the emotional stress that associated with the move. While her best friend Meg is back in minnesota,Riley has faced barriers in making new relationships at her new school.
Emotional Development Milestone: Individuals within the age group of 10-14 tend to go through a roller coaster of emotions, realizing their balance between both ends of the spectrum of joy and sadness. Emotionally sensitivity is prevalent during this time, as individuals can be easily offended or hurt. Being angry, and talking violently to others due to emotional outbreaks may also occur. (ATI, 2013)
Gross & Fine Motor Skills Milestone (6-12 year old (Perry, 2014): ❖ ❖ ❖ ❖ ❖
Enjoys crafts and board games Enjoys participating in sports Can ice skate Playing a muscle instrument Begin new hobbies
Riley: Developed within milestone. ❖ ❖ ❖ ❖
Plays ice hockey (including ice skating) Is able to run Participates in school craft and art work. Has a sense of mastery/accomplishment in scoring for hockey games.
Riley: Displays huge emotional outbursts, as she is happy one moment, and sad when she sees her dad dealing with stress. Riley begins to fight with her parents, giving the “silent” treatment when her father instructed Riley to go to her room during dinner. Her sadness begins to overwhelm her emotions as life doesn’t seem the same, without the same routine/friends, around.
Developmental Theories
Erikson’s - Industry vs. Inferiority:
During this stage, the individuals ages 6-12 develops self-worth, as a result of participating in activities. Taking pride in accomplishments from sports, school, or home. If they fail what is expected of them however, inferiority may take over. (ATI, 2013)
Piaget - Concrete Operations:
Transitioning from the preoperational stage, individuals are now capable of mature thought. Using transductive reasoning allows a better understanding between cause and effect. The individual learns the idea of “conservation” which means matter is unable to change when its form is altered. (ATI, 2013)
Moral - Kohlberg Conventional: Individuals within ages 7-11 has a set conscious, in which there is a set of standards that is prioritized. They believe that these rules need to followed to please other people, and ultimately be a “good” person. (ATI, 2013)
Fortunately, for Riley she has developed her sense of worth by gaining a passion for ice hockey. In the home setting, Riley accomplishes her school work on time. However, throughout the movie she moves from industry to inferiority, being unable to sustain a close relationship with both parents, displaying a poor performance during hockey tryouts, and lacking the ability to create new friendships. Riley successfully understands how her sadness can bring her back to joy. When sadness takes over, she is able to approach her parents to fully express her feelings, rather than running away. Her mature thought continues to adapt, as she deals with conflicting emotions. She may have thought the best thing to do was to run away, as her emotions directed her too.
For Riley, she is used to having a joyful, upbeat personality that brightens up people’s day. This is her idea of of her standards. She follows the rules of both her teacher, and parents. Although she displaying a rebelloius attitiude, she begins to pave way into the post-conventional stage as her moral process of decision making is revealed as she deecids to get off the bus instead of running away back to Minnesota.
Nutrition Status Expected nutrition (11-16 yo):
Nearing the end of school age,, children should be eating adult sized portions, incorporating dense nutrient foods in their diet. To prevent obesity (common in this age group), parent should be educated, and direct their child to eating a balanced diet. It is ideal to avoid junk/fast food that contains large amounts of fat, sugars, and sodium. Riley: Riley is at the 50th percentile for weight for her age, as well as a BMI of 19.5. She is within a healthy range, neither overweight or under. However, her eating habits are not necessarily on par with nutrition guidelines. She has often skipped out on meals, and chooses not to eat her vegetables. She eats pizza/chinese food, which can be very oily.
Orem’s Self-Care Requisities (11-16 year olds) Feelings ● Beginning to discover how her own feelings and emotion affect her “normal” routine. ● Having a growth spurt experience, dealing with emotional conflict,, shifting from the usual happiness to the unexpected mood of angry and sadness. Family/Friends ● Riley is unable to overcome making new friends, as she feels isolated. Although, in Minnesota resides her best friend Meg. ● Has a close relationship with both the mother and father, and realizes that her family connection is vital to her happiness. Sex/Sexuality ● At this age, curiosity may drive the individual about sexuality., thus leading to risky behaviors. ● Riley displayed a slight form of sexuality by having a “awkward moment” with the boy at the skating rink. Drug/Alcohol Use ● During this age, environmental hazards such as cleaners/chemicals should be out of reach. ● Children of this age should be educated to say no to alcohol/illegal substances. Riley had no use of alcohol or drugs, nor is surrounded by the use of it. Body Image ● School age children are more likely to prioritize privacy due to numerous physiological/physical changes happening in the body. ● Riley pays little attention to her own body image, however she is in physical shape.
QSEN Competency: Safety
Although there are 6 competencies, one competency that is a priority Riley is safety. The CDC states that. The most common cause of severe injury and death in school age children is motor vehicle accidents, as a pedestrian or passenger (Perry, 2014). Not only does her age place her at high risk for injury, Riley is more prone to dangerous accidents from falls due to her ice skating activity. The nurse should first examine risk factors associated with riley - like if she is wearing a helmet, or physically and cognitively capable to simply perform ice skating. Riley may begin to exhibit some hyperactivity due to her growth state, which her parents should be informed about. Riley may do tend to do “exciting” and “dangerous” activities in regards to her capabilities due to her refined muscular coordination and control (Perry, 2014). It is up to the nurses to implement and discuss risk reduction strategies to both the parents and Riley to prevent any sort of potential harm (Graduate QSEN Competencies, 2014).
Potential Issues
Nursing Interventions
Nutrition:: Riley’s psychological behavior has caused her eating habits to become poor. A study shows that, female adolescents who are distressed wanted weight loss, and achieved it through exercise, meal skipping, and starvation (Mallick, Ray, Mukhopadhyay, 2014). Although Riley is just a year shy of being an “adolescent”, we can observe her downtrend of proper nutrition due to the stress and frustration of having to move to S.F.
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Safety: The primary concern for Riley is bodily damage. Her physical and cognitive capability of playing ice hockey places her in a risky situation for injury. The hard ice that she skates on beneath her is hazardous, and has the potential to break bones if fell upon. (Perry, 2014).
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Social Development: During Riley’s age, it is ideal for her to have a best friend to adventure, share experiences, talk, have secrets with (ciite). Ever since the move to S.F., Riley has been anxious to make any new friends at all, thus putting her in a state of isolation and loneliness. Without any new friends or interactions, Riley may lose her sense of self-worth and industry.
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Physical development: Riley is at a risk of delayed height growth, being on the borderline of the 5th percentile for her age. A potential explanation is “constitutional delay of growth and puberty”, which is a low pre-adolescent growth rate, accompanied by a normal size at both birth and adulthood (Rogol, 2016).
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Weigh and measure heigh of the child, using a growth chart to determine pattern which reflects nutrition (Ackley, 2015). Recognize that a large percentage of girls and teens are dieting, which can result in nutritional problems. (Ackley, 2015) Watch for symptoms of malnutrition in child - observing for short stature, thin arms/legs, poor skin turgor, or visible vertebrae/rib cage. (Ackley, 2015) Stress eye/ear/mouth protection when engaging in potentially hazardous sports (Perry, 2014). Emphasize proper safe practices and equipment for sports and activities. (Perry, 2014) Suggest caution when engaging in hazardous sports. (Perry, 2014)
Assess the client’s social support system (Riley’s family). Assist the child who is identifying loneliness as a feeling and to identify the cause related to this feeling (Ackley, 2014). Evaluate current and past peer relationships (Ackley, 2014)
Provide normal sleep-wake times for children to promote growth and development (Ackley, 2014). To determine risk/actual deviations in normal development, use screening tool. (Ackley, 2014). Encourage parents to take their child for routine health visits to the family pediatrician (Ackley, 2014).
References Ackley, B., & Ladwig, G. (2014). Nursing diagnosis handbook: An evidence-based guide to planning care (10th ed.). Maryland Heights, Mo.: Elsevier. Assessment Technologies Institute (2013). RN nursing care of children Content mastery series review module (9th ed.) Clinical Growth Charts. (2016). 2 to 20 years: Girls Stature-for-age and weight-for-age percentiles. CDC . Retrieved from: https://www.cdc.gov/growthcharts/clinical_charts.html Graduate QSEN Competencies. (2014). QSEN Institute. Retrieved from: http://qsen.org/competencies/graduate-ksas/ Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015) Family health care nursing: theory, practice and research (5th ed.). F.A. Davis: Philadelphia. Mallick, N. Ray, S., Mukhopadhyay, S. (2014). Eating behaviors and body weight concerns among
adolescent girls. Advances in Public Health. (14). http://dx.doi.org/10.1155/2014/257396
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal child nursing care. Maryland Heights, MO: Mosby Elsevier. Rogol, A. (2016). Causes of short stature. UpToDate. Retrieved from: http://www.uptodate.com/contents/causes-of-short-stature
Image References Front page: Retrieved from: http://metro.co.uk/2016/01/03/someones-made-a-version-of-inside-out-without-the-inside-bit s-5598259/ Boy at the rink – Retrieved from: https://www.youtube.com/watch?v=9EbgEJ6GokU Emotional roller coaster - Retrieved from: https://helenmacmillan.com/2013/07/getting-off-the-emotional-roller-coaster/ Riley doing homework - Retrieved from: http://www.timigustafson.com/2010/learning-how-to-eat-right/ Riley out the door – Retrieved from: https://www.pinterest.com/vernitseng/inside-out/ Riley eating – Retrieved from: https://www.pinterest.com/yaelishmonzi/inside-outside/ ABCs of eating - Retrieved from: http://www.timigustafson.com/2010/learning-how-to-eat-right/ Inside out – Retrieved from http://movies.disney.com/inside-out Safety – Retrieved from http://www.clipartkid.com/safety-first-cliparts/ Riley skating in the backyard – Retrieved from: https://www.pinterest.com/emikat1/riley-anderson/