NURS232 Growth & Development Visual Report - Menke

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The Growth and Development of Agnes Gru Created By: Richell Menke California State University, San Marcos


Table of Contents Meet Agnes Gru and Her Family pg 2-3 Gru Family Structure pg 4 Growth & Development pg 6-8 Nutrition pg 9 Orem’s Self-Care Requisites pg 10 Parental Concerns with Interventions pg 11-12 References pg 13-14 1


Meet Agnes Gru and Her Family

Agnes is a joyful, fearless, and energetic 6-year-old who loves candy and fluffy things. She is the youngest of three sisters whom is not needy but dependent on her older sister, Margo, for guidance. Agnes is a social butterfly with an active imagination appropriate for her age. She is obsessed with unicorns and dreams of one day having one for a pet, unaware of the fact they are mythical creatures. Her innocence and pure nature contribute to her friendliness and ability to look at everything in a positive light. Agnes has a talent of charming others and bringing the best out of the people she meets. Agnes is happy, well-nourished, and appropriately

AGNES GRU

developed for her age in spite of being an orphan most of her life. She enjoys spending her time hanging out with family and attending dance class. With the first day of kindergarten school around the corner, Agnes is anxious and scared because she would rather be at home with her sisters and adoptive father.

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Edith Gru

Margo Gru

Felonius Gru and Lucy Wilde

Edith, 9-years-old, and Margo, 12-years-old, are Agnes’ older sisters. Edith can be described as a tomboy and sometimes destructive. She is known for her mischievousness and grim sense of humor.Margo comfortably takes the role of oldest sister and is very protective of her sisters. She can be insensitive, blunt, and suspicious of others until she warms up to someone. Despite her difficulty trusting people, she is very optimistic and a pillar of hope for the girls’ happiness. The three girls are inseparable. Although they are not biological sisters, the three girls have developed their relationship through their time spent together at Miss Hattie’s Home for Girls. The girls have lived at the orphanage as long as they can remember, with little recollection of their lives before they became orphans. They all shared the dream of one day having a nice family who would adopt and love them. Felonius Gru is 52 years old and the proud adoptive father of Agnes, Edith, and Margo. He works as a scientist and formerly enjoyed a side job as a jelly manufacturer. People tend to describe his personality as cruel, sadistic, and cold-hearted which is attributed to his strained relationship with his neglectful and somewhat verbally abusive mother, Marlena Gru. At first the adoption was for selfish reasons, but his genuine love for the girls flourished after spending time with them. He intends on providing for the girls and ensuring the love and happiness they deserve. Lucy Wilde is a 38 year old detective, the new wife of Felonious, and the girls’ new adoptive mother. After meeting Felonious on one of her cases, she fell in love with him and his girls. Her cheerful and perky personality captures the hearts of the Gru family and they are beyond happy for the new addition to their family.


Family Structure The Gru family is not like an average family because of the experiences they have went through to become the family they are today. Felonius and the girls were an adoptive, single-parent family until Felonious met Lucy becoming an adoptive family. The family also may be described as extended because of the frequent involvement of their grandmother and father’s employees who they consider as uncles. Despite an abnormal progression through the typical life-cycle stages, the Gru family has entered into multiple life-cycle stages simultaneously. The stages are newly married adults and school age child stage. Their multifaceted phase in the life-cycle may be difficult for others, but the Gru family’s closeness and trust in one another will help them through challenges. Initially, Felonious’ parenting style could have been described as uninvolved because of his selfish ways. However, through the growing experience as a father to girls, he has learned how to use a more authoritative parenting style, which will foster a supportive, loving, and fairly disciplined home environment. Although religion is not regularly practiced within the home, Felonious and Lucy encourage the girls to follow their desired religious beliefs.

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Growth and Development Agnes’ princess themed party for her sixth

birthday marked the starting of her growth and development stage transition from a preschool child to a school age child.

Physical Development Agnes continues to grow appropriately for her stage at a steady rate of 1 ½ to 2 ½

inches per year and 3 to 5 pounds per year. (Ball, Bindler, & Cowen, 2015)

Height: 3 feet 8 inches Weight: 42 pounds

Fine and Motor Skills School age milestones for fine motor skills are; enjoys craft projects and plays card

and board games. Gross motor skills are; rides a two-wheeler, jumps rope, and roller

skates or ice skates. Agnes is at the age where she is starting to develop new abilities, such as drawing and jump rope. (Ball & Bindler, 2015; The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System, n.d.) * Using the motivation of catching

the ice cream man, Agnes removed her training wheels and learned how to ride her bicycle on two

wheels. She had improved in dance class by moving in time with the beat of the music. Agnes also

demonstrated artistic made a portraither of the girlsskills on the wall to add to her family tree.

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Cognitive Development Using the age ranges specified in Piaget’s

theory of cognitive development, Agnes is in the preoperational stage and the

intuitive substage and will mature to

concrete operation at the age of seven. The preoperational stage is where the child

begins correlating words with symbols, but logical thinking is not fully developed. In the intuitive substage, the child uses

transductive reasoning to decide logic.

Transductive reasoning is the developing of conclusions using one’s inference and

linking it to another. The relationship of

cause and effect is often impracticable or

created by magical thinking. Animism also occurs at this stage where life is given to inanimate objects. Lastly, centration is

expressed, which is the ability to focus on

one feature of a situation at a time. (Ball &

Bindler, 2015) *Agnes is able to speak in complex

sentences, however, she often thinks in childish ways. Once she was sad

that her caterpillar did not turn into

a butterfly, but what she thought was a caterpillar was really a cheeto puff. She believes if she holds her breath when she is upset she will get what she wants. To Agnes, her fluffy

unicorn is alive and enjoys having tea time.


Psychosocial Development

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According to Erikson’s theory of psychosocial

development, Agnes is shifting from initiative versus guilt to industry versus inferiority. In the initiative

versus guilt developmental stage, the child initiates new activities and considers new ideas. The child

becomes busy and involved by exploring the world. Guilt is felt when she experiences constant criticism or

anxiousness. A sense of purpose symbolizes successful achievement of this stage’s virtue. In the industry versus inferiority developmental stage, Agnes will

develop new interests and become involved in more activities. A sense of self-worth and pride will blossom with accomplishments at home, school, sports, community, and other activities. Failures in the activities lead to a

feeling of inferiority. Competence or mastery is the virtue attained in the stage when she is successful. (Ball & Bindler, 2015; Davis & Clifton, n.d.) *Dancing makes Agnes happy and dance class is one of the only activities that can get her out of

the house. She has her first solo part in the next recital. Agnes also wants to start a dog

grooming service with her sisters for the their neighborhood.

Moral Development Based on Kohlberg’s moral development, preconventional is the moral reasoning level Agnes is currently in. In the preconventional level, the child’s decisions are mainly

based on their desire to please other

people and avoiding any consequences or punishment. (Ball & Bindler, 2015.)

*At Agnes’ birthday party she knew

Felonious was dressed as the magical fairy princess but she still played along for the sake of the other children at her party.


Nutrition Dietary Recommendations for females aged 4 to 8 years old Calories: 1200 kcal/d Fat 25-35% Dairy: 2 cups Lean Meat/Beans: 3 oz Fruits: 1.5 cups Vegetables: 1 cup Grains: 4 oz (American Heart Association, 2015)

What Agnes usually eats: Chicken nuggets Macaroni and Cheese Green beans Cereal Corn Sweets….. Candy Ice Cream Pancakes

When looking at Agnes’ food list, it is obvious that her choices are not ideal. However, a

healthy diet promotes optimal growth and well-being of a child. It also prevents obesity and weight related disease. Healthy food and nutritious snacks are necessary in school age

children. Although their growth rate is consistent and slow, they need to eat approximately

4 to 5 times a day, to include snacks. During this stage, children are developing food habits. Family, friends, and the media are influential factors in how they decide their food choices and eating habits. Typically sufficient areas of consumption are fats, sugars, and sodium. (The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System, n.d.)

Agnes’s BMI & Percentile

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Height: 3 feet 8 inches Weight: 42 pounds BMI: 15.3, healthy weight Percentile: 51st (Centers for Disease Control and Prevention, n.d.)


Orem’s Self-Care Requisites

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Respect Respect Met. Wise beyond her years, Agnes has always been a respectful child. With her positive thinking and cheerful attitude, she is always looking to make her friends and family happy. Her favorite rule is none other than “the golden rule”. Family Family

Friends Friends

Met. Family is life to Agnes, other than her unicorn, Papoy. It is all she knows and all she has ever really wanted. Now that she has the family she has dreamt of, she loves spending all of her time with them and can’t imagine being away from them. Separation may be emotionally difficult at first for Agnes, but with support and love from her family she will be okay.

Partially Met. Agnes has very few friends, but it is not because she is unpopular. She has little experience being in situations with new children. Her only friends consist of girls in her dance class and back at the orphanage. However, with Kindergarten soon there is no doubt that her little butterfly wings will flap and she will have plenty of friends in no time.

School habits School Habits Unmet. Since she has yet to start school, Agnes’ school habits are undetermined, but Felonious and Margo have lectured her on the importance of school. Anxiety rises in Agnes when she thinks about school because she sees it as an element that takes her away from her family. The only aspect helping her through the idea of school is that Edith and Margo will be in school at the same time and after school they can be together again. Not to mention the fact that Felonious promises to pick her up everyday after school.


Parental Concerns with Interventions Quality & Safety Education for Nurses (QSEN)

Patient/Family-Centered Care: The patient and family are “recognized as the source and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs (Drenkard, 2013).” Patient and family should always be included when creating a plan of care and desired outcomes. Interventions should be individualized for the patient.

Focus

Concern

Interventions

Nutrition

“Nearly 1 in 3 children in America is

Teach/encourage family to:

overweight or obese (American

-Limit candy, soft drinks, and high-

Academy of Pediatrics, 2016).” Agnes fat foods. loves her sweets and sugary drinks.

-Offer 5 servings of vegetables and

candy and ice cream. If she continues

day.

She considers her favorite meal as

fruits at meals and for snacks every

her current eating habits she is on the -Offer water or milk instead of road to obesity, diabetes, and other health issues related to nutrition.

sugary fruit drinks and sodas. -Make sure Agnes is active for 1 hour or more daily.

(American Academy of Pediatrics, n.d.) Physical

development

Agnes’ love for sweets and sugary

Teach/encourage family to:

nutrition, but her dental health. She

day, after breakfast and before bed.

beverages not only affects her

tends to forget to brush her teeth.

She is only reminded by her father or sisters when she goes to bed. One

night as Felonious was watching her

brush her teeth, Agnes pointed out a loose tooth. At that instance,

Felonious realizes he does not

remember the last time he took the

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girls to the dentist.

-Help Agnes brush her teeth twice a Also help her floss her teeth once a day.

-Use a pea-sized amount of

toothpaste with fluoride when brushing .

-Schedule at least two visits per year to the dentist.

(American Academy of Pediatrics, n. d.)


Parental Concerns with Interventions Focus

Concern

Development/

Agnes is very happy with her adoptive Teach/encourage family to:

development

child who was an orphan to have

social

Intervention

family. However, it is possible for a

-Listen to Agnes without judgement

feelings of rejection from being

-Create daily home rituals to

abandoned by their biological

parents. The feeling of rejection may induce the fear of failure or

motivation to try some activities.

Lucy and Felonius are also worried

when she wants to talk.

include time together and bonding activities.

-Take Agnes to see the school and meet the teacher.

Obtain a referral to a psychiatrist

about Agnes’ separation anxiety once or psychologist in order to help she begins kindergarten. Agnes through feelings of rejection. (American Academy of Pediatrics, n.d.; Blatt, 2015) Safety

teaching

Safety is important for school age children. School age children are

highly active. They need physical

activity and peer approval, and want to try more daring and adventurous behaviors. Agnes likes to be

independent and had to be yelled at

in multiple instances for going out by the pool, running out into the street, or riding her bicycle outside by herself.

Teach/encourage family to: -Help Agnes learn to swim to prevent drowning.

-Watch Agnes around water. -Teach Agnes how to cross the street safely. Children are not ready to cross the street alone until age 10 or older. -Provide a good-fitting helmet and safety gear for biking. Inform

Agnes that it is unsafe for her to

ride her bicycle alone in the street. (American, Academy of Pediatrics, n.d.)

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References 15 awesome couples costumes for halloween [Online image]. (2015). Retrieved from Costume Wall: http://costumewall.com/blog/15-awesome-couples-costumes-for-halloween/

Agnes [Online image]. (n.d.). Retrieved from iFunny: https://ifunny.co/tags/agnes/1451336525 American Academy of Pediatrics. (2016). Childhood Nutrition. Retrieved from Healthychildren.org: https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Childhood-Nutrition.aspx American Academy of Pediatrics. (n.d.). Bright Futures parent handout 5 and 6 year visits. Retrieved from Bright Futures : https://brightfutures.aap.org/Bright%20Futures%20Documents/C.MCh.PH.5,6yr.pdf American Heart Association. (2015). Dietary recommendations for healthy children. Retrieved from AHA: http://www.heart.org/HEARTORG/HealthyLiving/Dietary-Recommendations-for-Healthy-Children_UCM_3 03886_Article.jsp#.V3L-tbgrKM8 Ball, J., Bindler, R., & Cowen, K. (2015). Principles of pediatric nursing: Caring for children (6th ed.). Boston: Pearson. Blatt, S. D. (2015). Adoption. Retrieved from Merck Manual: http://www.merckmanuals.com/home/children-s-health-issues/social-issues-affecting-children-and-theirfamilies/adoption Centers for Disease Control and Prevention. (2016). Middle childhood (6-8 years of age). Retrieved from CDC : http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle.html Centers for Disease Control and Prevention. (n.d.). BMI percentile calculator for child and teen . Retrieved from CDC: https://nccd.cdc.gov/dnpabmi/calculator.aspx Coffin, P., & Renaud, C. (Directors). (2010). Despicable Me [Motion Picture]. Coffin, P., & Renaud, C. (Directors). (2013). Despicable Me 2 [Motion Picture]. Davis, D., & Clifton, A. (n.d.). Psychosocial theory: Erikson. Retrieved from Haverford.Edu: http://www.haverford.edu/psychology/ddavis/p109g/erikson.stages.html

Despicable me 1 & 2 [Online image]. (n.d.). Retrieved from Pinterest: https://www.pinterest.com/pin/355573333057774296/

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Drenkard, K. N. (2013). Patient-centered care. Retrieved from American Association of Colleges of Nurses: http://www.aacn.nche.edu/qsen/workshop-details/orlando/KD-PCC.pdf

Edith Gru [Online image].(n.d.). Retrieved from Despicable Me Wiki: http://despicableme.wikia.com/wiki/Edith_Gru

Family photo, minions, and Gru [Online image]. (n.d.). Retrieved from Pinterest: https://www.pinterest.com/pin/570549846514350279/

It's okay Gru, I know you're the fairy princess [Online image]. (2014). Retrieved from Pinterest: https://www.pinterest.com/pin/237494580322514903/

Lucy Wilde [Online image]. (n.d.). Retrieved from Despicable Me WIKI: http://despicableme.wikia.com/wiki/Lucy_Wilde

The Gru family [Online image]. (2016). Retrieved from Deviant Art: http://ares89.deviantart.com/art/The-Gru-Family-184016532 The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. (n.d.). Helpful

feeding information for your school-age child. Retrieved from Johns Hopkins Medicine: http://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/school-aged_child_nutrition_90, P02280/ The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. (n.d.). The

growing child: School-age (6 to 12 years). Retrieved from Johns Hopkins Medicine: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/pediatrics/the_growing_child_schoolage_6_to_12_years_90,P02278/

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