N13 - Maternal and Child Nursing 2nd Semester AY 2021-2022

Identified problems

Rationale 

Goals of Care

Interventions

Ginny

Jennifer

00002 Imbalanced nutrition: less than body requirements r/t social demand to lose weight aeb BMI below 5th percentile

Adolescence is a period of physical and lifestyle changes. Shifting levels of hormones manifest in body growth and development. It is also at this period where caloric needs are increased to meet the body’s demands. Ginny is underweight with her BMI below the 5th percentile. Despite that, she expressed her desire to lose weight. A lacking nutrition and dietary intake can impair growth and development.

• 1 week after the intervention, the client will report adherence to the meal plan as recorded in her Food Diary.

• After the intervention, the client will achieve a normal body weight aeb a BMI in the 5th percentile.

• Demonstrates selection and preparation of food that will provide the client with the recommended dietary intake

Nutrition Management (1100)

• Attain the 24-hr diet recall

• Conduct a nutrition education discussing the Pinggang Pinoy for adolescents.

• Create a meal plan with the client and her mother while considering their food preferences and financial capability.

• Discuss with the client and her mother how to record their meals in a Food Diary.

• Review the Food Dairy after 1 week.

• Assess the client’s BMI after 1 month or so until she reaches the ideal body weight.

00153 Risk for situational low self-esteem 

This pertains to vulnerability to developing a negative perception of self-worth in response to a current situation, which may compromise health. Ginny is already extra conscious about her face and neck acne. By addressing this problem, chronic low self-esteem can be prevented.

• Client verbalizes positive appreciation of self and acceptance of body changes through expression of understanding that physical changes are normal in puberty and that acne can be treated.

• Expresses positive affirmations about her daughter’s physical changes.

Self esteem enhancement (5400)

• Assess the client’s level of control over the situation.

• Explore with the client her strengths and reinforce them.

• Provide the client a health education about acne treatments.

• Refer her to dermatologists if agreed upon.

• Encourage self pep talks and positive affirmations to self daily.

00118 Disturbed body image

Puberty involves a lot of body changes for the client such as acne, breast enlargement, hip widening and others. Particularly, she expressed her feeling of self-consciousness regarding her face and neck acne. It is also possible that ehr desire to lose weight is brought on by a social norm. Preventing a disturbed personal identity can  help the client cope better in seeking treatment for acne or modifying her lifestyle to achieve a physically fit body without having to remain underweight.

• Demonstrates enhanced body image by ability to look, touch, care for, and talk about body parts going through changes.

Body image enhancement (5220)

• Assess for the client’s expected body image considering she is an adolescent.

• Ask how her peers and family influence her perception of her body image.

• Assist client in discussing all possible body changes caused by puberty.

• Assist the client in identifying body parts that have positive associations with them.

• Assist client in identifying ways to enhance appearance while maintaining good nutrition, as appropriate

Anticipated Problems

00058 Risk for impaired attachment

This problem is defined as being vulnerable to disruption of the interactive process between parent/ significant other and child that fosters the development of a protective and nurturing reciprocal relationship. We can connect this to Jennifer's situation of having difficulties in communicating with Ginny as she spends more time with her peers. This lack of communication can negatively impact parent-child connection since there is little avenue for the child to express her feelings and concerns about her body changes and stressors (struggle to maintain high grades for college application).

• The client will demonstrate enhanced and reciprocal interaction with her mother by allotting a particular time to talk about her feelings and concerns.

• The parent will respond appropriately to her daughter’s communication cues to foster an honest and open  communication.

• The parent/s will not force the child to speak so as to consider her right to privacy

Coping enhancement (5230)

• Encourage the client to verbalize feelings about perceived stressors.

• Assist the client in identifying resources that can help lessen the burden of stressors.

• Determine how her peers, classmates, or teachers influence her perception of stressors.

• Encourage the client to seek out positive support system that can help her manage her struggle in maintaining high grades.

Learning Outcomes

Key Message/ Content

Teaching/Learning Activity

Resources 

Method of Evaluation

At the end of the nutrition intervention/education, the client must be able to:

1. Demonstrate mastery of Daily nutritional guide pyramid for Filipinos evidenced by modified daily portion intake following the recommended portions 1 weeks after the nutrition education.

1. Daily nutritional guide pyramid for Filipino Teens ( ages 13-19); an eating plan that includes specific recommended serving sizes for each group of common foods; food journal format in tabular form.

2. Pinggang Pinoy: one is to allot more plate portion for the Go (e.g., rice, bread, etc.) and Glow vegetables (e.g., malunggay, kalabasa, etc.); allot less portions for the Grow (e.g., meat, fish, protein-packed food) and Glow fruits.

1. Daily food journal for two weeks. Mechanics:

• Client is given a Food Diary format with two columns: food per meal, and household serving sizes, respectively.

• The client and her mother are still allowed to go back to the suggested serving portions in the food pyramid given the fact that memorizing it may take practice.

2. Matching activity. A plate visual aid that is identical to the Pinggang Pinoy is shown to the client; the fields or the portions are blank and unlabeled.

Instructions: 

• The client/s is/are given a situation normally observed in a household, one that they would relate to.

• “Halimbawa po maghahanda kayo (Mother and/or daughter) ng tanghalian para sa araw ng Martes. Meron po kayong kanin, pritong galunggong, ginisang ampalaya, at saging na saba. Gaano po karami ng mga nabanggit na pagkain ang ihahanda niyo para sa sarili niyo?”

• Ginny and Jennifer must be able to place or match the given examples on the correct plate fields. 

• Daily Nutritional Guide pyramid for Filipino Teens (ages 13-19)

• A table to be labeled; one column for the given food examples, and another for the serving sizes. 

• Blank format of Pinggang Pinoy, Pictures/cut-outs of the given food examples: rice, pritong galunggong, ginisang ampalaya, banana

1. Daily food journal for two weeks.

Mechanics:

• Client is given a Food Diary format with two columns: food per meal, and household serving sizes, respectively.

• The client is still allowed to go back to the suggested serving portions in the food pyramid given the fact that memorizing it may take practice. The aim of the activity is to make sure that the client is able to correctly apply the suggested portion for each food group in her daily meals. It also aims to develop nutrition modification.

• This activity combines evaluation on the client’s mastery of the Pinggang Pinoy and her ability to apply it to actual meal planning.

• The output should look like the image below