Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Student Name: Julianna Brauchle

Age: 6-10 years old Allergies: NKA

Admitting medical diagnosis and brief explanation of pathophys:

Failure to thrive (malnutrition) due to feeding difficulties and noncompliance of caregivers. Organic failure to thrive is due to inadequate intake,
increased losses, compromised utilization of ingested calories, excessive metabolic demands, or combinations of all of these factors (Medscape,
2017).
Additional diagnosis:
Cerebral Palsy, feeding difficulties, hypothyroidism, celiac disease
Pertinent past medical/surgical history:
Undescended tests (bilateral orchiplexy), failure to thrive (g-tube placement)
Likes/Dislikes/Comfort measures: (Ask nurse or patient/family)
Patient only likes to take Pediasure out of orange cup, likes TV on at all times, likes to be talked to and soothed by voice. Play is primary means of
care.
Current treatment/Complementary health practices:
Speech therapy for swallow test, nutrition consult for nutritional deficit- Pedisaure supplements for normal diet, GI consult for celiac disease.
Nursing Assessments Related to Diagnosis and Treatments (IV, dressings & wounds care, feeding tubes, etc.)
Tubes, lines, drains or treatments: Purpose Nursing assessment/documentation
MIC-KEY button g-tube placement on Provide nutritional supplementation due to Tube is locked and in place, residual of 15
10/3/2017 failure to thrive status mL for correct placement, dressing is intact
and dry, scant amount of dried blood found
on dressing.

Steri-strips on testes Bilateral orchiopexy to fix undescended Steri strips in place, dry, and intact. No
testes erythema, heat, or pain noted in area. No
drainage or foul odor.

Lab and diagnostic data (normal that pertain to Dx and/or abnormal findings
Test/value or result Why was it ordered? If abnormal—potential How is abnormal being Additional space here if
reason treated? needed
Vitamin D-22 ng/mL Assess nutrition level Vitamin D deficiency Normal level- not
applicable
Magnesium- 1.8 mg/dL Suspicion of Malnutrition Normal level- not
hypomagnesemia applicable
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Phosphate-2.6 mg/dL Suspicion of Malnutrition Normal level- not

hypophosphatemia applicable

VITAL SIGNS

YOUR SHIFT HOSPITAL STAY HOSPITAL STAY NORMAL VALUES FOR

VITAL SIGNS 0800 1200 LOWEST HIGHEST AGE
Temperature 98.6 98.6 98.4 100.2 98.0-99.9
HR 110 108 104 122 60-95
RR 22 20 20 24 14-22
Blood Pressure 117/71 110/76 120/76 104/70 100-120/60-75
Pain level 0 0 0 3
Pulse OX 100% 100% 98% 100% 93-100%
Supplemental O2 Room Air Room Air Room Air Room Air
IV sol, rate, site Not present
Diet Normal solid food diet with
supplemental tube feeds of
Pediasure
Activity order Ambulate ad lib
Intake 730 (tube feed and free water)
Output 200 mL

ADDITIONAL INFO AS NEEDED:

Patient is nonverbal and wheelchair bound
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

SHOW YOUR MATH Calculated for patient Actual for patient

Weight
46.86 lbs 21.3 kg

INTAKE / OUTPUT 100 mL x 10 kg = 1,000 mL 730 mL/shift x 3 shifts (24 hours) = 2190
24 Hour Fluid Requirement: 50 mL x 10 kg = 500 mL mL/24 hours
100ml x first 10kg 20 mL x 1.3 kg = 26 mL
50ml x next 10kg
20ml x remainder of weight in kg
SHOW YOUR MATH Total of 1,526 mL/24 hours

Shift Fluid Requirement:
_ 8 hour
Hourly Fluid Requirement:
1,526 mL/ 3 shifts = 508.67 mL of fluid per 8 hours 0800 -240 mL Pediasure flushed with 30 mL
free water
1200- 240 mL Pediasure flushed with 30 mL
free water
1430- 160 mL Pediasure flushed with 30 mL
free water
Total of 730 mL/shift
1,526 ml / 24 hours = No IV X Saline lock

64.58 mL/ hour OR:

IV Fluid: ___________________
@ ___________________mL/hour
IV bag change due:_______
IV tubing change due: __________
Medication tubing change due: _________

24 Hour Output Requirement:
1 – 2ml/kg/hour
1 ml/kg/hour x 21.3 kg = 21.3 ml/hour
2 ml/kg/hour x 21.3 kg = 42.6 ml/hour
21.3 mL/ hour x 24 hours= 511.2 mL/day
42.6 mL/ hour x 24 hours= 1022.4 mL/day
Diaper weight: 30 grams
0800: 120 gram wet diaper with 90 mL of urine
1200: 100 gram wet diaper with 70 mL of urine
1400: 70 gram wet diaper with 40 mL of urine
200 mL x 3 shifts (24 hours) = 600 mL/day
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Shift Output Requirement: 21.3 mL/hour x 8 hours = 170.4 mL/shift Diaper weight: 30 grams
_ 8 hour 42.6 mL/hour x 8 hours = 340.8 mL/shift 0800: 120 gram wet diaper with 90 mL of urine
1200: 100 gram wet diaper with 70 mL or urine
1400: 70 gram wet diaper with 40 mL of urine

Shift output: 200 mL

Based on your calculations, was the patient’s intake and output adequate? Explain: Based upon the calculations, the patient’s intake and
output was adequate. Over a 24 hour period, based upon weight, the patient required 1,526 mL of fluid. Actually, the patient took would take in
2,190 mL. Over an 8 hour period, the patient required 508.67 mL of fluid, and over the time I was there the patient took in 730 mL through his
Pediasure tube feeds and the free water used to flush his g-tube. As far as output requirements, the patient was to put out between 170.4 mL and
340.8 mL, and the patient put out 200 mL of clear yellow urine.
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

MEDICATIONS
(Include PRN’s)
Patient Wt. 21.3 kg

Medication Nursing Ordered Recommende Wt Based Dosage Safe Why is patient Major side effects & nursing
+ Diagnosis Dosage d Dosage Calculation (mg/dose) Y/N receiving? implications
Classification number & Route (mg/kg/dose) SHOW MATH
25 mcg 4-5 4 mcg/kg x 21.3 kg = 85.2 Y Hypothyroidis Side Effects: Angina pectoris,
Synthroid through mcg/kg/day mcg/day Start m tachycardia, hyperthyroidism,
(Thyroid g-tube 5 mcg/kg x 21.3 kg = 106.5 dose weight loss, heat intolerance,
Hormone Start at 25 mcg/day accelerated bone maturation in
replacement) mcg/day children.
Nursing Implications: Take in
the morning on an empty
stomach. Monitor growth in
children, monitor for
hyperthyroidism as this is a
symptom of toxicity. Take with
a full glass of water.
20 mg 20 kg and Y Hyperacidity, Side Effects:
Omezaprole through greater: 20 mg celiac disease Pseudomembranous colitis,
(Protein Pump g-tube orally once a abdominal pain,
Inhibitor) day hypomagnesemia, bone
fracture, hypersensitivity
reaction.
Nursing Implications: Monitor
bowel function (C-diff), assess
for frank or occult blood in
stool, emesis, aspirate. Monitor
serum magnesium. Administer
before meals in the morning.
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

No blanks or N/A for care map submission---use “unable to assess” or “not present” or “not utilized” for spaces as indicated

Neuman Systems Variables Assessment Physiological (Systems Review) Assessment

PSYCHOLOGICAL NEURO
Coping/comfort methods Comforted by voice LOC Alert
Mood/Affect Cooperative Wakefulness Awake
Cognitive abilities Unable to assess Orientation Unable to assess
Agitation Not present Speech Nonverbal
Values Unable to assess Follows commands Unable to assess
Pupils equal, round, reactive to light,
Memory Unable to assess PERRLA accommodated
Swallow/gag reflex Present and intact
Musculoskeletal
Extremity strength Hypotonic
DEVELOPMENTAL STAGE Movement/ Sensation + Spastic, hypotonic, minimal muscle mass
Developmental stage (Erikson) Industry vs. Inferiority ROM Passive
Maturational events Unable to assess Activity/Gait Dependent, scooches in bed
Significant life/family events Foster care Equipment/ CPM/Traction Wheelchair, leg braces
Role/Occupation Not present CARDIAC
Heart sounds Normal rate and regular rhythm, no murmurs
Pulses Present, 2+
SOCIO-CULTURAL Edema +1 pitting edema in scrotal area
Access to healthcare Present- CHIP Capillary refill <3 seconds
Family resources Foster care SCDs Teds Not present
Financial concerns/support Foster care
Foster care, bio father and mother, 6
Family structure siblings RESPIRATORY
Ethnic-cultural Unable to assess O2 amt/mode Room air
Language(s) Not present O2 saturation 100%
Literacy Unable to assess Respiratory effort Normal effort
Primary caregivers/partners Foster care Lung sounds Clear and equal in all lobes
SPIRITUAL Cough/Secretions Not present
Religious beliefs Unable to assess Chest tube Not present
Spiritual values Unable to assess
Hopefulness Unable to assess GI
Chaplain/spiritual leader visit Not present Abdomen Non-tender, scaphoid, soft, non-distended
Physiological (start systems review) Bowel sounds Normoactive in all four quadrants
INTEG Appetite/% eaten Tube fed, no solid food eaten
Color/Temp Appropriate for ethnicity, warm Nausea/vomiting Not present
Turgor/Moisture Dry, no tenting, intact, Tube feeding: type/site G-tube in lower left quadrant
Mucous membranes Pink, intact, moist Other tubes/drains Not present
Patent, no erythema, no heat, soft, dressing
IV site is dry and intact GU
Braden score/stage 23 Urine description Yellow, no foul odor, diaper
Catheter Not present
Bladder scan Not utilized
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Growth and Development

1. What is the stage of development that your patient is in? (ex. newborn, infant, toddler, etc.) Technically patient is a school-
aged child, however patient is non-verbal and failure to thrive so he is not school-aged.
2. According to Piaget and Erickson, what developmental stage is expected for their age range?
Piaget: The concrete operational stage
Erickson: Industry vs. Inferiority
3. What developmental milestones should your patient have achieved by this point?
a. Gross Motor: Ride a two-wheel bicycle, learn sports, swim well, throw and catch a ball, jump rope, walk (BabyCenter, 2015).
b. Fine Motor: Print words, write cursive, draw detailed pictures, manage any task requiring dexterity (BabyCenter, 2015).
c. Language: Use most parts of speech, use and understand passive sentences, explain what had been learned, word variety (Home
Speech Home, 2015).
d. Social: Describes thoughts, feelings, and knowledge, demonstrates knowledge of social customs, typically over dramatic, values
friends, communicates needs, wants, and emotions in healthy ways, notices the impact of personal behavior on others and modifies
(PBS, 2017).
4. What does your book say regarding the child’s potential reaction to hospitalization and procedures for their age?
For school aged children- typical responses include fear of body mutilation, pain, imminent death or disability, enforced dependence
and loss of competence, fear of loss of bodily function, and going under anesthesia may create anxiety and raise questions. Also self-
conscious behavior to sexual characteristics occurring to the body (Wake Med, 2017).
5. Which of these behavioral reactions did you observe in your patient? Provide examples: Patient nonverbal and seemed to
have little understanding of what was happening. The only reaction noted was fear of pain when patient was going to be changed as
he had pain in his scrotal area.
6. Summary: How did your patient compare with the textbook’s description of milestones, and Erickson’s and Piaget’s
theories of development? Provide examples: Patient has cerebral palsy and developmental delays. Patient was nonverbal and
wheelchair bound. Gross and fine motor skills, language skills, and social skills were not met, and the patient did not identify with
the stages he should have been in when looking at Piaget and Erikson’s models. He identified more with infant levels of the models
rather than school-aged models.
7. Based on your knowledge of growth and development for this patient’s age, how did you adjust your approach when
assessing this child and providing care? Provide examples: Patient’s developmental skills did not match his age range, as he
has cerebral palsy. This proved to be slightly challenging when approaching patient care, however the patient identified more with a
toddler or infant. The approach was changed to more of a small-child approach, with tickling and cartoon talk to help calm the
patient and make sure he was comfortable.
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Physiological Stressor # 2
Physiological Stressor # 1
S
S: Inadequate nutritional dietary assessment for S: Client seems uncomfortable and scooches T
Student Concept Map, p1 himself when he has been in the same spot for
body height and weight, facial expression of disgust U
when eating Life threatening stressors penetrate too long. D
Core E
O: 2.5 kg weight loss over 1 month, documented O: Braden Score of 23, wheelchair bound, g- N
inadequate nutritional intake, poor muscle tone, dry Abnormal Symptoms penetrate tube placement, inability to express when T
hair, positive celiac test, guarding of mouth normal line of defense needing to be moved, eczema, incontinence
A: Imbalanced nutrition: Less than body N
requirements related to inability to procure adequate Stressors penetrate flexible line of A
amounts of food secondary to cerebral palsy as A: Risk for impaired skin integrity related to
defense & ^risk for penetration of M
evidenced by rapid weight loss, documented immobility and nutritional deficits
NLD E
inadequate caloric intake, muscle weakness, dry
hair, dry skin. P: The client will maintain tissue integrity
D
through absence of redness, irritation, and no
P: The client will display nutritional ingestion A
skin breakdown on the day of care.
sufficient to meet metabolic needs on the day of Medical Diagnosis: T
care. Failure to thrive E
CC: Weight loss

Positive Variable Aiding

Positive Variable Aiding Resistance:
Defense: Patient is up to date on all
Lives with foster family Age: 6-10 immunizations; prophylactic
and has an ample amount years old Tylenol for pain
of support; biological
family at bedside

Other Stressor # 4
Physiological Stressor # 3
S: Staring out of the door when someone
S: “Can my son get an infection?” “How can I help HPI: Patient born with cerebral palsy, leaves the room and saying “no”, crying
reduce the risk of infection?” hypothyroidism and has been
diagnosed as failure to thrive. out for attention, look of frustration
O: Incisions on testes, g-tube placement, decreased
nutritional status, eczema scratching O: Nonverbal, no real interactions aside
from medical care, bouts of anger and
A: Risk for infection related to a site for organism agitation.
invasion secondary to enteral feedings and bilateral
orchiopexy Flexible line of defense
A: Impaired social interaction related to
P: The client will remain free of infection, aeb by Normal line of defense current hospitalization and condition as
normal vital signs, and absence of signs and evidenced by loneliness, crying, shouting
Lines of Resistance
symptoms on infection on the day of care. “no”, look of frustration.
Basic Structure/Central
Core P: The client will show enjoyment in
interacting with people other than medical
staff before end of day of care.
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Nursing Concept Map p.2: Attach clinical prep sheet to this form
Student Name: Julianna Brauchle Patient Initials:
Nursing Dx: Imbalanced nutrition: Less than body requirements related to inability to procure adequate amounts of food secondary to cerebral
palsy as evidenced by rapid weight loss, documented inadequate caloric intake, muscle weakness, dry hair, dry skin.
Behavioral Outcome: The client will display nutritional ingestion sufficient to meet metabolic needs on the day of care.

Interventions: Rationale: Implementation: Evaluation/ Pt. Responses:

Weight loss is vital to nutritional Patient’s weight is

Note exact weight, no Patient is placed on a recorded in
assessment, measurements must be
estimates accurate as they will be the basis for weighted bed to get the most decimal places and
caloric and nutrient requirements accurate weight fluctuations is most recently
(Moorhouse & Doenges, 2016) recorded at 21.3 kg

Family members can provide a more Patient not consuming

Take a nutritional history with accurate detail on eating habits,
the participation of significant especially when patient has altered
others perception
(Moorhouse & Doenges, 2016)
Full nutritional history is solid foods and
sometimes goes without
obtained from the foster eating. Patient has lost
family. 2.5 kg over one month.

Patient is seen by
dietician; it is
Ascertain healthy body weight for A dietician can determine the determined that
age and height. Refer to a dietician patient’s daily requirements of Dietician consult is patient needs high
for complete nutritional assessment specific nutrients to promote placed calorie Pediasure to
sufficient nutritional intake supplement for
(Moorhouse & Doenges, 2016) nutrition.

Patient is given 240

Consider the need for enteral Nutritional support may be mL 3 times a day
recommended for patients who are With support of foster family, Pediasure through g-
nutritional support with the tube feedings and
unable to maintain nutritional intake patient supplemented with
caregivers as appropriate by oral route
tolerates feedings
Pedisaure g-tube feedings. well. Patient is
(Moorhouse & Doenges, 2016) maintaining weight.

Upon discharge, help the family Change is difficult and can be Unable to
identify areas to change, such as overwhelming. With the new g-tube Information on the MIC-KEY
tube feedings, to contribute to better placement, family needs to be aware
assess at this
button g-tube and how to tube
nutrition of how to supplement solid food feed is gathered for the foster time.
(Moorhouse & Doenges, 2016) family
Assessment of behavioral outcome: Patient displayed ingestion of sufficient supplement to maintain a healthy body weight on the day of care.
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Nursing Concept Map p.2: Attach clinical prep sheet to this form
Student Name: Julianna Brauchle Patient Initials:
Nursing Dx: Risk for impaired skin integrity related to immobility and nutritional deficits
Behavioral Outcome: The client will maintain tissue integrity through absence of redness, irritation, and no skin breakdown on the day of care.

Interventions: Rationale: Implementation: Evaluation/ Pt. Responses:

Establishes risk for skin breakdown Patient’s

Determine client’s risk for Braden Scale utilized to Braden score is
and necessary implementations to
skin breakdown using a risk help prevent further breakdown. assess patient risk for recorded as
assessment tool (Moorhouse & Doenges, 2016) skin breakdown highest risk,a
23

Patient moves
Assist client to turn at least Relieves pressure off of bony himself slightly to
prominences and dependent Patient is turned every 2 alleviate any
every two hours unless hours into a different pressures. Upon
contraindicated areas assessment of the
(Moorhouse & Doenges, 2016) position. skin, no areas of
redness or
breakdown noted.

Perform actions to keep client In order to reduce the risk of Patient stays
skin surface abrasion and Pillow placed under knees sitting upright
from sliding down in bed when bed is elevated above 30
shearing in bed without
degrees. sliding down.
(Moorhouse & Doenges, 2016)

Apply moisturizing lotion to To prevent drying of the skin Patient’s skin

the skin at least once a day which may cause breakdown Lotion is applied after bathing remains moist
(Moorhouse & Doenges, 2016) to help protect patient’s skin
and intact

Patient
Ensure an adequate nutritional To maintain healthy skin and maintains an
adequate nutrition to prevent skin adequate intake
status Patient has a nutritional
breakdown of Pediasure
consult and special diet and caloric
(Moorhouse & Doenges, 2016)
has been ordered intake
Assessment of behavioral outcome: No redness, skin breakdown, or irritation noted on day of care.
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Nursing Concept Map p.2: Attach clinical prep sheet to this form
Student Name: Julianna Brauchle Patient Initials:
Nursing Dx: Risk for infection related to a site for organism invasion secondary to enteral feedings and bilateral orchiopexy
Behavioral Outcome: The client will remain free of infection, aeb by normal vital signs, and absence of signs and symptoms on infection on the
day of care.

Interventions: Rationale: Implementation: Evaluation/ Pt. Responses:

Assess and monitor nutritional
status, weight, and history of
weight loss
Patients with poor nutritional status
may be anergic or unable to muster a
cellular immune response to
pathogens making them susceptible
to infection (Moorhouse & Doenges,
2016)
Nutrition consult placed,
weight taken, history of
weight loss assessed
Patient lost 2.5 kg over
one month, patient weighs
21.3 kg, and has been
diagnosed with failure to
thrive Patient necessitates
Pediasure
supplementation

People with incomplete Patient is

Assess immunization status immunizations may not have Patient chart checked for currently up to
and history sufficient acquired active immunization status. date with all
immunity (Moorhouse & Doenges, immunizations.
2016)

Helps support the immune Patient found by

Encourage intake of protein- nutrition to need a
system responsiveness Patient’s diet assessed for
rich and calorie-rich foods high calorie
(Moorhouse & Doenges, 2016) current nutritional intake Pediasure to
supplement his
intake.

Patient caregivers
Teach the family the importance of Patients and caregivers can spread verbalized an
washing hands often, especially after infection from one part of the body Patient’s biological family and understanding of
toileting, before meals, and before and to another, handwashing reduces foster family taught the the importance of
after administering care. hand hygiene prior
these risks. (Moorhouse & Doenges, importance of hand hygiene.
2016) to the end of care.

Monitor for redness, swelling,
increased pain, purulent discharge
from incisions, injury, and exit
sites of tubes
These are the classic signs of
infection- any suspicious signs of
drainage should be cultured.
(Moorhouse & Doenges, 2016)
Patient’s steri-strip sites
monitored, g-tube exit site is
monitored
Patient’s g-tube exit site without
erythema, no heat or pain. Steri-
strips intact and clean, no pain or
erythema, swelling decreased. No
signs of infection in either site.

Assessment of behavioral outcome: Patient maintained normal vital signs and there were no signs or symptoms of infection on the day of care.
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Nursing Concept Map p.2: Attach clinical prep sheet to this form
Student Name: Julianna Brauchle Patient Initials:
Nursing Dx: Impaired social interaction related to current hospitalization and condition as evidenced by loneliness, crying, shouting “no”, look of frustration.
Behavioral Outcome: The client will show enjoyment in interacting with people other than medical staff on the day of care.

Interventions: Rationale: Implementation: Evaluation/ Pt. Responses:

Patient is distracted
Depressed clients lack concentration
Provide activities that require Patient’s TV is turned on through TV and
and memory. Activities that have no smiling. Patient
minimal concentration such as “right or wrong” or “winner or loser” to cartoons. seems to be less
listening to the TV and music minimizes opportunity for the client depressed.
to feel depressed (Moorhouse &
Doenges, 2016)
.
Maximizes potential for Patient is
When client seems depressed, interactions while minimizing Student nurse spends 30 calmer, more
involve the client in one-to- anxiety levels. (Moorhouse & minutes with patient cooperative,
one activity Doenges, 2016) talking to him and playing. and smiles as a
result.

Involve the client in group Socialization minimizes Unable to

feeling of isolation. Genuine Student nurse talks to Child assess before
activates (art therapy, music Life about getting some type of
therapy) regard for others can increase end of care.
music therapy or someone to
feelings of self-worth come in and play with patient.
(Moorhouse & Doenges, 2016)
In future, hopeful that
Maximize the client’s contacts Contact with others distracts through Child Life
patient will have
with others Student nurse maximized patient
the client from depression contact by inviting other student further interactions.
(Moorhouse & Doenges, 2016) Patient enjoyed the
nurses into the room.
other student nurses
by smiling and laghing
continuously
The client and family can gain
Refer the client and family to tremendous support and insight Unable to
self-help groups in the Student nurse discussed this
from people sharing their assess before
teaching with nurse, a note was
community experiences (Moorhouse & made that they will be referred to a end of care.
Doenges, 2016) help group for diabled children.

Assessment of behavioral outcome: Unfortunately, the student nurse was not able to assess the patient’s interactions with people other than
medical staff before the end of the day of care.
 Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

REFERENCES:
BabyCenter. (2015, September 29). Physical development milestones/Gross motor skills (ages 5 to 8). Retrieved October 10, 2017, from

https://www.babycenter.com/0_physical-development-milestones-gross-motor-skills-ages-5-to_3659044.bc

BabyCenter. (2015, September 29). Physical development milestones/fine motor skills (ages 5 to 8). Retrieved October 10, 2017, from

https://www.babycenter.com/0_physical-development-milestones-fine-motor-skills-ages-5-to_3659048.bc

Home Speech Home. (2015). Language development in cchildren 8-9 years - Everything you need to know. Retrieved October 10, 2017, from

http://www.home-speech-home.com/language-development-in-children-8-9-years.html

Medscape. (2017, August 21). Nutritional considerations in failure to thrive. Retrieved October 11, 2017, from

http://emedicine.medscape.com/article/985007-overview

Moorhouse, M. F., & Doenges, M. E. (2016). Nurse's clinical pocket manual: Nursing diagnoses, care planning, and documentation. Philadelphia:

Davis.

PBS Parents. (2017). Social and emotional growth. Retrieved October 10, 2017, from

http://www.pbs.org/parents/childdevelopmenttracker/eight/socialandemotionalgrowth.html

Wake Med. (2017). Tips for hospitalized school age children. Retrieved October 10, 2017, from https://www.wakemed.org/childrens-school-age-6-

12-years

Growth Charts:

CDC. (2017, June 16). National center for health statistics. Retrieved October 11, 2017, from https://www.cdc.gov/growthcharts/clinical_charts.htm