Mariano Marcos State University

Republic of the Philippines

Batac, Ilocos Norte
College of Health and Sciences

GROWTH AND DEVELOPMENT

CASE STUDY

BSN II-D Group 1 Cluster 2

Ansagay, Mc Lein A.

Antolin, Chloe Rosette B.

Asuncion, Keziah Claire D.

Asuncion, Mary Joyce R.

Aurelio, Lyca Mae M.

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 I. PERSONAL DATA

Name of Child: E.C.A.

Date of Birth: June 14, 2016
Age: 4 years, 4 months, 14 days
Place of Delivery: MMHC &MC, City of Batac Ilocos Norte
Weight:16.5 kg Height: 104 cm

Name of Parents:
Mother: J.M.A. Age: 24
Occupation: Restaurant waitress & Beauty products seller
Educational Attainment: College Undergraduate

Father: J.C.A. Age: 25

Occupation: Tricycle Driver & Farmer
Educational Attainment: College Undergraduate

Civil Status: Married

Religion: Roman Catholic
Monthly Income: Php. 15,000

Siblings:
Name(s): R.J.A.
Birthdate: October 15, 2018
Age: 2

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 II. Health History

A. Family Health History

Family Genogram

The child’s grandfather on the paternal side is hypertensive, diagnosed year 2012 by Dra.
Ruth de Lara at Solsona RHU. It is managed with Amlodipine 5 mg OD, Benazepril 10 mg OD
and low-salt and low-fat diet. Meanwhile, his grandmother on maternal side is also suffering from
hypertension, diagnosed year 2014 by the same physician mentioned. It is managed with
Amlodipine 10 mg OD, Metoprolol 50 mg BID and low-salt and low-fat diet. Other than these,
the family that the child belongs does not have any hereditary diseases.

The mother and father of the child as well as his aunts and uncle from both sides, said that
they did not suffer from any hereditary diseases, however they only experience common illnesses
like fever, colds and coughs. On the paternal side of the child, his father and his uncle and aunt
practiced traditional method of treating their illnesses such as utilizing herbal medicines like
decoction of “oregano” or “lagundi leaves” in treating their cough. Moreover, they said that after

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doing these along with enough rest and sleep, they would eventually feel better. On the maternal
side of the child, his aunt and his mother go to the RHU whenever they feel ill. Management
includes taking antibiotic which they failed to remember and also OTC drugs like Paracetamol
Biogesic.

Regarding immunization status, the parents are not sure if they are completely immunized
due to unavailability of records however, vaccine scar is seen in the mother and the father’s left
upper arm . The child has a 2-year old brother fully immunized with BCG, Hepa B, DPT,
Polio, Measles vaccine. His brother is healthy and was delivered normally at Mariano Marcos
Memorial Hospital. According to the mother, his youngest son did not have any serious diseases
but had only suffered common illnesses as he grew up. They manage his illness by going to the
RHU and taking prescribed medication by Dra. Ruth de Lara such as Disudrin for his colds 2.5 ml
every 6 hours and Carbocisteine 2.5 ml four times daily for his cough. As for our client, the mother
said that he grew up to be a healthy child despite being hospitalized immediately after birth. In
both the maternal and paternal side, their heights and body built are average, eye color are gray,
skin complexion are medium brown, and hairs are straight and color black. The child carried all
these physical characteristics mentioned.

B. Past Health History

The patient had been delivered through normal spontaneous delivery. He was underweight,
weighing only 2.33 kg. Prior to the delivery of the child, his mother had a Maternal Urinary Tract
Infection (UTI) during her last term of pregnancy that caused the child to be hospitalized after he
had been born and stayed at the Neonatal Intensive Care Unit (NICU) for seven (7) days.
According to his mother, he was given antibiotics as a form of treatment but she cannot recall the
specific name nor dosage and frequency of the drug. More so, there had been no apparatus that has
been inserted to the patient.

When the child was just 8th month-old, he was rushed at Piddig District Hospital for a
week because of loose watery stool. The mother said that the child was given medications by Dr.
Rabang, unfortunately she could no longer remember the type of drug that was given to the child,
but she does remember that the child had an IV medication administered to him.

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 However, after just about 2 weeks, the child had a high fever, this again lead them to seek
medical help at Salun-at Polyclinic at Solsona, Ilocos Norte, although the mother could no longer
remember the name of the doctor, she said that she recommended them to go to Karmelli Hospital
at Laoag City because the doctor suspects Dengue symptoms on the child. The child undergo blood
testing and was confined in the hospital for 3 days. He was given IV medications and other drugs
that the mother can no longer remember. The test result was negative for dengue and according to
the mother, the medications given to her child was effective because the body temperature lowered
down to normal range and fever was gone in just 2 days. According to the mother, the child had
been healthy since then.

C. Present Health History

Upon detailed physical assessment, there was a problem on the oral hygiene as evidenced by
the 5 caries on the upper right lateral incisor, upper central incisor, left canine, upper right first
molar, and lower left second molar. According to the mother, the child loves to eat sweets
especially chocolate and brushes only twice a day. The mother also said that they have not brought
their child to the dental clinic yet because she thought that the teeth of the child still have a chance
to be better in his succeeding years.

The child is cheerful and active and shows a general appearance of a healthy boy. The child
also takes multivitamins – Regivit Syrup, 5 ml, once a day and Ascorbic Acid Zinc, Ceelin Plus,
5ml, once a day.

Overall, the child is healthy and is without any present illness and is assured with
appropriate care from both parents.

III. Factors Influencing the Growth and Development

A. Hereditary/Genetics

The child’s grandfather on the paternal side is hypertensive, diagnosed year 2012 by Dra. Ruth
de Lara at Solsona RHU. It is managed with Amlodipine 5 mg OD, Benazepril 10 mg OD and
low-salt and low-fat diet. Meanwhile, his grandmother on maternal side is also suffering from

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hypertension, diagnosed year 2014 by the same physician mentioned. It is managed with
Amlodipine 10 mg OD, Metoprolol 50 mg BID and low-salt and low-fat diet. Hypertension is the
only disease linked to the family of the child. According to the study by Ranasinghe and Cooray
(2015), about 30 % of the blood pressure variance can be attributed to genetic factors. However,
it is more likely that people with a family history of high blood pressure share common
environments and other potential factors that increase their risk.

Regarding immunization status, the parents are not sure if they are completely immunized due
to unavailability of records however, vaccine scar is seen in the mother’s left upper arm. Besides,
child’s brother is already fully immunized with BCG, Hepa B, DPT, Polio, Measles vaccine.
Immunization is a simple and effective way of protecting families. It triggers the immune system
to fight against certain diseases, this either prevents the disease from developing or reduces the
severity (WHO, 2019).

In both the maternal and paternal side, their heights and body built are average, eye color are
gray, skin complexion are medium brown, and hairs are straight and color black. The child carried
all these physical characteristics mentioned. Furthermore, his mother observed that the child is
already starting to excel academically which they thought the family’s genetics have something to
do with it. Each parent contributes 23 chromosomes to their child and these chromosomes contain
all the genetic information for each person in their DNA, which is carried by genes (Genes in Life,
n.d.) Simply, people pass on traits or characteristics to their children or the next generations
through genes.

B. Environment

Their house is located at Barangay #6, Nagpatpatan, Solsona, Ilocos Norte. It is a bungalow
type of house with a floor area of 10m x 12m, consisting of four rooms; living room which is
approximately 3m x 3m, a bedroom which is approximately 3m x 3m, a dining and kitchen room
and one comfort room which is approximately 3m x 3m. The house is adequate for their family as
they are only 4 currently residing and is a nuclear type of family.

The living room of the family includes their television, two sofas and, an electric fan, the
living room has an adequate space for the family as it is spacious for the family. The tables and
chairs has sharp edges that may injure the child or his brother. There are also cable wires which

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may cause him to trip and fall. In their house, there are two cats that he is usually playing with but
those cats have already been vaccinated.

Their dining area consists of a dining table and four chairs, their kitchen consists of a
countertop, which they use for preparations for their meal, cupboards mounted on the wall for their
cooking utensils, a medicine cabinet, and a cabinet for their eating utensils. Their water supply for
cooking is from their faucet connected to their water tank. The family said that the water tank is
connected to their well.

The knives are safely stored in a knife block that is located near the wall so that the children
will not access the knives, the medicine is stored in a medicine cabinet that is not within the reach
of the children, and lastly the poisonous substances or chemicals such as pesticides are places in a
lock cabinet at the corner just before the comfort room that is approximately 5 feet above the
ground where it is not near the food or medical supplies and it is not within the reach of the
children. Their gas stove is elevated located a meter away from the countertop in a corner, left side
of the room, furthermore the gas stove is away from the curtain and other flammable materials.
Their refrigerator is located on the right side of the room.

From the dining area, a door that leads to the bedroom, this room consists of a bed, a cabinet
drawer for their clothes located at the right side of the room, a sofa in front of the bed, a table just
few feet from the sofa and an electric fan. The child shares one bedroom with his parents and his
brother, they sleep comfortably on the bed. According to the verbalization of the mother, she
always checks if the her children are getting enough sleep , because of this both the child and his
brother gets 8 to 10 hours sleep, they go to bed at 8 PM and they usually wakes up at 5:30 or 6:00
AM.

The water supply in their comfort room is from their water well pump. The comfort room has
a drainage system that helps drain the water from the room. Their toiletries are located in at the
sink area.

Their backyard is a vacant lot consisting only a few trees. The backyard is the space between
their house and the plots for farming. At the front of their house, there are plants and cacti, which
may cause risk for injury not only to the child but to his sibling. There is also a canal, although it

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has a pavement cover, it may still contain stagnant water that may be a breeding ground for
mosquitoes.

There are also livestock roaming around the environment and there are also fertilizers near
the plots for farming in which the family verbalized "The manures and fertilizers often emit strong
and foul odors."Additionally, there are no barbed wires surrounding the home and there were no
protruding galvanized iron or metals such as nails outside their home.

There were no shards of glass found in the exterior and interior of their house. They do daily
cleaning and once a month of general cleaning as well. The septic tank is located 22 m away from
their water source which is good and is sanitary. Adjacent to their house is the house of his cousin
which he plays with every day. Since their house is at the roadside, although it is not a busy street,
they are being strictly attended during their playtime by their grandmother. He usually goes to his
cousin's house and play with him and goes home before 4 PM to avoid being bitten by mosquitoes.
Upon arriving home, he would then play with his tablet and his parents' cellphone to watch
YouTube® educational videos.

Their neighborhood consists of houses approximately 18 meters away from each other. And
the only loud noises where usually from cars, livestock and machineries for farming.

The family has a harmonious relationship where they get along well and bond during the
weekends like having a picnic to improve their bond.His parents and relatives had a few
misunderstandings once in a while but they make sure that the children are not aware. His family
members use Ilocano as their means of communication. They often go to mass together and as well
as pray together before meals and at night.

C. Health

The child appears healthy, he is active and cheerful. According to the mother, the child
takes vitamins such as Regivit Syrup®, 5 ml, once a day and Ascorbic Acid Zinc, Ceelin Plus®,
5ml, once a day. Good personal hygiene also became a routine of the child. It includes washing
hands before and after eating or playing, taking a bath two times a day, brushing teeth two times a
day, making nails short and clean, and cleaning ears with cotton buds frequently. According to the
mother, they taught their child how to take care of himself in the best way he could at his young

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age in order for him to stay healthy and be away of any illnesses caused by poor hygiene. However,
despite the care given to the child, he still had dental problems as evidenced by the 5 caries on the
upper right lateral incisor, upper central incisor, left canine, upper right first molar, and lower
left second molar. According to the mother, the child loves to eat chocolates and anything sweet
which had probably caused the caries of the child.

Moreover, the child eats 3 meals a day and also eat snacks in between. The child likes to
eat bread and chocolate as his snacks however sometimes he also drinks soda (coke) about 60 ml
only. The child also takes a bath twice a day daily and plays only inside the house and their front
yard. According to the mother, the child also gets out their house sometimes to play with his peers
but the parents always checks on the child every 2 hours to change his clothes if they are soiled or
wet from sweating. The mother also said that sometimes the child goes to play at the farm near
their house and would get muddy, immediately, the parents will wash the child and remind him no
to play in the fields again because they are worried of snakes or insects that might bite the child.

Good hygiene habits are key to ensuring the safety of the child and the children he interact
with, as the old saying goes, prevention is better than cure. Also, inculcating the principles of
correct hygiene at an early age can help keep individuals healthy in later life, and be taught to
future generations (Johnson, 2019). Moreover, multivitamin supplement provides additional
nutrients to complement child's diet and provides with the reassurance that the child gets enough
vitamins and minerals he needs.

Based from the data given above, aside from the dental problem of the child, the hygienic
practices of the child is well maintained as well as the nutrition of the child, therefore there is a
high probability that in the future the child will grow healthy and safe from serious illnesses if this
health practices will be maintained further.

D. Nutrition

The patient was breastfed for 24 months and when he stopped, he started drinking Nido®
milk. When the child was able to eat soft foods already, he likes to eat Cerelac®. Then, the child
only drinks milk occasionally because he much prefers beverages like Yakult®, Chuckie® and
Dutchmill®.

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 According to the mother, when the child was already on his 2 -3 years the child could finish
1 scoop of rice already as long as he has soup. The mother said that the child nearly likes all foods
and vegetables except “ampalaya” because of its bitter taste. He likes milkfish especially when it
is fried and likes chicken amongst all types of meat.

As the child grows up, he happened to like vegetable soup and egg as his usual breakfast
and, sometimes he also eats instant noodles in the morning usually with egg. According to the
mother, the child is not picky when it comes to food that is why he eats whatever is on the table.
Because of this, he is able to eat a balanced diet for they always eat variations of vegetables and
pork, vegetables and beef, vegetables and chicken, vegetables and fish and he also eats fruits like
apple, orange, papaya fruit and other seasonal fruits like watermelon and “rambutan”. The mother
said that she makes sure that the child eats 3 times a day with snacks in between.

As for his usual snacks, he likes chocolates and bread usually partnered with chocolate
drink. The child does not frequently drink sodas but when he does the mother said that he just
drinks in small amounts, she said that she pours only about 60 ml to the small cup of the child. He
drinks water after drinking sodas, overall, he drinks about 8 glasses of water every day.

The age of the child (52 months) and weight is normal 16.5 kg based on the normal range
of his age 13.4 to21.7.

Nutrition in early life is crucially important for children to grow and develop into healthy
adults. Children can reach their growth and development potential if their nutritional needs are met
in a healthy environment (Denney et. al., 2013).

As a conclusion, the patient is provided with the necessary nutrients and supplementary
foods that he should be taking in which is substantiated by the fact that he didn’t acquire any
diseases and illnesses while growing up although there had been outbreaks of these illnesses in the
past few months. However, the parents should watch the child preference on breakfast because
eating too much instant noodles might put the child at risk for malnutrition and of acquiring kidney
diseases due to its high sodium content.

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 E. Socio-economic Status

Foods Php. 4,000

Childcare Php. 2,500
Transportation Php. 2,000
Personal Care Php. 1,100
Recreation Php. 1,000
E-load Php. 800
Education Php. 800
Electricity Php. 750
Savings Php. 500
Household Items Php. 500
Medication Php. 350
Gas for Cooking Php. 250
Water Php. 250
TV Cable Php. 200
TOTAL Php. 15,000

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 The child’s father is a tricycle driver and a seasonal farmer who earns Php. 7,000/month while
his mother is waitress at a snack house earning Php. 6,000/month and Php. 2,000/month on her
beauty products business. In total, the family’s monthly income is Php. 15,000 which is allocated
for food, childcare, transportation, personal care, recreation, e-load, education, electricity, savings,
household items, medication, gas, water and TV cable. The mother is being in-charge on budgeting
their monthly income and expenses.

Php. 4,000/month is allocated for food however sometimes they are spared from buying
rice, vegetables, fruits and meats because it is already available within their home. The table below
shows how the mother budget for food:

Snacks Php. 650

3kg of Pork Php. 600

Vegetables Php. 500

2 kg beef Php. 500

2 kg chicken Php. 300

3 packs frozen foods Php. 300

Fruits (apple, orange, rambutan, watermelon) Php. 300

Sugar and coffee Php. 200

1L cooking oil Php. 200

5 canned goods Php. 150

10 pcs instant noodles Php. 150

Food seasonings Php. 150

Php. 2,500/month is allocated for childcare; Php. 1,800 for milk, the younger brother
regularly drinks milk however, the child only drinks milk occasionally because he much prefers
beverages like Yakult, Chuckie and Dutchmill and also Php. 700 for multi-vitamins. Then, they
have a tricycle and motorcycle which serves as their means of transportation and since they do not
travel much in far places, they only budget Php. 2,000/month for their transportation services. For

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personal care, Php. 1,100/month is reserved. It includes shampoo and conditioner, soap, haircut
and other grooming products and services.

More so, the family go for recreation once a month in which Php. 1,000/month is spent.
For internet, calls and text messaging, Php. 800/month is allocated for e-load, since the children
love to watch educational and entertainment videos online. The child is studying in a public day
care center so they only spend minimally for him and his school stuff are mostly gifted by their
relatives. However, during this modular learning the parents pay a relative to tutor the child for
only Php. 750/month since they are busy with their work and Php. 150 for school supplies, for a
total of Php. 800/month for education.

They are only paying Php 750/month for their electricity since their appliances and lights
are low consuming and minimally used. For emergency and future purposes, the family save Php.
500/month. Further, Php. 500/month is allocated for household items such as dishwashing soap,
laundry soap and some kitchen utensils.

In case someone is sick, Php. 350/month is reserved for medication. The family uses stove
for cooking and consumed 1 LPG (Php. 750) for 3 months, therefore Php. 230/month is budgeted.
More so, they drink mineral water for safety purposes and consume 10 gallon/month for Php. 250.
In addition to the expenses is Php. 200/month for TV cable.

The Philippine Statistics Authority (2019) stated that a Filipino family of five needed no
less than Php7,337, on average, to meet the family's basic food needs for a month. To cover both
food and non-food needs, a Filipino family of five will need no less than Php10,481, on average.
Since the family is also living in a rural area cost of living is lower due to food security and
environmental factors. Indeed, the family has an adequate fund for them to meet all their basic
necessities for now, however as children grows, it is expected that expenses will also grow due to
increase cost of their food, clothing and most especially education. The parents need to increase
their finance in the future in order to sustain the increasing expenses of the children and live a
decent life.

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 F. Race/Religion

The child is a pure-blooded Filipino. His black and straight hair, gray eyes, average body built
and height, medium brown skin complexion and not so pointed nose are all in conformity with the
physical attributes of a Filipino. Problems with the child’s race are not present.

The family share the same religion which is Roman Catholic. Along with, the child was
baptized during his first birthday. Due to busy schedule of work, the family only attend mass once
a month and during special occasions like Christmas, new year and holy week. However, they
practice praying before eating and sleeping which already became a habit of the child. In 2008, a
study was conducted by Bartkowski and colleagues look at the impact religion has on child
development. That study found that religion was linked to enhanced psychological adjustment and
social competence among primary school-age children (kindergartners). The child internalize
religious values, thus he is less likely to engage in bad behaviors even when circumstances
motivate him to do so.

G. Culture

The child and his family adhere to various Filipino cultures particularly the Ilocano culture.
First, pinag-atang, which involves food offering to unseen forces in order to appease them. This is
done when the patient/family believes that the illness or the disease is inflicted by these unseen
forces. Second, an-annong, it is a belief on being ill through the influence of the spirit of one’s
dead relative. Third, the family seeks “manghihilot” whenever a member suffers from abdominal
pain, sprains, fractures and musculoskeletal conditions. Fourth, they are fond of eating Ilocano
dishes like “dinengdeng” (vegetable stew), “pinakbet” (shriveled vegetables with fish paste),
“igado” (pork with soy sauce and vinegar, sautéed with spices), “bagnet “(deep fried pork belly)
and dinardaraan (blood stew). Lastly, they are known to be thrifty which reflects their Ilocano
identity. The parents of the child taught him how to save money. They said that before the new
normal, whatever money is left in the pocket of the child they taught him put it in his piggy bank
in order to have some spare money during special occasion.

The family mainly uses Ilocano as a form of their communication. Indeed, the child practiced
showing respect to the elder population with certain gestures and honorifics use before the person's
name such as “ate”, “kuya”, “lolo”, “lola”, “anti” and “uncle”, even the person is not a relative.

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The family also value peace in their home, in actions and in words. They do not speak bad words
to the child and do not abuse the child verbally nor physically. Problems that arise in the family
are being talked privately between the mother and the father and resolve issue as soon as possible.
They also value honesty and trains their children to practice honesty under any circumstances,
however because of a young age, the child still commits minor lies to his parents for example when
the child wrote drawings on the wall, he would say he did not do it because he is afraid of being
punished.

In the past two decades, researchers like Robert McCrae have shown how culture can shape
personality. It shows cultural values are relatively enduring, and seem to have an effect on how
kids develop over time. Parent’s cultures also play an important role in moulding children’s
behaviour and thinking patterns (Ketchell, 2018) because typically parents are the ones who
prepare the children to interact with wider society. The way the family treats each other gently in
words and in actions help the child to grow up without any burden psychologically. This will make
the child to be an adult who gives respect and value relationship with other people.

H. Family Structure

Since his parents were still young during the time that he was conceived, there is a negative
reaction coming from his father. However, after some time he was able to accept it and the
relationships between the children and their family has been nurtured. The patient's family is
nuclear. The patient lives with his parents and a younger brother aged two. They are close to one
another and has inseparable with one another ever since his brother was born. Also, he lives near
his aunt and uncles across the street who are his caregivers also. His grandmother serves also as
his mentor and is someone who nurtures him and his morality, teaching him values especially on
the conduct that he should have towards treating other people. Since they have a nuclear family,
he is always being taught to be independent and help in the house chores and his ideas are nurtured
well, and being made sure that he’s having the best kind of care for him to grow healthily.

According to a research conducted by Dr. Pollak, Ph.D., a Hernreich Professor of Economics

in Arts & Sciences and the John M. Olin School of Business, family structure plays a vital role in
the development of learning skills in a child. The traditional nuclear family has a positive impact
on how kids are raised. In a nuclear family system, mothers are responsible for sharpening the

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relationship skills and emotional response skills of their children, thus enabling them to have
stronger relationships in their lives. Fathers on the other hand train children in general handiwork
skills, sports skills and other competitive and survival skills, which eventually ensure success for
kids from such nurturing backgrounds. Children who are raised by both parents tend to grow up in
a more relaxed environment, since both parents assist each other in the bringing up duties of the
children. Children who are raised by both parents tend to grow up in a more relaxed environment,
since both parents assist each other in the bringing up duties of the children (Family Dynamics,
Parenting Style, 2013).

I. Prenatal influences:

She had healthy habits during her pregnancy. She would eat fruits in the morning and fuel
herself with a cup of rice, a cup of vegetables and a cup of the meat (pork, chicken, beef or fish)
that had been cooked that day. She’d eat in such manner for three times a day and would often
have a snack in between. Chocolate was her favorite food to eat whilst pregnant. She also drank
milk during her pregnancy as a supplemental food. She also added that she takes Ferrous Sulfate
once a day which is prescribed by her doctor- Dra. Ruth de Lara. She said that she goes to the
RHU for her monthly consultation with Dra. Ruth de Lara. She said that she did not take any other
medicines when she was pregnant because she is afraid it would bring harm to the child. With this,
she said that she did not experienced any other sickness when she was pregnant other than just
simple colds which she managed by drinking calamansi juice. She said that this helps her relive
from her colds. In addition to that, during the third term of pregnancy, she would walk around in
the afternoon to help ease the contractions that she’s feeling and to reduce edema in her feet.

The mother of the child had a full-term pregnancy with a complication during the last term.
Despite that, the patient was still underweight at birth, weighing only 2.35 kg. She had Maternal
Urinary Tract Infection (UTI) for the growing uterus blocks the drainage of the urinary bladder.
This is also believed to be the reason why the patient had been at the ICU for seven days and was
given antibiotics as a management. His parents were not active in sex during the pregnancy.

The developing fetus is completely dependent on the mother for life, and it is important that
the mother receives prenatal care, which is medical care during pregnancy that monitors the health

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of both the mother and the fetus. According to the National Institutes of Health ([NIH], 2013),
routine prenatal care can reduce the risk of complications to the mother and fetus during pregnancy.

Overall, the influence of the prenatal practices has reflected on the health of the patient. He
might have acquired infection during the first week of his birth but he was able to recover from it
and surpassed the challenge that had been brought about by the conditions of pregnancy of her
mother.

IV. Developmental Milestone

Erik Erikson's Stages of Psychosocial Development

A. Trust vs Mistrust

The trust versus mistrust is the first stage of development and it begins at birth and last until
the child is around 18 months old or 1 year and 6-month-old. According to Erik Erikson, this stage
is the most important period of a child's life because it will affect on how they will view and shape
the world as well as their overall personality. If a child successfully develops trust, he will feel
safe and secure around other people.

The child was able to pass this stage because he trusted us by letting us establish a rapport with
him easily also before the assessment, we were able to get to know him more before doing the
MMDST. During the assessment of the MMDST, despite him having a short attention span which
is normal because he is a child, he was able to comply with the task we told him to do such as
drawing, walking, skipping, and so on.

The trust vs mistrust stage serves as a foundation of development. The outcomes of this can have
effects that influence the rest of an individual's life. (Cherry & Grans, 2020)

B. Autonomy vs. Shame and Doubt

The autonomy versus mistrust the second stage of development and it begins when the child is
18 months old and last until a child turns 3 years of age. According to Erikson, children at this

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stage are focused on developing a sense of personal control over physical skills and a sense of
independence.

During the conduct of the MMDST assessment, the child was able to pass the task were given
him, one of which is under the personal-social the buttons up task, he was able to button his own
polo shirt without the help of his mother and the one assessing him. Another one is, the child was
able to dress himself without the help of his mother or any supervision from his mother. Buttoning
up his shirt and dressing without supervision illustrates his growing sense of independence and
autonomy.

Furthermore, one of the characteristic behaviors of child who has a sense of autonomy is they
are able to work by themselves or with others, depending the situation. During the assessment, the
child was able to do the task we've given to him independently for example, drawing a +, circle
and a human being with 3 parts without the assistance of anyone not even the student nurse
assessing him.

Children who successfully complete this stage feel secure and confident, while those who do
not are left with a sense of inadequacy and self-doubt. This stage also serves as an important
building block for future development. Kids who have confidence in their skills are more likely to
succeed in subsequent tasks such as mastering social, academic, and other skills. (Cherry & Grans,
2019).

C. Initiative vs. Guilt

The initiative versus guilt is the third stage of development and it begins when the child is 5
years old and last until a child turns 5 years old. According to Erikson, children at this stage are
assert themselves more frequently through directing play and other social interaction. Indeed,
central to this stage is play, as it provides children with the opportunity to explore their
interpersonal skills through initiating activities.

According to the child’s mother, he plans activities, make up games, and initiate activities with
his playmates. Given this situation, the child develops a sense of initiative and feel secure in their
ability to lead others and make decisions. Conversely, if this tendency is squelched, either through
criticism or control, children develop a sense of guilt. For the child to exercise self-control or have

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a conscience, his parents did not restrict the child’s initiative too much as long it is safe and beyond
their control.

Success in this stage leads to a sense of purpose, while failure results in a sense of guilt. (Cherry
& Grans, 2019). Kids with initiative will understand that mistakes happen and they just need to try
again. Children who experience guilt will instead interpret mistakes as a sign of personal failure,
and may be left with a sense that they are "bad."

V. Physical Assessment
Head and Neck

 Head is normocephalic
 Hair is black and evenly distributed
 Eyes
o Sclera is white
o Eyes are symmetric
o Iris is color gray
o No eye protrusions
 Eyebrows are even
 Ears
o No redness, swelling, tenderness, discharge and foreign bodies
 Nose is midline, symmetric and proportional
 Mouth
o Lips are moist
o 15 deciduous teeth (5 has caries)
o Tongue is midline and has adequate movement
o Tongue, gums and buccal cheeks are pink and moist
o Uvula is midline
o No lesions
 Throat is midline
 Free of lesions

Anterior and Posterior thorax

 Sternum is midline
 Trachea is midline
 Spinal column is midline
 No bulging or protrusions
 Free of lesions

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Abdomen

 rounded abdomen
 Umbilicus is midline
 No hernias
 Free of lesions
Musculoskeletal

 Normal range of motion

 Nodes are not tender
 Active movement against full resistance
 Reflexes are illicited
 Arms are symmetrical and are of equal length
 Legs are symmetrical and are equal of length

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VI. MMDST

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 Date and time of assessment: October 29, 2020 (7- 7:53 pm)

A. PERSONAL-SOCIAL

TASK SCORING ADMINISTRATION JUSTIFICATION

1.BUTTONS UP PASSED WE ASKED THE THE CHILD WAS

CHILD TO BUTTON ABLE TO BUTTON
HIS POLO SHIRT. HIS POLO SHIRT.

2.DRESSES WITH PASSED WE ASKED THE ACCORDING TO

SUPERVISION MOTHER IF THE THE MOTHER,
CHILD CAN THE CHILD CAN
ALREADY DRESS ALREADY DRESS
HIMSELF WITH HIMSELF WITH
SUPERVISION. SUPERVISION.

3. PUTS ON PASSED WE ASKED THE THE CHILD WAS

CLOTHING. CHILD IF SHE ABLE TO PUT ON
COULD PUT ON CLOTHES.
HIS CLOTHES.

4.SEPARATE PASSED WE ASKED THE THE MOTHER

FROM MOTHER MOTHER IF THE SAID THAT THE
EASILY CHILD CAN CHILD ALLOWS
ALREADY ALLOW THE MOTHER TO
THE MOTHER TO BE SEPARATE
SEPARATE FROM FROM HIM.
HIM.

5.DRESSES PASSED WE ASKED THE THE CHILD CAN

WITHOUT MOTHER IF THE DRESS AND
SUPERVISION CHILD CAN DRESS UNDRESS
AND UNDRESS HIMSELF.
HIMSELF.

CHILD’S AGE: 4 years, 4 months, 15 days

Based from the assessment the child was able to button-up his clothes, this is supported by
the ease of his performance of the task, therefore we marked it as “PASSED”. In this particular
task, the child, who is 4 years, 4 months and 14 days old, is expected to pass this task because

22
according to the MMDST form, 75% of children at that age can perform the task. When we asked
his mother if he is able to dress himself with supervision, the mother answered that he can already
dress himself with supervision, therefore we marked it as “PASSED” by report. The child can also
put on his clothing by himself, therefore we marked it as “PASSED”. This particular task is
expected to be passed by a child under such age because if not it may be considered as delay
already, because 90% of children can perform the task at the age of 3 ½ years. We also asked the
mother if the child can separate from his mother already, the mother answered that the child allows
her to go somewhere, for example at work without him, therefore, we marked it as “PASSED” by
report. This task is expected to be passed by 50-75% of children at such age. For the last task in
this aspect, we asked the mother if the child can dress and undress himself without supervision,
the mother answered yes and therefore we marked it as “PASSED” by report.

Overall, the child showed good performance of the tasks for personal-social area. The child
passed all the tasks given and it means that he is active in playing and interacting with other people
and in taking care of himself.

B. FINE MOTOR ADAPTIVE

TASK SCORING ADMINISTRATION JUSTIFICATION

1.COPIES + PASSED WE ASKED THE THE CHILD WAS

CHILD TO IMITATE ABLE TO IMITATE
THE DRAWING THE DRAWING +

2.COPIES PASSED WE ASKED THE THE CHILD WAS

ENCLOSED SHAPE CHILD TO DRAW A ABLE TO DRAW A
CIRCLE CIRCLE WITH A
CLOSED FORM

3.IMITATES PASSED WE THE CHILD WAS

DEMONSTRATED ABLE TO IMITATE
HOW TO DRAW THE SHAPE
THE SHAPE AND
ASKED THE CHILD
TO IMITATE THE
DRAWING

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 4.DRAW MAN IN PASSED WE ASKED THE THE CHILD WAS
THREE (3) PARTS CHILD TO DRAW A ABLE TO DRAW A
MAN WITH 3 MAN WITH A PAIR
PARTS OF ARMS AND
LEGS AND A
HEAD WHICH IS
EQUIVALENT TO 3
PARTS

5.PICKS LONGER PASSED WE ASKED THE THE CHILD WAS

LINE CHILD TO PICK ABLE TO
THE LONGER LINE RECOGNIZE THE
LONGER LINE (3/3)

CHILD’S AGE: 4 years, 4 months, 15 days

Based from the table the child was able to imitate the + sign that was shown by the
examiner, this is because about 75% of children at such age can already perform the task, therefore
we marked it as “PASSED”. The child was also able to copy an enclosed form or a circle, therefore
we marked it as “PASSED”. About 70-90% of children at that age are expected to perform the
task. The child was also able to imitate as demonstrated by the examiner, therefore we marked
it as “PASSED”. The child was also able to draw a man with three parts, therefore we marked it
as “PASSED”, although 25-50% of children can only perform that task, the child was able to do
it with ease. The child was also able to picks up the longer lines, therefore, we marked it as
“PASSED”.

Overall, the child was able to utilize his fine motor skills in picking up small materials, his
movements are coordinated and are without extra motions.

C. LANGUAGE

TASK SCORING ADMINISTRATION JUSTIFICATION

1.COMPREHENSIVE PASSED WE ASKED THE THE CHILD WAS

COLD, TIRED, CHILD OF WHAT ABLE TO TELL OF
HUNGER HE DOES IF HE IS WHAT HE DOES IF

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 COLD, TIRED, HE IS COLD,
HUNGRY TIRED, HUNGRY

2.COMPREHENDS PASSED WE ASKED THE THE CHILD WAS

PREPOSITIONS CHILD TO PUT THE ABLE TO
PENCIL UNDER COMPREHEND
AND ON TOP OF THE
THE TABLE PREPOSITIONS
AND WAS ABLE
TO PUT THE
PENCIL UNDER
AND ON TOP OF
THE TABLE

3.OPPOSITE PASSED WE ASKED THE THE CHILD WAS

ANALOGIES CHILD TO ANSWER ABLE TO TELL
THE OPPOSITE THE OPPOSITE OF
CHARACTERISTICS THE WORDS WE
OF THE WORDS WE SAID
ASKED

RECOGNISES 3 FAILED WE ASKED THE THE CHILD WAS

COLORS CHILD TO NAME NOT ABLE TO
ATLEAST 3 NAME 3 COLORS
COLORS (1/3).

GIVES FIRST AND PASSED WE ASKED THE THE CHILD WAS

LAST NAME CHILD TO SAY HIS ABLE TO SAY HIS
FIRST AND LAST FIRST AND LAST
NAME NAME

CHILD’S AGE: 4 years, 4 months, 15 days

As shown in the results, the child was able to tell us what he does when he is hungry, cold,
and tired, therefore we marked it as “PASSED”. The child was able to comprehend 3 prepositions
as well, therefore we marked it as “PASSED”. We asked the child to put the pencil under and on
top of the table. We also asked the child to name 3 colors but the child failed to do so, naming only
1/3, we marked this as “FAILED”. This is not a delay because the child can still learn to perform
the task in his succeeding years. We marked “PASSED” on the task of opposite analogies as well

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as when we asked the child about his first name and last name. Overall, the child can comprehend
instructions and responds clearly when talked to.

D. GROSS MOTOR

TASK SCORING ADMINISTRATION JUSTIFICATION

1.BALANCE ON PASSED WE ASKED THE THE CHILD WAS

ONE FOOT IN TEN CHILD TO ABLE TO
SECONDS BALANCE ON 1 BALANCE ON ONE
FOOT IN 10 FOOT FOR TEN
SECONDS SECONDS

2.HOP ON ONE PASSED WE ASKED THE THE CHILD WAS

FOOT CHILD TO HOP ON ABLE TO HOP ON
ONE FOOT ONE FOOT

3.CATCHES PASSED WE ASKED THE THE CHILD WAS

BOUNCE BALL CHILD TO CATCH ABLE TO CATCH
A BOUNCED BALL A BOUNCED BALL

4.PEDALS PASSED WE ASKED THE THE MOTHER

TRICYCLE MOTHER IF THE SAID THAT THE
CHILD IS ABLE TO CHILD CAN
PEDAL PEDAL A
TICYCLE.

5.HEEL TO TOE PASSED WE ASKED THE THE CHILD WAS

WALK CHILD TO WALK ABLE TO WALK
HEEL TO TOE HEEL TO TOE

6.BALANCE 1 PASSED WE ASKED THE THE CHILD WAS

FOOT FOR 5 CHILD TO ABLE TO
SECONDS BALANCE HIS BALANCE 1 FOOT
FOOT FOR 5 FOR 5 SECONDS
SECONDS

7.BACKWARD PASSED WE ASKED THE THE CHILD WAS

HEEL TOE CHILD TO WALK ABLE TO WALK
BACKWARD HEEL BACKWARD HEEL
TOE TOE

CHILD’S AGE: 4 years, 4 months, 15 days

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 Based from the result, the child was able to balance on 1 foot for 10 seconds, therefore we
marked it “PASSED”. He was also able to hop on 1 foot and so we marked it “PASSED”. He
was also able to catch bounced ball and walk heel to toe, so we marked both as “PASSED”. When
we asked the mother if the child can pedal a tricycle, the mother answered that he can pedal a
tricycle, this task is expected to be done even by a 3 ½ years old child, therefore it is expected for
our client to be able to perform it as well. The result was marked “PASSED” by report.
Furthermore, the child was also able to perform both the backward heel toe and balance on foot
for 5 seconds, which we marked “PASSED” for both.

ANALYSIS:

As seen in the table of the four aspects of growth and development of a child, he was able
to pass all the tasks at the Personal-Social aspect, Fine Motor Adaptive, and Gross Motor.
However, in the Language aspect, the child was able to pass all the tasks except for the recognition
of colors, which the child failed to perform. However, the task mentioned is at the right side of the
intersection of the actual age of the child, therefore, the child will still have the chance to be able
to do it in his succeeding age. Overall, the child is normal as seen in the result of the assessment.

VII. Nursing Care Plan

Nursing Diagnosis #1

Impaired dentition due to inadequate oral hygiene as evidenced by the 5 caries on the upper
right lateral incisor, upper central incisor, left canine, upper right first molar, and lower left second
molar.

Nursing Inference

Dental caries or cavities, more commonly known as tooth decay, are caused by a
breakdown of the tooth enamel. This breakdown is the result of bacteria on teeth that breakdown
foods and produce acid that destroys tooth enamel and results in tooth decay. Tooth decay happens
when sweetened liquids or those with natural sugars such as milk formula and fruit juices cling to
infants’ teeth for a long time.

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Nursing Goal

After 3 days of rendering nursing interventions, the client will be able to;

a. Practice brushing of teeth 3 times a day by applying the proper brushing technique

b. Recall the importance of having a good oral hygiene.

c. Limit his intake of sugary foods in his snacks

Nursing Intervention

Intervention Rationale

Demonstrate the proper way of brushing the Regular brushing of teeth especially after each
teeth and encourage the client to brush his teeth meal is vital to prevent the build-up of bacteria
3 times a day after each meal. that causes caries or tooth decay.

Remind the client to brush teeth by using Since the client is a child using pantomime will
pantomime. encourage the client to engage some fun while
learning at the same time.

Give the client health teachings about the Right knowledge helps prevent possible dental
importance of having a good oral hygiene. problems and good oral hygiene allows healthy
eating habits and may decrease the child's
chance of having more dental caries.

Encourage the client to limit sugary and high- To reduce the buildup of plaque and the risk of
carbohydrate foods in snacks. cavities caused by acids associated with the
breakdown of sugar.

Nursing Evaluation

After 3 days of rendering nursing interventions, the client was be able to;

a. Practice brushing of teeth 3 times a day by applying the proper brushing technique

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b. Recall the importance of having a good oral hygiene.

c. Limit his intake of sugary foods in his snacks

Nursing Diagnosis #2

Readiness for enhanced nutrition as manifested by the mother the desire to enhance
nutrition of the child.

Nursing Inference

Readiness for enhanced nutrition will help the child maintain the desired weight for his age
and get nutrients necessary to sustain his body as he grows old

Nursing Goal

After a week of rendering nursing intervention, the mother will be able to;

a. Safely prepare and store foods.

b. Demonstrate behaviors to maintain appropriate weight of the child.

c. Minimize instant noodles as breakfast of the child.

d. Remove soda as the child’s snack.

Nursing Intervention

Intervention Rationale

Assess eating patterns and food and fluid Helps to identify specific strengths and
choices in relation to any health risk factors weaknesses that can be addressed
and health goals.

Verify that age-related and developmental Children require small meals and constant
needs are met. attention to needed nutrients for proper growth

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 and development while dealing with child’s
food preferences and eating habits.

Nursing Evaluation

After a week of rendering nursing intervention, the mother was be able to;

a. Safely prepare and store foods.

b. Demonstrate behaviors to maintain appropriate weight of the child.

c. Minimize instant noodles as breakfast of the child.

d. Remove soda as the child’s snack.

Nursing Diagnosis #3

Readiness for enhanced spiritual well-being as per verbalization of “kayat ko mapan met
ag Sunday school,” when the child was asked if he is attending Church activities

Nursing Inference

Readiness to enhanced spiritual well-being since the child expresses desire to enhanced
participation in religious activity and prayerfulness. This expression of desire is due to the
influence of his peers who religiously attend Sunday-school.

Nursing Goal

After a week of emotional preparation, the child will be able to:

a. Demonstrate behavior congruent with verbalizations that lend support and strength for daily
living.

b. Attend Sunday-school and enjoy fellowship.

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Nursing Intervention

Intervention Rationale

Determine relational values of support system Comfort can be gained when family and
to one’s spiritual centeredness. friends share client’s beliefs and support
search for spiritual knowledge

Determine influence of cultural beliefs and Most individuals are strongly influenced by the
values. spiritual or religious orientation of their family
of origin, which can be a major determinate for
client’s choice of activities and receptiveness
to various options

Discuss life’s or God’s plan for the individual, Helpful in determining individual goals and
if client desires choosing specific options.

Nursing Evaluation

After a week of emotional preparation, the child as be able to:

a. Demonstrate behavior congruent with verbalizations that lend support and strength for daily
living.

b. Attend Sunday-school and enjoy fellowship.

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