Feedback: Case Study 1 - Part 4
- Safety:
- Assess Damon for bruising.
- House safety for possible injuries.
- Parental assessment for stress/coping/reaction to the diagnosis of autism
- Assessment of Damon: Developmental status of Damon, including eating habits, sleeping habits, social and behavioral status
- Support services
- Family dynamics, including needs of siblings
What are the developmental milestones that are expected of a 2-year-old child?
Says more than 50 words, short sentences
Follows two-step commands
Copies adults and older children
Sings Jumps with both feet; kicks or throws a ball
Names many body parts and people Stacks objects Plays alongside other children
2-5 years: Gains about 4 to 5 pounds per year
At 2 years: 31.5-37 inches
What are the development milestones that are expected of a 3-year-old child?
Gross motor skills: Most 3-year-olds can walk a line, balance on a low balance beam, skip or gallop, and walk backward. They can usually pedal a tricycle, catch a large ball, and jump with two feet.
Fine motor skills: By age 3, can usually wash and dry their hands, dress themselves with a little assistance, and turn pages in a book. Most preschoolers can hold a writing instrument with their fingers, not their fists.
Major highlights: Many 3-year-olds are also ready to be potty trained
Learns to share and take turns, but may not always like it.
Starts to understand emotions, both their own and others. Your child may use simple expressions such as "I'm mad!" "I'm sad!," or "I'm happy!" to let you know how they feel.
Speech & Language: Vocabulary of about 300 words, and likely they understand much more than that. Speaks in simple sentences, their comprehension is also getting stronger every day.
Play: As noted above, instead of engaging in parallel play, 3-year-olds may begin to play cooperating with other children, develop friendships, and engage in simple games or activities that require them to practice patience.
Enjoys listening to books and may even attempt to "read" them on their own.
Identifies basic shapes and colors. Says the alphabet.
What are the signs of autism?
In the 3 yr old child:
- Nonresponsive when their name is called
- Doesn’t make eye contact
- No joyful expression
- Fails to point to objects
- Prefers to be alone
- Lack of communication
- Loss of speech.
- Limited interests
- Repetitive behaviors
- Inability to show empathy
- Inappropriate Reactions
- Strict Routines
- Sensory Sensitivity
- Repetitive speech
- He started speaking around a year old and then stopped when he was
- He has temper tantrums and is a poor sleeper.
- His behaviors include rocking back and forth, screaming when approached by strangers, and not responding to his name or to directions from his parents.
- He likes to play with puzzles and his parents’ cell phones.
What behaviors does Damon display that are characteristic of Autism?
The behaviors include:
- Nonresponsive when their name is called
- He started speaking around a year old and then stopped when he was
- He has temper tantrums
- His behaviors include rocking back and forth, screaming when approached by strangers, and not responding to his name or to directions from his parents
Identify the stresses experienced by the family members.
Mother: adjustment to diagnosis and child’s behaviors. Disruption of family routine and needs to take time off work to care for Damon. Stress in the marital relationship due to Damon’s illness and husband’s adjustment
Father: Adjustment to diagnosis and child’s behaviors. Handling his frustrations with Damon without physical force. Marital strain due to loss of finances and stress of illness
Siblings: Adjustment to Damon’s illness and behaviors. Need for additional parental attention to Damon. Experience stress of parents as they adjust to the changes in routine and behaviors
Identify the specific needs of each family member, including Damon.
All family members need to adjust to the stresses listed above. The mother needs to be assured of her husband's care and concern, their financial stability, and her desire to work outside of the home. Needs support from knowledgeable support health and
education and social support personnel. The father has the same needs and continues to provide for his family. The siblings need to be able to progress through their developmental stages without disruption
How will the nurse assess these needs?
The home nurse should assess the needs of Damon and the family at each visit.
Assess physical and social stage developmental of Damon at each visit.
Assess stress levels and adaptive and coping mechanisms of parents and siblings.
Assess Father’s ability to manage his frustrations.
What goals would the nurse identify for each family member?
The nurse should expect each family member to adapt and cope and adjust to Damon’s illness and maintain positive family dynamics and personal mental, physical, and social health. The parents should strive for a balanced life with their
family responsibilities while focusing on maintaining a strong relationship with one another. All family members should feel safe and valued and have access to support when they experience difficulties.
The nurse should assess how these expectations are met at each visit.
Identify the educational needs of this family.
The family needs to know about autism and all of its features as it relates to Damon and to one another. They need to learn how to respond to and handle Damon, and to understand how he processes the feelings, situations, and behaviors of others. They should learn what actions, behaviors, and responses provide comfort to and soothe Damon.
Detail how the nurse should address these educational needs.
Based on continual assessment of educational needs, the nurse should anticipate learning needs and learning strategies appropriate for each member; Provide educational resources: handouts and reading resources and online and community resources;
remain current concerning the best practices in the treatment of Autism, and continually seek feedback from the family to know their needs.