Substance Abuse and Abuse Q 43
A community nurse conducts a primary prevention, home-visit assessment for a newborn and mother. Mrs. Smith has three other children, the oldest of whom is age 12. She tells the nurse that her 12-year-old daughter is expected to prepare family meals, to look after the young children, and to clean the house once a week. Which of the following is the most appropriate nursing diagnosis for this family situation?
A. Delayed growth and development, related to performance expectations of the child.
B. Anxiety (moderate), related to difficulty managing the home situation.
C. Impaired parenting, related to the role reversal of mother and child.
D. Social isolation, related to lack of extended family assistance.
Correct Answer: C. Impaired parenting, related to role reversal of mother and child.
The role of a 12-year-old child in a family should not be that of a parent. In this situation, the child and mother have reversed roles. Assess parents for the achievement of developmental tasks of self and understanding of child’s growth and development; how they are bonded and attached to the child; how they interpret and respond to the child; how they accept and support the child; how they meet the child’s social, psychological and physical needs. Provides information about parent-child relationship and parenting styles that may lead to child abuse; identifies parents at risk for violence or other abusive behavior.
Option A: Teach parents developmental tasks for child and parents, difference in developmental level between child and parents, and appropriate tasks for age levels. Provides information that assists parents in responding realistically and appropriately to child’s needs at different age levels.
Option B: Assess the level of anxiety and fear in the child and how it is manifested; Determine the source of anxiety and note reactions to staff and parents at each contact. Provides information about the source and level of anxiety and what might relieve it and basis to judge improvement.
Option D: There is no evidence that the child has delayed growth or development, the mother in this situation is not demonstrating signs of anxiety, and there is no evidence in this situation that the family is socially isolated. Discuss with parents methods to reduce conflict, to be consistent in approach to child’s behavior and needs, to avoid siding with the child or other parents. Promotes a more positive child-parent relationship.