Failure to thrive 26.5
A home care nurse is providing care to a client diagnosed with failure to thrive (FTT). Which interventions are appropriate for this client and family? (Select all that apply.) Frequent growth and weight measurements Encouraging the use of a food diary Suggesting breastfeeding as the primary means of nutrition Providing community resources Observing the parent-child relationship in the home
Frequent growth and weight measurements Encouraging the use of a food diary Providing community resources Observing the parent-child relationship in the home
Collaborative therapy for FTT - infants and children
Physical exam and diagnostic testing are used to rule out other problems first. Establish a routine for feeding. Provide adequate caloric intake. Promote normal growth. Learn to identify cues of hunger followed by an appropriate response. Assessment it the primary diagnostic tool
A pediatric home health nurse cares for several infant clients who are diagnosed with failure to thrive (FTT).The nurse wants to initiate community interventions to decrease the number of pediatric diagnoses of FTT. What can the nurse do to help prevent FTT within the community? Advocate for genetic testing Teach the proper method of tube feeding Educate infant caregivers Insist that caregivers feed only with breast milk.
Educate infant caregivers
Clinical manifestations of FTT
Feeding disorders are marked by persistent weight loss; no evident weight gain with normal feedings; or loss of weight in a child under six years of age. Some cases present with a physical manifestation causing the feeding disorder; however, 80% of cases of FTT have no underlying physical disorder.3 Infants that display inorganic FTT are often developmentally delayed, fail to gain weight, are malnourished, withdrawn, have poor eye contact, and lack appropriate fear of strangers. Some signs associated with feeding disorders include: Food refusal Erratic sleeping patterns Irritability Difficulty being comforted Not meeting expected growth pattern
Causes of FTT
Can be organic or inogranic. undernutrition is the most common excessive calorie waste/expedenture inadequate calorie intake inadequate calorie absorption Esophageal reflux Neurological disease Congenital AIDS Metabolic diseases Non organic are usually feeding disorders.
The nurse is providing care to a client who is admitted for diagnostic testing for failure to thrive (FTT). Which diagnostic test does the nurse not anticipate for this client? Detailed history Extensive blood studies Physical assessment Comparison of height and weight to standard growth charts
Extensive blood studies
Nursing diagnoses for FTT
Nursing diagnoses may address actual problems; potential problems (risks); or opportunities to enhance the client's wellness. Potential for imbalanced nutrition Impaired growth and development Alterations in bonding Increased risk of altered parenting Diminished activity Increased fatigue Potential for enhanced wellness (for example, through adjusted sleep pattern) Potential for enhanced knowledge
The nurse is providing care to a client diagnosed with failure to thrive (FTT). Which option does the nurse anticipate will be prescribed to treat FTT in this client? Formula feedings by gastric tube Nutritional supplements Proton pump inhibitors Beta-blockers
Nutritional supplements
The nurse educator of a pediatric medical-surgical unit is conducting an educational session for the nursing staff related to failure to thrive (FTT). The educator wants the staff to identify families who may be at risk of having children with FTT. Which populations will the educator include in the session? (Select all that apply.) Mental retardation Substance abusers Low income status Depression Single parent homes
Parents or caregivers who suffer from substance abuse, depression, and mental retardation are more likely to place a child at risk of FTT. Low income status and single parent homes do not appear to be factors in failure to thrive.
Geriatric failure to thrive
disorder of undernutrition in an older adult who is under weight.
What is failure to thrive?
is made when an infant falls or is falling below the fifth percentile for weight and height on a standard growth chart. FTT can be present in low-birth-weight infants, and accounts for 1-5% of pediatric hospitalizations in children under one year of age as well as many additional cases handled in the community
The nurse is conducting a health history for a client diagnosed with failure to thrive (FTT). Which questions should the nurse include in the family assessment for a client diagnosed with FTT? (Select all that apply.) "Did you have any problems during the pregnancy?" "How many diapers does your infant soil each day?" "Are there any stressors in your life that affect your interaction with your child?" "Do any of your other children have a history of feeding disorders? "Which developmental milestones has your child accomplished?
"Did you have any problems during the pregnancy?" "Are there any stressors in your life that affect your interaction with your child?" "Do any of your other children have a history of feeding disorders? "Which developmental milestones has your child accomplished?
The nurse is providing education to the family of a client diagnosed with failure to thrive (FTT). Which statements by the family indicate appropriate understanding of the teaching session regarding treatment options and goals for FTT? (Select all that apply.) open double quote"There is no medication for her condition.close double quote" open double quote"Nutritional supplements will help restore the missing nutrients and calories.close double quote" open double quote"Blood work done every three months will tell us if she is getting enough nutrition.close double quote" open double quote"She needs to be in the tenth percentile on the growth chart in order to be healthy.close double quote" open double quote"My child must gain two pounds before discharge.close double quote
"There is no medication for her condition." "Nutritional supplements will help restore the missing nutrients and calories."
Assessment physical assessment - FTT
Accurate measurement of height and weight BMI Measured and documented percentiles and growth patterns with each visit Activity level Developmental milestones Interaction patterns Ability to be comforted Eye contact Touch Cuddliness Observe feeding and how child demonstrates hunger and satiety Observe interactions between the parent and child during feeding Observe actions and postures of the caregivers for rocking, singing, touching, and talking Ask about stressors affecting the parent-child relationship
The nurse is providing care for a client diagnosed with failure to thrive (FTT). Which assessment finding supports the diagnosis for this client? Being below the fifth percentile for weight on the standardized growth chart Frequent diarrhea Being above the fifth percentile for height on the standard growth chart Lack of sleep
Being below the fifth percentile for weight on the standardized growth chart
The nurse is conducting an assessment for a child diagnosed with failure to thrive (FTT). Which parent-child interaction is not included in the nursing assessment? History of the pregnancy and birth Touching Eye contact Cuddling
History of the pregnancy and birth
Risk factors FTT - infants and children
Infants and children who lack a nurturing and loving relationship with a caregiver. Infants require touching, stimulation, and cuddling to adjust effectively to self and environment. Adults who suffer from - Substance abuse Mental retardation Depression Psychosis History of abuse Social or emotional isolation - put the child at greater risk. Parents who cannot provide adequate nutrition or who misinterpret hunger cues may produce a child who does not display clear hunger signs.
The nurse educator is teaching a group of students about the risk factors associated with the diagnosis of failure to thrive (FTT). Which risk factor stated by the students indicates appropriate understanding of the lecture material? (Select all that apply.) Neurological disease Inadequate calorie intake Excessive caloric expenditure Esophageal reflux Lactose intolerance
Neurological disease Inadequate calorie intake Excessive caloric expenditure Esophageal reflux
The nurse is providing care for an older adult client who is diagnosed with failure to thrive (FTT). Which treatment is appropriate for the nurse to include in the discharge instructions for this client? Teaching about the use of selective serotonin reuptake inhibitors (SSRIs) for depression, per order Eating larger meals three times per day Teaching the family to prepare all the client's meals Providing foods recommended by the dietitian
Older adult clients diagnosed with FTT may require teaching about SSRIs as a treatment method if the FTT is caused by depression. The client would be instructed to eat more small meals each day and to choose foods that the client enjoys. The nurse would assess the client's ability to prepare meals instead of teaching the family that all meals must be prepared for the client.
The nurse is preparing to perform a nursing assessment of a client diagnosed with failure to thrive. Which item in the health history will the nurse assess prior to beginning the nursing assessment of this client? Percentiles on growth chart for previous visits Caregiver interactions with the child Current activity level Height and weight for current visit
Percentiles on growth chart for previous visits
The nurse is providing care to a client diagnosed with failure to thrive (FTT). Which nursing intervention item will the nurse include at each visit for this client? Referring the family to counseling Assessing entries in the food journal Plotting weight on the growth chart Suggesting the use of herbal supplements
Plotting weight on the growth chart
Prevention of FTT
Prevention of FTT can be enhanced by educating caregivers. Information about nutritional needs, feeding habits and normal growth chart progression can assist the caregivers in preventing FTT. Home nursing visits can also assist in the education of the family and the nutritional needs and assessment of the client
The nurse is providing care to the family of a child diagnosed with failure to thrive (FTT). Which intervention is aimed at the family's psychosocial needs? Assessing weight Referring the family to community resources Maintaining a food diary Measuring height
Referring the family to community resources
The nurse is writing a plan of care for a client diagnosed with failure to thrive (FTT). Which goal is a priority for this client? The child will sleep through the night. The parent-child relationship will improve. Complications from poor nutrition will be prevented. The child will attain adequate growth and normal development.
The child will attain adequate growth and normal development.
Evaluation FTT
The client's response to all nursing interventions The degree to which the client's goals and outcomes were achieved The need for revising the client's plan of care, including modifying, adding, or discontinuing nursing diagnoses and interventions. The parent verbalized an understanding of child's nutritional needs Child attained adequate growth and normal development Complications related to poor nutrition were prevented The parent-child relationship improved.
Planning - FTT
The parent will verbalize understanding of child's nutritional needs. Child will attain adequate growth and normal development. Complications related to poor nutrition will be prevented. Parent will demonstrate appropriate bonding during feeding (holding, rocking, touching, and eye contact)
Assessment Health history - FTT
History of the pregnancy and birth Developmental milestones History of other children in the family with feeding disorders Percentiles from previous visits
The nurse is teaching a caregiver about treatment for failure to thrive (FTT). Which statements made by the caregiver indicate a need for further education? (Select all that apply.) open double quote"Medications are given daily to treat this condition.close double quote" open double quote"Nutritional supplements will help meet the caloric requirements.close double quote" open double quote"I hope my baby will not need surgery; that idea scares me.close double quote" open double quote"I can monitor height and weight at home to see if any progress is being made between doctor visits.close double quote" open double quote"Most babies do not sleep well anyway; my baby will sleep when she is tired.close double quote
Treatment of FTT includes re-establishing eating and sleeping patterns for the client. Surgery is necessary only if an organic cause of FTT is identified. There are no medications used in the treatment of FTT. Monitoring height and weight to assess progress and providing nutritional supplements indicate appropriate understanding of treating FTT.
Pharm and non pharm interventions for FTT
There are no medications used for primary treatment of failure to thrive. The focus of treatment is to identify the cause and promote the client's ability to absorb the amount of calories needed. Nutritional supplements can be provided to treat nutritional deficiencies. Educating caregivers about nutritional needs and caloric requirements can assist with failure to thrive. Home care visits with education can also reduce the occurrence of failure to thrive. Educating and assessing breastfeeding clients can also decrease the incidence of FTT. It may be necessary to hospitalize a client with FTT to assist in re-establishing feedings and sleep patterns, and in educating the caregivers. The goal of this therapy is to promote growth and development.
Implementation - FTT
Carries out independent and collaborative nursing interventions that support the client's achievement of the identified client goals and outcomes. For the pediatric client with failure to thrive, nursing interventions are aimed at improving nutritional status; improving the parent-child relationship; increasing growth and development; and other considerations Assessing height, weight, and BMI with every visit Recording and monitoring placement on the standard growth chart Observing parent interact with child during feeding time Teaching about the child's nutritional requirements Discussing the importance of the parent's keeping a food journal Teaching parent how to identify the child's hunger cues Teaching parent how to hold, rock, make eye contact, and bond with the child during feeding time Referring parent to community resources to enhance parenting skills when necessary