Presenting Problems: Kirk
Educably Mentally Impaired, short attention span, frequent upper respiratory infections, history of failure to thrive.
Family Background
History of environmental deprivation and abuse by natural parents who were 17 (mother) and 21 (father) years old at client's birth. Natural father stutters. Natural mother is at educable level.
At age 12 months, client's mother is unemployed, fatherworks as a stock person for a grocery store. Protective Services have been notified. Father's parents are supportive.
Client adopted by grandparents at age 4. Grandfather is 53, partially disabled from chronic back pain, and works intermittently. He earns approximately $18,500.00/yr and has no disability insurance. Grandmother is 51 years old and a full-time homemaker. Both grandparents have grade school education.
Development
- Activity at age 7 months: client noted to be lethargic.
- At age 12 months: client was able to sit up and roll over
but was crawling with difficulty.
Psychosocial Problems
- Impairement: delayed speech, short attention span, EMI
- Life-event stressors: physical abuse by father
- Social support: adequate with adoptive parents.
- Fears-Anxiety: decreasing at 7 years.
- Emotional Psych: almost normal.
Health History
Birth: Product of 40 week gestation and 15 pound weight gain.Mother smoked a pack of cigarettes daily and drank occasionally.
- One week: Bronchitis
- 11 months: dehydration, malnutrition
- 12 months: failure to thrive, physical abuse
- 4 years: surgery for undescended testicle, repeated twice following original surgery.
Anthropometric measurements
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| Height for age: | <5th percentile |
| Weight for height: | <50th percentile at age 5 & 6 |
| at 50th percentile at age 7 |
Laboratory findings
|
|
Actual |
Normal |
| 12 mo | hemoglobin, gm/dl | 8 | 11-16 |
| hematocrit, % | 32 | 32-45 | |
| 7 yrs | hemoglobin, gm/dl | 12.4 | 11-16 |
| hematocrit,% | 33 | 32-45 | |
| serum iron, mcg/dl | 51 | 50 | |
| serum glucose, mg/dl | 99 | 70-100 | |
| total serum protein, gm/dl | 7.3 | 6.3-8.3 | |
| serum albumin, gm/dl | 3.6 | 2.8-4.4 | |
| serum ascorbic acid, mg/dl | 1.7 | 0.2 | |
|
|
Actual |
Normal |
| 7 yrs | ascorbic acid recovery, % | 23 | 17 |
| xanthurenic acid, mg/24 hr | 5 | 50 |
Systems Problems
None at birth.
| 12 mo | 7 yrs | |
| Cardiovascular | none | none |
| Respiration | bronchitis | none |
| Genitourninary | none | toilet trained, bedwets occasionally |
| Gastrointestinal tract | vomiting/diarrhea | vomits when coughing or laughing |
| Endrocine | none | none |
| Skin | none | pallor |
| Extremities | none | none |
| Neurologic | sleep difficulty | delayed speech |
Supplements
| Birth | 12 mo | 7 yrs | ||
| none | Multi-vitamin and mineral supplements were prescribed but not given by natural parents | none |
Nutrition
| Birth | Diet Order: Enfamil with iron ad lib |
| 12 mo | Diet history: Homogenized milk at 6 months. Not included in WIC program. Sometimes will eat 2-3 tsp of cereal at breakfast. Drinks from bottle (32 oz/day), unable to drink from cup or feed self with fingers. Mother states client "just plays with food and makes a mess", has poor appetite, no food preferences. |
| 7 years |
Diet Order: General Diet Diet history: Client has had poor appetite. However, grandmother indicates client is made to clean plate. States she tries hard to get special treats for Kirk. Uses milk that is not fortified with vitamin D (Fortification was not required at the time of assessment; supposedly, only kind of milk available in that store, in that town, at that time). Also uses bread that is not enriched. Client is able to feed himself. Feeding Problems: Difficulty chewing meat, partly due to dental caries. Computer nutrient analysis of his 3-day food record showed deficiencies in calories, iron, zinc, magnesium, vitaminD and pyridoxine. |
Three day food Recall*
| DAY 1 | DAY 2 | DAY 3 | |||
| 7:15AM | 1 sl toast 1 t margarine 5 oz canned butterscotch pudding |
7:15 | 1 c cornflakes 2/3c whole milk 3 t sugar |
7:15 | 1 fried egg 1 link sausage 1/2 sl toast 1/2 t margarine 3/4 cup whole milk |
| 11:40 | 3/4 cup Hi-C grape juice 1 cup bean & bacon soup |
11:40 | 2/3 cup Hi-C orange-pineapple juice 3/4 cup canned vegetable soup 2 fig bars 1 slice bread 1 tsp jelly |
11:40 | 3 peach halves 1/2 cup syrup 3/4 cup whole milk 1 slice bread 1/2 oz bologna 1/2 t. mustard |
| 3:45 | 1/2 cup whole milk 2 fig bars |
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| 5:50 | 1/4 banana 1/4 apple lettuce 3 t mayonaise 1/2 oz hamburger 3/4 cup canned spaghetti 3/4 cup whole milk |
6:15 | 1/2 oz fried steak 3 T gravy 3 T corn 1 T cottage cheese |
6:15 | 3 oz boiled potato 1/2 oz roast pork 5 T applesauce 3 T gravy 1/2 cup broccoli 3/4 cup whole milk |
| 8:00 | 1 fudgesicle | 8:00 | 1 ice cream bar (vanilla with chocolate) |
8:00 | 1 ice cream bar |