This paper examines a hypothetical assessment of a specific diagnosis in a child. It was designed to help us begin to implement proper coping skills for hospitalized children.

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Hypothetical Assessment
Lindsey Holland
University of Georgia
HDFS 4810

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Demographics:
A therapeutic activity plan is essential for child life specialists and members of the
healthcare team to work together to assess and treat the patient. The patient came into the
emergency room in the middle of a presumed asthma attack. She was coughing and was
experiencing chest tightness during a soccer game. The patient has been diagnosed with asthma.
Her father has been diagnosed with asthma and he recognized these symptoms. The patient is a
female, Hispanic, preschooler who is from a Spanish-speaking family. She is an only child and
both of her parents are present with her.
Diagnosis:
Asthma is described as a condition where airways swell and become more narrow. It is
possible that more mucus is produced in the airways as well. Asthma cannot be cured, but the
symptoms can be controlled. Some symptoms include; shortness of breath, chest tightness,
wheezing when exhaling, trouble sleeping, coughing attacks (Asthma 2020). Asthma can be
caused by various external factors. There is exercise-induced asthma which can be triggered by
air that is cold and dry and more oxygen is being taken in due to physical activity. This patient
appears to be experiencing exercise-induced asthma due to the cold Janurary weather and it
occurred while she was playing in a soccer game. (Exercise-induced asthma 2020)
The diagnosis process involves lung tests. A spirometry test estimates the narrowing of
bronchial tubes by checking how much air is exhaled after a deep breath and how fast it is
breathed out. The doctor proposed doing an exercise-specific test involving a challenge
involving exercise and conducting a spirometry test before and after the challenge to provide
evidence of exercise-induced bronchoconstriction (Exercise-induced asthma 2020). The patient
will have each of these tests done and then her asthma can be classified. It is likely that the

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patient's asthma is mild intermittent. This is when there are mild symptoms from two times a
week to two times a month. The patient's mother stated that this has happened two other times
also at soccer games in the past three months. (Asthma 2020)
The proposed treatment plan involves the patient and her family tracking the asthma
symptoms and introducing a short-acting beta-agonist before exercise. This is an inhaled drug
that can help open the airways. They are very commonly used and generally very effective.
They will continue to monitor symptoms and have a follow-up appointment in two weeks to
review any other possible triggers and see if the medicine is helping. (Exercise-induced asthma
2020)
Developmental Tasks:
This patient is in the Initiative vs guilt stage of Erikson’s Stages of Psychosocial
Development. Initiative vs guilt is the conflict that occurs in the preschool years. During this
stage, children are beginning to assert their power and control over their environment through
play and social interactions. Children are having greater social interactions in a school
environment and there are more opportunities to explore and develop interpersonal skills.
Childrens’ curiosity is beginning to grow and due to that, they begin asking more questions.
This can lead to the child having a sense of purpose if accomplished. However, if a child
struggles with this due to too much control or criticism, then it could lead to a sense of guilt or
disapproval. (Mcleod)
This patient is also in the preoperational stage of Piaget’s Theory of Cognitive
Development. Children tend to have an egocentric mindset and understand the world in concrete
terms. Children can not use logic or transform, combine, or separate ideas. The development of

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this stage is centered around building experiences through adapting and working towards the
concrete operational stage. (Mcleod)
Impacts of Hospitalization:
For this patient in the preschool range of ages, hospitalization affects many aspects of
their development. The patient cannot be as creative because their ability to play is interrupted.
There can be a greater sense of nervousness as well as fear from experiencing an asthma attack.
Lastly, she could view the hospital situation as a punishment that is backed by pain. The child
may question the fact that if they did not do anything wrong, The pain experienced can be seen
as a threat to their intimacy and lead to protest and anger.
Possible Family Stressors:
Possible family stressors can be best explained through Broffenbrenners Ecological
Systems theory. This theory looks at many aspects of a developing child’s life that the child
interacts with and is affected by. It looks at individual development as well as other influencing
factors and the environmental context of development. The patient is directly affected by the
microsystem. This consists of what has direct contact with the child such as their parents,
siblings, teachers, and friends. Relationships in a microsystem are bi-directional, meaning the
child can be influenced by other people in their environment and is also capable of changing the
beliefs and actions of other people too. Furthermore, the reactions of the child to individuals in
their microsystem can influence how they treat them in return. A hospitalization will directly
affect the child in the microsystem but will also fall into affecting the other systems as well. The
mesosystem is the relationship between the microsystem and exosystem. The hospitalization
could put stress on the patient's ability to participate in athletic activity with their peers, this will
then add more stress on the parents emotionally due to fear of their child being left out. The

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exosystem contains formal and informal social structures, which do not themselves contain the
child, but indirectly influence them as they affect one of the microsystems. The parents having
to take off work to be at the hospital can put stress on their work situation and economic situation
and then that will affect the child as well. (Guy-Evans, 2020)
Cultural and Language Impacts:
The patient is from a family that speaks Spanish as their first language. This can impact a
child during hospitalization greatly. If there is not a nurse that is already fluent, a translator is
needed. Many translators are electronic now and so it can make it harder to connect with the
healthcare team because there is no direct communication. For this patient, the nurse had a basic
understanding of Spanish, but was not fluent and needed to use the translator for the majority of
the communication. This makes it harder to communicate effectively for the patient and their
family as well as the healthcare team.
Possible Future Implications:
Future implications for this patient include continuing to monitor asthma and the
medication effectiveness. This means that there will be more frequent doctors appointments.
This could also mean more economic stress. It is an adjustment, but with the proper
precautionary measures taken the child will still be successful.

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References
Guy-Evans, O. (2020, November 9). Bronfenbrenner's ecological systems theory.
Bronfenbrenner's Ecological Systems Theory | Simply Psychology. Retrieved October 5,
2021, from https://www.simplypsychology.org/Bronfenbrenner.html.
Mayo Foundation for Medical Education and Research. (2020, August 11). Asthma. Mayo
Clinic. Retrieved October 5, 2021, from
https://www.mayoclinic.org/diseases-conditions/asthma/diagnosis-treatment/drc-20369660.
Mayo Foundation for Medical Education and Research. (2020, December 16). Exercise-induced
asthma. Mayo Clinic. Retrieved October 5, 2021, from
https://www.mayoclinic.org/diseases-conditions/exercise-induced-asthma/diagnosis-treatm
ent/drc-20372306.
Mcleod, S. (n.d.). Erik Erikson's stages of Psychosocial Development. Erik Erikson |
Psychosocial Stages | Simply Psychology. Retrieved October 5, 2021, from
https://www.simplypsychology.org/Erik-Erikson.html#:~:text=Initiative%20vs.%20Guilt,-I
nitiative%20versus%20guilt&text=During%20the%20initiative%20versus%20guilt,play%
20and%20other%20social%20interaction.&text=If%20given%20this%20opportunity%2C
%20children,lead%20others%20and%20make%20decisions.
Mcleod, S. (n.d.). The preoperational stage of cognitive development. Preoperational Stage -
Egocentrism | Simply Psychology. Retrieved October 5, 2021, from
https://www.simplypsychology.org/preoperational.html.