Final Visual Report

Jeffrey Samson ABSN Cohort 26

Growth and Development of Charlie Kelmeckis The Perks of Being a Wallflower

Charlie Kelmeckis Charlie is a 15-year-old caucasian male who has just entered his freshman year of highschool. His best and only friend at the time committed suicide during the summer before high school, and he had not spoken to anyone outside of his family since then. Additionally, he is coping with the death (car accident) of his Aunt Helen from when he was 7-years-old. Although he has a good relationship with his family he will not say anything about how he is feeling if his parents ask, because he does not want them to think he might get “bad” again (Chbosky & Powers, 2012). He spends his free time listening to music, reading books and writing. Charlie is intelligent and reserved as he is seen answering his teacher’s questions correctly in his notebook, but will not raise his hand even if extra credit is offered.

Charlie spends the beginning of high school trying to make friends. Unfortunately, he ends up getting called names (i.e. faggot, freshman toad, and being bullied by classmates. It is not until the first football game where Charlie meets two seniors who will become his best friends. These friends introduce him to parties, drugs, alcohol, music, musicals, and his first sexual relationship.

Physical Appearance Charlie has short brown hair, brown eyes, slender build, light skin, and no visible physical deformities.

He has a height of 5’9” and weighs 149 pounds. He does not have any tattoos, piercing, facial hair, or acne. He regularly wears plain long sleeve shirts, jeans, and a hoodie. On occasion he can be seen wearing a suit and tie for school dances, and when his new friends get him a suit for Christmas.

Parenting Style Charlie’s parents exert little or not control over his behaviors, and they consult with him when making decisions (Perry, Hockenberry, Lowdermilk, & Wilson, 2014). Charlie’s parents often give him advice when they communicate, but charlie does not express all of his thoughts and feelings to them. His parents tend are unable to see behavior problems and may not provide organizational support to assist charlie with his psychological health (Kaakinen, Coehlo, Tabacco, & Hanson, 2015). His parent truly care for the well-being of their children, but are unable to see when they are in distress.

Social Networks School Charlie excels at English as he is in an advanced course and wants to become a writer when he grows up. He is often bullied by his freshman classmates in class, but he spends time with his senior friends whenever possible. Charlie has developed a great relationship with his English teacher, Bill Anderson. Charlie has asked for advice from Bill that he would not bring up with his parents, and Bill will give his favorite books for Charlie to read.

Friends Sam is the first person to find out Charlie’s best friend shot himself over the summer. She was molested by her father’s boss while growing up and was known for sleeping around in high school. Charlie helps Sam study for the SATs and she eventually gets into Penn State. Charlie falls in love with Sam, but does not pursue her until soon before she leaves for college.

Patrick is Sam’s gay stepbrother who is the first person to accept Charlie at school. He introduces him to Sam and the party scene.

Family Candace Kelmeckis is a senior in high school and has a close relationship with her younger brother. She trusts him with bringing her to an abortion clinic when she finds out she is pregnant. Charlie is willing to express his concerns about Candace’s abusive relationship with her boyfriend.

Chris Kelmeckis is Charlie’s older brother who is a freshman at Penn State. He cares for Charlie and was there for him when his best friend committed suicide.

When he comes back from college for Charlie’s birthday he shows his concerns for Charlie’s health.

Charlie’s father and mother truly care and provide for their family. Charlie’s father has no problems working on his woodshop project and is willing to give Charlie extra money for a white elephant present.

Charlie’s mom is worried about his psychological condition, but does not know how trouble he is.

Aunt Helen was Charlie’s “favorite person” although she was molested as a child from a family friend that frequently visited her house (Powers & Chbosky, 2012). She fell into drugs, alcohol, and abusive relationships but was able to get out of it as she matured. Unfortunately, she molested Charlie growing up and was killed in a car accident on his seventh birthday.

Growth and Development: Adolescence, ages 12-20 Expected Growth/Development Observed Growth/Development ●

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The final 20% to 25% of height is achieved in boys between the ages of 10 ½ and 16 (Perry et al., 2014).

The average boy will gain 4 to 12 inches in height and 16 to 66 pounds in weight (Perry et al., 2014).

Muscle development increases with boys.

Acne may occur.

Testicle/penile enlargement.

Hair growth on the upper lip, chin/jaw, armpit, pubic region, arms, and legs.

Voice usually changes to a deeper tone.

More high school students attend religious services regularly (Perry et al., 2014).

Adolescents start spending less time with family and more time with peers.

To gain acceptance by peers, teenagers need to conform to others by dressing similarly or having things in common (Perry et al., 2014).

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At 5’9”, Charlie may have room to grow but may also be at his peak height.

Charlie appears to have very little muscle growth despite having visible abdominal muscles.

Charlie has not developed acne.

He has not developed hair on the chest and face. He does have armpit hair.

His voice is deeper than those of school-age.

Charlie goes to catholic mass every Sunday.

Charlie spends most of his time in his room or out with his friends, and he is not seen taking part of family activities other than eating dinner and going to church.

Charlie has similar tastes in music has Sam and Patrick.

He conforms to the party scene by taking part in drugs and alcohol.

Fine and Gross Motor Skills ●

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The adolescent should have almost fully developed fine and gross motor skills.

They should be able to perform and master advanced fine motor skills.

Adolescents will develop greater physical strength and endurance.

Age appropriate activities include: nonviolent music, sports, reading, movies, and school dances.

Charlie describes himself as not being athletic but he was able to participate in a play as a last minute substitute and deliver an acceptable performance.

Charlie can use a typewriter without making mistakes.

Charlie reads books in his free time.

He attends school dances, movies, and musicals with his friends.

Piaget, Erikson, and Kohlberg Piaget: Cognitive

Erikson: Psychosocial

Kohlberg: Moral

At this stage of cognitive development, formal operations, adolescence are able to form more abstract thoughts and are concerned with the possible (Perry et al., 2014). They can also maintain attention for long periods of time.

Identity versus role confusion is the psychosocial development that occurs during the ages of 12 to 18 years. Adolescents tend to form a sense of group and personal identity.

Adolescents find pressure to belong to a group that provides them with a status (Perry et al., 2014). Music, dancing, language, and activities tend to conform to the group. They come to see themselves as unique and separate from every other individual (Perry et al., 2014).

The postconventional stage occurs at this stage of moral development. Adolescents gain autonomy from the views of adults by substituting their own set of morals and values (Perry et al., 2014). Their decisions involving moral dilemmas must be based on a set of principles that allows them to perform actions that are consistent with their ideals (Perry et al., 2014).

Charlie meets this by being able to to sit through class without spacing out, and he is able to tutor Sam for the SATs for multiple sessions.

Charlie is always wondering what Sam is thinking, and he asks himself what it would be like if he took the initiative and went after Sam romantically.

He initially does not want to go after Sam romantically because he wanted her to be happy with her current boyfriend.

Charlie also refused to break up with his first girlfriend, Mary Elizabeth, because he did not want to hurt her feelings.

Charlie is meeting milestones for this stage of cognitive development.

Charlie felt the pressure of finding a group of friends at the start of high school.

He conformed to his group of peers by participating in their interests: parties, alcohol, drugs, musicals.

His friends support his decisions and strengthen his desires.

He is able to decide that he does want to pursue writing as a profession when he grows up.

Charlie is on the correct path to achieving this stage.

Morality is questioned when Charlie is peer pressured into participating in drugs, alcohol, and a relationship he did not initially want.

He decided that he would never take LSD again.

Charlie was going to ask Sam to be his girlfriend but did not due to her already being in a relationship.

Those who are close to Charlie tend to be in abusive relationship, but he believes they are in a bad situation and tries to intervene.

Nutrition Charlie’s Nutrition

Expected Nutrition ●

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Nutritional requirements are increased due to the adolescent’s extensive increase in muscle mass, height, and weight (Perry et al., 2014).

Quality nutrients such as calcium, iron, protein, and zinc are necessary for adequate growth (Assessment Technologies Institute [ATI], 2016).

According to the U.S. Calorie Levels 2,200 - 3,200 kcal Department of Health and Human Services (HHS) and Protein 52 g U.S. Department of Agriculture (USDA), these are Carbohydrate 130 g the dietary guidelines for american males between the Dietary Fiber 30.8 g ages of 14 to 18 (HHS & USDA, 2015).

Added Sugars <10% kcal Charlie has a BMI of 22 with a height of 5’9” and a weight of Total Fat 25-35% kcal 149 pounds. This is considered normal body weight (HHS & Calcium 1,300 mg USDA, 2015).

Zinc

11mg

Iron

11 mg

Food choices when not at home: ● Ice cream ● Milkshakes ● Nachos ● Soda ● Chocolate milk ● Apple ● Potato Chips ● French Fries ● Brownies ● Grilled Cheese ● Pie ● Alcohol ● Cookies Mother’s cooking: ● Chicken paprikash ● Green beans ● Rice ● Water with lemon

Oremâ&#x20AC;&#x2122;s self-care requisites Feelings

Family and Friends

Partially Met. Charlie is able to vent to his parents when he is not happy in his relationship with Mary Elizabeth, but does not want to mention how he feels about his best friend committing suicide. He only talked about the death of his best friend when he was high on marijuana for the first time. Charlie expresses his feelings through writing as he wants to pursue a profession in writing.

Charlie believed his Aunt Helen was his favorite person until the resurfacing of his repressed memories. It was then he realized that Aunt Helen had molested him in front of his sleeping sister. He is unable to vent these feelings until he tells his psychiatrist after having a mental breakdown and being admitted into the hospital.

Met. Although Charlie does not tell his family and friends everything, he has their full support. His parents care about his well-being, attend catholic mass every Sunday, and have dinner together. His friends fully support his decision to become a writer and buy him a suit for christmas. His friends invite him to every outing.

Sex and Sexuality Partially met. Charlie is developing in sexual maturity. During his relationship with Mary Elizabeth he states that he is â&#x20AC;&#x153;tired of fondlingâ&#x20AC;? her breasts implying they have not had intercourse yet (Powers & Chbosky, 2012). He has kissed Mary Elizabeth and Sam. Additionally, Patrick kissed Charlie but apologized soon after. Charlie is interested in women and is in love with Sam.

Drug and Alcohol Use Not met. Charlie was peer pressured to drink wine after his first date with Mary Elizabeth. He has consumed marijuana brownies and LSD.

Body Image Met. Charlie does not have any issues about his body appearance. He was willing to be a last minute substitute in a musical where he was expected to cross dress and undress to his underwear. Afterwards, he asked if he could be a permanent substitute.

Problems or Concerns Nutrition

Social Development

Although Charlie is at a healthy BMI and his mother’s cooking has a healthy variety, his food choices outside of school are poor. His diet includes an excessive amount of sugar, salt, saturated fat, and alcohol. He consumes the recommended daily amount of calcium with an excess intake of dairy products.

Interventions: Adolescents with a normal BMI should be asked to limit sugary beverages, limit portion sizes, limit fast food, and increase meals with the family (Perry et al., 2014). To ensure a balanced diet is consumed, have Charlie look at the USDA’s recommendations at www.choosemyplate.gov (ATI, 2016).

Charlie has a great relationship with his new friends but will need to make new friends next year as they will have graduated high school. To fully mature, adolescents need to free themselves from their family to find their own identity.

Interventions: It is important to encourage Charlie with education and activities that improve self-esteem, because it will help his resocialization process and facilitate acceptance from new peers (Perry et al., 2014).

Educate Charlie’s parents that he needs a supportive peer group that is not only his family (Perry et al., 2014).

Physical Development

Quality and safety education for nurses (QSEN) defines safety as minimizing the risk of harm to the patient and their providers with individual performance and system effectiveness (QSEN, 2018). At this age the major causes of morbidity and mortality are health-damaging behaviors such as injury, depression, and STIs (Perry et al., 2014).

Interventions: It is important to provide instruction for safe use and respect for devices potential to danger, be alert for signs of suicide and depression, learn to practice safe sex, and reinforce the dangers of drugs and alcohol (Perry et al., 2014). Have Charlie demonstrate what he would do in a situation of peer pressure to participate in drugs, alcohol, or unprotected sex. Have Charlie describe the signs he may be depressed or contemplating suicide, and what he should do to receive help.

Charlie is at a normal BMI but appears skinny and can benefit from an increase in muscle mass. He consumes an excess amount of calcium and should continue to do so as he has the potential to grow more. He is frequently out late at night with his friends and does not get enough sleep.

Interventions: Advise Charlie to sleep 7-9 hours per night as the need for sleep increases during years of active growth (ATI, 2016).

Physical development is associated with adequate nutrition and Charlie should consume 11 mg of iron for muscle expansion and blood volume,1300 mg of calcium and 11 mg of zinc a day for bone growth (Perry et al., 2014).

Safety

References Assessment Technologies Institute. (2016). RN nursing care of children edition 10.0.

Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. (2015). Family health care nursing: theory practice, and research. Philadelphia: F.A. Davis Company.

Perry, S. E. Hockenbery, M. H., Lowdermilk, D. L., & Wilson, D. (2014). Maternal child nursing (5th ed.) St. Louis, MO: Mosby: Elsevier.

Powers, J. (Producer), & Chbosky, S. (Director). (2012). The Perks of Being a Wallflower [Motion picture]. United States: Summit Entertainment.

References Quality and Safety Education for Nursing. (2018). Retrieved from http://qsen.org/competencies/pre-licensure-ksas/ U.S. Department of Health and Human Services & U.S. Department of Agriculture. (2015). Dietary guidelines for americans (8th ed.). Retrieved from http://health.gov/dietaryguidelines/2015/guidelines/.

[Untitled image of Charlie, Patrick, and Sam]. Retrieved from https://theperksofbeingawallflowerge.weebly.com/ [Untitled image of Charlie in woodshop]. Retrieved from https://anempireofwords.wordpress.com/2013/10/16/perk -of-being-a-wallflower-2012/ [Untitled image of the Kelmeckis family]. Retrieved from https://theperksofbeingawallflowerge.weebly.com/

References [Untitled image of Patrick passing woodshop]. Retrieved from https://theperksofbeingawallflowerge.weebly.com/ [Untitled image of Charlie drinking a milkshake]. Retrieved from http://collider.com/the-perks-of-being-a-wallflower-movi -review/ [Untitled image of Charlie and his friends]. Retrieved from https://theperksofbeingawallflowerge.weebly.com/