Preschooler Behavior & Cognitive Development Ages 3-5

Preschooler Behavior & Cognitive Development (Ages 3-5)

• Preschoolers shift from egocentric thought to social awareness, considering others' viewpoints
• Judgements are based on visual appearance
• Language develops from three to four-word sentences at ages 3-4, to four to five-word sentences at ages 4-5
• Less ritualistic and negative than toddlers, but self-assertion remains

Piaget's Stages

• Preconceptual Stage (2-4 yrs): Symbolic thought emerges along with pretend play, logical reasoning and conservation is still a struggle
• Preoperational Phase (4-7 yrs): Intuitive thought transitions at around age 4, which lasts until age 7

Variations in Preschooler Thinking

• Magical Thinking: Thoughts are believed to be all-powerful and can cause events
• Animism: Lifelike qualities are assigned to inanimate objects
• Centration: Focus is only on one aspect, without considering alternatives

Behavior

• Increasing independence in dressing, eating, and toileting occurs by ages 4-5
• Children become more sociable, eager to please, and internalize family and cultural values
• Questioning parental values and comparing themselves with peers and authority figures begins
• More awareness of family roles emerges, which may cause struggles with changes (new sibling)
• Preschoolers can usually follow warnings of danger but younger ones (3-4 years) may still push boundaries

Night Terrors

• Caused by internal or external stressors and frequently occur in early childhood (ages 3-6)
• Often triggered by sleep deprivation, stress, illness, or CNS immaturity
• Factors: Moving, new family member, sickness, medications, loud noises, bright lights at night affect nervous system immaturity

Interventions For Night Terrors

• Keep a consistent bedtime routine
• Try a night light or a favorite toy
• Leave a drink of water by the bed
• Reassure frightened preschoolers but discourage sleeping with parents
• Ignore attention-seeking behaviors

Common Fears

• Common in preschool years, involves fears of the dark, being alone, monsters, or imagined threats
• Cause unknown, but inappropriate television viewing may increase fears due to difficulty distinguishing fantasy from reality
• Animism (attributing life to inanimate objects) can contribute (fearing a toilet after seeing it "come alive" in media)
• Fear of body loss (annihilation) can occur due to unclear body boundaries (fear of medical procedures like IV insertion)

Managing Fears

• Involve children in practical solutions (using a nightlight)
• Gradual exposure to feared objects in a safe environment (watching others interact with a dog)
• Modeling fearlessness can be effective when the child progresses at their own pace

When To Seek Professional Help

• Most fears fade by age 5-6, but severe, disruptive fears may require professional help

Adolescent Social Media

• Leisure time activities shift from family-centered to peer-centered, which aids in social, physical, and cognitive development
• Social media and technology play a major role in adolescent interactions, creating virtual communities
• Online interactions allow identity exploration and social skill development, which benefits those with limited access to friends
• Most teens interact online with the same peers they engage with at school
• Text messaging is widespread but can be disruptive and lead to cyberbullying

Risks of Social Media Use

• Cyberbullying and sexting (sending sexually explicit images/messages)
• Contact with online predators who may pose as adolescents
• Exposure to violent or sexual content, potentially influencing behavior.
• Distracted driving occurred in 39.2% of adolescents in 2017 who texted or emailed while driving within a 30-day period
• Multitasking with technology is common (listening to music, watching TV, texting, and surfing the web simultaneously):
• Legal concerns: Many states have banned handheld mobile device use while driving

Body Image

• Preschoolers (3-6 years) begin to recognize difference in appearance and identify what is considered acceptable and unacceptable
• By age 5, comparing themselves with peers starts
• Poor understanding of anatomy makes intrusive experiences frightening, so bandages after an injury are important to preschoolers
• Recognition of differences in skin color and racial identity and becoming vulnerable to learning prejudices and biases occurs
• They are aware of the meaning of words such as pretty or ugly
• By 5 years old, height and size comparison with peers starts; become conscious of being large or short
• Early experiences of body dissatisfaction can emerge

Parents Role on Body Image

• Parents should instill positive principles on body image
• Parents should give their children encouraging feedback regarding their appearance.
• They should emphasize the importance of accepting individuals no matter their differences in appearance
• School-age children (6-12 years): solidity body image
• Curiosity about sexuality should be addressed with education regarding sexual development and the reproductive process
• School-age children are more modest than preschoolers and place more emphasis on privacy issues.

Preadolescence

• Preadolescence is typically when prepubescence occurs
• Onset of physiological changes begins around age 9, particularly in girls
• Rapid growth in height and weight occurs
• Differences in rate of growth and maturation become apparent between boys and girls
• Visible sexual maturation is minimal in boys during preadolescence
• Permanent teeth rupture
• Bladder capacity differs but remains greater in girls than boys
• Immune system improves
• Bones continue to ossify
• Adolescents: base their own morality on comparisons with peers
• The image established during adolescence is retained throughout life

Club Foot

• A complex deformity of the ankle and foot known as congenital talipes equinovarus
• Can affect one or both feet, occur as an isolated defect, or in association with other disorders (cerebral palsy and spina bifida)
• Categorized as positional (occurs from intrauterine crowding), syndromic (occurs in association with other syndromes), and congenital (idiopathic)
• Present from birth

Club Foot Treatment

• Casting Procedure: Series of casting applied during the 1st month of life and continues (5-8 weeks) until maximum correction
• Weekly manipulation of the foot stretches the muscles with placement of a long-leg cast
• Heel cord tenotomy is performed followed by long leg cast application for 3 weeks
• After casting, a Denis Browne bar & specialized sandals (abduction brace) are applied to maintain alignment and prevent recurrence, they are worn at bedtime for 3-5 yrs

Head Injury

• MRI and CT scans can diagnose a head injury

Priority Nursing Actions for Head Injuries

• Focus on stabilizing the cervical spine while simultaneously maintaining patent airway (ABC's) and keep HOB at 30 degrees and head midline
• Monitor vital signs and neurological status, including N/V checks with EKG monitoring
• Hyperventilate patient & avoid suctioning when possible

Other Actions for Head Injuries

• Mechanical ventilation
• ICP monitoring
• Craniectomy

Concussion

• Concussion: (temporary alteration in brain function)
• It is self resolving and treatment focuses on rest and gradual return to activities

Medications To Decrease Intracranial Pressure

• Mannitol/Hypertonic Saline (3%/5% NS) rapidly decrease intracranial pressure
• Phenobarbital induces coma to decrease body metabolic demands
• Opioids and anticonvulsants may also be used

Severe Head Injuries

• Can come from a mechanical force that involves cranium, scalp, or brain
• Leading cause of death in children >1 year of age are unintentional head injuries

Communication and Atraumatic Care

• Therapeutic care minimizes/eliminates psychological & physical distress for children/families
• Prevention, diagnosis, treatment, or palliation of acute/chronic conditions included
• Care can be given at home, in hospitals, or other healthcare settings
• Personnel include all individuals directly involved in providing therapeutic care
• Psychological interventions include preparing children for procedures; physical include allowing parents to stay with the child

Psychological Distress

• Anxiety, fear, anger, sadness, guilt, disappointment, shame
• Pain, sensory disturbances, sleeplessness, immobilization

3 Core Principles of Atraumatic Care

• Prevent or minimize separation from family
• Promote a sense of control for the child
• Prevent or minimize bodily injury and pain

Examples of Atraumatic Care

• Encouraging the parent-child relationship during hospitalization
• Preparing the child before unfamiliar treatments or procedures
• Managing and controlling pain effectively
• Ensuring privacy for the child
• Providing play opportunities to express emotions (fear, aggression)
• Offering choices to give children a sense of autonomy
• Respecting cultural differences in care
• Provide competent care without undue physical & psychological distress by promoting self-esteem and dignity
• Using interventions that minimize or eliminate physical & psychological distress
• Use a treatment room for painful procedures and avoid in “safe places”
• Use developmentally appropriate terminology when explaining procedures
• Offer choices to the child

Cardiac: Tetralogy of Fallot

• Four defects that result in mixed blood flow: pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
• Consists of four heart defects: PROV: Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, Ventricular septal defect
• VS/LABS: O2 Sat 65-85% (hypoxemia), report any HGB over 22g/dL
• Cyanosis at birth- progressive cyanosis over the 1st years of life, Systolic murmur
• Episodes of acute cyanosis and hypoxia (blue or “Tet” spells) happen due to stress & leads to not enough blood flow to lungs

Surgical Procedures for Tetralogy of Fallot

• Shunt placement until able to undergo primary repair
• Complete repair within the first year of life
• Most common cyanotic heart defects in children

Nursing Actions for Tetralogy of Fallot

• During episode→ babies: Put KNEES to CHEST, kids: squat on the floor
• Do not interrupt sleep and environment should be calm and quiet
• Offer a pacifier when crying, small/frequent feedings
• Swaddle/hold the infant during procedures to calm them down

Order of Priority for Tetralogy of Fallot

• Knee to Chest position
• 100% O2
• Morphine Sulphate as prescribed
• IV fluids
• Documentation

Sibling Care & Consideration

• Common emotions include loneliness, fear, worry, anger, resentment, jealousy, and guilt
• Possible loss of status within family or social group
• Older siblings and those with more severely ill siblings may have a lower quality of life
• Factors That Increase Negative Effects on Siblings are younger age, experiencing significant changes, being cared for outside the home, receiving little or no information about their sibling's illness
• Provide developmentally appropriate explanations about the illness
• Encourage sibling visitation when appropriate, preparing them beforehand
• Arrange phone calls or letter exchanges between siblings; identify a support person to provide extra attention
• Give small daily gifts as a reminder that they are in their parents' thoughts
• Plan special time with siblings outside the hospital if feasible
• Educate parents on common sibling reactions, including anger, jealousy, and resentment

Adolescent Cognitive Development

• Piaget: Formal operation
• Able to think through more than 2 categories of variables concurrently
• Capable of evaluating the quality of their own thinking; able to maintain attention for longer periods
• Highly imaginative and idealistic; increasingly capable of using formal logic to make decisions
• Thinks beyond current circumstances; able to understand how the actions of an individual influence others
• Able to think in terms of abstract possibilities and hypothetical situations

Tumor Lysis

• This typically occurs in patients with acute lymphoblastic leukemia or Burkitt lymphoma during initial treatment but may occur spontaneously before therapy:
• The risk Factors are high WBC count at diagnosis(2 cancer patients who are at higher risk are leukemia and Wilms tumor), large tumor burden, cancer cell sensitivity to chemotherapy and high proliferative rate
• Medications, such as allopurinol, that reduce uric acid formation and promote excretion of byproducts of purine metabolism, are often used

Pediatric Cancer & Post Operative Care (Leukemia/Testicular)

• Most common in ages of 15 and 35
• Wilms tumor (Nephroblastoma) affects the Kidneys and presents as a palpable mass on the abdomen
• Modes of therapy: Surgery, chemotherapy, radiation therapy, biologic response modifiers, bone marrow transplantation and S/E would include alopecia, weight loss, immunosuppression, neutropenia
• Bone marrow transplantation involves the matching of a histocompatible donor with the recipient
• Autologous bone marrow transplant= Uses the patient's own marrow that was collected from disease free tissue
• Consider collecting stem cells from a baby with down syndrome due to them being at risk for cancer
• Cancer S/S includes pain (Leukemia=leg pain/growing), fever (sick more often/ sick season), skin changes (pallor, mottled), anemia, abdominal mass, swollen lymph nodes, lethargic and ulcers etc

Chemotherapy & Treatments

• Vaccines given 2 weeks before or during chemotherapy no longer work
• Liver and spleen most severely affected organs
• Always do bone marrow biopsy and blood cells counts can also diagnose leukemia
• Lumbar Puncture to evaluate CNS involvement, looking for increased WBCs in CSF
• Chemotherapy Transfusion monitors for Infection: Fever, neutropenia
• Adherence to Therapy is a must since one should ensure compliance with maintenance medications to prevent relapse

IV Medications for Cancer & Adverse Reactions

• Vincristine: Adverse reactions include Neurotoxicity (peripheral neuropathy, constipation)
• Methotrexate: Adverse reactions includes Mucositis, renal toxicity (leucovorin rescue used)
• Cyclophosphamide: Adverse reactions include Hemorrhagic cystitis (monitor urine for blood)
• Anthracyclines (Doxorubicin): Adverse reactions includes Cardiotoxicity (monitor heart function)

Post-op care for Pediatric Cancer

• Pain Management: should monitor and treat pain post-bone marrow aspiration or lumbar puncture.
• Infection Prevention: Strict hand hygiene, monitor for fever and administer antibiotics if needed
• Bleeding Precautions: Monitor platelet levels, assess for bruising or uncontrolled bleeding
• Hydration and Nutrition: Encourage fluids and well balanced diet
• Emotional Support: Help with anxiety and worries for the child and their family

Testicular Tumors:

• Not very common, but those showing in adolescence are typically malignant
• Most commonly diagnosed cancer in males from the age of 15 to 44
• Key to this is testicular self examination
• Treatment includes, orchiectomy, followed by chemo or radiation

IV Chemo Transfusion

• Phlebitis is the most common complication of and requires immediate medical attention
• During the IV chemo or transfusions, Adverse reactions also known as infusion reaction can range from mild

Bites (Insect, humans, animals)

• Includes insects and arachnids
• Some spiders and scorpions can inject deadly venom
• Animals bites are mostly from dogs
• Treatment includes Wound cleaning with saline, wound dressing and apply with pressure

Biting Wounds:

• Hymenopteran stings causes intense reactions
• Animal and Human bites causes damage to that area and should be cleaned and have prophylactic antibiotics to take care of
• Human bites requires immediate care and washing
• Ensure kids have safety around animals and animals should be socialized
• High pressure damages the brain
• A decrease in oxygen in the vessels decreases consciousness

Moderate Signs and Symptoms of High Pressure

• Headache
• Disorientation
• Sudden vomiting

Late Deadly Signs and Symptoms of High Pressure

• Lungs= Abnormal breathing patterns
• Neck = Rigidity
• High pressure can be caused by too much fluid
• Fractures complications and interventions requires more caution

Birth Control Methods/Contraindications

• Should be washed up after use with MILD soap
• Does not protect against STIs
• Contraindicted during pelvic relaxation and or after UTI infections

Birth control

• IUD= small T shaped device with bendable arms for insertion of mucus inside the uterus
• May cause UTI or bleeding
• Levontrestrols IUD
• Injectal progestrine injection that can make a women sterile
• Needs an adequate amount of calcium to decrease risks

Inadequate Calcium is a risk

• There is a great need to engage in exercises for both moms and the kids for better osteoporosis management

Cardio in mom's

• Blood volume and cardio output increases in Mom's
• Heart increases and peaks at ~#2 weeks
• Blood volume should stay in the same

Pregnancy adaption

• There are no obvious changes to anything in the1st trimester
• Skin and other changes start to arise in the #2 trimester

Pregnancy Skin Changes

• Striae gravidraum on the lower abdomen parts
• A dark like known as Linea Negria on the umbilicus
• Nail and hair increases during pregnancy

Progesterone

• Projesterone is a crucial hormone for pregnancy that helps thicken and prepare the uterus by preparing the uterus for breast milk production purposes

Syphillis

• Syphillis is among one of the most earliest STIs

Treatment, Symptoms & Signs of Syphillis

• Caused by a treponema
• Transmission is mainly sexually
• Chancre is a major signal of the STI
• Causes rashes also
• It is crucial to treat and be aware of your allergy to penicillin

Mentrual Cycle:

• Mentruation occurs approximately 14 weeks before ovulation
• Its monitored by the pituitary glands

Ovarian Phase

• The follicle releases ~day#14
• Corpus Luteum secretes Progeterone and if it implanted it does not reigress.

Cyclic Changes

• Basal temp rises with ovulation
• Muucus thin that stretch at ovulation
• Avg at 51 years
• Hormone fluctuations
• Abeseence is shown with preganncy.

Amenhorrea Cause

• Amenorhea due to loss of wt and poor nutrition also for those who work out to hard
• Sexual and economics
• Common violence
• There are factors that can increase violence in women and most women abused prior to pregnancy will be abused during

Best Care of a Pregnant Patient

• Patients show an overuse in certain fields
• Its also important to be aware of those who take the pill due to the high influx of horomone

Common Cancer

• In women that include radiation
• Most common due to low sex
• Gold is needed and recc for those with dense breast PET scans can detect disease
• Dysmennorea occurs with women
• Pain occurs on with periods with abnormal menstrual cycles

Pregnancy:

Sterrogen can increase defects to the baby Teratagon is about ~#4 hours after Best position is to lie on your side Magnessium sulfate lowers those risks

• Premature and preterm mom has that baby is born can give the baby sterorids

Important Information on Premature Pregnancy

• Watch out for chorioamnionitis
• Always assess the patients fluids in pregnancy or labor
• Best position is the on the patients side for birth giving procedures and more.