Nursing Care of a Family With a Pre-Schooler PDF

# Nursing Care of a Family With a Pre-Schooler **April Joyce L. Dela Cruz, RN, MAN** **Instructor** ## Pre-Schooler - 3-6 years old - Physical growth - slows down - Cognitive and personality - rapid rate ### Physical Growth - Body type becomes apparent - Ectomorphic (slim) - Endomorphic...

# Nursing Care of a Family With a Pre-Schooler **April Joyce L. Dela Cruz, RN, MAN** **Instructor** ## Pre-Schooler - 3-6 years old - Physical growth - slows down - Cognitive and personality - rapid rate ### Physical Growth - Body type becomes apparent - Ectomorphic (slim) - Endomorphic (large) - Handedness begins to be obvious - Ability to learn extended language - URTI remains localized to the nose ## Pre-Schooler - Physical Growth - PR 85bpm - BP 100/60 mmHg - Some exhibit genu valgus (knock-knees) - Weight - increases 2kg/year - Height - 6-8cm/year ## Pre-Schooler - Developmental Milestone - **Language Development** - A 3-year-old child has a vocabulary of about 900 words. - Mostly "how" and "why" questions. - "Why is snow cold? How do worms hear? What does your tongue do?" - 4 and 5-year-old children continue to ask many questions. - Enjoys participating in mealtime conversation. - Describe something from their day in great detail. - **Language Development** - Preschoolers imitate language exactly, so if they hear less-than-perfect language, this is the language pattern they adopt. - They may imitate and use "bathroom language" if not corrected because of the attention from adults this generates. - They are egocentric - describes things in relation to them. - **Play** - Imitation Games - Pretends to be a policeman, firefighter, robber, doctor. - Imaginary Friends - Due to active imagination exists until they enter formal schooling. - 4-5 years old - Rough play and imitative play - plays with playmate. - Enjoys group songs or games. ## Pre-Schooler - Developmental Milestone - Table The following table summarizes the preschool growth and development: | Age (yr) | Fine Motor | Gross Motor | Language | Play | |---|---|---|---|---| | 3 | Undresses self; stacks tower of blocks; draws a cross | Runs; alternates feet on stairs; rides tricycle; stands on one foot | Vocabulary of 900 words | Able to take turns; very imaginative | | 4 | Can do simple buttons | Constantly in motion; jumps; skips | Vocabulary of 1500 words | Pretending is major activity | | 5 | Draws a 6-part man; can lace shoes | Throws overhand | Vocabulary of 2100 words | Likes games with numbers or letters | ## Pre-Schooler - Emotional Development - **Developmental Task**: Initiative vs. Guilt - Initiative - learning new things is fun. - Guilt - punished in doing things/learning things. - **Imitation**: - Let the child play however he wants to imitate a person - firefighter catching a thief - policeman putting out a fire. - **Fantasy**: - Cannot differentiate fantasy from reality - toddler. - Makes differentiation - preschooler. - **Fantasy**: - Parents should always present reality. - Do not strengthen the feeling of a preschooler's magical thinking. - **Oedipus & Electra Complex**: - Child competes with same-sex parent for love and affection - normal behavior. - **Gender Roles**: - They have to be familiar with opposite gender roles. - Exposure to other people will help them be familiar. ## Pre-Schooler - Emotional Development - **Socialization**: - 3 year old - capable of sharing. - Children exposed to other environments have a lot of opportunities to learn. - 4 year old - argumentative - more certain of roles. - 5 year old - "best friends" - 3 will fight 4 will play. ## Pre-Schooler - Cognitive Development - **Intuitional thought - second phase.** - **Centering**: - They lack the insight to view themselves as others see them or put themselves in another's place. - They feel they are always right. - **Conservation**: - Pre-schoolers are not aware of this. - That if they have two balls of clay of equal size, but one is squashed flatter and wider than the other, preschoolers will insist the flatter one is bigger. ## Pre-Schooler - Moral and Spiritual Development - Right and wrong is based on parent's rules. - Enjoys the security of religious holidays and religious rituals such as prayer and grace before meals because these rituals offer them the same reassurance and security as a familiar nursery rhyme read over and over. ## Pre-Schooler - Health Promotion - **Promote Preschooler Safety**: - Keeping Children Safe, Strong and Free. - Motor Vehicle and Bicycle Safety. - Promoting Nutritional Health of the Preschooler. - Recommended Dietary Reference Intakes. - Promoting Nutritional Health With a Vegetarian Diet. - Promoting Development of the Preschooler in Daily Activities. - Dressing. - Sleep - fear of the dark. - **Promoting Development of the Preschooler in Daily Activities**: - Exercise. - Hygiene. - Care of Teeth - **Bruxism**: Grinding the teeth at night - releases tension and allows themselves to fall asleep. - **Promoting Healthy Family Functioning**: - Discipline. ## Pre-Schooler - Health Promotion - **Parental Concerns Associated with the Preschool Period**: - **Common Health Problems of the Preschooler**. - **Common Fears of the Preschooler**: - Fear of the Dark. - Fear of Mutilation. - Fear of Separation or Abandonment. - **Behavior Variations**: - Telling Tall Tales. - Imaginary Friends. - Difficulty Sharing. - Regression. - Sibling Rivalry. - **Parental Concerns Associated with the Preschool Period**: - **Preparing for a New Sibling**. - **Sex Education**. - **Choosing a Preschool or Child Care Center**. - **Preparing a Child for School**: - Broken Fluency - (repetition and prolongation of sounds, syllables, and words). - "Bathroom Language" ## Nursing Care of a Family with a School-Aged Child **April Joyce L. Dela Cruz, RN, MAN** **Instructor** ## School-Aged - 6 - 12 years old ### Physical Growth - 10 years - Brain growth is complete. - Refined fine motor coordination. - IgG and IgA reaches adult levels. ## School-Aged - Physical Growth - **Sexual Maturation**: - Brain maturity -> hypothalamus transmits enzyme to anterior pituitary gland = produces gonadotropic hormones = puberty. - **Sexual and Physical Concerns**: - **Female**: - Hips become broader. - Menarche. - Irregular periods. - **Male**: - Gynecomastia may occur. - Nocturnal emission - ejaculation during sleep = due to increase seminal fluid production. - **Transgender**: - Depression and anxiety is common-identity confusion. ## School-Aged - Developmental Milestone | Age | Gross Motor | Fine Motor | Play | Language | |---|---|---|---|---| | 6 | Endlessly jumps, tumble, skip and hop; walks in a straight line; can ride a bicycle; skip ropes | Easily ties their shoelaces; cut and paste well; draws a person with good detail; can print letters; routinely reverse letters - "eraser year" - focuses more on fine motor skills | Discovers reading as an enjoyable activity | Talks in full sentences; still defines objects by their use (key is to unlock the door) | | 7 | More quiet compared to an active 6 year old | Can read regular-size type (eyes are well-developed); writes script in addition to print | Requires more props for play; imaginative play starts to decline; develops interests in collecting items | Can tell time in hours; struggles with "half past" and "quarter to"; can name months of the year and the holidays; can add and subtract simple numbers. | | 8 | More graceful movements | | Sorting and cataloging the collected items; becomes more involved in science projects and experiments; prefers table games - changes rules to keep from losing | | | 9 | On-the-go constantly; "always have a deadline to meet" | Writing begins to look mature and less awkward | Plays hard (before, during and after school); talents for music and arts becomes evident | | | 10 | More interested in perfecting their athletic skills | | Interested in playing screen games; slumber parties and campouts become popular; interested in rules and fairness | | | 11 | Feels awkward because of growth spurts; channels their energy into constant motion instead | | Enjoys dancing and playing table games; time with friends spent with talking | | | 12 | Plunges into activities with intensity and concentration; refreshingly cooperative around the house; shows ability to handle great responsibility; completes given tasks | | | Carry on adult conversations; stories are limited due to lack of experience. | ## School-Aged - Emotional Development - **Developmental Task**: Industry vs. Inferiority - Learning how to do things WELL - Finished tasks will help them achieve industry. - They spend more time with their peers than at home. - Problem solving: encourage the child to solve issues rather than offer solutions. - "Let's talk about possible ways to solve the problem." - NOT “This is how you do it.”" ## School-Aged - Emotional Development - **Developmental Task**: Industry vs. Inferiority - They are so focused in accomplishing tasks and forgets they must work with others to achieve their goal. - They show empathy but can't relate others experiences to their own. - **Socialization**: - **6 year old**: - Plays in group, but when tired, they prefer one-to-one contact. ## School-Aged - Emotional Development - **Developmental Task**: Industry vs. Inferiority - **Socialization**: - **7 year old**: - Increased awareness of family roles and responsibilities. - Promises must be kept - pinky swear. - **8 year old**: - Seeks company of other children. - **9 year old**: - Values peer group seriously. - Ready for activities away from home. ## School-Aged - Emotional Development - **Developmental Task**: Industry vs. Inferiority - **Socialization**: - **10-11 year old**: - Often insecure. - Often attempts many uncomfortable and awkward social experiences before forming comfortable relationships. ## School-Aged - Cognitive Development - **Concrete Operational Though**: - **Decentering**: - Ability to project one's self into other people's situations and see the world from another’s viewpoint rather than focusing only on their own. - **Accommodation**: - Ability to adapt thought processes to fit what is perceived, such as understanding there can be more than one reason for other people's actions. - **Conservation**: - **Class Inclusion**: - Ability to understand that objects can belong to more than one classification. ## School-Aged - Moral and Spiritual Development - **Preconventional Reasoning**: - Concentrates on "niceness" or "fairness" - rule oriented. - "Why is it wrong to steal from your neighbor?" - "Because if you do, you will go to jail." ## School-Aged - Health Promotion - Promoting School-Aged Safety. - Promoting Nutritional Health of a School-Aged Child. - Establishing Healthy Eating Patterns. - Let them help with meal planning. - Recommended dietary intake. - Vegetarian diet. - Promoting Development of a School-Aged Child in Daily Activities. - Dress - care for their own belongings. - Sleep. - Exercise. ## School-Aged - Health Promotion - Promoting Development of a School-Aged Child in Daily Activities. - Hygiene. - Care of Teeth. - Promoting Health Family Functioning. - "Tell me about it" is more preferable to "What is it?" ## School-Aged - Health Problems of the School-Aged Period - Caries. - Malocclusion. - Deviation of tooth position from the normal. ## Concerns and Problems of the School-Aged Period - ADHD and ASDs. - Language Development. - Broken fluency. - r, I and w problems. - Common Fears and Anxieties. - Anxiety related to beginning school. - School Refusal or Phobia - Social phobia. - Concerns and Problems of the School-Aged Period - Common Fears and Anxieties - Anxiety related to beginning school - School Refusal or Phobia - Social phobia - Homeschooling - Children who spend time independently - Sex Education - Violence or Terrorism - Bullying - Recreational Drug Use ## Piaget's 4 Stages of Cognitive Development The following table shows the stages of cognitive development: | Stage | Age | Characteristics | |---|---|---| | Sensorimotor stage | 0 to 2 Year old | Motor activity without use of symbols | | Preoperational stage | 2 to 7 years old | Development of language, memory, & imagination. | | Concrete operational stage | 7 to 11 years old | More logical and methodical manipulation of symbols. | | Formal operational stage | 12 Year to Up | Use of symbols to relate to abstract concepts. | ## Sensorimotor Stage (Infant): - Practical intelligence. - Object permanence. - As early as 4 months, they identify their parents as different from other people. - Separation anxiety (8 to 12 months) - infants continue to cry knowing their parent still exists and come to them even if out of sight. ## Preoperational Stage (Toddler) - Trial and error to discover new characteristics of objects and events. - Intuitive Thinking (Preschooler): - When a child looks at an object, they only see one of its characteristics. - Conservation (ability to discern truth, even though physical properties change). - Reversibility (ability to retrace steps). ## Preoperational Stage - Role Fantasy - strongly influences the preschooler's way of thinking - how children would like something to turn out - "magical thinking". - Assimilation - taking in information and changing it to fit their existing ideas. - Accommodation - changing their ideas to fit reality rather than the reverse. ## Concrete Operational Thought (School-aged) - Children can be seen using practical solutions to everyday problems as well as begin to recognize cause-and-effect relationship - "reasoning". - A plastic toy is easily broken because it is made of plastic ## Formal Concrete Operational Stage (Adolescent) - Final form cognition is achieved. - Thinking of possibility "what could be?" (abstract thought). - Scientific reasoning. ## Kohlberg's Stages of Moral Development | Level/Stage | Age Range | Description | |---|---|---| | I: Obedience/Punishment | Infancy | No difference between doing the right thing and avoiding punishment. | | I: Self-Interest | Pre-school | Interest shifts to rewards rather than punishment - effort is made to secure the greatest benefit for oneself. | | II: Conformity and Interpersonal Accord | School-age | The "good boy/girl" level. Effort is made to secure approval and maintain friendly relations with others. | | II: Authority and Social Order | School-age | Orientation toward fixed rules. The purpose of morality is maintaining the social order. Interpersonal accord is expanded to include the entire society. | | III: Social Contract | Teens | Mutual benefit, reciprocity. Morally right and legally right are not always the same. Utilitarian rules that make life better for everyone. | | III: Universal Principles | Adulthood | Morality is based on principles that transcend mutual benefit.. | ## Erikson's Theory of Psychosocial Development - Trained in psychoanalytic theory but developed psychosocial development. - Stresses the importance of culture and society in development of personality. - A person's social view of self is more important than instinctual drives in determining behavior. - Allows for a more optimistic view of the possibilities of human growth. ## Erikson's Theory of Psychosocial Development - He looked for actions that lead to mental health. - Describes eight (8) developmental stages covering the entire life span. - Each stage has a conflict between two opposing forces - resolution in each conflict or accomplishment of each developmental task = moving on to the next phase. ## Erikson's Stages | Stage | Basic Conflict | Virtue | Description | |---|---|---|---| | Infancy | Trust vs. mistrust | Hope | Trust (or mistrust) that basic needs, such as nourishment and affection, will be met. | Early childhood | Autonomy vs. shame/doubt | Will | Develop a sense of independence in many tasks. | Play age | Initiative vs. guilt | Purpose | Take initiative on some activities-may develop guilt when unsuccessful or boundaries overstepped. | School age | Industry vs. inferiority | Competence | Develop self-confidence in abilities when competent or sense of inferiority when not. | Adolescence | Identity vs. confusion | Fidelity | Experiment with and develop identity and roles. | Early Adulthood | Intimacy vs. isolation | Love | Establish intimacy and relationships with others. | Middle age | Generativity vs. stagnation | Care | Contribute to society and be part of a family. | Old age | Integrity vs. despair | Wisdom | Assess and make sense of life and meaning of contributions. ## Trust vs Mistrust (Infant) - **Trust**: - Learned if they are in need or in distress, parents will come and meet the need. - **Mistrust**: - Inconsistent care, inadequate, rejection. - Infant becomes fearful, suspicious of people and the world. ## Autonomy vs Shame/Doubt (Toddler) - **Autonomy**: - Self-governance or independence. - Children take pride in new things they can accomplish. - Wanting to do things independently. - "NO" - their favourite reply (Let me!). - **Shame/Doubt**: - Felt by toddlers if they do not have a chance to practice autonomy. ## Initiative vs Guilt (Preschooler) - **Initiative**: - Learning how to do things on their own.. - Initiate in doing motor activities and not responding or imitating others. - Creativity. - Fantasy or play. - **Guilt**: - If they are made to feel that their activity is bad, questions are a nuisance, play is silly. - Will have limited brain-storming and problem-solving skills. - They wait for clues or guidance from others before acting. ## Industry vs Inferiority (School-aged) - **Industry (self-confidence)**: - Learning how to do things WELL. - If they are encouraged in their efforts to do tasks and are praised and rewarded, sense of industry grows. - **Inferiority**: - Caregivers not showing appreciation for the child's effort. - Caregivers who are always "busy". ## Identity vs Role Confusion (Adolescent) - **Identity**: - Bringing everything they learned together about themselves as a person. - **Role Confusion**: - They are left unsure of what kind of person they are or what kind of person they want become. - Common for adolescents to explore and express their identity in different ways. ## Intimacy vs Isolation (Late Adolescent) - **Intimacy**: - Ability to relate well with other people in preparation for developing future relationships. - **Isolation**: - Being rejected, hurt when offering love or relationship (if they did not develop a sense of trust and autonomy). ## Freud's Psychoanalytic Theory - Austrian neurologist and founder of psychoanalysis. - Offered the first real theory of personality development. - Based on Freud's observation of adults experiencing mental disturbances. - Adult behavior is the result of instinctual drives of a primarily sexual nature (libido). ## Freud's Psychoanalytic Theory - Described child development as a series of psychosexual stages. - Sexual gratification becomes focused on a particular body part at each stage. ## Freud's Psychoanalytic Theory - **Criticisms of Freud's Theory**: - He relied his theory on his knowledge of people seen in his practice and looked at circumstances leading to mental illness. - "Looking at illness" rather than "looking at wellness" limits the applicability of theory as health promotion measure. - Gender-biased. ## Erikson's Theory of Psychosocial Development - Trained in psychoanalytic theory but developed psychosocial development. - Stresses the importance of culture and society in development of personality. - A person's social view of self is more important than instinctual drives in determining behavior. - Allows for a more optimistic view of the possibilities of human growth. ## Erikson's Theory of Psychosocial Development - He looked for actions that lead to mental health. - Describes eight (8) developmental stages covering the entire life span. - Each stage has a conflict between two opposing forces - resolution in each conflict or accomplishment of each developmental task = moving on to the next phase.