COLEGIO SAN AGUSTIN-BACOLOD

COLLEGE OF NURSING
OBSERVATIONAL CASE STUDY OF THE PRESCHOOLER
I. Profile of the Preschooler
Name: Z.N.I.
Age: 3 years old
Gender: Male
Date of Birth: September 18, 2011
Place of Birth: Brgy. 20, Bacolod City
Religion: Roman Catholic
Address: Brgy. 20, Bacolod City
Nutritional Status: Z.N.I. eats his meal 3 times a day. He also eats snacks in between meals.
He doesnt likes vegetables and he is not fond of eating meat if it is paired
with rice. He also takes vitamins like Tiki-Tiki regularly.
Weight: The average weight of a 3 years old boy is 14.6 kg. Z.N.I. has a weight of 15 kg which
is normal for his age.
Height: The average height for his age his 94.9 cm. His height which has been measured
recently is 97 cm which is considered to be normal for his age.
Physical Handicapped: (if present-describe)
No signs of any abnormality.
Fathers Name: L.M.
Occupation: N/A
Mothers Name: K.J.I.
Occupation: Housewife

II. Introduction/Description why you chose the child

The preschooler learns the social skills needed to play and work with other children. As time
passes, the child is better able to cooperate with a larger number of peers.

Although 4- to 5-year-olds may be able to start playing games that have rules, the rules are
likely to change often at the whim of the dominant child. Preschool is the developmental stage
from the ages 3 to 6 years old-- those who have moved beyond toddlerhood but aren't yet old
enough for kindergarten.

This level of education is aimed at equipping children with various skills such as problem
solving skills, self-help skills, social skills, team work, creative development, and communication.
Jean Piaget's Theory of Cognitive Development says that a young child's understanding is certainly
different from an adult's. As a child's body and physical abilities change, her way of knowing and
perception of the world also change. According to Piaget's Theory, a pre-schooler belongs to the
preoperational stage. This stage focuses on the development of concept through make-believe play
and development of symbolism. For example, a child is able to use an object to represent
something else, such as pretending a broom is a horse. Role playing also becomes important during
the preoperational stage. Children often play the roles of "mommy," "daddy," "doctor" and many
other characters. Language development is one of the hallmarks of this period. Piaget noted that
children in this stage do not yet understand concrete logic, cannot mentally manipulate information,
and are unable to take the point of view of other people, which he termed egocentrism. In Sigmund
Freud's Psychosexual Theory of Development, a pre-schooler is in phallic stage. Freud believed
that during this stage boy develop unconscious sexual desires for their mother. Because of this, he
becomes rivals with his father and sees him as competition for the mothers affection. During this
time, boys also develop a fear that their father will punish them for these feelings, such as by
castrating them. This group of feelings is known as Oedipus Complex (after the Greek Mythology
figure who accidentally killed his father and married his mother). Later it was added that girls go
through a similar situation, developing unconscious sexual attraction to their father. Although Freud
Strongly disagreed with this, it has been termed the Electra Complex by more recent
psychoanalysts. For Erik Erikson's Psychosocial Development, a pre-schooler is on the third stage
of development which is the Initiative vs. Guilt. It is during in this stage that children need to begin
asserting control and power over the environment by taking initiative by planning activities,
accomplishing tasks and facing challenges.

During this stage, it is important for caregivers to encourage exploration and to help children
make appropriate choices. Caregivers who are discouraging or dismissive may cause children to
feel ashamed of themselves and to become overly dependent upon the help of others. The work of
Lawrence Kohlberg is an outstanding example of research in the Piagetian tradition. He used
Piaget's storytelling technique to tell people stories involving moral dilemmas. In each case he
presented, a choice to be considered for example between the rights of some authority and the
needs of some deserving individual who is being unfairly treated. His research was cross-sectional,
this means that he interviewed children of different ages to see what level of moral development
they are at.

When Z.N.I. was still 1-2 years old, his mother and grandmother think that he cant speak. He
stopped breastfeed when he was 9 months old and started bottle feed. His mother uses su-am as
his substitute for milk. He started speaking when he is 2 years old. He has a younger brother
named, M.I. Z.N.I. is one of those kids that whose vegetables are not on the list of their favorite
foods. His mother told me that his favorite food is fish and noodles. He is not fond of eating meat
that is paired with rice. For example, he only wants to eat chicken joy alone without the rice. Z.N.I.
takes his vitamin regularly. He can stay up as late as 12:00 or 1:00 AM and he wakes up in the
morning by 6:00 or 7:00 AM.

If he has no class, he plays counterstrike as soon as he wakes up in the morning and

according to his mother he usually spends half the day playing it. He learned how to operate the
computer when he was 1 year old and he learned how to play counterstrike by just watching his
cousins play. He learned nursery rhymes and watch episodes of Barney in Youtube. If he is not
allowed to play counterstrike, he would often have tantrums and he would not stop unless his
mother finally allows him. According to his mother, Z.N.I. will not stop crying unless she lets him
play the computer. She is aware that this behavior is not right but she said that she cant tolerate
Z.N.I. having a tantrum because she is afraid that Z.N.I. will have fever at night. She said that
whenever Z.N.I. is having a tantrum and will not stop crying, he would have a fever at night and
this was experienced several times.

Z.N.I. also has a habit of not wanting to share the computer even if he is done playing with
it. He would play again just to stop others from using the computer. According to his mother, he is
not fond of watching cartoons unlike other kids. He likes watching action movies. He is fond of
playing miniature cars and he imagines objects with a rectangle end that it is a gun. He has a small
bike at home. He is afraid of aliens and he refers ugly objects as alien. His mother told me that this
first started when they went into a restaurant and the movie that is showing has aliens. From then
on, Z.N.I. is afraid of aliens. His mother disciplines Z.N.I. by spanking him using her hands.
According to his mother, his learning process slows down if he is not having fun. He likes it if he is
tickled while studying. He is not totally dependent on his mother when he is at school but he would
sometimes peek at the door to check if his mother is still there.

I chose Z.N.I. as the subject of this observational case study because as I was observing all the
children in the preschool, my attention were caught by him. Unlike his classmates who were
playing with toys and running inside the room, he is just sitting quietly in his seat, watching his
classmates play. As I continue observing him, I noticed that he is somehow doesn't show full
dependence on his mother. During their snack time, he will just eat all by himself without requiring
the help of his mother. What intrigued me the most is, when I ask him questions like, "What's your
name?", "Where do you live?" and other questions, he will just look straight at me without
answering my questions and his facial expressions were mostly blank but according to the
information that Ive gathered, his behaviour at school and at home is different. He is usually quiet
at school but at home he often have tantrums according to his mother.These were the reasons why I
chose Z.N.I. as my subject.

III. Home Condition

The owner of the house that Z.N.I. and her mother are staying at is the property of K.J.I's
grandmother. It was inherited by the family. The house is in good condition. It is made of wood,
it is not huge but the space is suitable for the family. They only have 1 room inside the house.
They also have living room, kitchen, and comfort room.

The family owns a speaker, television and computer. The ventilation is good enough for air
to go through in and out the house. The distance of the school from the house is not too far. It has
a walking distance however, if the sun is way too hot, Z.N.I and his mother ride a traysikad with
Php 10.00 as their fare.
The mother of Z.N.I. accompanies him every weekdays to school and she waits for the class
to be dismissed. She doesn't leave Z.N.I. alone in the school. She raises Z.N.I. and her other
child together with his mother. They community that they live in is congested but the
surroundings are clean and suitable for a family to live in. The house is not on the side of the
road. They need to walk their way to the house from the corner. Their family structure is
extended. The family shares the house with K.J.I.'s siblings together with her mother.
IV. Observation
Topic

Book View

Observation

PHYSIOLOGICAL
DEVELOPMENT
1.

Physical Growth

2. Gross Development

The weight gain is slight

during the preschool years.
The average child gains
only about 4.5 lb or 2kg/ yr.
Height gain is also minimal
during this period; as only
2.5-3inches/yr or 6 to 8cm.
Appetite remains as it was
during the toddler years,
which is considerably less
expect. They have 20
deciduous teeth by 3 years
of age. The bladder is
easily palpable above the
symphysis pubis.

At this stage, the childs

balance continues to
improve. They are
constantly in motion such
as jumping and skipping.
They are also becoming
more skilled in running,
throwing and kicking and
able to pedal a small

ZNI has a weight of 15 kg which is

normal for a pre-schooler. He has a
height of 97 cm which is higher than
the average height of a pre-schooler
which is 94.9 cm. As to his voiding,
he usually voids 5-7 times a day. He
is a picky eater. He doesnt eat
vegetables and meat if it paired with
rice. He does not usually finishes his
food and he has many left overs.

He is fond of running and skipping

around the classroom. He also loves
to throw balls and he plays with his
small bicycle at home.
.

tricycle for their age.

3. Fine Motor
Development

During this stage, copying

figures becomes easier for
them and they are able to
trace any letter, object and
number. The child also
undresses self with
supervision; molds
clay/play-dough; able to
color shapes; can make sign
of the cross.

He can trace letters and numbers

accordingly for his age. He is able to
undress himself with the help of his
mother. He is able to color shapes and
mold clay. He can pile objects
together. He is able to make sign of
cross. He started using the computer
when he was 1 year old and he can
play counterstrike.

COGNITIVE
DEVELOPMENT
As for Piaget, a pre-schooler is in
the preoperational stage
1.
C
a A child resembles logic
u thought, explains concepts
s as what he heard about it
a and as described by others
l but their understanding is
i limited.
t
y
2.

L
a
n
g
u
a
g
e

ZNI is able to explain a concept

according to what he has heard about
it and he can also memorize songs.

At the age of 3-4 years,

children can form a
sentence of about 3-4 words
and includes only the most
essential words. This is also
called as Telegraphic due to
its brevity and length. As of
broken fluency, which is
the stuttering of words and
Dyslalia which is inability
to speak verbal languages.
The average vocabulary of
a pre-schooler ranges to
approximately 2100 words.

When ZNI wants to play

counterstrike, he would usually say,
Hampang ko strike. He is not fond
of talking and he is usually quiet in
the classroom. He doesnt speak
clearly. Whenever he says something,
he usually mutters the words.

Preschoolers tend to seek

new experiences to their
parents and guardians by
asking how and why.

ZNI discovers new things on his own.

His mother doesnt assist him when
she knows that ZNI can do it on his
own. She wants ZNI to stop being too

PSYCHOSOCIAL
DEVELOPMENT
As for Erik Erikson, a preschooler is in the Initiative vs.
Guilt stage.
1 . Family Relations

They feel a sense of

accomplishment
and
satisfaction
in
their
activities. When conflicts
arise, the children tend to
overstep the limits of their
ability, inquiry, experience
and
not
behaving
appropriately.

dependent. If ZNI accomplishes

something such as doing his school
activity, he show it to his mother. He
is proud of his accomplishments.
Although he doesnt have a father
beside him, his mother is very
supportive of him. His mother is also
patient in answering ZNIs questions.
Doesnt want to share the computer
at home with others; he does not cry
and knows that his mother is waiting
outside the classroom; fond of
shooting games; have tantrums if
he is not allowed to play
counterstrike; can eat food without
supervision. His mother doesnt assist
him when she knows that Z.N.I. can
do it on his own.

2.

3.

S
o
c
i
a
l
i
z
a
t
i
o
n

Children who are exposed

to other playmates have an
easier time learning to
relate to people than those,
for instance, who are raised
in milieu where they never
see other children of the
same
age.
Although
preschoolers enjoy to play
in groups, they may be
involved in arguments
more, especially as they
become more certain of
their role in the group. This
development may make
parents worry that a child is
regressing. However, it is
really forward movement,
involving some testing and
identification of their group
role.

P
l
a
y

Preschoolers do not need

many
toys.
Their
imaginations are keen.
They enjoy games that uses
imitation such as playing
house. They imitate what
they see their parents are
doing such as eating meals,
mowing the lawn, cleaning
house and arguing. They
also want to play pretend
games such as pretending to
be
teachers,
cowboys,

ZNI loves playing together with his

boy classmates but he is not afraid of
interacting with his girl classmates.
He is not usually involved in quarrels
with his classmates because he is
quiet in the classroom. At home, he
doesnt want to share the computer
especially when he is playing
counterstrike.

ZNI loves pretending to be an

action movie star. According
to him he wants to shoot bad
guys.
He
loves
playing
shooting games and he also
wants to race.

firefighters and store clerks.

Many preschoolers have
imaginary friends as a
normal part of having an
active imagination. These
often exist until children
formally begin school.

PSYCHOSEXUAL
DEVELOPMENT
As for Freud, a pre-schooler is in
the Phallic Stage.
1 . Sexuality

ZNI doesnt touch his genital all by

himself. He only touches it if
Phallic stage is the third somebody touches it. He doesnt
stage
of psychosexual show Oedipus Complex because he
development, spanning the does not have a father.
ages of three to five years,
wherein
the
infants libido (desire)
centers upon his or her
genitalia as the erogenous
zone.
When
children
become aware of their
bodies, the bodies of other
children, and the bodies of
their parents, they gratify
physical
curiosity
by
undressing and exploring
each other and their
genitals, the center of the
phallic stage, in course of
which
they
learn
the physical differences
between
male
and
female,
and
the gender differences
between boy and girl,
experiences which alter the
psychologic dynamics of
the parent and child
relationship.

MORAL DEVELOPMENT
As for Kohlberg, a pre-schooler
is in the preconventional or
premoral level.

It follows intuitive thought

and is based on external
control.
Preschoolers
determined right from
wrong based on their
parents rules. They have
little understanding of the
rationale for these rules or
even whether the rules are

At school, ZNI is usually quiet

around his classmates but at home
there are times that he is restless and
naughty but everytime youre going
to tell him that what he is doing is
wrong, he would listen to you and
would stop what he is doing.

consistent. Because they

only depend on their
parents supply rules for
them, when faced with a
new situation they have
difficulty seeing that the
rules they know may also
apply to a new situation.

Common
Health
Problems

Common cold

Pneumonia

Definition

Signs and Symptoms

Prevention

Treatment

It is a viral infectious
disease of the upper
respiratory
tract which primarily
affects the nose.

Symptoms
include coughing, sor
e throat, runny
nose, sneezing,
and fever which
usually resolve in
seven to ten days,
with some symptoms
lasting up to three
weeks.

Washing of
hands often;
use sanitizers
or alcohol base
hand rinses.

Getting plenty of
rest, drinking
fluids to maintain
hydration,
and gargling with
warm salt water,
are reasonable
conservative
measures.

It is
an inflammatory cond
ition of
the lung affecting
primarily the
microscopic
air sacs known
as alveoli.

Typical symptoms
include
a cough, chest
pain, fever,
and difficulty
breathing.

Pneumococcal
vaccine;
Always wash
hands before
eating and after
going outside;
at a daily diet
that includes
foods rich in
antioxidants,
such as fresh,
dark-colored
fruits and
vegetables and
other nutrients.

Medications
should be taken
exactly as
prescribed by a
physician; Rest in
bed until body core
temperature
returns to normal;
Drink six to eight
glasses of liquids
daily to help keep
mucous thin and
easy to cough up.

Cough

Constipation

Fever

Signs and symptoms

that point to an
infection
include fever, chills,
body aches, sore
throat, nausea,
vomiting, headache,
sinus pressure, runny
nose, night sweats,
and postnasal drip.
Sputum, or phlegm,
sometimes indicates
an infection is
present, but it is also
seen in noninfectious
causes.

Wash hands
frequently;
Increase fluid
intake; Take
vitamins
regularly;
Avoid
secondhand
smoke.

He may attempt to
use over-thecounter cold
remedies to
relieve the
symptoms. Acute
coughs that are
caused by
allergies are often
relieved with
allergy
medication, and
coughs due to
environmental
irritants will
respond to
elimination of the
irritating agent.

It is an abnormal
pattern of bowel
movements that
causes a person to
pass stools less often
than usual.

Abdominal bloating,
cramps or pain,
Lethargy, passing
hard stools

Drink a lot of
fluids, have
enough fiber
from whole
grains or
cereals, fruits
and vegetables.
Do not eat too
much junk
foods.

Give your child

plenty of fluids,
especially water.
Make sure that
your child eats
fruits and
vegetables every
day.

Fever is one of the

most
common medical
signs and is
characterized by an
elevation of body
temperature above
the normal range of
36.537.5 C (97.7
99.5 F) due to an
increase in the
temperature
regulatory set-point.

A fever is usually
accompanied
by sickness behavior,
which consists
of lethargy, depressio
n, anorexia, sleepines
s, hyperalgesia, and
the inability to
concentrate.

Wash hands
often; Cover
your mouth
and nose
when
sneezing and
coughing;
Handle food
with clean
hands; Eat a
healthy diet
including
fruits and
vegetables;
Get the proper
amount
of sleep.

A lukewarm bath
or washcloth may
temporarily cool
your child off;
Stay away from
cold water and ice
baths; Giving your
child lots of fluids
-- including ice
pops or Jell-O -will help his body
battle the illness
and keep him
hydrated;
Ibuprofen
(Motrin/Advil) can
also be used to
break a fever in
patients over 6
months of age.

Cough is a sudden
and often repetitively
occurring reflex
which helps to clear
the large breathing
passages from
secretions, irritants,
foreign particles
and microbes.

V. References
Pilliteri, A. (2010). Maternal and Child Health Nursing (Vol.2, pp. 862-869)
Los Angeles, California: Wolters Kluwer Health
Macapagal, M, Teh, L. (2007) General Psychology for Filipino College
Students (p. 63) Quezon City: Ateneo De Manila Press
Macapagal, M, Teh, L. (2007) General Psychology for Filipino College
Students (p. 69) Quezon City: Ateneo De Manila Press
Growth. (1995) In Comptons Encyclopedia (Vol. 9, p. 292).
Chicago: Comptons Learning Company, A Tribune Publishing Company
Preschool. Retrieved September 26, 2014, from www.babycenter.com
Preschooler Development. Retrieved September 26, 2014, from
http://www.nlm.nih.gov/medlineplus/ency/article/002013.htm
Preoperational. Retrieved September 26, 2014, from
www. psychology.about.com/od/piagetstheory/p/preoperational.htm
Sexual Development. Retrieved September 26, 2014, from
http://allpsych.com/psychology101/sexual_development.html
Kohlberg. Retrieved September 26, 2014, from
http://faculty.plts.edu/gpence/html/kohlberg.htm
Fine Motor Skills. Retrieved September 27, 2014, from
http://www.the-preschool-professor.com/fine-motor-skills.html
Cognitive Development. Retrieved September 27, 2014, from
http://www.education.com/reference/article/cognitive-development-preschoolers/
Common Cold. Retrieved September 27, 2014, from http://en.wikipedia.org/wiki/Common_cold
Most Common Diseases in Children. Retrieved September 27, 2014, from
http://www.livestrong.com/article/172383-most-common-diseases-in-children/
Pneumonia. Retrieved September 27, 2014, from
http://ehealthmd.com/content/how-can-pneumonia-be-prevented

COLEGIO SAN AGUSTIN- BACOLOD

COLLEGE OF NURSING

Case Study
of a
Pre-schooler

Submitted by: Aya Bolinas, SN CSAB

Submitted to: Mrs. Maria Fe Tabujara, RN, MAN