Chapter 31

Nursing Care of a Family With a Preschool Child

Nursing Process: Healthy Development of the Preschooler

Assessment Nursing diagnosis Outcome identification, planning Implementation Outcome evaluation

Overview
Assessment Health history with a complete physical and developmental evaluation Usual performance level General appearance- alert, happy, active, healthy

Nursing diagnosis Health seeking behaviors Readiness for enhanced parenting Risk for injury Delayed growth and development Risk for poisining Imbalanced nutrition Parental anxiety Imbalanced nutrition

 Outcome identification and planning Establishing a schedule for discussing normal preschool development Accident prevention- How to cross the streets safely Plan opportunities for adventurous play or messy play

Implementation Imitates moods as well as actions Role playing a mood or attitude Role modeling

 Outcome evaluation Continuous and frequent Evaluating specific areas to see progress

Growth and Development of a Preschooler

Physical growth Slim, tall, childlike proportions Handedness begins to be obvious Lymphatic tissue increases Levels of IgG and IgA increases (makes illnesses more localized) Physiologic splitting of heart sounds- murmurs (because of the changing size of the heart)

85 bpm 100/60 mmHg Bladder easily palpable Voids 9-10 times Well formed arch of the foot Muscles are stronger Genu valgus or knock knees-disappears with increased skeletal growth

 Slight gain- 4.5 lbs or 2 kg per year Height gain is minimal- 2 to 3.5 inches or 6 to 8 cm a year Head circumference is not routinely measured on children over 2 years of age Teeth
All have 20 deciduous teeth by 3 years old

 Developmental milestones
Language development 900 words Asks around 400 questions a day how and why At 4 or 5 yrs - Mealtime conversations Can describe something from their day Imitate languages exactly

 Egocentric
Defines objects in relation to themselves Key- what I use to open the door Car- what mom uses to take me to school

Play Does not need many toys Enjoys games that use imitation Imitates exactly what parents are doing Imaginary friends (because of active imagination) 4 and 5 years old rough-housing and imitative play 5 year olds are interested in group games or songs New events and places

 Emotional development Developmental tasks Initiative A child with a well developed sense of initiative discovers that learning new things is fun If children are criticized or punished for attempts at initiative, they develop a sense of guilt for wanting to try new activities or have new experiences Expose to a wide variety of experiences and play materials Creative play, experiences outside the home

 Imitation Free rein to imitate Learning what activities adults carry out at home Introduce to parents work environment Remind parents to introduce their other self

 Fantasy Can begin to differentiate from fantasy and reality Support the imitation, let children know they are still recognizable, still herself

 Oedipus and electra complex

Each child competes with the same sex parent for love and attention of the other parent

Gender roles Needs exposure to an adult of the opposite gender so they can become familiar with opposite gender roles

Socialization Capable of sharing Plays with other children Expose to other playmates to learn to relate to people Become involved in arguments- a forward movement, testing and identification of their group role 5 y/o- best friend

 Cognitive development Intuitional thought Lack the insight to view themselves as others see them or put themselves in anothers place Feel they are always right Not aware of property of conservation- only the form, not the amount has changed

 Moral, spiritual development Determines right from wrong based on their parents rules Little understanding of the rationale of the rules Tend to do good out of self interest

Health Promotion
Safety
Needs supervision to be certain that they do not injure themselves or other children Never take medicine in front of children

 Keeping children safe, strong, free Educate about potential threat of harm from strangers how to address bullying behavior from people they meet in school or at play Present information in a calm yet serious manner Motor vehicle, bicycle safety Buckle up in car seats Seat belts Safety helmet Demonstrate safe riding habits

 Nutritional health
Recommended dietary reference intakes-food pyramid Offer small serving of foods Check that child is not snacking frequently Nutritional health with vegetarian dietsources of vit D, vit B12 and calcium

 Daily activities
Dressing
bright colors, let children choose their own clothes

Sleep
sleeps when tired, refuse to go to sleep because of fear of the dark, night waking, night light

Exercise
Rough housing, active games Develops motor skills, prevents childhood obesity

 Bathing/ hygiene Can wash and dry their hands adequately Regulate temp of water heater (under 120F) Help clean fingernails, ears Use nonirritating shampoo No bubble baths Teeth Night grinding (bruxism) Way of letting go, to release tension Refer to pedodontist- for evaluation, repair and conservation Check tooth surfaces after the child brushes her teeth to make sure its clean floss

 Healthy family functioning Encourage vocabulary development Read aloud to a child

Discipline
Dont discourage child from having a right to their own opinion timeout

 Parental concerns
Health problems Major cause of death- automobile accidents, poisoning and falls Minor illnesses- colds, ear infections and flu symptoms Children with parents who smoke- can have ear infection (otitis media) and respiratory infections Children who attend preschool- gastrointestinal disturbances like vomiting and diarrhea, from exposure to other children

 Fears- because of an active imagination Dark Reluctant to go to bed or go back to sleep Monitor stimuli that children are exposed to especially around bedtime Reassure children that they are safe Mutilation Intense reaction of a preschooler to injury Because they do not know what part of their body is essential and which ones can be easily replaced Boys- fear of castration Provide good explanation for health care procedures Separation or abandonment Sense of time is distorted Sense of distance is limited Relate time and space

 Parental concerns Behavior variations Telling tall tales Stretching stories Help separate fact from fiction Imaginary friends Normal Expose to real playmates Separate fact from fantasy Sharing Needs practice to understand the idea and learn it Define limits Expose to mine, yours, ours

 Regression Related to stress Revert to behaviors they outgrew like thumbsucking, negativism Because of new baby, new school, bad news in tv Normal Remove the stress Assure that there will be no changes Sibling rivalry Jealousy of a brother or sister First time for them to express how they feel because of increased vocabulary, awareness of family roles, new brother or sister is born

 Parental concerns
New sibling
New bed 3 months before the new sibling comes Start preschool or child care before the new baby is born or 2-3 months after the babys birth Prepare child from separation during childbirth, maintain contact

Sex education
dont convey that body parts are never to be talked about, teach about sexual abuse

 Choosing preschool or child care center

Ensure safety and enjoyable experience of the child; ask what happened in school, what they learned, names of new friends

Preparing child for school

Discuss school as something to look forward too

Broken fluency
Repetition and prolongation of sounds, syllables and words; associated with rapid speech pattern

Bathroom language
Imitating vocabulary of the parents or older children; swear words

Question
A previously toilet trained 4-year-old child has many episodes of urinary incontinence while in the hospital for a fractured femur. Which of the following actions should the nurse implement?
A. Awaken the child every 2 hours through the night to try to use the bedpan. B. Explain that children will usually quickly regain control over a previously mastered skill once home again. C. Send a urine specimen for analysis. D. Limit consumption of fluids between meals.

Answer
B. Explain that children will usually quickly regain control over a previously mastered skill once home again. Rationale: Stressful events may cause a child to regress back from a previously mastered task. Hospitalization, trauma, and separation from parents are all examples of what may induce this.

Question
A 4-year-old boy will not stop throwing sand at his sister. Which of the following punishments would be most effective with this child? A.Send him to his room for 30 minutes. B.Restrict television viewing for a day. C.Sit him in timeout for 15 minutes. D.Spank him on his bottom.

Answer
C. Sit him in timeout for 15 minutes. Rationale: Trying to correct behavior while allowing the child the right to his or her opinion works best without use of physical punishment.

Question
To encourage fluency, you would advise a preschoolers mother to
A. encourage the preschooler to recite in front of friends. B. allow the preschooler to have time to talk. C. encourage the preschooler to speak slowly. D. stop the preschooler and tell him or her to start over.

Answer
B. Allow the preschooler to have time to talk. Rationale: Children who do not feel rushed to speak have less broken fluency.