PRESCHOOL CASE STUDY

I.

Objectives of the Study After conducting preschool case study, I will be able to: Knowledge 1. Determine the current health condition of the family. 2. Differentiate the major problems from minor problems. 3. Make accurate nursing care plan for the identified problems. 4. Describe normal growth and development and common parental concerns of the preschool. 5. Identify areas related to care of the preschool age child that could benefit nursing research. Skills 1. Perform accurate assessment on physical, emotional, sociological of a preschooler. 2. Conduct appropriate nursing care. 3. Gather beneficial data during home visit. 4. Assess a preschooler for normal growth and developmental milestones.

Attitude 1. Maintain long patience in dealing with preschoolers. 2. Establish rapport. 3. Communicate therapeutically. 4. Serve as a role model as educated individual. 5. Display Augustinian values at all time. the

II.

Socio- Demographic Profile Childs Name: Alwen Padilla Sex: Male Age: 4yrs. old Date of Birth: May 28, 2005 Weight: 16kg Height:105cm Fathers Name: Albin Padilla Fathers age: 32 y.o. Fathers Occupation: Dicer

Educational Attainment.: Vocational course graduate Mothers Name: Angelina Padilla Mothers age: 28 y.o. Mothers Occupation: Owns a Carinderia Educational Attainment: high school graduate Childs no. of siblings: one Physical handicapped/impairment if there is any: none III. Family Composition Family P is a Nuclear Family which is only composed of Mrs. and Mr. P, their eldest child and their youngest; AP. Mr. P is 32 years old and works as a dicer in a certain establishment. Mrs. P is 28 years old and owns a carinderia in front of their house. The eldest child is 5 years and also still on preschool but attending the afternoon class. They were living in a compound in which their other relatives are also living there. Mr. and Mrs. P took good care of all the needs of their two children and see to it that they are always in a good condition. You could really observe that they all have a harmonious relationship. The children are certainly affectionate and tender to their parents. IV. Home Condition

A. Home Conditions observed that is detrimental to the child The house of Family P is mostly composed of light materials and other parts are needed to be repaired. It was just small enough for them to move comfortably. Kitchen utensils are easily to be reached by the children. Their backyard is not that that big and sometimes they cant really move freely when they are playing. They have a tree in their backyard and the children would just climb to it at any time and thus this would risk them for falls. Other materials like wood sticks and plastic tubes are just place anywhere. Sometimes children would just use these things when they are playing especially the Pretend Play in which they were acting that they are fighting. B. Condition of the Neighborhood The familys neighborhood is at the back of their house. They lived in a unanimity milieu and they are very open to each other. They bond when they are free and they never quarrel at all. Sometimes misunderstanding may occur but they tend to talk over the issues so that not to make things worse. The children of their neighborhood especially his best friend G is always playing at APs house after they arrived at school but sometimes as alternate AP tend to go with his best friends house and play. Gs house is made of woods but it is strong and the risk for falls is very minimal because they have no stairs and the place was organized properly. They would just sit inside the living room and watch their favorite T.V show, The Myx. Vehicular accident is rarely to occur since their house is located distant from the public highway.

C. Distance of home to transportation facilities

day

care

center

and

The distance from their house and the day care center is approximately 300m. And so Mrs. P and the children would just walk every morning as she guided them. It is an advantage for them for they wont spend any more for their transportation and it is indeed very accessible to them. They wouldnt have a hard time looking for a motor cycle just to arrive home especially when the weather is not good. D. Name of guardians/escort and his/her relation to the child Both parents are the ones who are there to guide AP- Mr. and Mrs. P. They would alternate on whom should bring AP to school. They make sure that APs study is being monitored and they would help him in doing home works and they are there to support AP in his school activities. E. Presence of extended family Their relatives are also living in the compound but they are living on a different house. It is composed of their grandparents and their uncle.

V.

Family Health Condition A. Health Beliefs

Their beliefs and practices when it comes to their health would definitely affect their health status. Both parents would always see to it that their children are in their pink of health. They ask help from the health center and private doctors during their ill state. They also believe in quack doctors, pang luy-a and hilot. B. Health Practices They ensure that the children would take their bath daily, brush their teeth and change clothes everyday. Everytime they are sick, they would seek medical help from the health centers and hospitals. Sometimes, they would also practice self-medication. There would also be time that they would ask help from the quack doctors. C. Health Condition Upon home visitation, I was informed that AP had just recovered from having a fever for one week. Both children have Hyperacidity due to their frequent drinking of carbonated drinks. The eldest also have UTI and recurrent Eczema. Both parents have claimed that they are physically fit and are not suffering from any diseases. Likewise, aside from Hyperacidity, AP doesnt have any more illness. He was physically well and a very active child. VI. Preschooler Health Promotion Practices A. Nutrition Ms. P ensures that they would eat nutritious foods especially of vegetables, fish and seldom of meat. She also provides milk before they will go to sleep. They would eat regularly- 3x a day

with in between snacks. Presently, she was avoiding her children to drink carbonated drinks. Sometimes, junk foods cant be avoided but she would make it sure that they are very minimal. B. Rest and Sleep As AP is a preschooler it is important to her to have 10-12 hours of sleep every night with several day naps. She would give milk to AP before bedtime, to induce sleep and also to aid in his growth development while sleeping. AP would always be told to rest if he would extremely tire himself from playing. C. Activity The activity that is AP was very active in singing with different songs; some came from the songs that they sing from their school and also dancing while the party songs sound. He is very interested in this activity especially with his peers. D. Play AP would usually play with his eldest brother and his friend G. they love running around their front yard and playing hide-and-seek. They also love to play Pretend Play. They would imitate the characters that they know and would follow their gesture and what they do. They play with their plastic guns, cars, bikes and ball. They just simple love associative play.

E. Literacy AP as a preschooler, he is really smart and active. He knows how to read a little, identify colors, numbers, animals and different occupations. He knows how to write and he loves drawing. Though there were times that he would be tired listening and would just do other things. Yet, at home his mother would follow-up what he had learned in school. Also, when he is being taught, he would easily grasp the ideas. F. Television/ Media As of their entertainment they consider watching television as part of their daily routine. They usually watch ABS-CBN as they are Kapamilya as verbalizes by Mrs. P. But with the children, especially in Gs house they usually watch Myx channel or studio 23 as to entertain them and to join singing their favorite song by David Archulet. Though they do not really watch T.V most of times, it is only when they are free that they watch T.V shows. G. Dental Health They never really had their regular dental check up with the dentist. But Mrs. P would constantly make it sure that AP had brush his teeth every after meal especially before sleeping at night. He has a complete set of milk teeth and they clean and free of cavities. VII. Safety and Injury Prevention A. Home Safety

Kitchen utensils should never be within reached of the children. It should be properly keep or arrange in a container. Electrical wirings should also be free of open wires and they should also be organized suitably. Plastic tubes and wooden sticks should not be just scattered anywhere. They should also be restricted from climbing the tree. C. Play Safety When playing, it should be made sure that children are not using harmful objects like woods with sharp edges especially that they love the Pretend play. Also, when biking, safety protectors should also be used like helmets, arm guards and shin guards. When playing, it should also be seeing to it that they wont ingest anything that is harmful and toxic.

C. Water Safety Their drinking water should always be clean and safe. They shouldnt drink water directly from the faucet or pump. They could boil it for 30min to kill the bacteria present and to avoid AGE. When swimming, they shouldnt be left alone especially on deep water. Adult should always accompany and oversee them. D. Safety with Others AP is really sweet and friendly thats why he should be told not to go with anyone he doesnt know. There should always be somebody who would go together with him specifically when he went out of their house or after school. So far, he is not a trouble maker and he doesnt instigate any fight first. D. Outdoor Safety AP doesnt go to a far places, she could have been inside their house or in her best friend house. This would probably safe for her. VIII. Growth and Development of the Preschooler TOPIC PHYSIOLOGICAL DEVELOPMENT 1. Physical The weight gain is slight Growth 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 2.53inches/yr or 6 to 8cm. Appetite remains as it was during the toddler years, which is considerably less expect. Physiologic AP is 16kg which is really the exact weight of a preschooler. And his height is much higher than of the desired average. Upon assessment he got a blood pressure at exactly 110/60 it increase a little maybe due to the BOOKVIEW OBSERVATION

splitting of heart sounds may be present for the first time on auscultation; innocent heart murmurs may be heard. This type of murmur occurs due to the changing size of the heart in reference to the thorax. The anteroposterior and transverse diameters of the chest reach adult proportions. Pulse rate decreases to about 85bpm; blood pressure holds about 100/60mmHg. The bladder is easily palpable above the symphysis pubis; voiding is frequent enough 9 to 10 times a day wherein the play is interrupted and accidents may occur if the child becomes absorbed in an activity. 2. Gross Motor At this stage they can totally balance themselves but some children who cannot but really try to improve it. They would also be refinement on their gross motor skills. They can run and when step to the stairs their feet is alternates. Can ride on a tricycle and can stands on one foot. They are also constantly in motion such as jumping and skipping. And finally can throw overhand. During this stage also where they are copying figures becomes easier and can able to trace any letters, objects, things and numbers. They know how to dress themselves neatly and properly. Can stacks a tower of blocks, draws a cross, objects or even a 6-part man, can do simple buttons and lastly can able to lace their shoes.

playing and activity he had earlier. As to his voiding, he usually void 8 to 9 times per day as beyond to the exact average. He has a good appetite and would consume his entire share.

He is able to balance himself. He could run fast, ride a tricycle and could stand on one foot. He is restless and would usually keep jumping and running around.

3. Fine Motor

AP can dress himself independently proper but isnt that neat. He is also able to wear his shoes but could not really tie his shoe lace. He can draw figures and shapes and would also pile objects together.

PSYCHOSEXUAL DEVELOPMENT

Preschoolers had strong attachment when exposing As Freud: Phallic to the opposite sex. stage Childrens gender- typical (Genitalia) actions are strengthened by parents, nursery school teachers, other family members and other children. Studies increasingly demonstrate that gender identification is a result of prenatal and postnatal psychologic factors, as biologic or genetic factors, and that most children are aware of their gender. Because preschoolers are keen observers but poor interpreters, they may recognize but not understand sexual activity. COGNITIVE DEVELOPMENT As Piaget: preoperational stage 1. Causality Resembles logic thought, explains a concept as they heard it, as described by others but their understanding is limited.

1. Sexuality

AP would usually cling to his mother. He would hug her and kiss her. But when his father came home, he wouldnt really mind him at all. In school he also likes to sit with his female classmates.

He is be able to explain a thing whenever may hear it and also he can memorize words, songs and others when he would hear and say it repeatedly. He could clearly speak and could convey what he want others to know. Though there are words he doesnt understand and sometimes, he would just stutter.

2. Language

At the age of 3- 4 yrs old can form a sentence of about 3-4 words and includes only the most essential words to convey a meaning. Such speech is termed as Telegraphic due to its brevity and length. There are also some abnormal findings about on how the child speaks. As of broken fluency which is the stuttering of words and Dyslalia which is inability to speak verbal languages. Their average vocabulary would range to approximately 2100 words.

PSYCHOSOCIAL DEVELOPMENT As of Erikson: Initiative Guilt Erik vs Preschoolers tends to seek new experiences to their parents and guardians by asking how and the why. They feel a sense of accomplishment and satisfaction in their activities. When conflicts arise from the children tend to overstep the limits of their ability, inquiry, experience and not having behaved appropriately. AP would always ask a lot of things, why this and that thing happen. And luckily, his parents would answer him patiently. His parents also teach him how a certain thing works, so that he would learn how to use. His parents are very supporting and encouraging.

1. Family Relations

2. Socializatio 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 a milieu where they never see other children of the same age. Although 4 yrs. Old children continue to enjoy play groups, they may become involved in arguments more, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry that a child is regressing. However, it is really forward movement, involving some testing and identification of their group role.

AP would rather enjoy her camaraderie in a same age group than same gender group. At times he may quarrel with his classmates but would definitely end up to their started friendship. He may argue for the thing that he see and would truly defend and boast himself as if he is right.

3. Play AP is really highly imaginative. He wanted to be a policeman someday and so he would act as if one. He would play with his plastic gun and pretend to

Preschoolers do not need many toys. Their imaginations are keener that they will be at any other time in their lives.

They enjoy games that use imitation, such as playing house. They imitate what they see parents doing: eating meals, mowing the lawn, cleaning house, arguing and so forth. They pretend to be teachers, cowboys, 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. MORAL DEVELOPMENT As of Kohlberg: It follows intuitive preconventional or thought and is based premoral level 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 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. SPIRITUAL DEVELOPMENT Children imitate As of Fowler: religious gestures and Intuitive- projective behaviors of others, without thorough understanding. Imaginative thinking leads to inquisition about religious activities. They enjoy the security of religious holidays, prayers, and grace said before and after meals, because these rituals can offer them

be shooting at someone. He play together with his eldest brother and his friend G.

There were times that AP would become 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. But after a while, he would repeat his act and then again, he would be rebuked.

AP knows how to make sign of the cross, he would also pray before and after their class and also on eating their meals. He respects the altar and could identify whose images were placed there.

the same reassurance that a familiar nursery rhyme does read over and over. IX. COMMON PROBLEMS OF THE PRESCHOOLER A. Bad Dreams and Nightmares Fears are common among young children and can take on additional dimensions in the fantasy world of dreams and nightmares. Although a nightmare may last only a few minutes, a young child can recall it in intricate detail. Bad dreams or night terrors can last much longer, and a child is usually unable to recall specific details that were frightening. These are commonly observed among children who are experiencing extreme stress in their lives, as when parents are divorcing. Talking with young children about their fears is often an appropriate approach for helping them to understand how fears can be manifested in frightening dreams. It may be helpful to hold the preschooler nurturantly and rock him or her for a short time. Comments that inform the child those frightening experiences are not real but are created by the imagination help in reassuring a preschooler. Parents also might examine the preschoolers bedtime and sleep hygiene routines and eliminate activities such as watching television shows that stimulate harmful fantasizing. B. Problems of Elimination Preschoolers can experience problems with bodily elimination functions occasionally. Typically, these include regression. Loss of elimination control (e.g., bed-wetting) is not considered problematic until a child reaches the school-age years. Regression in toilet training might happen: as a reaction to the birth of a new baby into the family system; as a reaction to extreme fatigue, excitement, or illness; as an expression of anxiety; or As a result of forgetfulness during periods of intense concentration during play activities or television viewing.

Commonsense measures help young children overcome these periods of regression in their elimination training. Reminding a child to use the bathroom may be all that is required to resolve the problem. In addition, protecting a child from situations that are over stimulating or frightening may be an easy solution. C. Eating Problems Young children are included in eating meals with other family members and sharing the family diet. Most parents understand that young children may eat the same foods as other family members, but in smaller portions. They are aware that the particular nutritional needs of young children include adequate amounts of protein, calcium, and vitamins from a variety of food sources. Many parents also know

the unhealthy aspects of allowing young children to eat a lot of empty calorie foods in their diet, such as snacks with high amounts of sugar and/or fat. Young children may gravitate toward acquiring problems with eating such as resistance to eating, dawdling over food served at meals, and developing peculiar desires for nonfood items

Because some parents are knowledgeable about what constitutes an adequate diet, they become conscientious about what foods are served to young children. However, overzealousness can cause young children to become resistant to eating. When children feel pressured to conform to parental desires and eating policies, they tend to resist eating certain foods. For example, if parents firmly believe that vegetables must be consumed when served at meals, some young children resent the pressure to comply with parents expectations and stop eating vegetables altogether. Parents may react by becoming greatly concerned about the childs nutrition and fret about the shortand long-term effects on the childs health and well-being. At times, some parents pressure children to eat something at meals, which may exacerbate the problem even more. D. Public Temper Tantrums What causes tantrums? When children become emotionally charged, they cant think. They simply cant function normally. They become rigid and unreasonable in what they want, and are unsatisfied with your attempts to give them what they want. They cant listen, and the slightest thing may bring them to tears or tantrums. Their minds are full of upset. They cant get out of that state without your help. One of the reasons children tantrums while shopping is because theyve lost their sense of connection. Parents have to find the car keys, make a list, make a few phone calls, get the children dressed, pack a snack or water, rush around, and then drive to the store. Our attention isnt on connectionlife is full of things to do! But this disconnected period of time upsets childrens delicate systems, which are designed to run on the premium fuel of connection, eye contact, play, and thoughtful messages from us. The help your child needs at this time is to have you set kind, sensible limits, and then for you to listen while he bursts out with the intense feelings he has. This spilling of feelings, together with your kind attention and patience, is the most effective way to speed your childs return to his sensible, loving self. A good, vigorous tantrum or a hearty, deeply felt cry will clear your childs mind of the emotion that was driving him off track and will enable him to relax again, feel youre caring, and make the best of the situation he is in. E. Anxiety Anxiety is a basic emotion experienced by all human beings. Everyone experiences anxiety at times in response to stress or to fearprovoking events. An anxiety reaction as a response to danger is actually helpful because it warns people to avoid or escape potentially dangerous situations. An anxiety reaction can be adaptive in certain situations, such as test-taking. Sometimes, however, anxiety becomes

excessive and causes significant distress. When anxiety results in fear or apprehension that is out of proportion to an individual's life situation or developmental stage and impairs an individual's ability to function, it is a mental health disorder. For example, some children have unusually strong or overwhelming feelings of anxiety. While many children are scared of things like the dark, taking tests, and meeting other kids, most eventually learn that there is nothing to fear about the dark, that studying helps pass tests, and that other kids are usually pretty friendly. Some children, however, have difficulty managing their anxiety and, instead of taking charge of their fears, they feel worse about themselves and their inability to control their anxiety. Anxious feelings might take the form of headaches, stomachaches, cold and clammy hands, rapid heartbeat, feelings of faintness, and a general feeling of tension. To avoid feeling anxious, these children may avoid the situations that are anxietyprovoking for them. Some common signs:

Difficulty going to, or staying in, school Afraid of being separated from parents Excessive worrying Trouble concentrating Extreme shyness of self-consciousness Frequent physical complaints-headaches or stomachaches Avoids specific places or situations Cries easily Lacks energy or interest in age-appropriate activities X. REFERENCES Maternal and child book by Pillitteri NCM 201 handouts Source: Pearson Allyn Bacon Prentice Hall Goggle.com(Education.com)

Colegio San Agustin- Bacolod College of Nursing

PRESCHOOL STUDY

CASE

Submitted by:

Cristine Joy P. Roce 3B/Grp. 7

Submitted to: Ms. Nelly Natividad, RN Clinical Instructor