NURSING CARE OF A FAMILY WITH A PRESCHOOL CHILD

Source:pelliteri

PHYSICAL GROWTH
- body proportion: slimmer, taller and more childlike positions - definite contour changes - ectomorphic (slim); endomorphic (large) - lymphatic tissues begins to increase in size particularly the tonsils; IgA and IgG increases - physiologic splitting of heart sounds - HR: 85bpm; BP: 100/60mmHg - bladder becomes palpable: urination increases to 9-10 times/day - pre-school exhibit genu valgus (knock-knees)

Weight, height and head circumference

- weight gain: 4.5 lbs/ year - height: 2-3.5 in/year - head circumference: not routinely measured

Developmental milestones
LANGUAGE DEVELOPMENT 3 years: vocabulary of 900 words 4 years: vocabulary of 1500 words 5 years: vocabulary of 2100 words PLAY 3 years: able to take turns; very imaginative 4 years pretending is major activity 5 years: likes games with numbers and letters

Developmental milestones
FINE MOTOR DEVELOPMENT 3 years: undresses self; stacks tower of blocks; draws a cross 4 years: can do simple buttons 5 years: draws a 6 part man; can lace shoes

Developmental milestones
GROSS MOTOR DEVELOPMENT 3 years: runs; alternates feet on stairs; rides tricycle 4 years: constantly in motion; jumps; skips 5 years: throws overhand

Emotional development
DEVELOPMENTAL TASK: initiative vs. guilt - they need to be exposed to a wide variety of experiences and play materials so they can learn as much about the world - guide preschoolers with this play because they are very imaginative - parents must not try to model

- imagination: need free rein to imitate the roles; they learn activities adults carry out at home; they should be also oriented to the work of their parents - fantasy: starts to differentiate reality between fantasy; magical thinking

OEDIPUS AND ELECTRA COMPLEXES - oedipus complex: strong emotional attachment of a preschool boy toward his mother - electra complex: strong emotional attachment of a preschool girl toward his father GENDER ROLES - need exposure to an adult of the opposite gender so they can be familiar with opposite gender roles

SOCIALIZATION - 3 years: play with other children - 4 years: more involved in arguments - 5 years: develops best friendships; odd number of children will have difficulty playing well together

Cognitive development
- according to Piaget: Preoperational - they lack the insight to view themselves as others see them or put themselves in anothers place (centering) - not yet aware of the property of conservation

Moral and spiritual development

- preschoolers determine right form wrong based on their parents rule ; have little rationale of these rules - preschoolers begin to have an elemental concept of God if they have religious training ; tend to do good out of self interest

Promoting preschooler safety

Ensure preschoolers do not stray away from home Remind them that they do not work in front or at the back of vehicles Do not tae medications in front of children Do not talk with or accept a ride from stranger Teach how to call for help If they are bullied or ask to keep secrets, instruct them to tell their parents Car safety Bicycle safety: head injuries

Promoting nutritional health of the preschooler

Offer small servings of food Check that preschoolers do not snack frequently that they may miss planned meals After school: offer snacks like fruits, cheese or milk rather than sugary foods like cookies Make mealtime a happy and enjoyable part of the day Make sure parents offer a variety of food to preschoolers

Promoting development in daily activities

DRESSING - most preschoolers can dress themselves - they prefer printed and bright colored clothes - for parents: fold matched clothes together SLEEP - preschoolers may resist naps - fear of the dark - waking from night mare or night terrors at its peak

EXERCISE - rough housing can be allowed as long as it does not become destructive - they love time-honored games HYGIENE - use non-irritating shampoo and mobile over the tub - do not use bubble bath - do not leave preschoolers in the tub alone

CARE OF TEETH - tooth brushing should be started by this time - avoid giving them candies for snacks - night grinding: bruxism (grinding of teeth at night) is a way of letting go

Promoting healthy family functioning

Encourage vocabulary development: read aloud to a child; answer questions Guide child through their struggles without discouraging them of their opinion; parents may use time out

Parental concerns associated with preschool period

HEALTH PROBLEMS -major cause of deaths: automobile accidents, poisoning, falls - minor illnesses: colds, ear infection and flu are also high

COMMON FEARS OF THE PRESCHOOLER 1. Fear of the Dark - a fear heightened by a childs vivid imagination Monitor the stimuli their children are exposed to , especially around bedtime Reassure child they are safe If continues to have difficulty sleeping , assessment should be done 2. Fear of Mutilation - revealed by intense reaction to minor injuries; they do not know which body parts are essential

3. Fear of Separation/ Abandonment - sense of time is still so distorted; sense of distance is also limited BEHAVIOR VARIATIONS 1. Telling Tall Tales - stretching stories to make them seem more interesting Help child separate fact from fiction 2. Imaginary Friends - normal as long as it does not affect their socialization

3. Difficulty Sharing - at 3 years they start to understand the concept of sharing Define limits and expose children to these three categories (mine, yours, ours) helps them understands which objects belongs to which category. 4. Regression - preschoolers under stress revert to behavior that they have already outgrown Remove the stress to help discontinue the behavior

5. Sibling Rivalry - they can better express themselves; preschoolers become more aware of family roles and responsibilities - firstborn serve as trial run Supplying them with something that only them has access PREPARING FOR A NEW SIBLING - should be started when the child feels that the new baby will make a difference - move preschoolers to a bed 3 months before the arrival of a new baby - encourage woman to maintain contact with their preschooler ; allow child to visit

SEX EDUCATION - parents must not convey to preschoolers that these body parts must not be talked about - masturbation: inform that some activities are to be done privately - avoid sexual abuse: do not touch organs without permission - answer simple questions with simple answers CHOOSING A PRESCHOOL/ CHILD CARE CENTER - provide interaction with peers as this would help develop their socialization - ask child frequently what happened in school - center should be safe

PREAPARING A CHILD FOR SCHOOL - discuss school in a positive way rather than a punishment - prepare child months before on what to expect at school BROKEN FLUENCY - repetition and prolongation of sounds, syllables, and words; secondary stuttering BATHROOM LANGUAGE - imitates words by adults; may include swear words into their vocabularies