Michigan State University
College of Nursing
NUR 440 Nursing Care of Children, Adolescents, & Their Families
Spring 2008
Week Three Class Topics
Nursing care of the family with a Preschooler
Nursing care of the family with a Schoolage child.
Nursing care of the child with poisoning, foreign body, bites, dental trauma
Nursing care of the child with ADHD
Required Readings:
• Ch 30
• Ch 31
• Ch 52 pg 1657, 16591667
• Ch 54 pg 17271732
Chapter 30 The Family with a Preschooler
Objectives:
After mastering the contents in this chapter, students should be able to:
1. Describe normal growth and development as well as common parental concerns of the
preschool period.
2. Assess a preschooler for normal growth and developmental milestones.
3. Implement nursing care related to normal growth and development of a preschooler, such
as preparing a preschooler for an invasive procedure.
4. Identify National Health Goals related to the preschool period that nurses can help the
nation achieve.
5. Identify areas related to the care of the preschoolage child that could benefit from
additional nursing research or application of evidencebased practice.
6. Use critical thinking to analyze additional ways in which growth and development
problems of the preschool child can be prevented and care can be familycentered.
7. Integrate knowledge of preschool growth and development with the nursing process to
achieve quality maternal and child health nursing care. Plan nursing care to meet a
preschooler’s growth and development needs, such as planning ageappropriate play
activities. Implement nursing care related to normal growth and development of a
preschooler, such as preparing a preschooler for an invasive procedure.
Outline
1. Nursing Process Overview
Assessment: health history & physical/developmental evaluation; preschoolers tend to talk
very little during the assessment and may even revert back to baby talk and that is why a
history that details their usual performance level is very important. Ht/wt/growth charts &
general appearance. Alert, happy, active, healthy, teeth free of cavities, gait symmetry?
o Risk for injury r/t being outside of the home.
o Delayed growth r/t freq. illness.
, o Risk for poisoning
o Parental anxiety r/t being unfamiliar with child development.
2. Nursing Assessment of the Growth and Development of a preschooler
a. Physical Growth
o Preschooler becomes slimmer, taller, with more childlike proportions.
o Two body types become apparent: ectomorphic (slim body build) &
endomorphic (large body build).
o Handedness also becomes apparent.
o Child learns extended language achieved by motor & cognitive development,
is also more easier to learn two languages when in bilingual families.
o Lymph tissue increases in size (esp in tonsils & levels of IgG and IgA
antibodies) therefore illnesses become more localized.
o Splitting of heart sounds and murmurs begin to be heard. Pulse rate
decreases to about 85, BP is at around 100/60.
o Bladder is palpable, voiding is freq enough to interrupt play and may cause
accidents.
o Arch in foot becomes more formed, mm are stronger, exhibit genu valgus
(knock knees) which disappear w/ increased skeletal growth.
i. Weight, Height and head circumference
o Wt gain is slight (gains only about 4.5lb/yr), appetite remains same
as toddler years. Parents become concerned that their child is
losing wt but really its just the changing of the body shape.
o Ht gain is minimal (23.5”/yr).
o Head circ is not measured on children older than 2.
ii. Teeth
o They generally have all 20 deciduous teeth by 3, rarely do new
teeth erupt during preschool.
b. Developmental Milestones
i. Language development:
o Vocab of about 900 words, they ask questions constantly, you
should respond with simple answers so curiosity, vocabulary
building and questioning are encouraged. Preschoolers imitate
language exactly and if not corrected, bad words may arise.
o Egocentrism they define objects in relation to them (a key is
something they use to open a door).
ii. Play
o Huge imagination, they enjoy games of imitation. Imaginary friends
are common and usually disappear when school begins.
o 4/5 yo divide their time between rough housing and imitative play.
5 yo like group games and songs.
iii. Emotional development
1. Developmental Tasks
, a. Initiative: (erikson’s task for preschoolers) they discover
that learning new things is fun. DO NOT criticize/punish
attempts at initiative. They need exposure to a wide
variety of experiences (zoo, amusement park) and play
materials (finger paints, bubbles), they want to see new
places all leading to increased vocabulary.
b. Imitation: role playing is important, should be fun and
does not need to be accurate. Bringing the child to work
is good for imitating and vocabulary.
c. Fantasy: begin to make differentiation between fantasy
and reality, begin to have magical thinking where they
believe thoughts and wishes can come true. Therefore
it’s important to let the child know that they are still
recognizable, esp regarding their health in the health
care setting.
iv. Gender roles: need exposure to opposite sex so they can become
familiar with them, esp when in a single parent family. Be careful with
actions as well as attitudes.
v. Socialization: children are more capable of sharing, and play with peers
much more agreeably. Sensitive and critical time for socialization, they
then have an easier time relating to people. 4yr olds still play in groups,
but may become more involved in arguments as they are more sure of
their roles (this is showing testing and identification of their roles in the
groups). 5yo begin to have best friends, they tend to play in even
numbers and quarrel in odd numbers.
vi. Cognitive Development: 3yopreoperational (piaget), children enter a
second phase called intuitional thought, they cannot view themselves as
others view them or put themselves in another’s place so they feel they
are always right; they cannot see your side of the situation so be careful
when explaining things to them. Also not yet aware of conservation, ex.
they view the same procedure done two different ways as two different
procedures.
3. Planning and Implementation for the health promotion of a preschooler and family
a. Promoting Preschooler Safety: 4yo think they’re independent and can take care
of their own needs but still need supervision to prevent injury, you may find them
exploring the blades of a lawn mower or an electric saw. Automobile safety is
huge, tell them “watch out for cars”. and “do not cross the street”. Instruct parents
never to take medicine in front of children for the imitation reason.
i. Keeping Children safe, strong and free: present information in a calm
and serious manner teach children about:
i. the harm of strangers (never talk to or accept
rides from strangers)
ii. how to call for help
College of Nursing
NUR 440 Nursing Care of Children, Adolescents, & Their Families
Spring 2008
Week Three Class Topics
Nursing care of the family with a Preschooler
Nursing care of the family with a Schoolage child.
Nursing care of the child with poisoning, foreign body, bites, dental trauma
Nursing care of the child with ADHD
Required Readings:
• Ch 30
• Ch 31
• Ch 52 pg 1657, 16591667
• Ch 54 pg 17271732
Chapter 30 The Family with a Preschooler
Objectives:
After mastering the contents in this chapter, students should be able to:
1. Describe normal growth and development as well as common parental concerns of the
preschool period.
2. Assess a preschooler for normal growth and developmental milestones.
3. Implement nursing care related to normal growth and development of a preschooler, such
as preparing a preschooler for an invasive procedure.
4. Identify National Health Goals related to the preschool period that nurses can help the
nation achieve.
5. Identify areas related to the care of the preschoolage child that could benefit from
additional nursing research or application of evidencebased practice.
6. Use critical thinking to analyze additional ways in which growth and development
problems of the preschool child can be prevented and care can be familycentered.
7. Integrate knowledge of preschool growth and development with the nursing process to
achieve quality maternal and child health nursing care. Plan nursing care to meet a
preschooler’s growth and development needs, such as planning ageappropriate play
activities. Implement nursing care related to normal growth and development of a
preschooler, such as preparing a preschooler for an invasive procedure.
Outline
1. Nursing Process Overview
Assessment: health history & physical/developmental evaluation; preschoolers tend to talk
very little during the assessment and may even revert back to baby talk and that is why a
history that details their usual performance level is very important. Ht/wt/growth charts &
general appearance. Alert, happy, active, healthy, teeth free of cavities, gait symmetry?
o Risk for injury r/t being outside of the home.
o Delayed growth r/t freq. illness.
, o Risk for poisoning
o Parental anxiety r/t being unfamiliar with child development.
2. Nursing Assessment of the Growth and Development of a preschooler
a. Physical Growth
o Preschooler becomes slimmer, taller, with more childlike proportions.
o Two body types become apparent: ectomorphic (slim body build) &
endomorphic (large body build).
o Handedness also becomes apparent.
o Child learns extended language achieved by motor & cognitive development,
is also more easier to learn two languages when in bilingual families.
o Lymph tissue increases in size (esp in tonsils & levels of IgG and IgA
antibodies) therefore illnesses become more localized.
o Splitting of heart sounds and murmurs begin to be heard. Pulse rate
decreases to about 85, BP is at around 100/60.
o Bladder is palpable, voiding is freq enough to interrupt play and may cause
accidents.
o Arch in foot becomes more formed, mm are stronger, exhibit genu valgus
(knock knees) which disappear w/ increased skeletal growth.
i. Weight, Height and head circumference
o Wt gain is slight (gains only about 4.5lb/yr), appetite remains same
as toddler years. Parents become concerned that their child is
losing wt but really its just the changing of the body shape.
o Ht gain is minimal (23.5”/yr).
o Head circ is not measured on children older than 2.
ii. Teeth
o They generally have all 20 deciduous teeth by 3, rarely do new
teeth erupt during preschool.
b. Developmental Milestones
i. Language development:
o Vocab of about 900 words, they ask questions constantly, you
should respond with simple answers so curiosity, vocabulary
building and questioning are encouraged. Preschoolers imitate
language exactly and if not corrected, bad words may arise.
o Egocentrism they define objects in relation to them (a key is
something they use to open a door).
ii. Play
o Huge imagination, they enjoy games of imitation. Imaginary friends
are common and usually disappear when school begins.
o 4/5 yo divide their time between rough housing and imitative play.
5 yo like group games and songs.
iii. Emotional development
1. Developmental Tasks
, a. Initiative: (erikson’s task for preschoolers) they discover
that learning new things is fun. DO NOT criticize/punish
attempts at initiative. They need exposure to a wide
variety of experiences (zoo, amusement park) and play
materials (finger paints, bubbles), they want to see new
places all leading to increased vocabulary.
b. Imitation: role playing is important, should be fun and
does not need to be accurate. Bringing the child to work
is good for imitating and vocabulary.
c. Fantasy: begin to make differentiation between fantasy
and reality, begin to have magical thinking where they
believe thoughts and wishes can come true. Therefore
it’s important to let the child know that they are still
recognizable, esp regarding their health in the health
care setting.
iv. Gender roles: need exposure to opposite sex so they can become
familiar with them, esp when in a single parent family. Be careful with
actions as well as attitudes.
v. Socialization: children are more capable of sharing, and play with peers
much more agreeably. Sensitive and critical time for socialization, they
then have an easier time relating to people. 4yr olds still play in groups,
but may become more involved in arguments as they are more sure of
their roles (this is showing testing and identification of their roles in the
groups). 5yo begin to have best friends, they tend to play in even
numbers and quarrel in odd numbers.
vi. Cognitive Development: 3yopreoperational (piaget), children enter a
second phase called intuitional thought, they cannot view themselves as
others view them or put themselves in another’s place so they feel they
are always right; they cannot see your side of the situation so be careful
when explaining things to them. Also not yet aware of conservation, ex.
they view the same procedure done two different ways as two different
procedures.
3. Planning and Implementation for the health promotion of a preschooler and family
a. Promoting Preschooler Safety: 4yo think they’re independent and can take care
of their own needs but still need supervision to prevent injury, you may find them
exploring the blades of a lawn mower or an electric saw. Automobile safety is
huge, tell them “watch out for cars”. and “do not cross the street”. Instruct parents
never to take medicine in front of children for the imitation reason.
i. Keeping Children safe, strong and free: present information in a calm
and serious manner teach children about:
i. the harm of strangers (never talk to or accept
rides from strangers)
ii. how to call for help
