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NSG 309 peds
Ch 18 - Preschoolers
| Question | Answer |
|---|---|
| Preschool stage | 3-6 age - exponential development of fine motor skills and increase coordination of gross motor skill - takes initiative to try new things - imagination/creativity |
| Health Assessment methodology | - involve child in PHI collection w/ simple questioning - give choice between sitting on exam table OR parent's lap - allow to play with safe things - visual acuity testing @ 4-5 - otoacoustic testing @ 3+ - routine BP check @ 3+ - ear exam pull UP + BACK (ear canal more developed) |
| Physical variations in preschoolers | - thoracic breathing at age 5 - more slender with stronger abdominal muscles |
| Eye development/variation in preschoolers | - visual acuity 20/20 @ 4-5 y.o (start annual eye exams) |
| genu valgum | knock knees |
| Bathroom habits for preschoolers | - full daytime bladder control at age 3 - nighttime bladder control at age 4-5 - possible stool holding during toilet training |
| Pain assessment in preschoolers | - unable to describe quality of pain - Oucher scale - FACES scale - use observational tools/caregiver report to assess pain |
| Oucher Scale | pain assessment tool with 6 points of faces showing different levels of pain from 0-100 point rating |
| Physical growth in preschoolers | Height: 2.5-3" growth/year Average 4 y.o height = 40" Weight: 5 lbs/year from 3-6 Average 4 y.o weight = 40 lbs Begin BMI measurement + document on growth chart to trend |
| Psychosocial developmental theory for preschooler | Erikson stage: Initiative vs Guilt - stronger self assertion and please parents - plans and initiate activities |
| Cognitive developmental theory for preschooler | Preoperational stage until age 4 - egocentric and focus on 1 aspect - transductive reasoning (until 4) - Intuitive thinking (4+) |
| transductive reasoning | connecting unrelated events |
| Intuitive thinking | develop logical thought from perception - Irreversibility - unable to reverse sequence of events - magical thinking - fantasy/vivid imagination |
| magical thinking | having fantastical/vivid imaginative thought process |
| Moral Developmental theory in preschoolers | Preconventional stage - right/wrong interpreted via punishment/reward - absoluteness of rules - increased levels of lying d/t increased imagination |
| Cognitive milestones in Preschoolers | - 3 y.o: draw circle after showing how, move hand away from hot stove - 4 y.o: know first/last name, memorize address, count to 10, understand time, tells what happens next - 5 y.o: draw 3+ body parts, tells what happens next, names colors, use fork/spoon |
| Movement/Physical milestones in preschoolers | - 3 y.o: use fork, put loose clothing on - 4 y.o: unbuttons, catch bounced ball, draw 3+ body parts, grasps pencil w/ thumb/finger, self feeding - 5 y.o: able to button, hop on 1 foot |
| Communication/Speech in preschoolers | - rapid language acquisition - use concrete language - learning via exposure |
| Language delays (cause/prevention) in preschoolers | - screening for language delays at each medical visit Causes/Risk factors: autism, cognitive impairment, emotional delay, low socioeconomic status/neglect, neurological disorder |
| language/communication milestones in preschoolers | 3y: stranger understand 75%, follow 2-3 step instruction, name friends, identify actions, say name, carries convo (who/what/when) 4y: sing song/tell stories, answer simple question, 4+ word sentences, talk about day 5y: count to 10, know name/address, makes up story |
| Social/Emotional development in preschoolers | - learns to cope with emotions - imaginary play/friends to explore communication/emotions - interest in basic sexuality by 5/6 - development of identity/independence - increased level of cooperation and learns to take turns/share |
| Safety considerations for preschoolers | - inability to comprehend risks and enjoys new experiences - role model with safe behaviors - stranger danger/street safety!!! - Teach address/phone Risks: improper firearm handling, poisoning, choking |
| School readiness for preschoolers | - read with picture books (books with few words per page) - ask open ended questions - provide structured environments with choices - encourage social interactions with peers - implementation of preschool services for low income families (eg. Head Start) |
| Play considerations for preschoolers | - Fine motor skills: use arts/crafts (eg. playdoh or crayons) - Learn to share/take turns (board games) - Outdoor activities: playground, bikes, unstructured physical activity - Avoid: toys w/ small parts, magnets, lead paint, excessive electronics |
| Sleep considerations for preschoolers | - 10-13 hours of sleep - naps end at 4y (1 long block of sleep) - nightmares - night terrors |
| Nightmares | child will wake up and want comfort talk about nightmare and assist back to sleep |
| Night terrors | Child not awake and does not remember -may kick, scream, thrash, push parent away - do NOT wake child |
| Discipline for preschoolers | - better behavior if given opportunities for independence w/ set limits - daily routines for consistency - explain consequences - Time outs (1 min/year of age) - avoid yelling/spanking -> lead to aggression/physical struggle |
| Nutrition for preschoolers | Healthy well rounded diet with fruits, vegetables, whole grains and lean protein - 1200-1400 kcal/daily requirement - avoid high fat/sugar foods - 3 meals w/ 1-2 snacks - involve in meal prep and offer choices - do not fix separate meals |
| Lying in preschoolers | - overactive imagination to avoid punishment - teach lying is not OK - role model positive behaviors and punish based on severity of lie - positive reinforcement for telling truth |
| Fifth Disease | AKA erythema infectiosum - infection of Parvovirus B19 (peak late winter/spring) S/S: bright red cheeks (slapped appearance), lacy rash on trunk/UE - Benign and self limiting disease - supportive tx with prodromal symptoms - avoid pregnant women -> virus harms fetus |
| Hand/Foot/Mouth Disease | d/t Coxsackie virus via a fecal-oral route - prevention with hand washing S/S: vesicular/pustular lesions of oropharynx, palms, foot soles, mild fever, moderate pain - Self limiting (self resolve in 1 week) - Supportive care - Monitor dehydration |
| Conjunctivitis | inflammation of conjunctiva (AKA pinkeye) - bacterial/viral/allergic etiology S/S: thick drainage, pruritis, possible visual change - very contagious but self limiting Tx: antibiotics, antihistamine, symptom mangement |
Created by:
sleepingbear