1) Donnie has brought his 4-year-old son, Isaac, to the pediatric free clinic for a kindergarten physical. Isaac is the older of two children of Donnie and Mary Smith. Donnie is employed as a farrier but his work does not provide insurance and he has come to a nurse-operated free clinic. Donnie shares that Isaac enjoys spending time with his father when he is working with the horses, but he is concerned that Isaac has an imaginary friend named "Tackle." On physical examination, Isaac is 39 in tall and weighs 35 lb. Donnie is a man of average height (5'9" with a slim build). Donnie is concerned that Isaac may be too small for his age. (Learning Objectives 1)

A) What can the nurse communicate to Isaac's father about his physical growth?

B) What can the nurse teach Isaac's father about his cognitive and psychosocial development?

C) What can the nurse teach Isaac's father about his moral development?

 

2) Nina is the 5-year-old adopted daughter of Sarah and Tim Johnson. Nina is the Johnsons' only child. They adopted Nina before her first birthday. The Johnsons have brought Nina to the clinic today to discuss some concerns they have about her development. Nina is attending a public kindergarten. Since beginning school, the Johnsons have noticed that they are catching Nina lying more. They are concerned that this may be a result of attending school. In addition, they are concerned about her verbal development and note that her teacher reported that Nina seems to be stuttering or repeating the term "um" when speaking. She also has some difficulty with "sh" and "th" sounds. When the Johnsons try to discuss these issues with Nina she becomes "very emotional" and retreats to her room. (Learning Objectives 2 and 6)

A)What can the nurse teach the Johnsons about lying in preschool children?

B) What can the nurse teach the Johnsons regarding stuttering and speech development with Nina?

C) What can the nurse teach the Johnsons regarding emotional development in preschool children?

 

1. A) The father should be educated on the significance of the weight to height ratio; in relation to age given that Isaac has a low weight to his age is important to note the family diet, and whether he eats well. Donnie should be advised on running some test on Isaac to rule out any causative aspects of reduced nutrition.

The nurse should advise Donnie on the need for follow up and nutritional boosters like multivitamins should be administered.

B) On the cognitive development, the nurse should teach Donnie that at this particular age there are lots of reasons to take care of Isaac, ample time should be given to him to create that rapport with close individuals to eliminate the loneliness that tend to be substituted with imaginary world. At Isaac's age there is tendency for isolation among kids so that they can hide some of their deeds which are portrayed by the parents as bad, or unpleasant.

Isaac should be introduced to friends so that the imaginary friend is suppressed.

C) Isaac still is in the stage of ID according to Sigmund Freud psycho analysis, (Freud, 1996, Et Al).this is the stage where some thoughts are repressed to allow the semiconscious mind to come onto action. The child's moral development is best nurtured by the parents since this is the time that the child regards the parent's directions as right. The objective is to satisfy the child's questioning, that's Id so that he/she can emulate the parent.

2.A) Children at the age of 4 to 6 develop to understand what is truth and not from their parents simply by knowing that they and others are not mind readers so they can convey their wish.The most common examples like a child complaining of abdominal pain in order to avoid going to school.

The nurse has to teach the following

• They lie in order to grab attention, to stay out of punishment, to make parents to listen them ,to fo their favour etc.,
• Do not force or put the child in a situation to lie ,so be friendly with the child
• The parents has to teach the child about honesty at this age
• Identifying why the child is lying and not encouraging or supporting them if it is going to spoil their behavior
• The parents has to workout with the child without making them frustrated Stuttering can occur when the child lacks adequate and appropriate verbal words.

B) The child has to be assessed once in every three months to know the status and plan the care

To encourage the child to speak without criticizing them for their wrong pronunciation, etc.,

Talk slowly to the child

Introduce more words to the child one at a time

Do not engage in a confusing conversation which the child cannot understand

Encourage and develop self confidence of the child. 

C) At this stage, the preschoolers are competetive, hardworkers and learns letters and shapes and develop a gross and fine motor skills. Emotional development evolves quickly in early childhood. To overcome these emotional factors, the nurse should teach the Johnson to

a) create a self awareness in his daughter 

b)make her engage in decision making  

c) make her to maintain a healthy relationships with others 

d) allow her to show interest and listen to thers while speaking

e) help her to share information with parents 

f) make her to affectionate with friends and families.