Whittaker, L. (2015). Backyard Playground. Retrieve from: http://www.installitdirect.com/blog/backyard-playground-ground-cover/
By: Xuan Dao Tran Pham
*
*
*
The child is a 6 year old boy named “Tommy” (not the actual name). Tommy is in the preschool age range and has ADHD. Tommy is from a nuclear family consists of mom, dad, older sister, and older brother (Ball, Bindler, & Cowen, 2015). Their parenting style is authoritative. The parents set rule and limits for Tommy, but they allow him to express himself through communication. The rules are flexible because Tommy has ADHD, so the family adjusted the rules according to his needs. For example, Tommy needs to finish his meal, but he is permitted to get up, walk around, and come back to eating his food. Due to his ADHD, Tommy cannot be seated for a long period of time. The parents use reasoning, reward, and punishment to discipline him. They are warm and nurturing, but they have limited time to spend with Tommy due to work demands. Tommy grew up in a large family and was always around members of his extended family. Tommy is Vietnamese and his family is Buddhist. In the Vietnamese culture, the family values respect and honor. The dad has the authority and is the decision maker. Asian parents expect the children to excel academically and also help out with chores in the household. The older children are in charge of caring for the younger siblings while the parents are working. Tommy’s sister is 6 years older and the brother is 8 years older. The Duvall’s family life cycle for this family is stage IV; family with school age children. Tommy loves to run, play soccer, video games, read, and swim. Tommy is in preschool, his sister in middle school and older brother is in high school. Tommy has two close friends that he hangs out and plays with. In school, Tommy has a hard time focusing due to his ADHD. He can’t stay seated for a long period of time. Prior to Tommy’s ADHD diagnosis, it was difficult for the parents to understand Tommy’s behavior.
Gettyimage (2012). Vietnamese Icons. Retrieve from: http://www.gettyimages.com/detail/illustration/collection-of-vietnamese-icons-royaltyfree-illustration/507088929
Gross Motor Skills * *
*
Tommy has spiky hair and tan skin. He has a slim figure with slender legs and arms. He has two missing teeth on the bottom gums. Tommy uses associative play where he likes to interact and engage with peers on similar activities and participate in groups. Also, he uses dramatic play by dressing up as a firefighter or doctor. He can throw a ball, hold objects, run without any difficulty and is stable on his feet. In school, Tommy learns how to write, read, and draw. Normal physical growth during the school years is 3-5 pounds gain per year and grow 6.5-9 cm per year (Ball, Bindler, & Cowen, 2015). Tommy gained 3.2 lbs. and grew 5.8 cm since last year. He gains the expected amount of weight for his age, but is a little shorter than the norm.
As children go through preschool, they can throw a ball overhand, climb well, and ride a bicycle (Ball, Bindler, & Cowen, 2015). Tommy is a good climber on the monkey bars at the playground. His mom enrolled him in an afterschool basketball program where he learns the rule of the game, works with others in a team, and how to dribble the ball. On the weekend, Tommy’s dad shows him how to ride a bike. Overall, Tommy was able to fully develop his gross motor skills with the help of his family.
Fine motor skills
* A preschooler can uses scissors, draw a circle, square and cross, brush their teeth, use a spoon, fork or knife, able to button clothes, tie their shoes, and draw at least a six part person(Ball, Bindler, & Cowen, 2015). Also, they enjoy art projects like string beads, pasting, and using clay. At school, the teacher shows Tommy how to draw different shapes and figures during activities time. His mom and sister show Tommy how to brush his teeth and get dressed in the morning. Tommy’s older brother teaches him how to tie his shoes. Tommy’s favorite activity is arts and crafts because he gets to express his imagination through drawing and painting. Tommy’s fine motor skills are fully developed from practicing and help from others.
Preoperational Stage
* The child’s logic has not yet fully developed, but they can think use
words as symbols. In the intuitive substage, the child uses transductive reasoning by transferring a conclusion from one fact to another (Ball, Bindler, & Cowen, 2015). They have magical thinking and unrealistic thinking between action and effect of the event through reason and observation. The child has centration where they can only consider one perspective of the situation at a time. Lastly, they give life to inanimate objects which is called animism. * Tommy understands that brunch time is a break when he gets to go out and play with his friends. He used his imagination to give life to his comic character, such as Capital Underpants. The character is a baby with super power to fight bad guys. Tommy believes that if he is good, then Santa Claus will come to give him a present at the end of the year. When Tommy’s hamster went missing, he thought someone kidnapped the animal. He was only able to focus on one aspect of the event by using his observation and he concluded the hamster was kidnapped. Tommy did not know the hamster passed away the night before, so his parents had to bury the pet. Tommy meets Piaget’s preoperational stage of cognitive development.
Keshet, A. (2016). Kids performing a theater play. Retrieved from: http://www.123rf.com/photo_16511452_kids-doing-physical-activities-through-play.html
Initiative versus Guilt Stage *In this stage, the child has new ideas and activities that they want to act on (Ball, Bindler, & Cowen, 2015). They are busy and involved in exploring the world around them. Guilt can develop if the child is under constant criticism, leading them to feel like they lack purpose.
*Tommy loves to try new activities in school
and initiates games of tag with his friends. One of his favorite activities is to draw and make comic book with his best friends. They make up story lines using the character SpongeBob SquarePants. Tommy meets the Erikson’s stage of initiative versus guilt.
Preconventional Stage * The child wants to please others and avoid punishment, thus, it influences their decision making (Ball, Bindler, & Cowen, 2015). For example, when Suzy got A’s and B’s on the report card, she was rewarded with a brand new doll house. Suzy learns that by getting good grades, her parents will reward her. Thus, Suzy continues to do well in school.
* Attention Deficit Hyperactivity Disorder is a
neurodevelopmental disorder in children. Children diagnose with ADHD have trouble paying attention, unable to control impulsive behaviors, fidget, talk nonstop, easily distracted, forget things, trouble completing tasks, impatient, and unable control emotions (National Institute of Mental Health, 2013). Due to Tommy’s A.D.H.D., he tends to get into a lot of trouble with the teachers due to the fact that he is easily distracted and unable to remain quiet and still for long periods of time. When Tommy was given treatment and medication (Focalin) for his A.D.H.D., he was able to focus more in class and be less hyperactive. With proper medication and treatment, Tommy was in good standing with his teachers and exhibited more appropriate behaviors. Thus, Tommy meets Kohlberg Preconventional stage of moral development.
*
Preschoolers need about 1,800 kcal a day; 13-19 gram of protein along with adequate iron, folate, vitamins A, calcium, and vitamin C; limited saturated fat to less than 10% of total caloric intake; and 5 servings of fruits and vegetable (Ball, Bindler, & Cowen, 2015). Preschoolers are picky eater and like to associate mealtime like a social event. Parents can allow the child to assist in meal preparation and table setting. Parents should prepare food that is provide the child with adequate amount of nutrition, limit fruit juice intake to 8-12 ounces a day, and limit excess caloric or saturated fat intake. Parent allow child to consume fast food once a week and teach them how to make nutritionally adequate food choices. Preschoolers should have three meals and three snacks a day. It is important to encourage good dental habit by brushing teeth twice a day, floss, and using fluoride supplement. During this time, the family should schedule a first dental appointment for lay out a routine of good dental care.
*
Tommy is 43 inches tall (25%), weighing in at 43.5 pounds (20%). Head circumference is 52.2 cm (50%). BMI is 16.5 (65%), which is normal weight (Centers for Disease Control and Prevention, 2015).
*
Tommy likes to eat McDonald, candy, and drink soda. The diet consists of meat, fish, milk, soup, vegetable, fruits, and whole grain products. For example, a typical dinner meal for the family will have brown rice, vegetable soup, chicken or beef dish, and fruit. Breakfast will consist of eggs, toast, soy sauce, orange juice, and an apple. Snacks are yogurt, oranges, and granola bar. Preschool will provide lunch meal. Parents should offer a variety of foods from each food group.
Nutrition Matters (2016). MyPlate Nutrition Guide-Preschool. Retrieve from: http://stores.numatters.com/myplat e-nutrition-guide-preschool/
Respect
Family
Need is met. Tommy shows respect for his parents, older siblings, and elders. In the Vietnamese’s culture, Tommy requires to pay respect to the elders. For example, Tommy must greet each aunt and uncle at a dinner party. Need is met. Tommy is from a nuclear family consists of dad, mom, one sister, and one brother. Tommy is closest to his older brother because they have a lot of things in common such as sport and video games.
Friends
Need is met. Tommy has two best friends name Gate and Will. The friends like to play soccer, video games, and read together.
School Habits
Need is met. With ADHD treatment and medication, Tommy is able to stay more focus and be less hyperactive. He attends preschool five days a week learning how to read, write, and draw shapes. Tommy excels in drawing, painting, and reading.
Patient care reply on evidence based practice and interventions. Evidence based practice integrate best and current evidence to improve outcome and guide patient care (AMSN, 2016). It provides problem solving approach that integrates patient value with clinical expertise and delivers the most relevant solution to solving problems. In Tommy’s case, the EBP was used to treat and maintain the ADHD under control. Also, EBP can help educate patient and family on proper nutrition, meeting development on each stage, and provide safely precaution.
West Virginia University (2015, November). Preschool Nutrition Education. Retrieved from http://familynutrition.ext.wvu.edu/preschool
Nutrition
Tommy loves to eat McDonald’s, candy, and drink soda. The parents need to limit his intake of McDonald’s to once a week because it has a high fat content that contributes to child obesity. They should feed Tommy lots of fruits, vegetables, whole grain products, low fat dairy food, protein, and vitamins. The parents need to educate Tommy on making better choices in selecting nutritionally adequate food. If the preschooler views mealtimes as a social event, then the parents can have daily dinner time where everyone need to eat at the same time. Soda and candy have high sugar content that can cause cavities and it should be limited (Ball, Bindler, & Cowen, 2015). Parents can be creative and use a little food coloring in the water to make it look more appealing for the child.
Physical Tommy’s height is in the 25% tile which is the lower range. Tommy needs to Developm consume adequate amount of calcium each day to promote bone growth. ent He needs about 800 milligrams of calcium in his diet (Centers for Disease Control and Prevention, 2015). The parent can offer calcium rich snack such as yogurt, cheese, and milk. Also, exercise and physical activity can promote bone and skeletal growth. Parents can limit video gaming time to an hour a day and encourage Tommy to do more physical activities. Tommy is at 20% tile of weight. The parents and school can provide him with 3 meals and 3 snacks a day to meet a diet of 1800 calorie a day (Ball, Bindler, & Cowen, 2015).
Social In the Vietnamese’s culture, parents will teach their children to not Developm express their feelings or emotions out in the open. The culture can hinder ent Tommy ability to effectively communicate emotion or express feelings to others. Siblings and parents can show more affection and encourage Tommy to express his feelings. For example, the parents can hug Tommy and express their love for the child more often. Next, encourage child to be independence through guidance, set clear limit, and recognize child accomplishments (Ball, Bindler, & Cowen, 2015).
Safety
During biking lesson, Tommy’s parents need to provide a fitted helmet and pads for him to wear to protect from bodily harm. It is important to apply sunscreen when the child is outdoor to protect the skin layer. The house should have smoke alarm on each floor (Bright Futures, 2015). The family needs to discuss a fire escape plan in case of a fire.
AMSN. (2016). Evidence-Based Practice. Retrieved from: http://ww.amsn.org/print/practiceresources/evidence-based-practice. Ball, J. W., Bindler, R. C., & Cowen, K. J. (2015). Principles of Pediatric Nursing, Caring for Children (6th ed.). Upper Saddle River, NJ: Pearson Education, Inc. Bright Futures. (2015). Bright Futures Parents Handout 5 and 6 year Visits. Retrieved from: https://brightfutures.aap.org/Bright%20Futures%20Documents/C.MCh.PH.5,6yr.pdf Centers for Disease Control and Prevention. (2015). About child & Teen BMI. Retrieved from: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens
_
bmi.html
Centers for Disease Control and Prevention. (2015). Middle childhood: 6-8 years of age. from: http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle.ht ml National Institute of Mental Health. (2013). Attention Deficit Hyperactivity Disorder. Retrieved from: http://www.nimh.nih.gov/health/publications/attention-deficithyperactivity-disorder-easy-to-read/index.shtml