Father Saturnino Urios University

Butuan City, Philippines

INDIVIDUAL CASE STUDY

Care of a Child with Normal Health Patterns

Brgy. Salvacion Day Care Center

Kathleen P. Josol
N – 21

Ms. Nathalie C. Fat, RN MAN

Supervising Clinical Instructor
 Introduction

Important goals of preschool programs are to help children acquire social skills and
learning-related skills. These programs are especially important for children, guiding them
toward healthier development and giving them the tools they need before school entry.
Participation in high-quality preschool can improve academic, behavioral, social-emotional, and
cognitive outcomes for students of varying backgrounds, including students from disadvantaged
backgrounds. The proliferation of preschool education can be connected to advances in
developmental psychology, such as in the work of Jean Piaget which revealed the nature of
psychological development that occurs in the early years of childhood, Sigmund Freud’s
psychosexual theory, wherein as a child grows physically certain areas of their body become
important as sources of potential frustration (erogenous zones), pleasure or both, Erik Erikson’s
psychosocial development that describes the impact of social experience across the whole
lifespan and in how social interaction and relationships played a role in the development and
growth of a child, and from Kohlberg’s moral development which refers to changes in moral
beliefs as a child grows older and gains maturity. This case helps design a nursing care plan
appropriate for the client’s condition such as the uniqueness of a child’s character such as being
self-centered, yet are significantly influenced by others, especially mom, dad, teachers, and other
significant adults. This case study would also equip the student with knowledge, skills and
attitude on how to manage future clients with the same condition or behavior. The case also
promotes skills and comprehend attitude to the client and especially to the nursing students who
might have handled or will handle this kind of behavior. This case also is to provide the
necessary nursing care and proper intervention for the wellness of the client, identify nursing
problems and the corresponding nursing considerations and maintenance of the client’s health.

Nursing Health History

Child K is a four-year old boy living in Barangay Salvacion, Butuan City, a six-member family,
consisting of two parents, Mr. and Mrs. K, and two children, child K and his older brother, and
an uncle. Parents are married. During pregnancy history, mother did not suffer any of the
following: excess weight, hemorrhage, high blood pressure, diabetes, chickenpox or
mumps, high fever, anemia, limbs swelling, dietical insufficiency and renal infections.
She was able to have a prenatal check-up once in a month at their health center and stated that
she had a prenatal check-up thrice at Butuan Medical Center. Mother’s age of gestation at the
time of labor was 27 years old. The baby came to life via normal spontaneous vaginal delivery
at Butuan Medical Center.

Health Perception – Health Management Pattern

Child K was never been checked for visual problems or hearing problems and has never
undergone any surgery or admission to hospital, accidents or illnesses and he has never suffered
any psychological disorders. Child K’s vaccinations are valid and fully immunized.
Nutrition – Metabolic Pattern

Dietary history shows that the family’s food consumption is mostly carbohydrates (rice,
bread) and vegetables. Further interviews also show that the client regularly consumes milk and
vegetables such as talong, batong, kamunggay, and it is only seldom that they consume both fish
and meat. The client has no problems of chewing or digestion were noted.

Elimination Pattern

Child K usually urinates of yellowish color urine 2-3 times a day. He defecates brownish
hard stool once in a day. No painful urination incontinence or retention and constipation was
noted.

Activity – Exercise Pattern

Child K’s typical day activities would include going to school such as walking up as
early as 6:30 in the morning, participates in the school activities, takes nap and watches TV
during free time. Child K is very active. He rarely sits because he wanted to play all day, all
around the classroom and outside at the playground. Able to move extremities through active
ROM. Able to extend arms front and resist active as pushed down/up on his hands. Upon
assessment, sensory system is intact, he was able to distinguish touch, pain, hot and cold and
uses spoon in order to eat on his own and able to walked without assistance. He is right-handed,
but he uses his left hand in activities such as playing and sometimes in his eating habits.
Regarding his body coordination (stability, graceful movements, walking), it is good. He holds
things steadily and he has a good grasp of his pencil.

Sleep – Rest Pattern

Child K usually sleeps at around 9:00 in the evening and wakes up at around 6:00 in the
morning and takes a nap from 1:00 PM. to 3:00 PM. Child K average duration of sleep is around
nine hours. Child K often sleeps late because he watches TV drama which happens to be shown
late at night. He feels well rested after each episodes of sleeping and doesn’t have any difficulties
in sleeping.

Cognitive – Perceptual Pattern

The child is currently attending a nursery school at Brgy. Salvacion Day Care
Center, Butuan City. He comprehends, remembers and follows oral instructions or orders. He
also remembers things in the right sequential order. He learns better by listening to
the person and he can discriminate between the left and right.
Self Perception – Self Pattern

The child’s strengths can be summarized in being smart, having a solid memory,
being outspoken, easy-going and protective.

Role – Relationship Pattern

Regarding his weaknesses, parents have to often remind him of his limits and
limitations, and specific activities cannot be planned beforehand, especially his sleep pattern.
He loves playing with other children, peers, older and younger ones. He has no difficulty in
standing still for specific temporal spans in order to complete a task.

Sexuality – Reproductive Pattern

Child K irritates his mom by always spanking his mom’s butt. Sometime, he includes the
teacher. He touches her breast and even the teacher’s butt.

Coping – Stress Tolerance Pattern

Child K is not characterized by anxiousness, stress, destructiveness, insomnia,

irritability, withdrawal or any other problematic and awkward kind of behaviour, but
during the first meeting child K was feeling anxious due to meeting strangers.

Value – Belief Pattern

Child K is a Roman Catholic and attends Sunday mass regularly together with his family.
The family of child K usually prefer herbal treatment than chemical medications. They seldom
go to the Health Center to acquire medications.

Physical assessment

Upon assessment, every effort was made to recognize and respect the child’s feelings as well as
to provide comfort measures and follow appropriate safety precautions. He is conscious and
coherent upon interaction and is very participative in activities especially during play time. He
already uses words in order to express himself. Moreover, he always maintained interest
when playing games, watching TV, looked at illustrated books and being read to by somebody
else and speech is comprehensible. Child K was assessed to have a height of 102 cm. and a
weight of 20 kg. Vital signs and statistics were recorded as follows: (a) Temperature (axillary) –
36.5 C; (b) Heart Rate – 72 bpm; (c) Respiratory Rate – 17 breaths per minute; (d) Head
Circumference – 52 cm.; (e) Chest Circumference – 59 cm; (f) Abdominal Circumference – 55
cm.
 INSPECTION PALPATIO PERCUSSIO AUSCULTATIO
N N N
MENTAL Patient’s build,
STATUS height and weight
are appropriate for
his age. There is no
deviation in his
posture and gait.
Client is active.
SKIN Skin color is Skin is warm
uniform throughout to touch.
the body. No lesions
noted.
HAIR Hair is short, and Client’s hair
straight and evenly is smooth and
distributed. Hair is thick. Hair
free of lice or feels dry to
infestations. touch.
NAILS Nail curvature does Capillary
not indicate any Refill returns
clubbing or within 2-3
 spooning. Nail beds seconds.
are pink in color. Nails are
No abnormalities on smooth.
nails except nails
are dirty and are not
trimmed.
HEAD Head is round in Scalp is
shape. Scalp is smooth. Head
white in color, no is free of
lesion was noted. bumps and
No dandruff seen. lesions.

NECK Neck is in midline No

with no inflammation
enlargements upon of lymph
observation. Neck nodes. No
has strength that abnormal
allows movement swelling of
back and forth, left muscles
and right. Client is noted.
able to freely move Trachea is in
his neck. midline.

EYES Eyes are No

symmetrical, black inflammation
in color, almond or pain
shape. Pupils during
constricts when palpation of
diverted to light and lacrimal
dilates when he gland and
gazes afar, nasolacrimal
conjunctivas are sac.
pink. Eyelashes are
equally distributed
and skin around the
eyes is intact. The
eyes involuntarily
blink. Eyebrows are
evenly distributed
and are symmetrical
in movement.
 Eyelashes curl
outward and are
evenly distributed.
Eyes are able to
move in six ocular
movements.
EARS Ears are slightly No pain upon
clean, slight ear wax palpation and
was noted and is able to
approximately of retain back to
the same size and its original
shape. Patient can formed when
hear normally when auricle is
spoken softly. folded. No
pain or
Ears are uniform in
tenderness
color to the face and
noted on
are slanted 10
mastoid
degrees vertically
process.
from head.
NOSE With narrow nose
bridge, there were
discharges noted
upon inspection.
Nose is in midline,
uniform in color
with the face and no
flaring indicated.
MOUTH AND Oral mucosa and
THROAT gingival are pink in
color, moist and
there were no
lesions nor
inflammation noted.
Tongue is pinkish
and is free of
swelling and
lesions. Lips are
symmetric and pink.
Client is able to
purse lips. Dental
carries evident
between two central
 incisors.
CHEST No abnormalities in Upon No presence
chest symmetry and palpation no of flat or dull
structure. Thorax pain was and
has normal noted. hyperresonan
curvatures. t was noted.
LUNGS No reports of pain
during the
inhalation and
exhalation.
Respiratory rate is
17 breathes per
minute.
Respiration/breathin
g quietly and
effortlessly.
HEART With a pulse rate of Skin
72 bpm. Superficial temperature
veins are absent in is uniform
extremities, skin throughout
color is uniform the body.
throughout the
body.
ABDOMEN Abdomen is slightly No presence
rounded in contour of pain as
and symmetrical. palpating the
4 quadrants.

BACK AND Client has normal Skin is dry,

EXTREMITIE spinal curvatures. and slightly
S No presence of rough to
marks/scars of touch
wounds in the arms
and legs.
Extremities are
symmetrical on
either sides. Able to
move extremities
through active
ROM. Able to
extend arms front
and resist active as
pushed down/up on
 his hands.

DEVELOPMENTAL MILESTONE

Assigned Patient: Child K (pseudonym)

Age: Four (4) years old
MILESTONE NORMAL ACTUAL INTERPRETATION
Gross Motor Children who are 3-4 Client was able to Gross motor skills are
Development yrs old can climb up dance, either important to enable
stairs using a method freestyle or through children to perform
of bringing both feet songs with everyday functions,
together on each step. movements. Jumping such as, walking,
However, young or hopping from running, as well as
children may still place to place on the playground skills.
need some “back up” floor made him Gross motor abilities
assistance to prevent happy too which was also have an influence
falls in case they a good thing for on other every day
become unsteady in developing his gross functions. For
this new skill. 3-4 yrs motor. He was also example, a child’s
old can jump and hop able to walk around ability to maintain
higher as their leg the classroom or table top posture
muscles grow even running inside. (upper body support)
stronger. He plays ball will affect their ability
together with other to participate in fine
children. motor skills (e.g.
writing draw, cutting)
and sitting upright to
attend to class
instruction, which
then impacts on their
academic learning.
Fine Motor Around ages 3-4 yrs, Client was able to The motor control to
Development children start to draw shapes, trace produce text through
manipulate clothing lines, such as tracing drawing, mark-
fasteners, like zippers letters and numbers making and symbolic
and snaps, and such as, numbers 1, representations of
continue to gain 2, 3, etc and draw letters is vital in the
independence in shapes such as, communication of the
dressing and circle, square and message. Fine motor
undressing triangle. He was also development is
 themselves. 3-4 yrs able to independently essential in
old continue to refine zipped his zipper. He developing the ability
their eating skills and uses non-dominant to mark-make and
can use utensils like hand to assist and write effectively, so
forks and spoons. stabilise the use of that a message can be
Young children at objects and communicated.
this age can also use manipulates clay Writing progress
larger writing hold material (rolls ball, depends largely on the
rather than just makes snake). He development of fine
grasping them with enjoys using pencil motor skills involving
their fist. They can and paper, thus small muscle
also use twisting lids writing makes him movements in the
off containers. busy and excited, hand (Huffman &
especially when Fortenberry, 2011,
teacher gives him p.100).
stars as a reward.
Language By around 4 yrs old Child was able to Parents and caregivers
they’re beginning to understand most of need to remember that
understand and use what is said. Hear language in the great
the rules of language (and respond to) majority of
to express possession someone calling to individuals develops
of something, him from the outside. very efficiently.
connect thoughts and Notice and respond Adults should try not
quantify trouble to sound in the to focus on problems,
using some speech environment (such as such as the inability to
sounds- for example, car horn). He was pronounce words as
saying ‘fing’ for able to speak in adults do (for
‘thing’, ‘den’ for complete sentences example, when
‘then’ or ‘wing’ for of four or more children pronounce r’s
‘ring’. He/she might words or syllables. like w’s). most
do also occasionally Speaks clearly children naturally
mispronounce some enough to be outgrow such things,
complex words by understood. Use most which are a tiny
missing sounds – for speech sounds, (such segment of the child’s
example, saying as, l,r, sh, h, y, z and total repertoire of
‘amblance’ instead of th). Repeats what is language. The point of
‘ambulance’ or heard and sings learning language and
‘paghetti’ instead of nursery rhymes. interacting socially,
‘spaghetti’. then, is not to master
rules, but to make
connections with other
people and to make
 sense of experiences.
Play Play is now highly Client was able to Choose activities
social and focused on show interest in where there aren’t too
peer relationships. being part of a group. many rules or
The preschool age He enjoys playing restrictions. If not, it
child participates in with others and can ruin the
circle time, singing interacting with his experience for them
and dancing games, peers more. Share and they’ll never want
and at art time. and cooperates with to play again
Group play replaces others and evert more (Wittenburg, 2019).
parallel play and the independence. Still, being confident
pre-schooler shows and comfortable part
interest in being a of successfully
friend. socializing, especially
as he/she gets older.

COMPARATIVE STUDY

Assigned Patient: S.D. (pseudonym)

Age: Four(4) years old
THEORY NORMAL ACTUAL INTERPRETATION
Sigmund Freud’s Pre-schoolers take He irritates his mom Sexuality is a person’s
Psychosexual pleasure in their by always spanking sexual curiosity and desire
Theory genitals and, his mom’s
butt. for other people; their
according to Freud, Sometime, he ability to have sexually
begin to struggle includes the teacher. stimulating occurrences and
with sexual desires He touches her
responses (Defining Sex,
toward the opposite breast and even the
Gender, and Sexuality).
sex parent. For boys, teacher’s butt too.
Sigmund Freud (1856-1939)
this is called the Later, when
he believed that the way parents
Oedipus complex, realizes his doings dealt with children's basic
involving a boy’s he immediately goes sexual and aggressive desires
desire for his mother back to his chair and would determine how their
and his urge to behave because he personalities developed and
whether or not they would
replace his father noticed that his
end up well-adjusted as
who is seen as a mother is getting
adults. In the Phallic stage, the
rival for the angry.
focus moves to genital
mother’s attention. stimulation and the sexual
At the same time, identification that comes with
boy is afraid of his having or not having a penis.
father will punish
him for his feelings,
 so he experiences
castration anxiety.
The Electra
complex, later
proposed by Freud’s
protégé Carl Jung,
involves a girl’s
desire for her
father’s attention
and wish to take her
mother’s place.
Erik Erikson’s Once the children During hand Children need to begin
Theory of reach the preschool washing he said he asserting control and power
Psychosocial stage, they are wanted to do it by over the environment by
Development capable of initiating himself without my taking initiative by planning
activities and assistance. He activities, accomplishing tasks
asserting control wanted to show off and facing challenges. During
over their world how well he could this stage, it is important for
through social do it by himself, caregivers to encourage

interactions and independently, exploration and to help

play. By learning, to though in reality children make appropriate

plan and achieve he’s not that good choices. Caregivers who are
discouraging or dismissive
goals while yet on doing it by
may cause children to feel
interacting with himself only. He
ashamed of themselves and
others, preschool knows how to return
to become overly dependent
children can master the toys he borrowed
upon the help of others.
this task. Initiative, a and able to
sense of ambition understand the
and responsibility, situation if the toy
occurs when parents he likes is someone
allow a child to else’s property,
explore within limits though it took or
and then support the could take a process
child’s choice. These before he agrees.
children will
develop self-
confidence and feel
a sense of purpose.
Those who are
unsuccessful at this
stage – with their
initiative misfiring
 or stifled by over-
controlling parents –
may develop
feelings of guilt
Jean Piaget’s During this stage, He shares that he It is argued that one of
Piaget’s main criticisms is that
Cognitive children can use and his family went he underestimates children in
Development symbols to represent to a beach and he his
theory (Lourenco & Machado,
Theory words, images, and even gives actions in 1996). Donaldson argued that
ideas, which is why every word he said. most preschool children are
capable of solving problems
children in this stage He’s very focus on associated with operational
engage in pretend sharing his thought if they were given
help
play. Logical experience at the and was very critical of
thinking is still not beach and stated Piaget’s experimental
methodology as situations
present, so children how he swam to the weren’t
cannot rationalize or water. Pretended to presented as optimal and
helpful as they could have,
understand more be a frog, dog and not showing us the child’s
true
complex ideas. Are even a cow
potential (Sutherland, 1992).
very egocentric, whenever they’re Though there is evidence that
proves higher competency in
meaning they focus playing with his children than previously
on themselves and seatmates. thought by Piaget (see
Donaldson, 1978. and Grieve
how actions will & Hughes,
impact them, rather 1990), the studies that try to
demonstrate operational
than others. They thought on preoperational
think that everyone children
haven’t brought any evidence
sees, thinks and feels that these competencies are
just like they do. equivalent to the operational
and the logic mathematical
competencies which Piaget
was interested (Lourenco &
Machado, 1996).

Kohlberg’s What is right and He attempts to go A child or even a teen will

Stages of Moral wrong is determined outside during class not follow a rule because of
Development by what is hours, wherein a fear of punishment.
punishable. Moral they’re doing some Someone will follow a rule
action is essentially writing activity but because their parents,
the avoidances of when his mother teachers, or even authority
punishment. Brings glares at him he figures will try to punish
reward and what immediately knows them if they follow it. They
people wants. Wants what he attempts to may not know why the
and needs come into do is not right, thus, behaviour is wrong, but
picture, but only in a going back to his they avoid it because of
reciprocal sense. chair and continued punishment. If there is a
the written activity. chance that they can break
 the rules without
consequence, they will do
that (Angers, 2019).

PROBLEM LIST

Problem Date Identified Problem

Number
1 July 16, 2019
2 July 16, 2019
3 July 16, 2019
4 July 17, 2019
5 July 17, 2019
6 July 17, 2019
7 July 16, 2019
8 July 16, 2019
9 July 16, 2019
10 July 16, 2019
Imbalanced Nutrition: Less than Body Requirements
Ineffective Airway Clearance
Self-Care Deficit: Hygiene
Risk for Impaired Oral Mucous Membrane
Risk for Injury
Risk for Other – Directed Violence
Impaired Social Interaction
Labile Emotional Control
Deficient/Learning Need
Risk for Delayed Development

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https://www.parents.com/toddlers-preschoolers/development/social/social-development-
milestones-age-1-to-4
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https://www.readingrockets.org/article/young-childrens-oral-language-development

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