COLEGIO SAN AGUSTIN-BACOLODCOLLEGE OF NURSING

OBSERVATIONAL CASE STUDY OF THE PRESCHOOLER

I. Profile of the Preschooler

Name: Z.N.I.

Age: 3 years old

Gender: Male

Date of Birth: September 18, 2011

Place of Birth: Brgy. 20, Bacolod City

Religion: Roman Catholic

Address: Brgy. 20, Bacolod City

Nutritional Status: Z.N.I. eats his meal 3 times a day. He also eats snacks in between meals.

He doesn’t likes vegetables and he is not fond of eating meat if it is paired

with rice. He also takes vitamins like Tiki-Tiki regularly.

Weight: The average weight of a 3 years old boy is 14.6 kg. Z.N.I. has a weight of 15 kg which

is normal for his age.

Height: The average height for his age his 94.9 cm. His height which has been measured

recently is 97 cm which is considered to be normal for his age.

Physical Handicapped: (if present-describe)

No signs of any abnormality.

Father’s Name: L.M.

Occupation: N/A

Mother’s Name: K.J.I.

Occupation: Housewife

II. Introduction/Description why you chose the child

The preschooler learns the social skills needed to play and work with other children. As time

passes, the child is better able to cooperate with a larger number of peers.

Although 4- to 5-year-olds may be able to start playing games that have rules, the rules are

likely to change often at the whim of the dominant child. Preschool is the developmental stage

from the ages 3 to 6 years old-- those who have moved beyond toddlerhood but aren't yet old

enough for kindergarten.

This level of education is aimed at equipping children with various skills such as problem

solving skills, self-help skills, social skills, team work, creative development, and communication.

Jean Piaget's Theory of Cognitive Development says that a young child's understanding is certainly

different from an adult's. As a child's body and physical abilities change, her way of knowing and

perception of the world also change. According to Piaget's Theory, a pre-schooler belongs to the

preoperational stage. This stage focuses on the development of concept through make-believe play

and development of symbolism. For example, a child is able to use an object to represent

something else, such as pretending a broom is a horse. Role playing also becomes important during

the preoperational stage. Children often play the roles of "mommy," "daddy," "doctor" and many

other characters. Language development is one of the hallmarks of this period. Piaget noted that

children in this stage do not yet understand concrete logic, cannot mentally manipulate information,

and are unable to take the point of view of other people, which he termed egocentrism. In Sigmund

Freud's Psychosexual Theory of Development, a pre-schooler is in phallic stage. Freud believed

that during this stage boy develop unconscious sexual desires for their mother. Because of this, he

becomes rivals with his father and sees him as competition for the mother’s affection. During this

time, boys also develop a fear that their father will punish them for these feelings, such as by

castrating them. This group of feelings is known as Oedipus Complex (after the Greek Mythology

figure who accidentally killed his father and married his mother). Later it was added that girls go

through a similar situation, developing unconscious sexual attraction to their father. Although Freud

Strongly disagreed with this, it has been termed the Electra Complex by more recent

psychoanalysts. For Erik Erikson's Psychosocial Development, a pre-schooler is on the third stage

of development which is the Initiative vs. Guilt. It is during in this stage that children need to begin

asserting control and power over the environment by taking initiative by planning activities,

accomplishing tasks and facing challenges.

During this stage, it is important for caregivers to encourage exploration and to help children

make appropriate choices. Caregivers who are discouraging or dismissive may cause children to

feel ashamed of themselves and to become overly dependent upon the help of others. The work of

Lawrence Kohlberg is an outstanding example of research in the Piagetian tradition. He used

Piaget's storytelling technique to tell people stories involving moral dilemmas. In each case he

presented, a choice to be considered for example between the rights of some authority and the

needs of some deserving individual who is being unfairly treated. His research was cross-sectional,

this means that he interviewed children of different ages to see what level of moral development

they are at.

When Z.N.I. was still 1-2 years old, his mother and grandmother think that he can’t speak. He

stopped breastfeed when he was 9 months old and started bottle feed. His mother uses “su-am” as

his substitute for milk. He started speaking when he is 2 ½ years old. He has a younger brother

named, M.I. Z.N.I. is one of those kids that whose vegetables are not on the list of their favorite

foods. His mother told me that his favorite food is fish and noodles. He is not fond of eating meat

that is paired with rice. For example, he only wants to eat chicken joy alone without the rice. Z.N.I.

takes his vitamin regularly. He can stay up as late as 12:00 or 1:00 AM and he wakes up in the

morning by 6:00 or 7:00 AM.

If he has no class, he plays counterstrike as soon as he wakes up in the morning and

according to his mother he usually spends half the day playing it. He learned how to operate the

computer when he was 1 year old and he learned how to play counterstrike by just watching his

cousins play. He learned nursery rhymes and watch episodes of Barney in Youtube. If he is not

allowed to play counterstrike, he would often have tantrums and he would not stop unless his

mother finally allows him. According to his mother, Z.N.I. will not stop crying unless she lets him

play the computer. She is aware that this behavior is not right but she said that she can’t tolerate

Z.N.I. having a tantrum because she is afraid that Z.N.I. will have fever at night. She said that

whenever Z.N.I. is having a tantrum and will not stop crying, he would have a fever at night and

this was experienced several times.

Z.N.I. also has a habit of not wanting to share the computer even if he is done playing with

it. He would play again just to stop others from using the computer. According to his mother, he is

not fond of watching cartoons unlike other kids. He likes watching action movies. He is fond of

playing miniature cars and he imagines objects with a rectangle end that it is a gun. He has a small

bike at home. He is afraid of aliens and he refers ugly objects as alien. His mother told me that this

first started when they went into a restaurant and the movie that is showing has aliens. From then

on, Z.N.I. is afraid of aliens. His mother disciplines Z.N.I. by spanking him using her hands.

According to his mother, his learning process slows down if he is not having fun. He likes it if he is

tickled while studying. He is not totally dependent on his mother when he is at school but he would

sometimes peek at the door to check if his mother is still there.

I chose Z.N.I. as the subject of this observational case study because as I was observing all the

children in the preschool, my attention were caught by him. Unlike his classmates who were

playing with toys and running inside the room, he is just sitting quietly in his seat, watching his

classmates play. As I continue observing him, I noticed that he is somehow doesn't show full

dependence on his mother. During their snack time, he will just eat all by himself without requiring

the help of his mother. What intrigued me the most is, when I ask him questions like, "What's your

name?", "Where do you live?" and other questions, he will just look straight at me without

answering my questions and his facial expressions were mostly blank but according to the

information that I’ve gathered, his behaviour at school and at home is different. He is usually quiet

at school but at home he often have tantrums according to his mother.These were the reasons why I

chose Z.N.I. as my subject.

III. Home Condition

The owner of the house that Z.N.I. and her mother are staying at is the property of K.J.I's

grandmother. It was inherited by the family. The house is in good condition. It is made of wood,

it is not huge but the space is suitable for the family. They only have 1 room inside the house.

They also have living room, kitchen, and comfort room.

The family owns a speaker, television and computer. The ventilation is good enough for air

to go through in and out the house. The distance of the school from the house is not too far. It has

a walking distance however, if the sun is way too hot, Z.N.I and his mother ride a traysikad with

Php 10.00 as their fare.

The mother of Z.N.I. accompanies him every weekdays to school and she waits for the class

to be dismissed. She doesn't leave Z.N.I. alone in the school. She raises Z.N.I. and her other

child together with his mother. They community that they live in is congested but the

surroundings are clean and suitable for a family to live in. The house is not on the side of the

road. They need to walk their way to the house from the corner. Their family structure is

extended. The family shares the house with K.J.I.'s siblings together with her mother.

IV. Observation

Topic Book View Observation

PHYSIOLOGICAL DEVELOPMENT

1. Physical Growth

The weight gain is slight during the preschool years. The average child gains only about 4.5 lb or 2kg/ yr. Height gain is also minimal during this period; as only 2.5-3inches/yr or 6 to 8cm. Appetite remains as it was during the toddler years, which is considerably less expect. They have 20 deciduous teeth by 3 yearsof age. The bladder is easily palpable above the symphysis pubis.

ZNI has a weight of 15 kg which is normal for a pre-schooler. He has a height of 97 cm which is higher than the average height of a pre-schooler which is 94.9 cm. As to his voiding, he usually voids 5-7 times a day. He is a picky eater. He doesn’t eat vegetables and meat if it paired with rice. He does not usually finishes his food and he has many left overs.

2. Gross DevelopmentAt this stage, the child’s balance continues to improve. They are constantly in motion such as jumping and skipping. They are also becoming more skilled in running, throwing and kicking and able to pedal a small

He is fond of running and skipping around the classroom. He also loves to throw balls and he plays with his small bicycle at home..

tricycle for their age.

3. Fine Motor Development

During this stage, copying figures becomes easier for them and they are able to trace any letter, object and number. The child also undresses self with supervision; molds clay/play-dough; able to color shapes; can make sign of the cross.

He can trace letters and numbers accordingly for his age. He is able to undress himself with the help of his mother. He is able to color shapes and mold clay. He can pile objects together. He is able to make sign of cross. He started using the computer when he was 1 year old and he can play “counterstrike”.

COGNITIVE DEVELOPMENT

As for Piaget, a pre-schooler is in the preoperational stage

1. Causality

A child resembles logic thought, explains concepts as what he heard about it and as described by others but their understanding is limited.

ZNI is able to explain a concept according to what he has heard about it and he can also memorize songs.

2. Language

At the age of 3-4 years, children can form a sentence of about 3-4 words and includes only the most essential words. This is also called as Telegraphic due to its brevity and length. As of broken fluency, which is the stuttering of words and Dyslalia which is inability to speak verbal languages. The average vocabulary of a pre-schooler ranges to approximately 2100 words.

When ZNI wants to play “counterstrike”, he would usually say, “Hampang ko strike.” He is not fond of talking and he is usually quiet in the classroom. He doesn’t speak clearly. Whenever he says something, he usually mutters the words.

PSYCHOSOCIAL DEVELOPMENT

As for Erik Erikson, a pre-schooler is in the Initiative vs. Guilt stage.

1 . Family Relations

Preschoolers tend to seek new experiences to their parents and guardians by asking “how” and “why”.

ZNI discovers new things on his own. His mother doesn’t assist him when she knows that ZNI can do it on his own. She wants ZNI to stop being too

They feel a sense of accomplishment and satisfaction in their activities. When conflicts arise, the children tend to overstep the limits of their ability, inquiry, experience and not behaving appropriately.

dependent. If ZNI accomplishes something such as doing his school activity, he show it to his mother. He is proud of his accomplishments. Although he doesn’t have a father beside him, his mother is very supportive of him. His mother is also patient in answering ZNI’s questions.

Doesn’t want to share the computer at home with others; he does not cry and knows that his mother is waiting outside the classroom; fond of “shooting” games; have tantrums if he is not allowed to play counterstrike; can eat food without supervision. His mother doesn’t assist him when she knows that Z.N.I. can do it on his own.

2. Socialization

Children who are exposed to other playmates have an easier time learning to relate to people than those, for instance, who are raised in milieu where they never see other children of the same age. Although preschoolers enjoy to play in groups, they may be involved in arguments more, especially as they become more certain of their role in the group. This development may make parents worry that a child is regressing. However, it is really forward movement, involving some testing and identification of their group role.

ZNI loves playing together with his boy classmates but he is not afraid of interacting with his girl classmates. He is not usually involved in quarrels with his classmates because he is quiet in the classroom. At home, he doesn’t want to share the computer especially when he is playing “counterstrike.”

3. Play

Preschoolers do not need many toys. Their imaginations are keen. They enjoy games that uses imitation such as playing house. They imitate what they see their parents are doing such as eating meals, mowing the lawn, cleaning house and arguing. They also want to play pretend games such as pretending to be teachers, cowboys,

ZNI loves pretending to be an action movie star. According to him he wants to shoot bad guys. He loves playing “shooting games” and he also wants to race.

firefighters and store clerks. Many preschoolers have imaginary friends as a normal part of having an active imagination. These often exist until children formally begin school.

PSYCHOSEXUAL DEVELOPMENT

As for Freud, a pre-schooler is in the Phallic Stage.

1 . Sexuality Phallic stage is the third stage of psychosexual development, spanning the ages of three to five years, wherein the infant’s libido (desire) centers upon his or her genitalia as the erogenous zone. When children become aware of their bodies, the bodies of other children, and the bodies of their parents, they gratify physical curiosity by undressing and exploring each other and their genitals, the center of the phallic stage, in course of which they learn the physical differences between “male” and “female”, and the gender differences between “boy” and “girl”, experiences which alter the psychologic dynamics of the parent and child relationship.

ZNI doesn’t touch his genital all by himself. He only touches it if somebody touches it. He doesn’t show Oedipus Complex because he does not have a father.

MORAL DEVELOPMENT

As for Kohlberg, a pre-schooler is in the preconventional or premoral level.

It follows intuitive thought and is based on external control. Preschoolers determined right from wrong based on their parents’ rules. They have little understanding of the rationale for these rules or even whether the rules are consistent. Because they only depend on their parents supply rules for

At school, ZNI is usually quiet around his classmates but at home there are times that he is restless and naughty but everytime you’re going to tell him that what he is doing is wrong, he would listen to you and would stop what he is doing.

them, when faced with a new situation they have difficulty seeing that the rules they know may also apply to a new situation.

Common Health

ProblemsDefinition Signs and Symptoms Prevention Treatment

Common coldIt is a viral infectious disease of the upper respiratory tract which primarily affects the nose.

Symptoms include coughing, sore throat, runny nose, sneezing, and fever which usually resolve in seven to ten days, with some symptoms lasting up to three weeks.

Washing of hands often; use sanitizers or alcohol base hand rinses.

Getting plenty of rest, drinking fluids to maintain hydration, and gargling with warm salt water, are reasonable conservative measures.

Pneumonia It is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli.

Typical symptoms include a cough, chest pain, fever, and difficulty breathing.

Pneumococcal vaccine; Always wash hands before eating and after going outside; at a daily diet that includes foods rich in antioxidants, such as fresh, dark-colored fruits and vegetables and other nutrients.

Medications should be taken exactly as prescribed by a physician; Rest in bed until body core temperature returns to normal; Drink six to eight glasses of liquids daily to help keep mucous thin and easy to cough up.

Cough Cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes. 

Signs and symptoms that point to an infection include fever, chills, body aches, sore throat, nausea, vomiting, headache, sinus pressure, runny nose, night sweats, and postnasal drip. Sputum, or phlegm,

Wash hands frequently; Increase fluid intake; Take vitamins regularly; Avoid secondhand smoke.

He may attempt to use over-the-counter cold remedies to relieve the symptoms. Acute coughs that are caused by allergies are often relieved with allergy

sometimes indicates an infection is present, but it is also seen in noninfectious causes.

medication, and coughs due to environmental irritants will respond to elimination of the irritating agent.

Constipation It is an abnormal pattern of bowel movements that causes a person to pass stools less often than usual.

Abdominal bloating, cramps or pain, Lethargy, passing hard stools

Drink a lot of fluids, have enough fiber from whole grains or cereals, fruits and vegetables. Do not eat too much junk foods.

Give your child plenty of fluids, especially water.Make sure that your child eats fruits and vegetables every day. 

Fever Fever is one of the most common medical signs and is characterized by an elevation of body temperature above the normal range of 36.5–37.5 °C (97.7–99.5 °F) due to an increase in the temperature regulatory set-point.

A fever is usually accompanied by sickness behavior, which consists of lethargy, depression, anorexia, sleepiness, hyperalgesia, and the inability to concentrate.

Wash hands often; Cover your mouth and nose when sneezing and coughing; Handle food with clean hands; Eat a healthy diet including fruits and vegetables; Get the proper amount of sleep.

A lukewarm bath or washcloth may temporarily cool your child off; Stay away from cold water and ice baths; Giving your child lots of fluids -- including ice pops or Jell-O -- will help his body battle the illness and keep him hydrated; Ibuprofen (Motrin/Advil) can also be used to break a fever in patients over 6 months of age. 

V. References

Pilliteri, A. (2010). Maternal and Child Health Nursing (Vol.2, pp. 862-869)

Los Angeles, California: Wolters Kluwer Health

Macapagal, M, Teh, L. (2007) General Psychology for Filipino College

Students (p. 63) Quezon City: Ateneo De Manila Press

Macapagal, M, Teh, L. (2007) General Psychology for Filipino College

Students (p. 69) Quezon City: Ateneo De Manila Press

Growth. (1995) In Compton’s Encyclopedia (Vol. 9, p. 292).

Chicago: Compton’s Learning Company, A Tribune Publishing Company

Preschool. Retrieved September 26, 2014, from www.babycenter.com

Preschooler Development. Retrieved September 26, 2014, from

http://www.nlm.nih.gov/medlineplus/ency/article/002013.htm

Preoperational. Retrieved September 26, 2014, from

www. psychology.about.com/od/piagetstheory/p/preoperational.htm

Sexual Development. Retrieved September 26, 2014, from

http://allpsych.com/psychology101/sexual_development.html

Kohlberg. Retrieved September 26, 2014, from

http://faculty.plts.edu/gpence/html/kohlberg.htm

Fine Motor Skills. Retrieved September 27, 2014, from

http://www.the-preschool-professor.com/fine-motor-skills.html

Cognitive Development. Retrieved September 27, 2014, from

http://www.education.com/reference/article/cognitive-development-preschoolers/

Common Cold. Retrieved September 27, 2014, from http://en.wikipedia.org/wiki/Common_cold

Most Common Diseases in Children. Retrieved September 27, 2014, from

http://www.livestrong.com/article/172383-most-common-diseases-in-children/

Pneumonia. Retrieved September 27, 2014, from

http://ehealthmd.com/content/how-can-pneumonia-be-prevented

COLEGIO SAN AGUSTIN- BACOLOD

COLLEGE OF NURSING

Case Study of a Pre-schooler

Submitted by: Aya Bolinas, SN CSAB

Submitted to: Mrs. Maria Fe Tabujara, RN, MAN