Chapter 32 1. Jumps off bottom step; walks upstairs alternating feet; stands on one foot 2. Rides tricycle using pedals 3. Constructs three-block bridge; builds tower of 9 or 10 cubes 4. Can unbutton front or side button; uses spoon C Sensory: visual acuity 20/30 D Vocalization and socialization 1. Vocabulary: about 900 words; uses three- to four-word sentences; uses plurals; may have hesitation in speech pattern; may stutter 1. Skips and hops on one foot; walks up and down stairs, alternating feet 2. Fastens buttons; laces shoes C Vocalization and socialization 1. Vocabulary: 1500 words or more 2. May have imaginary companion 3. Can be selfish and impatient; takes pride in accomplishments; exaggerates; boasts; tattles on others A Physical: height and weight increase similar to previous year 1. Gross motor abilities: well developed; balances on one foot for about 10 seconds; can jump rope, skip, and roller skate 2. Can draw picture of a person; prints first name and other words as learned D Vocalization and socialization 1. Vocabulary: about 2100 words; talks constantly; asks meaning of new words 2. Generally cooperative and sympathetic toward others E Mental abilities (Piaget’s phase of intuitive thought) A Loosely organized group; membership and rules change readily B Learns to cope with reality and control feelings C Expresses emotions through actions rather than words D Physically oriented; imitative and imaginary; blurred line between reality and fantasy (e.g., may have imaginary playmates) E Tends to exaggerate; be impatient, noisy, selfish F Increased sharing and cooperation, especially 5-year-olds 1. Fears about body image and bodily harm greater than fear of separation 3. May regress to earlier developmental behaviors (e.g., bedwetting) 5. Cries when parents arrive/leave, but usually is calm when parents are not present 6. May find physical examinations threatening; may require modification of procedures (e.g., handling equipment, having child sit/lay on parent’s lap, allowing child to guide hand during assessment of abdomen) B Parental support: can prepare child for interventions because of increased cognitive and verbal ability A Begin preparing for elective hospitalization several days before, not sooner, because of vague concept of time; encourage to bring security article or special toy B Clarify cause and effect because of phenomenalistic thinking (in child’s mind proximity of two events relates them to each other) C Keep verbal explanation as simple as possible and always honest D Explain routines but not everything at once, may be overwhelming; add details about procedures, drugs, surgery, based on cognitive level and past personal experiences E Initiate therapeutic play (e.g., dolls, puppets, make-believe equipment, dress-up doctor and nurse clothes) as an outlet for fear, anger, and hostility, as well as temporary escape from reality A Cancer of blood-forming organs; overproduction of immature, nonfunctioning leukocytes B Incidence: most common type of childhood cancer; prognosis is improving 1. Acute lymphoblastic leukemia (ALL): affects lymphocytes a. Divided into subtypes based on morphological, cytochemical, and immunologic characteristics (T, B, null, and pre-B subtypes) b. Five-year disease-free survival: 91% when diagnosed at younger than 5 years of age 2. Acute myelogenous leukemia (AML): acute nonlymphoblastic leukemia 1. Decreased erythrocytes: anemia (e.g., pallor, weakness, irritability) 2. Decreased neutrophils: increased risk for infection (e.g., fever) 3. Decreased platelets: bleeding tendencies (e.g., ecchymoses, petechiae, bleeding gums and other mucous membranes) 4. Invasion of bone by leukemic cells: bone pain, fractures 5. Enlarged spleen, liver, and lymph glands 6. Intestinal inflammation: anorexia, vague abdominal pain 7. Later signs: central nervous system (CNS) involvement and frank hemorrhage 1. Chemotherapy: protocols for AML and ALL are different; each protocol is based on child and disease factors (see Chapter 3, Integral Aspects of Nursing Care, Neoplastic Disorders, Related Pharmacology) a. Induction therapy for ALL: 4 to 6 weeks b. Intensification (consolidation) therapy for ALL: further decreases number of leukemic cells; combination of two or more drugs given in routine periodic stretches of administration (pulses) during first 6 months c. CNS prophylactic therapy: irradiation and triple intrathecal medications (e.g., methotrexate, cytarabine, hydrocortisone) because leukemic cells invade brain; most antileukemic drugs do not pass blood-brain barrier d. Maintenance therapy: preserves remission and further reduces number of leukemic cells 2. Hematopoietic stem cell transplantation (HSCT); not performed during first remission 3. Transfusions to replace and provide needed blood factors (e.g., RBCs, platelets, WBCs) 1. Encourage adjustment to chronic illness; stress need for maintaining lifestyle 2. Identify perception of illness and death based on level of understanding a. Preschooler: concept that death is reversible; greatest fear is separation b. Young school age (6 to 9 years old): death is personified as individual who comes to remove child c. Older school age (over 9 years old): adult concept of death as irreversible and inevitable 3. Support while experiencing side effects of medications; administer prescribed antiemetics (e.g., ondansetron) before chemotherapy 4. Encourage adequate nutrition despite anorexia; provide preferred foods, even hot dogs 5. Teach infection prevention: hand washing; avoiding contact with those with active infections; avoiding crowded places 6. Handle gently to reduce pain, risk for hemorrhage 7. Use pain rating scale and medicate appropriately 8. Provide gentle oral hygiene: use soft-tipped applicator; saline mouth rinses; offer soft, bland foods; cool liquids/food rather than cold or hot
Nursing Care of Preschoolers
Growth and Development
Developmental Timetable
Three Years
Four Years
Five Years
Health Promotion of Preschoolers
Play (Cooperative Play)
Hospitalization of Preschoolers
Data Base
General Nursing Care of Preschoolers
Health Problems Most Common in Preschoolers
Leukemia
Data Base
Nursing Care of Children with Leukemia
Planning/Implementation
Evaluation/Outcomes
