Competency Appraisal: Pediatric Nursing Case Scenario # 4

4NUR 6 RLE 3A
Pea, Eden, G.
Peol, Mickaela Cristie R.
Pineda, Patricia Ericka C.

Pira, Beatriz Dominique B.

Pulanco, Ivan Dominique C.
Puno, Geneviere Audrie T.

The orphanage conducts home school education to some of their residents. Among those
enrolled in the program are Carlo, 9 years old and Samantha, 14 years old. They have both been in
the orphanage for less than a year. Carlo is enrolled in home-school program parallel with a first
grader. He has never been in school and has not started in learning and reading and writing.
Samantha, on the other hand, is not as delayed in her schooling. She stopped just a year ago when
her parents both died in the flood. They live in Cagayan de Oro. She was brought here to Manila by
her relatives who also eventually abandoned her. Now the sisters in the orphanage adopted her. She
has given her intention to become a nun too.
Nurse Conchitina also helps in the program by tutoring some of the children. She finds it very
rewarding teaching Carlo because just like a "sponge", he eagerly absorbs everything taught to him
and is always eager for more. He usually arrives earliest in the study room and would arrange the
chairs and tables before the others arrive. He would usually volunteer tasks for the teacher. It just
makes him feel a little bit uncomfortable knowing that he is the oldest in the grade 1 level.
Samantha, on the other hand, is an "angel" as what the sisters call her. She is very kind to the
other children and would serve as their "ate" in times of need. She said in Cagayan where they live
before she has many friends who goes with her as they --- movies of her favorite actor whom she has
a crush on and she used to be the president of their club, the Legion of Mary. She is definitely an asset
to the orphanage and the sisters considers her being brought to them a blessing. More recently though,
she was observed to be a little bit "moody" shying away from the company of her other friends and
would spend time alone just reading a book.
Answer the following questions:
1.

What stage of development are the two in? What stage in Erikson's, Freud's and
Piaget's theory do they belong? Explain a little bit about these stages.
THEORIES OF DEVELOPMENT
Carlo, 9 years old
Stage of Development - (6 12 years)

A time of steady growth and development. Keener interest in the difference

between genders observed. Most only play with children of the same sex. Children at
this stage tend to be competitive but become more adept in relationships and are able
to work in groups by stage 8-9. They become more sophisticated in understanding of
time and numbers. Development of physical/sports skills like throwing or balancing
starts to develop. Children at this stage may also be argumentative, sulky and be hard
on their little siblings.

Freud - Latency Stage (5/6 puberty)

Stage of dormant/repressed sexual feelings. No psychosexual behaviour

occurs. Child receives pleasure from social interactions. The child channels his
attention to socially acceptable behaviour (i.e: arranging chairs) to reduce the tension
of the phallic stage. Sexual impulses are repressed during the latent stage and sexual
energy can be sublimated towards school work, hobbies and friendships. Much of the
child's energy is channelled into developing new skills and acquiring new knowledge
and play becomes largely confined to other children of the same gender.

Piaget - Concrete Operational (7 11 years)

Marks the beginning of logical or operational thought that is required for

schooling. The child is now mature enough to use logical thought or operations (i.e.
rules) but can only apply logic to physical objects (hence concrete operational). This
appreciation for facts, numbers and rules explains a childs eagerness and ability to
manipulate numbers in things multiplications tables or interest in the past through
history stories.
A key feature of this stage is CONSERVATION or the understanding that
something stays the same in quantity even though its appearance changes. By around
seven years the majority of children can conserve liquid. 5 year old children would
assume that the quantity of the liquid has changed because of the change in shape.

Erikson - Industry (5 - 12 years)

Children learn to read and write, to do sums, to do things on their own.

Teachers begin to take an important role in the childs life as they teach the child
specific skills.
It is at this stage that the childs peer group will gain greater significance and
will become a major source of the childs self-esteem. The child now feels the need to
win approval by demonstrating specific competencies that are valued by society, and
begin to develop a sense of pride in their accomplishments.
If children are encouraged and reinforced for their initiative, they begin to feel
industrious and feel confident in their ability to achieve goals. If this initiative is not
encouraged, if it is restricted by parents or teacher, then the child begins to feel inferior,
doubting his own abilities and therefore may not reach his or her potential.
If the child cannot develop the specific skill they feel society is demanding (e.g.
being athletic) then they may develop a sense of inferiority. Some failure may be
necessary so that the child can develop some modesty. Yet again, a balance between
competence and modesty is necessary. Success in this stage will lead to the virtue of
competence.

Samantha, 14 years old

Adolescents/Teenagers (13 18 years)

As the teens enter highschool, they begin to develop the independence and
responsibility required for adulthood. Abstract thinking becomes more common
amongst teens, with pondering on grey-areas as opposed to seeing things in clear
black and white. Logic and reasoning skills are enhanced. Tensions start to develop

between them and their parents as they strive for independence. Physical and sexual
development speeds up with the development of breasts or body hair and growths
spurts. Romance and friendship becomes more important than cliques though ones
taste in music, clothing, mediaetc are still heavily influenced by ones peer groups.
Lots of teenagers pair off into couples. Dating becomes more pervasive, and some
teens develop intense romantic relationships.
Freud Genital Stage (puberty adulthood)

A time of sexual reawakening and sexual experimentation. Successful

resolution of the stage leads to settling down in a loving one-to-one relationship with
another person in our 20's. Source of pleasure now stems from someone outside the
family. For Freud, the proper outlet of the sexual instinct in adults was through
heterosexual intercourse. Unresolved conflicts with parents re-emerge at this stage
and once resolved, allows to individual to develop mature and loving relationships and
develop into adulthood.

Piaget Formal Operation (11+ years)

As adolescents enter this stage, they gain the ability to think in an abstract
manner, the ability to combine and classify items in a more sophisticated way, and the
capacity for higher-order reasoning. This is demonstrated with them being able to
manipulate objects in their head or to draw conclusions off hypothetical situations
without physical information.
A perfect example of this is the question, If Kelly is taller than Ali and Ali is
taller than Jo, who is tallest? Children who can imagine the scenario and come up with
an answer in their heads without drawing the 3 figures on a sheet of paper have
successfully entered formal operation. Children at this stage also approach things in a
more systematic fashion, testing different variables in a given problem rather than
solving situations by random. This indicates they are thinking logically, in the abstract,
and could see the relationships between things.

Erikson - Identity vs. Role Confusion (12 18 years)

This is the important transition from childhood to adulthood. Children are

becoming more independent, and begin to look at the future in terms of career,
relationships, families, housing, etc. They want to belong to a society and fit in.
The child has to learn the roles he will occupy as an adult. It is during this stage
that the adolescent will re-examine his identity and try to find out exactly who he or she
is and the body image of the adolescent changes.
Erikson claims that the adolescent may feel uncomfortable about their body for
a while until they can adapt and grow into the changes. Success in this stage will
lead to the virtue of fidelity and self-identity.
During this period, they explore possibilities and begin to form their own identity
based upon the outcome of their explorations. Failure to establish a sense of identity
within society can lead to role confusion. Role confusion involves the individual not
being sure about themselves or their place in society.

2.

In response to role confusion or identity crisis an adolescent may begin to experiment

with different lifestyles (e.g. work, education or political activities). Also pressuring
someone into an identity can result in rebellion in the form of establishing a negative
identity, and in addition to this feeling of unhappiness.

What are the characteristics of Carlo that typically shows that he is a school-age
child? What are the characteristics of Samantha that typically shows she is an
adolescent? Give at least two (2) and elaborate on this.
CHARACTERISTICS
Carlo, 9 years old
Eager to learn and to do more

School children do indeed soak things up like a sponge. According to

research by from neurologist Harold Chugani in UCLA, their brain structure have
trillions more connections between different neurons compared to an adult brain. Their
brains metabolize more glucose and are generally according to PET scans conducted
by Chuganis team. By age 4, a childs brain can be 2x more active than an adult brain.
This huge number of connections and high brain activity explains why children
tend to learn things like foreign languages and musical instruments easier than most
adults. It is when we enter adulthood that our brain recognizes which connections in
the cerebral cortex are important and which ones can be eliminated. It is through
repetition that we retain important facts and skills. Carlo is an eager and effective
learner because his brain is wired to allow children his age to be like that.

Arrives earliest in the study room and arranges chairs and tables before the others arrives.

Children at this age views things in moral absolutes (i.e good boy/good girl
mentality) and derive pleasure when praised for doing socially acceptable or moral
things. Their energies are devoted to things moral acts and in competitive play
between their peers. They seek to win approval by demonstrating their worth through
specific competencies held at high value by their peer groups or figures of authority.
Examples include being good at sports or being number one in the class.

Samantha, 14 years old

Observed to be a little bit "moody"

Teenagers can selfish, reckless and irritable because their brains develop
slower than their bodies, scientists have claimed. Psychologists used to blame the
unpleasant characteristics of adolescence on hormones. However, new brain imaging
scans by the team of Jay Giedd, at the National Institute of Mental Health in Bethesda,
Maryland have reveal that the true cause could be a high number of structural changes
in teenagers and those in their early 20s.

Teens experience a sudden, natural increase in nerve activity in the prefrontal

cortex, the brain region that weighs experience and perception to determine
appropriate action. It also plays a key role in controlling social behaviour. According to
a Psychology Today article from 2003, the increased nerve activity leads to a sort of
temporary reorganization that may make it difficult for adolescents to process
information and read social situations. This could be particularly tough, as social
interactions are often the dominant influence on teenage behaviour.

Samantha has been observed to be shying away from her friends and would spend time alone

3.

Teenagers are on the stage of developing sense of identity. Samantha was

known to be very kind and had a lot of friends. During adolescence, we are much more
self-conscious about our changing identities than at any other stage in our lives.
Successful resolution leads to a secure identity; failure leads to role confusion and a
weak sense of self. The key to resolving this crisis lies within the adolescent's
interaction with others. A positive self-identity is correlated with positive self-esteem.
All identities are not equally valued by society, so some adolescents may especially
need reinforcement to help them construct a positive sense of self.

What are the most frequently encountered problems school nurses usually face
as she deals with schoolers and adolescents? Give at least two (2) for each age group.
Answer may not necessarily come from the case scenario.
PROBLEMS AMONG SCHOOLERS
Dentition

Common problems: cavities, malocclusion, periodontal diseases (gingivitis), dental

injury (fractures, chipping, avulsion)

Age of loose tooth and ugly duckling stage

Gains 28 teeth between 6 12 years old

First permanent tooth (secondary) teeth erupt at about 6 years of age

At 6 years of age, all the primary teeth are present and secondary dentition are well
formed

Nutrition

Quality depends on familys pattern of eating

Acquires taste of increasing variety of foods

Strongly influenced by mass media

Fast food and junk foods (encourage consumption of fruits, nuts and other
wholesome finger food to meet his needs)

Sleep

Bedtime resistance

Night time terrors

Sleep walking

Injury

Motor vehicular accidents/ bicycle injury (rear seat is the safest place; wear gears)

Drowning (check water depth; have a companion)

Teach child how to swim (use floating devices)

Burns (smoke detectors at home; instruct child regarding behaviors in area involving
contact with potential burn hazards)

Poisoning (keep away from childs reach; ensure prober labeling)

Bodily damage/ School injury playground (always supervise the child)

School Phobia

May be caused by fear of separation from parents due to overprotection; fear of a

particular teacher or a particular situation like tests or a school bully (may develop
physical signs like vomiting, diarrhea or abdominal pain during school days)

Child should continue attending school after illness has been ruled out

PROBLEMS AMONG ADOLESCENTS

Parenting & family adjustment
Psychosocial adjustment
Injuries
Dietary habits, eating disorders, obesity
Physical fitness
STDs, unintended pregnancy
Depression & suicide
Physical, sexual, emotional abuse
Health problems: hypertension, hyperlipidemia, infections

SCHOOL-AGE

Dentition age of loose tooth and ugly duckling stage

Dental Health cavities, malocclusion, periodontal diseases (gingivitis), dental injury

(fractures, chipping, avulsion)

Nutrition fast food and junk foods

School injury/ playground

ADOLESCENT

Health concerns:

Here are some health issues school nurses encounter, with prevalence rates.

AMONG ALL SCHOOL-AGED CHILDREN

Obese, overweight, 32%

Vision deficiencies, 24%

Prescribed medication for more than 90 days, 13%

Mental, emotional or behavioral problems, 10%

Illness or injury resulting in more than 11 missed school days, 6%

Asthma, 10%

Food allergies, 5%

Seizure disorder, 5%

Hearing deficiencies, 5%

Attention Deficit Hyperactivity Disorder, 5%

Among 12th-graders:
Sexually active, 65%

Use of an illicit drug, 47%

Source: National Association of School Nurses.
http://www.wsj.com/articles/SB10000872396390444358804578016221407143166