Growth and development Flashcards
Developmental theories
Provide a framework for identifying a patient’s normal developmental needs and any problems that exist.
- Help nurses use clinical judgment to accurately assess a person’s response to an illness and develop an individualized treatment plan.
- Guide caregivers in selecting appropriate interventions.
Erki Erikson
- Trust vs. mistrust (birth to 12 to 18 months)
- Autonomy vs. sense of shame and doubt (18 months to 3 years)
- Initiative vs. guilt (3 to 6 years)
- Industry vs. inferiority (6 to 12 years)
- Identity vs. role confusion (puberty)
- Intimacy vs. isolation (young adult)
- Generativity vs. self-absorption and stagnation (middle age)
- Integrity vs. despair (old age)
developmental theories
Cognitive developmental theory–Jean Piaget
Period I: Sensorimotor (birth to 2 years)
Period II: Preoperational (2 to 7 Years)
Period III: Concrete Operations (7 to 11 Years)
Period IV: Formal Operations (11 Years to Adulthood)
Research in adult cognitive development
Proposed fifth stage of development: Postformal thought
moral development theory
Moral development theory
Kohlberg’s Theory of Moral Development
Level I: Preconventional reasoning
Level II:Conventional reasoning
Level III: Postconventional reasoning
Kohlberg’s critics
Moral reasoning and nursing practice
human growth and development
- Human growth and development are continuous and complex.
- Stages are typically organized by age groups.
- Growth and development are based on timing and sequence of developmental tasks
Newborn: Growth and Development
First 28 days of life
Physical changes – lose up to 10% of birth wt first wk; regained 2nd wk
Cognitive changes – responds to faces, black/white patterns, bright colors
Psychosocial changes
* attachment
* Health promotion
* Screening
* All newborns are screened to identify life-threatening conditions before symptoms begin.
Car seats
* Teaching parents about car seat use is an essential component of discharge.
Sleep and cribs
- Safeguards to reduce risk for sudden infant death syndrome
- Cribs must not have drop side rails and require more durable mattress supports and crib slats
growth and development: infancy
1 month old to 1 year of age
Physical changes
* Size increases rapidly – Growth charts
* Development of sight, hearing, and fine- and gross-motor movements
Cognitive changes
- Continued development of sight, hearing, and touch
- Memory and language development begins (3-5 words)
- Psychosocial changes
- Separation and individuation
Play – solitary, exploratory (Rattles, blocks, stuffed animals
Health risks
Injury prevention (MVA, suffocation, falls, poisoning)
Child maltreatment (Abuse or neglect)
Health promotion
Nutrition-Breastfeed/formula
* solid foods introduced at 6 mo
* Supplementation-fortified cereal; fluoride for teeth
* Immunizations-Scheduled; side effect (low grade fever)
* Sleep-at 6mo sleep 9-11 hrs through night
growth and development: toddler
12 to 36 months of age
Physical changes
* Elongation of legs; fine- and gross-motor movements (walking, dressing, running, jumping, eating, drink from cup, draw circles
Cognitive changes
* Memory, language (10 – 300 words, simple sentences)
Psychosocial changes
* Sense of autonomy (temper tantrums), parallel play (stack blocks)
Health risks
Increased locomotion
* Poisoning, drowning, motor vehicle accidents; hospitalization (separation from parents)
Health promotion
Nutrition – develop lifetime eating habits; need whole milk til age 2; offer variety, finger foods
Toilet training – developing sphincter control; motivation
growth and development: preschooler
3 to 5 years of age
Physical changes
* Growth slows but continues. (4.5-6.5 lb/yr) little difference btwn sexes
* Gross- and fine-motor movements continue to develop. (run well, up/down stairs, skate, swim, scribbles; hand/eye coordination
Cognitive changes
* Recognition of cause-and-effect relationships; inanimate objects/lifelike qualities
- Language continues to develop. (2100 words)
Psychosocial changes - Increased social interaction, cooperative play with one other child – up to 3 others
- Computer games; nonviolent tv (1 hr/day) read, physical activity
Health risks
* Children need to learn about safety
- Parental example is important (wearing bike helmet)
Health promotion
Nutrition – intake half of adult, engage them in meal prep
* Sleep – 12 hr/night; infrequent naps
* Vision – screenings start
growth and development school aged-child
6 to about 12 years old
Physical changes
* Consistent growth, improved coordination (girls exceed boys in ht and wt)
- Fine motor skills improve, posture more erect (catch/throw; drawing; 20/20 vision)
Cognitive changes
* Begin to demonstrate logical, more concrete thinking; understand viewpoints
- Language development is rapid (phrasing, generalizations, jokes)
Psychosocial changes: Self-concept, sense of worth
Peer relationships – group goals, teamwork
Sexual identity – curiosity, sex education
Stress– more than earlier generations (expectations, violence); after school care, coping skills
Virtual learning vs face-to-face learning (more independent)
Health risks
Accidents– increased risk-taking
Infections – poverty/increased prevalence
Health promotion
Perceptions – identity and self-concept become stronger and individualized
Health education – critical to establishing healthy adult behaviors; exercise, nutrition, body changes
Health maintenance – immunizations, screenings, dental care
Safety – accidents (wearing helmets and seatbelts)
Nutrition – independent healthy choices, obesity
growth and development: adolescent
13 to 20 years old
Puberty – the point at which reproduction becomes possible
**Physical changes **
* Increased growth rate of skeleton, muscle, viscera
Sex-specific changes
* Alteration in distribution of muscle and fat
* Cognitive changes (rank possibilities, solve problems)
Language skills – vocabulary expands; communicates thoughts/feelings
Psychosocial changes
Sexual identity– physical evidence of maturity
Peer group identity – Self-esteem & acceptance
Family identity – peers more important than parents
Health identity – perception of health maintenance & health promotion
growth and development: adolescent
Health risks
* Accidents; MVA (leading cause of death)
* Violence and homicide (2nd leading cause of death in US)
* Suicide – in past 30 years (doubled{11-14}/tripled{15-19})
* Substance abuse – decreasing opioid & tobacco use
* Eating disorders – screening perception of body image
* Sexually transmitted infections – affects millions of adolescents
* Pregnancy – highest rate of industrialized countries
Health promotion
* Health education – private & confidential
* Minority adolescents – greater percent of health problems
* Gay, lesbian, and bisexual adolescents – hiding increases depression and suicide
growth and development: young adults
Late teens to mid-30s
* Emerging adulthood is late teens to mid-20s – Focus on becoming independent
Physical changes – complete physical growth
Cognitive changes – Critical thinking, Formal & Informal Education, occupation
Psychosocial changes
* Lifestyle – health risk behaviors
* Career – Successful Employment
* Sexuality - Maturation
* Childbearing cycle
* Types of families – Single to Partnerships
* Singlehood – pressure to Marry
* Parenthood – Pressure to have children
* Alternative family structures and parenting
Emotional health – Need resources and support systems
growth and development: young adult
Health risks
* Family history – disease development risk
* Violent death and injury – common cause of death
* Intimate partner violence – 4.8 million women/2.9 million men/yr in us
* Substance abuse – Alcohol, drugs, marijuana, caffeine
* Human trafficking – runaway or homeless
* Unplanned pregnancies – adverse health outcomes
* Sexually transmitted infections – syphilis, chlamydia, gonorrhea, herpes, hpv, aids
Environmental or occupational factors – Work-related hazards
Health concerns
* Health promotion - education
* Psychosocial health
* Job stress – situational (new boss, deadlines)
* Family stress – relationships, situational
* Infertility – 10-15% couples are infertile
* Obesity – 16% at risk
* Exercise – suggested 5 hrs/wk
growth and development: young adults
Health concerns
* Pregnant woman and the childbearing family
* Prenatal care – good health practice (avoid alcohol, no smoking, folic acid)
Physiological changes – morning sickness, fatigue, abdominal growth
Postpartum – (6 wks) return to prepregnant state, lactation
Needs for education – breastfeeding, newborn
Psychosocial changes – body image, role change, sexuality, coping & stress
Health concerns – mom & baby, bonding
Acute care
* Causes of acute care include accidents, substance abuse, exposure to environmental and occupational hazards, stress-related illnesses, respiratory infections, gastroenteritis, influenza, urinary tract infections, and minor surgery.
* Restorative and continuing care
* Restorative and continuing care often results from motor vehicle accidents, trauma from violence, or chronic diseases affecting the young-adult population, such as multiple sclerosis, rheumatoid arthritis, AIDS, and cancer.
growth and development: middle aged adults
Aged 35-64 years – 37% of us population
Sandwich generation– responsible for children and aging parents
* Physical changes – graying, wrinkles, thick waist, vision/hearing changes
* Perimenopause and menopause
* Climacteric – decreasing testosterone
Cognitive changes
* Rare, unless illness or trauma occurs
Psychosocial changes
Expected events – children move away
Career transition - choices
Sexuality – redefine relationship after last child leaves
Family psychosocial factors
Singlehood – delayed marriage and parenthood; education and career
Marital changes– marriage, divorce, death of spouse
Family transitions – children leave home, readjustment
Care of aging parents
growth and development: middle adults
Health concerns
* Health promotion and stress reduction
* Obesity – health consequences (high bp; diabetes heart disease)
* Forming positive health habits – reduce risk of disease
* Health literacy – ability to gain access to, and understand information
Psychosocial health
* Anxiety – response to changes in middle age
* Depression – mood disorder
* Early-onset dementia – affects family responsibilities, maintain independence
Health concerns
* Community health programs – self-help groups, primary care, education
* Acute care
* Longer recovery period, slower healing process
* Restorative and continuing care
* Chronic illnesses affect roles and responsibilities
growth and development: older adults
- Myths & stereotypes
- Ageism
- Discrimination against people due to increasing age
- Banned by current laws
Nurses can:
* Promote a positive perception regarding the aging process when establishing therapeutic relationships and value the experiences of older adults
- Use clinical judgement in a way that objectively assesses a patient’s functional, physiological, psychosocial, and emotional status
- assess their own attitude toward older adults and their own aging.
Developmental tasks for older adults
* Associated with varying degrees of change and loss
* Health, significant others, a sense of being useful, socialization, income, and independent living
* Coping with Retirement, Residence change, or Death of a spouse
* Adult children
growth and adults: older adults
- Community-Based and Institutional Health Care Services
- Nurses encounter older-adult patients in a wide variety of community and institutional health care settings:
- Private homes, apartments, retirement communities, adult day care centers, assisted-living facilities, and senior living communities
- Nurses and social workers can help older adults and their families by providing information and answering questions as they review care options.
growth and development: older adults
Gerontological nursing
* Involves the provision of care that addresses mutually established goals for an older adult, the family, and health care team members
Physiological assessment - changes
* General survey
* Initial inspection may reveal some universal aging changes.
Integumentary system
* Skin loses resilience and moisture.
Head and neck
- Facial feature may become more pronounced.
- Visual and auditory impairments may be present.
- Salivary secretion is reduced, and taste buds lose sensitivity.
Thorax and lungs
* Respiratory muscle strength decreases.
* Anteroposterior diameter of thorax increases.
growth and development: older adults
Heart and vascular system
* Decreased contractile strength of the myocardium results in decreased cardiac output.
Breasts
* Milk ducts of the breasts are replaced by fat, making breast tissue less firm.
- Atrophy of glandular tissue coupled with more fat deposits results in a slightly smaller, less dense, less nodular breast.
Gastrointestinal system and abdomen
* Aging leads to an increase in the amount of fatty tissue in the trunk and abdomen.
- Gastrointestinal function changes include a slowing of peristalsis, noted by auscultating reduced bowel sounds, and alterations in secretions.
growth and development: older adults
Reproductive system
* Changes in the structure and function of the reproductive system occur as the result of hormonal alterations.
Urinary system
* Prostate gland hypertrophy is frequently seen in older men.
- Urinary incontinence is an abnormal and typically embarrassing condition that is more common in women but may also occur in men.
Musculoskeletal system
* With aging, muscle fibers become smaller.
* Bone density and bone mass decrease with age.
Neurological system
* All voluntary reflexes are slower, and individuals often have less of an ability to respond to multiple stimuli.
growth and development: older adults
Functional changes
* Functional status in older adults includes the day-to-day activities of daily living (ADLs) involving activities within physical, psychological, cognitive, and social domains.
- A decline in function is usually linked to illness or to disease and degree of chronicity.
- When a decline is identified, focus interventions on maintaining, restoring, and maximizing an older adult’s functional status to maintain independence while preserving safety and dignity.
growth and development: older adults
Cognitive changes
* Delirium
* Acute confusional state
* Dementia
* Generalized impairment of intellectual functioning that interferes with social and occupational functioning
* Depression
* The Geriatric Depression Scale is an easy-to-use screening tool that can be used in conjunction with an interview with the older adult.
Psychosocial changes
* Life transitions
* Retirement
* Social isolation
* Sexuality
* Housing and environment
* Death
growth and development: older adults
Physiological concerns
* Nutrition
* Dental problems
* Exercise
* Falls
* Sensory impairments
* Pain
* Medication use
* Health promotion and maintenance
Psychosocial concerns
* Elder mistreatment
* Therapeutic communication
* Touch
* Reality orientation
* Validation therapy
* Reminiscence
* Body image interventions
growth and development
Acute care settings pose increased risks for adverse events:
* Delirium
* Dehydration
* Malnutrition
* Health care–associated infections
* Urinary incontinence
* Falls
Types of ongoing care:
* Continuation of recovery from acute illness
- Support of chronic conditions that affect day-to-day functioning
- Goal to regain or improve prior level of independence, ADLs, instrumental activities of daily living (IADLs)
- Focus on activities that allow older adults to remain functional and safe within their living environments.
