215- Ch. 7 Assessing for Psychosocial, Cognitive, Moral Development

The mother of a 7 month old attempts to scoop cereal with his palm and reach his mouth, but drops several pieces of cereal on the floor. His mother asks if this feeding behavior is normal. What is the nurse's best response?

"Fine grasp is just now starting to develop at this age." -At age 7-13 months, an infant uses pincer grasp to pick up objects. A child is not expected to feed himself with a spoon and cup until age 10-14 months.

Name the indicators that put the picture together for psychosocial development

-mental/emotional health -role development -self-concept -coping patterns -stress -spiritural beliefs -relationships

Explain the phallic stage

-the infant has moved away and no longer sees themeselves as an extension of their mother -they move into their toddler years and pre-school years where they start exploring/recognizing and noticing their own body which is why they are always touching themeselves

Explain the latency stage

Not much happens here -haven't hit puberty yet, they discovered their bodies and basically in this idea they are existing

During a home visit the nurse notes that an 8-month-old baby crawls to a place on the sofa and lifts up a small blanket to retrieve the television remote control which the mother had hidden to prevent the child from playing with the device. What behavior is this child demonstrating?

Object permanence -According to Piaget, object permanence appears at approximately 8 months and is the awareness that an object continues to exist even though one is not in direct contact with that object. For example, if a toy is hidden under a blanket, the child will attempt to retrieve it from under the blanket. The child is not playing peek a boo or hide and seek. Mental repression is stopping a behavior before acting upon it.

The mother of an adolescent is concerned because the client's personality "seems to be changing daily." If Erikson's theory is followed, what should the nurse include when responding to this mother?

Personality evolves throughout the life span -According to Erikson, personality development continues to evolve throughout the life span. This child is not confused and does not have a personality disorder. According to Freud, personality is predetermined by the preschool age years.

Name the 8 stages of Erikson's psychosocial development

-Infant -Toddler -Pre-schooler -School-anger -Adolescent -Young adult -Middle adult -Older adult

Describe the infant phase

-basic trust vs mistrust -when an infant cries it is not to manipulate, when they cry its for very specific reasons and the longer the patients wait to respond, the longer and louder the cry becomes -if parent continues to not respond (self-soothing theory)—> the infant learns to mistrust its environment and it's caregivers, it recognizes no one is coming and learns to rely on itself

Describe how Erikson and Freud psychosocial theory interact

-connection between them Ex: the phallic stage where they are supposed to be taking initiate but they're really recognizing how their body is being experienced Ex: in that latent phase where none of this sexual associated component are happening, they're suppose to be industrious and helping develop that strong ego

Describe the sensorimotor stage

-exploring the world, putting things in their mouth, touching it, throwing it, etc.

Explain the positive/negative resolution in erikson's psychosocial theory

-if it was positive in the one before, its going to help the one next but if the next one becomes negative its going to affect the next one and that's kind of how this theory moves along

Describe the concrete operation phase

-its that school age that can start making sense but concrete Ex: thinking about fundamentals in health assessment, health assessment is pretty concrete because its either this or that, either normal or abnormal and only one way to do the assessment

Describe the pre-operational stage

-its that young child who can't situate the thinking and is a very literal individual saying "I can't do that" or "I'm not that big", its very literal how they see themselves in the world

Explain the anal stage

-potty training, they suddenly become aware

What are the three stages of Kohlberg

-pre-conventional (pre-moral), there are no morals -conventional (maintain external expectations of others), they have authority over them that is basically defining/describing/role-modeling what is right and what is wrong -post-conventional (maintain internal principles of self), we learn our morals/values from our parents but we choose as we get older whether or not to keep those

Explain the oral stage

-what is in their world, where does everything go? In the mouth! Babies always put everything in their mouth so this makes sense

During the Erikson stage of Autonomy versus Shame and Doubt, the nurse can best foster development by encouraging which action?

Potty training -Erik Erikson (1963) provided a valuable model for viewing individual development over time. His model divides the life span into eight stages, with different psychosocial tasks to complete at each stage. During the autonomy versus shame and doubt stage (toddler), the child should be learning to become independent, such as when using the bathroom. During the infant stage, or trust versus mistrust, needs should be attended to in a timely fashion to foster trust. Sharing ideas with peers should be encouraged during the preschooler (initiative versus guilt) stage. Becoming a worker, or being industrious, occurs during the school age period of industry versus inferiority.

A parent tells the nurse she is concerned that her 5 year old has an imaginary friend. The nurse understands that the child is in what stage of Piaget's cognitive development.

Preoperational -The preoperational stage lasts from ages 2 to 7 years. The child has magical thinking during this time. Sensorimotor occurs at the infant stage. Concrete is from ages 7 to 11 years. Formal operations occurs during adolescence.

A client marvels at having a good relationship with an older sibling now but really "hated" the older sister when growing up. What does this indicate about the client's development?

The older sister is viewed as a companion -During the adult years, many siblings who had earlier disagreements come to value each other as companions. Older siblings are usually jealous of younger siblings. According to Freud, a young child first loves himself only. Younger siblings experience anticipatory rivalry.

Which of the following statements is true regarding Piaget's concept of transductive thinking?

Transductive thinking can be used by formal operational thinkers. -In transductive reasoning, thinking occurs from specific to specific; if two things are alike in one aspect, the child thinks they are alike in all aspects.

The mother of an infant states he cries every times she leaves. She is concerned that there is something wrong. The nurse recognizes the infant is experiencing what stage of Erikson?

Trust -Autonomy is associated with the toddlers and is demonstrated when they can make simple choices and can exert some control. Initiative is associated with preschoolers and is demonstrated by cooperating with others. Identity occurs during adolescence and is demonstrated by establishing own views. Trust is at the infant level and they gain trust through consistency.

During this stage of Erikson, the nurse will find the client to be suspicious and fearful.

Trust vs. basic mistrust -The client will be fearful and suspicious in the trust vs. basic mistrust developmental stage. Autonomy vs. shame and doubt exhibited by doubting abilities. Fear of disapproval may be demonstrated during initiative vs. guilt. The school-ager may feel a sense of failure during industry vs. inferiority.

Describe the formal operational stage

Where that person can handle those abstract ideas and develop more abstract thinking

The nurse suspects that a middle-aged adult is having an issue with generativity. What did the nurse assess to come to this conclusion?

Lack of interest in future generations -Without generativity, stagnation occurs and the middle-aged adult is not able to give to future generations. Sharing personal items with a young neighbor, attending an event with small children, and talking with younger people indicates achievement of generativity.

Oral is what age?

0-1 1/2 years

Phallic stage is what age?

3-6 years

Anal is what age?

1 /1/2- 3 years

What are the 5 stages of Freud's psychosocial development?

1. Oral 2. Anal 3. Phallic 4. Latency 5. Genital

What are the four stages of Piaget's theory

1. Sensorimotor 2. Pre-operational 3. Concrete operational 4. Formal operational

Latency is what age?

6-11 years

Genital is what age?

Adolescence

In what life stage, defined by Erikson, is group identity important?

Adolescence -Adolescents tend to cling together in cliques and crowds. Doing so helps to protect against the loss of identity through the assumption of a group identity that temporarily defines for the adolescent how to dress, act, and belong. Erikson explained that this behavior will eventually fall away as the individual defines his or her own identity. The other options are distractors for this question.

The nurse prepares information for an in-service program on the selection of nursing diagnoses to address psychosocial needs. Which diagnosis would be appropriate for any client age?

Anxiety -The diagnosis of "anxiety" would be appropriate for any age of client. Sedentary lifestyle and Parental role conflict are appropriate for a young adult. Impaired religiosity is appropriate for an older adult.

A nurse is assessing a 40-year-old client in terms of his psychosexual, psychosocial, cognitive, and moral development using both subjective and objective data. Which of the following are examples of objective data collected by the nurse? Select all that apply.

Appears to rely on internalized principles of self when making moral decisions Is capable of repressing anxious thoughts Demonstrates generativity Is capable of readjusting and modifying goals as necessary -The ability to repress anxious thoughts, the ability to readjust and modify goals as necessary, demonstration of generativity, and reliance on internalized principles of self when making moral decisions are all objective findings of assessments of development performed by the nurse. The client's age and education level are examples of subjective data, which the client has provided to the nurse.

A 3-year-old boy walks into an examination room with his mother and sees a tongue depressor. He points to it and says, "popsicle!" The nurse recognizes this as which adaptive process, as described by Piaget?

Assimilation -A schema is a unit of thought and a classification for a phenomenon, behavior or event. Assimilation is an adaptive process whereby a stimulus or information is incorporated into an already existing schema. Accommodation is the creation of a new schema or the modification of an old one to differentiate more accurately a stimulus or a behavior from an existing schema. Equilibration is the balance between assimilation and accommodation.

Describe the toddler phase

Autonomy vs. shame and doubt -started to explore beyond mom/dad/caregiver and start to identify a little bit of this person and finding their place in this world -just trying to figure out what the rules are and how they are supposed to exist in this world -ex: toddler running away from you but will look over their shoulder because they are waiting for you to tell them where that line is and this is that autonomy -parents can find this frustrating but if they take on the idea that its this exploratory age and allow them to do that exploring they won't develop that shame/doubt in themselves

A nurse is assessing a 73-year-old client in terms of her psychosexual development. Which of the following would the nurse most likely identify as an abnormal finding in this client?

Avoidance of relationships -Sexual intimacy; occasional forgetting or misplacement of things; and effective use of previous experiences, self, and others to grieve loss are all normal characteristics of older adults, according to Freud. Avoiding relationships, on the other hand, is an abnormal finding of psychosexual development.

Describe the school-ager phase

Industry vs. Inferiority -suppose to be industrious, when shamed in any way they may start to feel inferior because they can't do or aren't allowed to do

Describe the pre-schooler phase

Initiative vs. guilt -wants to take initiative, wants to try things but they make mistakes and things don't work and when in this stage we have to be careful that we're supporting that initiate and that willingness to play such as standing by the sink for hours making waterfalls with plastic cups -when one doesn't allow that they will develop this inner guilt

Describe the young adult phase

Intimacy vs. isolation -getting marries, forming relationships and are supposed to have healthy intimate relationships but if those relationship don't go well they start moving into stages of isolation

Describe the older adult phase

Ego integrity vs. despair -that i still matter, i am still important, i am worthwhile and people still need me -if they don't have this they fall into that despair because they no longer have a connection and no longer feel that they are generating any productive means of life and don't have anyone visiting them

What term refers to the drive to establish and guide the next generation?

Generativity -The essence of generativity is that people need to be needed. With maturity comes satisfaction from what has been produced. Generativity is principally the drive to establish and guide the next generation. The three distractors are also terms from Erikson's Model of Individual Development. In the late adulthood stage ego integrity versus despair is paired. Ego integrity is when one comes to terms with one's life choices. When one does not reach this developmental mark, despair can result. In the middle adult stage generativity is paired with stagnation. Stagnation results when one does not meet generativity as described above.

Describe the middle adult phase

Generativity vs. stagnation -working, providing for the family, they are generating incomes/providing a stable environment -if that's not happening them may feel that they are very stagnant and that their life no longer has any meaning

The nurse completes her interview of a 39-year-old female client who seems happily married with four healthy children who are doing very well in school and who works part time as a college professor. The nurse would be able to conclude that this client is in which of the following psychosocial developmental stages?

Generativity. -During the stage of generativity the middle-aged adult is able to share self with others and establish nurturing relationships. The adult will be able to extend self and possessions to others.

A middle-aged adult nurse is having difficulty using the computerized documentation system. What does this indicate about the nurse's developmental level?

Has difficulty meeting work expectations -The middle-aged adult who has not attained or maintained formal operational thought experiences difficulty remaining current at work and meeting expectations in all aspects of life in general. This nurse is not able to alter plans for the future, has not learned to adapt quickly to change, and does not prefer to guide young people to achieve independence.

The nurse notes that an adolescent client demonstrates confusion and the inability to focus on tasks. According to Erikson, which central task is this client having difficulty completing?

Identity versus role confusion -According to Erikson, an adolescent who is confused and unfocused is experiencing a negative resolution of the central task identity versus role confusion. Intimacy versus isolation is the central task of a young adult. Ego integrity versus despair is the central task of an older adult. Generativity versus stagnation is the central task of a middle-aged adult.

Describe the adolescent phase

Identity vs. Role confusion -trying to figure out who they are, how they exist and how they see themselves -if they don't have this opportunity to figure this out, they come out with a lot of role confusion

A nurse is discussing summer plans with a 16-year-old girl. The client tells the nurse she will be working her first job. The nurse recalls that, according to Erikson, which of the following is the primary task of adolescents?

Identity vs. role confusion -The primary task of adolescents is identity vs. role confusion. Autonomy vs. shame and doubt is the primary task of toddlers, initiative vs. guilt the primary task of preschoolers, and industry vs. inferiority the primary task of school-aged children.

The nurse recognizes that a child is most likely in Piaget's preoperational stage of development when observing which activity?

Pretend play -Using language and pretend play are characteristics of the preoperational stage. Seriation refers to the ability to arrange objects by quantitative dimensions, characteristic of the concrete operational stage. Formal operations also include verbal problem-solving skills. The adolescent who uses formal operations can be presented verbally with "A = B, B = C, A ? C" and substitute the "=" for the question mark without having to see the written problem. The amygdala (that part of the brain involved in processing emotional information) matures sooner than the prefrontal cortex (Santrock, 2012). This finding may partially explain why teens frequently react emotionally before weighing the consequences of such behavior and why they may do things and not realize beforehand what the consequences might be- formal operations stage.

Explain the genital phase

Puberty, hormones are surging

The parents of a teenager tell the nurse he has become despondent and does not associate with any of his old friends but is not involved a crowd that uses drugs. The nurse recognizes the teen is experiencing what state of Erikson?

Role confusion -Role confusion occurs when the teen struggles with how they are seen by others and who they are. Autonomy is associated with the toddlers and is demonstrated when they can make simple choices and can exert some control. Initiative is associated with preschoolers and is demonstrated by cooperating with others. Trust is at the infant level and they gain trust through consistency.

A nurse is assessing a 24-year-old client in terms of her psychosocial development, following Erikson's approach. Which of the following would the nurse most likely identify as an abnormal finding in this client?

Sexual promiscuity -Although this stage focuses on the desire for a special and permanent love relationship, it also includes the ability to have close, caring relationships with friends of both genders and a variety of ages. Having established an identity apart from the childhood family, the young adult is now able to form adult friendships with parents and siblings. However, the young adult will always be a son or daughter. If the young adult cannot express emotion and trust enough to open up to others, social and emotional isolation may occur. Loneliness may cause the young adult to turn to addictive behaviors such as alcoholism, drug abuse, or sexual promiscuity.

The nurse prepares to assess a school-age child's cognitive functioning. According to Piaget, which areas should the nurse recall as being necessary for cognition to occur? Select all that apply.

Social interaction Physical maturity Experience in general Environmental stimulation -According to Piaget, the interrelationships of physical maturity, social interaction, environmental stimulation, and experience in general are necessary for cognition to occur. Meaningful work is not identified as a variable for the development of cognition.