Care Across the Lifespan

In which stage of development do people look back over their lives and take stock in their accomplishments and failures?

Ego identity vs. Despair (Late adulthood)

Gross and fine motor skills at 12 months

Gross: sits down from a standing position w/out assistance & walks with one hand held Fine: tries to build a two-block tower w/out success & can turn pages in a book

Gross and fine motor skills at 8 months

Gross: sits unsupported Fine: begins using pincer grasp

What gross and fine motor skills would you expect at 2 years?

Gross: walks up and down stairs Fine: builds a tower with six or seven blocks

What gross and fine motor skills would you expect at 15 months?

Gross: walks w/out help, creeps upstairs, & assumes standing position Fine: uses cup well & builds tower of two blocks

Dementia

Chronic, progressive, and possibly with an unknown cause (Alzheimer's disease, vascular dementia)

Expected pulse for a newborn

110-160 bpm

Age appropiate activities from infancy to 1 year

- Rattles - Mobiles - Teething toys - Nesting toys - Playing pat-a-cake - Playing with balls - Reading books

Riding a tricycle

3 years old

Expected respirations for a newborn

30-60/min

Parallel play

Action in which children play with similar toys, in a similar manner, but do not interact with each other

What gross and fine motor skills would you expect at 1 month?

Gross motor skills: demonstrates head lag Fine motor skills: has a strong grasp reflex

What gross and fine motor skills would you expect at 2.5 years?

Gross: jumps with both feet & stands on one foot momentarily Fine: draws circles & has good hand-finger coordination

Gross and fine motor skills at 9 months

Gross: pulls to a standing position Fine: has a crude pincer grasp & dominant hand preference evident

Gross and fine motor skills at 6 months

Gross: rolls from back to front Fine: holds bottle

Ego Integrity vs. Despair

(Late adulthood - 65 years and older) Individuals review their lives, and if they are satisfied and feel a sense of accomplishment, they will experience ego integrity. If dissatisfied, they may experience despair.

Describe the various lifestyle changes that occur during the ego integrity vs. despair stage of development.

- Adjust to lifestyle changes related to retirement (decrease income, living situation, loss of work role) - Adapt to changes in family structure (can be role reversal in later years) - Adapt to changes in living environment - Deal with multiple losses (death of a spouse, friends, siblings) - Face death

Identity vs. Role Confusion

- Adolescense (12 to 20 years) - They develop a sense of personal identity, failure to do so may result in role confusion - Adolescents strive for independence from guardians and identify more w/peers

Age appropriate activities for a toddler

- Filling and emptying containers - Playing with blocks - Looking at books - Playing with push and pull toys - Toss a ball

What cogintive developments would you expect in the first year of life?

- Learn to respond to visual stimuli - Use cry as a form of communication - Cry patterns can change to reflect different needs

Age appropriate activities for preschoolers

- Playing ball - Putting puzzles together - Riding tricycles - Playing pretend and dress-up activities - Musical toys - Playing w/puppets - Painting, drawing, coloring - Cooking and housekeeping toys - Looking at illustrated books - Technology to support development and learn new skills

Initiative vs. Guilt

- Preschoolers (3 to 6 years) - Important events: exploration & play - Preschoolers take on many new experiences, despite not having all of the physical abilities necessary to be successful at everything. When children are unable to accomplish a task, they can feel guilty and believe they misbehaved. Guide preschoolers to attempt activities within their capabilities while setting limits

Industry vs. Inferiority

- School-age (6 to 12 years) - School-age children develop a sense of industry through advances in learning. - Tasks that increase self-worth motivate them. - Stress is increasingly common in this age group from parental and peer expectations, their environment, or observed violence. - Fears of ridicule by peers and teachers over school-related issues are common. Some children manifest nervous behavior to deal w/stress.

Autonomy vs. Shame and Doubt

- Toddlers (1 to 3 years) - Important events: toileting & dressing - Independence is paramount as toddlers attempt to do everything for themselves - Separation anxiety continues when parents leave - A toddler may show regression (bed-wetting, thumb sucking) as a response to anxiety or separation - Engages in parallel play, but by age 3 begins to play and communicate w/others

Give examples of how adults strive for generativity.

- Use life as an opportunity for creativity and productivity - Have concern for others - Consider parenting an important task - Contribute to the well-being of the next generation - Strive to do well in one's own environment - Adjust to changes in physical appearance and abilities

Intimacy vs. Isolation

- Young adulthood (20 to 35 years) - Young adults can take on more adult commitments and responsibilities - Young adults' occupational choices relate to: - High goals/dreams - Exploration/experimentation - Young adults needs to form intimate, loving relationships w/other people; failure to do so may result in loneliness and isolation

Erikson's Stages of Development

1. Trust vs. mistrust 2. Autonomy vs. shame and doubt 3. Initiative vs. guilt 4. Industry vs. inferiority 5. Identity vs. role confusion 6. Intimacy vs. isolation 7. Generativity vs. stagnation 8. Ego integrity vs. despair

Critical thinking

12 to 20 years old

High attention span

12 to 20 years old

Solving moral dilemma

12 to 20 years old

Expected respirations for an adult

12-20/min

Expected respirations for an adolescent

16-20/min

Expected respirations for a preschooler

20-25/min

Expected respirations for a school-aged child

20-25/min

Expected respirations for a toddler

25-30/min

Expected respirations for an infant

25-30/min

Able to see what hand is dominant

3 years old

Asking "why"?

3 years old

Jumping

3 years old

Delirium

Acute, temporary, and can have a physiologic source (infection, sleep deprivation, or pain) or related to a change in surroundings (being in an unfamiliar or new environment); delirium is often the first manifestation of infection (UTI) in older adults

4-5 word setences

4 years old

Can figure out how to use scissors

4 years old

Hops on one foot

4 years old

Starting to use swear words

4 years old

One of the greatest causes of death in the United States and Canada is colon cancer. The nurse instructs the community on which of the following factors? A. Annual screening after the age of 50 B. Endoscopic exam every year after 30 C. <20 g of fiber intake per day D. Administration of a stool softener daily

A Rationale: Colorectal screening annually after the age of 50.

Expected pulse for an older adult

40-100 bpm

Tying shoes

5 to 6 years old

Asking what words mean

5 years old

Jump rope

5 years old

Print letters/numbers

5 years old

Skipping

5 years old

Telling stories

5 years old

Expected pulse for a teenager

50-100 bpm

Playing board games

6 to 9 years old

Playing hopscotch

6 to 9 years old

Starting a stamp collection

6 to 9 years old

Expected pulse for an adult

60-100 bpm

Expected pulse for a preteen

60-110 bpm

Expected pulse for a child

70-120 bpm

Expected pulse for a toddler

80-140 bpm

Building models

9 to 12 years old

Making crafts

9 to 12 years old

Expected pulse for an infant

90-160 bpm

A nurse is teaching new mothers about infant care and safety. What would the nurse include as a teaching point? A. Keep infants younger than 6 months out of direct sunlight. B. Use honey instead of sugar in homemade baby food. C. Place the baby on his or her stomach for sleeping. D. Keep crib rails down at all times.

A

The nurse sees a client age 4 years and her mother at the pediatric clinic. The client is here for immunizations. She is bubbly and talkative, and tells you about her dance lessons and her new baby brother. Her mother tells you she encourages her daughter to try new experiences and enjoy life. You know that according to Erikson's developmental theory, the client is well on the way to achieving which of the following? A. Initiative B. Industry C. Self-identity D. Autonomy

A Rationale: Confidence gained as a toddler allows the preschooler (ages 4 to 6 years) to take the initiative in learning so that the child actively seeks out new experiences and explores the how and why of activities. If the child experiences restrictions or is reprimanded for seeking new experiences and learning, guilt results. The other choices are Erikson's stages for other ages.

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? A. "I give my daughter juice at breakfast and when she is thirsty during the day." B. "She drinks three 6-ounce cups of whole milk each day." C. "When she doesn't eat well at meals we give her nutritious snacks." D. "New foods are offered along with ones she likes."

A Rationale: High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition.

The nurse is assessing the 18-month-old infant. The nurse notes the anterior fontanel (fontanelle) has closed. What initial action by the nurse is indicated? A. Document the findings as normal. B. Review the birth records of the infant to see if there were any other anomalies. C. Notify the infant's health care provider. D. Measure the infant's head circumference.

A Rationale: The anterior fontanel (fontanelle) most often closes between 12 and 24 months of age. The closure of the fontanel (fontanelle) at 18 months of age does not signal any health issues for the infant.

A more thorough medical examination of a 30-month-old is indicated when the nurse observes that the child has difficulty A. Kicking a ball B. Dressing himself C. Tying his shoes D. Brushing his teeth

A Rationale: Toddlers learn to use upper muscles of the arms and legs before finger or toe muscles. A 30-month-old should be able to kick balls, jump, walk up and down stairs, ride tricycles, and run.

A high school nurse is counseling parents of teenagers who are beginning high school. Which issues would be priority topics of discussion for this age group? Select all that apply. A. The influence of peer groups B. Bullying C. Water safety D. Eating disorders E. Risk-taking behavior F. Immunizations

A, B, D, E

A nurse is assessing a 2-week-old newborn during a routine checkup. Which of the following findings should the nurse expect? (Select all that apply). A. Sleeps 14 to 16 hours each day B. Posterior fontanel closed C. Pincer grasp present D. Hands remain in a closed position E. Current weight same as birth weight

A, D, E

A nurse is reviewing car seat safety with the parents of a 1-month-old infant. When reviewing car seat use, which of the following instructions should the nurse include? A. Use a car seat that has a three-point harness system. B. Position the car seat so that the infant is rear-facing. C. Secure the car seat in the front passenger seat of the vehicle. D. Convert to a booster seat after 12 months.

Answer: B Rationale: Instruct parents to position the infant car seat in a rear-facing position until the infant reaches age 2, or outforws the seat limitations. The parent should place the seat in the center of the vehicle, when possible.

During which stage of development should a child contribute to self-care activities such as dressing, feeding, and toilet training?

Autonomy vs. shame and doubt (Toddler)

A nurse caring for patients in a primary care setting refers to Erikson's theory that middle adults who do not achieve their developmental tasks may be considered to be in stagnation. Which patient statement is an example of this finding? A. "I am helping my parents move into an assisted-living facility." B. "I spend all of my time going to the doctor to be sure I am not sick." C. "I have enough money to help my son and his wife when they need it." D. "I earned this gray hair and I like it!"

B

A nurse working with adolescents in a group home discusses the developmental tasks appropriate for adolescents with the staff. What is an example of a primary developmental task of the adolescent? A. Working hard to succeed in school B. Spending time developing relationships with peers C. Developing athletic activities and skills D. Accepting the decisions of parents

B

The nurse encourages parents of hospitalized infants and toddlers to stay with their child to help decrease what potential problem? A. Problems with attachment B. Separation anxiety C. Risk for injury D. Failure to thrive

B

A nurse is working in a pediatric clinic. The parent has brought in the 2-year-old toddler for a well-child checkup. The parent asks what the common health problems are common for this age. The nurse's correct reply includes which of the following? A. Food allergies B. Accidents C. Lice infestation D. Scoliosis

B Rationale: Accidents are a major health concern for toddlers due to their mobility and exploration of their environment.

As the nurse is preparing an immunization for a male client 2 years of age, his mother discovers that he has soiled his underpants. She scolds him and calls him a "bad boy" because he "dirtied" his underwear. The nurse gives the immunization and provides some education to the mother about appropriate expectations for this age group. The nurse knows that according to Erikson's theory for this client's age group, he is at risk to develop which of the following? A. Isolation B. Shame and doubt C. Guilt D. Inferiority

B Rationale: According to Erikson, the toddler's task is to achieve autonomy versus shame and doubt. If the caregivers are overprotective or have expectations that are too high (such as the client's mother), shame and doubt, as well as feelings of inadequacy, might develop in the child.

A nurse is assessing a 12-month-old infant who is brought to the clinic by the parents for well-child visit. The nurse reviews the infant's health history and notes that the infant weighed 8 lb. at birth. When assessing the infant's weight at this visit, the nurse would anticipate that the infant would weight approximately how much at this time? A. 16 lb. B. 24 lb. C. 30 lb. D. 36 lb.

B Rationale: Although weight gain during the first year varies and is highly individualized, birth weight usually triples by 1 year.

Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone? A. develop a fear of strangers B. be able to turn over onto the back C. insist on things being done the infant's way D. have many "blue" or moody periods

B Rationale: At four months of age, the infant is able to lift the head and look around. The infant can roll from prone to supine.

Trust vs. Mistrust

Birth to 1 year Infants trust that others will meet their feeding, comfort, stimulation, and caring needs.

What would you expect in terms of weight development in infants?

Birth weight should double by 4 to 6 months and triple by the end of the year

A nurse is teaching parents of toddlers how to spend quality time with their children. Which activity would be developmentally appropriate for this age group? A. Playing video games B. Playing peek-a-boo C. Playing in a sand box D. Playing board games

C

A school nurse is preparing a talk on safety issues for parents of school-aged children to present at a parent- teacher meeting. Which topics should the nurse include based on the age of the children? Select all that apply. A. Child-proofing the home B. Choosing a car seat C. Teaching pedestrian traffic safety D. Providing swimming lessons and water safety rules E. Discussing alcohol and drug consumption related to motor vehicle safety F. Teaching child how to "stop, drop, and roll"

C, D, F

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take? A. Refer the child to a developmental specialist for evaluation. B. Explain that the child could start walking any day. C. Ask the parent if the child has been ill recently. D. Explain that children can take their first steps as late as 18 months of age.

D Rationale: Infants can begin walking as early as 8 to 9 months and as late as 18 months of age. Telling the parent that the child will start walking any day is true but not guaranteed. Asking if the child has been ill recently is an appropriate question during a well-child visit but does not address the parent's concerns. Since the child is on track developmentally, there is no indication to refer the child to a developmental specialist.

The nurse has completed an education program on normal communication abilities in the preschool-age child. Which statement by a participant indicates a need for further education? A. "I am glad to know that my 4-year-old child asking so many questions is normal." B. "My child is finally talking in a way that most of my friends can understand her speech." C. "When my child counts numbers, it is only to 10 and we are slowing working on counting higher." D. "Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that."

D Rationale: The preschool-age child is known for asking lots of questions, and this is normal. At this age, 75% of the child's speech is understood by others outside of the family. The preschool-age child can easily count to 10, and the parents stating they were slowly working on counting higher is acceptable, as long as the parents do not push the child. A child at 5 years of age should be able to state one's name and address.

Label the following definition with one of the following; Dementia, Delirium or Depression A temporary state of confusion, is an acute illness with a specific, underlying cause that can last from hours to weeks.

Delirium

Label the following definition with one of the following; Dementia, Delirium or Depression Various organic disorders that progressively affect cognitive functioning. It is chronic and usually develops gradually. Alzheimer's disease is an example of this term.

Dementia

Label the following definition with one of the following; Dementia, Delirium or Depression Extreme or prolonged sadness and not a normal part of aging.

Depression

Generativity vs. Stagnation

During middle adulthood, individuals experience a need to create or nurture things that will outlast them, often having mentees or creating positive changes that will benefit other people.

What gross and fine motor skills would you expect at 2 months?

Gross motor skills: lifts head off mattress when prone Fine motor skills: holds hands in an open position & grasp reflex fading

Gross and fine motor skills at 3 months

Gross motor skills: raises head and shoulders off mattress when prone & only slight head lag Fine motor skills: no longer has a grasp reflex & keeps hands loosely open

Gross and fine motor skills at 4 months

Gross motor skills: rolls from back to side Fine motor skills: grasps objects with both hands & places objects in mouth

Gross and fine motor skills at 5 months

Gross motor skills: rolls from front to back Fine motor skills: uses palmar grasp dominantly

Gross and fine motor skills at 7 months

Gross: bears full weight on feet & sits, learning forward on both hands Fine: moves objects from hand to hand

Gross and fine motor skills at 10 months

Gross: changes from a prone to a sitting position Fine: grasps rattle by it's handle

Gross and fine motor skills at 11 months

Gross: cruises or walks while holding onto something Fine: places objects in a container & neat pincer grasp

What gross and fine motor skills would you expect at 18 months?

Gross: jumps in place w/both feet Fine: manages spoon w/out rotation & turns pages in book two or three at a time

During which stage of development should a child be able to state their first and last name and count to 20?

Initiative vs. Guilt (Preschool age)

What gross motor skills would you expect at 5 years?

Jump rope, walk backward with heal to toe & move up and down stairs easily

What gross motor skills would you expect at 3 years?

Ride a tricycle, jump off a bottom step & stand on one foot for a few seconds

Fulmer SPICES tool

S: Sleep disorders. P: Problems with eating or feeding. I: Incontinence. C: Confusion E: Evidence of falls. S: Skin breakdown.

What gross motor skills would you expect at 4 years?

Skip and hop on one foot & throw a ball overhead

What would you expect in terms of weight development for newborns?

They may lose 5% to 10% of body weight in the first few days, but should regain it by the second week