Module 19: Growth and Development Chapters 17,18,19

Older Adult -Ageism and common stereotypes

-Ageism= a form of prejudice, like racism, in which older adults are stereotypes by characteristics found in only a few members of their group -Older people may be incorrectly viewed as being rigid or narrow-minded, unable to learn, unreliable because of memory loss, too old to enjoy sexual pleasure, or child-like and dependent -Most older adults are satisfied with their lives, finding retirement and old age more enjoyable than they had anticipated. -Most older adults maintain close ties with their families and have incomes above the poverty level

Older Adult -Physiological Development

-In older adults, all organ systems undergo some degree of decline in overall functioning, and the body becomes less efficient. -The term sarcopenia refers to the loss of muscle mass that frequently occurs in older adults; sarcopenic obesity describes the muscle loss combined with an increase in body fat as people age -Resistance training and adequate dietary protein are management strategies that can prevent or reverse this process -There is growing evidence that aging is not synonymous with loss of function and disability -The greatest threat to the health of older adults is loss of the physiologic reserve of the various organ systems -When illness occurs, increased physical and emotional stress places an older adult at risk for complex reactions

School age- growth and development in physiological, cognitive, psychosocial areas; common health problems; role of the nurse

School aged children= 6 to 12 years of age Physiologic Development: -Brain reaches 90% to 95% of adult size; by 12 years of age, the nervous system is almost completely matured, resulting in coordinated body movements -Motor abilities progress from the ability to hold a pencil and print words at 6 years of age to the ability to write in script and in sentences at 12 years of age -Sexual organs grow but are dormant until late in this period, when hormonal changes begin -All permanent teeth are present, except for the second and third molars, by 12 years of age -Height increases 2 to 3 inches and weight increases 3 to 6 pounds Cognitive Development: - The school-aged child is in Piaget's concrete operational stage of development, organizing facts about the environment to use for problem solving - School-aged children have well-developed language skills, using language in a more sophisticated manner. Psychosocial Development: -Freud's Theory: The school aged child is in the latency stage of Freud's theory, with psychosocial energies being channeled toward strong identification with ones own sex and creative activities -Erikson's Theory: The industry-versus-inferiority stage of Erikson's theory, with the child focused on learning useful skills and thereby developing positive self-esteem. -Havighurt's Theory: Learning physical game skills, learning appropriate social roles, developing fundamental skills in reading, writing, and calculating, developing concepts necessary for everyday living, achieving personal independence, developing conscience, morality, and a scale of values -Special Considerations:Peer relationships become the major gauge for determining status, skill, and ability to be personable. They also act as a transition modes for the child as the child leaves the total caregiver influence and heads toward adult independence. Sexual development results in a strong need to understand body function and to have accurate information about sexuality Moral Development: -Most of middle childhood is spent in the conventional phase of moral development -Behavior is based on familial and peer group beliefs, and conformity to the norm is common Spiritual Development: -In Fowler's theory, school-aged children view religious faith as a relationship that involves reciprocal fairness. -The importance of spiritual beliefs and the possibility of life after death is accepted, even if not totally understood Health of the School-Aged Child -Accidents continue to be common in school-aged children -Communicable conditions such as scabies, impetigo, and head lice are more prevalent. -The CDC recommends the vaccination of 11 and 12 year old girls with three doses of HPV vaccine. -Obesity, attention deficit hyperactivity disorder, and learning disability and enuresis (bed wetting). -Sickle cell anemia, hyperactivity, seizure disorder, hypertension, diabetes, and obesity -Scoliosis Obesity: Over the past 20 years, obesity among school-aged children has more than doubled. The changes created by the U.S. Department of Agriculture include an increased emphasis on fruits and vegetables; fat-free or low-fat milk options; more whole-grain offerings; and less calories, sodium, and saturated and trans fat in the meals ADHD and Learning Disabilities: Developmentally inappropriate degree of inattention, impulsiveness, and hyperactivity. -To be diagnosed with this disorder, the child must have manifested symptoms before 7 years of age, and symptoms must be present in at least two settings. -Learning disabilities is a group of disorders in which the child has significant difficulty in listening, speaking, reading, writing, reasoning, mathematic abilities, or social skills Enuresis: -Diagnosed when a child is at least 5 years of age and is still having involuntary urination, usually at night Role of the Nurse in Promoting Health and Preventing Illness: - Involves individual and family teaching, often conducted by school nurses - Recommended approaches include increasing opportunities for students to become involved in physical activities and ensuring that students have healthy food and beverage choices while at school -They need to be alert for warning signs of bullying and other dangerous dangerous behaviors and be involved in efforts to promote a safe environment in playgrounds, buses, and schools -In addition, nurses often function as advocates for vulnerable populations -Children of this age in the hospital should be allowed to have some measure of control over allowable activities and should be encouraged to do what they can, such as playing competitive games and making their own bed

Preschooler- growth and development in physiological, cognitive, psychosocial areas: common health problems; role of the nurse

-3 to 6 years old Physiologic Development: Head is close to adult size by 6 years of age. The body becomes leaner and more coordinated. Motor abilities include skipping, throwing and catching a ball, copying figures, and printing letters and numbers. Full set of 20 deciduous teeth is present; baby teeth begin to fall out and are replaced by permanent teeth. Average weight at 5 to 6 years of age is 45 lb, with boys being slightly heavier than girls. Cognitive Development: Piaget's preoperational stage of development. Passing through the pre-conceptual and intuitive phases. -Egocentrism decreases as socialization with other children increases, and the ability to express self verbally improves -Play is related more to real life events -Basic curiosity results in constant questions and improved reasoning ability -Language development is seen in more elaborate and grammatically correct sentences -Preschoolers clearly identify themselves as male or female, can understand basic body functions, and have a curiosity about sex differences Psychosocial Development: -Freud's theory: Phallic stage, with the biologic focus primarily genital. -Erikson's theory: The preschooler is in stage of initiative versus guilt. -Havighurst's theory: learn sex differences and modesty. describe social and physical reality through concept formation and language development, to get ready to read, and to learn to distinguish right from wrong. -Special Considerations: Preschoolers often have fears such as the dark, new places, and fear during nightmares. Most fears are made worse because of their imaginations Moral and Spiritual Development: -The focus of this stage is obeying rules to avoid punishment or receive a reward -The preschooler might attend activities at church or synagogue with family, but does not understand religion concepts -Concepts such as heaven, hell, and holy spirits are incomprehensible and often frightening Health of the Preschooler: -Communicable diseases and respiratory tract infections are common, especially with increased interaction with other children at nursery schools and daycare. -Preschoolers are prone to accidents because of their increased curiosity about the world -Dental caries become common if teeth are neglected -Currently, more than one-third of children and adolescents are overweight or obese; young children who are obese are more likley to become obese adults -Rise in type 2 diabetes Role of the Nurse in Promoting Health and Preventing Illness: -Nurses play a vital role in identifying children at risk for obesity, teaching families about the health consequences, providing information and health teaching, and promoting wellness in this vulnerable population -Nurses must recognize the importance of a child's fear of pain as well as separation anxiety

Adolescence and young adult- growth and development in physiological, cognitive, psychosocial areas; common health problems; role of the nurse

-Adolescence begins with puberty and extends from 12 to 20 years of age -Young adult period is considered to be 20s and 30s -A person is defined as an adult when that person is "physically and psychologically mature, ready to assume adult responsibilities and be self-sufficient" -Develops internal and external controls and values acceptance to society Physiologic Development: -Feet, hands, and long bones grow rapidly, and an increase in muscle mass -Primary and secondary sexual development occurs, with maturation of the genitalia; presence of body hair; breast development and menstruation in girls; facial hair growth, voice changes, and spermatogenesis in boys -Puberty=time when the ability to reproduce begins. Starts at age 9 to 13 years in girls (menstruation beginning between 10 and 14 years of age) and at 11 to 14 years of age in boys -Sebaceous and axillary sweat glands become active -Full adult size is reached, although some young men might continue to grow into their 20s. -Prepubescence: Secondary sex characteristics begin to develop, but the reproductive organs do not yet function -Pubescence: Secondary sex characteristics continue to develop, and ova and sperm begin to be produced by the reproductive organs -Postpubescence: Reproductive functioning and the development of secondary sex characteristics reach adult maturity Cognitive Development: -Adolescence is the stage when the cognitive development of formal operations is developed. -Egocentrism returns, and imaginary audiences and daydreaming are common -Young adults, in comparison to the adolescent, are more creative in thought, are objective and realistic, and are less self-centered Psychosocial Development: -Freud's Theory: The adolescent and young adult are in Freud's genital stage. The libido re-emerges in a mature, adult form, and the person is capable of full sexual function. Creativity and pleasure are found in love and work -Erikson's Theory: The adolescent tries out different roles, personal choices, and beliefs in the stage called identity versus role confusion. The young adult, in the intimacy-versus-isolation stage, needs to complete tasks such as achieving independence from parents, establishing intimate relationships, and choosing an occupation or career. -Havignhurst's Theory: More mature relationships with both boys and girls of the same age are achieved, a masculine or feminine social role is developed, ones personal appearance is accepted, and a set of values and ethical system as a guide to behavior are internalized -Levinson's Theory: The years from 18 to 22 are characterized by early adult transition. During the years from 22 to 28, the young adult builds on previous choices, but there might be a transient quality to occupational choices and friendships -Gould's Theory: Views young adults as having established their own control as adults separate from the family -Special Considerations: A major psychosocial development requirement for the young adult is choosing a vocation. Establishing a family involves both parents, even though the physiologic changes of pregnancy take place in the woman. Moral Development: -The child enters adolescence with a law-and-order orientation and might never progress beyond that point. Young adults who have mastered previous levels of moral development reach the conventional level and are concerned with maintaining expectations. They also value conformity, loyalty, and social order. Some people might enter the post-conventional stage, in which they make moral judgements on the basis of universal beliefs. Spiritual Development: Adolescents and young adults can think in the abstract and might question beliefs and practices that no longer serve to stabilize their identity or purpose. The individuating-reflective period in the young adult brings discovery of the meaning of values as they relate to the achievement of social purposes and the acceptance of the value of systems of others. Health of the Adolescent and Young Adult -Health promotion focuses on nutrition, relationships, with self and others, and safety -Young adults should have a tetanus and diphtheria booster every 10 years. -HPV Vaccine -Injuries are the leading cause of death for adolescents and young adults -Sports related injuries -Substance Abuse=Smoking and the use of illegal drugs pose serious health risks, and use of alcohol is significantly related to risk taking behavior for adolescents and young adults -OTC drugs most commonly misused by this age include dextromethorphan (found in common cold and cough medicines), caffeine medicines and energy drinks, and diet pills. -Opioid analgesics and Adderall are among the more commonly abused prescription medications in this age group -Marijuana is thought to lower IQ and impair mental abilities Suicide: -Suicide rate of adolescents has increased drastically, and it is more prevalent in this age group than any other age Pregnancy: -US leads the developed countries in the pregnancy rate of 15 to 19 years old adolescents -These pregnancies are physically, psychologically, and economically costly for the adolescent mother, the infant, the family, and society Nutritional Problems: -Fad dieting and habitually eating fast foods are common among adolescents and young adults -The most common eating disorders are anorexia nervosa and bulimia -Energy drinks are consumed at an increasing rate in this age group -Excessive caffeine levels can result in anxiety, rapid pulse, abnormal cardiac rhythms, nervousness, and panic disorders Sexually Transmitted Infections: -Lack of knowledge, lack of psychosocial maturity, embarrassment,and a lack of planning ahead and not using condoms are the most common reasons for increased risk -Chlamydia, and infection of the genital tract, is the most common STI in the United States -Acquired immunodeficiency syndrome (AIDS) poses the greatest single threat to people and society as a whole Developmental and Situational Stressors: -Stressors about choices about lifestyle, occupation, and relationships -Sexual orientation defines a person's physical and emotional attraction to a person of the same and/or opposite gender -Family-centered stressors include both positive and negative factors, such as marriage, divorce, parenthood, and death of parent -An increasing number of men and women are remaining single, either by choice or situation -Couples might encounter difficulties conceiving, delay childbearing until their careers are established, or choose not to have children -Divorce is high in our society, with rates being highest among those marrying young, having low income, and having low educational levels Role of the Nurse in Promoting Health and Preventing Illness: -A true assessment of adolescent development must include the profound changes in reproductive functioning -One of the more significant nursing activities for people in this stage is facilitating healthy family relationships -If hospitalized, an adolescent's and young adults motivation to recover and resume normal activities is strong

Older Adult -Psychosocial Development

-An older adult who has a strong sense of self-identity and has successfully met challenges earlier in life will probably continue to do so. -The loss of the privilege of driving has serious repercussions for older adults. Aging results in slower reaction times and changes in vision such as increased sensitivity to the glare from approaching headlights as well as alterations in peripheral vision. -Losing driving privileges is disheartening and can cause older adults to feel anxious and lonely, which may be viewed as another negative consequence of aging. -This lack of independence may also result in less opportunity for activities or interactions with friends and family Disengagement Theory: -Older adults often withdraw from usual roles and become more introspective and self-focused -Later studies showed that isolation is not desired or acceptable and that as societal interactions decrease, healthy older adults increase their close relationships with family and friends -The identity- continuity theory assumes that healthy aging is related to the older adult's ability to continue similar patterns of behavior from young and middle adulthood. Erikson's Theory: -Identified ego integrity versus despair and disgust as the last stage of human development, which begins at about 60 years of age -It is a time for realization of a "wholeness" perspective, with an inner search for meaning and order in the life cycle. -Life review or reminiscence= A way for an older adult to relive and restructure life experiences and is part of achieving ego integrity -Ego integrity is facilitated when an older adult has successfully accomplished tasks earlier in life -A person who regrets the past and sees current problems as insurmountable, however, may despair. -A despairing person may want to do things over but fears the lack of time before death -Older adults still strive to guide the coming generations and to leave something behind Havignhurst's Theory: -The major tasks of old age are primarily concerned with the maintenance of social contacts and relationships -Successful aging depends on a person's ability to be flexible and adapt new age-related roles.

Older Adult -Common health problems

-As the number of older adults increases, nurses will spend more time providing care for this population -Most older people are not impaired but are functional in the community, thereby benefitting from health-oriented interventions -Older people are more vulnerable to physical, emotional, and socioeconomic problems than people in other age groups and may require special attention to health promotion and maintenance Chronic Illness: -The probability of a person becoming ill increases with age. -The leading causes of death in older adults are heart disease, cancer, and stroke -Chronic health conditions can negatively affect an older adult's functioning and quality of life, but many of these can be prevented or modified with behavioral interventions Implications for health care: -Older adults use more health care than any other age group. -Meeting the expenses of health care is often difficult for older adults and their families -Medication costs related to chronic illness typically continue for the rest of a person's life, with multiple medications being the rule rather than the exception -Polypharmacy= the use of many medications at the same time, can pose many hazards for older adults -Nurses must be able to recognize adverse drug reactions in this population instead of mistaking them for age-related changes -Hospital and health care costs continue to rise and may be more than the patient or family can pay -Special diets, special equipment, and medical supplies increase economic difficulties -Family members must learn to cope with the needs of a ill person -Family members must also adapt to psychological stressors such as changes in communications, changes in roles, and changes in their own lifestyle as they become the caregivers Diversity and Chronic Illness: -As the U.S population ages dramatically and becomes more diverse, it is important to consider how cultural differences can affect future patterns of disease, disability, and health care use -The prevalence of certain diseases varies among racial and ethnic groups; research has not yet proven definitively what effect early health behaviors and practices have on the disease patterns of older adults in these various groups List on pages 434-435 Accidental Injuries: -The older adult is at increased risk for accidental injury because of changes in vision and hearing, loss of mass and strength of muscles, slower reflexes and reaction time, and decreased sensory ability. -Falls are the most common cause of injuries and hospital admission in older adults -Falls may result in a traumatic brain injury, which accounts for 46% of fatal falls among older adults. -95% of hip fractures are caused by a fall -Recommendations for prevention of falls in older adults now include an exercise component and vitamin D supplement -The combined effects of chronic illness and medications may make an older adult more prone to accidents. Dementia, Depression, and Delirium: -Dementia refers to various organic disorders that progressively affect cognitive functioning -Alzheimer disease (AD)= is the most common degenerative neurologic illness and the most common cause of cognitive impairment -Alzheimer disease affects brain cells and is characterized by patchy areas of the brain that degenerate -Sundowning syndrome: older adult habitually becomes confused, restless, and agitated after dark -There is no effective treatment for AD at this time -A medical or nursing intervention can trigger a sequence of adverse events in a frail older adult. This downward spiral and decline is referred to as cascade iatrogenesis -The Fulmer SPICES tool has proved effective in identifying common problems experienced in older adults that can lead to negative outcomes S= sleep disorders P=Problems with eating or feeding I=Incontinence C=Confusion E=Evidence of falls S= Skin breakdown -Both the patient and family caregivers need emotional support and teaching, and may benefit from community resources that can ease the family's burden. -Delirium= a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment. -Drug interactions, circulatory or metabolic problems, nutritional deficiencies, or a worsening illness are likely the real cause. -Treatment of delirium may include stopping unnecessary medications, as well as interventions to resolve infection and metabolic alterations. -The benzodiazepines are usually avoided because they may increase confusion and cause over-sedation -The nurse can use reality orientation, which involves interventions to redirect the patients attention to what is real in the environment -Extreme or prolonged sadness in an older adult may be a warning sign of depression -Treatment of depression usually involves psychotherapy or counseling along with antidepressant medication Elder Maltreatment: -The increase in the number of older adults coupled with increasing lifespan has resulted in greater awareness about the problem of elder maltreatment. -It is difficult to determine an accurate number of elder maltreatment incidents because 84% of elder abuse cases are never reported -Neglect accounts for more than half of all elder maltreatment reports made to adult protective care agencies -It can be active or passive and occurs when a caregiver fails to adequately meet the physical, social, or emotional needs of an older adult, resulting in harm to that person -Physical abuse causes pain, impairment, or deliberate physical injury to an older adult. -Sexual abuse involves nonconsensual sexual contact of any kind with an elderly person, while financial abuse involves exploitation or misuse of another's property -Indications of abuse are often misinterpreted as normal signs of aging -If you suspect abuse, attempt to speak to the older adult in a private setting away from the caregiver -All assessment data should be objectively documented, including direct quotes from both parties Role of the Nurse in Promoting Health and Preventing Illness: -The nurse should teach the patient and family general health promotion activities. -Eat a diet that includes all food groups -Make exercise part of daily activities -Discuss with your primary physician whether to include a vitamin D supplement -Drink alcohol in moderation -Do not smoke -An older adult who requires surgery or medical treatment for chronic or acute illness has special, age-related needs regardless of the setting for care -Nurses must recognize physiologic and psychosocial interrelationships and view older patients holistically -The ill patient is under increased physical and emotional stress, which increases the risk for complications because of the lack of physiologic reserves. -An older patient is more likely than a younger patient to suffer multisystem dysfunctions, iatrogenic complications, accidents such as falls, and increasing dependence and confusion. The focus of nursing care is to assist older patients to function as independently as possible and to support their individual strengths. -The nurse collaborates with the family and other disciplines to prevent complications of illness, to secure a safe and comfortable environment, and to promote the patient's return to health.

Piaget

-Assimilation is the process of integrating new experiences into existing schemata -Accommodation is the alteration of existing thought processes to manage more complex information *Sensorimotor Stage (Birth to 24 Months): Progression through a series of developmental tasks *Preoperational Stage (Ages 2 to 7 years): The stage is characterized by the beginning of the use of symbols, through increased language skills and pictures, to represent the preschooler's world *Concrete Operational Stage (Ages 7 to 11 years): Children learn by manipulating concrete or tangible objects and can classify articles according to two or more characteristics. Children become increasingly aware of external events and realize that their feelings and thoughts are unique and may not be the same as those of other children their age. *Formal Operational Stage (Age 11 years or older): This stage is characterized by the use of abstract thinking and deductive reasoning.

Middle Adult -Common health problems

-Both acute and chronic illnesses are more likely to occur, and recovery takes longer. This is a result of slower and more prolonged responses to stressors, more pronounced reactions to an illness, and the possibility of more than one illness being present at a time -The leading causes of death in middle adults are malignant neoplasms; cardiovascular disease; unintentional injury including poisoning, motor vehicle accidents, and falls; diabetes mellitus; chronic lower respiratory disease; and cerebrovascular causes -As one gets older, energy requirements decrease. Middle adults tend to maintain previous eating patterns and caloric intake while being less physically active -Chronic illness in middle adults has a major effect on self-concept and may precipitate changes in life structure -Many men and women remain healthy throughout their lives, but knowing preventive health care practices and their special needs at this age can help middle adults have improved quality and quantity of life.

Family Influences

-Environment & Nutrition

Principles of growth and development

-Environmental factors from birth through the early years of growth provide initial physchological and social contract through positive or negative experiences with caregivers -Development is influenced by a wide variety of psychological experiences as well as circumstances in the physical environement -Growth and development are orderly and sequential as well as continuous and complex -Although growth and development occur in individual ways for different people, certain generalizations can be made about the natre of human development for everyone

Theories of Aging

-Genetic Theory of Aging: Genes within the organism control "genetic clocks", which determine the occurrence and rate of metabolic processes, including cell division -Immunity Theory of Aging: The immune response declines steadily after younger adulthood as the thymus loses size and function. Age-associated changes in the immune system, also known as immunosenescence, are thought to be responsible for the increase in infections such as pneumonia and septicemina, immune disorders, and cancer as adults age -Cross-Linkage Theory: As one ages, cross-links accumulate, leading to essential molecules in the cell binding together and interfering with normal cell function -Free Radical Theory: Free radicals, formed during cellular metabolism, are molecules with separated high-energy electrons, which can have adverse effects on adjacent molecules. Over time, irreversible damage results from the accumulated effects of this damage

Factors influencing growth and development

-Genetic heredity: *The characteristics inherited from each parent are carried in gene pairs on the 23 pairs of chromosomes, which carry genetic information that determines the person's cellular differentiation, growth, and function *Genomics is the study of the structure and interactions of all genes in the human body, including their interactions with each other as well as the environment *Pharmacogenetics is the study of how genetic variation affects a person's response to drugs. -Prenatal, individual, and caregiver factors: *Fetal development can be affected by the mother's actions, age, prenatal care *Abuse, accidents, neglect, mental illness -Environment and Nutrition: *Poverty, violence, unsafe living conditions, presence of lead or mold in the home, quality of air or water in the environment *Nutritional influences, substance abuse, school meal programs, housing

Applying Growth and Development Theories

-Health care needs change quickly as a person grows and passes through life -The theories summarized in this chapter help us understand cognitive, psychological, moral, and spiritual development -To understand the whole person, nurses need to evaluate all the components of growth and development to understand certain life events or concerns

Middle Adult -Psychosocial Development

-Increased social freedom -Increased responsibility and an awareness of ones own morality. -One realizes that ones life may be half or more past and may feel many things are still undone Erikson's Theory: The middle adult is in a period of generativity versus stagnation. The tasks are to establish and guide the next generation, accept middle-age changes, adjust to the needs of aging parents, and reevaluate ones goals and accomplishments Havighurt's Theory: Learned behaviors arising from maturation, personal motives and values, and civic responsibility Levinson's Theory: The middle adult may choose either to continue an established lifestyle or to reorganize ones life in a period of midlife transition Gould's Theory: A time when adults look inward (Ages 35 to 43); accept their lifespan as having definite boundaries, and have a special interest in spouse, friends, and community (ages 43 to 59); and increase their feelings of self-satisfaction, value spouse as a companion, and become more concerned with health

Older Adult -Cognitive Development

-Intelligence increases into the 60s, and learning continues through life. -Mild short-term memory loss is common but can be remedied by and older adult using notes, schedules, and calendars. -Dementia, Alzheimer disease, depression, and delirium might occur and cause cognitive development -Long term memory usually remains intact.

Erik Erikson

-Stages of development -Development goals or tasks -Psychosocial crises -The process of coping Trust vs Mistrust (Infancy): The infant learns to rely on caregivers to meet basic needs of warmth, food, and comfort, forming trust in others Autonomy vs Shame and Doubt (Toddler): As motor and language skills develop, the toddler (ages 1 to 3 years) learns from the environment and gains independence through encouragement from caregivers to feed, dress, and toilet self. If the caregivers are overprotective or have expectations that are too high, shame and doubt, as well as feelings of inadequacy, might develop in the child Initiative vs Guilt (Preschool): 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 reprimands for seeking new experiences and learning, guilt results, and the child hesitates to attempt more challenging skills in motor or language development Industry vs Inferiority (School-aged children): Focusing on the end result of achievements, the school-aged child gains pleasure from finishing projects and receiving recognition for accomplishments. Identity vs Role Confusion (Adolescence): Childhood to adulthood. Trying on roles and even rebellion can be normal behaviors as the adolescent acquires a sense of self and decides what direction to take in life. Intimacy vs Isolation (Young adulthood): The tasks for the young adult are to unite self-identity with identities of friends and to make commitments to others. Fear of such commitments results in isolation and loneliness. Generativity vs Stagnation (Middle Adulthood): Involvement wit family, friends, and community. The time to be concerned for the next generation and desiring to make a contribution to the world. Ego Integrity vs Despair (Late Adulthood): Reminiscence about life events provides a sense of fulfillment and purpose. (Could create despair or happiness)

Middle Adult -Role of the nurse in promoting health and preventing illness

-The nurse has a major role in promoting health and preventing illness in middle adults by teaching, serving as a role model, and encouraging self-care responsibilities. -Eat a diet low in fat and cholesterol -Regular exercise -Drink alcohol in moderation, if at all -Do not smoke -The middle adult needs to know the dangers of substance abuse

Implications for Nursing

-The nurse must plan care based on the patient's general and unique health needs and must continually revise aspects of care as the growth process evolves or alterations in health status occur -Nurse is uniquely positioned to address the sensitive emotional, psychological, and educational issues related to genomic discoveries

Conception and prenatal- growth and development in the physiological areas; common health problems; role of the nurse

-The pre-embryonic stage lasts for about 3 weeks -The zygote implants on the uterine wall, it has three distinct cell layers -Endoderm (innter layer) becomes the respiratory system, digestive, liver, and pancreas -Mesoderm (middle layer) becomes the skeleton, connective tissue, cartilage, muscles, and the circulatory, lymphoid, reproductive and urinary system -Ectoderm (outer layer) becomes the brain, spinal cord, nervous systems, and outer body parts (skin, hair, nails) -The embryonic stage occurs from 4th to the 8th week. There is rapid growth and differentiation of the cell walls. -By the end of this stage, basic organs are established, bones begin to ossify, and some human features are recognizable -Embryo is especially vulnerable to any factor that might cause congenital anomalies -The fetal stage lasts from 9 weeks to birth. -At the end of 12 weeks gestation, some reflexes are present, kidney secretion begins, the heartbeat can be heard by doppler, and sex of the fetus is distinguishable. -End of the 2nd trimester (24 weeks), fetal heart tones are audible by stethoscope, the liver and pancreas are functioning, hair forms, sleep-wake patterns are established, lung surfactant is produced, and eyelids are open. -End of 3rd trimester (40 weeks), testes descend, lung alveoli are formed, subcutaneous fat is deposited, and the fetus actively kicks. -During pregnancy, adequate maternal nutrition is essential for normal growth and development of the embryo and fetus -Low birth weight is one of the leading causes of infant mortality and the leading cause of infant death during the first month of life -Infants born premature have increased risks for disordered such as cerebral palsy, mental retardation, and chronic respiratory problems

Freud

-The unconscious mind: contains memories, motives, fantasies, and fears that are not easily recalled but that directly affect behavior -The id: Part of the mind concerned with self-gratification by the easiest and quickest available means -The ego: Conscious part of the mind that serves as a mediator between the desires of the id and the constraints of reality so that one can live effectively within ones social, physical, and psychological behavior. -The superego: Part of the mind commonly called the conscience Oral Stage: Infant uses the mouth as the major source of gratification and exploration Anal Stage: Development of neuromuscular control to allow for control of the anal sphincter Phallic Stage: Child has increased interest in gender differences and his or her own gender Latency Stage: Increasing sex-role identification with the parent of the same sex prepares the child for adult roles and relationships Genital Stage: Sexual interest can be expressed in overt sexual relationships

Middle Adult -Cognitive Development

-There often is an increased motivation to learn, especially if the knowledge gained can be applied immediately and has personal relevance. -Problem-solving abilities remain throughout adulthood, although response time may be slightly longer. This is due not to any decreased ability but, rather, a longer search through more memories and to a desire to think a problem through before responding

Middle Adult -Physiological Development

Middle adult is aged 40 to 65 -As time passes, gradual internal and external physiologic changes occur. -The person must modify self-image and self-concept to adapt successfully to and to accept these normal changes -Women undergo menopause, a gradual decrease in ovarian function, with subsequent depletion of estrogen and progesterone. -The loss of estrogen also increases the risk for osteoporosis and heart disease -Men do not experience physical symptoms from the decreased levels of hormones, called andropause. Androgen levels diminish slowly; the man may have some loss of sexual potency but its still capable of reproduction

Neonate- Growth and development in physiological, cognitive, psycho-social areas; common health problems; role of the nurse

Neonate= Birth to 28 days Physiologic Development: - Reflexes such as the Moro reflex, the stepping reflex, hand-to-mouth activity, sucking, swallowing, blinking, sneezing, and yawning - Body temp responds to environment - Senses are used to respond to environment - Stool and urine are eliminated - Both an active crying state and a quiet alert state are exhibited -The neonate inherits a transient immunity from infections as a result of maternal immunoglobulins that cross the placenta - Breastfeeding provides more protection Health of the Neonate: - Respiratory difficulties might occur, especially if drugs given to the mother during labor and delivery have sedated the neonate - Premature and c-section neonates are more at risk for respiratory issues - Incompatibility between the neonate's and mother's blood groups requires prompt care at birth -Some birth traumas cause temporary symptoms are an area of concern because parents must be reassured symptoms will disappear. Examples include caput succedaneum (localized edema of the scalp), molding (elongation of the skull as the baby passes through the birth canal) and subconjunctival hemorrhage. -Neonates born to mothers who smoke, use drugs, or drink alcohol are more at risk for developmental deficits and complications during birth - Fetal alcoholism is a leading cause of birth defects

Infant- Growth and development in physiological, cognitive, psycho-social areas; common health problems, and the role of the nurse

Physiologic Development: -Brain grows to about half of adult size - Body temp stabilizes - Motor abilities develop, allowing use of building block, attempting to feed self, crawling, and walking -Eyes begin to focus and fixate - Heart doubles in weight, heart rate slows, and blood pressure rises. -Deciduous teeth begin to erupt at 4 to 6 months - Birth weight usually triples by 1 year, when the average male infant weights 22 lb and female weighs 21 lb. Length increases by 50% Cognitive Development: - Sensorimotor stage of development described by Piaget. - Language development (coos and makes sounds) - By 12 months, babies can convey their wishes using few key words Psychosocial Development: -Oral stage (Freud), striving for immediate gratification of needs and having a strong sucking need -Develops trust (Erikson) if caregiver can be counted on -Meets developmental tasks (Havighurst) by learning to take solid food, walk, and talk -Attachment= Active, affectionate, reciprocal relationship between two people -Bonding= Occurs during a sensitive period in the first few hours after birth (although bonding also might occur later in the first few months) is necessary for later attachment -Play= Play progresses from self-pleasure to interaction with others. Two dimensions of play are social play and cognitive play. -Temperament= Primarily inborn, although is influenced by environment. A baby or child might be said to be "easy" "slow to warm" or "difficult" Health of the Infant: -Gastroenteritis and food allergies are common - Heat rash - Eczema -Thrush -Infant Colic= uncontrollable, extended crying in an otherwise healthy and well-fed baby -Failure to thrive= Condition of inadequate growth in height and weight resulting from the infant's inability to obtain or use calories for growth -Accidental Injuries= Aspiration is a risk. As infant becomes more mobile, the risk for falls or for being caught in a dangling cord. Special car seats and restraints for infants -Sudden Infant Death Syndrome (SIDS)=Refers to the sudden death of an infant under the age of 1 year when consideration of the infant's history, a postmortem examination, and investigation of the scene where death occurred fails to reveal a cause of death -Sudden Unexplained Infant Death (SUID)= All-encompassing term used for sudden, unexplained infant deaths occur suddenly and unexpectedly and the cause of death cannot readily be identified prior to an investigation -Suffocation= Nurses should speak to parents to promote a safe sleeping environment by placing infants on their backs in a safety-approved crib, encouraging co-sleeping with the infant in a three-sided bassinet placed next to the bed rather than in the same bed as the parent, and recommending against the use of pillows, comforters, other soft bedding and toys in the crib. -Child maltreatment= May occur at any age, most victims are from birth to 4 years. Neglect is the most common form. CDC defines it as "an act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child" ROLE OF NURSE IN PROMOTING HELATH AND PREVENTING ILLNESS: -The most essential role of the nurse in promoting health of the infant is teaching family members and caregivers. -Immunization - Health care providers need to listen to parents' concerns about immunization and guide them to resources with current immunization information and schedules - The crucial areas of development assessed in the DDST are gross motor behavior and skills, fine motor behavior and skills, language acquisition, and personal and social interaction. - Separation anxiety= occurs when a child is separated from loved ones who offer security - Nurses should encourage patients to stay with the hospitalized infant and provide care, and when that is not possible, consistent health care providers are important to maintain the infant's trust in others

Toddler- growth and development in physiological, cognitive, psychological areas; common health problems; role of the nurse

Toddler= 1 to 3 years Physiologic Development: -Rapid brain growth, bone, and muscles -Uses fingers to pick up small objects -Walks forward and backward, runs, kicks, climbs stairs, and rides a tricycle - Drinks from a cup and uses a spoon - At 2, the toddler is typically four times the birth weight, averaging 30 to 35 lb. and 23 to 27 inches in height - Has bladder control during the day and sometimes during the night - Turns pages in a book, and by 3, draws stick people Cognitive Development: - Piaget's last 2 stages of sensorimotor development: beginning to understand object permanence, following simple commands, and anticipating events -Can understand self as separate from others and have a beginning perception of body image -Gender identity -Language begins at 1 -At 2, children begin to use short sentences Psychosocial Development: -Freud's Theory: The toddler is in Freud's anal stage. Increased muscle development and sphincter contraction and relaxation. -Erikson's Theory: Autonomy is developing from independence in feeding, walking, dressing, and toileting , as well as the ability to express wishes verbally -Negativism= Result from the toddler's efforts at control over the environment -Regression= behavior that is more characteristic of a younger age, can occur at any time in response to stressful circumstances -Separation anxiety in response to separation from the mother figure intensifies at about 18 to 24 months -By 24 months there is independence from the mother -Havighurst's Theory: The toddler has the developmental task of learning to control the elimination of urine and feces and begins to learn sex differences, form concepts, learn language, and distinguish right from wrong Health of the Toddler: -Accidents-such as motor vehicles crashes, poisonings, burns, drowning, choking and aspirations, and falls-are the major causes of death in toddlers -Children ingesting batteries -Dental problems are also common, especially if the toddler is allowed to sleep with a bottle of sweetened liquid -Respiratory tract infections and ear infections are also common -OTC cold medications can have serious adverse effects in infants and toddlers Role of the Nurse: -The role of the nurse in promoting health in the toddler continues to be primarily teaching -Caregivers should encourage their toddler's independence while setting firm limits -Every effort should be made to have consistency of health care providers and to maintain familiar routine and rituals