Primary Care and Wellness Ch. 21, 22 and 23

Cephalocaudal Growth

"Head to tail" or "Head to Toe" Growth is fastest at the head and slower at the tail. The first trend, is that the head and brain develop first, then the rest of the body. They learn to use the upper limbs before the lower limbs.

Genetic History

- Genetic Inheritance. - Characteristics inherited from each parents chromosomes. - Influences things like hair color, eye color, height - Also influences development of many diseases (cancer, diabetes)

Prenatal

-Fetal development can be affected by maternal age (Greater risk for moms < 15 and > 35) -Inadequate maternal nutrition, prenatal care or substance abuse while pregnant can effect fetal development (brain development, vision impairment, hearing impairment, cause failure to thrive)

Environment/ Nutrition

-Influences all 4 stages of development!!! - Environment influences: poverty, violence, unsafe living conditions, presence of mold/ lead in home. -Examples: alcohol and drug abuse more prevalent in teenagers who live in poor families situations. They also tend to have more low self esteem and poor social skills -Child abuse= decreased emotional/ physical development -Nutrition examples: Infant malnourished in utero-> develops fewer brain cells -Substance abuse while pregnant= risk for prematurity, poor nutrition, low birth weight, increase in still birth, congenital abnormalities.

Principles of Growth and Development

-Orderly and sequential -Continuous and complex -Follow regular and predictable trends -Aspects occur at different stages and rates, and can be modified -Pace is specific for each person

Trust vs. Mistrust (Erikson)

0-1 years. Infant learns to rely on caregivers to meet basic needs. Mistrust can result in inadequate/ unsafe care.

Oral Stage (Freud)

0-18 months, During the oral stage, the infant uses the mouth as the major source of gratification and exploration. Pleasure is experienced from eating, biting, chewing and sucking. The infants primary need is for security, this is why major conflicts can occur with weaning.

When is an APGAR Score taken?

1 minute after birth and 5 minutes after birth

8 Stages of Erikson's Psychosocial Theory

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. integrity vs. despair

Anal Stage (Freud)

18mos - 3 years, receives pleasure with toilet training; establishing freedoms and social control through this success.

Phallic Stage (Freud)

3-7 years, child has increased interest in gender differences. Experiences conflict and resolution with parent of the same sex. (Oedipus in boys, Electra in girls) Curiosity about genitals increase

Latency Stage (Freud)

7-12 Years, this stage marks the transition to the genital stage during adolescence. increasing sex-role identification with the parent of the sex as the child for adult roles and relationships.

The nurse is educating new parents about meeting the newborn's needs such as providing warmth, comfort, and feeding when hungry. According to Erikson, which stage of growth and development will be met if the parent's are successful in this phase? a. Trust vs. Mistrust b. Autonomy vs. Shame and Doubt c. Industry vs. Inferiority d. Identify vs. Role Confusion.

A. Trust vs. Mistrust

Growth

An increase in body size or changes in body cell structure, function, and complexity

Development

An orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences and learning.

What is a common cause of regression in toddlers?

Being ill or in pain

How can nurses reduce fear in pre-school aged children?

By explaining the procedure in a language that the child can understand and by being honest about the pain the procedure will cause.

What are common accidental injuries for older adults?

Changes in vision and hearing Loss of mass and strength of muscles Loss of collagen in skin Slower reflexes and reaction time Decreased sensory ability Combined effects of chronic illness and medications Economic factors

Temporary state of confusion that is usually reversible, usually occurs with an acute illness or specific underlying cause that can last from hours to weeks. It resolves once underlying cause is resolved. Can be caused by extreme pain or sleep deprivation. Can also be caused by dehydration and or infection, most common in older adults who may have a UTI.

Delirium

Progressively effects cognitive functioning, it is chronic and usually develops gradually, usually NOT reversible. Most common form is Alzheimer's. Cause of Sundowners Syndrome- Confused, restless or agitated. Like to wonder and sometimes hallucinate and experience paranoia.

Dementia

Culture

Different languages, beliefs can influence development.

Four Main Preventable Causes of Toddler Deaths

Drowning Falls Motor Vehicle Accident Poisoning

Erikson's Psychosocial Theory

Each stage builds on tasks of the previous stage, successful mastery leads to sense of self; Builds off of Freuds theory, adds in cultural and social influences as well.

Freud Theory of "Psychoanalytic" Development

Focuses on the motivation for human behavior Influenced by instinctual drives: sex, aggression, survival Behavior is controlled by Id (urges), Ego (balance), and Superego (conscience)

Signs of ADHD Include:

Inattention or inability to stay focused Inability to concentrate Hyperactivity Impulse control or difficulty controlling behavior

What effects can substance use during pregnancy have on the child?

Increases the risk for congenital anomalies Low birth weight Premature birth Potential poor nutrition

Ego Integrity vs Despair (Erikson)

Later Adult; Reminisces about events in life leads to fulfillment and purpose. If person feels that they have failed in life = Despair

Generativity vs Stagnation (Erikson)

Middle adult, become concerned with next generation and desire to make a contribution to the world. If not meet = stagnation

What are some common myths surrounding older adults?

Most older adults are in long-term care facilities. Older adults are sick, and mental deterioration occurs. Older adults are not interested in sex. Older adults do not care how they look and are lonely. Bladder problems are a problem of aging. Older adults do not deserve aggressive treatment for illnesses.

What is the most common cause of mortality among adolescents or young adults?

Motor Vehicle Accidents

The use of many medications at the same time, that can pose many hazards for older adults is called what?

Polypharmacy

Initiative vs Guilt (Erikson)

Preschool ages 4-6. Toddler gains confidence by seeking out new experiences. If child receives restrictions/ reprimands= guilt

What is the main goal of nursing care for the older adult population?

Promote Independent Function

Genital Stage (Freud)

Puberty-Adulthood, sexual interest can be expressed in overt sexual relationships. Sexual pressure and conflicts typically cause turmoil as the adolescent makes adjustments in relationships.

Normal Characteristics of a Neonate (Birth to 28 days)

Reflexes Develop Body Temperature can drop quickly Active Crying Quiet Alert State

Identity vs Role Confusion (Erikson)

Role confusion can occur if adolescent is unable to establish their own identity

What assessment tool is used to allow nurses to quickly identify problems with older adult patients where they can use interventions to individualize patient care?

SPICES Assessment Tool S - Sleep disorders P - Problems with eating or feeding I - Incontinence C - Confusion E - Evidence of falls S - Skin breakdown

Industry vs. Inferiority (Erikson)

School aged children, Child gains pleasure from finishing projects and receiving recognition. If not accepted by peers= inferiority or lack of self-confidence.

Autonomy vs Shame and Doubt (Erikson)

Toddler ages 1-3. Child learns from environment and gains independence through encouragement of caregivers. If caregiver is overprotective or has high expectations can lead to shame/ doubt

As many as two million people older than 65 years of age suffer from abuse, neglect, or exploitation, inflicted by family members in 90% of cases. True or False?

True

Both acute and chronic illnesses are more likely to occur in middle adulthood, and recovery takes longer. True or False?

True

In the pre-pubescent stage the reproductive organs do not yet produce ova or sperm. True or False?

True

The most essential role of the nurse in promoting health of the infant is teaching family members and caregivers. True or False?

True

Intimacy vs Isolation (Erikson)

Young Adult, Try to unite their identity with identities of friends/ significant other to make commitments.

1. A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as: a. abandonment. b. exploitation. c. neglect. d. emotional abuse.

a. Abandonment

After the nursing plan of care has been developed, the nurse knows that: a. Each encounter with the client is an opportunity to reassess and revise the plan of care, if necessary. b. The plan will be followed by other health care providers and filed with the client's chart upon discharge. c. The responsibility for the assessment of the client has ended. d. The plan of care can only be changed by the nurse who developed it.

a. Each encounter with the client is an opportunity to reassess and revise the plan of care, if necessary.

When assessing an older adult client's home for safety, the nurse should recommend what? a. Eliminating throw rugs b. Using low lighting c. Taking tub baths d. Avoiding air conditioning in summer

a. Eliminating throw rugs

A school nurse is aware of the importance of creating and carrying out interventions that resonate with the developmental tasks of the adolescent population. Such interventions should appeal to adolescents' prioritization of their what? a. Identity b. Vulnerability c. Skepticism d. Goals

a. Identity

The school nurse is teaching growth and development in a health class. What should the nurse teach the students about development? a. It is the process of ongoing change b. It centers around an increase in body's size c. It is best defined as intellectual growth. It is influenced by genetically predisposed alterations.

a. It is the process of ongoing change.

When providing nursing care and education to an adolescent, the nurse recognizes that which of the following groups has the greatest influence during this period of development? Taylor pg 551 a. Peer group b. Immediate family c. Extended family d. Teachers and coaches

a. Peer Group

An resident of a long-term care facility, age 82 years, often tells stories of the role that he played in the Korean War. According to Erikson, which of the following needs may underlie the resident's storytelling? a. The need to demonstrate that his life was meaningful and purposeful b. The need to show that his life was characterized by moral integrity. c. The need to demonstrate that he was capable of physical aggression in earlier adulthood d. The need to show that others were dependent on him in earlier stages of life

a. The need to demonstrate that his life was meaningful and purposeful

The nurse is caring for Michelle, a 15-year-old female, who was admitted for a concussion suffered while playing hockey. Her parents are at her bedside and appear very concerned about her. She ignores them for the most part and spends her time texting her hockey friends. Which of the following describes how her behavior is related to Erik Erikson's theory of growth and development? a. The peer group acts as the greatest influence. b. Abstract concepts are being utilized c. She is learning about gender social roles d. This stage is about learning useful skills

a. The peer group acts as the greatest influence.

The nurse is working in a long-term care facility and overhears a group of unlicensed assistive personnel (UAP) discussing some of the residents of the facility. What statement made by a UAP indicates that education regarding older adult clients is needed? a. "Older adult clients still enjoy sexual relations." b. "All old people start to deteriorate mentally." c. "Some of the residents still like to look their best." d. "Not all people that are elderly live in long-term care facilities"

b. "All old people start to deteriorate mentally."

The nurse performs discharge teaching for a client. How would the nurse best evaluate the effectiveness of the discharge teaching? a. Review it to see if all health care provider prescriptions were covered. b. Ask the client to repeat back to the nurse how care will be conducted at home. c. Determine if critical pathways were completed. Ask if the client understands the teaching

b. Ask the client to repeat back to the nurse how care will be conducted at home.

The nurse is caring for an older adult client on the medical unit admitted for diagnostic testing. The client is alert and oriented and lives independently. The client was wearing glasses upon admission. Which nursing intervention will be most effective in the prevention of falls for this client? a. using a gait belt each time the client ambulates b. ensuring the client's glasses are close by the bed c. placing a bed alarm on the bed d. moving the client to a room close to the nurse's station

b. ensuring the client's glasses are close by the bed

Which statement shows that the nurse does not practice ageism? a. "Most older adults are lonely." b. "Older adults have incontinence." c. "Neither intelligence nor personality normally decline because of aging." d. "Older adults do not mind how they look."

c. "Neither intelligence nor personality normally decline because of aging."

A nurse must call a health care provider to request a prescription for a client who is experiencing pain unrelieved by the previous medication prescribed. When the nurse makes the call, the provider screams at the nurse and states, "Just do what the prescription says! I am not giving you another prescription for pain medication!" What is the best response by the nurse? a. "You shouldn't treat the client that way!" b. "OK. Don't give me a prescription, I will just call the chief of staff." - c. "Speaking to me that way is unacceptable. We should work together for the benefit of the client." d. "I don't know why you won't give me a prescription for the pain medication. You are so rude!"

c. "Speaking to me that way is unacceptable. We should work together for the benefit of the client."

Which statement regarding the difference between data collected for assessment and data collected for evaluation is correct? a. There is no difference between data collected for assessment and data collected for evaluation. b. Data collected for assessment relate to the client health history, whereas data collected for evaluation identify the actions of physician orders. c. Data collected for assessment identify client health issues, whereas data collected for evaluation determine whether client outcomes are being achieved. d. Data collected for assessment are part of the client's health record but are not further used for client care.

c. Data collected for assessment identify client health issues, whereas data collected for evaluation determine whether client outcomes are being achieved.