Human Development

Toddlers - 1-3 years

-Continued growth and development -Increased fine and gross motor skills -Likes routine and rituals -Considerable language development -Family awareness and involvement -Eats well but may be picky (food jags) -Potty training usually accomplished

A parent asks the nurse why a 10-month-old infant gets otitis media more frequently than a 10-year-old child. How should the nurse respond?

"An infant's eustachian tubes are shorter." Rationale: Infants and young children are more prone to otitis media because their eustachian tubes are shorter and lie more horizontally. Pathogens from the nasopharynx can more readily enter the eustachian tube of the middle ear. The tendency toward otitis media isn't related to the ability to blow the nose or to lying flat. The baby's immune system may not be as developed as the older child's, but that is not the reason for recurrent otitis media.

A 16-year-old adolescent is brought to the clinic for evaluation for a suspected eating disorder. To best assess the effects of role and relationship patterns on the client's nutritional intake, the nurse should ask:

"Do you like yourself physically?" Rationale: Role and relationship patterns focus on body image and the client's relationship with others, which commonly interrelate with food intake. Therefore, asking the adolescent about physical self-image is appropriate. Questions about activities and food preferences elicit information about health promotion and health protection behaviors, not role and relationship patterns. Questions about food allergies elicit information about health and illness patterns.

A mother is concerned that her neonate, who was born without complications at 38 weeks, isn't eating enough and will lose too much weight. The mother states, "The baby only breast-feeds for about 3 minutes on one side." Which instruction should the nurse provide to this mother?

"I understand your concern, but the baby has stored nutrients before birth just for this reason."

A school nurse is educating a class of female middle school students on how to promote urinary system health. Which statement by one of the girls indicates understanding?

"I will wipe from front to back after going to the toilet."

Risk factors for Infants

-Absence of or inadequate prenatal care -Exposure to illicit drugs or alcohol -Genetic disorders -Congenital infections and disorders Birth Risk: -Premature birth -Low birth weight -Birth trauma -Anoxia

How long is the neonatal period for a newborn?

28 days

For a diagnosis of Klinefelter syndrome, what would be the chromosome pattern to identify this disorder?

47, XXY

Adolescents (12-18 years)

A time of change: Physically - •Puberty begins •Skeletal growth ends Socially - •Relationships outside of family are most important •Interest in opposite sex •Part-time jobs Mentally - •Sophisticated use of language and abstract thinking •Career choices •Develop own morals and values

The nurse is explaining the expected developmental tasks of a typical family with adolescents. Which of the following would be incorrect for the nurse to include?

Adjustment to retirement

In a discussion with a group of high school teachers about oppositional defiant disorder (ODD), the nurse says that behavior modification of the parents and teachers toward such children forms the basis of therapy. What is the most appropriate rationale that the nurse gives when asked about this strategy?

Adolescents with ODD learn maladaptive behavior at home and it can be perpetuated at school.

A nurse on the pediatric floor is caring for a toddler refusing to take liquid acetaminophen for fever. What would be the best option?

Allow the parent to hold the child and give the medication.

What is the correct amount of wet diapers a mature infant should produce each day?

An infant should have 6 to 8 wet diapers/day.

Which behavior by a 3-year-old child does not validate Erikson's developmental task for preschoolers?

Compares his soccer abilities with his peers.

Which term refers to a failure of one or both or both of the testes to descend into the scrotum?

Cryptorchidism Rationale: Cryptorchidism is the failure of one or both of the testes to descend into the scrotum. Hydrocele is a collection of fluid, generally in the tunica vaginalis of the testes. Varicocele is an abnormal dilation of the veins of the pampiniform venous plexus in the scrotum. Phimosis is a condition in which the foreskin is constricted so that is cannot be retracted over the glans.

The nurse enters the room of an older adult client diagnosed with Alzheimer disease to perform a head-to-toe assessment. What assessment findings by the nurse are reflective of the normal signs of aging? Select all that apply.

Decreased near vision Increased systolic and diastolic blood pressure Decreased tissue elasticity

During a developmental screening, the nurse notes the toddler is not meeting expected developmental milestones. What is the best action by the nurse?

Discuss the delay in milestones with the primary care provider and family.

A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client?

Formal operational thought

Maslow's Hierarchy of Needs

From highest to lowest: •Self Actualization •Esteem •Love and Belonging •Safety and Protection •Activity •Physiological Needs

What self-concept is demonstrated when a child says that he wants to be "just like my dad"?

Ideal self

Twelve to eighteen years

Identify vs Role Confusion

Six to twelve years

Industry vs Inferiority

65 years to death

Integrity vs Despair

18 - 25(35) years

Intimacy vs Isolation

The student nurse is caring for a 2 1/2-week-old in the newborn intensive care unit. Which term is most accurate when discussing this client?

Newborn Rationale: A more accurate term for this child would be newborn rather than infant because the newborn or neonatal period of infancy is defined as the period from birth until 28 days of age. Infancy is the period of time up to 1 year old. Child and baby don't refer to the client's age accurately.

A preschool-age child tells the nurse about an imaginary friend. The parents are concerned because the child refuses to do anything without the friend's help. Which nursing diagnosis is most applicable for the family?

Parental anxiety related to lack of understanding of childhood development Rationale: The parents need to understand that the child's behavior is not uncommon. Imaginary friends are common in the preschool-age child. The child's behavior is not abnormal. The child does not have a deep-set psychological need. The child is not at risk for social isolation.

According to Maslow, which category of needs represents the most basic on the hierarchy?

Physiologic needs

In terms of Maslow's hierarchy of need, families living in poverty may be focused more on which type of needs rather than self-actualization?

Survival

The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent?

The adolescent will likely have the greatest influence on one's own decisions.

A nurse is working with a child undergoing behavioral modification therapy for attention deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be the most likely reason for this observation?

The child cannot sit through meals. Rationale: Children with ADHD are not patient enough to sit through meals. This results in reduced dietary intake. This is the most likely reason for children with ADHD to be thin. Children with ADHD do not have impaired taste sensation. These children do not have loss of appetite unless they are on drugs like methylphenidate. It is not known whether children with ADHD are genetically predisposed to being thin.

The nurse is providing care for a client who has obsessive-compulsive disorder (OCD). What aspect of this client's history was the most likely contributor to its etiology?

The client's mother had OCD

While teaching a sex education class to a group of preadolescents, the school nurse explains that human growth and development begins at which of the following events?

When ovum is fertilized by sperm

The nurse caring for a 2-year-old client offers the child the choice to hold the syringe and squirt the medication in the mouth or have the nurse give the medication. According to Erikson, what does this help the child achieve?

autonomy

One to three years

autonomy vs shame and doubt

he most critical time for teratogenic influence in embryonic development is:

from day 15 to day 60 after conception.

A client with Down syndrome is admitted to the pediatric unit with asthma. The client does not enunciate words well and holds onto furniture when walking. The nurse should ask the caregiver

how the client's condition today differs from their normal condition.

The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiologic effects?

impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression Rationale: Unrelieved acute pain can lead to impaired mobility; anorexia, causing poor nutritional intake; delayed wound healing; anxiety and irritability; somatic symptoms; sleep disturbances; avoidance; developmental regression; and increased parental distress. Constipation, nausea, vomiting, nocturnal enuresis, and migraine headaches are not effects of acute pain.

Three to six years

initiative vs guilt

The best way for an infant's parent to help the child complete the developmental task of the first year is to:

respond to the infant consistently.

Birth to one year

trust vs mistrust

Infants - birth to 12 months

§Rapid physical growth - weight doubles by six months and triples by one year §From breast milk/formula to solid food §Beginnings of language development §Socializations skills §Sleep and rest patterns §Rapid progression in fine and gross motor skills

Middle Aged Adults 35-65 Years

•Achieve stability •"Sandwich Generation" •Physiological changes and health concerns •Psychosocial changes •Career transition •Economic realities and planning •Relationships with adult children •Unexpected transitions •Wellness and physical fitness •Stress management •Future family stability (grandchildren)

Young Adults 18-35 Years

•Ages 18-29 - millennial generation •"always connected" •Adapt to new experiences •More ethnically and racially diverse •Establish career goals •Decide on remaining single or get married •Have completed physical growth •Active with few illnesses •Critical thinkers •Flexible and adaptable when secure with self

Older Adults 65 Years to Death

•Decline and change varies considerably in all these areas: -Physiological, cognitive, and psychosocial health -Levels of functional ability -Dependence vs. independence -Strengths and abilities •Deals with different types of loss •Redefining of relationships

Risk Categories for young Adults 18-35 Years

•PHYSICAL -Family history of disease -STDs -Personal hygiene, including dental care •SAFETY -Violence is the greatest cause of mortality and morbidity. -Motor vehicle safety -Occupational safety •PSYCHOSOCIAL -Substance abuse -Stress management •FAMILY DYNAMICS -Pregnancy -Infertility -Parenting -Child abuse

Risk Categories for Middle Aged Adults 35-65 Years

•PSYCHOSOCIAL •Stress management •PHYSICAL -Risks for illness -Screenings •FAMILY DYNAMICS -Elder abuse -Family stability

School Age 6-12 years

-Enjoys school, learning, reading -May start sports, dance, music -Team play and competition -School friends important; family still a priority -Handles household chores -Establishes role/gender identity -Rapid intellectual growth - math, abstract ideas, -technical learning, handling money

Preschoolers (3-5 years)

-Period of rapid cognitive growth -Begins to enjoy playing with others -Gross motor skills well-developed -Rapid language development -Uses imaginary play -Begins to do chores -Carries out most self-care skills -Draws, colors, pastes, enjoys crafts

Which statement made by a senior citizen who has taken a class on stress reduction would indicate to the nurse the need for further instruction?

"As one grows older, their stress decreases."

Preschool risk categories

•SAFETY -Motor vehicle safety -Play safety •PREVENTATIVE SCREENINGS •Vision, hearing, developmental, immunizations, anemia •NUTRITION -Balanced diet

Risk categories for toddlers

•SAFETY -Stranger safety -Street/vehicle safety -Home safety -Play safety

Risk categories for School Age

•SAFETY •Motor vehicle safety •Play safety •ESTABLISH BOUNDARIES •Use of electronics •Sleep and activity •PSYCHOSOCIAL NEEDS •Approval and praise •Social interactions (risk taking)

Risk Categories for Adolescents

•SAFETY •Motor vehicle safety •Substance abuse •Sports •PSYCHOSOCIAL •Sexuality •Life style behaviors (risk taking) •Depression •Relationships

Changes with older Adults

Functional Changes: •Usually linked to illness or disease and degree of chronicity •The performance of ADLs is a sensitive indicator of health or illness. •Perception of well-being defines quality of life Psychosocial Changes: •Retirement •Social isolation •Sexuality •Housing and environment •Death

25(35) - 65 years

Generativity vs Stagnation

The nurse observes an elderly client teaching an adolescent how to crochet a pot holder. The nurse evaluates this behavior as evidence of resolution of Erickson's developmental stage of what?

Generativity vs. stagnation

A child is taking methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which side effect must be monitored in this child?

Growth delays

The nurse is caring for a 10-year-old child admitted for a surgical procedure to be done the next day. The nurse takes the child to a special area in the playroom and lets the child "start" an IV on a stuffed bear. This is an example of:

therapeutic play.

A mother and grandmother bring a 2-month-old infant to the clinic for a routine checkup. As the nurse weighs the infant, the grandmother asks, "Shouldn't the baby start eating solid food? My kids started on cereal when they were 2 weeks old." Which response by the nurse would be most appropriate?

"Babies can't digest solid food properly until after they are 4 months old."

A parent brings a 2-year-old child in to the clinic for a wellness check-up and informs the nurse that toilet training is not going well. The parent states, "I thought it would be easy to toilet train for bowel movements, but my child is still having accidents." What is the best response by the nurse?

"Children vary in their readiness but daytime bowel control may be attained at 30 months."

The mental health nurse assesses for the most common mental health disorder found in children when asking which question?

"Do you ever get scolded at school for not sitting still? Rationale: One in five to 10 children and adolescents surveyed exhibited symptoms of attention deficit hyperactivity disorder, which can sometimes be evidenced by an inability to sit still in school.