NCM101: growth and development Physical Growth measurable aspect of an individuals increase in physical measurements; measurable growth indicates

includes changes in Height Weight Teeth Skeletal structures Sexual characteristics Development occurs gradually and refers to changes in skill and capacity to function qualitative in nature and difficult to measure in exact units. Predictable characteristics such development proceeds form Simple to Complex General to Specific Head to Toe (cephalocaudal) Trunk to extremities (proximodistal) Differentiation process by which cells and structures become modified and develop more refined characteristics. Major Factors Influencing Growth and Development 1. Forces of Nature 2. External Forces Forces of Nature 1. Heredity 2. Temperament Heredity Genetic endowment determines, sex, race, hair and eye color, physical growth, stature and to some extent psychological uniqueness. Temperament characteristic psychological mood with which the child is born and includes behavioral styles of easy, slow-to-warm, and difficult. It influences interactions between the individual and environment. External Forces 1. Family 2. Peer Group 3. Life Experiences 4. Health Environment 5. Prenatal Health 6. Nutrition 7. Rest, Sleep and Exercise 8. State of Health 9. Living Environment Family Protect and nurture its members Function is for survival, security, assistances with emotional and social development assistance with maintenance of relationships, instruction about society and world and assistance in learning roles and behaviors Influences through its values, beliefs customs and specific patterns of interaction and communication.

to achieve group purposes by meeting demands, pressures and expectations. Life Experience

Life experience and learning processes allow individual to develop by applying what has been learned to what needs to be learned. Learning process involves series of steps: o Recognition of need to know task o Mastery of skill to perform task o Mastery of task o Expertise in performing task which expands capabilities o Integration into whole functioning o Use of accumulated skills and experiences to develop repertoire of effective behavior

Health Environment Level of health affects individuals responsiveness to environment and responsiveness of others to the individual Prenatal Health Preconception o Genetic and chromosomal factors o Maternal age o Health Postconception o Nutrition o Weight gain o Use of tobacco and alcohol o Medical problems o Use of prenatal services Factors affect fetal growth and development.

Nutrition Growth is regulated by dietary factors. Adequacy of nutrients influences whether and how physiological needs, as well as subsequent growth and development needs are met. Rest, Sleep and Exercise Balance between rest and sleep and exercise is essential to rejuvenating body. Disturbance diminishes growth, whereas equilibrium reinforces physiological and psychological health. State of Health Illness or injury potentially hampers growth and development. Nature and duration of health problem influences its impact. Prolonged injury or illness may cause inability to cope and respond to demands and task of developmental stages. Living Environment Factors affecting growth and development include season, climate, home life and socioeconomic status. Four Areas of Theory Development 1. Biophysical Development 2. Psychosocial Development 3. Cognitive Development 4. Moral Development BIOPHYSICAL DEVELOPMENT The process of biological maturation. Describe the way our physical bodies grow and change. These changes are quantified and can be compared against established norms. Arnold Gesells Theory of Development psychologist who obtained his medical degree to help him explain the physiological process he was observing in the behavior of children.

Peer Group Provides new and different learning environment Provides different patterns and structures of interaction and communication, necessitating different style of behavior. Function is to allow individual to learn about success and failure. To validate and challenge thoughts, feelings and concepts, to receive acceptance ,support and rejection as unique person apart form family, and

Fundamental to Gesells theory of development is that a childs pattern growth directed by the activity of genes. Environmental factors can support, change and modify the patterns but they do not generate progression of development. Arnold Gesells Theory of Development He found the patter of maturation as a fixed developmental sequence in all humans. Sequential development is seen in fetuses where there is a specified order of development of the various organ systems. After birth, children grow according to their genetic blueprint and gain skills in an orderly fashion, but at each individual own pace. PSYCHOSOCIAL THEORY describes human development form the perspective of personality, thinking and behavior development of personality. Sigmund Freud first person to provide, formal structure theory of personality development. his theory is grounded in the belief that two internal biological forces essentially drive psychological change in the child: 1. Sexual (Libido) 2. Aggressive energies Motivation for behavior is to achieve pleasure and avoid pain created Freuds Psychoanalytic Model of Personality development 1. Oral 2. Anal 3. Phallic 4. Latency 5. Genital Oral birth to 1 y/o; initially, sucking and oral satisfaction is not only vital to life but also extremely pleasurable in its own right. Late in this stage, the infant begins to realize that the mother is something separate form self. Disruption in the physical or emotional availability of the parent could have an impact on the infants development. Anal 1 to 3 y/o; focus of pleasure changes to the anal zone. Children become increasingly aware of pleasurable sensation of this body region with interest in the products of their effort.

Genital Puberty through Adulthood; time of turbulence when earlier sexual urges reawaken and are directed to an individual outside the family circle. Components that regulates behavior according to Freud 1. Id 2. Ego 3. Superego Id instinctual impulses drive to achieve pleasure Ego reality component mediating conflicts between the environment and the forces of the id. helps us judge reality accurately, regulate impulses, and make good decisions. Superego performs regulating, restraining and prohibiting actions; often referred to as the conscience; Superego is influenced by the standards of outside social forces. (parent teacher) Erick Erikson expanded Freuds psychoanalytic stages into a psychosocial model that covered the whole life span Ericksons 8 Stages of Life 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 Trust VS Mistrust (birth to 1 y/o) starting w/ oral satisfaction, the infant learns to trust` the caregivers as well as self. Trust is achieved when infant will let caregiver out of sight without undo distress Key to this stage is consistent care giving. Autonomy VS Shame and Doubt (1 to 3 y/o) child is now becoming accomplished in some basic self-care activities, including walking, feeding, and toileting. Toddler develops his autonomy by making choices. Choices typical for the toddler age-group include activities related to relationships, desires, and playthings. Initiative VS Guilt (3 to 6 y/o) Children like to pretend and try out new roles.

Phallic
3 to 6 y/o: genital organs become the focus of pleasure. Boy becomes interested in the penis; the girl becomes aware of the absence of the penis know as the Penis Envy. Exploration and imagination as the child fantasizes about the parent of the opposite sex as his or her first love interest, Oedipus Son to Mother Electra Daughter to Father By the end of this stage, the child attempts to reduce this conflict by identifying with the parent of the same sex in a way to win recognition and acceptance.

Fantasy and imagination allow children to further explore their environment. Children are developing their superego/conscience. Conflicts often arise between the childs desire to explore and the limits placed on his or her behavior. These conflicts may lead to feelings of frustration and guilt Industry VS Inferiority (6 to 11 y/o) School-age children are eager to apply themselves to learning socially productive skills and tools. They learn to work and play with their peers.

Latency
6 to 12 y/o; Sexual urges are repressed and channeled into productive activities that are socially acceptable. Child places energy and effort in the educational and social world in where there is much to learn and accomplish.

School-age children thrive on their accomplishments and praise Identity VS Role Confusion (Puberty) Dramatic physiological changes associated with sexual maturation mark this stage.

predictable in his or her habits. Marked preoccupation with appearance ad body image. This stage in which identity development begins with the goal of achieving some perspective or direction answers the question Who am I? Acquiring a sense of identity is essential for making adult decisions such as choice of vocation or marriage partner. Intimacy VS Isolation (Young Adult) developed sense of identity, deepen their capacity to love others and care for them. Time to be fully participative in the community, enjoying adult freedom and responsibility. If sense of personal identity isnt achieved, they may experience feelings of isolation form others and the inability to form meaning full attachments. Generativity VS Stagnation
(Middle Age) adult can focus on supporting future generations. Ability to expand ones personal and social involvement is critical to this stage of development. Middle age adults should be able to see beyond their needs and accomplishments to the needs of society. Dissatisfaction with ones place and achievements often lead to stagnation May find sense of fulfillment by volunteering some time in a local school, hospital or church. .

Open and adaptable to change and displays a mild to moderately intense mood that is typically positive.

The Difficult Child highly active, irritable, and irregular in habits. Negative withdrawal towards others is typical, and the child requires a more structure environment. Adapts slowly to new routines, people or situations. Mood expressions are usually intense and primarily negative.

The Slow to- Warm-Up Child typically reacts negatively and with mild intensity to new stimuli. Adapts slowly with repeated contact unless pressured and responds with mild but passive resistance to novelty or changes in routine.

Robert Havighurst defined a series of essentials task that arise from predictable internal and external pressures w/c include increasing physical maturity, cultural pressure of society and individual's personal goals aspirations. Physical Maturity development of skills such as walking, talking or eating Cultural Pressure creates the conditions necessary to learn social behaviors and ethical norms. Havighurst believed that there are critical periods when the individual is most receptive to the learning necessary to achieve success in performing these tasks. Effective learning and achievement of tasks during one period lead to happiness and success with later tasks. Failure leads to unhappiness, disapproval by society and difficulty with later tasks. Schools have considerable responsibility in helping a child attain success necessary to lead to achievement of later adult development. Roger Gould conducted extensive research that supported a set of development themes within stages of adult development. Goulds Development Themes 1. 20s I have to get away from my parents

COGNITIVE DEVELOPMENT Jean Piagets Theory of Cognitive 1. Sensorimotor Phase 2. Preconceptual Phase 3. Intuitive Thought Phase 4. Concrete Operation Phase 5. Formal Operation Phase Sensorimotor Phase 1. Use of Reflexes 2. Primary Circular Reaction 3. Secondary Circular Reaction 4. Coordination of Secondary Schemata 5. Tertiary Circular Reaction 6. Inventions of New Means Use of Reflexes birth to 1 month; most actions are reflexive Primary Circular Reaction 1 to 4 months; Perception of events is centered on the body. Objects are extension of self. Secondary Circular Reaction 4 to 8 months; acknowledges the external environment, actively makes changes in the environment. Coordination of Secondary Schemata 8 to 12 months; Can distinguish of a goal from a means of attaining it. Tertiary Circular Reaction 12 to 18 months; Tries to discovers new goals and ways to attain goals; Rituals are important. Inventions of New Mean 18 to 24 months interprets the environment by mental image; uses make-believe and pretend play. Preconceptual Phase 2 to 4 y/o; Uses an egocentric approach to accommodate the demands of an environment. Everything is significant and relates to ME Explores the environment Language development is rapid. Associates words with objects. Intuitive Thought Phase 4 to 7 y/o; Egocentric thinking diminishes.

2.

30s Is what I am the only way for me to be?

3.

Mid 30s Have I done that right thing? Is there time to change? 40s The die is cast

4.

Stella Chess and Alexander Thomas

The Easy Child easygoing and even-tempered. Regular and

Thinks of one idea at a time. Includes others in the environment. Words express thoughts. Concrete Operations Phase 7 to 11 y/o; Solves concrete problems, Begins to understand relationship such as size. Understands right and left. Cognizant view of point. Formal Operations Phase 11 to 15 y/o; Uses rational thinking; Reasoning is deductive and futuristic MORAL DEVELOPMENT THEORY pattern of change in moral behavior with age; relating to right and wrong. Lawrence Kohlbergs Moral Development Theory follows Piagets cognitive developmental theories; there 3 Levels of moral Development and 6 Stages 3 Levels of Kohlbergs Moral Development: 1. Preconventional Level 2. Conventional Level 3. Postconventional Level 6 Stages of Kohlbergs Moral Development 1. Punishment and Obedience Orientation 2. Instrumental Relativist Orientation 3. Good Boy- Nice Girl Orientation 4. Society-Maintaining Orientation 5. Social Contract Orientation 6. Universal Ethical Principle Orientation Preconventional Level person reflects on moral reasoning based on personal gain. These consequences can come in the form of punishment to r rewards. Punishment and Obedience Orientation child response to a moral dilemma is in terms of absolute obedience to authority and rules. reasoning is I must follow the rules; otherwise I will be punished (motivation to behave) Eg. Nurse follows s order of physician in order not to be fired.
Instrumental Relativist Orientation child recognizes there I more than one right view; teacher may have one view that is different that the childs parent. The decision to do something morally right is based on satisfying ones own needs, and occasionally the needs of others. Punishment is perceived not as a proof of the child being wrong but as something that one wants to avoid. Ill do something if I get something for it or because it pleases you Eg. Client stays in bed if nurse will buy him a newspaper. Conventional Level person sees moral reasoning based on his or her own personal internalization of societal and others expectations Good Boy- Nice Girl Orientation individual wants to win approval and maintain the expectation ones immediate group A person in this stage may stay after school and do odd jobs to win the teachers approval. Society-Maintaining Orientation Individuals expand their focus from relationship with others to societal concerns. Moral decisions take into account societal perspectives. (maintaining the social order)

Adolescents may choose not to attend a party where they know beer will be served, not because they are afraid of getting caught, but because they know that it is not right. Right behavior is obeying the law and following rules Postconventional Level person finds a balance between basic human rights and obligations and societal rules and regulations. individuals move away from moral decisions based on authority or conformity to groups to define their own moral values and principles. Social Contract Orientation individual may follow the societal law but recognizes the possibility of changing the law to improve society. Based on orderly to laws that protects welfare and rights of others Nurse arranges Moslem client to have privacy for prayer Universal Ethical Principle Orientation defines right by decision of conscience in accord with self-chosen ethical principles. (GOLDEN RULE) Carol Gilligan believes there may be parallel ways that men and women develop, with one not being superior to the other. Separation and Individuation are critically tied to male development Separations child recognition of biological distinctness and is based on his emergence from a dependent relationship wit his mother. Separation from mother is essential for the boy in his development of masculinity Individuation based on childs awareness of differences in will, viewpoint and needs. This process permits the individual to gradually assume a more independent role and identify. Male moral development focus on logic, justice and social organization whereas female moral development focuses on interpersonal relationships Carol Gilligan Moral Development 1. Caring for Oneself 2. Caring for Others 3. Caring for Self and Others Caring For Oneself person is concerned only with caring for the self. , individual feels isolated, alone and unconnected to others. The focus of this stage is survival. Caring for Others individual recognizes the selfishness of earlier behavior and begins to understand the need for caring relationships with others. Caring relationship bring with them responsibility, meaning selfsacrifice where good is considered to be caring for others The individual now approaches relationships with a focus of not hurting others causing the individual to be more responsive and submissive to others needs excluding an thoughts of meeting ones own needs. Caring for self and others person sees the need for a balance between caring for others and caring for the self. The concept of responsibility now includes responsibility for the self and for other people. Care remains the focus on which decisions is made. However, the persons recognizes the interconnections between the self and others and realizes that if ones won needs are not met, other people may also suffer. SPIRITUAL DEVELOPMENT THEORIES James Fowler describes the development of faith as a force that gives meaning to a persons life. uses faith as a form of knowing, a way of being in relation to an ultimate environment. Faith is a relational phenomenon; it is an active mode-of-being-in-

relation to another or others in which we invest commitment, belief, love, risk and hope. Fowlers Stages of Development 1. Undifferentiated 2. Intuitive-Projective 3. Mythic-Literal 4. Synthetic-Conventional 5. Individuating-Reflexive 6. Paradoxical-Consolidative 7. Universalizing Undifferentiated (0 to 3 y/o) Infant unable to formulate concepts about self or the environment.

1 y/o weight gain 3 times its body weight Birth Length 50 cm Crown-to-Rump sitting length Top of the head to the base of the heel 6 mos length gain 13.75 cm 12 mos length gain 7.5 cm (all in all at the age of 1 y/o infant should be 71.25cm)

Intuitive-Projective (4 to 6 y/o) a combination of images and beliefs given by trusted others, mixed with the childs own experience and imagination. Mythic-Literal (7 to 12 y/o) Private world of fantasy and wonder; symbols refer to something specific dramatic stories and myths used communicate spiritual meanings. Synthetic-Conventional (Adolescent or Adult) World and ultimate environment structured by the expectations and judgment of others interpersonal focus. Individuating-Reflexive (After 18 y/o) Constructing ones own explicit system; high degree of self-consciousness Paradoxical-Consolidative (After 30 y/o) Awareness of truth from a variety of viewpoints. Universalizing (Maybe Never) Becoming an incarnation of the principles of love and justice. Westerhoff describes faith as a way of being and behaving that evolves from an experienced faith guided by parents and others during persons infancy and childhoods to an owned faith that is internalized in adulthood and serves as directive for person action. Westerhoffs Four Stages of Faith 1. Experienced Faith 2. Affiliative Faith 3. Searching Faith 4. Owned Faith Experienced Faith (Infancy/early adolescence) Experiences faith through interaction with others who are living a particular faith tradition. Affiliative Faith (Late adolescence) Actively participates in activities that characterize a particular faith tradition; experiences awe and wonderment; feels a sense of belonging. Searching Faith (Young Adulthood) Through process of question and doubting own faith; acquires cognitive as well as an affective faith. Owned Faith (middle adulthood/old age) Puts faith into personal and social action and is willing to stand up for what the individual believes even against nursing community.

Head-Chest Circumference

Normal Head Circumference at Birth 35 cm Chest Circumference at birth less than 2.5cm that head circumference 9 10 mos head-chest circumference equal in size After 1 y/o chest circumference is larger

Head Molding

Fontanelle unossified membranous o Anterior Fontanelle diamond in shape; closes at 9 18 mos

o
Vision

Posterior Fontanelle triangle in shape; closes at 2 3 mos

Sutures junction lines of the skull bone

4 months Recognize familiar objects, follow moving ones 9 months recognize facial characteristic often smile in response to familiar faces. 12 mos depth perception developed

Hearing

Few Days of Birth able to distinguish different sound 5 months will pause sucking in order to listen to mothers voice 9 months Able to locate the source of sounds and recognize familiar ones 1 y/o listen sounds, begins to distinguish words and respond to simple commands

INFANCY (28 Days - 1 y/o)

Physical Development

Birth Weight 2.7 3.8 kgs. Physiologic Weight Loss 5% - 10% of Body Weight 5 6 mos weight gain 2 times its body weight

Smell and Taste Functional shortly after birth

 Touch Reflexes

Prefers sweet taste Able to recognize the smell of their mothers milk Will developed after birth Skin to skin touching is important Responds positively to warmth, love, security when touched, held and cuddled. Sensitive to extreme temperature (temperature) 1. 2. 3. 4. Sucking Reflex Rooting Reflex Moro Reflex Palmar Grasp Reflex Plantar Reflex Tonic Neck or Fencing Reflex Stepping Reflex Babinski Reflex

follows moving and bright objects to midline with eyes

3 months o Actively holds object in hands

Raises head and shoulder 45o to 90o when in prone

4 months o Holds head steadily while in sitting position o Grasp object with both hands o Rolls over 5 months

o
o

5.
6. 7. 8.

Sits for a longer period when back is supported Actively grasp and object taking to its mouth.

Sucking Reflex occurs when infants lips are touched; persist throughout infancy

6 months o Lifts chest and shoulders off the table when prone o Able to bear weight on hands. Manipulates small objects

Rooting Reflex feeding reflex elicited by touching the babys check causing the babys head to turn to the side that was touched. Disappear after 4 months Moro Reflex Assessed to estimate the maturing of the Cranial Nervous System (e.g. loud noise change in position Palmar Grasp Reflex occurs when a small object is placed against the palm of the hand, causing the fingers to curl around. Disappears after 3 months Plantar Reflex an object s placed just beneath the toes causing them to curl around. Disappears after 8 months Tonic Neck or Fencing Reflex when a baby whos laying on its back turn its head to the right side while its left hand stretches out. Disappears after 4 months Stepping Reflex holding the baby upright so that the feet touch a flat surface then its legs move up and down Disappears at about 2 months Babinski Reflex when sole of the foot is stroked the big toe rises and the other toes fan out Motor Development

7 months o Sits alone without support o o Bears weight on legs when held in standing position Transfers object from one hand to another

8 months o Reaches for toys out of reach o Feeds self with fingers o Stands holding on 9 months o Creep and Crawls

o
o

Beginner pincer grasp :with thumb and forefinger Pulls self to standing position

10 months o Stands holding on to support o Sits by falling o Pulls self to sitting position 11 months o Stands alone momentarily o o Walks while holding onto furnitures Neat pincer grasp with thumb and index finger

12 months o Walks alone with help o Uses spoon to feed self.

New Born Turns head from side-to-side when in prone position Grasp by reflex when object is placed in palm or hand 2 months

Psychosocial Development Displays displeasure by crying and satisfaction by soft vocalization Attends to adult face and voice by eye contact and quieting. 2 months o Displays social smile o Smile and vocalizes to a familiar voice

lifts head 45o when prone

3 months o Coos and babbles o Laughs aloud 4 months o Enjoys social interactions o Vocalizes displeasure when left alone 5 months o Discriminates between strangers and family o Vocalize displeasure when desired object is removed.

10 highest possible score 4 7 with little difficulty Done at 1 5 mins

Denver Developmental Screening Test (DDST)

Used to screen children form birth to 6 y/o of age. The test is intended to estimate the abilities of a child compared to those of an average group of children of the same age. Function of the baby On going Nursing Assessment 1. Assessment Guidelines 2. NANDA a. Health seeking behaviors (parental) related to the physical care of infant. b. Altered parenting related to parents inability to meet infants psychosocial needs.

6 months o Starts to imitate sounds o Vocalizes one syllable sound: mama. papa

7 months o Shows fear of strangers o Imitates simple acts and sounds o Plays peek-a-boo 8 months o Reaches with open arms to be picked up o Responds to the word no o Cries when scolded o Bashful and nervous with strangers o Complies with simple verbal commands.

Promoting Health and Wellness 1. Protective Measures Handwashing|

1% Silver Nitrate for gonorrhea: place on the eye lids of the baby(NSD) Vitamin K for blood clotting, incase of trauma Smegma present also in female not only in male (protective mechanism of the baby)

9 months o Displays fear of being left alone o Waves bye-bye 10 months o Looks under an object for toy o Aware of own name 11 months o Reacts with frustration when restricted o Plays interactive games using body gestures o Shakes head for no 12 months o Clings to mother in unfamiliar situations o Demonstrates emotions

Immunizations o BCG IM

o o o 2.
3.

DPT 13 dosage, IM thigh OPB 2 oral drops Measles subcutaneous, 9 mos, early 6 mos.

Health Maintenance Visits 2 weeks after birth 2, 4, 6, 9 and 12 months of age Skin Care Sponge bathe for newborns Miliaria rubra (prickly heat) Nutrition Breast milk or formula Feedings are required every two and half hours, Demand Feeding feed the baby whenever they are hungry. Regurgitation 4 y months addition of solid foods to client 6 months requires iron supplements 12 months Weaning Achieved

Cognitive Development Paigets sensorimotor 4 8 months o Being to have perceptual recognition 6 months o Responds to new stimuli o Remember certain objects and look for them for a short time.

4.

12 months o Concept of both space and time.

5.

Moral Development

Associate right and wrong with pleasure and pain In late years and months, can tell easily and quickly by changes in parental expressions and voice tones that their behavior is either approved or disapproved.

Health Assessment APGAR Score Appearance, pulse, grimace, activity, respiration.

Bottle Mouth Syndrome Tooth Decay due to the milk bottle, being left in the babys mouth when falling asleep Elimination Meconium 1st stool of the baby Purpose of Rectal temp for infant is to check for the anal patency Urine Output 15 60 ml/day after birth Adult 30 ml 250 500 ml/day y first year adult 20 x 24 May Urinates often as 20x a day. Rest and Sleep 10 12 hours up to 22 hours a day Crying 1 2 hours/ day normal 8 10 hours/day colicky Stimulation through play Holding, touching and looking at the infant Primarily large, colorful and hanging objects over the crib. Talking to the infant is a soothing voice.

Able to pick up small objects and place in receptacle. Able to hold Spoon and Cup.

6.

Able to walk upstairs with assistance o 2 y/o Probably crawl down the stairs

7. 8.

Able to run; gait is steady

Can balance on one foot and ride a tricycle. o 3 y/o

Most are toilet trained

Freuds Anal Phase Eriksons Autonomy VS Shame/Doubt

Frequent used of word is NO

Temper Tantrums Parents should be consistent in setting limits Separation Anxiety fear and frustration that come with parental absences Abandonment the greatest fear Regression bed-wetting and baby talks Receptive input; listening (comes first) Expressive output; forming its own words (comes second) 1 y/o recognizes their own name. Cognitive Development Can solve problems by trial and error

9.

TODDLER (1 3 y/o) Physical Development

At 2 y/o loose baby look

Weight gains 4x its Birth Weight - Wt gain at 1 2 y/o 2kgs - Wt gain at 3 3 y/o 1-2kgs Height Average growth at - 1 2 y/o 10 12 cm - 2 3 6/o 6 8 cm Head Circumference @ 2 y/o average adult size Brain is 70% of its adult size.

Pronounced lumbar lurdosis and protruding abdomen.

1 3 y/o can solve problems mentally Lear about sequence of time Have some symbolic thoughts Moral Development Begins to know some activities, elicit affection and approval. Recognize that certain rituals (prayers) also elicit approval 2 y/o learns what attitude their parents hold about moral matters.

Sensory Abilities o Visual acuity fairly established. at 3 y/o can look away from a toy prior to reaching out or picking it up

o o

Hearing is at adult level Taste buds are sensitive to natural flavors

Spiritual Development Aware of some religious practices Involved in learning knowledge emotional reactions rather than establishing spiritual beliefs.

Motor Abilities o Fine motor coordination and gross motor skills improve

1 y/o

Health Assessment Assessment outlines NANDA Dx. o High risk for Poisoning related to toddlers normal developmental behavior (maturing motor activities)

Allow child to bring soft toy or blanket to bed Activities prior to bed time should be physically quieting and emotionally soothing.

Parental Knowledge Deficit related to toilet training Toddler must be able to walk Buy potty trainer Bathroom shouldnt be slippery Appropriate praise if successive Shouldnt punish or scold if not successive in eliminating nor voiding

Sleep Disturbance normal result of the developmental level as the child begins to deal with the idea of separations. Stimulation Through Play o Freedom main ingredient that the child needs to facilitate

Health Maintenance Visit 15 18 mos Immunization Safety

o o

On-Looker Play watching TV Parallel Play wants someone to play with but not share toys. Associated Play wants a playmate and coordinates and shares toy.

o
o

Accidents leading cause of mortality. Toddler Proofing the House

Promoting Health and Wellness

Vision should be screened for: o Amblyopia reduced visual acuity in one eye.

Cognitive Stimulation development of logic and reasoning by: o Simple games and solving puzzles o Hiding objects and have child find them Putting small objects in the container for the child to retrieve.

Strabismus crossed eyed.

Dental Health o Dental Carries o 2 y/o initial visit to the dentist Nutrition o Can eat most food and 3 meals a day o o o Meals should be short due to short attention span. Intake meal time should be pleasant time Offer a variety of simple attractive foods in small portions

PRESCHOOLER (3 6 y/o) Physical Development Weight o Generally slow o 5 y/0 gains about 3 5kgs Height o

o
Vision

5 6.25 cm /year 5 y/o Body Length is doubled (100 cm)

o o

Nutrition (Continued) o o o Do not use food as reward neither as punishment. Scheduled meals and snack time that will allow for optimum appetite and behavior Avoid the routine use of sweet dessert.

Hyperopic farsighted Emmetropic refracts light momentarily as the eyes grow in length. (normal) Myopic nearsighted; if the eyes become too long.

Hearing and Taste o Ability to listen has matured

Elimination o 29 mos average age of completion of daytime toilet training.

Taste either Yummy or Yucky

33 mos average age of completion of day and night toilet training.

Motor Abilities o 5 y/o

Rest and Sleep o 10 14 hours/day

able to wash their own hands, face

and brush their teeth

 Self conscious about expressing their bodies Run skillfully and can jump 3 steps Able to balance on their toes Dress themselves without assistance. Psychosocial Development

Motor Development

Capable of pro-social behavior (kind) Largely learned by modeling.

Spiritual Development Enroll in Sunday school and faith oriented classes Learn to imitate religious behavior Requires simple explanation Health Assessment Can participate in answering questions Can distinguish activities they enjoy NANDA Dx. o Sleep Patterns Disturbance related to nightmares. Night fears and awakening

Eriksons Stage Initiative VS Guilt Must solve problems in according with their conscience Imitate behavior, imaginations and creatively become lively Aware of 2 sexes and identifies with the correct one.

Altered health Maintenance related to missed well-child appointments and un-immunized child

Freuds Stage Theory Phallic envy o Becomes interested in clothes and hair style. Four Adaptive Mechanisms 1. Identification 2. Introjections 3. Repression 4. Imagination

Promoting Health and Wellness 1. Health Maintenance Visit and Immunization 2. Safety 3. Dental Health 4. Nutrition 5. Elimination 6. Rest and Sleep 7. Stimulation through Play 8. Social Interaction 9. Language 10. Cognitive Promoting Health and Wellness 1. Health Maintenance Visit and Immunization Annual Follow-up Check up

Identification perceives self as similar to another person and behaves like that person.

Introjections similar to identification; assimilation of the attributes of others.

2.

Repression removing experiences, thought and impulses from awareness related to Oedipus and Electra.

Safety Accidents continue to be the major cause of mortality but can be prevented by a. Control of environment b. Education of the child Dental Health Nutrition Eats adult foods Enjoy helping in kitchen, and should encourage in doing so. 80% of children have tooth decay Fluoridation of water.

3.

Imagination Important part of preschoolers life; active imagination and fantasizes. Gradually emerge as a social being. 4 y/o

4.

o
o 5 y/o o o o

Tends to believe what they know is right Capable of long conversations

5. 6.

Elimination able to take responsibility for independent toileting Rest and Sleep - requires 12 hours of sleep at night - Night Terror wakes up frequently at night

Speaking skills are well0developed Abel to draw a person including all features . Learn about feelings and able to control them Needs to feel that they are loved; shows signs of jealousy.

7.

Stimulation through Play main activity continues to be play; enjoy planning activities. Social Interaction Enjoy playing with peers Provides them with opportunities to learn the rules of play and cooperation.

Cognitive Development Learning through trial and error Think of only one idea at a time 5 y/o can count coins Reading sills start to develop.

8.

9.

Language Encourage child to tell stories Never criticize the childs speech

10

Play word games Read and discuss stories

o
o

8 14 y/o initial growth of pubic hair Vaginal secretion becomes milky and changes from Alkaline to an Acid pH

10. Cognitive
understand the concept of time, memory and creativity. SCHOOL-AGE (6 12 y/o) Physical Development

Weight average weight gain is 3.2kg/year Major weight gain occur from age: o 10 12 y/o boys

Psychosocial Development

Erik Eriksons Stage Industry VS. Inferiority Begin to create and develop a sense of competence and perseverance Motivated by activities that provides a sense of worth Always faced with possibility of failure Have restraints of the school system imposed on their behavior and learn to develop control. Compare their skills with those of their peers in a number of areas Develops a number of adaptive mechanisms: 1. Malingering 2. Rationalization 3. Ritualistic Behavior 4. Regression selfish group Joins gang, small groups of peers Gradually become less self center and More cooperative and conscious of the Self concept continue to mature

9 12 y/o girls

Height gain o 6 y/o both boys and girls have the same height

12 y/o 150 cm

Growth Spurt o 10 12 y/o for girls

12 14 y/o for boys

Extremities tend to grow quicker tan the trunk 6 y/o thoracic curvative starts to develop

Vision

6 y/o full binocular vision 6 8 y/o depth and distance perception of children 9 11 y/o 20/20 vision usually well established Saellens Chart used for testing vision

Recognize similarities and difference between themselves Children who feel unaccepted by peers can feel inferior and worthless. Parents and care gives can assist children to develop psychosocially by: 1. Recognizing success and providing praise for achievement. 2. 3. 4. Guiding children to perform task in which they are likely to succeed. Guiding the child to complete task Teaching children how to get along with peers and adults.

Hearing Auditory perception is fully developed Well0developed sense of touch Pre-Pubertal Changes Endocrine functions slowly increase Changes in endocrine function can result in increase perspiration and more active sebaceous gland. Boys o o o o o o o Girls o o Pelvis and hips broaden Breast tissue develop and maybe tender Testes and scrotum increase in size Skin over the scrotum changes color Breast may enlarge slightly Sparse, downy pubic hair grows at the base of the pelvic Penis gradually becomes wider and longer Grows taller and shoulder widen Axillary Sweating begins

Cognitive Development

Paigets Phase of Cognitive Concrete Operation Phase Changes from egocentric interactions to cooperative interactions. Develops and increase understanding of concepts that are associated with specific objects Develops logical reasoning form intuitive reasoning Learn about cause and effect relationship 7 8 y/o knows the value of coins

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Concept of time also learned

5 10 y/o kidneys double in size Urinates 6 8 times per day 1 2 Bowel Movement per day Enuresis involuntary passage of urine Nocturnal Enuresis

6 y/o o o 9 y/o o o o o o o

Begins to read a clock Reading Skills are developed

Self-motivated Likes to talk, discuss different subjects and likes to debate Act to avoid being punished Do things to benefit themselves Fairness becomes important Shifts from the concrete interest of individual to the interest of the group.

Rest and Sleep 8 12 hours/day without daytime naps

8 y/o 10 hours of sleep

Spiritual Development

11 - 12 y/o less sleep, bedtime maybe as late as 10 pm Activity and Exercise Very active physically Sexuality Motor skills increase Enjoy having parents/siblings attend their games and activities

Fowlers Stage of Spiritual Development mythical-literal stage fact Lear to distinguish fantasy from

Needs to have concept given as prayers present in concrete terms. Generally believe that God is good and always present to help Health Assessment Assessment guidelines NANDA o High risk for injury related to active participation in sport activities o Altered Nutrition; more than body requirements related to dietary intake patter actively and weight increase.

6 y/o strong identification with the parent of same sex 6 12 y/o learn role and concepts of their gender 8 9 y/o concerned about specific sex roles Concerns about sexuality and reproduction arises

Social Interaction Wants to be accepted by peers and enjoys having best friends. Understanding right and wrong

Can begin to take responsibility for self-care Be encouraged to utilize appropriate precutive measures

Cognitive Stimulation Learns a variety of concepts and ideas through academic subjects. Language skills continue to expand an memory capabilities increase Enjoys watching TV and playing games School nurse play an important role.

Promoting Health and Wellness Health maintenance visits and immunization annually Health lifestyle habits Regular dental-checkups 7 y/o permanent teeth begins to appear

Nutrition Continues to be a high priority for growing children Requires a balanced diet. Undernourished children becomes easily fatigued and face a greater risk of infection Obesity tends to result in decrease activity as well as psychosocial problems.

ADOLESCENCE (12 20 y/o) Physical Growth Fastest for boys at age 14 Maximum ht reached at about 18 to 19 y/o @ 20s men add another 1 2 cm 12 fastest rate of growth in girls 15 16 female gains about 25kgs and grows about 24 cm

Growth noted 1st in the musculoskeletal system Sequential pattern of growth Posture is common problem Glandular Changes 1. Eccrine 2. Apocrine Sebaceous Glands o Becomes active under the influence of androgens in both male and female o Secretes sebum

Elimination Reaches maturity during this period

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Becomes most active in the: 1. Face 2. neck 3. shoulder 4. upper back 5. chest 6. genitals

Intimacy lays the ground work for the commitments of adulthood. Sexually active and may engage in masturbation Homosexual and heterosexual activity At 15 y/o gradually draw away from the family and gain independence Brief crushes to teachers and neighbors Generation gap. Restriction and guidance need to be presented in a manner that makes them feel loved Need consistence in guidance and fewer restrictions Peer group assume great importance Dating helps prepare adoslencents for marriage dating start for boys at 15 y/o dating start for girls at 11 y/o For homosexual it is difficult time

Acne Pimple Comedones blackheads

Physical Development Sexual Characteristics o In puberty both primary and secondary sex characteristics developed

Pubic Hair first noticeable sign that puberty has begun in male 1 Ejaculation is the milestone of male puberty at 14 y/o At 18 sexual maturity is achieved.
st

o
o

Sexual Characteristic (Female) o Appearance of breast bulks

o o
o

Menarche milestone of female Ovulation established at 1 2 years after menarche At 18 02 females internal reproductive organs reach adult size. Cognitive Development Matured

Piagets formal operation Highly imaginative and realistic Becomes informed about the world and environment. Uses new information to solve everyday problem Can communicate with adults on most subjects Capacity to absorb and use knowledge is great Usually select their own areas for learning. Explore interest from which they may evolve a career plan Study habits and learning skills that developed are used throughout life.

Psychosocial Development Stage usually ask o Who am I? o What Am I to Be? o Eriksons Stage: Identity vs Role Confusion

Freuds Stage Genital

Establishment of Identity or confusion Usually concerned about their bodies, appearances and physical abilities. Hair styling, skin care and clothes becomes very important In search for new identity have to re-fight the battles of many previous stages of development. Needs to establish a self-concept that accepts both personal strengths and weakness. Faced with traumatic changes in body structure and function and greater expectation to assure responsibility. Need to learn to build on their strength and not be preoccupied by problems such as acne. Those with physical handicaps and illness are particularly vulnerable to peer rejection. Nurse and educators can provide peer understanding and acceptance. Gain self-concepts largely from the impression that others have of them. Identification is a significant part. Job and family roles are less traditional and less sex specific Begin to establish intimacy with partner

Moral Development

Kohlbergs Conventional level Most still accept the golden rule Want to abide by social orders and existing laws. Examine their values, standard and morals May discard values they have adopted form parents When moved in Postconventional level start to question rules and laws of society. Right thinking and right action becomes a matter of personal values and opinion Consider the possibility of rationally changing the laws and emphasize individual rights.

Spiritual Development Deciding any differences are wrong Compartmentalizing to difference Obtaining advice from a significatn others Health Assessment

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Assessment guidelines NANDA: o Self-esteem disturbance relation to development of chronic disease o Altered nutrition: less body requirements related to dietary patterns.

o o o

Variety of female hygiene products Through cleaning of genital area Dysmenorrhea

Sexuality o What to know about sex but often un easy about discussing the concern o o o o Nurses, school and family need to provide adequate information Should be asked directly what they know about sex, contraceptions and reproduction STD are most common bacterial infections among adolescents Increase in STD are due to 3 factors: 1. Changing sexual morals of the young 2. 3. o o sense of vulnerability increase number of sexual partners.

Promoting Health and Wellness Health Maintenances visit and immunization: Routine health assessment (Annual) Appropriate laboratory screening Periodic dental care (Annual) Safety o Accidents are lading cause of mortality and injury o Suicide and homicide are the 2 leading cause of deaths.

Skin Care o Can o Body Odor Nutrition o Need for calories and nutrients increases. o An adequate diet is 1 qt of milk/day and appropriate amounts of meat, vegetables, fruits, breads and cereals Have active life style and irregular eating patterns Parents should avoid conflicts that relates to food Common Problems: Obesity Anorexia nervosa Bulimia Rest and Sleep 8 10 hours/day of sleep Change in sleep pattern is common Nocturnal emission WET DREAMS

STD elicits feelings of guilt shame and fear. Adolescent pregnancy

Personal Habits o Greatly influence the immediate and future health o Drug substance abuse: Signs teen misuse drugs: 1. Drop in school achievement 2. Mood Swings 3. Sleepiness or fatigue 4. Personality Changes

o o o

YOUNG ADULT (20 40 y/o) Prime years physically Musculoskeletal system well developed and coordinated Periods when athletic endeavors reach their peak All other systems of the body are also functioning at peak efficiency.

o o

Activity and Exercise o Engage in a variety of physical activities o o o o The experience of working with a team Experience of winning and loosing Nurses and parent should encourage both sexes to develop interest Should have regular health maintenance check ups.

Psychosocial Development

Eriksons: intimacy vs isolation Developing an intimate lasting relationship with another person Basic strengths that evolve form the relationship is love. Outcome of negative resolution is exclusivity Face a number of new experience and changes life style as they progress toward maturity. Makes decision for themselves Many of decisions made now influence the persons life style in years to come Expectations are often taken for granted. Choices must be made about o Education o Employment o To marry or stay single o Starting a home o Rearing children Social responsibility include forming new friendship and assuming some community activities Occupational choice and education are largely inseparable

Menstruation o Menstrual cycle

A typical menstrual cycle lasts 28 days. It begins with three to five days of menstruation, the shedding of the uterine lining, during which hormone levels are low. At the end of menstruation, a pituitary hormone stimulates new follicles to develop in the ovary. These secrete estrogen as they mature, causing cells in the lining of the uterus to proliferate. Midcycle, one mature follicle releases an egg. The empty follicle forms the corpus luteum, an endocrine body that secretes progesterone. Under the added influence of progesterone, the uterine lining thickens further and swells in preparation for the implantation of a fertilized egg. If fertilization does not take place, the corpus luteum dies and hormone levels fall. Without hormonal support, the uterine lining disintegrates and discharges, beginning a new menstrual period and cycle

o o Self-care responsibilities Subtle signs of pregnancy

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Education influences: o Occupational opportunities o Enhances employment opportunity o Enriches leisure time o Ensures economic survival Many women re-enter the work force in their late 30s Remaining singe is becoming the life style of more and more you adults. Problem arises when single person gets ill

Cancer detection: o Need to be informed about self examination techniques.

o o o o o
Safety o o o 1. 2. 3. 4. o

Women: Self breast Exam (once a month) Men: Testicular Exam Breast Cancer most frequent cause of death in women Cervical Cancer Cervical exam Testicular cancer most common neoplasm in men ages 20 - 34 Accident prevention is important health promotion Motor vehicle accidents- leading cause of mortality Other cause: Drowning Fire burns Fire arms Suicide Exposure to natural radiation (sun)

Cognitive Development

1. 2. 3. problem 4.

Piagets Formal operation Egocentrism Continues to decline Post formal operations Information processing Encoding the items involved with a problem Inferring relationship among parts applying relationship and justifying solutions to the Responding with the answer.

Moral Development

Kohlbergs Post Conventional Level Able to separate self from the expectation and rules of others Define morality in terms of personal principles Judge according to their own principle

Nutrition o Nutritional habits established at this stage often lay the foundation for the patterns maintained through out persons life

o
o

Need to increase make of Vit C Maintain adequate iron intake Include Iron rich foods in the diet

MEN Ethic of Justice

WOMEN Obligation is to CARE and avoid hurt Spiritual Development

Enter Individuality Reflective Period Focus on Reality Religious teachings may be accepted or redefined.

Common Problems o Hypertension o Obesity

Health Assessment Interested in meeting health needs Nurse need to offer teachings guidance in several health care areas. NANDA o Health seeking behavior related to personal cardiovascular health o Altered Family process related to loss of employment.

Promoting Health and Wellness Health maintenance visit and immunization Should be encouraged to requires a specific health maintenance schedule. At age 20 Health risk Appraisal Regular audiometry test if the person is at risk Visual examination every 2 4 years Yearly dental Assessment Yearly Pap smear for female Prostate exam every 6 years for male.

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Exercise o Actual amount of exercise that each person needs is highly individual

Concept of Service to others, love and comparison gain prominence Marriage partners have more time for companionship and recreation Marriage can be more satisfying. Have time to work in volunteer activities Have time for recreation Able to feel a sense of comfort in their lifestyle Stagnation o Have difficulty in accepting their aging bodies o o o Becomes withdrawn and isolated Pre-occupied with self and unable to give to others Some may regress.

o
o o

Fitness physically fit Tend to take their health for granted Nurse should provide on going support and encouragement for clients about their fitness activities.

Sexuality o Often concerned about normal sexual response o o o o Many problems arise in relationship Couples need to communicate Both partners should focus on being patient with one another STD are common

Work and Career Choices o Both men and women make career choices

Looks older and may feel older Some have extra marital affairs and marry younger ones New freedom to be independent Does not make comparison with others No longer fears aging and death Relaxes the sense of competitiveness Other peoples opinion becomes less important. Establishes moral and ethical standards Religion and philosophical concerns become important Robert Peck o Although physical capabilities and function decreases with age, mental and social capacities tend to increase in latter part of life. Gail Sheehy o Suggest that the transition into middle life is as critical as adolescent. Hutch and Deutch o Its is not the event themselves that make midlife a crisis but an individuals response to these life events. What nurse should do is to promote psychosocial health during midlife: 1. Encourage both men and women to do some of the things they never had time to do previously 2. 3. 4. Support in accepting changes of the period and adjusting them Assist in discussing their changing role as parents Emphasize the positive outcome of maintaining old friendship and self-seeking ones Discuss the middle-aged adults role in the care of aging parents. Review the individuals plans for retirement

o
o o

Job or workplace is where the socialize and make new friends. Young women have added burden of balancing career goals with child bearing responsibilities Nurse should be aware of work related difficulties.

Personal Relationship o Divorce o o Battered or abused women Nurses Should: Have open communication Help to develop self-esteem Provide information and resources continue to support and educate

1. 2. 3. 4.

Personal Habits o Drug Abuse o Prolonged use of Alcohol o Smoking

MIDDLE AGED ADULTS (40 65 y/o) Physical Development Number of changes takes place At 40 most can function as effectively as they did in their late twenties 40 65 many physical changes occur Menopause o Menstruation ceases o Absence of menstruation within 1 year o Usually occurs between 40 55 (47 avg) o Can be anxiety producing time. Climacteric (Andropause) o Change of life in men o o o o Sexual activity decrease No change comparable to the menopause of women. Androgen levels decrease very slowly Fear of getting old, retirement, boredom and finances.

5. 6.

Cognitive Development
Change very little Include 1. 2. 3. 4. Reaction time Memory perception Learning Problem and solving

Psychosocial Development Generativity VS Stagnation

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5.

Creativity

Piagets Formal Operation Ca reflect on the past and current experience and can imagine, anticipate, plan and hope

Sufficient Ca and Vit d for post menopausal women to prevent osteoporosis Should be warmed about obesity, DM, HPN, problems of mobility. Heart burn Acid indigestion Avoid fried and fatty foods

Moral Development

o
o

Kohlbergs Post- Conventional Level Believed that extensive experience of personal moral choice and responsibility is required before people can reach the post-conventional level.

Spiritual Development Can view truth from number of view points Tend to be less dogmatic about religious belief Religion offers more comfort than it did previously Often rely on spiritual beliefs to help them deal with illness, death and tragedy.

Menopause o Hot flashes (different symptoms) May occur 20 30x a day lasting for 3 5 minutes o Rise of Body temp, may trigger a flash

Health Assessment Assessment guidelines NANDA o Knowledge deficit related to menopause o Diversional activity defeat related to a life change 1. 2. 3. 4.

Women should be advise to consider ff: Maintain comfortable environment Use measures to cool body temp Avoid food hat may trigger a flash

Exercise o Key factors in delaying the aging process

o
o

Nurse must assess the clients current level of activity and clients physical fitness Any exercise program: Being Gradually increase to moderately strenuous level Be consistent Avoid over exertion Trembling, nausea, chest pain, extreme shortness of breath, sudden headache stop the program immediately

Promotion of Health and Wellness Yearly PE Audiometry if high risk group Yearly visual examination Yearly dental assessment Yearly mammogram Early pap smear test in high risk group Yearly prostate and testicular exam Should learn to recognize the sings and symptoms of cancer Cancer is the leading cause of death among people ages 25 64 y/o MEN cancer of ling, and bladder WOMEN Breast, colon, rectum, Uterus, and Lungs FEMALE monthly breast examination MALE monthly testicular exam Post menopausal women should report and vaginal bleeding Safety o o o o Accident prone (falls, fire, burns poisoning, drowning) Motor vehicle accidents are the most common cause of accidental death Decrease reaction time and visual acuity may make them prone to accidents. Occupational accidents continue to be significant safety hazards.

Exercise Program o Those over 50 should exercise with additional caution o o Overall objective is to increase the efficiency of the VS and respiratory system Walking briskly Jogging and swimming

Male Climacteric (Andropause) o Difficult to evaluate o o o More prone to sexual dysfunction than females Experience a decrease in ability to perform sexually May take longer to attain erection

Divorce o

Women suffer more than men with respect to emotional stress, economic status, and role loss. Men by contrast have more difficulty with the daily tasks Children also suffer emotionally and need support counseling.

o o

Personal Habits o Alcoholism Excessive use of alcohol is a multi faced problem for the individual and society May result in unpleasant disrupted homes, accidents and diseases.

Nutritional o Continue to eat a balance diet o 2 3 L of fluid/day

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Nurse should provide information about the dangers of excessive alcohol use.

o
o

Heavy Smoking o Increases the risk of pulmonary diseases

Orthostatic hypotension changes in systolic blood pressure Working capacity of the heart deminished sensory/perceptual

OLD AGE (65 OVER) Physical Changes Integumentary o Dryness of skin o Decrease sensation o Lentigo senilus (brown age spots) o Pale and loses elasticity o Hollow or gaunt appearance o Baldness and hair loss o Lost of hair color o Nail becomes thickened and brittle o Double chin o Sagging of eye lids and earlobes o Wrinkling of skin o Bony Prominences become visible o Elderly women: breast becomes smaller and sags Body Temperature o Decreases

Shrunken appearance of the eyes Slowed blink reflex Loss of visual acuity Less power of adaptation to darkness and aim light Decrease accommodation to near and far objects Lost of peripheral vision Presbyopia relative infelxibility of the lenses Cataracts lens opacity Presbycusis loss of hearing ability Poorer sense of taste and smell, less stimulated by food Number of taste buds decreases = poor nutrition Increase threshold sensation to pain and touch Changes in digestion o Significantly less impaired

o o
o o o

Not uncommon to have 35oC especially in AM 37.5oC can represent a marked fever Poor tolerance to cold Sluggish sweating ,cant cope with heat Important to have a comfortable environment

o
o

Decrease number of absorbing cell in the intestinal tract And rise in gastric pH = indigestion and constipation. Changes in Urinary Elimination o Function of the kidney diminishes o Urinary urgency and frequency

Neuromusculoskeletal o Gradual reduction in speed and power o o o o o o Open complain of lack of speed and quickly get tired. Activity can still be carried out but at a slower pace Balance is impaired Reaction time is slow Slight loss overall structure Problems: Kyphosis Osteoporosis Pathologic fracture

o Nocturnal frequency and retention of residual urine. Changes in Sexual Activity and Reproductive Organs o Sex drive persist into 70s, 80s and 90s o Those who are sexually active in you and middle adulthood will remain active during their late years. o frequent o Sexual activity becomes less Some medications are used

Cardiopulmonary Changes o Respiratory efficacy is reduced o o o o o Inhales a smaller volumes of air Decreases capacity to cough efficiently Mucous secretions tends to collect more readily in respiratory tree Increased susceptibility to respiratory infection Dyspnea occur frequently BP significant increase in systolic slight increase in diastolic

Psychosocial Development Retirement o Majority are unemployed o o o o Many who are healthy continue to work on a full time or part time basis No longer governed by alarm clock Spend much time resting and sleeping Outlets: community projects, volunteer services intellectual or recreational pursuits, hobbies Travel opportunities are expanding

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Robert Browning: Grow old with me! The best is yet to come ,the last of life for which the first was made Those who learned early in life to live wellbalanced and fulfilling lives are generally more successful in retirement

Derives a sense of worth by sharing expereinces or views Religion takes a new meaning for them who may find comfort, solace and affirmation in religious activities Have strong religeon convictions.

Economic Changes o Financial needs vary considerably o Problem with income: low retirement benefits lack of pension, increase length of retires years. Nurses should be aware of the cost of the health relocation. The work involves in maintaining the house may become burdensome Making decisions to move in often very stressful Some need to relocate to nursing homes

Health Assessment Assessment guidelines NANDA o Social Isolation related to inadequate individual resources. o o Health seeking behavior related to home safety measures that prevent fall Impaired home maintained management related to inadequate social support system.

o o o o

Promotion of Heath and Wellness Health maintenance visit and immunization Should have routine health assessment Safety o o o The primary concern with change of sense Accident prevention is a major concern Reflexes are slowed, bones are brittle Climbing a stairs, driving a car and even walking requires cautious May forget that iron and stove is left on Reduced sensitivity to pain and heat Many suffer and die each year because of hypothermia Heat promotion to maintain body temperature

Facing Death and Grieving o Great bonds of affection and closeness can develop during this period of aging together and nurturing each other o When a male dies, the remaining partners inevitable experience feelings of loss, emptiness and loneliness Some window or widowers remarry Women face bereavement and solitude more often than man Feelings of serenity or guilt and in adequacy can arise Person who have some meaningful friendships, economic secure and ongoing interest in the community copes more easily

o o o o o

o o o o

Nutrition o Requires the same basic nutrition as the younger adults o Fewer calories are needed: because of decrease metabolic rate and physical activity. Major problem periodontal Decrease thirst sensation plus self-imposed limitation due to incontinence. dehydration 8 glass of water/day

o o
o

Cognitive Development

Piagets Formal operation Dementia general term for permanent and progressive organic mental disorder. Personality changes, confusion, disorientation and intellectual functioning, and impaired control 3 types of Dementia o Primary directly attack the brain, irreversible

NANDA o Altered nutrition: less than body requires related to variety of physical and psychosocial factors. o Altered nutrition more than body requirement

o o

Secondary dont directly attack the brain

Elimination o Constipation May believe that regulatory means BM/day Should be advice that normal pattern of BM vary considerables. Adequate roughage of client, exercise, 6 8 glasses of water/day Incontinence Decline in balder capacity Weaker muscle tone Toilet facilities should be accessible

Multiple reversible if the underlying disease is treated Moral Development

Kohlbergs Conventional and post Conventional level May at to meet others needs Follows societys rules of conduct in response to the expectation of others Nurs must identify and consider the specific value o the older client when nursing care is planned.

Spiritual Development Strives to incorpurate views of relight into thinking

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Should be instructed to give themselves enough time to go to bathroom Bladder training exercise Regular toilet schedule Cystocele and Rectocele (produces pressure and reduces bladder capacity, urinary urgency and frequency) UPUTI = kidney is affected UTI o

Physical Abuse Financial abuse Neglect Abuse Intringement of person rights Sexual abuse

Drug Use and Misuse o Problems related to medications are common o o Costly in terms of both time and money Should be given written instruction in a large print an language they can udnerstand Side effects

Activity and Exercise o Should refresh rather than fatigue o Stress test determines the type an intensity of exercise program that is best for the individual client. Safety measure for exercise program: Wearing proper shoes Avoid slick surfaces Well-lighted areas Awareness of adverse signs of exercise Beginning slowly

Alcoholism o Problems of few are often hidden

o o o o
o

Began drinking in their youth Began excessive alcohol use in later life Many late onset alcoholics are widowers Chronic drinking has major effects on all body system Should be accepted, listened to

Rest and Sleep o 70 y/o 6 hours/day o o o o Tend to make some what longer to get to sleep Wake up frequently during the night Stay longer in bed or nap frequently through out the day. Amount of sleep varies

Maintain Independence and Self-Esteem o Shortly thrive on independence o To maintain sense of self-respect Encourage to do as much as possible for themselves Need to recognized for their unique individual characteristic Need to acknowledge clients ability to think reaosn and make decision Listen to suggestion and advice but dont want to be ordered around Appreciates thoughtfulness consideration and acceptance of their waning abilities Values and Standards held by them need to be accepted

o o o
o

o
o

Elder Abuse o Those who are unable to care for themselves are after cared for by family members o Caring often causes a great deal of strath and frustration in a relation and may lead to violence or abuse Types of Abuse Against elderly Psychologic abuse

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