Growth and Development Concepts

Growth & Development: General Concepts

• Growth is physical changes, like height, weight, and organ size.
• Development is mental, emotional, social, and functional maturity.
• Development occurs from head to toe (cephalocaudal), center out (proximodistal), and simple to complex.
• People grow at different rates, and development is continuous and individualized.

Fetal & Prenatal Development

• Three stages include: pre-embryonic (0–3 weeks), embryonic (4–8 weeks), and fetal (9 weeks–birth).
• The embryonic stage is most vulnerable to teratogens.
• Folic acid prevents neural tube defects; 400–800 mcg daily is recommended.
• Advanced maternal age increases the risk of Down syndrome, preeclampsia, and miscarriage.

Developmental Milestones: Infants (0–12 months)

• Infants triple their birth weight and increase height by 50%.
• Motor skills include rolling, sitting, crawling, and pulling to stand.
• Cognitive development: Object permanence is achieved around 8 months.
• Psychosocial development:
  • Freud's oral stage involves exploring the world through the mouth.
  • Erikson's stage is Trust vs. Mistrust.
  • Piaget's sensorimotor stage involves learning via senses/movement.

Developmental Milestones: Toddlers (1–3 years)

• Physical milestones include walking, running, scribbling, and beginning potty training.
• Cognitive skills include following simple commands and using short sentences.
• Psychosocial development:
  • Freud's anal stage focuses on toilet training.
  • Erikson's stage is Autonomy vs. Shame/Doubt.
  • Piaget's stage spans from sensorimotor to preoperational.

Developmental Milestones: Preschool (3–6 years)

• Motor skills involve jumping, using scissors, and drawing stick figures.
• Cognitive development: Children frequently ask "why?" and have active imaginations.
• Psychosocial development:
  • Freud's phallic stage focuses on gender awareness.
  • Erikson's stage is Initiative vs. Guilt.
  • Piaget's stage is Preoperational.

Developmental Milestones: School Age (6–12 years)

• Milestones include telling time, reading, and understanding rules.
• Risks include accidents, obesity, bullying, and enuresis.
• Psychosocial development:
  • Erikson's stage is Industry vs. Inferiority.
  • Piaget's stage is Concrete Operational, marked by logical thought.
  • Kohlberg's stage marks the beginning of conventional morality.

Developmental Milestones: Adolescents (12–20 years)

• Changes include puberty, peer pressure, and risky behaviors.
• Cognitive development involves abstract reasoning and future planning.
• Psychosocial development:
  • Erikson's stage is Identity vs. Role Confusion.
  • Piaget's stage is Formal Operational.
  • Kohlberg's stage progresses from conventional to post-conventional morality.

Developmental Milestones: Young Adults (20–40 years)

• Brain development finishes around age 25.
• Erikson's stage is Intimacy vs. Isolation.
• Focus is on relationships, career, and independence.

Developmental Milestones: Middle Adults (40–65 years)

• Menopause/Climacteric involves hormonal changes.
• Risks include heart disease, diabetes, and depression.
• Erikson's stage is Generativity vs. Stagnation.

Developmental Milestones: Older Adults (65+)

• Normal aging includes slower reaction time, decreased muscle mass, and decreased memory recall.
• Confusion, falls, and delirium are not normal and warrant investigation.
• Erikson's stage is Ego-integrity vs. Despair.

Hygiene: Key Concepts

• Hand hygiene is the most effective method to prevent healthcare-associated infections (HAIs).
• Skin is the first line of defense; assess for breakdown during care.
• Mucous membranes are found in the mouth, nose, respiratory, GI, urinary tract, and genitals.
• Mucous membranes protect against pathogens by trapping and flushing them out.

Hygiene: Skill Highlights

• Oral Care (Unconscious Patient): Position patient side-lying, keep suction ready, and avoid pouring fluid into the mouth.
• Denture Care:
  • Line the sink with a towel to prevent breakage.
  • Use lukewarm water.
  • Store dentures in a labeled container with solution or water.
• Nail/Foot Care:
  • Never soak diabetic feet, as it can cause infection.
  • Cut nails straight across.
• Perineal Care: Clean from front to back; frequent care is needed with incontinence.
• Bathing: Promotes circulation, allows assessment, and builds trust.

Mobility: Muscle Types

• Skeletal muscles are voluntary and control movement.
• Cardiac muscle is involuntary and found only in the heart.
• Smooth muscles are involuntary and found in internal organs.

Mobility: Key Skills

• Range of Motion (ROM):
  • Active ROM builds strength.
  • Passive ROM maintains flexibility.
• Body Mechanics:
  • Maintain alignment of ears, shoulders, and hips.
  • Lift with legs, not the back.

Mobility: Assistive Devices

• Cane: Use on the strong side; move cane, then weak leg, then strong leg.
• Walker: Move the walker, then the weak leg, then the strong leg.
• Crutches: Maintain a wide base of support, with elbows at ~30° bend.
• Gait Belt: Stand on the patient's weak side.

Mobility: Effects of Immobility

• Skin: Can lead to pressure ulcers.
• Cardiovascular (CV): Can cause deep vein thrombosis (DVT) and orthostatic hypotension.
• Respiratory: Can result in pneumonia and decreased lung expansion.
• Gastrointestinal (GI): May lead to constipation.
• Genitourinary (GU): Can cause urinary retention and urinary tract infections (UTIs).
• Musculoskeletal (MSK): Can result in atrophy and contractures.
• Psychological: Can contribute to depression and isolation.

Communication Styles

• Assertive: Direct and respectful; the best style for nurses.
• Aggressive: Blaming and disrespectful.
• Passive: Not speaking up.
• Passive-Aggressive: Indirect resistance and sarcasm.

Motivational Interviewing

• OARS: Open-ended questions, Affirmation, Reflection, Summary..
• Goal: To support the patient’s own motivation to change.

Professionalism & Leadership: Benner’s Novice to Expert Model

1. Novice: Follows rules.
2. Advanced Beginner: Recognizes patterns.
3. Competent: Organizes and prioritizes well.
4. Proficient: Sees the “big picture.”
5. Expert: Has an intuitive grasp of situations.

Professionalism & Leadership: Delegation - The 5 Rights

1. Right Task
2. Right Circumstance
3. Right Person
4. Right Direction/Communication
5. Right Supervision

Professionalism & Leadership: Leadership Styles

• Authoritative: Makes all decisions (efficient in a crisis).
• Democratic: Team-oriented.
• Laissez-faire: Hands-off, passive.

Professionalism & Leadership: Professionalism

• Shows respect, honesty, and reliability.
• Unprofessional behavior includes poor communication, unsafe actions, and tardiness.

Rest & Sleep: Stages of Sleep

1. Stage 1: Lightest sleep.
2. Stage 2: Heart rate and temperature decrease, harder to wake up.
3. Stage 3: Deep sleep, muscle and immune recovery.
4. Stage 4 (REM): Dreaming, irregular HR/RR.

Rest & Sleep: Sleep Needs

• Newborn: 14–17 hours.
• Toddler: 11–14 hours.
• Adult: 7–9 hours.
• Older adult: Lighter, fragmented sleep.

Rest & Sleep: Promoting Sleep

• Avoid caffeine/nicotine 4–6 hours before bed.
• Keep the environment cool, quiet, and dark.
• Avoid screen time.
• Consume a light carbohydrate snack (e.g., toast).

Rest & Sleep: Sleep Disorders

• Insomnia: Difficulty falling or staying asleep.
• Sleep Apnea: Ceasing to breathe for ≥10 seconds.
• Narcolepsy: Sudden sleep during activity.
• Restless Legs Syndrome (RLS): Tingling, crawling urge to move legs.

Fluid & Electrolytes: I&O Monitoring

• Input: IV fluids, oral intake, enteral feeds.
• Output: Urine, diarrhea, vomit, drains.
• Net balance helps assess hydration and fluid overload.