Growth and Development from a Nursing Perspective PDF

Growth and Development from Nursing Perspective  Unit 1 Concepts of Growth and Development ✓Introduction ✓Definition of growth & development. ✓Principles of growth & development. ✓Factors influencing growth & development  Growth ▪It is the process of physical...

Growth and Development from Nursing Perspective  Unit 1 Concepts of Growth and Development ✓Introduction ✓Definition of growth & development. ✓Principles of growth & development. ✓Factors influencing growth & development  Growth ▪It is the process of physical maturation resulting in an increase in size of the body and various organs. ▪It occurs by multiplication of cells and an increase in intracellular substance. ▪It is quantitative changes of the body. ▪It structural and physiological changes.  Development ❖Functional and physiological maturation of the individual. ❖It includes psychological, emotional and social changes ❖Acquisition of a variety of skills and capacity to function. ❖It is related to maturation and myelination of the nervous system. ❖It is qualitative aspects. ❖It is a progressive series of changes that occur in an orderly predictable pattern as a result of maturation and experience. ❖It is concerned with growth as well as those changes in behavior which results from environmental situations. Principles of Growth and Development I. General to Specific Children use their cognitive and language skills to reason and solve problems. Children at first are able hold the big things by using both arms hold things in a single hand, then pick small objects like peas, cereals Children when able to hold pencil, first starts draw circles then squares then only letter after that the words. The sequence of the development is the same for all children, but the rate of development varies from child to child. Principles of Growth and Development I. General to Specific Development is cumulative Development is a result of interaction of Maturation and Learning Development is a product of contribution of Heredity and Environment. Growth pattern of every individual is unique Principles of Growth and Development II. Cephalocaudal direction From head down to tail. Improvement in structure and function come first in the head region, then in the trunk, and last in the leg region. An infant will gain control over their neck muscles first, which allows them to hold their head steady. Principles of Growth and Development III. Proximodistal direction From center or midline to periphery direction. Development from the center or core of the body in an outward direction toward the extremities. The spine develops first in the uterus, followed by the extremities and finally the fingers and toes  Factor Influencing Growth and Development: 1- Genetic factors Sex Race and Nationality 2- Prenatal factors Intrauterine environment is an important predominant factor of growth and development. Maternal malnutrition Maternal infection Maternal substance abuse Maternal illness Hormones Factor influencing Growth and Development: 3- Postnatal factors: Socio economic status Growth potential Climate and season Nutrition Play and exercise Childhood illness Birth order of the child Physical environment Intelligence Psychological environment Hormonal influence Cultural influence  Unit 2 Growth and Development Theories: ✓Erikson's psychosocial development theory ✓Psychosexual theory of Sigmund Freud. ✓Maslow’s Hierarchy & Defense Mechanisms ✓Jean Piaget Cognitive Theory  1- Psycho Social Development Theory Erik Erikson proposed a lifespan model of development, taking in five stages up to the age of 18 years and three further stages beyond, well into adulthood Erikson put a great deal of emphasis on the adolescent period, feeling it was a crucial stage for developing a person’s identity. Shows impact of social experiences across ones whole lifespan The main elements behind his theory is the identity of one’s ego According to Erikson when conflicts arise people have opportunity to grow or fail equally 1- Trust vs. Mistrust Occurs in infancy, (birth-18 months) Babies must learn to trust their parents care and affection. If not done babies could develop distrust and view world as inconsistent and unpredictable 2- Autonomy vs. Shame and Doubt. Occurs in the toddler age, (18 months-3 years) Child learns to feed them-selves and do things on their own. Or they could start feeling ashamed and doubt their abilities.  3- Initiative vs. Guilt Preschool age (3-5 years old) Using initiative in planning or carrying out plans Or develop a sense of guilt over misbehavior regarding parents’ limits.  4- Industry vs. Inferiority: School age (5-11 years of age) Learn to follow the rules imposed by schools or home Or the child can start believing they are inferior to others 5- Identity vs. Role Confusion Adolescence (11-18 years of age) Acquire a sense of identity Or can become confused about ones role in life  6- Intimacy vs. Isolation Young adulthood,(18-40 years of age). Develop a relationship and joint identity with a partner Or can become isolated and stay away from meaningful relationships 7- Generativity vs. Stagnation Middle adulthood (40-65 years of age) Making use of time and having a concern with helping others and guiding the next generation Or can become self-centered, and stagnant  8- Integrity vs. Despair Late adulthood (60-and up) Understand and accept the meaning of temporary life Or complains about regrets, not having enough time, and not finding a meaning throughout life 2- Jean Piaget (1896-1980 ,Switzerland) ▪ He was one of the 20th century’s most influential researchers in the area of developmental psychology. ▪ He originally trained in the areas of biology and philosophy ▪ Piaget wanted to know how children learned through their development. ▪ He believed the child’s cognitive structure increased with development.  Concepts of Piaget’s Theory 1- Schema: an internal representation of the world. Schemas as “units” of knowledge 2-Assimilation :is using an existing schema to deal with a new object or situation 3-Accommodation:changing or altering our existing schemas in light of new information  Concepts of Piaget’s Theory 4-Equilibration Cognitive development did not progress at a steady rate, but rather in leaps and bounds. Equilibrium is occurs when a child's schemas can deal with most new information through assimilation. Equilibration is a balance between assimilation and accommodation. Disequilibrium: Occurs when new information cannot be fitted into existing schemas (assimilation)  Concepts of Piaget’s Theory 5-Adaptation: Piaget’s term for what most of us would call learning  Stages in Piaget’s Theory 1. Sensorimotor Stage: birth to 2 years) (Infancy). The child's knowledge is limited to sensory perceptions and simple motor activities 1. Preoperational Stage: (2 to 7 years) (Toddler and Early Childhood). Developing language and concepts. More complex mental representation. Unable to use ‘operations’, i.e. Logical 3. Concrete Operational Stage: (7 to 12 years of age). ▪It characterized by the appropriate use of logic  Stages in Piaget’s Theory 4. Formal Operational Stage:12 years and up) (Adolescence and Adulthood) Individual’s thought becomes increasingly flexible and abstract Solve a problem in a logical and methodical way. Logical thought, deductive reasoning. Understand that the rules. Understand that nothing is absolute  3- Abraham Maslow’s Theory (1908- 1970) ▪Is an American psychologist ▪Maslow was not interested in animal or laboratory studies of human behavior. ▪He study outstanding individuals. ▪He believe people have needs that are unchanging and genetic in origin. ▪Both physiological and psychological  Maslow’s Theory There are 5 levels of needs arranged in a hierarchy Once one level is satisfied, the next level will emerge as the depressed need seeking to be satisfied The physiological and security needs are finite but the needs of higher order are infinite and are likely to be dominant in persons at higher levels in the organization. Maslow suggests that various levels are interdependent and overlapping.  Maslow’s Theory This hierarchy is most often displayed as a pyramid. The lowest levels of the pyramid are made up of the most basic needs, while the more complex needs are located at the top of the pyramid.  Maslow’s Theory Hierarchy of Needs: has 2 Types of Needs A. Deficiency Needs (D-needs) -Contains the most fundamental and basic four layers of the pyramid: physiological needs, security or safety needs, love and belonging, and esteem. -These needs arise due to deprivation. -The satisfaction of these needs helps to “avoid” unpleasant feelings or consequence. B.Growth Needs -It is also known as being needs or B-needs. -Growth needs do not come from a place of “lack”, but rather from a desire to grow as a person.  Maslow’s Theory 1. Physiological Needs -These include the most basic needs that are vital to survival, such as the need for water, air (oxygen), food, and sleep/rest. -Maslow believed that these needs are the most basic and instinctive needs in the hierarchy. 2-Safety o Security Needs -Includes a desire for steady employment, health care, safe neighborhoods, and shelter from the environment. -These needs have to do with man’s yearning for a predictable, orderly world in which injustice and inconsistency are under control. FAIRNESS  Maslow’s Theory 3-Love and Belonging It involves emotionally-based relationships in general, such as friendship, sexual intimacy, acceptance and having a supportive and communicative family. 4-Self-Esteem Needs -It includes the need for things that reflect on self-esteem, personal worth, social recognition, and accomplishment. -People need to engage themselves to gain recognition and have an activity or activities that give the person a sense of contribution, to feel accepted and self- valued, be it in a profession or hobby.  Maslow’s Theory 5-Cognitive Needs -Needs to increase intelligence and thereby chase knowledge. -Cognitive needs is the expression of the natural human need to learn, explore, discover and create to get a better understanding of the world around them. 6-Aesthetic Needs -This is the desire to appreciate symmetry, beauty, balance and order. -This need is a higher level need to relate in a beautiful way with the environment and leads to the beautiful feeling of intimacy with nature and everything beautiful  Maslow’s Theory 7-Self-Actualization -Self-actualization is the instinctual need of humans to make the most of their abilities and to strive to be the best they can. -Need for growth, development and utilization of potential, becoming all that one can be, self-fulfillment. Transcendence -The need for helping others to self-actualize. This need when fulfilled, leads to feelings of integrity. MASLOW LEVELS OF PYRAMID 4- Kohlberg’s Theory of Moral Development  Kohlberg’s Theory of Moral Development Level 1: Preconventional morality: believing rules to be external to the self rather than internal: Stage 1 (2-3 years.): punishment-and-obedience orientation: The physical consequences of an action determine morality (whether its good or bad). Right and wrong is determined by what is punished. Follow rules to avoid punishment. (e.g “if I get caught and punished for doing it, it’s wrong. If I'm not caught or punished then it must be right”).  Kohlberg’s Theory of Moral Development Level 1: Preconventional morality Stage 2 (4-7 years): Naïve hedonism: Looking to gain rewards or satisfy personal objectives (needs). Right and wrong is determined by what is rewarded. (e.g “I’ll do this for you if you do this for me” OR “if you do something bad to me then it’s okay if I do something bad to you”)  Kohlberg’s Theory of Moral Development Level 2: conventional morality: (9-20 years) striving to obey rules and social norms to win other’s approval or to maintain social order. Stage 3 (7-10 years): “Good-boy” and “Good-girl” orientation: wanting to please others. Right and wrong is determined by close others’ approval or disapproval. Child is becoming socially sensitive. Stage 4 (10-12 years): social-law and order-maintaining morality: conforming to the rules of legal authority. Right and wrong is determined by society’s rules and laws, which should be obeyed rigidly.  Kohlberg’s Theory of Moral Development Level 3: Postconventional (or principled) morality: defining right and wrong based on broad principles of justice. Stage 5: the social-contract orientation: obeying laws because laws express the will of the majority. Right and wrong is determined by society's rules and laws which are viewed as fallible rather than absolute. Right is determined by what is best for the majority. Exceptions to rules can be made if a person’s welfare is violated. The end no longer justifies the means.  Kohlberg’s Theory of Moral Development Stage 6: morality of individual principles of conscience: Following self-chosen ethical principles whether there is a conflict with written laws or not. Achieved by only morally mature individuals. These people do what they think is right regardless of other’s opinions and legal law. Actions are guided by internal standards Willing to die for their beliefs Right and wrong is determined by abstract ethical principles that emphasize equity and justice.  Kohlberg’s Moral Ladder As moral development progress, the focus of concern moves from the self to the wider social word. 1st. Morality of self interest: to avoid punishments or gain concrete rewards. 2nd. Morality of law and social rules: to again approval or avoid disapproval. 3rd: Morality of abstract principles: to affirm agreed-upon rights and personal ethical principles. Kohlberg’s Moral Ladder 5- Freud’s Psychosexual Stages Theory  Unit 3 Promoting Health from Conception Through School-Age Children: ✓ Introduction ✓ Conception and Prenatal Development ✓ Neonates and Infants (Birth to 1 Year) ✓ Toddlers (1 to 3 Years) ✓ Preschoolers (4 and 5 Years) ✓ School-Age Children (6 to 12 Years)  Developmental Age Periods: 1) Fetal period 2) Infancy 3) Early Childhood 4) Middle Childhood 5) Late Childhood There are differences for these Various Age Levels in: a)Function of various organ system; b)Degree of immunity to disease; c)Response to the effects of disease; d)Drug dosages and tolerance to drugs; e)Mental and motor ability, f)Pattern of emotional response.  1) Fetal period ▪From fertilized ovum formed until to delivery (about 40 weeks). ▪Length of time from conception (fertilization followed by implantation) to birth is about nine months (266 days) Pregnancy/ Gestation ▪Feature of Fetal period: easy abortion or malformation Fetal Growth Assessment Methods 1-Measure the size of uterus on abdominal examination. 2-Palpate fetal head and body on abdominal examination. 3-Measure the size of fetus using antenatal ultrasonography (ultrasound). 4- Fetal movements: -It indicate that the fetus is well. -The fetal movements first felt: a. At about 20 weeks in a Primigravida. b. At about 16 weeks in a Multigravida.  Human Development Divided Into Two Parts a. Embryonic development (months 1 , 2) Major organs are formed b Fetal development (months 3-9): Structures are refined  Stages of Fetal Development 1-Ovum ▪ The ovum is the female sex cell. ▪ It is regularly released by the ovary through the process of ovulation. ▪ The egg cell has a lifespan of 24 hours, it can only be fertilized within this period. ▪ After 24 hours, it regresses and is resorbed. 2-Sperm Cell -The sperm cell has a lifespan of 48 to 72 hours -Sperm Cell kinds: a. Gynosperm : This is the X carrying sperm cell. b. Androsperm :The sperm cell which carries the Y chromosome  Zygote: Initial name for fertilized ovum(From fertilization to implantation) Embryo: Name of product of conception from second through 8th week of pregnancy(From fertilization to 5 to 8 weeks) Fetus: Name of product of conception from 9th week through duration of gestational period(From 8 weeks until term) Conceptus: Developing embryo or fetus and placental structures throughout term  Fertilization ▪During ovulation the ovum leaves the ovary and enters the fallopian tube. ▪Fertilization generally occurs in the outer third of the fallopian tube. ▪Subsequent changes in the fertilized ovum from conception to implantation are illustrated  Segmentation -Within a few hours after fertilization, the zygote, begins a process of internal division. -This process of cell division in the zygote is called segmentation. First, it divides into two cells, then four, eight, sixteen, and so on, doubling the number with each new division.  Segmentation It transforms the zygote into a cluster of cells called Morula which, seen through a microscope, resembles a mulberry‫اﻟﺘﻮت‬. The morula slowly moves down the Fallopian tubes toward the uterus, where it arrives after about three days. By this time, it has developed into a hollow ball of cells called Blastocyst.  Implantation -It takes 3 to 4 days for the zygote journey to the uterus, where implantation will take place and during such journey cell division happens. -It takes 7 to 8 days from fertilization to implantation. -Implantation occurs at high and posterior portion of the uterus. -On implantation, the structure is called embryo until 5-8 weeks when it begin to be referred to as fetus.  Fetal development stages In the beginning sperm joins with ovum (egg) to form - one cell, it is smaller than a grain of salt. -This union brings together the 23 chromosomes from the father with the 23 chromosomes from the mother to make a single new life with 46 chromosomes - The genetic blue print for the development of every detail this new person will ever have.  Fetal development stages -At the end of the first week it implants itself into the lining of the uterine wall and draws nourishment from its mother. - Day 1: conception takes place -10 days: mother’s menses stop -From Days 10-14 the developing embryo signals its presence through placentaI chemicals and hormones to the mother’s body telling it to cease menstruation.  Fetal development stages - Day 15: The primitive streak can be seen on the left side of this embryo. - Day 17 : The primitive streak can still be seen, and the opposite end of the embryo is starting to fold up. - 18 days: heart begins to beat - The fetus’s heart beats 54 million beat during pregnancy - Day 19: The neural tube is seen along with somites on either side of it.  Fetal development stages By only Day 20 foundations of the brain, spinal cord and nervous system are already established 21 days : heart pumps own blood through separate close circulatory system with own blood type By the 4th week, the backbone and muscles are forming. Arms, legs, eyes, and ears have begun to show.  Fetal development stages 28 days – eye, ear, and respiratory system begin to form 42 days – brain waves recorded skeleton complete, reflexes present  Fetal development stages - One month old, the embryo is 10,000 times larger than the original fertilized egg and is developing rapidly. At Week 5 five fingers can be discerned in the hand. The eyes darken as pigment is produced. Brain waves can be detected and recorded The embryo has a marked C-shaped body and a rudimentary tail.  Fetal development stages At Week 6 the liver is now taking over production of blood cells, the brain begins to control muscle movements and organs. Week 7 - The embryo begins to move spontaneously. The jaw forms, including teeth buds in the gums. capable of thumb sucking Soon the eyelids will seal to protect the embryo’s developing light-sensitive eyes, and will reopen at about the seventh month The head is rounded and nearly erect. The eyes have shifted forward and closer together, and the eyelids begin to form.  Fetal development stages By the 8th Week now-called fetus is a little more than an inch long. The fetus has now everything found in a fully developed adult, all body systems present. The heart has been beating for more than a month, the kidneys are functioning; the stomach is producing digestive juices. And it responds to touch. At Week 9 the tiny one has fingerprints and will curve its hand around an object placed in its palm.  Fetal development stages By Week 10 the fetus can squint, swallow, and wrinkle its forehead moves tongue, makes fist 11 weeks – spontaneous breathing movements, has fingernails, all body systems working The fetus is now about 2 inches long. Urination occurs. Muscle movements are becoming more coordinated  Fetal development stages 12 weeks – weighs one ounce Now 3 months old, the unborn sleeps, awakens, and exercises its muscles. It “breathes” amniotic fluid to help develop its respiratory system. Fine hair is growing on the head. The fetus at 14 weeks: During this period of rapid growth, the skin is so transparent that blood vessels are visible beneath it. More muscle tissue and body skeleton have developed, and they hold the fetus more erect.  Fetal development stages 16 weeks – Genital organs clearly differentiated, Grasps with hands, Swims, kicks, turns, somersaults, ( still not felt by the mother) At 4 months the fetus is 8-10 inches long and weighs half a pound. The mother starts to “show.” The baby’s ears are functional. It can hear its mother 18 weeks – Vocal cords work  Fetal development stages 20 weeks Has hair on head, weighs one pound, 435 to 465 G and measures about 19 cm. Subcutaneous deposits of brown fat make the skin a little less transparent. “Woolly” hair covers the head, and nails have developed on the fingers and toes. There is definite movement felt by the mother. The unborn may jump in reactions to startling or loud noises.  Fetal development stages 23 weeks – 15% chance of viability outside of womb if birth premature 24 weeks : 56% of babies survive premature birth. At the 6th month oil and sweat glands are now functioning. The delicate skin is protected from the fetal waters by a special ointment called “vernix.” 25 weeks 79% of babies survive premature birth  Fetal development stages At Month 7 the baby now uses the four senses of hearing, vision, taste, and touch. The child can respond to his or her mother’s voice. In the 8th month the skin begins to thicken with a layer of fat stored underneath for insulation and nourishment. Antibodies increasingly build up.  Fetal development stages In the 8th month The baby is nearly ready for life outside the womb, toward the end of this month the baby is ready for birth. By this time the infant normally weighs 6 to 9 pounds, and his or her heart is pumping 300 gallons of blood per day.  2) Infancy a. Neonate: Birth to 28 days Features of Neonatal period: The physiological regulation ability and adaptation to circumstances are very poor. The morbidity and mortality are very high Health needs: 1- Nutrition 2- Proper Care 3-prevention of diseases  2) Infancy b. Infancy: 1 month to 1 year (From Birth to 1 year) Features of Infant period: 1- Most rapid growth and development in the lifespan. 2-Fastest brain growth 3-Nutrition and energy requirement are high 4-Digestion and absorption functions are poor 5-Passive immunity gradually drops  2) Infancy b. Infancy: 1 month to 1 year (From Birth to 1 year) Features of Infant period: 6- Morbidity and mortality related to: ▪ Congenital anomalies, ▪ Low birth weights, ▪ Accidents, closed head trauma and falls Health needs : a. Nutrition b. Prevention from diseases  3) Early Childhood: 1-6-7 years a. Toddler: 1-3 years. Features of Toddler period: 1-Growth becomes slower Health needs: 2 -Intelligence develops faster a. Nutrition 3- Curious and very active b. Prevention of disease 4-Favorite word is No! c. Prevention of accident 5- Separation anxiety 18-24 months  3) Early Childhood: 1-6-7 years b. Preschool: 3-6-7 years Features of Preschool period: 1-Growth becomes slower, 2-More mature intelligence. 3-Strong desire for knowledge 4- Imitating adult’s behavior 5- Achieved some independence from parents with simple tasks. 6-Toilet trained around 3rd birthday.  3) Early Childhood: 1-6-7 years b. Preschool: 3-6-7 years Health needs: Features of Preschool period: a. Nutrition 7- Gross motor skills well defined. b. Prevention of diseases 8-Can walk, run, jump and climb c. Prevention of accident efficiently. d. Good habit training 9-Fine motor skills developing 10-Enjoy coloring, drawing, manipulating smaller toys 11-Favorite word is why?  4) Middle Childhood: School age: 6 to 12 years Features of Middle Childhood: 1-Growth becomes relatively steady 2- More mature intelligence developed 3- Increasing desire for knowledge 4-Decreasing incidence of diseases 5-Fine motor skills continue to develop.  4) Middle Childhood: School age: 6 to 12 years Features of Middle Childhood: 6-Eager to please parents and other adults 7- Friends becoming more important. 8- Compares self to others. 9- Learning rules, ‘winners’ and ‘losers.  4) Middle Childhood: School age: 6 to 12 years Health needs: 1-Nutrition 2-Prevention of myopia (‫ﻗﺼﺮ اﻟﻨﻈﺮ‬and dental caries 3-Prevention of psychological problems 4-Emotion and behavior care  5) Late Childhood Adolescent from 13 years to approximately 18 years -Female: from 11-12 years to 17-18 years -Male: from 13-14 years to 18-20 years Features of Adolescence: 1-The second fastest period of growth and development 2-Neuroendocrine regulation unsteady 3-Having problems in psychology, emotion, behavior 4-Struggle for independence  5) Late Childhood Adolescent from 13 years to approximately 18 years Features of Adolescence: 5-Peers more important to them than family 6-Significant peer pressure 7-Puberty begins. 8-Participating in group activities and fitting in is vital 9-Participation in sports with more risk (skateboarding, rock climbing) 10- Morbidity and mortality in adolescence related to: ▪ Accidents e.g motor vehicle accidents, drowning, sports injuries, head trauma firearm injuries ▪ Cancer ▪ Homicide and suicide assessment of growth: Done by anthropometric measurement and the study of velocity(speed) of physical growth.  1) weight ❑Is one of the best criteria for assessment of growth ❑Weight of the full terms neonate at birth is approximately 2.5 kg to 3.5kg. ❑10% loss of weight first week of life, which regains by 10 days of age. ❑Then, weight gain is about 25- 30 gm per day for 1st 3 month and 400gm/ month till one year of age.  1) weight ❑The infants double weight gain their birth weight by 5month of age ❑Trebled by one year ❑Fourth time by two years ❑Five times by three year ❑Six times by five year ❑Seven times by seven year ❑Ten times by ten year. ❑Then weight increases rapidly during puberty followed by weight increase to adult size  2) Length and Height ▪Increase in height indicates skeletal growth. ▪Yearly increments in height gradually diminished from birth to maturity. ▪At birth average length of a healthy newborn baby is 50 cm. ▪It increases to 60 cm at 3 months, ▪Increases70 cm of 9 month ▪75 cm at one year of age.  2) Length and Height ▪In second year, there is 12 cm increase ▪In third year it is 9 cm, ▪In fourth year it is 7 cm ▪In fifth year it is 6 cm. ▪So the child doubles the birth by 4 to 4.5 years of age afterwards there is about 5 cm increases in every year till onset of puberty.  3) Body Mass Index (BMI) ❑Assess the normal growth or its deviations i.e. malnutrition or obesity. Weight in Kg BMI = -------------------------------- (Height in meter) 2 ❑BMI remains content (relaxed) up to the age of 5 years.  3) Body Mass index (BMI) ❑If the BMI is more than 30 kg/m2, it indicates obesity ❑If it is less then 15Kg/m2, it indicates malnutrition. ❑BMI Categories:- –Underweight =