Growth and Development Chapter PDF

8 Human Growth Science and Development...

8 Human Growth Science and Development CHAPTER OBJECTIVES After completing this chapter, you should be able to: Identify at least two physical, mental, emotional, and social developments that occur during each of the seven main life stages. Explain the causes and treatments for chemical abuse. Identify methods used to prevent suicide and list common warning signs. Recognize ways that life stages affect an individual’s needs. Describe the five stages of grieving that occur in the dying patient and the role of the health care worker during each stage. List two purposes of hospice care and provide justifications for the “right to die.” Create examples for each of Maslow’s Hierarchy of Needs. Name the two main methods people use to meet or satisfy needs. Describe a situation that shows the use of each of the following defense mechanisms: rationalization, projection, displacement, compensation, daydreaming, repression, suppression, denial, and withdrawal. Define, pronounce, and spell all key terms. KEY TERMS acceptance cognitive early childhood adolescence compensation emotional affection (cahm 0-pen-say 9-shun) esteem Alzheimer’s disease daydreaming growth (Altz 0-high-merz) defense mechanisms hospice (hoss 9-pis) anger denial infancy arteriosclerosis depression late adulthood (ar-tear 0-ee-oh-skleh-row 9-sis) development late childhood bargaining displacement life stages chemical abuse early adulthood mental 240 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  H u ma n G ro w th a n d Deve l opme n t 241 KEY TERMS (CONT.) middle adulthood rationalization sexuality motivated (rash0-en-nal-ih-zay9-shun) social needs regression suicide physical repression suppression physiological needs right to die tension (fizz 0-ee-oh-lodg9-ih-kal) safety terminal illness projection satisfaction withdrawal puberty (pew 0-burr9-tee) self-actualization Introduction 8:1 Life Stages Human growth and development is a process that Even though individuals differ greatly, each person passes begins at birth and does not end until death. Growth through certain stages of growth and development from refers to the measurable physical changes that occur birth to death. These stages are frequently called life stages. throughout a person’s life. Examples include height, A common method of classifying life stages is as follows: weight, body shape, head circumference, physical char­ Infancy: birth to 1 year acteristics, development of sexual organs, and dentition (dental structure). Development refers to the changes Early childhood: 1–6 years in intellectual, mental, emotional, social, and functional Late childhood: 6–12 years skills that occur over time. Development is more dif­ Adolescence: 12–18 years ficult to measure, but usually proceeds from simple to complex tasks as maturation, or the process of becoming Early adulthood: 19–40 years fully grown and developed, occurs. During all stages of Middle adulthood: 40–65 years growth and development, individuals have certain tasks Late adulthood: 65 years and older that must be accomplished and needs that must be met. A health care worker must be aware of the various life As individuals pass through these life stages, four stages and of individual needs to provide quality health main types of growth and development occur: physical, care (Figure 8–1). mental or cognitive, emotional, and social. Physical FIGURE 8–1 An understanding of life stages is important for the health care worker, who may provide care to individuals of all ages; from the very young (left) to the elderly (right). © Andrew Gentry/Shutterstock.com © michaeljung/Shutterstock.com Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  242 CHAPTER 8 refers to body growth and includes height and weight to remember, however, that the rate of progress varies changes, muscle and nerve development, and changes among individuals. Some children master speech early, in body organs. Mental or cognitive refers to intellec­ others master it later. Similarly, an individual may expe­ tual development and includes learning how to solve rience a sudden growth spurt and then maintain the problems, make judgments, and deal with situations. same height for a period of time. Emotional refers to feelings and includes dealing with Erik Erikson, a psychoanalyst, has identified eight love, hate, joy, fear, excitement, and other similar feelings. stages of psychosocial development. His eight stages of Social refers to interactions and relationships with other development, the basic conflict or need that must be people. resolved at each stage, and ways to resolve the conflict Each stage of growth and development has its own are shown in Table 8–1. Erikson believes that if an indi­ characteristics and has specific developmental tasks that vidual is not able to resolve a conflict at the appropriate an individual must master. These tasks progress from the stage, the individual will struggle with the same conflict simple to the more complex. For example, an individual later in life. For example, if a toddler is not allowed to first learns to sit, then crawl, then stand, then walk, and learn and become independent by mastering basic tasks, then, finally, run. Each stage establishes the founda­ the toddler may develop a sense of doubt in his or her tion for the next stage. In this way, growth and devel­ abilities. This sense of doubt will interfere with later opment proceeds in an orderly pattern. It is important attempts at mastering independence. TABLE 8–1 Erikson’s Eight Stages of Psychosocial Development Stage of Basic Major Life Development Conflict Event Ways to Resolve Conflict Infancy Trust versus Feeding Infant develops trust in self, others, and the environment when caregiver is Birth to 1 Year Mistrust responsive to basic needs and provides comfort; if needs are not met, infant Oral–Sensory becomes uncooperative and aggressive, and shows a decreased interest in the environment Toddler Autonomy Toilet Training Toddler learns control while mastering skills such as feeding, toileting, and 1–3 Years versus dressing when caregivers provide reassurance but avoid overprotection; if Muscular–Anal Shame/ needs are not met, toddler feels ashamed and doubts own abilities, which Doubt leads to lack of self-confidence in later stages Preschool Initiative ver- Independence Child begins to initiate activities in place of just imitating activities; uses imagina- 3–6 Years sus Guilt tion to play; learns what is allowed and what is not allowed while beginning to Locomotor develop a conscience; caregivers must allow child to be responsible while provid- ing reassurance; if needs are not met, child feels guilty and thinks everything he or she does is wrong, which leads to a hesitancy to try new tasks in later stages School-Age Industry School Child becomes productive by mastering learning and obtaining success; child 6–12 Years versus learns to deal with academics, group activities, and friends when others show Latency Inferiority acceptance of actions and praise success; if needs are not met, child devel- ops a sense of inferiority and incompetence, which hinders future relation- ships and the ability to deal with life events Adolescence Identity ver- Peer Adolescent searches for self-identity by making choices about occupation, 12–18 Years sus Role sexual orientation, lifestyle, and adult role; relies on peer group for support Confusion and reassurance to create a self-image separate from parents; if needs are not met, adolescent experiences role confusion and loss of self-belief Young Adulthood Intimacy Love Young adult learns to make a personal commitment to others and share life 19–40 Years versus Relationships events with others; if self-identity is lacking, adult may fear relationships and Isolation isolate self from others Middle Adulthood Generativity Parenting Adult seeks satisfaction and obtains success in life by using career, family, 40–65 Years versus and civic interests to provide for others and the next generation; if adult does Stagnation not deal with life issues, feels lack of purpose to life and sense of failure Older Adulthood Ego Integrity Reflection on Adult reflects on life in a positive manner, feels fulfillment with his or her own 65 Years to versus and Acceptance life and accomplishments, deals with losses, and prepares for death; if fulfill- Death Despair of Life ment is not felt, adult feels despair about life and fear of death Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  H u ma n G ro w th a n d Deve l opme n t 243 Jean Piaget, a developmental biologist, identified Health care providers must understand that each cognitive stages of development based on how an organ­ life stage creates certain needs in individuals. Likewise, ism adapts to its environment. His basic concept is that other factors can affect life stages and needs. An individ­ infants are born with reflexes that the infant uses to ual’s sex; race; heredity (factors inherited from parents, adapt to the environment. Through assimilation, a pro­ such as hair color and body structure); culture; life expe­ cess by which a person’s mind takes in information from riences; and health status can influence needs. Injury or the environment, and accommodation, the process of illness usually has a negative effect and can change needs changing cognitive ideas based on the new information, or impair development. the person learns to maintain equilibrium, or a balance with the environment. Piaget’s four stages of cognitive Infancy development are shown in Table 8–2. During each level, Piaget believes new abilities are learned that prepare the PHYSICAL DEVELOPMENT individual for the next level. The most dramatic and rapid changes in growth and development occur during the first year of life. A new­ born baby usually weighs approximately 6–8 pounds TABLE 8–2 Piaget’s Four Stages of Cognitive Development (2.7–3.6 kg) and measures 18–22 inches (46–55 cm) Stage Characteristic Behavior (Figure 8–2). By the end of the first year of life, weight Sensorimotor Initially uses simple reflexes such as has usually tripled, to 21–24 pounds (9.5–11 kg), and (Birth to 2 sucking and grasping height has increased to approximately 29–30 inches years) Recognizes self as causing an action and (74–76 cm). repeats action intentionally Muscular system and nervous system develop­ Begins to understand that objects are ments are also dramatic. The muscular and nervous permanent even when they can’t be seen systems are very immature at birth. Certain reflex Explores new possibilities and discovers actions present at birth allow the infant to respond to ways to get different results the environment. These include the Moro, or startle, Begins to recognize cause and effect reflex to a loud noise or sudden movement; the rooting relationships reflex, in which a slight touch on the cheek causes the Preoperational Begins to use words and images to mouth to open and the head to turn; the sucking reflex, (2 to 7 years) represent objects caused by a slight touch on the lips; and the grasp reflex, Tends to be egocentric (self-centered) in which infants can grasp an object placed in the hand Classifies objects in simple ways, such as (Figure 8–3). Muscle coordination develops in stages. shape, color, or important features At first, infants are able to lift the head slightly. By 2–4 Reacts to all similar objects as though they months, they can usually roll from side to back, support are identical themselves on their forearms when prone, and grasp By age 4, begins to understand concepts or try to reach objects. By 4–6 months, they can turn but has limited logic the body completely around, accept objects handed By age 6 to 7, understands the difference between reality and fantasy Concrete Egocentrism decreases and speech Operational becomes more socialized (7 to 11 years) Thinks logically about events, objects, and the environment Still experiences difficulty with abstract or hypothetical concepts Understands reversibility, or an ability to retrace mental steps to solve problems Classifies objects and can position them in a series based on specific features Formal Thinks logically about abstract propositions Operational and hypotheses to solve problems (Above 11 Becomes less dependent on concrete reality years) and is able to reason contrary to facts Develops ability to become concerned with ideological problems and the future FIGURE 8–2 A newborn baby usually weighs approximately 6–8 pounds and measures 18–22 inches in length. © Philip Lange/Shutterstock.com Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  244 CHAPTER 8 (A) (B) (C) (D) FIGURE 8–3 Some reflex actions an infant has at birth include (A) rooting, (B) sucking, (C) grasp, and (D) Moro. to them, grasp stationary objects such as a bottle, and as those of smell, taste, sensitivity to hot and cold, and with support, hold the head up while sitting. By 6–8 hearing, while good at birth, become more refined months, infants can sit unsupported, grasp moving and exact. objects, transfer objects from one hand to the other, and crawl on the stomach. By 8–10 months, they can MENTAL DEVELOPMENT crawl using their knees and hands, pull themselves to a Mental development is also rapid during the first year. sitting or standing position, and use good hand–mouth Newborns respond to discomforts such as pain, cold, coordination to put things in their mouths. By 12 or hunger by crying. As their needs are met, they grad­ months, infants frequently can walk without assistance, ually become more aware of their surroundings and grasp objects with the thumb and fingers, and throw begin to recognize individuals associated with their small objects. care. As infants respond to stimuli in the environment, Other physical developments are also dramatic. learning activities grow. At birth, they are unable to Most infants are born without teeth, but usually have speak. By 2–4 months, they coo or babble when spo­ 10–12 teeth by the end of the first year of life. At birth, ken to, laugh out loud, and squeal with pleasure. By 6 vision is poor and may be limited to black and white, months of age, infants understand some words and can and eye movements are not coordinated. By 1 year of make basic sounds, such as “mama” and “dada.” By 12 age, however, close vision is good, in color, and can months, infants understand many words and use single readily focus on small objects. Sensory abilities such words in their vocabularies. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  H u ma n G ro w th a n d Deve l opme n t 245 EMOTIONAL DEVELOPMENT transmission of infection by washing hands thoroughly and observing standard precautions is also essential Emotional development is observed early in life. New­ during care. borns show excitement. By 4–6 months of age, distress, delight, anger, disgust, and fear can often be seen. By 12 months of age, elation and affection for adults is evi­ Early Childhood dent. Events that occur in the first year of life when these PHYSICAL DEVELOPMENT emotions are first exhibited can have a strong influence During early childhood, from 1–6 years of age, physical on an individual’s emotional behavior during adulthood. growth is slower than during infancy. By age 6, the aver­ age weight is 45 pounds (20.4 kg), and the average height SOCIAL DEVELOPMENT is 46 inches (116 cm). Skeletal and muscle development Social development progresses gradually from the self- helps the child assume a more adult appearance. The centeredness concept of the newborn to the recogni­ legs and lower body tend to grow more rapidly than do tion of others in the environment. By 4 months of age, the head, arms, and chest. Muscle coordination allows infants recognize their caregivers, smile readily, and the child to run, climb, and move freely. As muscles stare intently at others (Figure 8–4). By 6 months of age, of the fingers develop, the child learns to write, draw, and infants watch the activities of others, show signs of pos­ use a fork and knife. By age 2 or 3, most primary teeth sessiveness, and may become shy or withdraw when in have erupted, and the digestive system is mature enough the presence of strangers. By 12 months of age, infants to handle most adult foods. Between 2 and 4 years of age, may still be shy with strangers, but they socialize freely most children learn bladder and bowel control. with familiar people, and mimic and imitate gestures, facial expressions, and vocal sounds. MENTAL DEVELOPMENT Mental development advances rapidly during early NEEDS AND CARE childhood. Verbal growth progresses from the use of sev­ Infants are dependent on others for all needs. Food, eral words at age 1 to a vocabulary of 1,500–2,500 words cleanliness, and rest are essential for physical growth. at age 6. Two-year-olds have short attention spans but Love and security are essential for emotional and social are interested in many different activities (Figure 8–5). growth. Stimulation is essential for mental growth. They can remember details and begin to understand While caring for infants, a health care provider should concepts. Four-year-olds ask frequent questions and give the parents or guardians support and reassurance and usually recognize letters and some words. They begin involve them in the infant’s care. Providing information to make decisions based on logic rather than on trial on nutrition, growth, development, sleep patterns, and error. By age 6, children are very verbal and want to meeting needs, and creating a healthy environment will learn how to read and write. Memory has developed to promote wellness in the infant. Care must be taken at all times to ensure the infant’s safety. Preventing the FIGURE 8–4 By 4 months of age, infants recognize their caregivers FIGURE 8–5 One to two-year-olds are interested in many different and stare intently at others. © Bendao/Shutterstock.com activities, but they have short attention spans. © Ami Parikh/Shutterstock.com Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  246 CHAPTER 8 the point where the child can make decisions based on also show less anxiety when faced with new experiences, both past and present experiences. because they have learned they can deal with new situations. EMOTIONAL DEVELOPMENT Emotional development also advances rapidly. At ages SOCIAL DEVELOPMENT 1–2, children begin to develop self-awareness and Social development expands from a self-centered (ego­ to recognize the effect they have on other people and centric) 1-year-old to a sociable 6-year-old. In the early things. Limits are usually established for safety, leading years, children are usually strongly attached to their the 1- or 2-year-old to either accept or defy such limits. parents (or to the individuals who provide their care), By age 2, most children begin to gain self-confidence and and they fear any separation. They begin to enjoy the are enthusiastic about learning new things (Figure 8–6). company of others, but are still very possessive. Playing However, children can feel impatient and frustrated as alongside other children is more common than playing they try to do things beyond their abilities. Anger, often with other children (Figure 8–7). Gradually, children in the form of “temper tantrums,” occurs when they learn to put “self ” aside and begin to take more of an cannot perform as desired. Children at this age also interest in others. They learn to trust other people and like routine and become stubborn, angry, or frustrated make more of an effort to please others by becoming when changes occur. From ages 4–6, children begin to more agreeable and social. Friends of their own age are gain more control over their emotions. They understand usually important to 6-year-olds. the concept of right and wrong, and because they have achieved more independence, they are not frustrated as NEEDS AND CARE much by their lack of ability. By age 6, most children The needs of early childhood still include food, rest, shelter, protection, love, and security. In addition, chil­ dren need routine, order, and consistency in their daily lives. They must be taught to be responsible and must learn how to conform to rules. This can be accomplished by making reasonable demands based on the child’s abil­ ity to comply. While caring for toddlers, a health care provider must be sensitive to the child’s fears and anxiety when dealing with strangers. Enlisting the help of parents or guardians, using a calm but firm approach, establishing rapport with the child, using play to alleviate fear, pro­ viding simple explanations to gain cooperation, allow­ ing the child to participate in care by providing one or two choices, and reassuring the child are all ways to FIGURE 8–6 By age two, most children begin to gain some self- FIGURE 8–7 Playing alongside and with other children allows confidence and are enthusiastic about learning new things. © Stuart preschoolers to learn how to interact with others. © matka_Wariatka/ Monk/Shutterstock.com Shutterstock.com Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  H u ma n G ro w th a n d Deve l opme n t 247 make care easier. After a painful procedure, it is essen­ tial to comfort the child. At all times, it is important to maintain a safe environment and prevent the transmis­ sion of infection. While caring for preschoolers, many of the same techniques can be used. Because the child is older, encouraging verbalization of fears, answering questions, allowing the child to make choices such as what color cast to use to splint a fractured bone, praising the child for cooperating, making health education fun, and lis­ tening to the child’s requests and trying to fulfill them are additional techniques that can be used. Late Childhood PHYSICAL DEVELOPMENT FIGURE 8–8 Role-playing allows a child to control fears and gain The late childhood life stage, which covers ages 6–12, is self-confidence. © Lisa Eastman/Shutterstock.com also called preadolescence. Physical development is slow but steady. Weight gain averages 4–7 pounds (2.3–3.2 kg) per year, and height usually increases approximately 2–3 inches (5–7.5 cm) per year. Muscle coordination is well developed, and children can engage in physical activ­ SOCIAL DEVELOPMENT ities that require complex motor-sensory coordination. Social changes are evident during these years. Seven- During this age, most of the primary teeth are lost, and year-olds tend to like activities they can do by them­ permanent teeth erupt. The eyes are well developed, and selves and do not usually like group activities. However, visual acuity is at its best. During ages 10–12, secondary they want the approval of others, especially their par­ sexual characteristics begin to develop in some children. ents and friends. Children from ages 8–10 tend to be more group oriented, and they typically form groups MENTAL DEVELOPMENT with members of their own sex. They are more ready Mental development increases rapidly because much to accept the opinions of others and learn to conform of the child’s life centers around school. Speech skills to rules and standards of behavior followed by the develop more completely, and reading and writing skills group. Toward the end of this period, children tend to are learned. Children learn to use information to solve make friends more easily, and they begin to develop problems, and the memory becomes more complex. an increasing awareness of the opposite sex. As chil­ They begin to understand more abstract concepts such dren spend more time with others their own age, their as loyalty, honesty, values, and morals. Children use dependency on their parent(s) lessens, as does the time more active thinking and become more adept at making they spend with their parents. judgments. NEEDS AND CARE EMOTIONAL DEVELOPMENT Needs of children in this age group include the same Emotional development continues to help the child basic needs of infancy and early childhood, together achieve a greater independence and a more distinct with the need for reassurance, parental approval, and personality. At age 6, children are often frightened peer acceptance. and uncertain as they begin school. Reassuring par­ Because this age group is prone to accidents and ents and success in school help children gain self- minor infections, health care providers must stress confidence. Role-playing also allows a child to control safety and healthy living principles. Information should fears and gain self-confidence (Figure 8–8). Gradually, be provided about nutrition, personal hygiene, sleep pat­ fears are replaced by the ability to cope. Emotions are terns, exercise, dental hygiene, preventing infection, and slowly brought under control and dealt with in a more puberty. It is also important to encourage independence effective manner. By ages 10–12, sexual maturation and to allow the child to make his or her own decisions and changes in body functions can lead to periods of whenever possible. Health care providers must be sen­ depression followed by periods of joy. These emotional sitive to the child’s need for privacy, but should make changes can cause children to be restless, anxious, and every effort to encourage the child to discuss his or her difficult to understand. concerns by using a nonjudgmental approach. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  248 CHAPTER 8 Adolescence PHYSICAL DEVELOPMENT Adolescence, ages 12 to 18, is often a traumatic life stage. Physical changes occur most dramatically in the early period. A sudden “growth spurt” can cause rapid increases in weight and height. A weight gain of up to 25 pounds (11 kg) and a height increase of several inches can occur in a period of months. Muscle coordination does not advance as quickly. This can lead to awkward­ ness or clumsiness in motor coordination. This growth spurt usually occurs anywhere from ages 11 to 13 in girls and ages 13 to 15 in boys. The most obvious physical changes in adolescents FIGURE 8–9 Adolescents use the peer group as a safety net as relate to the development of the sexual organs and sec­ they try to establish their identities and independence. ©iStock.com/Chris ondary sexual characteristics, frequently called puberty. Schmidt Secretion of sex hormones leads to the onset of menstru­ ation in girls and the production of sperm and semen in boys. Secondary sexual characteristics in females include growth of pubic hair, development of breasts and wider attempt to develop self-identity and independence, they hips, and distribution of body fat leading to the female seek security in groups of people their own age who have shape. The male develops a deeper voice; attains more similar problems and conflicts (Figure 8–9). If these peer muscle mass and broader shoulders; and grows pubic, relationships help develop self-confidence through the facial, and body hair. approval of others, adolescents become more secure and satisfied. Toward the end of this life stage, adolescents MENTAL DEVELOPMENT develop a more mature attitude and begin to develop patterns of behavior that they associate with adult behavior Since most of the foundations have already been estab­ or status. lished, mental development primarily involves an increase in knowledge and a sharpening of skills. Adolescents learn NEEDS AND CARE to make decisions and to accept responsibility for their actions. At times, this causes conflict because they are In addition to basic needs, adolescents need reassur­ treated as both children and adults, or are told to “grow ance, support, and understanding. Many problems up” while being reminded that they are “still children.” that develop during this life stage can be traced to the conflict and feelings of inadequacy and insecurity EMOTIONAL DEVELOPMENT that adolescents experience. Examples include eating disorders, drug and alcohol abuse, and suicide. Even Emotional development is often stormy and conflicted. though these types of problems also occur in earlier As adolescents try to establish their identities and inde­ and later life stages, they are frequently associated with pendence, they are often uncertain and feel inadequate adolescence. and insecure. They worry about their appearance, their Eating disorders often develop from an excessive abilities, and their relationships with others. They fre­ concern with appearance. Three common eating quently respond more and more to peer group influ­ disorders are anorexia nervosa, bulimia, and bulimarexia. ences. At times, this leads to changes in attitude and These disorders are discussed in detail in Chapter 11:5, behavior and conflict with values previously established. Weight Management. All three conditions are more Toward the end of adolescence, self-identity has been common in female than male individuals. Psychological established. At this point, teenagers feel more comfort­ or psychiatric help is usually needed to treat these able with who they are and turn attention toward what conditions. they may become. They gain more control of their feel­ Chemical abuse is the use of substances such as ings and become more mature emotionally. alcohol or drugs and the development of a physical and/or mental dependence on these chemicals. Chem­ SOCIAL DEVELOPMENT ical abuse can occur in any life stage, but it frequently Social development usually involves spending less time begins in adolescence. Reasons for using chemicals with family and more time with peer groups. As adolescents include anxiety or stress relief, peer pressure, escape Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  H u ma n G ro w th a n d Deve l opme n t 249 from emotional or psychological problems, experi­ Early Adulthood mentation with feelings the chemicals produce, desire for “instant gratification,” hereditary traits, and cul­ PHYSICAL DEVELOPMENT tural influences. Chemical abuse can lead to physi­ Early adulthood, ages 19–40, is frequently the most cal and mental disorders and disease. Treatment is productive life stage. Physical development is basically directed toward total rehabilitation that allows the complete, muscles are developed and strong, and motor chemical abuser to return to a productive and mean­ coordination is at its peak. This is also the prime child­ ingful life. bearing time and usually produces the healthiest babies Suicide, found in many life stages, is one of the (Figure 8–10). Both male and female sexual develop­ leading causes of death in adolescents. Suicide is always ment is at its peak. a permanent solution to a temporary problem. Reasons for suicide include depression, grief over a loss or love MENTAL DEVELOPMENT affair, failure in school, inability to meet expectations, Mental development usually continues throughout this influence of suicidal friends, or lack of self-esteem. The stage. Many young adults pursue additional education risk for suicide increases with a family history of sui­ to establish and progress in their chosen careers. Fre­ cide; a major loss or disappointment; previous suicide quently, formal education continues for many years. attempts; and/or the recent suicide of friends, family, The young adult often also deals with independence, or role models (heroes or idols). The impulsive nature makes career choices, establishes a lifestyle, selects a of adolescents also increases the possibility of suicide. marital partner, starts a family, and establishes values, all Most individuals who are thinking of suicide give warn­ of which involve making many decisions and forming ing signs such as verbal statements like “I’d rather be many judgments. dead” or “You’d be better off without me.” Other warn­ ing signs include: Sudden changes in appetite and sleep habits Withdrawal, depression, and moodiness Excessive fatigue or agitation Neglect of personal hygiene Alcohol or drug abuse Losing interest in hobbies and other aspects of life Preoccupation with death Injuring one’s body Giving away possessions Social withdrawal from family and friends These individuals are calling out for attention and help, and usually respond to efforts of assistance. Their direct and indirect pleas should never be ignored. Sup­ port, understanding, and psychological or psychiatric counseling are used to prevent suicide. Because of the many conflicts adolescents experi­ ence, health care providers must be nonjudgmental to establish rapport while providing care. It is essen­ tial to listen to the adolescent’s concerns, be sensitive to their nonverbal behavior, involve them in deci­ sion making, and answer questions as honestly and completely as possible. It is also important to pro­ vide education about hygiene, nutrition, develop­ mental changes, sexually transmitted diseases, and FIGURE 8–10 Early adulthood is the prime childbearing time and substance abuse. usually produces the healthiest babies. © Rohit Seth/Shutterstock.com Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  250 CHAPTER 8 EMOTIONAL DEVELOPMENT MENTAL DEVELOPMENT Emotional development usually involves preserving Mental ability can continue to increase during middle the stability established during previous stages. Young age, a fact that has been proved by the many individu­ adults are subjected to many emotional stresses related als in this life stage who seek formal education. Middle to career, marriage, family, and other similar situations. adulthood is a period when individuals have acquired an If emotional structure is strong, most young adults can understanding of life and have learned to cope with many cope with these worries. They find satisfaction in their different stresses. This allows them to be more confident achievements, take responsibility for their actions, and in making decisions and to excel at analyzing situations. learn to accept criticism and to profit from mistakes. EMOTIONAL DEVELOPMENT SOCIAL DEVELOPMENT Emotionally, middle age can be a period of contentment Social development frequently involves moving away and satisfaction, or it can be a time of crisis. The emo­ from the peer group. Instead, young adults tend to asso­ tional foundation of previous life stages and the situations ciate with others who have similar ambitions and inter­ that occur during middle age determine emotional status ests, regardless of age. The young adult often becomes during this period. Job stability, financial success, the involved with a mate and forms a family. Young adults end of child rearing, and good health can all contribute do not necessarily accept traditional sex roles and fre­ to emotional satisfaction (Figure 8–11). Stress, created by quently adopt nontraditional roles. For example, male loss of job, fear of aging, loss of youth and vitality, illness, individuals fill positions as nurses and secretaries, and marital problems, or problems with children or aging par­ female individuals enter administrative or construction ents, can contribute to emotional feelings of depression, positions. Such choices have caused and will continue to insecurity, anxiety, and even anger. Therefore, emotional cause changes in the traditional patterns of society. status varies in this age group and is largely determined by events that occur during this period. NEEDS AND CARE Needs of early adulthood include the same basic needs as SOCIAL DEVELOPMENT other age groups. In addition, young adults need indepen­ Social relationships also depend on many factors. Family dence, social acceptance, self-confidence, and reassurance. relationships often see a decline as children begin lives of During care, information must be provided to allow their own and parents die. Work relationships frequently young adults to make wise decisions regarding their replace family. Relationships between husband and wife health status and wellness goals. Even though this is usu­ can become stronger as they have more time together ally the healthiest life stage, choices made at this time and opportunities to enjoy success. However, divorce can affect both middle and old age. It is also important rates are also high in this age group, as couples who have to listen to what the person is saying and to observe non­ remained together “for the children’s sake” now separate. verbal behavior. Individuals in this age group frequently Friendships are usually with people who have the same experience stress due to their responsibilities. Sensitive interests and lifestyles. supportive care is essential. Middle Adulthood PHYSICAL DEVELOPMENT Middle adulthood, ages 40–65, is frequently called middle age. Physical changes begin to occur during these years. The hair tends to gray and thin, the skin begins to wrinkle, muscle tone tends to decrease, hearing loss starts, visual acuity declines, and weight gain occurs. Women experience menopause, or the end of menstruation, along with decreased hormone production that causes physical and emotional changes. Men also experience a slowing of hormone production. This can lead to physical and psychological changes, a period frequently referred to as the male climacteric. However, except in cases of injury, disease, or surgery, men never lose the FIGURE 8–11 Job stability and enjoyment during middle adulthood ability to produce sperm or to reproduce. contribute to emotional satisfaction. © Nagy Melinda/Shutterstock.com Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  H u ma n G ro w th a n d Deve l opme n t 251 NEEDS AND CARE Needs of middle adulthood include the same basic needs as other age groups. In addition, these individuals need self-satisfaction, a sense of accomplishment, and sup­ portive social relationships. Health care providers must encourage middle-aged adults to identify risk factors to their health status and to make changes to promote wellness. Increasing exercise, improving nutrition, avoiding obesity, quitting smok­ ing, eliminating or decreasing alcohol intake, and other similar actions can improve health status and increase longevity. At this life stage, individuals begin to see the physical signs of aging. With proper guidance, they can learn how to practice better health principles that will FIGURE 8–12 Elderly individuals who are willing to learn new things show fewer signs of decreased mental ability. © privilege/Shutterstock.com help establish a pattern for later years of life. Nonjudg­ mental supportive care is important while helping indi­ viduals to establish and meet health goals. alert and well oriented, other elderly individuals show decreased mental capacities at much earlier ages. Short- Late Adulthood term memory is usually first to decline. Many elderly individuals can clearly remember events that occurred PHYSICAL DEVELOPMENT 20 years ago, but do not remember yesterday’s events. Late adulthood, age 65 and older, has many different Diseases such as Alzheimer’s disease can lead to irre­ terms associated with it. These include “elderly,” “senior versible loss of memory, deterioration of intellectual citizen,” “golden ager,” and “retired citizen.” Much atten­ functions, speech and gait disturbances, and disorienta­ tion has been directed toward this life stage in recent tion. Arteriosclerosis, a thickening and hardening of the years because people are living longer, and the number walls of the arteries, can also decrease the blood supply to of people in this age group is increasing daily. the brain and cause a decrease in mental abilities. These Physical development is on the decline. All body diseases are discussed in greater detail in Chapter 10:4. systems are usually affected. The skin becomes dry, wrinkled, and thinner. Brown or yellow spots (frequently EMOTIONAL DEVELOPMENT called “age spots”) appear. The hair becomes thin and Emotional stability also varies among individuals in this frequently loses its luster or shine. Bones become brittle age group. Some elderly people cope well with the stresses and porous, and are more likely to fracture or break. presented by aging and remain happy and able to enjoy Cartilage between the vertebrae thins and can lead to a life. Others become lonely, frustrated, withdrawn, and stooping posture. Muscles lose tone and strength, which depressed. Emotional adjustment is necessary throughout can lead to fatigue and poor coordination. A decline in this cycle. Retirement, death of a spouse and friends, phys­ the function of the nervous system leads to hearing loss, ical disabilities, financial problems, loss of independence, decreased visual acuity, and decreased tolerance for tem­ and knowledge that life must end all can cause emotional peratures that are too hot or too cold. Memory loss can distress. The adjustments that the individual makes dur­ occur, and reasoning ability can diminish. The heart is ing this life stage are similar to those made throughout life. less efficient, and circulation decreases. The kidney and bladder are less efficient. Breathing capacity decreases SOCIAL DEVELOPMENT and causes shortness of breath. However, it is important Social adjustment also occurs during late adulthood. to note that these changes usually occur slowly over a Retirement can lead to a loss of self-esteem, especially long period. Many individuals, because of better health if work is strongly associated with self-identity: “I am and living conditions, do not show physical changes of a teacher,” instead of “I am Sandra Jones.” Less contact aging until their 70s and even 80s. with coworkers and a more limited circle of friends usu­ ally occur. Many elderly adults engage in other activities MENTAL DEVELOPMENT and continue to make new social contacts (Figure 8–13). Mental abilities vary among individuals. Elderly people Others limit their social relationships. Death of a spouse who remain mentally active and are willing to learn new and friends and moving to a new environment can also things tend to show fewer signs of decreased mental abil­ cause changes in social relationships. Development of ity (Figure 8–12). Although some 90-year-olds remain new social contacts is important at this time. Senior Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  252 CHAPTER 8 abandonment, and loneliness. They fear the unknown. They become anxious about their loved ones and about unfinished work or dreams. Anxiety diminishes in patients who feel they have had full lives and who have strong religious beliefs regarding life after death. Some patients view death as a final peace. They know it will bring an end to loneliness, pain, and suffering. Stages of Dying and Death Dr. Elisabeth Kübler-Ross has done extensive research on the process of death and dying, and is known as a leading expert on this topic. Because of her research, FIGURE 8–13 Social contacts and activities are important during most medical personnel now believe patients should late adulthood. © Monkey Business Images/Shutterstock.com be told of their approaching deaths. However, patients should be left with “some hope” and the knowledge that they will “not be left alone.” It is important that all staff centers, golden age groups, churches, and many other members who provide care to the dying patient know organizations help provide the elderly with the opportu­ both the extent of information given to the patient and nity to find new social roles. how the patient reacted. Dr. Kübler-Ross has identified five stages of griev­ NEEDS AND CARE ing that dying patients and their families/friends may Needs of this life stage are the same as those of all other experience in preparation for death. The stages may life stages. In addition to basic needs, the elderly need a not occur in order, and they may overlap or be repeated sense of belonging, self-esteem, financial security, social several times. Some patients may not progress through acceptance, and love. all of the stages before death occurs. Other patients may While caring for older adults, health care provid­ be in several stages at the same time. The five stages are ers must use a nonjudgmental, supportive approach. denial, anger, bargaining, depression, and acceptance. Encourage them to talk; allow them as much indepen­ Denial is the “No, not me!” stage, which usually dence as possible; recognize achievements they have occurs when a person is first told of a terminal illness. accomplished; provide required health care information It occurs when the person cannot accept the reality of as illnesses occur; help them adjust and adapt to physi­ death or when the person feels loved ones cannot accept cal and mental changes; allow them to express fears and the truth. The person may make statements such as “The regrets, but remind them of positive accomplishments; doctor does not know what he is talking about” or “The and help them find support systems and social networks. tests have to be wrong.” Some patients seek second med­ Providing a safe environment and preventing infection ical opinions or request additional tests. Others refuse to are also essential. discuss their situations and avoid any references to their illnesses. It is important for patients to discuss these feel­ S TUDE N T: Go to the workbook and complete the ings. The health care worker should listen to a patient assignment sheet for 8:1, Life Stages. and try to provide support without confirming or deny­ ing. Statements such as “It must be hard for you” or “You feel additional tests will help?” will allow the patient to express feelings and move on to the next stage. 8:2 Death and Dying Anger occurs when the patient is no longer able to deny death. Statements such as “Why me?” or “It’s your Death is often referred to as “the final stage of growth.” fault” are common. Patients may strike out at anyone who It is experienced by everyone and cannot be avoided. In comes in contact with them and become hostile and bitter. our society, the young tend to ignore its existence. It is They may blame themselves, their loved ones, or health usually the elderly, having lost spouses and/or friends, care personnel for their illnesses. It is important for the who begin to think of their own deaths. health care worker to understand that this anger is not a When a patient is told that he or she has a personal attack; the anger is caused by the situation the terminal illness, a disease that cannot be cured and will patient is experiencing. Providing understanding and sup­ result in death, the patient may react in different ways. port, listening, and making every attempt to respond to the Some patients react with fear and anxiety. They fear pain, patient’s demands quickly and with kindness is essential Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  H u ma n G ro w th a n d Deve l opme n t 253 FIGURE 8–15 The support and presence of others is important to the dying person. ©iStock.com/Jodi Jacobson may complete unfinished business and try to help those around them deal with the oncoming death. Gradually, patients separate themselves from the world and other people. At the end, they are at peace and can die with dignity. During this final stage, patients still need emo­ tional support and the presence of others, even if it is just the touch of a hand (Figure 8–15). Hospice Care FIGURE 8–14 Depression can be a normal stage of grieving in a Providing care to dying patients can be very difficult, but dying patient. © Voronin76/Shutterstock.com very rewarding. Providing supportive care when families and patients require it most can be one of the greatest during this stage. This stage continues until the anger is satisfactions a health care worker can experience. To be exhausted or the patient must attend to other concerns. able to provide this care, however, health care workers Bargaining occurs when patients accept death must first understand their own personal feelings about but want more time to live. Frequently, this is a period death and come to terms with these feelings. Feelings of when patients turn to religion and spiritual beliefs. At fear, frustration, and uncertainty about death can cause this point, the will to live is strong, and patients fight workers to avoid dying patients or provide superficial, hard to achieve goals set. They want to see their children mechanical care. With experience, health care workers graduate or get married, they want time to arrange care can find ways to deal with their feelings and learn to pro­ for their families, they want to hold new grandchildren, vide the supportive care needed by the dying. or other similar desires. Patients make promises to God Hospice care can play an important role in meet­ in order to obtain more time. Health care workers must ing the needs of the dying patient. Hospice care offers again be supportive and be good listeners. Whenever palliative care, or care that provides support and com­ possible, they should help patients meet their goals. fort. It can be offered in hospitals, medical centers, and Depression occurs when patients realize that death special facilities, but most frequently it is offered in the will come soon and they will no longer be with their patient’s home. Hospice care is not limited to a specific families or be able to complete their goals. They may time period in a patient’s life. Usually it is not started express these regrets, or they may withdraw and become until a physician declares that the patient has 6 months quiet (Figure 8–14). They experience great sadness or less to live, but it can be started sooner. Most often and, at times, overwhelming despair. It is important for patients and their families are reluctant to begin hospice health care workers to let patients know that it is “OK” to care because they feel that this action recognizes the end be depressed. Providing quiet understanding, support, of life. They seem to feel that if they do not use hospice and/or a simple touch, and allowing patients to cry or care until later, death will not be as near as it actually is. express grief are important during this stage. The philosophy behind hospice care is to allow the Acceptance is the final stage. Patients understand patient to die with dignity and comfort. Using pallia­ and accept the fact that they are going to die. Patients tive measures of care and the philosophy of death with Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  254 CHAPTER 8 dignity provides patients and families with many com­ can then decide whether or not to take the medication forts and provides an opportunity to find closure. Some when he/she is ready to die. Many other states are consid­ of the comforts provided by hospice may include provid­ ering Death with Dignity acts to allow individuals to have ing hospital equipment such as beds, wheelchairs, and assistance with their right to die. bedside commodes; offering psychological, spiritual,