Human Growth and Development PDF

Human Growth and Development  Stages of Growth and Development Human growth and development are continuous and complex. Stages are typically organized by age groups. Growth and development are based on timing and sequence of developmental tasks  Human development begins with conce...

Human Growth and Development  Stages of Growth and Development Human growth and development are continuous and complex. Stages are typically organized by age groups. Growth and development are based on timing and sequence of developmental tasks  Human development begins with conception which marks the beginning of prenatal development. Prenatal development is followed by newborn, infancy, childhood, adolescence, adulthood, and late adulthood stages.  Each stage of development between conception and late adulthood is characterized by unique physical, cognitive, and emotional changes that define each stage.  Intrauterine Life Gestation (pregnancy) stages: Preembryonic stage = First 14 days Embryonic stage = Day 15 through week 8 Fetal stage = End of week 8 until birth Full-term pregnancy Lasts 40 weeks Divided into trimesters Placenta development Teratogens  Health Promotion During Pregnancy Diet has significant effect on fetal development Pregnancy includes physiological, cognitive, and emotional changes, accompanied by stress and anxiety Maternal age impacts fetus Physiological changes can bring discomfort to mother Educate the mother on maternal and fetal health  Transition from Intrauterine to Extrauterine Life The transition from intrauterine to extrauterine life requires profound physiological changes in the newborn and occurs during the first 24 hours of life. Physical changes Apgar score Nursing interventions Psychosocial changes Attachment  Apgar Scoring Indicator 0 points 1 point 2 points A Appearance (skin Blue; Pale Pink body; Blue Pink color) extremities P Pulse Absent Below 100/min Over 100/min G Grimace Floppy Minimal response to Prompt response to (reflect irritability) stimulation stimulation A Activity Absent Flexed arms and Active legs R Respiration Absent Slow and irregular Vigorous cry Apgar Scoring  At one minute and five minutes after birth, the newborn is assessed and scored based on color, heart rate, reflexes, muscle tone, and respiration.  Each trait is scored as 0, 1, or 2, then added together to yield the overall Apgar score.  The highest (best) possible score is 10, but a score of 7 or higher is considered normal.  Apgar scores may vary and are influenced by gestational age, birth weight, maternal medication or anesthesia use, and congenital anomalies.  Newborn The neonatal period is the first 28 days of life Physical changes Nursing assessment Normal physical characteristics Neurological function assessment Normal behavioral characteristics  Newborn (Cont.) Sleeping Cognitive changes Begins with innate behavior, reflexes, and sensory functions Newborns initiate reflex activities, learn behaviors, and learn their desires Importance of providing sensory stimulation Crying is a means of communication to provide cues to parents  Newborn (Cont.) Psychosocial changes During the first month of life most parents and newborns develop a strong bond that grows into a deep attachment. Interactions during routine care enhance or detract from the attachment process.  Newborn (Cont.) Health promotion includes screening, use of car seats, and education about cribs. All newborns are screened to identify life-threatening conditions before symptoms begin. Teaching parents about car seat use is an essential component of discharge. Cribs should meet government standards for the safety of the newborn.  Infant 2 days through 1 year old Physical changes Increases in height and weight Development of sight, hearing, and fine- and gross-motor movements Cognitive changes Development of vision, hearing, and touch Language and memory development Psychosocial changes Separation of self from others Purposeful smiling  Infant (Cont.) 1 month old to 1 year old Need for stimulation Health risks Injury prevention Child maltreatment Health promotion Nutrition Immunizations Sleep  Toddler 12 to 36 months Physical changes Growth and development; fine- and gross-motor movements Cognitive changes Memory, language Psychosocial changes Sense of autonomy, parallel play  Toddler (Cont.) 12 to 36 months Health risks Poisoning, drowning, motor vehicle accidents Health promotion Nutrition Toilet training  Preschooler 3 to 6 years old Physical changes Growth slows but continues. Large- and fine-motor movements continue to develop. Cognitive changes Curiosity abounds: “Why?” Understanding is linked to concrete experiences. Psychosocial changes Increased social interaction, play  Preschooler (Cont.) 3 to 6 years old Health risks Injury prevention Home safety Health promotion Nutrition Sleep Vision  School-Age Children and Adolescents 6 to 18 years old Expansion, development, and refinement of physical, cognitive, moral, and psychosocial skills Environment in which they develop skills also expands and diversifies Review appropriate developmental expectations for each age group  School-Age Children 6 to 12 years old Physical changes: Consistent growth, improved coordination Cognitive changes Begin to demonstrate logical, more concrete thinking Psychosocial changes: Self-concept Peer relationships Sexual identity Stress  School-Age Children (Cont.) 6 to 12 years old Health risks Accidents Infections Health promotion Perceptions Health education Health maintenance Safety Nutrition  Adolescents Adolescence: Psychological maturation Puberty: Reproduction becomes possible 13 to 20 years old Physical changes in four areas: Increased rate of growth Sex-specific changes (shoulder and hip width, menarche) Distribution of muscle and fat Development of reproductive system Adolescence is time of dramatic physical, cognitive, and psychosocial growth. The term adolescence means to “grow and mature” and refers to the transitional period between the onset of sexual maturity and ending with the cessation of growth and movement toward emotional maturity. Brain and Hormonal Changes During Puberty  Adolescents (Cont.) Cognitive changes Ability to think rationally Think about the future Communication skills in situations Communication with adolescents: Ask open-ended questions Look for the meaning behind their words or actions Be alert to clues to their emotional state Involve other individuals and resources when necessary  Adolescents (Cont.) Psychosocial changes Search for personal identity Development of ethical system Consideration of future Sexual identity Group identity Family identity Health identity Young adults usually complete physical growth by age 20. All organs and body systems are fully developed and mature by this age; however, brain development continues until approximately age 25.  Adolescents (Cont.) Health risks Accidents are the leading cause of death Violence and homicide Suicide warning signs Decrease in school performance Withdrawal Loneliness, sadness, and crying Appetite and sleep disturbances Verbalization of suicidal thought  Adolescents (Cont.) Health risks (Cont.) Substance abuse Eating disorders STIs Pregnancy  Adolescents (Cont.) Health promotion Health education Minority adolescents Gay, lesbian, and bisexual adolescents Adolescents are much more likely to use health care services if they encounter providers who are caring and respectful. Males and females experience a change of life referred to as climacteric. Climacteric in females is referred to as menopause which marks the cessation of menses.  Young Adults Late teens to mid- to late-30s Emerging adulthood is 18 to 25 years Physical changes Cognitive changes Psychosocial Changes  Psychosocial Changes Lifestyle Career Sexuality Childbearing cycle Types of families Parenthood Alternative family structures and Singlehood Emotional health parenting  Health Risks Family history Personal hygiene habits Violent death and injury Substance abuse Human trafficking Unplanned pregnancies Sexually transmitted infections Environmental or occupational forces  Health Concerns Health promotion Psychosocial health Infertility Obesity Exercise Pregnant woman and childbearing family Psychosocial Stressors  Acute Care Includes treatment for Accidents Substance abuse Exposure to the environment Stress-related illness Respiratory infection Influenza Urinary tract infection Conditions requiring minor surgery  Restorative and Continuing Care Causes of chronic illnesses include hypertension, coronary artery disease, accidents, rheumatoid arthritis, AIDS, and cancer. Nursing interventions relate to sense of identify, establishment of independence, reorganization of relationships, and launching a chosen career.  Middle Adults Begins in the mid 30s and lasts through the late 60s Physical changes May impact self-concept and body image Cognitive changes Rare, unless illness or trauma occurs  Psychosocial Changes Expected events Career transition Sexuality Family psychosocial events: Singlehood Marital changes Family transitions Care of aging parents  Health Concerns Health promotion and Forming positive health habits stress reduction Obesity Positive health habits Psychosocial health: Anxiety and depression Community health programs  Acute and Restorative Care Recovering from an injury or illness may take longer. Chronic illnesses affect roles and responsibilities. Your role in assessment includes determining the coping mechanisms of the patient and family, as well as adherence to treatment and rehabilitation regimens and the need for community and social services, with appropriate referrals.  Older Adults Variability Among Older Adults Physiological, cognitive, and psychosocial health Levels of functional ability Dependence vs. independence Strengths and abilities  Myths and Stereotypes Older adults are: Ill, disabled, and unattractive Forgetful, confused, rigid, boring, unfriendly, and poor Unable to learn and understand new information Not interested in sex or sexual activities These ideas demonstrate ageism, which is discrimination against people because of increasing age.  Nurses’ Attitudes Toward Older Adults Nurses must assess their own attitude toward older adults and their own aging. Nurses need to gain knowledge about aging and health care needs of older adults: Respect Dignity Involvement in care decision and activities  Developmental Tasks for Older Adults Associated with varying degrees of change and loss Health, significant others, a sense of being useful, socialization, income, and independent living Coping with Retirement Residence change Death Adult children  Community-Based and Institutional Health Care Services Nurses encounter older-adult patients in a wide variety of community and institutional health care settings: Private homes, apartments, retirement communities, adult day care centers, assisted-living facilities, and nursing centers Older adults need to help with decisions regarding which type of health care service is appropriate for them.  Assessing the Needs of Older Adults Nursing assessment to ensure an age-specific approach The interrelation between physical and psychosocial aspects of aging Effects of disease and disability on functional status Tailoring the nursing assessment to an older person  Physiological Changes Older adults’ concepts of health generally depend on personal perceptions of functional ability. General survey Begins during initial nurse-patient encounter Quick, but careful, head-to-toe scan Eye contact and facial expression Presence of universal aging changes  Physiological Changes (Cont.) Integumentary system Skin Lesions Head and neck Facial features Visual acuity Auditory changes Salivary secretion  Physiological Changes (Cont.) Thorax and lungs Respiratory muscle strength decreases Anteroposterior diameter of thorax increases Heart and vascular system Decreased contractile strength of the myocardium results in decreased cardiac output Breasts  Physiological Changes (Cont.) Gastrointestinal system and abdomen Reproductive system Urinary system Musculoskeletal system Neurological system  Functional Changes Functional status in older adults includes the day-to-day activities of daily living (ADLs) involving activities within physical, psychological, cognitive, and social domains. Changes are usually linked to illness or to disease and degree of chronicity. Performance of ADLs is a sensitive indicator of health or illness. Occupational and physical therapists are your best resources for a comprehensive assessment.  Cognitive Disorders Delirium Acute confusional state Dementia Generalized impairment of intellectual functioning Depression A mood disturbance characterized by feelings of sadness and despair  Psychosocial Changes Retirement Social isolation Sexuality Housing and environment Death  Learning Needs Cognitive and sensory changes are challenges for teaching older adults During assessment, the nurse needs to determine additional needs for teaching and limitations of the older adult in their capability to learn Learn at a slower rate Difficulties processing multiple bits of information at one moment  Addressing the Health Concerns of Older Adults Healthy People 2020 goals: Increase the number of older adults with one or more chronic conditions who report confidence in maintaining their conditions. Reduce the proportion of older adults who have moderate-to-severe functional limitations. Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-term physical activities.  Addressing the Health Concerns of Older Adults (Cont.) Increase the proportion of older adults who receive diabetes self- management benefits. Increase the proportion of the health care workforce with geriatric certification.  Educating Older Adults Inadequate health literacy disproportionately affects older adults in the United States, causing misunderstanding of health information and subsequent nonadherence. Nurses must use more than words when teaching older adults Assist in selecting, understanding, and using health-related information about medications  Health Promotion and Maintenance: Physiological Concerns (Cont.) To increase the desire for older adults to participate in health promotion, use an individualized approach, taking into account a person’s beliefs about the importance of staying healthy and remaining independent. Limitations in ADLs limit the ability to live independently. Most older adults want to remain independent and prevent disability.  Health Promotion and Maintenance: Physiological Concerns (Cont.) Heart disease Cancer Chronic lung disease Stroke Smoking Alcohol abuse  Health Promotion and Maintenance: Physiological Concerns (Cont.) Nutrition Dental problems Exercise Falls Sensory impairments Pain Medication use  Health Promotion and Maintenance: Psychosocial Concerns Elder mistreatment Therapeutic communication Touch Reality orientation Validation therapy Reminiscence Body-image interventions  Older Adults and the Acute Care Setting Acute care settings pose risks for adverse events: Delirium Dehydration Malnutrition Health care–associated infections Urinary incontinence Falls  Older Adults and Restorative Care Types of ongoing care: Continues recovery from acute illness Addresses chronic conditions that affect daily functioning Goal To regain or improve prior level of independence, ADLs, instrumental activities of daily living (IADLs)  Developmental Theories Propose ways to account for how and why people grow as they do. Provide a framework for examining, describing, and appreciating human development. Help nurses assess and treat a patient’s response to illness.  Human growth Cephalocaudal Proximodistal Cephalocaudal Principle  Human development follows a head-to-toe progression.  For example: Infants gain control over their neck and head before extremities. Proximodistal Principle  Human development progresses from the center of the body in an outward direction.  For example, the spine develops first, followed by extremities, then fingers and toes.  Growth and Development Theorists Freudian theory posits that the adult personality is the result of moving successfully from one psychosexual stage to the next, and that failure to resolve conflicts or being fixed in any of the psychosexual stages results in personality problems. Each stage of psychosexual development is characterized by sexual pleasure in the mouth, anus, and genitals He identified five stages of development: Stage 1: Oral (birth to 18 months) Stage 2: Anal (18 months to 3 years) Stage 3: Phallic or Oedipal (3 to 6 years) Stage 4: Latency (6 to 12 years) Stage 5: Genital (puberty through adulthood)  Sigmund Freud (Cont.) Believed the id, ego, and superego regulate behavior Critics: Freud based his theory on biological determinants and ignored influence of culture and experience His assumptions are not applicable across different cultures  Erikson’s Psychosocial Stages Stage 1: Trust versus mistrust (birth to 1 year) Stage 2: Autonomy versus shame and doubt (1-3 yrs.) Stage 3: Initiative versus guilt (3-6 yrs.) Stage 4: Industry versus inferiority (6-11 yrs.) Stage 5: Identify versus role confusion (puberty) Stage 6: Intimacy versus isolation (young adult) Stage 7: Generative versus self-absorption and stagnation (middle age) Stage 8: Integrity versus despair (old age)  Perspectives on Adult Development Aging changes come more slowly as people continue to develop new abilities to adapt to shifting environments. Quilting keeps this older adult active  Cognitive Developmental Theory Jean Piaget’s four stages: Period I: Sensorimotor (birth to 2 years) Period II: Preoperational (2 to 6 years) Period III: Concrete operations (6 to 12 years) Period IV: Formal operations (12 years to adulthood)  Moral Developmental Theory Attempts to define how moral reasoning matures for an individual Refers to changes in a person’s thoughts, emotions, and behaviors that influence the perception of right or wrong Kohlberg’s moral developmental theory Moral reasoning develops in stages. Six stages in three levels  Lawrence Kohlberg’s Theory of Moral Development Level I: Preconventional reasoning, when children ask “why?” Stage 1: Punishment and Obedience Orientation: Children view illness as a punishment. Stage 2: Instrumental Relativist Orientation Level II: Conventional reasoning, when moral reasoning is based on internalization of societal and others’ expectations Stage 3: Good Boy-Nice Girl Orientation Stage 4: Society-Maintaining Orientation  Lawrence Kohlberg’s Theory of Moral Development (Cont.) Level III: Postconventional reasoning occurs when a person finds a balance between basic human rights and obligations and societal rules and regulations Stage 5: Social Contract Orientation Stage 6: Universal Ethical Principle Orientation, where right is defined by the decision of conscience in accord with self-chosen ethical principles Kohlberg’s critics  Growth and Development Theorists  Freudian theory posits that the adult personality is the result of moving successfully from one psychosexual stage to the next, and that failure to resolve conflicts or being fixed in any of the psychosexual stages results in personality problems.  Erikson’s theory includes eight stages of psychosocial development; each stage has a unique crisis that builds on the tasks of the previous stage. Successful resolution of the crisis at each stage leads to psychosocial growth and development. Growth and Development Theorists  Piaget’s theory on cognitive development is based on how an individual acquires knowledge, intellect, and cognition over time.  Kohlberg believed that children progressively develop moral reasoning as they gain the ability to think logically and contended that moral development continued throughout the lifespan.  References 1. ATI – Engage Fundamentals RN Module: Human Growth and Development 2. ATI – Content Mastery Series Review Module; Fundamentals for Nursing edition 10.0 3. Craven, R.F., Hirnle, C.J., & Henshaw, C.M. (2021). Fundamentals of Nursing Concepts and Competencies for practice (9th ed.). Wolters Kluwer 4. Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2017). Fundamentals of nursing (9th ed.). Mosby.