Growth and Development

Intra-UterineStages of fetal growth

Heart functions by 2-3 weeksPlacenta begins to function at 3 weeks and

fully functioning 4 monthsTransports nutrients, oxygen, and wastes

Amniotic Fluid and membranesMaintains temperature, provides cushioning, and

protects from infectionEmbryo to fetus at 8 weeks when all organs

are developedSex visible by week 12Vernix and lanugo at 20 weeksHearing ability by week 24 Lungs developed by week 28

Birth to One YearErikson

Trust vs Mistrust (needs attachment to a nurturing person)

Piaget (Birth to 2 years)Sensorimotor

Infant gains knowledge about the world through sensory and motor skills

Birth to One Year

BowlbyEmotional attachment (usually mom) to

an adult is necessary to survivalEmergence of basic emotions (joy,

anger, fear)Kolberg

PreconventionalInfant is not aware of right or wrong

Birth to One Year

A nurse is reinforcing instructions to a new mother regarding the psychosocial development of the infant. Using Erikson’s psychosocial development theory, the nurse would instruct the mother to:

1.Allow the infant to signal a need.2.Anticipate all of the needs of the infant.3.Avoid the infant during the first 10 minutes of

crying.4.Attend to the infant immediately when crying.

Birth to One Year

A nurse is reinforcing instructions to a new mother regarding the psychosocial development of the infant. Using Erikson’s psychosocial development theory, the nurse would instruct the mother to:

1.Allow the infant to signal a need.2.Anticipate all of the needs of the infant.3.Avoid the infant during the first 10 minutes of

crying.4.Attend to the infant immediately when crying.

Birth to One YearAt birth head circumference is larger

than chest circumferenceHeight increases ¾ inch per month (9

inches or more in a year)Double weight by 3-6 months, Triple by

one yearAnterior fontanel closes by 12-18

months, posterior fontanel closes by 3 months

First teeth appear by 6-8 months

Birth to One Year Milestones

2-3 monthsSmiles, turns head side to side, follows

objects, holds head midline4 months-6 months

Turns over by selfGrasps objects with palmEnjoys social interaction and shows

memoryAware of unfamiliar surroundings

Birth to One YearMilestones:

6 months- 7 monthsSits with supportImitates and waves good-byeFear of strangers, mood swings, holds arms out

Transfers objects from one hand to another (5 months)

Birth to One YearMilestones

8-9 monthsSits without supportCrawls and pulls to stand and can stand while

holding onPincer grasp

10-11 monthsChanges position from prone to sittingStands securely and walks while holding on to

furnitureEntertains self

12 monthsWalks with hand held and can take a few steps

without fallingDrinks from a cup

Birth to One YearReflexes (neurological)

Rooting, suckling, eye blinking and withdrawalSenses

Recognizes familiar odorsDifferentiates tastesFeels painHears pitches in the range of the human voicePrefers to look at patterned stimuli

Understand some speech, may speak in two-word sentences

Birth to One YearPlay

Solitary playColorful mobiles, musical toysTeething toysPlastic blocks, rattlesNon-breakable mirror (6-12 months)

SafetyRear facing car seat for 1 year

Longer if weighs less than 20 poundsBottle mouth caries syndrome

Birth to One YearHospitalization

Separation anxietyFear of injury and painLoss of control

Nursing InterventionsSwaddleUse FACE pain scalePacifierProvide stimulation, contrasting

colors/textures

One to Three YearsErikson

Autonomy vs Shame and DoubtPiaget

Preoperational (2-4 years)Relates to the world only through their own

perspective Bowlby

Complex emotions (guilt, embarrassment, pride)Kohlberg

Begins to know right from wrong by punishments and rewards

One to Three YearsPhysical

Anterior fontanel closes between 12-18 months

Myelin still being developedWalks unassisted by 15 months, but bodies

are top-heavy, crawls up stairsCan run and walk backwards by 2 yearsAt age 2, average weight is 27 pounds and

average height is 34 inchesLordosis (pot belly)Bowel control develops before bladder control

Good bowel and bladder control (during the day) by age 3

One to Three YearsPlay

Parallel play (1-2 years) Cooperative play (3 years)Short attention spanExplores body parts of self and othersPush-pull toys, blocks, sand, finger paints,

bubbles, balls, crayons, trucks and dolls, containers, play dough, toy telephones, cloth books, wooden puzzles

SafetyCurious about the world (dangling cords, stove

burners, windows, stairs, unlocked cars/containers, water, medicine/poisons

Forward facing car seat until 40 lbs

One to Three YearsRecognizes self in mirror by 15 monthsBy age 3, speaks up to 10 word

sentences, vocabulary up to 300 words“No” and “Why”Picky eaters, needs high protein

One to Three YearsHospitalization

Separation anxiety (try and get parents to stay)Temper tantrumsRefusal to comply with normal routines

RegressionFear of pain and injury

Nursing InterventionsDo not punish regressive behaviorExplain procedures in simple terms

Use puppets and dollsLeave special objects in the crib

Preschool (3-5 Years)

EriksonInitiative vs Guilt (try new things, handle failure)

PiagetPreoperational Thinking

Can’t see others’ perspectivesKohlberg

Preconventional (4-7 years old)Decisions based on desire to please others

and avoid punishment

Preschool 3-5 years

A mother of a 3-year-old tells the nurse that the child is constantly rebelling and having temper tantrums. The appropriate instruction to the mother is to:

1. Punish the child every time the child says “no,” to change the behavior

2. Allow the behavior, because this is normal at this age period

3. Set limits on the child’s behavior4. Ignore the child when this behavior occurs.

Preschool 3-5 years

A mother of a 3-year-old tells the nurse that the child is constantly rebelling and having temper tantrums. The appropriate instruction to the mother is to:

1.Punish the child every time the child says “no,” to change the behavior.

2.Allow the behavior, because this is normal at this age period.

3.Set limits on the child’s behavior.4.Ignore the child when this behavior occurs.

Preschool 3-5 yearsPhysical

Gains 5 lbs and 3 inches per yearAverage 43 inches and 32 lbs at age 5

12 hours of sleep/day (security object)Primary/deciduous teeth in- dental health important

Motor skills refined Age 3- rides tricycle, copies circleAge 4- Throws ball overhand, catches ball,

copies a squareAge 5- Jumps rope, balances on one foot, ties

shoes, uses scissors

Preschool Age 3-5Good bowel/bladder control- occasional

accidentsNutrition

1800 cal/dayVerbal

Age 3- 3-4 word sentences, Age 5- 6 word or longer sentences

Vocabulary 900 words at age 3, 2100 words at 5Play

Cooperative and associative- Not necessarily organized play. No gender preferenceUnderstands sharingFine motor- puzzles, crayons, paintsOutdoor activity, Dress-up

Preschool Age 3-5

SafetyMagical thinking: Cartoons real, flying

possibleAble to learn simple safety practices

Fire safety, 911, Name and addressStranger Danger

Booster seat until 8 years or 60 lbs

Preschool Age 3-5Hospitalization

Separation anxietyLess severe and less obvious, but when

stress increases anxiety will worsenMay displace feelings onto othersWithdrawn, imagines things worse, thinks it’s their fault

Loss of newly learned skills, regression, wants to keep routines

Uncooperative with meds, wants to do own ADL’s

Preschool, Age 3 to 5Nursing Interventions

Allow expression of fear, anger and accept regression

Allow mobility, encourage play (diversion) with others

Explain procedures simplyAllow underpants

Preschool, Age 3 to 5

Which of the following developmental tasks should be achieved during the preschool years?

1. Sitting up alone2. Dressing independently3. Following several directions at once4. Comprehending satire

Preschool, Age 3 to 5

Which of the following developmental tasks should be achieved during the preschool years?

1.Sitting up alone2.Dressing independently3.Following several directions at once4.Comprehending satire

School Age (6-12 years)Erikson

Industry vs InferiorityNeeds to master tasks and gain competence

PiagetConcrete Operations (7-11 years)

Inductive Reasoning- beginning logicTakes an incident and generalizes problem

solving

KohlbergConventional (7-11 years)

Increasing awareness of others feelingsConformity

School Age 6-12Physical

2 inches per year, 5 lbs per year (girls growing faster)Average height- 59 inches at age 12Average weight- 88 lbs at age 12

First secondary teeth around age 6 (dental important- soft bristles)

Sleeps 10-12 hours per nightFood pyramid- 1800-2200 cal/dayMotor skills refined- increasing strength and

endurance

School Age 6-12Play

Cooperative and competitiveRules and rituals importantSecret clubs, peer group activities

(scouts)Team sports

Drawing, collecting, dolls, pets, board games, radio/TV, reading, video/computer games

School Age 6-12Hospitalization

Better coping with separationConcerned about privacyShould be involved in plan of careFear of mutilation

Nursing InterventionsAccept regressionProtect privacyAllow socialization (talking on phone)Allow to make choicesExplain procedures- can understand

complexUse diagrams or outlines

School

School Age 6-12 Safety

Less fearTools, guns, bikes, skateboards, fire

Teach Traffic safetyStranger danger, drugs/alcohol, sexual

predatorsFire drills

Car lap belt, shoulder belt used if not crossing over face/neck

School Age 6-12

An 8 year old boy with a fractured femur is hospitalized in a two-bed room. With which of the following roommates should the boy share a room?

1. A 14 year old boy with colitis2. A 9 year old boy with an appendectomy3. A 10 year old girl with cancer4. A 6 year old girl with asthma

School Age 6-12

An 8 year old boy with a fractured femur is hospitalized in a two-bed room. With which of the following roommates should the boy share a room?

1.A 14 year old boy with colitis2.A 9 year old boy with an appendectomy3.A 10 year old girl with cancer4.A 6 year old girl with asthma

AdolescenceErikson: Identity vs Role confusion (12-

20)Develops sense of self apart from others

PiagetFormal Operations

Deductive reasoning- from generalizations to specificsConsiders alternative outcomesDeals with contradictions in the worldDraws logical conclusions

Adolescence

PhysicalWeight gain- 15-60lbsPubertySebaceous and sweat glands active2nd fastest growth period- growth spurtsNutrition- high calories- Calcium, zinc,

iron, folic acid, and protein importantBone formation complete at 17 for

female and 19-21 for male8 hours of sleep

AdolescencePlay

AthleticsCompetition and strict rulesSports, video/computer games, movies,

reading, parties, dancing, hobbies, experimenting (especially with body image)

Friends- IMPORTANTSafety

Risk takersDrugs, alcohol, smoking, seat belts, water

safety, STD’s, date rape

AdolescenceHospitalization

Coping mechanisms similar to adults- help identify positive ones

Seek help, then reject itBody image important- mutilationSeparation from peers and friends

Friends going on with their livesPsychosomatic complaints

Adolescence

Nursing InterventionsExplain procedures using body

diagramsRoom with peersPrivacy- especially during ADL’sTelephoneEncourage independence (wear own

clothes)- accept regressionAllow favorite foods

Adolescence Which of the following interventions are

appropriate for an adolescent male with a broken femur?

1. Suggest that his parents room in2. Provide a television and DVDs for him to

watch3. Restrict visitors4. Encourage him to get enough rest5. Allow him to perform his own morning

care

AdolescenceWhich of the following interventions are

appropriate for an adolescent male with a broken femur?

1.Suggest that his parents room in2.Provide a television and DVDs for him to

watch3.Restrict visitors4.Encourage him to get enough rest5.Allow him to perform his own morning

care

Young AdulthoodErikson (20-35)

Intimacy vs. IsolationEstablishing intimate bonds- love and

friendship

KohlbergFormal operations

Young AdulthoodGrowth completeIgnore physical symptoms- postpone

seeking health careSeparating from familyLearning to adapt to new situationsMaking life decisionsLifestyle habits

Developing modifiable risk factorsRisk for STD’s

Middle AdulthoodErikson (35-65 years)

Generativity vs. StagnationFulfilling life’s goals that involve

family, career and societyAbility to care for others Unsuccessful: self absorption

Middle Adulthood Mid 30’s to Mid 60’s

Reproductive changes Physiological changes have an impact on self concept and body image

Interested in learning new skillsChange in Career?

Psychosocial changesKids moving awayUnexpected death of friends/familyRelationship redefining after kids goneGrandparenting

Middle Adult (40 to 60 years)

When performing a psychosocial assessment, a nurse would expect a health middle adult to:

1. Develop an acceptance of diminished strength and increased dependence on others.

2. Feel frustrated that time is too short for attempting to start another life.

3. Accept one’s life a s creative and productive.4. Find someone with whom to share one’s life.

Middle Adult (40 to 60 years)

When performing a psychosocial assessment, a nurse would expect a health middle adult to:

1.Develop an acceptance of diminished strength and increased dependence on others.

2.Feel frustrated that time is too short for attempting to start another life.

3.Accept one’s life a s creative and productive.4.Find someone with whom to share one’s life.

Late AdulthoodErikson (65 years-death)

Integrity vs. despairLooking back at life and accepting its

meaningSense of integrity and fulfillmentUnsuccessful: Dissatisfaction with life

Late Adulthood Delirium, as opposed to dementia, is

typically:

1. Acute.2. Chronic.3. Progressive in nature.4. Caused by unknown factors.

Late AdulthoodDelirium, as opposed to dementia, is

typically:

1.Acute.2.Chronic.3.Progressive in nature.4.Caused by unknown factors.

Late Adulthood Presbyopia is common visual age

related change that results in a decline:

1. Far vision2. Near vision3. Central vision4. Peripheral vision

Late AdulthoodPresbyopia is common visual age

related change that results in a decline:

1.Far vision2.Near vision3.Central vision4.Peripheral vision