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"promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing."

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What is expected from maternal and child health nurses?

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What is expected from maternal and child health nurses?

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1. give preconceptual health care
2. care of women during the three trimesters and the puerperium
3. care of infants during the perinatal period
4. care of children from brith through adolescence
5. care in settings as varied like birthing room or home

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- Family is the basic part of society.
- Families can come in various forms and sizes and racial, ethnic, cultural ,and socioeconomic diversity.
- Children and grow both individually and as part of a family.

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"from womb to tomb"

- health promotion: preparing clients to become aware of good health through teaching and role modeling
- health maintenance: intervening to maintain health when there are risks of illnesses
- health restoration: diagnosing and treating illnesses using interventions that will help client return to wellness quickly
- health rehabilitation: stopping further complications from an illness; bringing an ill client back to their most optimal state of wellness or helping a client accept the inevitable death

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MODULE 1 LESSON 1: GROWTH AND DEVELOPMENT

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MODULE 1 LESSON 1: GROWTH AND DEVELOPMENT

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- Growth and development can be independent and interrelated.
- Growth = physical change
- increase in physical size or quantitative change, increase in weight
- growth rates vary on different stages
- rapid (peak) - infancy, adolescence
- slows - childhood
- minimal physical growth - adult

- General Growth
- Respiratory, Digestive, Renal, Musculoskeletal, and Circulatory Tissue peak time is during childhood
- Neurologic tissue peak time is first 2 years
- Lymphoid Tissue peak time is during infancy and childhood
- Reproductive Organs peak time is puberty

- Development increases ability to function
- synonym: maturation (aging and adapting to new situations)
- Behavior is the most thorough indicator of one's developmental status

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Factors Influencing Growth and Development 

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Factors Influencing Growth and Development 

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- Genetic Inheritance
- examples: race, intelligence, nationality, temperament, sex
- Environmental Influences
- example: parent-child relationship, ordinal position in the family, health, nutrition

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1. constant process that starts from conception and ends at death
2. proceeds in an orderly manner (sequences are predictable)
3. different children passes through the stages, but at different rates (principle of asynchronism)
4. every body system does not grow at the same rate
5. development is head to toe (cephalocaudal)
6. development starts from proximal to distal parts of the body
7. development starts from gross to refined skills
8. there are best times for initiating experiences or learning
9. neonatal reflexes have to be gone before development can continue
10. a big amount of skill and behavior is learned through practicing

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- Developmental Theories give maps that explain human development.
- Accomplishments happen at one stage and affect the following stages afterwards.
- Psychosocial Development (Erickson)

- Psychosexual Development (Freud)
- Trust vs. Mistrust (Infancy): satisfying needs on time leads to security
- Autonomy vs. Shame and Doubt (Toddler age 1 to 3): offering choices leads to decision making
- Initiative vs. Guilt (age 3 to 6): exploring and imagination leads to fine motor development
- Industry vs. Inferiority (age 6 to 12): giving workload in manageable levels leads to doing things well
- Identity vs. Role Confusion (age 12 to 20): self discovery leads to acceptance of self and new body image and that leads to seeking freedom
- Intimacy vs. Isolation (age 20-30): searching for lifetime partner or career focus
- Generativity vs. Stagnation (age 30-65)
- Ego Integrity vs. Despair (65-death)

- Psychosexual Development (Freud)
- Oral Stage (birth to age 1): suck leads to enjoyment and release of tension
- Anal Stage (age 1 to 3): ready for toilet training
- Phallic Stage (age 3 to 6): interested in their genitalia and various sensations; learns difference between genders
- Latency Period (age 6 to 12): school phobia
- Genitalia Stage (age 12 and older): sexual maturity leads to learning to establish satisfying relationships with opposite sex; sexual awakening leads to engaging in sexual intercourse

- Moral Development (Kohlberg)
- Preconventional Level of Morality (age 2 to 7): punishment and obedient orientation and instrumental relativist Orientation
- Conventional Level of Morality (age 7 to 12): Interpersonal Concordance Orientation, Societal Focus, and Law and Order Orientation
- Postconventional Autonomous Level of Morality (age 12 and older): social contract legalistic orientation, universal focus, universal ethical principle orientation

- Cognitive Development (Piaget)
- Sensorimotor (brith to age 2):from reflex activity, through simple repetitive behaviors to imitative behaviors
- Preoperational (age 2 to 7): magical thinking time and increased capability to use language and symbols
- Concrete Operational (age 7 to 11): thought process becomes more logical and reasonable
- Formal Operational Thought (age 11 to 20): adaptability and flexibility, can make logical conclusions from observations

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MODULE 1 LESSON 2: THE FAMILY WITH AN INFANT

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MODULE 1 LESSON 2: THE FAMILY WITH AN INFANT

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Weight
2x     4-6 months
3x     1 year

Weight Gain
1st 6 months     2 lbs/month
2nd 6 months    1 lb/month

Average
1 y/o male     10 kg
1 y/o female    9.5 kg

Height
- increases by 50% during the first year
- grows from the average birth length of 20 in. to about 30 in (50.8 cm to 76.2 cm)

Head Circumference
- increases very quickly and reflects brain growth
- Brain reaches 2/3 of adult size at the end of the first year

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dentition starts at 6 months

2 lower incisors

milk/deciduous teeth (20)

complete by 2-3 yrs old

sheds off by 6 to 7 yrs old

replaced by 32 permanent teeth

formula

age in month - 6 = answer

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Gross Motor

ability to accomplish big body movements

ventral suspension position

newborn allows the head to hang down with little effort or control

1 month old child can lift the head momentarily

3 month child can maintain lifting the head

Landau Reflex

3 month olds' head, legs, and spine extend when held at ventral suspension

hips, knees, and elbows flex when head is depressed

Parachute Reflex

6-9 month olds' arms extend like they are to protect themselves from falling when the infants are suddenly lowered toward a table from ventral suspensions

Gross Motor Development

Prone Position

Newborns can turn their heads to move it out of position where breathing is impaired when they are lying on their stomach

Neck Righting Reflex

when 4 month olds turn their head to the side, shoulder, trunk, and pelvis turn in that same direction

Sitting Position

When a 1 month old is placed on his/her back and is pulled to a sitting position, they have gross head lag in the first days of life

6 month olds can sit momentarily with support

Standing Position

The infant's knees and hips flex rather than support more than momentary weight in a standing position

fades away at 3 months

Fine Motor

measured by watching or testing prehensile ability (ability to coordinate hand movements)

Fine Motor Development

1 month olds continue to have a strong grasp reflex

2 month olds will hold an object for a few minutes before dropping it as the grasp reflex starts to fade

4 month olds begin to have thumb opposition which is the ability to bring the thumb and fingers together

10 month olds have pincer grasp which enable the child to pick up small objects

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Universal language of child: play

Solitary play

Enjoys mobile/ teether/ music box/ rattle

Important: safety

Stranger anxiety begins at 6-7 months, peak at 8 months, and diminishes 9 months

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Aspiration

Leading cause of death in infants

Parents either underestimate or overestimate the child's ability

Round, cylindrical objects are more dangerous

Things within the child's reach must be safe to put into the mouth

Toys should not have removable parts

examples: clothings with decorative buttons or popcorn or peanuts for children under 5 yrs old

Falls

Second major cause of infant accidents

Don't leave the child unattended on a raised surface

Teach parents to be prepared for their infant to roll over by 2 months of age

Car Safety

Always use car seats through toddlerhood

Infants up to 20 lbs should be placed in rear facing seats

Bathing and Swimming

Don't leave an infant unattended in a tub, even when propped up out of the water

Childproofing

Move furniture in front of electrical sockets or buy protective caps for the outlets

Check sources of lead paint on painted cribs and rails

Check stairways for safety

Check table tops for pins or sharp objects that could be swallowed

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A baby who is overweight during the first year of life is more likely to become an obese child

Introducing Solid Food

A normal term infant can thrive on breast milk or formula milk without the addition of any solid food until 6 months.

Chewing movements do not begin until 7 to 9 months thus food that require chewing are not given before this age.

Extrusion Reflex

The infant automatically thrusts with his/her tongue any object/food placed on the its anterior 2/3 of the tongue.

Life saving reflex that prevents an infant from swallowing or aspirating foreign objects.

This reflex fades at 3-4 months

Complementary Feeding

Offer new food one at a time to make out possible food allergies

Wait 5-7 days before introducing new things

Introduce small amounts of new food: 1 or 2 teaspoonfuls at a time

Newborn: 30 ml (2 tablespoons)

1 year: 240 ml (1 cup)

Quantities of Types of Food
Cereal

First food given to infants

Not needed to ass sugar in the cereal

Rich in iron

Children should preferably be fed cereal until age 3 or 4 years

Vegetable and Fruit

Vegetable have HIGH iron content, they are usually the second food added to the diet

Fruit is usually offered 1 month after beginning vegetable (approx 8 months)

Meat and Eggs

Meat is presented at 9 months and egg yolks is introduced at 10 months

Egg yolk alone should be given first

Protein of egg while could cause allergies or may be difficult to digest

Cook eggs well due to danger of salmonella

Weaning

Infants are capable of approximating their lips to a cup effectively and controlling the flow at 9 months

The sucking reflex begins to diminish in intensity between ages 6 months and 9 months making this the time to consider weaning

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Infant period is from 1-12 months

Children double their weight at 4-6 months and triple it at 1 year

Infants get their first tooth at about 6 months

By 12 months, they have 6-8 teeth.

Important gross motor milestones during the infant year are:

2: lifting the chest off at bed

6-8: sitting

9: creeping

10-11: cruising

12: walking

Important fine motor accomplishments during the first year are:

7: ability to pass an object from one hand to the other

10: pincer grasp

Important milestones of language development during the first year are:

2: differentiating a cry

5-6: simple vowel sounds

12: saying 2 words besides mama and dada

The more the infants are spoken to, the easier it is for them to learn a language

Giving infants the right toys to play with helps with development

Important milestones of vision development during the first year are:

3: follows moving object past midline

focus securely without eyes crossing

According to Erikson, the development task of an ifnat is Trust vs Mistrust

Nurses play a key role in teaching parents about these problems and measures to deal with them

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MODULE 2 LESSON 3: FAMILY WITH A TODDLER

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MODULE 2 LESSON 3: FAMILY WITH A TODDLER

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15 Months
Fine Motor

Places small pellets into small bottles

Scribbles on their own with a pencil or crayon

Holds spoon well but could still turn it upside down on the way to mouth

Gross Motor

Walks alone well

Seat themselves in chair

Can creep upstairs

Play

Can stack 2 blocks

Enjoys being read to

Drops toys for adult to get for them (sense of permanence)

Language

4-6 words

18 Months
Fine Motor

Doesn't rotate the spoon anymore to bring it to mouth

Gross Motor

Can run and jump in place

Can walk up and down the stairs while holding onto a railing

Usually places both feet on one step before advancing

Language

7-20 words

Uses jargon

Can name 1 body part

Play

Copies household chores

Starts parallel play

24 Months
Fine Motor

Can open doors by turning doorknobs

Can unscrew lids

Gross Motor

Can walk upstairs alone

Still using both feet on same step at once

Language

50 words

2-words sentences with noun-pronoun and verb

Play

Parallel play

30 Months
Fine Motor

Can make simple lines or strokes for crosses with pencil

Gross Motor

Can jump down from chairs

Language

Verbal language increases steadily

Knows full name

Can name a color and hold up fingers to show age

Play

Spend times playing house

Copying parents' actions

Active or "rough-housing"

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Quick brain growth, bone length and muscle growth increase

Uses fingers to pick up smaller objects

Walks, runs, kicks, climbs, rides tricycles, and drinks from up

4x birth weight

Bladder control during the day, occasionally at night

Turns pages in book, and by 3 years old draws stick people

Freud - anal stage, toilet training is a big focus

Erikson - autonomy versus shame and doubt

Havinghurst - tasks of learning to control elimination process, learn sex differences, form concepts, learn language, and distinguish right from wrong

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Stage 5 (btw 12 and 18 months)

Tertiary Circular Reaction Stage

"little scientist"

experiments through trial and error methods

Stage 6 (btw 18 and 24 months)

Toddlers are capable to try out different actions mentally instead of having to actually perform them - this is the beginning of problem solving or symbolic thought

Deferred Imitation

remembers an action and imitates it later

Preoperational Thought

Children deal much more constructively with symbols

Assimilation

change the situation (or how they see it) to fit their thoughts

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Negativism

Ritualistic behavior

Slowness in carrying out requests/ambivalence

Temper tantrums

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Accidental ingestions (poisoning) are the type of accident that happens most frequently

Potential Accidents

Automative accident

Burns

Falls

Poisoning drowning

Suffocation and choking

Electric shock

Animal bites

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Assessment

Taking a careful health history

Ability to carry out ADL

Careful observation

child-parent relationship

Parents = BEST source of info

Nursing Diagnosis

Focus on the parent's eagerness to learn more about the parameters of normal growth and development or issues of safety or care

Outcome Identification and Planning

Focus mainly on family education and anticipatory guidance

Create realistic goals and outcomes so they can meet the quickly changing needs of their toddler and learn to cope with usual toddler behavior

Implementation

Teach parents a good rule is to think of a toddler as a visitor from a foreign land who wants to be part of everything the family is doing but doesn't know the customs or language

Teach parents not only how to approach a current problem but also how to learn adequate methods for resolving similar situations that are sure to come up in the future

Health visits provide opportunities to help parents learn healthy coping techniques

Demonstrating good communication skills with toddlers can serve as a model for healthy communication behavior with them

Outcome Evaluation

Children change so much and learn so many new skills during this time that their abilities and associated parental concerns can change from day to day

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MODULE 1 LESSON 4: FAMILY WITH A PRESCHOOLER

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MODULE 1 LESSON 4: FAMILY WITH A PRESCHOOLER

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An important period of growth for parents

setting limits

physical growth slows considerably during this period, personality, and cognitive growth continue at a very fast rate

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Physiological Development of Preschooler 

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Physiological Development of Preschooler 

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Head is near to adult size by 6 years old

Pulse rate lessens to about 85 bpm; blood pressure holds at about 100/60 mm Hg

Bladder is easily palpable above the symphysis pubis

Voiding is frequent enough (9-10x a day) that play must be interrupted

Motor abilities include jumping, skipping, throwing a ball, printing letters and numbers

Full set of 20 deciduous teeth

Weight gain is slight

Average child gains only about 4.5 (2 kg) a year

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3 Years Old
Fine Motor

Undresses themselves

Stacks tower of blocks

Draws a cross

Gross Motor

Runs

Alternates feet on stairs

Rides tricycle

Stands on one foot

Language

Vocabulary of 900 words

"How" and "why" questions

Play

Ables to take turns; very imaginative

4 Years Old
Fine Motor

Can do simple buttons

Gross Motor

Constantly moving

Jumps, skips

Language

Vocabulary of 1500 words

Play

Pretend

Imaginative, creative play

Make-believe, fantasy play

5 Years Old
Fine Motor

Draws a 6-part man

Can tie shoe laces

Gross Motor

Throws overhand

Language

Vocabulary of 2100 words

Play

Likes games with numbers or letters

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Developmental Task: Initiative Versus Guilt

If children are criticized or punished for attempts at initiative, they develop a sense of guilt for wanting to try new activities or have new experiences

Need exposure to a wide variety of experienced and play materials so they can learn as much about the world as possible

Ready to reach outside their homes for new experiences, such as a trip to the zoo or an amusement park

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Cardiovascular: heart rate decreases to 110-120 bpm by the end of the first year

Respiratory: respiration rate decreases to 20-30 breaths per minute

Immune System: function by 2 months of age and able to create immunoglobulin G and M by 1 year of age

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Significant others now include grandparents, siblings, and preschool teachers (parents stay central)

Regular interaction with same-age children is needed to further develop social skills

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Running and jumping in open space

Creative play

Art activities

Trips to museum or shopping mall

Swimming and other individual sports to encourage gross motor development

Puzzles and toys to aid fine motor development

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Urge parents to provide play materials that encourage creative play

Finger paints

Mud to make into pies

Clay to make into pretend cookies

Imitation

Need free rein to imitate roles of people around them

Role playing should be fun and doesn't have to be accurate

Imitate those activities best that they see their parents performing at home

Fantasy

Begin to make this differentiation

Become so engrossed in a fantasy role, however, they become scared they have lost their own identity or have become "stuck" in their fantasies

Both supporting the fantasy and yet reassuring a child they are still themselves

Let children know they are still recognizable

Oedipus and Electra Complexes

Each child competes with the same-sex parent for the love and attention of the other parent

Parents may need assistance in handling feelings of jealousy and anger if a child is vocal in expressing feelings toward a parent

Gender Roles

Need exposure to an adult of the opposite gender so they can become familiar with opposite gender roles

Encourage single parents to plan opportunities for their children to spend some time with adults other than themselves

Socialization

Play with other children their age much more

sensitive and critical time for socialization

Elementary Rule: an odd number of children will have difficulty playing well together pertains to children at age 5: 2 or 4 will play, but 3 or 5 will quarrel

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3 years, cognitive development according to Piaget is still preoperational

Enter a 2nd phase known as intuitional thought (intuitive thought phrase)

Centering

Lack the insight to view themselves as others see them or put themselves in another's place

An important point to remember when explaining procedures to preschoolers

Not aware of the property of conservation yet

Implications: not able to comprehend that a procedure done two separate way is the same procedure

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Determine right from wrong based

On their parents' rules

Have little understanding of the rationale for these rules or even whether the rules are consistent

Depend on parents to supply rules them, thus, with difficulty seeing that the rules they know may also apply to a new situation

Begin to have en elemental concept of God if they have been provided some form of religious training

Belief in an outside force aids int he development of conscience

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Mortality of children during the preschool years is low

Major cause of death being automobile accidents, followed by poisoning and falls

Minor illnesses, such as colds, ear infections, and flu symptoms, is also high

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Fear of the dark

heightened by a chid's vivid imagination

Night waking from nightmares or night terrors reaches its peak
• Night light

reassurance they are safe, that whatever was chasing them was a dream and is not in their room

source of the stress needs to be investigated

Fear of Mutilation

revealed by the intense reaction of a preschooler to even a simple injury such as falling and scraping a knee or having a needle inserted for an immunization

need good explanations of the limits of health care procedures

fear of castration

Fear of Separation or Abandonment

intensifies because their keen imagination allows them to believe they have been deserted when they are safe

Relating time and space to something a child knows, such as meals, television shows, or a friend’s house, is

most effective

“Mommy will pick you up from preschool after you have had your snack”

A hospital admission or going to a new school often brings a child’s fear of separation

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Telling Tall Tales

Caution parents not to encourage the kind of storytelling, but instead help the child separate fact from fiction

Imaginary Friends

separate fact from fantasy about their imaginary friend

Difficulty Sharing

Assure parents that sharing is a difficult concept to grasp and that, as with most skills, preschoolers need practice to understand and learn it

Defining limits and exposing children to these three categories (mine, yours, ours) helps them determine which objects belong to which category

Regression

in relation to stress, revert to behavior they previously outgrew, such as thumbsucking, negativism, loss of bladder control, and inability to separate from their parents

new baby in the family

a new school experience

seeing frightening and graphic television news

stress in the home from financial or other problems, marital difficulties

separation caused by hospitalization

removing the stress is the best way to help

a child discontinue this behavior

Thumb-sucking or other manifestations of stress are best ignored

Sibling Rivalry

A firstborn child is rarely allowed the privileges of a second child. The parents were untried, unsure of how far they should let a child venture or what level of responsibility a child could accept when the child was younger, or the firstborn serves as the “trial run” for all children who come after

feel secure and promote self-esteem, by supplying them with a private drawer or box for their things that parents or other children do not touch can be helpful

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Thumbsucking

Food likes and dislikes

Enuresis

Bed-wetting

Encopresis

fecal incontinence or soiling

Bruxism or grinding the teeth at night

(usually during sleep), is a habit of many young children

way of “letting go” , to release tension and allow themselves to fall asleep

identifying and relieving the source of anxiety is essential for treatment

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MODULE 1 LESSON 5: CARE OF A FAMILY WITH A SCHOOL-AGE CHILD

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MODULE 1 LESSON 5: CARE OF A FAMILY WITH A SCHOOL-AGE CHILD

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School age

or middle childhood

refers to the stage of a child’s life from ages

6 to 12 years

The school-age years can be a spectacular

journey filled with joys and successes as the child

continues to grow and mature

time of slow physical growth, cognitive growth

and development continue to proceed at rapid rates

always assess children as individuals to understand the
particular developmental
needs of each child based on what
developmental status has been achieved,
not on what stage you think the child
should have reached

Children of school age may be
more influenced by the attitudes of
their friends

the first time children begin to make truly
independent judgments

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annual average weight gain is approximately 3 to 5 lb (1.3 to 2.2 kg); the increase in height is 1 to 2 in (2.5 to 5 cm)

posture becomes more erect

slims down and becomes more agile and graceful

10 years of age

brain growth is complete, so fine motor coordination becomes refined

adult vision level is achieved

If the eruption of permanent teeth and growth of the jaw do not correlate with
final head growth

malocclusion (a deviation from the normal) with teeth malalignment

immunoglobulins IgG and IgA reach adult levels and lymphatic tissue continues to
grow up until about age 9

Appendicitis

Frontal sinuses develop at about 6 years

sinus headache

pulse rate decreases to 70 to 80 beats per minute; blood pressure rises to about 112/60 mm Hg

Maturation of the respiratory system leads to increased oxygen–carbon dioxide
exchange

increases exertion ability and stamina

Scoliosis may become apparent for the first time in late childhood

over age 8 should be screened

Girls tend to develop slightly faster than boys; although boys are, on average, taller and heavier than girls until the adolescent growth spurt

The pubertal growth spurt begins in girls at about age 10 and in boys at about
age 12

Feet are the first part of the body to experience a growth spurt

Increased foot size is followed by a
rapid increase in leg length and then
trunk growth

leg growth increases more dramatically
than trunk growth in boys although girls
have a greater growth spurt in hip width,
boys exceed girls in other areas of bone
growth

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in girls usually occurs between 12 and 18 years; in boys, between 14 and 20 years

gonadal hormone levels increase and cause the sexual organs to mature

onset of puberty varies widely, between 10 and 14 years of age

Sexual and Physical Concerns

time for parents to discuss with children the physical changes that will occur and the sexual responsibility these changes dictate

time to reinforce previous teaching with children that their body is their own, to be used only in the way they choose

Concerns of Girls

Prepubertal girls are usually taller, by about 2 in (5 cm) or more than preadolescent boys

girl notices the change in her pelvic contour when she tries on a skirt or dress from the year before and realizes her hips are becoming broader

Crash diet

Girls are usually conscious of breast development and whether they are overdeveloped or underdeveloped

Breast self-examination and sexual responsibility

Supernumerary (additional) nipples may darken or increase in size at puberty

Early preparation for menstruation is important for future childbearing and for
the girl’s concept of herself as a woman

good hygiene and reassurance they can bathe, shower, and swim during their periods

use either sanitary napkins or tampons take precautions to avoid toxic shock syndrome

first menstruation, called menarche, usually starts around age 12 but can occur as early as age 9 and still be considered normal

The menstrual cycle may be irregular at first

consistent irregularities in her period should be assessed for
malnourishment and obesity

Emotions

if irregularity continues beyond the first year, a careful history of the
girl’s school, social, nutrition, level of exercise, and home
adjustment should be taken

vaginal secretions will begin to be present

Explain that any secretions that cause vulvar irritation should be
evaluated

Concern of Boys

aware of increasing genital size

testicular development precedes penis growth

be informed that hypertrophy of breast tissue

(gynecomastia) can occur in prepuberty (most often in stocky or obese boys)

although they have pubic hair, they cannot yet grow a beard or do not have chest hair

seminal fluid is produced, boys begin to notice ejaculation during sleep, termed nocturnal emissions

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Physiological Development of School-Age Child (6 to 12 years)

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Physiological Development of School-Age Child (6 to 12 years)

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Brain reaches 90% to 95% of adult size, nervous system almost mature by age 12

Motor abilities progress to writing in script and in sentences by age 12

Sexual organs grow but are dormant until late in this period

All permanent teeth present except for 2nd and 3rd molars by age 12

The average child gains 28 teeth between 6 and 12 years of age: the central and lateral incisors; first, second, and third cuspids; and first and second molars

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Attending school marks an acceleration in the separation of the child from his parents

introduces the child to a new set of authority figures (teachers, school administrators) and strengthens the concept of peer relationships

Erikson’s stage of industry versus inferiority

child wants to work and produce, accomplishing and achieving tasks

focus on learning useful skills, self-identity emerges

if too much is expected of him, or if he feels unable to measure up to set standards, the negative attributes of inadequacy and inferiority may prevail

Language development and socialization

child has an efficient vocabulary and begins to correct previous mistakes in usage

begins to understand the double meanings of words and becomes proficient at giving others directions without using physical signals

Six-year-olds talk in full sentences, using language easily and with meaning

define objects by their use: a key is to unlock a door; a fork is to eat with

7-year-olds can tell the time in hours, but they may have trouble with concepts such as “half past” and “quarter to,” especially with the prevalence of digital clocks and watches

know the months of the year and can name the months in which holidays fall

can add and subtract and make simple change

age 9

discover “dirty” jokes

Like to tell them to friends or try to understand those told by
adults

use swear words to express anger or just to show other
children they are growing up

have a short period of intense fascination with “bathroom
language”

12 years of age

a sense of humor is apparent

can carry on an adult conversation, although stories are
limited because of their lack of experience

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peers are increasingly significant to the child

Same-sex cliques are established

competition becomes more common

bragging over accomplishments

child may be overly concerned with peer rules

more sensitive to criticism and ridicule

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continues to be rough at age 6

when children discover reading as an enjoyable activity that opens doors to other worlds, they can begin to spend quiet time with books

Many children spend hours playing increasingly challenging video games, an activity that can either foster a healthy sense of competition or create isolation from others

7 years of age

decline in imaginative play

interest in collecting items such as baseball cards, dolls, rocks, or marbles

8 years of age

collections may become increasingly structured as
children develop skills for sorting and cataloging

10 years of age

children become very interested in rules and fairness in competitive play situations

Children also begin discovering the Internet and how other children out there are waiting to talk to them in chat rooms

Music and artistic expression

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School and learning are viewed as an exciting experience

require concentration, attendance, and complex auditory and visual processing

major developmental tasks at this time are achievement in school and acceptance by peers

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Cognitive Development of School-Age Child 

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Cognitive Development of School-Age Child 

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In Piaget’s concrete operational stage, organizing facts and problem-solving

Uses inductive reasoning to solve new problems

Thinks logically and develops concepts of measurement

Generalizes about people, places, and things

Develops classification systems, understands reversal of events

Has an awareness of other’s feelings

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Decentering

the ability to project oneself into other people’s situations and see the world from their viewpoint rather than focusing only on their own view

Accommodation

the ability to adapt thought processes to fit what is perceived such as understanding that there can be more than one reason for other people’s actions

Conservation

the ability to appreciate that a change in shape does not necessarily mean a change in size

Class Inclusion

the ability to understand that objects can belong to more than one classification

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ability to trust others and with a sense of respect for their own worth

can accomplish small tasks independently because they have gained a sense of autonomy

have practiced or mimicked adult roles and had the opportunity to explore at preschool or other social environments

should have learned to share, to have discovered that learning is fun and an adventure

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Kohlberg’s Conventional Level

child behaves according to socially acceptable norms because an authority figure tells him to do so

This obedience is compelled by the threat of punishment (external factors)

Ages 11 to 12

as the child begins to approach adolescence, school and parental authority is questioned and, occasionally, even challenged or opposed

importance of the peer group intensifies, and rough, bold, or even brazen behavior becomes increasingly common

peer group becomes the source of behavior standards and models

Parental guidance, love, and support are absolutely essential for the development of values during this time

child at this age needs the opportunity to make decisions within defined boundaries

those boundaries are set by responsible adults in the child’s life

Spiritual lessons should be taught in concrete terms during this stage

Repeated religious rituals, such as praying and attending church services, may comfort them

begin to learn about the rituals and meaning behind their religious practices, so the distinction between right and wrong becomes more important

Parent role modeling is also important

school-age children are rule-oriented; when they pray, they may expect their God to follow rules also (if you are good and pray for something, you should receive it)

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School Phobias

called school refusal or school avoidance

may be a sign of a separation anxiety

occur after a particular trauma, such as the death of a pet, illness within the family, or a move to a new school

fear of the school itself and what the child experiences there

Possible reasons for school phobias include:

being the target of a bully

anxiety about academic achievement

having problems adapting to the school structure

Stealing

simply wants items for himself

Stealing at the end of middle childhood is commonly a sign that something is lacking in that child’s life

Possible causes include a lack of:

financial means

attention from a parent or caregiver

sense of property rights

Parents should recognize the child’s property rights and offer some privacy in this regard, when possible

A child who knows that his own property is respected is more likely to understand the importance of respecting the property of others

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MODULE 1 LESSON 6: CARE OF FAMILY WITH ADOLESCENTS 

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MODULE 1 LESSON 6: CARE OF FAMILY WITH ADOLESCENTS 

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THE PERIOD BETWEEN 13 AND 18 OR 20 YEARS

TIME THAT SERVES AS A TRANSITION BETWEEN CHILDHOOD AND YOUNG ADULTHOOD

DEFINED NOT SO MUCH BY CHRONOLOGIC AGE BUT BY PHYSIOLOGIC, PSYCHOLOGICAL, AND SOCIOLOGIC CHANGES

DIVIDED INTO:

EARLY PERIOD (13 TO 14 YEARS)

MIDDLE PERIOD (15 TO 16 YEARS)

LATE PERIOD (17 TO 20 YEARS)

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ASSESSMENT

OBTAIN A HEALTH HISTORY SEPARATELY FROM PARENTS TO PROMOTE INDEPENDENCE AND RESPONSIBILITY FOR SELFCARE

BE AWARE THEY MAY BE VERY SELF-CONSCIOUS WITH PHYSICAL EXAM

NURSING DIAGNOSIS

HEALTH-SEEKING BEHAVIORS RELATED TO NORMAL GROWTH AND DEVELOPMENT

LOW SELF-ESTEEM RELATED TO FACIAL ACNE

ANXIETY RELATED TO CONCERNS ABOUT NORMAL GROWTH AND DEVELOPMENT

RISK FOR INJURY RELATED TO PEER PRESSURE TO USE ALCOHOL AND DRUGS

READINESS FOR ENHANCED PARENTING RELATED TO INCREASED KNOWLEDGE OF TEENAGE YEARS

OUTCOME IDENTIFICATION AND PLANNING

RESPECT THE FACT THEY HAVE A STRONG DESIRE TO EXERT INDEPENDENCE OR DO THINGS THEIR OWN WAY

INCLUDING THEM IN PLANNING IS ESSENTIAL SO THE PLAN WILL BE AGREEABLE AND ACCEPTED

ESTABLISHING A CONTRACT

ARE VERY PRESENT ORIENTED

TEACHING BY PEERS

IMPLEMENTATION

EVALUATE HOW AN INTERVENTION APPEARS FROM AN ADOLESCENT’S STANDPOINT BEFORE BEGINNING TEACHING

OUTCOME EVALUATION

CLIENT STATES SHE IS ABLE TO FEEL GOOD ABOUT HERSELF EVEN THOUGH SHE IS THE SHORTEST GIRL IN HER CLASS

CLIENT STATES HE HAS NOT CONSUMED ALCOHOL IN 2 WEEKS

PARENTS STATE THEY FEEL MORE CONFIDENT ABOUT THEIR ABILITY TO
PARENT AN ADOLESCENT.

CLIENT STATES SHE FEELS HIGH SELF-ESTEEM DESPITE PERSISTENT FACIAL ACNE

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Growth and Development of an Adolescent 

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Growth and Development of an Adolescent 

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GROW BOTH RAPIDLY AND MATURE DRAMATICALLY

RECOGNIZING THAT ADOLESCENTS MAY HAVE DIFFERING RESPONSIBILITIES AND LIFE EXPERIENCES BASED ON CULTURAL EXPECTATIONS CAN BE USEFUL WHEN MAKING AN ASSESSMENT

INCLUDE FACTORS SUCH AS OCCUPATIONAL HAZARDS OR THE EFFECTS OF JOB, FAMILY, AND FINANCIAL STRESS ON AN ADOLESCENT

READINESS FOR EARLY CHILDBEARING MAY ALSO BE IMPORTANT

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Apocrine sweat glands

Heart and lungs increase in size more slowly than the rest of the body

PR: 70 bpm

RR: 20 breaths per minute

BP: 120/70 mm Hg

Major milestone: onset of puberty at 9 to 12 years of age and cessation of body growth at 16-20 years of age

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Ages 11 and 14 years

Begins to menstruate

Begins to produce spermatozoa

Puberty is the time at which an individual first becomes capable of sexual reproduction

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Primary Sexual Characteristics

Body structures that make reproduction possible

Penis

Testes

Vagina

Ovaries

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Primary and Secondary Sex Characteristics

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Primary and Secondary Sex Characteristics

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Males

Primary sex characteristics

Growth of scrotum and testes

Secretion of hormones related to sperm production

Growth of penis

Secondary sex characteristics

Body and facial hair

More muscle mass

Greater height than females

Broadening shoulder

Females

Primary sex characteristics

Increase in size of vagina and uterus

Ovaries produce hormones to start the menstrual cycle

Secondary sex characteristics

Hips widen

Development of breasts

Distribution of fats to hips

Body gets curvier

Similarities

Pubic hair

Oily skin

Voice deepens

Acne

Increase in height

Increase in body odor

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Opportunity

Potential

Danger

Who am I?

Play or Recreation

Urge parents to encourage youngsters to play sports for their own health and well-being and the companionship involved

15-old children may spend a great deal of time in their room

work with others, accept responsibility, and spend money wisely

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Developmental Tasks: Identity versus Role Confusion

Establishing a value system or what kind of person they want to be

Accepting their changed body image

Becoming emancipated from their parents

Give adolescents more freedom, help parents continue to place some restrictions on adolescents behavior thus, helping adolescents accept the responsibility that must come with independence

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Health Promotion for an Adolescent and Family

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Health Promotion for an Adolescent and Family

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PROMOTING ADOLESCENT SAFETY

ACCIDENTS, MOST COMMONLY THOSE INVOLVING MOTOR VEHICLES, ARE THE LEADING CAUSE OF DEATH

MOTORCYCLES, MOTORBIKES, AND MOTOR SCOOTERS

EVERY SAFETY PRECAUTION AVAILABLE WHEN IN A MOTOR VEHICLE

DRIVERS AND RIDERS SHOULD WEAR SAFETY HELMETS TO PREVENT HEAD INJURY

LONG PANTS TO PREVENT LEG BURNS FROM EXHAUST PIPES

FULL BODY COVERING TO PREVENT ABRASIONS IN CASE OF AN ACCIDENT.

ADVISE ADOLESCENTS WHO CHOOSE THESE FORMS OF TRANSPORTATION TO BE AS FAMILIAR WITH SAFETY RULES AS AUTOMOBILE DRIVERS

THEY NEED TO WAIT TO DRIVE MOTORCYCLES OR SCOOTERS UNTIL THEY ARE EMOTIONALLY MATURE ENOUGH TO USE SOUND DRIVING JUDGMENT

DROWNING IS ANOTHER CHIEF ACCIDENT

TEACHING ALL CHILDREN TO SWIM IS NOT THE ONLY PREVENTIVE MEASURE, BECAUSE SOME DROWNINGS OCCUR WHEN GOOD SWIMMERS GO BEYOND THEIR CAPABILITIES
ON DARES OR IN HOPES OF IMPRESSING FRIENDS

TEACHING WATER SAFETY, SUCH AS NOT SWIMMING ALONE OR WHEN TIRED

HOMICIDE AND SUICIDE, RELATED TO THE EASY ACCESSIBILITY OF GUNS TO TEENAGERS

GANG VIOLENCE AND THE DESIRE TO PROTECT THEMSELVES

ACCIDENTAL GUNSHOT INJURIES

ATHLETIC INJURIES BECAUSE OF THE VIGOROUS LEVEL OF COMPETITION

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INCREASED NUMBER OF CALORIES

NECESSARY CARBOHYDRATES, VITAMINS, PROTEIN, AND MINERALS ARE ESSENTIAL

LARGE AMOUNTS OF IRON ARE NECESSARY

FEMALES REQUIRE A HIGH IRON INTAKE

INCREASED CALCIUM PLUS PHYSICAL EXERCISE IS NECESSARY FOR RAPID SKELETAL GROWTH AS WELL AS TO “STOCKPILE” CALCIUM TO PREVENT OSTEOPOROSIS LATER IN LIFE

ZINC IS NECESSARY FOR SEXUAL MATURATION AND FINAL BODY GROWTH

GOOD SOURCES OF IRON ARE MEAT AND GREEN VEGETABLES; CALCIUM IS ABUNDANT IN MILK AND MILK PRODUCTS; MEAT AND MILK ARE ALSO HIGH IN ZINC

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Promoting Nutritional Health with a Varied Diet 

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Promoting Nutritional Health with a Varied Diet 

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VEGETARIAN DIETS

VEGETABLES SHOULD BE CONSUME LARGE AMOUNTS

BE CERTAIN ALL ADOLESCENT VEGETARIANS ARE FOLLOWING A DIET AND NOT EATING ONLY FRUITS AND VEGETABLES AS A METHOD TO LOSE WEIGHT

GLYCOGEN LOADING

ATHLETES NEED MORE CARBOHYDRATE OR ENERGY THAN DO PEOPLE WHO DO NOT ENGAGE IN STRENUOUS ACTIVITY

GLYCOGEN LOADING IS A PROCEDURE USED TO ENSURE THERE IS ADEQUATE GLYCOGEN TO SUSTAIN ENERGY THROUGH AN ATHLETIC EVENT

THEY THEN SWITCH TO A DIET HIGH IN CARBOHYDRATE. WITH THE RENEWED CARBOHYDRATE INTAKE, MUSCLE GLYCOGEN IS STORED AT APPROXIMATELY TWICE THE USUAL LEVEL, READY TO SUPPLY TWICE THE GLUCOSE FOR SUSTAINED ENERGY

EATING A WELL-BALANCED DIET, ARE ALSO THE BEST RULES FOR ATHLETES, RATHER THAN DIETS THAT INTERFERE WITH CARBOHYDRATE, FLUID, OR FAT INTAKE

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Language Development

1. Cooing sounds

3. Squeals with pleasure

4. Talkative, cooing, babbling, gurgling and able to lol

5. Simple vowel sounds like goo-goo gah-gah

7. Can imitate simple vowel sounds like oh-oh ah-ah

9. Speaks a first word like da-da

12. Can say 2 words beside ma-ma and da-da
- Use those 2 words with meaning

Play

1. Interested in watching the mobile over the crib
- Spends time watching parent's face

3. Can handle small blocks or rattles

5. Handles plastic rings, keys, and squeeze toys

6. Enjoy teething rubber rings and bathtub toys

7. Likes objects for transferring

8. Enjoys toys with different textures

9. Needs space for creeping

10. Plays games like peek-a-boo

11. Cruises like walks with support

12. Enjoys put-in, take-out toys

Development of Senses
Vision

1. Regards object in middle of vision

2. Focuses well and follows objects with eyes
- Achieves binocular vision which is the ability to fuse 2 images in one

3. Hand regard

4. Recognizes familiar objects

6. Capable of depth perception

7. Object permanence

Hearing

1. Quiets momentarily at a distinct sound (example bell)

3. Turns head to attempt to locate sound
10. Can recognize his/her name and listen when spoken to
12. Can easily locate sound in any direction

Emotional Development: Socialization
1. Can differentiate between face of caregiver and other objects
6 wks Social smile
5. May show displeasure when object is taken away
- Laughs when seeing a funny face
8. Stranger anxiety
9. Aware of changes in tone of voice (cries when scolded)
12. Overcomes fear of strangers
- Likes to play interactive games and joins family activities

Cognitive Development
3. Primary Circular Reaction

Explores objects by grasping or mouthing them

Infant appears to be unaware of what actions he/she can cause

6. Secondary Circular Reaction

Realizes that his/her actions can initiate pleasurable sensations

10. Coordination of Secondary Schema

The infant discovers object permanence or realizes that an object out of sight still exists

Cephalocaudal Development
Neonate. No head control: Head Lag
2. Lifts head until chin
4. Lifts head until chest
6. Lifts head until buttocks (sits with support)
8. Sits without support
10. Stands with support
12. Stands alone, walks with support
14-15. Walks alone

Proximo-distal Development
0. Hands closed
3. Can open hands
6. Palmar Grasp
- Can hold feeding bottle
9. Pincer Grasp
Note:
CNS develops fastest
Reproductive System: slowest

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Promoting Development of an Adolescent in Daily Activities 

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Promoting Development of an Adolescent in Daily Activities 

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ADEQUATE SLEEP

FREQUENT LACK OF SLEEP CAN LEAD TO CHRONIC FATIGUE OR DEPRESSION

DRESS AND HYGIENE

EXERCISE

LITTLE REAL EXERCISE

ADVICE ON INCREASING EXERCISE GRADUALLY SO THEY DO NOT OVERDO AND CONSEQUENTLY DEVELOP MUSCLE SPRAINS OR OTHER OVERUSE INJURIES

CARE OF TEETH

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COUNSEL PARENTS TO APPRECIATE THAT ALTHOUGH IT IS NOT EASY TO LIVE WITH A TEENAGER, IT IS EQUALLY DIFFICULT TO BE THE TEENAGER

“FALLEN ANGEL” SYNDROME

HAVE TROUBLE RESPECTING PARENTS WHO ARE SO OBVIOUSLY IMPERFECT

MAY FOLLOW HEALTH ADVICE POORLY BECAUSE THEY VIEW HEALTH CARE PERSONNEL IN THE SAME LIGHT

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HYPERTENSION

BLOOD PRESSURE IS ABOVE THE 95TH PERCENTILE, OR 127/81 MM HG FOR 16-YEAR-OLD GIRLS AND 131/81 FOR 16-YEAR-OLD BOYS FOR TWO CONSECUTIVE READINGS IN DIFFERENT SETTINGS

OBESE

WHO ARE AFRICAN AMERICAN

WHO EAT A DIET HIGH IN SALT

WHO HAVE A FAMILY HISTORY

NEW MEDICATION PLUS EDUCATION IN RISK FACTORS MAKES TREATMENT AT THIS AGE SUCCESSFUL

POOR POSTURE

TENDENCY TO ROUND SHOULDERS, AND A SHAMBLING, SLOUCHY
WALK

IMBALANCE OF GROWTH THAT ARISES FROM THE SKELETAL
SYSTEM GROWING A LITTLE MORE RAPIDLY THAN THE
MUSCLES

ADOLESCENTS WHO REACH ADULT HEIGHT BEFORE THEIR PEERS

URGE CHILDREN OF BOTH SEXES TO USE GOOD POSTURE DURING
THESE RAPID-GROWTH YEARS

TALL ADOLESCENTS OF BOTH SEXES ARE GENERALLY PICKED
OUT BY BASKETBALL OR TRACK COACHES AND SO MAY HAVE
THE INCENTIVE, IF PROPERLY GUIDED, TO MAINTAIN GOOD
POSTURE

ASSESS POSTURE AT ALL ADOLESCENT HEALTH APPRAISALS TO
DETECT THE DIFFERENCE BETWEEN SIMPLE POOR POSTURE AND
THE BEGINNING OF SCOLIOSIS (LATERAL CURVATURE OF THE SPINE)

BODY PIERCING AND TATTOOS

STRONG MARK OF ADOLESCENCE

BOTH SEXES HAVE EARS, LIPS, CHINS, NAVELS, AND BREASTS PIERCED
AND FILLED WITH STUDS, OR TATTOOS APPLIED TO ARMS, LEGS, OR
THEIR CENTRAL BODY

TO MAKE A STATEMENT THAT THEY ARE DIFFERENT FROM THEIR
PARENTS

KNOW THE SYMPTOMS OF INFECTION AT A PIERCING OR TATTOO SITE
(REDNESS, WARMNESS, DRAINAGE, SWELLING, MILD PAIN) AND TO
REPORT THESE TO A HEALTH CARE PROVIDER IF THEY OCCUR AS
SERIOUS STAPHYLOCOCCAL OR STREPTOCOCCAL INFECTIONS CAN
OCCUR AT PIERCING SITES

CAUTION ADOLESCENTS THAT SHARING NEEDLES FOR PIERCING OR
TATTOOING CARRIES THE SAME RISK AS SHARING NEEDLES FOR INTRAVENOUS DRUG USE

FATIGUE

INVESTIGATE AS A LEGITIMATE CONCERN AND NOT UNDERESTIMATED

ASSESS AN ADOLESCENT’S DIET, SLEEP PATTERNS, AND ACTIVITY
SCHEDULES, BECAUSE ALL CAN CONTRIBUTE GREATLY TO FATIGUE

NOTE WHEN THE FATIGUE BEGAN

SHORT PERIOD OF EXTREME TIREDNESS IS MORE LIKELY TO SUGGEST
DISEASE THAN A LONG, ILL-DEFINED REPORT OF ALWAYS FEELING TIRED

ACNE

SELF-LIMITING INFLAMMATORY DISEASE THAT INVOLVES THE SEBACEOUS GLANDS THAT EMPTY INTO HAIR SHAFTS (THE PILOSEBACEOUS UNIT)

MOST COMMON SKIN DISORDER OF ADOLESCENCE, OCCURRING IN AS MANY AS 80% TO 95% OF ADOLESCENTS

SLIGHTLY MORE FREQUENTLY IN BOYS THAN IN GIRLS

PEAK AGE FOR THE LESIONS TO OCCUR IN GIRLS IS 14 TO 17 YEARS;
FOR BOYS, 16 TO 19 YEAR

ACNE IS CATEGORIZED AS:

MILD (COMEDONES ARE PRESENT),

MODERATE (PAPULES AND PUSTULES ARE ALSO PRESENT)

SEVERE (CYSTS ARE PRESENT)

MOST COMMON LOCATIONS OF ACNE LESIONS ARE THE FACE, NECK, BACK, UPPER ARMS, AND CHEST

OBESITY

BOTH INHERITANCE AND ENVIRONMENT PLAY A PART

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Concerns Regarding Sexuality and Sexual Activity

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Concerns Regarding Sexuality and Sexual Activity

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BECAUSE OF INCREASING EXPOSURE TO AND ACCEPTANCE OF PREMARITAL SEXUAL RELATIONS IN SOCIETY, MORE ADOLESCENTS THAN EVER BEFORE ENGAGE IN HIGH-RISK SEXUAL BEHAVIORS EXPOSING THEM TO SEXUALLY TRANSMITTED INFECTIONS OR CONCEPTION

ASK IF THEY ARE SEXUALLY ACTIVE OR ARE CONCERNED ABOUT SEXUAL RISK BEHAVIORS

OFFER SUPPORT TO ADOLESCENTS WHO ARE HAVING DIFFICULTY TELLING
THEIR PARENTS ABOUT THEIR PERCEIVED SEXUAL ORIENTATION. TO THEIR
SURPRISE, THEY OFTEN DISCOVER THEIR PARENTS ALREADY KNOW WHAT THEY ARE GOING TO SAY BEFORE IT IS VOICED

CAUTION ADOLESCENTS ABOUT THE DANGERS OF FLUNITRAZEPAM
(ROHYPNOL), THE “DATE-RAPE DRUG,” A COLORLESS, ODORLESS, AND
FLAVORLESS BENZODIAZEPINE DRUG THAT, IF DROPPED INTO A DRINK,
CAN REMAIN UNDETECTED BUT CAUSE DROWSINESS, IMPAIRED
MOTOR SKILLS, AND AMNESIA

STALKING

REFERS TO REPETITIVE, INTRUSIVE, AND UNWANTED ACTIONS
DIRECTED AT AN INDIVIDUAL TO GAIN THE INDIVIDUAL’S ATTENTION OR EVOKE FEAR

THE USUAL STALKER IS A MALE WHO STALKS A FEMALE WHO HAS
REJECTED HIM

STALKERS INSTILL FEAR INTO THEIR VICTIMS BY CONSTANT AND
THREATENING PURSUIT

IN SOME INSTANCES, THE STALKER CAN RESORT TO ATTACKING A VICTIM AND EVEN MURDER IF FURTHER REJECTED

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HAZING

REFERS TO DEMEANING OR HUMILIATING RITUALS THAT PROSPECTIVE MEMBERS HAVE TO UNDERGO TO JOIN SORORITIES, FRATERNITIES, ADOLESCENT GANGS, OR SPORTS TEAMS

MOST RITUALS ARE SECRET AND IN THE PAST WERE ACCEPTED AS “RITES OF PASSAGE”

HAZING HAS BECOME SO EXTREME THAT THE PRACTICE HAS MOVED OUT OF THE "JUST FUN” CATEGORY INTO ACTIVITIES THAT CAN CAUSE PHYSICAL AND CERTAINLY PSYCHOLOGICAL HARM

RITUALS MAY BE AS SUBTLE AS BEING CALLED NAMES, FORCED TO WEAR RIDICULOUS CLOTHING, OR ENGAGE IN CRUDE OR LEWD SKITS

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REFERS TO THE USE OF CHEMICALS TO IMPROVE A MENTAL STATE OR INDUCE EUPHORIA

COMMON AMONG ADOLESCENTS THAT AS MANY AS 50% OF HIGH SCHOOL SENIORS REPORT HAVING EXPERIMENTED WITH SOME FORM OF DRUG

DRUG USE OCCURS FROM A DESIRE TO EXPAND CONSCIOUSNESS OR TO FEEL MORE CONFIDENT AND MATURE

CAN BE A RESPONSE TO PEER PRESSURE OR A FORM OF ADOLESCENT REBELLION

THIS TYPE OF REBELLION IS MORE EMOTIONALLY CHARGED THAN ACTS SUCH AS STAYING OUT LATE OR WEARING CLOTHING OTHER THAN THOSE APPROVED BY PARENTS, BECAUSE IT IS NOT ONLY HARMFUL BUT ALSO ILLEGAL

TYPES OF ABUSED SUBSTANCES

PRESCRIPTION AND OVER-THE-COUNTER DRUGS

ADOLESCENTS MAY BEGIN DRUG EXPERIMENTATION BY TAKING SEDATIVES, PAIN MEDICATION, OR COUGH SYRUP CONTAINING DEXTROMETHORPHAN, ABBREVIATED DXM, PRESCRIBED FOR ANOTHER FAMILY MEMBER OR A PET

A SMALL AMOUNT OF DXM CAUSES LIGHTHEADEDNESS

TOBACCO

ALTHOUGH IT IS WELL DOCUMENTED THAT CIGARETTE SMOKING LEADS TO INCREASED CARDIOVASCULAR AND RESPIRATORY ILLNESSES BY MIDDLE AGE, EVERY DAY APPROXIMATELY 4000 AMERICAN YOUTH AGED 12 TO 17 YEARS TRY THEIR FIRST CIGARETTE

ABOUT 23% OF HIGH SCHOOL STUDENTS REPORT CURRENT CIGARETTE USE AND 14% REPORT CURRENT CIGAR USE. EIGHT PERCENT OF HIGH SCHOOL STUDENTS AND 18% OF WHITE MALE HIGH SCHOOL STUDENTS REPORT CURRENT SMOKELESS TOBACCO USE

ALCOHOL

AS MANY AS 90% OF HIGH SCHOOL SENIORS REPORT HAVING USED ALCOHOL

AS MANY AS 25% OF HIGH SCHOOL STUDENTS REPORT HAVING ENGAGED IN EPISODIC HEAVY OR BINGE DRINKING

AT LEAST 10% OF HIGH SCHOOL STUDENTS REPORT DRIVING A CAR OR OTHER VEHICLE WHEN THEY HAD BEEN DRINKING ALCOHOL

TWENTYNINE PERCENT OF STUDENTS REPORT HAVING RIDDEN IN A CAR OR OTHER VEHICLE DRIVEN BY SOMEONE WHO HAD BEEN DRINKING ALCOHOL

ALTHOUGH ITS USE IS CORRELATED WITH MOTOR VEHICLE ACCIDENTS, HOMICIDE, AND SUICIDE IN ADOLESCENTS, ALCOHOL HAS NEVER CARRIED THE STIGMA OF OTHER DRUGS

SOME PARENTS ARE ACTUALLY RELIEVED WHEN THEY REALIZE THEIR CHILD’S STRANGE BEHAVIOR ON RETURNING HOME FROM A PARTY IS CAUSED BY DRUNKENNESS AND NOT ILLEGAL DRUGS

ALCOHOL USE CANNOT BE TAKEN LIGHTLY

LINKED TO DISEASES SUCH AS CIRRHOSIS, COGNITIVE CHALLENGE, AND DESTRUCTIVE BEHAVIORS SUCH AS ADDICTION, DEPRESSION, AND VULNERABILITY TO DATE RAPE

PERFORMANCE-ENHANCING DRUG ABUSE

ANABOLIC STEROIDS ARE DERIVATIVES OF THE NATURAL HORMONE
TESTOSTERONE

COMMON
NAMES ARE STANOZOLOL, AN ORAL COMPOUND, AND TESTOSTERONE
PROPIONATE, AN INJECTABLE FORM. ADOLESCENTS TAKE STEROIDS (OBTAINED
ILLEGALLY) TO ENHANCE LEAN BODY MASS AND MUSCULAR
DEVELOPMENT AND SO IMPROVE THEIR ATHLETIC ABILITY OR APPEARANCE (VAN DEN
BERG ET AL., 2007). ANABOLIC STEROIDS ALSO HAVE
THE SIDE EFFECTS OF EUPHORIA AND LESSENED FATIGUE, WHICH MAKE
THEM DOUBLY APPEALING

MARIJUANA

MARIJUANA (WIDELY KNOWN AS POT OR GRASS) IS DERIVED FROM THE LEAVES AND STEMS OF THE INDIAN HEMP PLANT, CANNABIS SATIVA

IT IS GENERALLY ROLLED INTO CIGARETTES (“JOINTS” OR “REEFERS”) AND SMOKED, ALTHOUGH IT CAN BE MIXED WITH FOOD OR SNIFFED

SCRAPING THE RESIN FROM THE FLOWERING LEAVES PRODUCES A MUCH STRONGER SUBSTANCE CALLED HASHISH

SINSEMILLA IS A SEEDLESS FORM THAT IS EVEN MORE POTENT

AMPHETAMINES

GROUP OF DRUGS SOMETIMES USED IN THE TREATMENT OF HYPERACTIVITY AND NARCOLEPSY, AMONG OTHER CENTRAL NERVOUS SYSTEM DISORDERS

EASILY MANUFACTURED IN “METH LABS” IN PEOPLE’S HOMES AND SO ARE READILY AVAILABLE TO ADOLESCENTS

AMPHETAMINES ARE CALLED UPPERS OR SPEED BECAUSE THEY GIVE THE USER A FALSE SENSE OF WELL-BEING, ALERTNESS, OR SELF-ESTEEM A NEWER, STRONGER FORM THAT PRODUCES INTENSE SYMPTOMS IS KNOWN AS ICE

SOME OF THE SIDE EFFECTS THAT CAN OCCUR ARE AGGRESSIVE OR DEMANDING BEHAVIOR, PARANOIA, AND EXTREME RESTLESSNESS

CHRONIC METHAMPHETAMINE ABUSE RESULTS IN SEVERE BLACKENED, CRUMBLING TEETH. BECAUSE AMPHETAMINES SUPPRESS THE APPETITE, ADOLESCENTS MAY LOSE
WEIGHT OR EAT ONLY SPORADICALLY WHILE TAKING THEM

THEIR USE WITHOUT A PRESCRIPTION IS ILLEGAL

COCAINE

ONE OF THE MOST POPULAR DRUGS OF ABUSE FOR YOUNG ADULTS AND ITS USE MAY BEGIN IN ADOLESCENTS

MAY BE SNIFFED INTO THE NOSE (SNORTED), SMOKED, OR INJECTED INTRAVENOUSLY

OCCASIONALLY IT IS COMBINED WITH HEROIN AND INJECTED (TERMED A SPEEDBALL). COMMON STREET NAMES FOR COCAINE ARE SNOW AND WHITE LADY, BECAUSE OF ITS FINE, WHITE POWDER

A STRONGER FORM, CALLED CRACK, IS MANUFACTURED BY EATING COCAINE POWDER WITH BAKING SODA AND WATER

THIS PREPARATION PROCESS IS DANGEROUS IN ITSELF BECAUSE IT INVOLVES USING VOLATILE SOLVENTS THAT CAN IGNITE OR EXPLODE

THE RESULTING DRUG, OFTEN CALLED FREEBASE OR ROCK, IS SO STRONG IT CAN CAUSE IMMEDIATE CARDIAC AND RESPIRATORY ARRHYTHMIAS

HALLUCINOGENS

EXAMPLES OF HALLUCINOGENIC DRUGS USED BY ADOLESCENTS ARE:

LYSERGIC ACID DIETHYLAMIDE (LSD)

DIMETHYLTRYPTAMINE (DMT)

2,5-DIMETHOXY-4-METHAMPHETAMINE (STP)

PHENCYCLIDINE HYDROCHLORIDE (PCP)

METHAQUALONE (QUAALUDE)

THE USE OF LSD HAS INCREASED IN POPULARITY SUBSTANTIALLY SINCE THE 1960S WHEN IT FIRST BECAME AVAILABLE, BECAUSE IT IS A DRUG THAT CAN BE MANUFACTURED BY AN INFORMED ADOLESCENT IN A “KITCHEN LAB

OPIATES

DRUGS SUCH AS HEROIN, MEPERIDINE (DEMEROL), AND MORPHINE. AT ONE TIME, THESE WERE NOT TYPICALLY USED BY ADOLESCENTS BECAUSE THEY ARE EXPENSIVE, BUT THEY NOW ARE GAINING POPULARITY AMONG TEENS

CAN BE EXTREMELY DANGEROUS BECAUSE OF THEIR TENDENCY TO DECREASE RESPIRATORY RATE

ADDICTION TO OPIATES AN CAUSE SUCH A PHYSIOLOGIC CRAVING THAT ADOLESCENTS, LIKE ADULTS, WILL STEAL, DEFRAUD, TURN TO PROSTITUTION, OR RESORT TO WHATEVER METHOD IS AVAILABLE TO SECURE ENOUGH MONEY TO BUY A DAY’S SUPPLY

IN ADDITION TO THE DIRECT DANGER OF OPIATES, ADOLESCENTS WHO USE THEM RISK THE DANGER OF CONTRACTING HIV/AIDS AND HEPATITIS B INFECTION IF THEY SHARE CONTAMINATED NEEDLES

“SNORTING” HEROIN CAN LEAD TO ACUTE CEREBRAL VASCULAR ACCIDENT AND DEATH

ASSESSMENT OF SUBSTANCE ABUSE

IF ADOLESCENTS TRUST HEALTH CARE PERSONNEL, THEY WILL GENERALLY ADMIT THEY HAVE ENGAGED IN DRUG EXPERIMENTATION

SOME COMMON FINDINGS ON THE HEALTH HISTORY THAT SUGGEST AN
ADOLESCENT IS ABUSING SOME SUBSTANCE ARE:

FAILURE TO COMPLETE ASSIGNMENTS IN SCHOOL

DEMONSTRATION OF POOR REASONING ABILITY

DECREASED SCHOOL ATTENDANCE

FREQUENT MOOD SWINGS

DETERIORATING PHYSICAL APPEARANCE

RECENT CHANGE IN PEER GROUP

EXPRESSED NEGATIVE PERCEPTIONS OF PARENTS

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Concerns Regarding Depression and Attempted Suicide 

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Concerns Regarding Depression and Attempted Suicide 

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SUICIDE

IS DELIBERATE SELF-INJURY WITH THE INTENT TO END ONE’S LIFE

SUCCESSFUL SUICIDE OCCURS MORE FREQUENTLY IN MALES THAN IN FEMALES, ALTHOUGH MORE FEMALES APPARENTLY ATTEMPT SUICIDE THAN MALES (ABOUT 8:1)

ADOLESCENT SUICIDES ARE ATTEMPTED MOST OFTEN IN THE SPRING OR THE FALL, REFLECTING SCHOOL STRESS AT THESE TIMES OF YEAR, AND BETWEEN 3 PM AND MIDNIGHT, REFLECTING DEPRESSION THAT INCREASES WITH THE DARK

SUICIDE IS SO COMMON IN ADOLESCENTS THAT IT RANKS THIRD AS A CAUSE OF DEATH IN THE 15-TO 19-YEAR-OLD GROUP

THIS STATISTIC MAY ACTUALLY BE UNDERESTIMATED, BECAUSE SOME WELL-MEANING CORONERS OR PHYSICIANS MAY REPORT THESE DEATHS AS ACCIDENTS TO SPARE THE FAMILY ADDITIONAL PAIN

ASSESSMENT

ADOLESCENTS NEED TO HAVE THOROUGH PHYSICAL EXAMINATIONS
AT HEALTH MAINTENANCE VISITS TO ASSURE THEM THEY ARE IN GOOD
PHYSICAL HEALTH

ASSESS FOR SIGNS OF DEPRESSION SUCH AS ANOREXIA, INSOMNIA, EXCESSIVE FATIGUE, OR WEIGHT LOSS

IN YOUNGER ADOLESCENTS, DEPRESSION MAY BE MANIFESTED BY BEHAVIOR PROBLEMS SUCH AS DISOBEDIENCE, TEMPER TANTRUMS, TRUANCY, AND RUNNING AWAY FROM HOME

SELF-DESTRUCTIVE BEHAVIOR OR ACCIDENT PRONENESS MAY BE NOTED

DIFFICULTIES IN SCHOOL;

ACTING OUT WITH CHEMICALS, ALCOHOL, OR SEXUAL PROMISCUITY

TROUBLE WITH LEGAL AUTHORITIES MAY BE FURTHER CLUES

OCCASIONALLY, DEPRESSED ADOLESCENTS FIND IT SO HARD TO BE ALONE THEY SEEK CONSTANT ACTIVITY AS A MEANS OF ESCAPE

IN CONTRAST, OTHERS MAY WITHDRAW FROM CONTACT WITH OTHER PERSONS AND BECOME COMPLETELY ISOLATED

EITHER BEHAVIOR CAN BE DETECTED THROUGH ASSESSMENT OF ACTIVITY AND INTERACTION LEVELS

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RUNAWAY

IS COMMONLY DEFINED AS A CHILD BETWEEN THE AGES OF 10 AND 17 YEARS WHO HAS BEEN ABSENT FROM HOME AT LEAST OVERNIGHT WITHOUT PERMISSION OF A PARENT OR GUARDIAN

THE FREQUENCY OF RUNNING AWAY FOR ADOLESCENTS MAY BE AS HIGH AS ONE IN EIGHT

FORTUNATELY, MOST DO NOT GO FAR OR STAY AWAY LONG (LESS THAN 1 WEEK)

ABOUT 1 IN 20 ADOLESCENT RUNAWAYS STAYS AWAY AS LONG AS 1 YEAR; SOME NEVER RETURN HOME

RUNAWAY ADOLESCENTS ARE MOST LIKELY TO BE FROM LOW- OR HIGH-INCOME FAMILIES

UNEMPLOYMENT, ALCOHOLISM, SEXUAL ABUSE, ATTEMPTED SUICIDE, AND POVERTY ARE FREQUENT CHARACTERISTICS

THEY ARE SLIGHTLY MORE LIKELY TO BE MALE THAN FEMALE

EVENTS THEY ENCOUNTER MAY BE SO TRAUMATIC THEY DEVELOP A POSTTRAUMATIC SYNDROME

ASSESSMENT

RUNNING AWAY IS USUALLY PRECEDED BY AN ARGUMENT WITH PARENTS
THAT IS OFTEN THE LAST STRAW AFTER A NUMBER OF LONG-TERM
DISAGREEMENTS

OTHER REASONS MAY BE PERSONAL CONCERNS SUCH AS LONELINESS,
PREGNANCY, AND PROBLEMS WITH FRIENDS, SCHOOL, OR THE POLICE

INCEST CAN ALSO BE A PRECIPITATING CAUSE, AS CAN OTHER PARENTAL
ABUSE

A SCHOOL HISTORY OFTEN REVEALS FREQUENT TRUANCY, FAILING
GRADES, POSSIBLE DRUG USE, AND RUNAWAY BEHAVIOR BY FRIENDS

IT IS A SAD FACT THAT SOME ADOLESCENTS ARE “THROWAWAYS” OR
CANNOT REMAIN AT HOME BECAUSE THEY HAVE BEEN REJECTED BY THEIR FAMILIES

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MODULE 1 LESSON 7: REPRODUCTIVE AND SEXUAL HEALTH

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MODULE 1 LESSON 7: REPRODUCTIVE AND SEXUAL HEALTH

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Sex: determined at time of conception

Gonad: a body organ that produces the cells necessary for reproduction

Ovary in females

Testis in males

At approximately week 5 of intrauterine life, primitive gonadal tissue is already formed

The gender of the child is all about dad’s genes. Aside from the fact that it is the father that carries the Y chromosome that combines with the X chromosome to make a BOY, according to studies, the balance in the amount of X and Y chromosome in the male can contribute to the gender of the child, (UTS Southern Medical Center, 2019). As soon as the Y carrying sperm fertilizes the mature ovum, the gender of the child has been sealed.

Week 5: primitive gonadal tissue is formed

Two undifferentiated ducts

Mesonephric (Wolffian)

Paramesonephric (Mullerian)

Week 7-8 (Chromosomal Males - srY gene)" differentiation into primitive testes

Week 10: In the absence of testosterone, differentiation into ovaries, containing oocytes

Week 12: external genitals develop

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Secondary sexual characteristics

Stimulated when the hypothalamus synthesizes and releases gonadotropin-releasing hormone (GnRH)

GnRH triggers the anterior pituitary to begin the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

FSH and LH stimulate production of estrogen and androgen

Poorly understood, especially in boys

The hypothalamus, under the direction of the central nervous system, may serve as a gonadostat

The theory is that a girl must reach a critical weight of approximately 95 lbs or develop a critical mass of body fat before the hypothalamus is triggered

The onset of puberty in girls usually start at the age of 10, peaks at 10 and 14 years of age, a year before the boys. Although girls might experience growth spurt earlier, it does not last long.

Before girls start menstruating, they have already reached close to their maximum height. The growth in height is accompanied by widening of the pelvis taking on a pelvis (hip)shape ideal for childbearing and childbirth (gynecoid shape).

Girls experience menarche at varied age (start of menstrual period). In the Philippines, the average menarche is 13 years old. Menarche signals the beginning of the capacity to reproduce (because of the maturation of the ovum that has been present even before birth)and the development of the secondary sex characteristics.

Up until puberty, there isn’t much difference between boys and girls who grows at about the same rate per year. Growth rates change during puberty when hormones start the process of physical change. The average boy starts growth spurt at 12 years old. At the end of puberty, boys are usually much taller than the girls. In boys, the muscles also develop at this time. Also, note that unlike in female oogenesis, spermatogenesis in male starts at the onset of puberty.

Remember: Genetics and epigenetics play a big part in growth patterns

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MODULE 1 LESSON 8: YOUNG AND MIDDLE-AGED ADULT

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MODULE 1 LESSON 8: YOUNG AND MIDDLE-AGED ADULT

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Adulthood is often divided into three phases:

young adulthood

young adults are defined as people 20 to 40 years old

middle adulthood

middle-aged adults as 40 to 65 years old

late adulthood

Adult Age Span includes three very different generations:

Baby Boomers(born in years 1945–1964)

more highly educated and have a large percentage of
women in the workforce occupying management roles

Generation X(birth years 1965–1978)

were frequently raised in two worker households where long hours at work were common

less impressed with corporate values, more skeptical, and
resist authority, but enjoy challenges and opportunities to
creatively problem solve

Generation Y or the Millennials (birth years 1979–2000)

technologically sophisticated (and dependent), and enjoy
public affirmation of their efforts

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adult depends on how adulthood is described in the social context of the individual, and this defining age is changing

Another criterion of adulthood is financial independence, which is also highly variable

boomerang kids have evolved, as young adults have moved back into their parents’ homes after an initial period of independent living

factors contributing to this trend include high housing costs, high divorce rates, high unemployment rates, and the problems resulting from substance abuse and maladaptive behaviors

Physical Development

Human body is at its most efficient functioning at about age
25 years

musculoskeletal system is well developed and coordinated

period when athletic endeavors reach their peak. All other systems of the body (e.g., cardiovascular, visual, auditory, and reproductive) are also functioning at peak efficiency

physical changes are minimal during this stage, weight and muscle mass may change as a result of diet and exercise.

extensive physical and psychosocial changes occur in pregnant and lactating women

Psychosocial Development

psychosocial development of the young adult is great

basic developmental task is establishing intimacy or very close friendship

Occupational choice and education are largely inseparable

sense of intimacy versus isolation

Cognitive Development

Young adults are able to use formal operations, characterized by the ability to think abstractly and employ logic

For example, young adults are able to generate hypotheses about what will happen, given a set of circumstances and do not have to engage in trial-and-error behavior

Moral Development

Young adults who have mastered the previous stages of Kohlberg’s theory of moral development enter the postconventional level

At this time, the person is able to separate self from the expectations and rules of others and to define morality in terms of personal principles

When individuals perceive a conflict with society’s rules or laws, they judge according to their own principles

Spiritual Development

According to Fowler (1981), the individual enters the individuating reflective period sometime after 18 years of age

the individual focuses on reality

The religious teaching that the young adult had as a child may now be accepted or redefined

Health Risks

Young adulthood is generally a healthy time of life

Health risks that do occur and are common in this age group include:

injury and violence

Suicide

hypertension

substance abuse

sexually transmitted infections (STIs)

eating disorders

certain malignancies

INJURY AND VIOLENCE

The leading causes of death differ among the various
population groups.

For example, unintentional injuries (primarily motor vehicle crashes) are the fifth leading cause of death for the total population but the leading cause of death for people 1 to 44 years of age

Education about safety precautions and injury prevention is a major role of the nurse in promoting the health of young adults

nurse needs to become familiar with community resources, such as adult protective services, shelters

Partners Anonymous, advocacy programs, victim assistance programs, and hotlines

SUICIDE

leading cause of death in the young adult age group (Edelman & Mandle, 2010, p. 585)

Many suicides may actually be mistaken for accidental death (motor vehicle crashes, combining alcohol and barbiturates, or discharging a gun while cleaning it)

Suicide may result from problems with close relationships such as those with marriage partners or parents, or from depression related to perceived occupational, academic, or financial failure

In general, suicide results from the young adult’s inability to cope with the pressures, responsibilities, and expectations of adulthood

HYPERTENSION

major problem for young African American adults, particularly men

Many of the causes for this higher incidence of hypertension are unknown

In addition to biologic inheritance, contributing factors may include smoking, obesity, a high-sodium diet, and high stress levels

Hypertension is a major risk factor in the development of chronic heart disease or stroke (cerebrovascular accidents)

Blood pressure measurements are usually advised at least every 2 years for young adults to screen for hypertension

SUBSTANCE ABUSE

major threat to the health of young adults

Alcohol, marijuana, amphetamines, and cocaine, for example, can bring about feelings of well-being that may be highly valued by people with adjustment problems

Prolonged use can lead to physical and psychological dependency and subsequent health problems

Addiction or physical and psychological dependence on a substance, is related to properties of the substance, the individual user, and the social network of the individual

For example, drug abuse during pregnancy can lead to fetal damage

Prolonged use of alcohol can lead to such diseases as cirrhosis of the liver and cancer of the esophagus

SEXUALLY TRANSMITTED INFECTIONS

STIs such as genital herpes, AIDS, syphilis, and gonorrhea are common infections in young adults

Chlamydia is the most prevalent STI, and in fact is the most prevalent infectious disease in the United States (Centers for Disease Control and Prevention, 2010).

Other STIs, such as gonorrhea, are becoming resistant to multiple antibiotics and therefore cause an increased risk for future health

Nursing functions are largely educational

The use of condoms greatly reduces the transfer of infectious microorganisms from one partner to another

Knowledge about the symptoms of these diseases can help the client
obtain early treatment. In dealing with clients with an STI, the nurse
must be nonjudgmental and accepting of the client’s lifestyle and treat
any information obtained as confidential

EATING DISORDERS

Many young adults battle with obesity

According to Healthy People 2020 goals and objectives for nutrition and weight status all Americans will avoid unhealthy weight gain (USDHHS, 2010a)

The nurse needs to assess nutritional concerns, discuss diet and exercise patterns with the client and assist in the development of an individualized
wellness plan

Other areas of nutritional needs for young women include meeting calcium requirements and proper nutrition during the childbearing years

MALIGNANCIES

Testicular cancer is the most common neoplasm in young men

Seminoma testicular cancer most commonly affects men ages 30 to 45

The yolk sac tumor is most common in 20- to 35-year olds (Holdstock, 2010).

More recent recommendations from the American Cancer Society (ACS) (2013b) are that men should have a testicular exam as part of a yearly physical exam

Men who have risk factors for testicular cancer should discuss monthly testicular self-examination with their primary care provider

Health Assessment and Promotion

Assessment guidelines for the growth and development of the young adult are shown in the accompanying Developmental Assessment Guidelines

Young adults are usually interested in meeting their health needs

because of the many stresses and changes that occur throughout the 20-year period from ages 20 to 40, the nurse needs to offer teaching and guidance in several health care areas

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The middle years, from 40 to 65, have been called the years of stability and consolidation

For most people, it is a time when children have grown and moved away or are moving away from home

Thus, partners generally have more time for and with each other and time to pursue interests they may have deferred for years

Maturity is the state of maximal function and integration or the state of being fully developed

Mature individuals are guided by an underlying philosophy of life

They take many perspectives into account and are tolerant of the views of others

A comprehensive philosophy allows a person to make sense out of life and thus helps that person maintain a sense of purpose and hope in the face of human tragedies.

Physical Development

A number of changes that start when young adults are in their mid-20s become noticeable as the fifth decade approaches

At 40, most adults can function as effectively as they did in their 20s

However, during ages 40 to 65 many physical changes take place

Both men and women experience decreasing hormonal production during the middle years

The term menopause refers to the so-called change of life in women, when menstruation ceases

occurred when a woman has not had a menstrual period
for 12 months

menopause usually occurs sometime between ages 40
and 55

average is about 47 years

At this time, ovarian activity declines until ovulation ceases

Common symptoms, related o a decline in estrogen are: hot flashes, chilliness, a tendency of the breasts to become smaller and less dense, and a decrease in metabolic rate that may lead to weight gain. Insomnia and headaches may also occur

Psychosocial Development

Erikson viewed the developmental choice of the middle-aged adult as Generativity versus Stagnation

Generativity is defined as the concern for establishing and guiding the next generation

the concern about providing for the welfare of humankind is equal to the concern of providing for self

People in their 20s and 30s tend to be self- and family-centered

In middle age, the individual collaborates with others

Marriage partners have more time for companionship and recreation; thus marriage may be more satisfying in the middle years of life

Partners have time to work together in volunteer activities, and time for one partner to go out for lunch and for the other to go fishing

Generative middle-aged persons are able to feel a sense of comfort in their lifestyle and receive gratification from charitable endeavors

Cognitive Development

The middle-aged adult’s cognitive and intellectual abilities change very little

Cognitive processes include reaction time, memory, perception, learning, problem solving, and creativity.

Reaction time during the middle years stays much the same or diminishes
during the latter part of the middle years

Memory and problem solving are maintained through middle adulthood

Learning continues and can be enhanced by increased motivation at this time in life.

Genetic, environmental, and personality factors in early and middle
adulthood account for the large difference in the ways in which individuals maintain mental abilities

The professional, social, and personal life experiences of middle-aged
individuals will be reflected in their cognitive performance

approaches to problem solving and task completion will vary considerably in a middle-aged group.

Moral Development

According to Kohlberg, the adult can move beyond the conventional level to the postconventional level

Kohlberg believed that extensive experience of personal moral
choice and responsibility is required before people can reach the postconventional level

Kohlberg found that few of his subjects achieved the highest level of moral reasoning

To move from stage 4, a law and order orientation, to stage 5, a social contract orientation, requires that the individual move to a stage in which rights of others take precedence

Spiritual Development

Not all adults progress through Fowler’s stages to the fifth, called the paradoxical-consolidative stage.

At this stage, the individual can view “truth” from a number of viewpoints

Fowler believes that only some individuals after the age of 30 years reach this stage

In middle age, people tend to be less dogmatic about religious beliefs, and religion often offers more comfort to the middle-aged person than it did previously

People in this age group often rely on spiritual beliefs to help them deal with illness, death, and tragedy

Health Risks

Leading causes of death in this age group include motor vehicle and occupational injuries, chronic disease such as cancer and cardiovascular disease

Lifestyle patterns in combination with aging, family history, and developmental stressors (e.g., menopause, climacteric) and situational stressors (e.g., divorce) are often related to health problems that do arise

Example: smoking and excessive alcohol consumption place an individual at greater risk of developing chronic respiratory problems, lung cancer, and liver disease

Overeating can result in obesity, diabetes mellitus, atherosclerosis, and its associated risk for hypertension and coronary artery disease

Many diseases of older age may be decreased by health-conscious and
lifestyle decisions made, and acted on, in midlife

The nurse can play an important role in teaching middle-aged clients
about preventive health care to avoid or minimize the risk of such health
problems.

INJURIES

Changing physiological factors, as well as concern over personal and work-related responsibilities, may contribute to the injury rate of middle-aged people

Motor vehicle crashes are the most common cause of unintentional death in this age group

Decreased reaction times and visual acuity may make the middle-aged adult prone to injury

Other unintentional causes of death for middle-aged adults include falls, fires, burns, poisonings, and drownings. Work-related injuries continue to be a significant safety hazard during the middle years

CANCER

Cancer is the leading cause of death in middle adulthood

The patterns of cancer types and incidences for men and women have changed during the past several decades

The ACS (2014) states that men have a high incidence of cancer of the lung, prostate, and colon

In women, lung cancer is highest in incidence, followed by breast cancer and colon cancer

Screening guidelines for early detection of cancer are constantly evolving as new data are analyzed

CARDIOVASCULAR DISEASE

Heart disease and cancer are the leading causes of death during middle adulthood

Risk factors for heart disease include smoking, obesity, hypertension,
hyperlipidemia, diabetes mellitus, sedentary lifestyle, a family history of
myocardial infarction or sudden death in a father less than 55 years old or in a mother less than 65 years old, and the individual’s age

A newly recognized cluster of risk factors that often occur together, termed
metabolic syndrome, increases the risk for heart disease

This syndrome includes the following risk factors: obesity with excessive
abdominal fat, hypertension, high lipid levels, and insulin resistance (McClendon, Dunbar, Clark, & Coverson, 2010)

Lifestyle activities and behaviors, such as diet modifications and increasing
physical activity play an important role in preventing the development of
metabolic syndrome risk factors

OBESITY

Middle-aged adults who gain weight may not be aware of some common
facts about this age period

Decreased metabolic activity and decreased physical activity mean a
decrease in caloric need

The nurse’s role in nutritional health promotion is to counsel clients to
prevent obesity by reducing caloric intake and participating in regular
exercise

Clients should also be educated that being overweight is a risk factor for many chronic diseases such as diabetes and hypertension and for problems of mobility such as arthritis

Recent changes in the Food Guide Pyramid propagated by the U.S.
Department of Agriculture now encourage nutrient intake based on physical activity, age, and gender

Clients may be directed to the new MyPlate website to design a customized, healthy diet plan for themselves

Clients should seek medical advice before considering any major changes
in their diets

ALCOHOLISM

excessive use of alcohol can result in unemployment, disrupted homes, injuries, and diseases

It is estimated that 4 million people in the United States are dependent on alcohol and can be considered alcoholics

Alcohol use may exacerbate other health problems

Nurses can help clients by providing information about the dangers of excessive alcohol use, by helping the individual clarify values about health, and by referring the client who abuses alcohol to special groups such as Alcoholics Anonymous

MENTAL HEALTH ALTERATIONS

Developmental stressors, such as menopause, the climacteric, aging, and impending retirement, and situational stressors, such as divorce, unemployment, and death of a spouse, can precipitate increased anxiety and depression in middle aged adults

Clients may benefit from support groups or individual therapy to help them cope with specific crises

Health Assessment and Promotion

Assessment guidelines for the growth and development of the middle-aged adult are shown in the accompanying Developmental Assessment Guidelines

Middle-aged adults usually take care of their health needs and are interested in maintaining health and preventing the acceleration of the aging process

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MODULE 1 LESSON 9: PROMOTING IN OLDER ADULTS

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MODULE 1 LESSON 9: PROMOTING IN OLDER ADULTS

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Because of the increase in numbers, nurses will be caring for older adults at some point

It is important for nurses to be aware of their own values and attitudes toward aging, and examine whether myths or stereotypes influence those attitudes

Ageism

is used to describe negative attitudes toward aging or older adults (Mauk, 2014, p. 10)

Ageism is discrimination based solely on age

young adults distanced themselves from older adults to shield themselves from being aware of their own mortality

These individuals engaged in activities that made them feel strong, increased their energy, and diminished their vulnerability

students who were exposed to the older population through frequency and quality of interactions were positively influenced and were more likely to make
careers of elder care

Myths and Stereotypes

Ageism contributes to the development of negative stereotypes about older adults

Stereotypes occur when younger people do not understand or identify with older adults as unique human beings

An older client only experiences loss of memory related to the onset of a neurological disease

Most causes of disability are related to the adverse effects of many drugs such as pain medications

Disease processes also increase the client’s risk of developing disabling conditions

Example: diabetes mellitus can result in loss of feeling in the extremities, diminished kidney function, and loss of vision

important for nurses to provide accurate information about aging

an effective intervention for reducing negative stereotypes and improving attitudes about aging

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The older adult population is characterized by unique and diverse individuals who may require a variety of health care professionals to meet their health care needs

Gerontology

is the study of aging and older adults

is multidisciplinary and is a specialized area within various disciplines such as nursing, psychology, and social work

Geriatrics

is associated with the medical care (e.g., diseases and disabilities) of older adults

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Older Adulthood

65 – 74 years

Adaptation to retirement and changing physical abilities often necessary

Chronic illness may develop.

Assist to keep physically and socially active and maintain peer group interactions

Middle Old

75 – 84 years

Adaptation to decline in speed of movement, reaction time and increasing dependence on others may be necessary

Assist to cope with loss. Provide necessary
safety measures

Old-old

85 and over

Increasing physical probs

Assist with self-care and maintaining independence

Development

Gerontological nursing involves advocating for the health of older adults at all levels of prevention (Mauk, 2014)

1960s, gerontological nursing became a subspecialty of nursing

1980s, gerontological nursing leaders stated that most practicing nurses did not have sufficient knowledge about gerontology

This prompted discussion of how to prepare nurses for gerontological nursing

late 1990s, the nursing profession has recognized the importance of preparing all practicing nurses with basic gerontological knowledge

As a result, schools of nursing provide classes or courses about nursing care of older clients

Practicing gerontological nurses can obtain gerontological nursing certification through the American Nurses Association

Advanced practice in gerontological nursing requires a master’s degree in nursing, of which there are two options: the gerontological clinical nurse specialist and the gerontological nurse practitioner

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provider of care

The nurse gives direct care to older adults in a variety of settings

Teacher

often focuses on modifiable risk factors (e.g., healthy diet, physical activity, stress management)

Manager

balance the concerns of the older client and family, as well as the concerns of nurses and other interdisciplinary team members

Advocate

empowers older adults by helping them remain independent and strengthen their autonomy and decision-making ability

research consumer

requires nurses to read the latest professional literature for evidence based practice to improve the quality of nursing care for older clients

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Acute Care Facilities

Nurses in an acute care setting focus on protecting the health of the older adult, with the goal of the older adult returning to his or her prior level of independence

Examples include the following:

Preventing nosocomial infections (e.g., urinary tract infections, pneumonia).

Preventing therapy-related problems (e.g., confusion, sleeplessness, dehydration, decreased nutrition)

Treating the health problem that resulted in the older adult’s admission plus assessing for potential undiagnosed health problems (e.g., depression, drug and/or alcohol abuse).

Preventing complications (e.g., decubitus ulcer)

Long-Term Care Facilities

Long-term care is the provision of health care and personal care assistance to clients who have a chronic disease or disability (Li & Jensen, 2011)

Long-term care facilities are also known as nursing facilities

Nursing facility is a new term that includes providers of care who are
certified by Medicare and institutions previously referred to as intermediate care

The primary difference between institutions is the care offered, and the level of care provided to the client

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Assisted Living

Older adults who do not feel safe living alone or require additional help with ADLs

usually have their own apartment

provides meals, weekly activities, and a pleasant environment to socialize with other residents

Some assisted living units are part of a larger facility

Intermediate Care

residents require additional assistance

Residents of intermediate care are no longer able to live independently. This level of care provides 24-hour nursing oversight to protect the client from injury and increase the client’s quality of life (Pratt, 2010, pp. 18–19).

Skilled Care Units or Skilled Nursing Facilities (SNFs)

designed to provide for the needs of clients whose acuity levels require a higher level of nursing care

Gerontological nurses working in SNFs often care for clients who require tube feedings, intravenous therapy, chronic wound therapy, and mechanical ventilators

Alzheimer’s units.

AD is characterized by progressive dementia, memory loss, and inability to care for oneself.

Gerontological nurses working in AD units have specialized knowledge and help family members understand and cope with the disease process affecting their loved one

Hospice

Gerontological nurses may also work in hospice and care for dying clients and their families

The majority of hospice clients are older adults

Hospice requires a great deal of patience, expertise, understanding, interdisciplinary communication, and compassion skills on the part of gerontological nurses

The goal of hospice care is to provide the client with pain management and with psychosocial and spiritual care through the dying process (End-ofLife Nursing Education Consortium Core Curriculum, 2013)

Rehabilitation

Gerontological rehabilitation nursing combines expertise in gerontological nursing with rehabilitation concepts and practice

Nurses working in gerontological rehabilitation often care for older adults with chronic illnesses and long-term functional limitations (e.g., orthopedic surgery, stroke, or amputation)

This rehabilitative care may be found in several settings: acute care hospitals, subacute or transitional care centers, and long-term care facilities

The nurse is an important member of the interdisciplinary
rehabilitation team

The role of the nurse is often as a health care coordinator, manager,

and counselor for older adults and their families

For example, nurses monitor the client’s health care, assist with ADLs, and assist older adults to regain and maintain the highest level of function and independence possible while preventing complications and enhancing quality of life

Community

Nurses often assess the older client’s needs and then try to match the need with a community resource

Examples of the different community areas in which gerontological nurses practice include the following:

Home health care is designed for those who are homebound due to the severity of illness or disability

Nurse-run clinics focus on managing chronic illness

Adult day care focus on social activities and health care

bathing, medication administration, wound dressing

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Sarcopenia

is a syndrome that results in muscle weakness leading to diminished independence and contributes to the client’ s decreased ability to perform ADLs

had a higher prevalence of being undernourished

can be exaggerated by muscular weakness resulting in a stooping posture and kyphosis (humpback of the upper spine)

Imbalance in the rates of absorption and formation of bone tissue occurs with aging, so that older adults have more porous and fragile bones than do younger adults, making older adults prone to serious fractures

Osteoporosis, a pathologic decrease in bone density that is more common in older than younger adults, may lead to spontaneous (i.e., without a fall or other trauma to the bone) fractures that are called pathologic fractures

Osteoporosis occurs more frequently in people with insufficient intake of dietary calcium, in women after menopause, in Caucasians and Asians, and in people who are immobilized or physically inactive

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Loss of peripheral vision, atrophy of lacrimal glands resulting in dry eyes, and difficulty in discriminating similar colors, especially blues, greens, and purples, also occur

Presbyopia, the inability to focus or accommodate due to a loss of flexibility of the lens, causes decreased near vision

This process generally starts around age 40. Visual acuity lessens gradually after age 50 and more rapidly after age 70 (Miller, 2012)

By the age of 80, nearly all older adults have some lens opacity (cataracts) that reduces visual acuity and causes glare to be a problem

Three other conditions result in visual impairment and blindness

1. age-related macular degeneration (ARMD)

2. glaucoma

3. diabetic retinopathy (Miller, 2012)

promote health by informing older clients that they should schedule routine eye examinations to maintain and protect their vision

wearing sunglasses will help avoid the damaging effect of ultraviolet light

The loss of hearing ability related to aging, called presbycusis, affects people over age 65

Gradual loss of hearing is more common among men than women, perhaps because men are more frequently in noisy work environments

Hearing loss is greater in the higher frequencies than the lower

older adults with hearing loss usually hear speakers with low, distinct voices best

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These theories focus on behavior and attitude changes during the aging process

One of the earliest, disengagement theory, developed in the early 1960s proposed that aging involves mutual withdrawal (disengagement) between the older person and others in the older person’s environment (Tabloski, 2014)

According to Havighurst’s activity theory (1972), the best way to age is to stay active physically and mentally

The continuity theory proposes that people maintain their values, habits, and behavior in old age

A person who is accustomed to having people around will continue to do so, and the person who prefers not to be involved with others is more likely to disengage (Tabloski, 2014)

This theory accounts for the great variety of behavior seen in older people

According to Erikson, the developmental task at this time is Ego Integrity versus Despair

People who attain ego integrity view life with a sense of wholeness and derive satisfaction from past accomplishments

They view death as an acceptable completion of life

People who develop integrity accept “one’s one and only life cycle” (Erikson, 1963, p. 263)

By contrast, people who despair often believe they have made poor choices during life and wish they could live life over

Acknowledging that the “young-old” and “old-old” differ not only in physical characteristics but also in psychosocial responses, many people have difficulty with Erikson’s singular developmental task

Peck (1968) proposed the following three developmental tasks of the older adult in contrast to Erikson’s task of ego integrity versus despair:
1. Ego differentiation versus work-role preoccupation
2. Body transcendence versus body preoccupation
3. Ego transcendence versus ego preoccupation.

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The ability to retire at the age of 65 is becoming increasingly more challenging for older adults based on the changes within the U.S. labor force

Economic risk has risen in the past several years

Today’s seniors may lack the assets needed to retire

Complicating this situation are rising health care costs and inadequate monthly income to meet the needs of seniors (Polivka, 2013)

Older adults may find that their retirement income has not kept up with inflation

They may need to continue working to meet medical, insurance, and housing costs.

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Piaget’s phases of cognitive development end with the formal operations phase

However, considerable research on cognitive abilities and aging is currently being conducted

Intellectual capacity includes perception, cognitive agility, memory, and learning

Perception

the ability to interpret the environment, depends on the acuteness of the senses

If the aging person’s senses are impaired, the ability to perceive the environment and react appropriately is diminished

Changes in the nervous system may also affect perceptual capacity

Cognitive Agility

In older adults, changes in cognitive abilities are more often a difference in
speed than in ability. Overall the older adult maintains intelligence, problem
solving, judgment, creativity, and other well-practiced cognitive skills. Intellectual loss generally reflects a disease process such as atherosclerosis, which causes the blood vessels to narrow and diminishes perfusion of nutrients to the brain. Most older adults do not experience cognitive impairments. Dementia affects 2.4 to 5.5 million Americans. Mild cognitive impairment is different from dementia since the client is able to perform ADLs independently (Lin, O’Connor, Rossom, Perdue, & Eckstrom, 2013).

It is important to note, that memory impairment is more prevalent in persons over age 85 than persons between the ages of 65 and 69. Cognitive impairment that interferes with normal life is not considered part of normal aging. A decline in intellectual abilities that interferes with social or occupational functions should always be regarded as abnormal. Family
members should be advised to seek prompt medical evaluation

Memory

is also a component of intellectual capacity that involves the following steps:
1. Momentary perception of stimuli from the environment referred to as
sensory memory
2. Storage in short-term memory (information held in the brain for immediate
use or what one has in mind at a given moment).
– An example of this type of memory is when you call information for a
telephone number and remember the number only for the brief time
needed to dial the number
– Short-term memory also deals with activities or the recent past of
minutes to a few hours that is often referred to as recent memory
3. Encoding during which the information leaves short-term memory and enters
long-term memory, the repository for information stored for periods longer
than 72 hours and usually weeks and years
– Memories of childhood friends, teachers, and events are stored in longterm memory
– Older people who remember the flowers in their wedding bouquet or the
names of the boys on their dance card are drawing from long-term memory

Leaning

Older people need additional time for learning, largely because

of the problem of retrieving information. Motivation is also important. Older adults have more difficulty than younger ones

in learning information they do not consider meaningful; therefore, the nurse should be particularly careful to discover what is meaningful to the older adult before attempting client education

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According to Kohlberg (1984), moral development is completed in the early adult years

Kohlberg hypothesized that an older person at the preconventional level obeys rules to avoid pain and the displeasure of others

stage 1: a person defines good and bad in relation to self

stage 2: may act to meet another’s needs as well as their own

Older adults at the conventional level follow society’s rules of conduct in response to the expectations of others found that moral reasoning does not decline in old age

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Older adults can contemplate new religious and philosophical views and try to understand ideas missed previously or interpreted differently

The older person may derive a sense of worth by sharing experiences or views

In contrast, the older adult who has not matured spiritually may feel impoverishment or despair as the drive for economic and professional success lessens

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Injuries

Chronic disabling disease such as hypertension

and arthritis

Drug abuse and misuse, alcoholism, dementia, and mistreatment

Leading causes of death in people ages 65 and over are heart disease, cancer, cerebrovascular disease (stroke), lower respiratory disease, pneumonia/influenza, and diabetes mellitus

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Injury prevention is a major concern for older people

Falls are a leading cause of morbidity and mortality among older adults (Edelman & Mandle, 2010, p. 635)

Because vision is limited, reflexes are slowed, and bones are brittle, caution is required in climbing stairs, driving a car, and even walking

Driving, particularly night driving, requires caution because accommodation of the eye to light is impaired and peripheral vision is diminished

Older people need to learn to turn the head before changing lanes and should not rely on side vision, for example, when crossing a street

Driving in fog or other hazardous conditions should be