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Lesson Module 1: Promoting Maternal & Child Health: Family-Centered Care

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Lesson Module 1: Promoting Maternal & Child Health: Family-Centered Care

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• Obstare - "to keep watch"
• Pais - "child"
• Pre-conceptual healthcare -focuses on the health of the mother and father to ensure the health of a baby in the future.
• Antenatal or prenatal care - care of women during the entire pregnancy
1st trimester of pregnancy: 1 to 3 months
2nd trimester of pregnancy: 4 to 6 months
3rd trimester of pregnancy: 7 to 9 months
• Intrapartal-care - care of women during labor and birth
• Post-partal care - care of women after 6 weeks of giving birth (recovery)
• Perinatal period - the period from 6 weeks before conception to 6 weeks after birth.
• Puerperium - the period of about six weeks after childbirth during which the mother's reproductive organs return to their original nonpregnant condition

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“Promotion and maintenance of optimal family health to ensure cycles of optimal child bearing and childrearing.”

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Summary: As maternal and child health nurses, we are expected to provide holistic family-centered care which means that the care that we are to provide will not only limit to the patient alone, but will also include other family members involved. Moreover, in this area of nursing, the length of time that we are to provide care should not be confined to merely the time of pregnancy. It should also include care during the pre-conceptual period, puerperium period, perinatal period, and even from the child's birth through adolescence.

With all these, the goal of promoting and maintaining
optimal family health to ensure cycles of optimal childbearing and childrearing may be achieved.

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▪ The family is the basic unit of the society.
▪ Families come in many different forms and sizes and represent racial, ethnic, cultural, and socioeconomic
diversity.
▪ Children grow both individually and as part of a family

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Maternal and Child Health Nursing Framework

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Maternal and Child Health Nursing Framework

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During the childbearing and childrearing years of our patients, maternal and child health nurses can come up with a care that encompasses everything we know about nursing such as nursing process, nursing theory, and evidence-based practice.

This can be visualized within the framework above which shows four phases of health care:
Promotion
Maintenance
Restoration
Rehabilitation

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1. Declining live births
2. Increased births attended by health professionals
3. >50% born to unwed mothers
4. More babies born to adolescent mothers
5. Infant Mortality remains unchanged
6. Relatively Low Maternal mortality ratio

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Indicators of Sustainable Development goal 3: Good Health & Well-being

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Indicators of Sustainable Development goal 3: Good Health & Well-being

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> Reduce child mortality
> Improve maternal health

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Factors such as (1) Genetic Inheritance and (2) Environmental Influences can influence or greatly affect growth and development.

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*spleen is usually not palpable in adults but is palpable in preschool children (1 or 2cm below left ribs)

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e.g. John is 6 years old. What body system is reaching its peak point of development at this time?
= Lymphatic system.

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1. continuous processes from conception until death
2. proceed in an orderly sequence
3. Different children pass through the predictable stages at different rates
4. All body systems do not develop at the same rate
5. Development is cephalocaudal
6. Development proceeds from proximal to distal body parts
7. Development proceeds from gross to refined skills
8. There is an optimum time for initiation of experiences or learning
9. Neonatal reflexes must be lost before development can proceed
10. A great deal of skill and behavior is learned by practice

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early childhood education (field of study)

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EDU144 - Principles of Growth and Development

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• Cephalocadual: from head to toe
• Proximodistal: from the trunk to the tips of the extremities/inward to outward
• General to specific: from simple tasks to more complex tasks

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Theory
• a systematic statement of principles that provides
a framework for explaining some phenomenon
Developmental Theories
• provide road maps for explaining human
development
Developmental Tasks
• skill or a growth responsibility arising at a
particular time in an individual’s life
• the achievement of which will provide a foundation
for the accomplishment of future tasks

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• Psychosexual Development – developing instincts or
sensual pleasure (Freud)
• Psychosocial Development – personality development
(Erickson)
• Moral Development – know right from wrong and
apply in real-life situations (Kohlberg)
• Cognitive Development – learn or understand from
experience, to acquire and retain knowledge to
respond to new situation and solve problems (Piaget)

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Child development theories focus on explaining how children change and grow over the course of childhood. These developmental theories center on various aspects of growth, including social, emotional, and cognitive development.

The study of human development is a rich and varied subject. We all have personal experience with development, but it is sometimes difficult to understand how and why people grow, learn, and act as they do.

Why do children behave in certain ways? Is their behavior related to their age, family relationships, or individual temperaments? Developmental psychologists strive to answer such questions as well as to understand, explain, and predict behaviors that occur throughout the lifespan.

In order to understand human development, a number of different theories of child development have arisen to explain various aspects of human growth.

History of Developmental Theories

Child development that occurs from birth to adulthood was largely ignored throughout much of human history. Children were often viewed simply as small versions of adults and little attention was paid to the many advances in cognitive abilities, language usage, and physical growth that occur during childhood and adolescence.

Interest in the field of child development finally began to emerge early in the 20th century, but it tended to focus on abnormal behavior. Eventually, researchers became increasingly interested in other topics including typical child development as well as the influences on development.

More recent theories outline the developmental stages of children and identify the typical ages at which these growth milestones occur.

Why Developmental Theories are Important

Developmental theories provide a framework for thinking about human growth and learning. But why do we study development? What can we learn from psychological theories of development? If you have ever wondered about what motivates human thought and behavior, understanding these theories can provide useful insight into individuals and society.

An understanding of child development is essential because it allows us to fully appreciate the cognitive, emotional, physical, social, and educational growth that children go through from birth and into early adulthood.

Why is it important to study how children grow, learn, and change? An understanding of child development is essential because it allows us to fully appreciate the cognitive, emotional, physical, social, and educational growth that children go through from birth and into early adulthood.

7 Best-Known Developmental Theories

There are many child development theories that have been proposed by theorists and researchers. Some of the major theories of child development are known as grand theories; they attempt to describe every aspect of development, often using a stage approach. Others are known as mini-theories; they instead focus only on a fairly limited aspect of development such as cognitive or social growth.

Freud's Psychosexual Developmental Theory

Psychoanalytic theory originated with the work of Sigmund Freud. Through his clinical work with patients suffering from mental illness, Freud came to believe that childhood experiences and unconscious desires influenced behavior.

According to Freud, conflicts that occur during each of these stages can have a lifelong influence on personality and behavior. Freud proposed one of the best-known grand theories of child development.

According to Freud's psychosexual theory, child development occurs in a series of stages focused on different pleasure areas of the body. During each stage, the child encounters conflicts that play a significant role in the course of development.

His theory suggested that the energy of the libido was focused on different erogenous zones at specific stages. Failure to progress through a stage can result in fixation at that point in development, which Freud believed could have an influence on adult behavior.

So what happens as children complete each stage? And what might result if a child does poorly during a particular point in development? Successfully completing each stage leads to the development of a healthy adult personality.

Failing to resolve the conflicts of a particular stage can result in fixations that can then have an influence on adult behavior.

While some other child development theories suggest that personality continues to change and grow over the entire lifetime, Freud believed that it was early experiences that played the greatest role in shaping development. According to Freud, personality is largely set in stone by the age of five.

Erikson's Psychosocial Developmental Theory

Psychoanalytic theory was an enormously influential force during the first half of the twentieth century. Those inspired and influenced by Freud went on to expand upon Freud's ideas and develop theories of their own. Of these neo-Freudians, Erik Erikson's ideas have become perhaps the best known.

Erikson's eight-stage theory of psychosocial development describes growth and change throughout life, focusing on social interaction and conflicts that arise during different stages of development.

While Erikson's theory of psychosocial development shared some similarities with Freud's, it is dramatically different in many ways. Rather than focusing on sexual interest as a driving force in development, Erikson believed that social interaction and experience played decisive roles.

His eight-stage theory of human development described this process from infancy through death. During each stage, people are faced with a developmental conflict that impacts later functioning and further growth.

Unlike many other developmental theories, Erik Erikson's psychosocial theory focuses on development across the entire lifespan. At each stage, children and adults face a developmental crisis that serves as a major turning point.

Successfully managing the challenges of each stage leads to the emergence of a lifelong psychological virtue.

Behavioral Child Development Theories

During the first half of the twentieth century, a new school of thought known as behaviorism rose to become a dominant force within psychology. Behaviorists believed that psychology needed to focus only on observable and quantifiable behaviors in order to become a more scientific discipline.

According to the behavioral perspective, all human behavior can be described in terms of environmental influences. Some behaviorists, such as John B. Watson and B.F. Skinner, insisted that learning occurs purely through processes of association and reinforcement.

Behavioral theories of child development focus on how environmental interaction influences behavior and is based on the theories of theorists such as John B. Watson, Ivan Pavlov, and B. F. Skinner. These theories deal only with observable behaviors. Development is considered a reaction to rewards, punishments, stimuli, and reinforcement.

This theory differs considerably from other child development theories because it gives no consideration to internal thoughts or feelings. Instead, it focuses purely on how experience shapes who we are.

Two important types of learning that emerged from this approach to development are classical conditioning and operant conditioning. Classical conditioning involves learning by pairing a naturally occurring stimulus with a previously neutral stimulus. Operant conditioning utilizes reinforcement and punishment to modify behaviors.

Piaget's Cognitive Developmental Theory

Cognitive theory is concerned with the development of a person's thought processes. It also looks at how these thought processes influence how we understand and interact with the world.

Theorist Jean Piaget proposed one of the most influential theories of cognitive development.

Piaget proposed an idea that seems obvious now, but helped revolutionize how we think about child development: Children think differently than adults.﻿﻿

His cognitive theory seeks to describe and explain the development of thought processes and mental states. It also looks at how these thought processes influence the way we understand and interact with the world.

Piaget then proposed a theory of cognitive development to account for the steps and sequence of children's intellectual development.

Sensorimotor Stage: A period of time between birth and age two during which an infant's knowledge of the world is limited to his or her sensory perceptions and motor activities. Behaviors are limited to simple motor responses caused by sensory stimuli.

Pre-Operational Stage: A period between ages 2 and 6 during which a child learns to use language. During this stage, children do not yet understand concrete logic, cannot mentally manipulate information, and are unable to take the point of view of other people.

Concrete Operational Stage: A period between ages 7 and 11 during which children gain a better understanding of mental operations. Children begin thinking logically about concrete events but have difficulty understanding abstract or hypothetical concepts.

Formal Operational Stage: A period between age 12 to adulthood when people develop the ability to think about abstract concepts. Skills such as logical thought, deductive reasoning, and systematic planning also emerge during this stage.

Bowlby's Attachment Theory

There is a great deal of research on the social development of children. John Bowbly proposed one of the earliest theories of social development. Bowlby believed that early relationships with caregivers play a major role in child development and continue to influence social relationships throughout life.

Bowlby's attachment theory suggested that children are born with an innate need to form attachments. Such attachments aid in survival by ensuring that the child receives care and protection. Not only that but these attachments are characterized by clear behavioral and motivational patterns.

In other words, both children and caregivers engage in behaviors designed to ensure proximity. Children strive to stay close and connected to their caregivers who in turn provide a safe haven and a secure base for exploration.

Researchers have also expanded upon Bowlby's original work and have suggested that a number of different attachment styles exist. Children who receive consistent support and care are more likely to develop a secure attachment style, while those who receive less reliable care may develop an ambivalent, avoidant, or disorganized style.

Bandura's Social Learning Theory

Social learning theory is based on the work of psychologist Albert Bandura. Bandura believed that the conditioning and reinforcement process could not sufficiently explain all of human learning.

For example, how can the conditioning process account for learned behaviors that have not been reinforced through classical conditioning or operant conditioning According to social learning theory, behaviors can also be learned through observation and modeling.

By observing the actions of others, including parents and peers, children develop new skills and acquire new information.

Bandura's child development theory suggests that observation plays a critical role in learning, but this observation does not necessarily need to take the form of watching a live model.﻿﻿

Instead, people can also learn by listening to verbal instructions about how to perform a behavior as well as through observing either real or fictional characters displaying behaviors in books or films.

Vygotsky's Sociocultural Theory

Another psychologist named Lev Vygotsky proposed a seminal learning theory that has gone on to become very influential, especially in the field of education. Like Piaget, Vygotsky believed that children learn actively and through hands-on experiences.

His sociocultural theory also suggested that parents, caregivers, peers, and the culture at large were responsible for developing higher-order functions. In Vygotsky's view, learning is an inherently social process. Through interacting with others, learning becomes integrated into an individual's understanding of the world.

This child development theory also introduced the concept of the zone of proximal development, which is the gap between what a person can do with help and what they can do on their own. It is with the help of more knowledgeable others that people are able to progressively learn and increase their skills and scope of understanding.

A Word From Verywell

As you can see, some of psychology's best-known thinkers have developed theories to help explore and explain different aspects of child development. While not all of these theories are fully accepted today, they all had an important influence on our understanding of child development.

Today, contemporary psychologists often draw on a variety of theories and perspectives in order to understand how kids grow, behave, and think. These theories represent just a few of the different ways of thinking about child development.

In reality, fully understanding how children change and grow over the course of childhood requires looking at many different factors that influence physical and psychological growth. Genes, the environment, and the interactions between these two forces determine how kids grow physically as well as mentally.

Additional Reading

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Influential Theories About How Children Grow and Develop

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There are many development theories. Learn some of the best-known child development theories as offered by Freud, Erickson, Piaget, and other famous psychologists.

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Sensorimotor: understands world through senses and actions
Preoperational: understands world through language and mental images
Concrete operational: understands world through logical thinking and categories
Formal operational: understands world through hypothetical thinking and scientific reasoning

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Stages
1: I do it so I don't get in trouble
2: I do it so I get something out of it
3: I do it so you like me
4: I do it because it is the law, and I respect the law
5: I do it because of a social contract we have with each other
6: I do it because it is the right thing to do

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FINE MOTOR is the ability to coordinate hand movements

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Gross motor is the ability to accomplish large body movements

Examples of gross motor movements in infants are: Ventral Suspension Position, Landau Reflex, Parachute Reflex, Prone Position, Neck Righting Reflex, Sitting and Standing Position.

developments in these movements are seen over different certain period of time.

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Infants are very prone to accidents. and so, these are one many things to look out for to ensure their safety:
• Falls
• Car safety
• Bathing & Swimming

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- Offer new food one at a time
- Wait 5-7 days before introducing new items
- Introduce small amounts of new food: 1 or 2 teaspoonful at a time

Newborn: 30ml (2tbsp)
1 year: 240ml (1cup)

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addtl:
• Four times birth weight
• Bladder control during the day, sometimes at night
• Turns pages in book, and by age 3 draws stick people

Comparing type of play between infants, toddler, and pre-school
• infancy - solitary play
• toddler - parallel play
• pre-school - pretend play

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Stage 5 (between 12 and 18 months)

• Tertiary Circular Reaction Stage
• “a little scientist”
• child experiments by trial and error methods

Stage 6 (between 18 and 24 months)

• toddlers are able to try out various actions mentally rather than
having to actually perform them—the beginning of problem
solving or symbolic thought
• Deferred Imitation
• remember an action and imitate it later

Preoperational Thought

• children deal much more constructively with symbols
• Assimilation
• change the situation (or how they perceive it) to fit their thoughts

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Toddlers are more fussy eaters compared to infants and food jags are commonly experienced. To ensure proper nutrition, 6 small meals containing iron-rich food should be given, and nutritious snacks are offered. Hotdog, peanuts, and grapes should be avoided.

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• Freud — anal stage, toilet training is major focus
During this stage, sphincter control is to be expected to start at age 2. Therefore, a child should should be already be taught proper toilet training. However, in when toilet training, a caregiver should consider readiness and never punish the child.

• Erikson — autonomy versus shame and doubt
It is during this stage that child develops sense of independence and it is a role of the child's primary caregiver to allow the child to explore the environment with encouragement and of course, with supervision as well. Always monitor safety.

• Havighurst — tasks of learning to control elimination
process, learn sex differences, form concepts, learn
language, and distinguish right from wrong

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• Negativism
• Ritualistic Behavior
• Slowness in carrying out requests/ambivalence
• Temper Tantrums

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• teach parents a good rule is to think of a toddler as a visitor
from a foreign land who wants to participate in everything
the family is doing but does not know the customs or the
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 arise 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

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notes:
Pre-school stage is an important period of growth for parents. While cognitive growth and personality continues to grow at rapid rate, physical growth during this stage slows down.

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LESSON MODULE 4: FAMILY WITH A PRE-SCHOOLER

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LESSON MODULE 4: FAMILY WITH A PRE-SCHOOLER

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• Head is close to adult size by six years old
• Pulse rate decreases to about 85 beats per minute; blood pressure holds at about 100/60 mm Hg
• Bladder is easily palpable above the symphysis pubis
• voiding is frequent enough (9 or 10 times 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 lb (2 kg) a year

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Erikson: 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

Piaget: (1st phase) Preoperational → (2nd phase) intuitional thought (intuitive thought phase)

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• Imitation
Watch adults and imitate behavior
• Fantasy
Imaginative= imaginary playmates
Creative and curious = WHY, HOW
• Oedipus and Electra Complexes
Each child competes with the same-sex parent for the love and attention of the other parent
• Gender roles
“sex” – be honest’
Masturbation may be seen
• Socialization
play with other children their age much more
Significant others now include grandparents, siblings, and preschool teachers (although parents remain central)

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Pre-scholers can determine right from wrong based on their parents' rule. However, unless the parents were able to supply rationale of these rules, pre-schoolers might have difficulty in applying the rules they know to a new situation.

Pre-schoolers begin to have an elemental concept of God if they have been provided some form of religious training

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

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

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- 6 to 12 years
- time of slow physical growth, but cognitive growth and development continue to proceed at rapid rates
- language and vocabulary is now more developed. six-year-olds begin to talk in full sentences.

The school-age years can be a spectacular journey filled with joys and successes as the child
continues to grow and mature. It is also at this stage that the child begins to make truly independent judgments. Children of school age may be more influenced by the attitudes of their friends

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By age 12,
Brain reaches 90% to 95% of adult size, nervous system almost mature, and so, motor abilities and coordination, compared to the previous ages, becomes more refined and developed already. All permanent teeth by this age will be present except for 2nd and 3rd molars

- 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
- Sexual organs grow but are dormant until late in this period

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• annual average weight gain is approximately 3 to 5 lb (1.3 to 2.2 kg); the
• pulse rate decreases to 70 to 80 beats per minute; blood pressure rises to about 112/60mm 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

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At this stage, puberty begins usually at 10-11 for girls, and 11-12 for boys. During this stage, there are significant changes in the body that will begin to appear. The following are some of these changes:

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Concerns of Boys
• increasing genital size
• testicular development precedes penis growth
• gynecomastia: condition of overdevelopment or enlargement of the breast tissue in men or boys; can occur in prepuberty
• although they have pubic hair, they cannot yet grow
a beard or do not have chest hair
• nocturnal emissions: ejaculation during sleep

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Concerns of Girls
• Prepubertal girls are usually taller, by about 2 in (5cm) or more than preadolescent boys
• Change in pelvic contour and hips become broader
• Breast development (whether overdeveloped or underdeveloped)
• Supernumerary (additional) nipples may darken or increase in size at puberty
• Early preparation for menstruation
• Menarche (first menstruation): age 9-12

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Developmental Milestones of the School Age

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Developmental Milestones of the School Age

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Erikson: Industry vs. Inferiority
- child wants to work and produce, accomplishing and achieving tasks.
- focuses on learning useful skills, self-identity emerges. However, i f 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

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Age 6: continues to be rough; but can discover reading and video games and can result to spending time alone, isolation or healthy sense of competition.
Age 7:  decline in imaginative play
Age 8: develop skills for sorting and cataloging; collections may become increasingly structured
Age 9: children become very interested in rules and fairness in competitive play situations; Music and artistic expression; begins to discover Internet;

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• Decentering
• Accommodation
• Conservation
• Class Inclusion

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Piaget's: Concrete Operational Stage
- In this stage, the level of thinking and reasoning of the child advances. Child already begin using inductive reasoning, thinks logically. (ACCOMMODATION)
- Child develops concepts of measurement, classification systems, (CLASS INCLUSION)
- Child understands reversal of events. (CONSERVATION)
- Child also begins to develop awareness of other’s feelings. (DECENTERING)

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During the preschool age, child have already been able to quite observe and explore. And so, during this stage, which is now the school age, child is more likely to:
- have the ability to trust others and with a sense of respect for their own worth
- have the ability to accomplish small tasks independently
- have practiced or mimicked adult roles
- have learned to share, and 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.
- However, at ages 11 to 12, when child begins to approach adolescence, school and parental authority is questioned and, occasionally, even challenged or opposed.  There comes the massive influence of peer group in terms of behavior standards and models

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

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Being Healthy, remember PEDS

Proper nutrition
Exercise
Dental hygiene
Sleep

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• Discover with the child the  “hows” and “whys” of actions
• Give a satisfactory explanation of why it must be done, because child might not cooperate with the procedure.
• Maintain a positive because child will more likely to watch and see the nurses' actions in a given situation

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LESSON 6: CARE OF FAMILY WITH ADOLESCENTS

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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

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• EARLY PERIOD (13 TO 14 YEARS)
• MIDDLE PERIOD (15 TO 16 YEARS)
• LATE PERIOD (17 TO 20 YEARS)

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

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FEMALE: estrogen
breasts and pubic hair grows, wide hips develop

MALE: testosterone
body hair grows, voice breaks, muscle growth increases

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• Age 13: change from school-age activities of active games to more adult forms of recreation
• They learn they are strong and capable to take care of themselves and help less fortunate people
• These activities fulfill an adolescent’s need for satisfying interaction and are indications of maturity and willingness to accept adult roles.

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Erik Erikson: Identity vs. Role Confusion
- Adolescents develop a sense of identity if their development is successful it leads to

the development of an identity they are proud of. However, if unsuccessful there will be role confusion and a weak sense of identity.
If young people do not achieve a sense of identity, they develop a sense of role confusion.

4 main areas to achieve a sense of identity
¹. Accepting their changed body image
2. Establishing a value system or what kind of person they want to be
3. Making a career decision
4. Becoming emancipated from their parents

2nd Developmental Task: Sense of Intimacy
• Once adolescents have achieved a sense of identity in early or mid-adolescence, they are ready to work on a second developmental task, that of achieving a sense of intimacy (Erikson, 1993).
• The ability to form intimate relationships is strongly correlated with the sense of trust, the first developmental task in infancy.
• Infants who are unable to form a sense of trust may be unable to relate to others on a deep enough level to form lasting and close relationships as adults.

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Jean Piaget: Formal Operations
- being able to manipulate your mind

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- In adolescence, an idealistic sense of social justice and fairness develops. They more likely have a need to have choices and make personal decisions, and a desire to make a difference in the world and in the lives of others.

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• Hypertension
• Poor Posture
• Body Piercings and Tattoos
• Fatigue
• Acne
• Obesity

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• Sexual Behaviors
• Stalking
• Hazing
• Drug or Substance Abuse
• Depression
• Suicide
• Runaway

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Three phases:
1. Young Adulthood: 20 to 40 years old
2. Middle Adulthood: 40 to 65 years old
3. Late Adulthood

Three very different generations
1. Baby Boomers: (born in years 1945–1964)
2. Generation X: (birth years 1965–1978)
3. Generation Y or the Millennials: (birth years 1979–2000)

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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

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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.

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HEALTH RISKS:
Young Adult
Injury and Violence
Suicide
Hypertension
Substance Abuse
Sexually Transmitted Infections
Eating disorder
Malignancies

Middle Adulthood:
Injury
Cancer
Cardiovascular Disease
Obesity
Alcoholism
Mental Health Alterations

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LESSON 8: PROMOTING HEALTH IN OLDER ADULTS

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LESSON 8: PROMOTING HEALTH IN OLDER ADULTS

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• Older Adulthood: 65 – 74 years
• Middle Old: 75 – 84 years
• Old-old: 85 and over

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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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• provider of care
• Teacher
• Manager
• Advocate
• research consumer

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• Acute Care Facilities
• Long-Term Care Facilities
• Hospice
• Rehabilitation
• Community

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Normal Physical Changes Associated with Aging

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Normal Physical Changes Associated with Aging

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Neuromuscular: Sarcopenia, Kyphosis (humpback of the upper spine), Osteoporosis
Sensory-Perceptual: Presbyopia, Presbycusis, Loss of peripheral vision, atrophy of lacrimal glands resulting in dry eyes, difficulty in discriminating similar colors, age-related macular degeneration (ARMD), glaucoma, diabetic retinopathy (Miller, 2012)

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Erik Erikson: 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

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Piaget:
-Phases of cognitive development end with the formal operations phase. However, considerable research cognitive abilities and aging is currently
being conducted
- Intellectual capacity includes perception, cognitive agility, memory, and learning

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Kohlberg: moral development is completed in the early adult years

• Older person at the preconventional level: obeys rules to avoid pain and the displeasure of others
• Older adults at the conventional level: follow society’s rules of conduct in response to the expectations of others

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

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• Promote independent function
• Support individual strengths
• Prevent complications of illness
• Secure a safe and comfortable environment
• Promote return to health

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LESSON 9: ASSESSING MATERNAL AND FETAL HEALTH

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LESSON 9: ASSESSING MATERNAL AND FETAL HEALTH

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Early Term: 37-38 weeks
Full Term: 39-40 weeks
Late Term: 41 weeks
Post Term: 42 weeks

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• Systemic: all systems except reproductive system
• Local: reproductive system including the breast

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• 1st trimester: 1-3 mos
• 2nd trimester: 4-6 mos
• 3rd trimester: 7-9 mos

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3P's:
Presumptive
Probable
Positive

• Presumptive: highly subjective (e.g. breast tenderness, enlarged uterus felt by the pregnant woman)
• Probable: (+) signs and symptoms but can be indicative of other health conditions (e.g. false positive pregnancy)
• Positive: undeniable sign; confirmed
3 signs of positive:
- fetal outline in UTZ
- fetal heart tone
- fetal movement felt by examiner

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- term used to describe how far along the pregnancy is.

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Bartholomew's Rule of Four
measuring the height of the fundus of the uterus above the pubic symphysis.
• above symphysis fundus: 12 weeks
• above umbilicus: 20 weeks
• in between symphysis fundus and ambilicus: 16 weeks
• above xiphoid process: 36 weeks
• fundus descend (lightening): 38 weeks

McDonald's Rule
measuring the height of fundus in centimeters (cm)
e.g. 36 cm = 36 weeks

assessment: position the pregnant woman in a supine position (slightly flexed with small pillow behind the right pelvis)

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CARDIOVASCULAR SYSTEM
• heart rate + 20 bpm; increased cardiac output
• palpitations
• mild hypertrophy (goes away after pregnancy)
• presence of extra heart sounds (s3)
*disclaimer: refer to physician if accompanied with DOB, chest pain
• blood pressure may decrease
• varicose veins
• edema on lower extremities only

URINARY SYSTEM
• high urinary frequency
• increased urine output

RESPIRATORY SYSTEM
• decreased RR; shortness of breath without DOB
• nasal stuffiness
• sinus congestion
• nose bleeds

GI SYSTEM
• constipation
• bloating
• morning sickness
• gastric reflux/heartburn

REPRODUCTIVE SYSTEM
• breast development
• increase in melanocyte: results to hyperpigmentation/darkening of skin
• melasma
• linea nigra: line from the symphysis pubis to umbilicus

ENDOCRINE
• increased thyroid activity
• increased metabolic needs
• slight enlarged thyroid