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153 Cards in this Set
- Front
- Back
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Increasing in body size related to changes in the cells is what?
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Growth
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What is development?
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Orderly pattern of changes in structure, thoughts, feelings and behaviors as a result of experiences, learning, and maturing.
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What is growth characterized by?
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1. Dynamic, continuous process thru life.
2. Ascents, plateaus and declines 3. Physical, cognitive, psychosocial, moral and spiritual |
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What is the nurses role in growth and development/
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To understand that each patient has unique health care needs so you must understand what is expected for each age/developmental level.
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What is the 1st principle of growth and development?
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It is orderly and sequential, continuous and complex, and there are milestones which is the expected level of development based on age. All milestones are on a very individualized basis.
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What is the 2nd principle of growth and development?
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Growth and development follows regular and predictable trends starting from head to toe (cephalocaudal), proximodistal (progress from gross motor movement to fine motor movements) and symmetric where both sides of the body develop at the same time.
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What is the 3rd principle of growth and development?
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It is both differentiated and integrated meaning that as the nerves develop, they become more specialized and each new skill is built on a previous skill.
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What is the 4th principle of growth and development?
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There are different aspects, different stages, different rates and there are modifying factors such as nutrition, love/affection from caregivers, and illnesses.
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What is the 5th principle of growth and development?
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The pace varies from person to person.
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What are the factors that facilitate or delay growth and development?
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Genetics, prenatal care, the individual, the caregiver, the environment and nutrition.
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What type of theorist was Erik Erikson?
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Psychosocial
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Name Erikson's 4 major organizing concepts.
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1. Stages of development
2. Development of goals/tasks 3. Psychosocial crisis 4. Process of coping |
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Name Erikson's 8 stages of development.
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1. Trust v. Mistrust (Birth-12mos)
2. Autonomy v.Shame/Doubt(1-3) 3. Initiative v. Guilt (4-6) 4. Industry v. Inferiority (6-11) 5. Identity v. Role Confusion (teens) 6.Intimacy v. Isolation (young adult) 7. Generativity v. Stagnation (middle adulthood) 8. Ego Integrity v. Despair (Later adulthood) |
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Explain Trust v. Mistrust
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It happens during the first year of life. The baby needs to learn that the caregiver will provide for their needs and this in turn develops trust. The crisis for this developmental stage is when the baby feels his/her needs aren't being met, mistrust is developed.
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Explain Autonomy v. Shame and Doubt
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This occurs between the ages of 1 and 3 where the child is into everything, learning about his/her world. They are developing motor and language skills. With encouragement from the caregiver, the child will learn independence. An overprotective caregiver will foster dependence thus shame, doubt and inadequacy.
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Explain Initiative v. Guilt
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This occurs during the preschool, or 4-6, ages. This is where the child asks lots of why questions and if met with restrictions or are repremanded for trying to learn, they develop guilt.
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Explain Industry v. Inferiority
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This occurs during the school-aged years, from 6-11 years of age. Children during this phase gain pleasure from achieving things, reward and praise are best handled than punishment, when they aren't accepted by their peers, they develop feelings of inferiority and lack of self-worth.
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Explain Identity v. Role Confusion
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This occurs during the adolescent years and is a transition from childhood to adulthood. Secondary sex characteristics begin developing, it is normal for them to rebel in an attempt to define themselves.
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Explain Intimacy v. Isolation
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This stage occurs during young adulthood and they are attempting to tie in their self identity with those of others. The crisis is a fear of commitment which leads to isolation and loneliness. Their process of coping is to try on different relationships.
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Explain Generativity v. Stagnation
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This occurs in middle adulthood when the individual has more concern for other than self. They have the need to guide and nurture the young to make a contribution to the future. the crisis is stagnation. Those are self-absorbed and obsesses w/their own needs. They regress to an earlier stage of coping.
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Explain Ego Integrity v. Despair
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This is in the final stages of life when they are reminiscent of their past life and if it doesn't provide them with a sense of fulfillment and purpose, the crisis is despair.
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What type of theorist is Jean Piaget?
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Cognitive
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Define Cognitive
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Cognitive has two steps according to Piaget:
Learning: Occurs as a result of the internal organization & making it into a plan. Basis for further plans on how we grow and develop. Intellectual Growth: Continual restructuring of our knowledge. Allows you to progress to higher levels of problem solving and how to think critically. |
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Define Assimilation
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Integrating new experiences
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What are the 4 stages of growth and development for Piaget?
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1. Sensorimotor (birth - 24mos)
2. Pre-operational (2-7) 3. Concrete Operational (7-11) 4. Formal Operational (11+) |
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Define the sensorimotor stage.
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0-1 mos: Basic reflexes
1-4 mos: Random behaviors (smiling) 4-8 mos: relates own behavior to a change. 8-12 mos: can coordinate more than one thought at a time. 12-18 mos: developed object permanence 12-24 mos: Reasoning begins and can anticipate events |
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Define the pre-operational stage.
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The child begins to use symbols thru language skills and pictures.
2 parts: Preconceptual stage: 2-4 Intuitive stage: 4-7 |
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Define Concrete Operational
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The child will now have the ability to perform mental operations, think logically, understand the relation between numbers, classify objects, lose egocentricity, manipulation of objects and parents can now begin to bargain with children at this age.
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Define Formal Operational
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The child/adolescent/adult now has abstract thinking, deductive reasoning, tests beliefs, can problem solve and continues to mature.
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What type of theorist is Robert. J. Havighurst?
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Developmental
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What are his stages of development?
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1. Infancy/Early Childhood
2. Middle childhood (6-12) 3. Adolescence ( 13-19) 4.Young Adulthood (20+) 5. Middle Adulthood (40+) 6. Later Maturity |
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Define the tasks of infancy/early childhood
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Tasks:
Physiological ability eats solid foods walk and talk relate to others control elimination understand the difference between right and wrong begin forming simple concepts |
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Define the tasks of Middle Childhood
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Develop the physical skills needed for games
Work on getting along Reading, writing, math develop a conscience, morality and values Personal independence is developed |
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Define the tasks of Adolescence
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Accepting ones own body.
Gender roles Emotional independence from parents/other adults Preparing for a career/marriage/family Being socially responsible Ethical system |
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Define the tasks of young adulthood
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Mate selection
Living with married partner starting a family managing a home occupation Civic responsibility Social group |
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Define the tasks of Middle Adulthood
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Physical changes
occupation Children Spouse Aging parents civic responsibility |
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Define the tasks of later maturity
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Physical changes
Retirement/reduced income death of a spouse change in roles living arrangements establishing an affiliation with an age group |
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What do infants 1-12 months experience in growth?
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Physical growth (teeth, weight, etc)
Gross motor skills (Head to toe, starting w/the neck) Fine motor skills (using whole hand first, then fingers, then pincer grasps and then can feed themselves by 6mos) |
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What do infants 1-12 months experience in development?
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Cognitive (watch, imitate, put things in their mouths to test/figure out)
Language (imitate sounds made by caregivers) Psychosocial (trust vs mistrust by having their needs met) |
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What is the difference between bonding and attachment?
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Bonding is something that occurs w/in the first few hours after birth.
Attachment is active, reciprocal, affectionate behavior that develops between parent and infant. |
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Are we born with our personality/temperment?
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Yes
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What are some health issues that infants face?
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Accidents
Choking Falls (babies fall OFF of things) Strangulation Colic Failure to thrive SIDS Child abuse |
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When do well visits occur?
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At 2, 4, 6, 12 weeks then at 9, 12, 15, 18, 24 months
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What immunizations do infants receive?
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Hep B
Rotavirus DTaP (Diptheria, Tetanus and Pertusis) Hib Pneumococcal IPV (inactive polio vaccine) Influenza >6 mos MMR Varicella Hep A |
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What type of growth will you see in a Toddler 1-3 years of age?
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Brain growth
becomes more physically active by age 2 more than 4 times birth weight achieve 50% of adult height by age 2 Potty training happens between 18-36 mos, sometimes later. Gross motor skills have increased and they can climb stairs, kick or even throw a ball Fine motor skills have increased to drinking from a cup, using a spoon and can draw stick figures by 3 |
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Cognitively, what are the tasks a toddler between 1-3 can achieve?
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Object permanence, anticipate events, know their own name, gender, age, language starts around the first year with 3-5 significant words
those increase to 200+ words by age 2 and by age 3 they should be forming 3-4 word sentences |
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What is the psychosocial development of a 1-3 year old?
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Learning to control urination and knowing right from wrong.
Temper tantrums begin (in an attempt to gain autonomy) Regression can happen Separation anxiety 1st shows up at 9 mos. |
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What are the health issues of toddlers between 1-3?
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Accidents (major cause of death for this age group i.e. MVA's, burns, choking, falls)
Dental caries (rotten teeth from constantly carrying a bottle and teeth being bathed in sugar constantly) common colds, upper resp. infections. |
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What kind of physical growth should you see in children between the ages of 3-6?
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By the age of 6, all 20 teeth are present and the head is fully grown.
Gross motor skills are developed Fine motor skills: they can write their names, left or right hand is established during this group. |
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What is the cognitive development of a child 3-6 years old?
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They ask lots of questions, increased reasoning ability, curious about physical differences, increased self-esteem w/compliments
Understand the basis of body functions |
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What are the language skills of the 3-6 year old group?
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6-18 word sentences, visual accuity occurs between 4-6, completely reached by 6
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What is the psychosocial development of this age?
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Their personalities are developed, they play life, fantasy, play all day
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What are the fears of the 3-6 age group?
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new places, new events, nightmares, increased imagination, toys should be puzzles, coloring books, or toys they can act out with (i.e. princess dresses)
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What are the health issues for children 3-6 years of age?
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Accidents
Dental Caries (parents should be teaching about the importance of brushing their teeth.) Speech disorders are common. If they aren't speaking by the age of 3, an evaluation needs to be done. |
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What is the anticipatory guidance of the 3-6 year age group?
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Nurses teach parents about safety (stranger danger, inappropriate touch)
Nutrition feed when hungry, 6 small feedings a day when they're older than 2, heart healthy diet, period of slow growth and they won't eat more than what they need to. Teach about handwashing and dental visits. Night time enuresis Night fears Discipline Masturbation Well child visits |
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What physical growth do you see between the ages of 6-12?
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Brain is fully developed by 12
Secondary sex characteristics are developing but remain dormant. Gross motor skills, they are coordinated and can even write in cursive by the age of 8. |
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What are the developmental changes of a child 6-12 years of age?
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language is well-developed, they become more sophisticated with their sentence structure, they're better at recalling and remembering and their long term memory is better.
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Who is the most important to the 6-12 year old?
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Peers
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In children 6-12, what defines their self-concept and leads to sexuality?
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Body image, self image and sexuality.
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What are the health issues of children 6-12?
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Accidents
Communicable diseases (lice, common colds, scabies) ADHD/Learning disabilities Enuresis Obesity |
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What is the anticipatory guidance a nurse can provide for the 6-12 age group?
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Safety, Hygiene, TV, Sexual development, physical activity, nutrition, discipline, well visits and immunizations.
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What are the physical changes of the 12-20 year old?
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Physical growth (growth spurts, menses)
Puberty: 9-13 for the female 11-14 for the male |
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What is the definition of a young adult?
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They're between the ages of 20-30, they're physically, psychologically mature and self-sufficient.
Their physical development has completed by the early 20's. Their cognitive development is developed as they are able to control behaviors by what is acceptable in society. |
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What are the health issues for adolescents and young adults?
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Injuries (MVA is #1, being shot is #2)
Substance abuse Suicide Depression Pregnancy Nutrition STDs AIDS Stress Child abuse Risk taking behaviors |
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What is the nurses role?
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Education, encourage healthy family relationships, encourage mutual respect
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What are the anticipatory guidance goals of the nurse for the adolescent/young adult patient?
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Driving behaviors
Drugs/Alcohol/Smoking Nutrition/Activity Risk taking behaviors Communication Independence Dental Sexual activity BSE/TSE Immunizations |
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What are the theories of aging?
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Genetic: metabolic process
Immunity: >age = <immunity Cross-Linkage: Chemical reaction that damages the DNA & causes cell death Free Radical: High energy molecules cause damage to the cells they sit next to causing cell death. |
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Define the "Middle Adult"
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Mid-30's - 65
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What are some of the physical changes that affect the middle adult?
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>40 <60:
Muscles weaken < metabolism <elasticity, skin gets dryer, discoloration, vericose veins, wrinkles hair thins, balding, greying <energy level senses diminish <cardiac output men<sperm count menapause ROM > pain levels <calcium |
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What is the cognitive development of the middle adult?
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They stay the same except they have increased motivation to get things done, and their problem-solving abilities are based on life experience.
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What are some changes a middle adult may experience?
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Employment
Spousal relationships Relationships w/children and aging family members |
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What is the middle adults spirituality?
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Less rigid w/beliefs
Increased faith in a spiritual/supreme being Increased trust in spiritual strength |
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What are some health issues of the middle adult?
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Lifestyle behaviors: Smoking, drinking, not wearing a seatbelt, nutrition
Developmental/situational crisis: mortgages, child development, chronic illnesses Chronic Illness: Heart disease, cancer, diabetes |
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What are the yearly examinations of the middle adult?
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Physical
Eye exam Mammogram Occult Blood PSA PAP Flu Vaccine |
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What are the monthly exams for the middle adult?
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BSE/TSE
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When should the middle adult get an oral exam?
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Every 6 months
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When should the middle adult get a colonoscopy and a pneumoccocal vaccine?
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Every 5 years
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How often should the middle adult get a Tetanus shot?
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Every 10 years
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As a nurse, what health topics should you promote with the middle adult?
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Diet, Exercise, Alcohol in moderation, and smoking cessation.
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Define the "Older Adult"
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Greater than 65
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Name some of the physiological changes of the older adult.
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Skin becomes more page, sagging, loose, changes color
>weakness, <muscle mass, brittle bones, < height <neurological response, loss of sensations, difficulty w/fine motor <sleep <senses Nails become thin/yellow<cap refill |
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What're the components of psychosocial well-being?
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Psychological
Emotional Social Spiritual Sexual |
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Explain the psychosocial/emotional element?
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It's how the person perceives themselves, significant others, the world and encompasses aspects such as self-concept, self-esteem, body imagine and cognitive function.
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Explain the social component.
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Ability to form cooperative and interdependent relationships with others. This area also deals with how someone deals with a loss.
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Explain the spiritual component
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Anything that pertains to a person's relationship with a life force or higher power. A person's source of hope.
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Explain the sexual component
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The way in which a person experiences and exhibits maleness and femaleness physically, emotionally, and mentally. It does encompass sexual behavior but it isn't limited to that.
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What is MSE?
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Mental Status Exam
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What does the MSE assess?
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Level of consciousness
Orientation (to person, place, time and situation) Mood/Behavior Appearance Thought Language Memory Knowledge Abstract Thinking Associations Judgement |
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What is the Glasgow Coma Scale?
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Tests the LOC of a person, the lowest # is a 3, highest is a 15. The higher the #, the more likely they are to improve.
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What is mood?
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Subjective description of feeling state.
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Is behavior associated with mood?
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Yes, they are congruent.
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What are deviations from a logical, organized, reality-based thought process?
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Hallucinations - believe that what you are seeing is real.
Illusions- see/hear something that turns out to NOT be real. Delusions - has to do w/belief systems. Really believe the delusion and it isn't likely to be seen with psychiatric illnesses. |
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How do you assess a patient for anxiety or areas of concern?
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You listen to what they're saying to pick up on a pattern or "thought content."
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What is aphasia?
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inability to use or understand language (spoken or written)
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What types of memory are there?
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Immediate or recall
Recent (past 24 hours) Remote (months or years) |
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When you assess cognitive function, what are you looking for?
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Memory type, if any at all
Attention span Insight and judgement |
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What is self-concept?
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A mental image or picture of ones self.
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What are the interrelated components of self-concept?
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Self-worth/self-esteem
Identity Body Image Roles |
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What is abstract thinking?
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Philosophical thinking with data.
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What is concrete thinking?
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literal thinking (like lawyers, cops)
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What are associations?
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The ability to associate concepts.
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Name the NANDA labels associated with psychosocial/emotional component.
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Body Image Distrub
Coping, ineffective individual Disturbed thought process Hopelessness/Powerlessness Noncompliance Relocation stress syndrome Personal identity disturbance Role performance ineffective Self-esteem, chronic low or situational low |
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What are the components of the social assessment?
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Have there been any recent losses or crises?
What are their coping strategies? Is there a social support system for them? If there were losses, were they maturational or situational? |
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What is loss?
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Loss is universal to all persons
Happens from birth until death and it is a crisis causing a period of adjustment. |
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Maturational Loss
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Necessary loss includes all normally expected life changes across the life span
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Situational Loss
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sudden unpredictable external events
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Grief is the response to loss, what are its components?
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It's subjective
necessary for mental health Process from recognition of loss to reinvestment of energy back into living. |
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What are the stages of grief?
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Denial/Isolation
Anger Bargaining Depression Acceptance |
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Length of time for grief?
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There is no timetable for grief.
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What affects the length of time one grieves?
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Support
Severity Multiple losses @ one time Their usual coping skills |
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What is grieving?
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An intellectual, emotional and behavioral response associated with actual or potential loss.
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What is Complicated (dysfunctional) grieving?
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a demonstration of persistent patterns of intense grief that does not result in a reconciliation of feelings.
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What are the S/S of complicated (dysfunctional) grieving?
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Prolonged intense feelings
Developmental regression Inappropriate expression of anger Difficulty expressing loss Interference in life roles |
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What is spiritual health?
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Spiritual health is when meaning, purpose, love, belonging and forgiveness are met.
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How do you assess Spiritual Health?
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Observe for symptoms of spiritual distress (i.e. a disruption in their belief system).
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Are there differences between spirituality, religion and faith?
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Yes, but they are all interrelated.
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What are some risk factors for spiritual distress?
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Loss or crisis
Discrepancy between beliefs and treatment Disruption in spiritual practices Questioning of spiritual beliefs |
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What is sexuality?
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Something that is:
personally/culturally defined describes one's thoughts and feelings about being a man or a woman Evolves throughout a life cycle Influenced by beliefs surrounding gender role, sexual orientation |
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How do you perform a sexuality assessment?
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Gain depth of information by verbal/nonverbal cues and indicators from assessment that a sexual concern or problem may exist.
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What are some indicators that a sexual concern may exist?
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Weight loss or gain (severe)
Surgery or disease of reproductive organs Pain Altered control of elimination Disfigurement Paralysis after CVA or spinal cord injury Loss of hair after chemo SE of drugs |
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What are the NANDA labels regarding sexual component?
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Ineffective sexuality patterns
Sexual dysfunction |
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What is the definition of Ineffective Sexuality patterns?
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State in which an individual experiences or is at risk of experiencing a change in sexual health.
State in which a person expresses concern about sexuality. |
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What are the major defining characteristics of Ineffective Sexuality Pattern?
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Identification of sexual difficulties, limitations or changes.
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Define Sexual Dysfunction.
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The absence of complete sexual functioning.
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Define the characteristics of sexual dysfunction.
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The pts focus on the inability to achieve desired sexual satisfaction.
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Define Rest
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decreased activity that gives you a feeling of being refreshed
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Define sleep
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state of rest with altered state of consciousness and relative inactivity
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What are the risk factors of not enough sleep?
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Heart disease
illness reaction time, memory loss, confusion poor work performance mood problems unhealthy weight gain or loss |
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What part of the brain helps maintain alertness and wakefulness?
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RAS (Reticular Activating System)
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What part of the brain produces sleep?
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Bulbar synchronizing region
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What part of the brain is the major control center for both sleeping ad waking?
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The Hypothalamus
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What is the body's biological clock based on a 24/hr period?
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Our circadian rhythm
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Define the 4 stages of NREM (non rem) sleep
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I: 5% of sleeping time, involuntary muscle contractions can happen
II: 50% of sleep time III: 10% of sleep time IV: 10% of sleep time, muscles are deeply relaxed and it's very difficult to awaken the person |
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What is REM sleep?
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The deepest form of sleep. It is an active part of sleep in which you spend 20-25% of your sleep time. Dreams happen in this state, vital signs actually increase for a short period of time.
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What happens in Sleep Deprivation?
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REM rebound happens if you have entered into REM sleep long enough.
REM sleep is needed for adaptation, memory, learning, and balance. |
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How many times do you cycle throughout the stages of sleep a night.
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4-5 cycles about 90 minutes each
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How much sleep do infants need?
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16 hours, 4 hrs at a time
sleeps through the night by 4 mos no longer have to wake to feed |
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How much sleep do toddlers need?
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12hrs a night w/naps during the day
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How much sleep do preschoolers need?
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8-12 hrs a night
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How much sleep do adolescents need?
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12-15 hours of sleep due to growth spurts. Not enough sleep causes them to be very moody.
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How much sleep do young adults need?
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6-8 hours of sleep
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What developmental issues begin to occur for the middle aged adults?
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total sleep time decreases
<REM stage Insomnia is common |
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What developmental issues begin to occur for older adults?
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50% report sleep problems
5-7 hours tops, problems w/falling and/or staying asleep |
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How does physical activity help sleep?
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increases relaxation
promotes sleep REM/NREM sleep increases |
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How do dietary issues affect sleep?
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Bedtime snacks can actually help promote sleep (small carb snacks)
Alcohol in moderation helps sleep, too much has the opposite effect. Caffeine is a CNS stimulant and interferes with the ability to sleep Nicotine also interferes with sleep, but going cold turkey causes temp. sleep disturbances. |
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What are the environmental issues that affect sleep?
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Strange new places, strange noises, light, dark, temp of the room
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What is the definition of sleep apnea?
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Not breathing or decreased breathing efforts during sleep
<HR <O2 sats > BP |
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What are the risk factors for sleep apnea?
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obesity, smoking, ETOH abuse, positive fam. history, short thick neck,
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What is EDS?
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Excessive daytime sleepiness
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How is mild sleep apnea treated?
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Encourage good sleep hygiene, weight loss
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How is moderate to severe sleep apnea treated?
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Tonsillectomy, oral appliance, CPAP, Surgery
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What is Parasomnia?
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Patterns of waking behavior that occur while you sleep like:
sleep walking sleep talking Night terrors Bruxism (teeth grinding) Eneuresis (bed wetting) And patients that eat during the night while they're still asleep |
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What is sleep deprivation?
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<amount, consistency, and quality of sleep.
Caused by illness, stress, medications |
