Key Terms

0 Anorexia Nervosa- an eating disorder characterized by

refusal to maintain a healthy body weight and an obsessive fear of gaining weight, often coupled with a distorted self image. Bulimia- an eating disorder that often has its roots in psychological problems. A person with bulimia consumes a great deal of food in a short amount of time and then purges the food from the body, most often by vomiting. Germinal Stage- this stage is characterized by rapid cell division and implantation of fertilized egg in the uterine wall. Embryonic Stage- characterized by rapid cellular differentiation, growth, and development of the body systems. Fetal Stage- characterized by rapid growth and differentiation of body system and parts.

Key Terms
0 Fetal Alcohol Syndrome (FAS)- a condition in which

0 0 0 0

fetal development is impaired and is manifested in the infant by characteristics physical attributes and intellectual problems. Obesity- weight that is 20% or more above the ideal body weight. Teratogenic Substances- any substance that can cross the placental barrier and impair normal growth and development. Assimilation- the process of taking in new experience or information. Accommodation- allows for readjustment of the cognitive structure to take in the new information. Adaptation- refers to the changes that occur as a result of assimilation and accommodation.

Fundamental Concept of Growth and Development

0 Growth- the quantitative (measurable) changes

in the physical size of the body and its parts, such as increase in cells, tissues, structures, and systems. e.g. physical changes in height, weight, bone density, and dental structures.
0 Development- the qualitative term that refers to

behavioral changes and increasingly competency in functional abilities and skills. e.g. ability to walk, run and talk.

Principles of Growth and Development

0Developmental occurs in cephalocaudal direction. 0Development occurs in a proximodistal manner 0Development occurs from simple to complex and from

general to specific. 0Growth and development do not proceed at a consistent rate 0Every person proceeds through stages of growth and development at an individual rate. 0Every stage of development has specific characteristics. 0Each stage of development has certain tasks to be achieved. 0Some stages are more critical than others.

Factors Influencing Growth and Development

0 Heredity

0 Life experiences
0 Health Status 0 Cultural Expectations

Theoretical Perspectives of Human Development

Nurses must have a thorough understanding of human growth and development in order to provide individualized care.
0 Physiological Dimension

Physiological growth of a child is influenced primarily by interaction of genetic predisposition, the CNS, endocrine system and maturation.
0 Psychosocial Dimension

Psychosocial dimension of growth and development consist of subjective feelings and interpersonal relationships.

Theoretical Perspectives of Human Development

0 Psychosocial

Dimension Self- Concept ( view of ones self, including body image, self- esteem, and ideal self.)

Theoretical Perspectives of Human Development

Psychosocial dimension is divides into two theories: Intrapsychic and Interpersonal Theory Intrapsychic Theory- focuses on individuals unconscious processes. Feelings, needs, conflicts, and drives are considered to be motivators of behaviour, learning, and development. Sigmund Frued, Erik Erickson and Robert Havighurst are the intrapsychic theorists. Refer to table 17-2 for Freuds stages of psychosexual development, table 17-3 for Ericksons psychosocial development and 17-4 for Havighurst.

Theoretical Perspectives of Human Development

Interpersonal Theory Harry Stack Sullivan theorized that relationships with others influence how ones personality develops. To form satisfying relationships with others, an individual must complete six stages of development which are shown in table 17-5.

Theoretical Perspectives of Human Development

0 Cognitive Dimension- characterized by the intellectual

process of knowing, which includes perception, memory, and judgement and develops as an individual progresses through the life span. Jean Piaget- theorized that children learn to think by playing and is categorized intellectual development into four phases. Refer to table 17-6.
The individual learns by interacting with others in the environment through the processes: Assimilation, Accommodation, and Adaptation.

Theoretical Perspectives of Human Development

0 Moral Dimension- consist of a persons value system hat

helps in differentiating right and wrong.

0 Moral maturity- the ability to independently decide fro oneself what is right.

Piaget and Lawrence Kohlberg are among the theorists who have studied the development of moral judgement. Refer to table 17-7 for Kohlbergs stages of moral development.

Theoretical Perspectives of Human Development

0 The spiritual dimension is characterized by a sense of

personal meaning. 0 Spirituality- refers to relationship with ones self, with others, and with a higher power or divine source 0 Refer to table 17- 8for Fowlers Stages of Faith.
Even though the ages at which individuals experience each stage will vary, the sequence remains still the same.

Holistic Framework for Nursing

Stages of the Life Cycle

Nursing Implications, Wellness Promotion and Safety Considerations

PRENATAL
0 Beginning with conception and ending with birth. 0 Critical time in the development of human beings. 0 Consist of three developmental phases: 0 Germinal stage: begins with conception and last

approximately 10- 14 days. 0 Embryonic stage: the first 2-8 weeks after fertilization. 0 Fetal stage: intrauterine developmental period from 8 weeks to birth. 0 Refer to table 17- 10 for fetal development.

Nursing Implications
0 Common health problems

are related to mothers lifestyle, physical and emotional health, nutritional and prenatal care.

0 Prenatal examination and

screening is important.

Wellness Promotion
0 Teach the pregnant woman

about proper nutrition. 0 Supplements should not be substituted for adequate intake of food. 0 Other Nursing intervention includes:
0 0 0 0 0

Screening Teaching Counseling Modalities to reduce stress Helping others to obtain prenatal care.

Safety Considerations
0 Pregnant woman should not

take in any teratogenic substance such as alcohol, cigarettes, drugs, etc. 0 (FAS)- a condition in which fetal development is impaired. 0 Teach pregnant women to check labels of all medicines for information about potential effects on fetus.

John Ryan Portugal

Trisomy 21 or Down Syndrome

NEONATAL

NEONATAL
0 The first 28 days of life

following birth. 0 Time of major adjustment from uterus to the outside environment. Table 17-11. 0 Neonates activities are reflexive in nature. Fig. 175, table 17-12. 0 The neonate progresses developmentally from a mass of reflexes to behaviour that is more goal directed.

0 Psychological adaptation

also undergoes. 0 The major psychological task of neonates is to adjust to parental figures. 0 Bonding- formation of attachment between parent and a child.

Nursing Implication
0 Colic, diaper rash, and

regurgitation are the common health problem that lead into changes in sleeping, feeding and elimination 0 Apgar assessment is performed immediately after delivery, includes evaluation of reflexes. Table 17-13. 0 Encourage the parents to cuddle the newborn. 0 Neonate must be also evaluated for any abnormalities.

Wellness Promotion
0 Teach the first-time parents the need information about 0 0 0 0 0 0 0

basic newborn needs. Teach the expected developmental milestones to parents. Continually assess the neonates physiological status. Provide warm and clean environment. Monitor nutritional status. Conduct screening test. Promote early parent- neonate interaction. Selection of feeding methods.

Safety Considerations
0 Teach parents how to use

infant car seat belts. 0 Neonate should not be in contact with a person experiencing an infectious disease. 0 Ensure integrity and cleanliness of neonates skin.

INFANCY

INFANCY
0 The developmental stage

from the first month to the first year of life. 0 Time of continued adaptation. 0 Infant experiences rapid physiological growth and psychosocial development.
0 Refer to table 17-14 for

the over view of infant development in different dimensions.

Nursing Implications
0 Focus is on safety,

prevention of infection, and incorporating child into the family. 0 Knowing the developmental milestone is important. 0 Nursing involves support, reassurance and information to the parents.

Wellness Promotion
0 Three areas in which

parents need guidance from the nurse in caring for their infants are nutrition, protection from infection and promotion of sleep.

Wellness Promotion
0

0
0 0 0 0

Nutrition The American Academy of Pediatrics recommends that infants should be breastfed for the 1st 6-12 months. Promotes maternal and infant bonding. Has immunological benefits. Easily digested. Enhances absorption of fat and calcium. Readily available and economical.

Wellness Promotion
Immunization 0 Nurse should confirm that infants receive all necessary immunizations.
0 Fig. 17-8A and 8B provide schedules for childhood immunizations.

Wellness Promotion
Promotion of Sleep 0 Providing a quiet room for infants. 0 Scheduling feedings and other care activities during periods of wakefulness and drowsy times. 0 Developing sensitivity to the unique sleep and rest periods established by the infants.

Safety Consideration
The use of infant car seats is one of the most effective measures parents can take to ensure infants safety.

TODDLER

TODDLER
0 Begins at 12-18 months and

ends up immediately at age 3. 0 Toddler is independent at this stage and NO is his favourite expression. 0 Family is important in language development and toileting skills. 0 Refer to table 17-15 for the development of the toddler.

Nursing Implications
0 Nurses needs to know that increased in mobility and

curiosity, inability to make judgements, and their immature immune system affects toddlers health. 0 Nurses needs to know that strangers and unfamiliar environment results in stress for the toddler. 0 Establishment of rapport is important in dealing with the toddler . 0 Nurses needs to be sure that the toddler have regular health examination and immunizations.

Nursing Implications
Nursing approaches to use with Toddlers
0 Explain what is being done in a calm tone of voice. 0 Use therapeutic play to alleviate anxiety. 0 Give short, simple directions. 0 After a painful procedure, comfort the child. 0 Encourage parents active participation in the care.

Wellness Promotion
0 Play can be used to

established an effective relationship with the child. 0 Teach parent about preventive measures in preventing infections and diseases. 0 Nutritional needs change during the toddler period as the rate of growth slows.

Wellness Promotion
Nurses should share with parents the ff. about dietary practices: 0 Avoid using of food as a reward. 0 Do not serve large helpings. 0 Expect sporadic eating patterns. 0 Avoid power struggles related to meals. 0 Establish a mealtime routine and follow it. 0 Provide nutritional snacks to meet dietary requirements.

Safety Considerations
0 Toddlers should ride in the back seat buckled into an

approved child safety seat. 0 Toddlers with their increased mobility and curiosity are prone to accidental poisonings especially in administration of medicine. 0 Parents should be taught to inspect toys for: 0 Age appropriateness. 0 Sharp objects. 0 Small parts that can be swallowed. 0 Flammable or toxic materials.

PRESCHOOLER

PRESCHOOL
0 The developmental stage
0

0 0

from the ages of 3 to 6 years old. Refer to table 17-16 for the development of a preschool. Favourite word is why. Ear, nose, throat, skin or urinary tract are the common health problems. Have difficulty of coping with fear

Nursing Implications

PLAY is an important tool that can be used to reduce fear and anxiety.

Wellness Promotion
0 Communicate at the childs

level of comprehension. 0 The child should be included in the health promotion activities. 0 Immunization is a major wellness intervention for pre-schoolers.

Safety Considerations
0 Parents must understand

the importance of teaching young children the meaning of no to prevent accidents. 0 The nurse should emphasize the education about protection from potential hazards.

SCHOOL- AGE

SCHOOL- AGE
0 Developmental stage from

the ages 6-12 years. 0 Refer to table 17-17 for the development od an school-aged child. 0 The school- aged child world expands greatly. 0 Cognitive abilities and creativity is expressed in a variety of unique ways.

Nursing Implication
0 Nutritional needs, obesity,

dental caries and other dental problems, unintentional injury, vision, and hearing deficits, learning disorder, and infectious diseases. 0 Nurses must work closely regarding with illness that requires home care.

Wellness Promotion
0 Nurses can intervene to promote the development of a

healthy lifestyle with children in schools. 0 Nurses can promote wellness in the school-age child by teaching the parents to: 0 Encourage healthy lifestyle 0 Have children immunized 0 Provide nutritional meals 0 Teach children appropriate hygienic measures 0 Schedule regular checkups 0 Schedule dental checkups 0 Establish sleep patterns 0 Report any symptoms of illness 0 Teach safety precaution

Safety Considerations
0 Children should be taught

safety rules for use of such toys. 0 Parents must frequently remind their children of the danger of playing near traffic. 0 Children also must be taught to use caution with strangers because of the possibility of abductions.

PREADOLESCENT

PREADOLESCENT
0 The later school-aged

years from 10-12 are frequently referred to as preadolescence or prepuberty. 0 Mark by rapid physiological changes with accompanying psychological, emotional, and social implications 0 Onset of puberty. 0 Refer to table 17-18 for the preadolescent development.

Nursing Implication
0 Provide health teachings

regarding the use of tobacco, exposure to violence, substance abuse, unsafe sexual practices, insufficient or excessive intake of food, dental problems, and self-image disturbances related to body changes. 0 Established a trusting relationship in dealing with preadolescents.

Wellness Promotion
0 Provide information about

nutrition, rest, activity, and the physiological things that are occurring, growth spurt, sexual changes and psychosocial changes.

Safety Considerations
0 Client education is a major

key in client safety:

0 Violence 0 Substance abuse 0 Sex education

0 Injury from sports and play activities.

0 Development of a healthy lifestyle

ADOLESCENT

ADOLESCENT
0 Developmental stage that

ranges from the onset of puberty to the ages 0f 18 to 20. 0 Major transition from child to adult. 0 Not only physiological changes but also psychosocial adjustments must be made by the adolescent. 0 Focus is on establishing a personal identity and appearance.

Nursing Implications
0 The nurse can support adolescents by providing

0 0 0 0

information and do health teaching about body changes and the common health problems that occur during adolescents including mental health. Use language or terminologies that can be easily understood. The use of non-judgemental approach is essential in establishment of rapport in dealing with adolescents. Encourage adolescent to share health concerns with parents. If possible, include the parents or the caregivers in sharing of the information.`

Wellness Promotion
0 The nurse promotes the

adolescents wellness primarily through teaching. 0 Education in areas of hygiene, nutrition, sex education, developmental changes, and substance abuse prevention. 0 It is done mostly in schools by the school nurse.

Safety Considerations
0 Unhealthy behaviours

contribute to the three major causes of adolescent death: 0 Accidents 0 Homicide 0 Suicide

0 Developmental factors

increase the adolescents risk for accidents.: 0 Impulsive behaviour 0 Sense of being invulnerable to accidents 0 Testing limits 0 Rebelling against adult advice

Safety Considerations
0 Many health problems in adolescents are related to sexual

behaviours including acquired immunodeficiency syndrome (AIDS), sexually transmitted diseases (STDs), and unplanned pregnancy. 0 The effect of teen pregnancy is great. 0 The pregnant adolescent needs expert prenatal care, a supportive environment, and information and prevention of STDs. 0 Nurses who teach adolescent clients on safe sex practice need to be especially sensitive to cultural influences on sexual activity.

Safety Considerations
0 Another major health problem during adolescence is 0 0

0
0

suicide. Perceived by the adolescent as the only alternative to an overwhelming situation. Low self-esteem, lack of maturity, and impulsive behaviour may increase the risk of suicidal behaviour. Refer to box 17-2 for signs of suicidal risk in adolescents. Refer to box 17-3 for indicators of adolescents substance abuse.