Nursing A Concept Based Approach to Learning VOLUME

Nursing: A Concept Based Approach to Learning VOLUME TWO EDITION VOLUME TWO| | SECOND EDITION MODULE 25 Development Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Normal Development • Growth refers to physical change, increase in size • Development refers to increase in complexity of function § Skill progression § Capacity, skill to adapt to environment Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Normal Development, continued • Principles § Continuous, orderly, sequential processes § All humans follow same pattern § Sequence of each stage predictable Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Normal Development, continued • Principles § Each developmental stage has own characteristics § Cephalocaudal, proximodistal directions § Development proceeds from simple to complex Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Concept Map Overview of Growth and Development Psychosocial Theories and Theorists

Theories of Growth and Development, continued • Psychosocial theories § Erikson • Life sequence of developmental stages or levels of achievement • Health of personality depends on level of success at each stage or crisis • Stages reflect positive, negative aspects of critical life periods • Stress can cause regression to unresolved stage Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Theories of Growth and Development, continued • Psychosocial theories § Erikson's Eight Stages of Development • • Infancy birth– 18 months Early childhood 18 months– 3 years Late childhood 3– 5 years School age 6– 12 years Adolescence 12– 20 years Young adulthood 18– 25 years Adulthood 25– 65 years Maturity 65 years–death Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Theories of Growth and Development, continued • Piaget's theory of cognitive development § Manner in which individuals learn to think, reason, use language § Orderly, sequential process § Variety of new experiences (stimuli) must exist before intellectual abilities can develop § Individual develops through each phase Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Theories of Growth and Development, continued • Piaget's Phases of Cognitive Development § § § Sensorimotor Preconceptual Intuitive thought Concrete operations Formal operations Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Screenings • Well child visits • Developmental assessments Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Lifespan and Cultural Considerations • Nutritional practices • Childrearing practices • Cultural groups have rules regarding patterns of social interaction • Genetic traits in certain ethnic or cultural groups Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Diagnostic Tests • Laboratory diagnostic tests generally are not used • Observational tools • Questionnaires • Screening tests Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Interventions and Therapies • Alterations in more than one area of function • Treatment approach varied Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Intrauterine Life • Terminology of gestation (pregnancy): § Pre embryonic stage = First 14 days § Embryonic stage, Embryo = Day 15 through week 8 § Fetal stage, Fetus = End of week 8 until birth • During gestation or the prenatal period, the embryo grows from a single cell to a complex, physiological being. Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Transition from Intrauterine to Extrauterine Life • APGAR score • Physical changes § Independent circulatory and respiratory functioning § Maintenance of body temperature • Psychosocial changes: attachment Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Newborn • Assessment: Physical changes § Measure height, weight, head and chest circumference, temperature, pulse, and respirations. § Observe general appearance, body functions, sensory capabilities, reflexes, and responsiveness. § Assess gestational age. • Attachment Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Newborn • Observe: Level of activity, alertness, irritability, and responsiveness to stimuli and the presence and strength of reflexes • Normal reflexes: Blinking in response to bright lights, startling in response to sudden loud noises or movement, sucking, rooting, grasping, yawning, coughing, sneezing, palmar grasp, swallowing, plantar grasp, Babinski, and hiccoughing • Normal behavioral characteristics: Periods of sucking, crying, sleeping, and activity Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Newborn • Cognitive changes: Innate behaviors, reflexes, sensory functions § Crying as communication § Need for sensory stimulation • Psychosocial changes § Attachment bond forms within first month. § Illness may compromise attachment process. Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Infants (Birth to 1 Year) • Physical growth and development § Rapid § Milestones • Cognitive development § Brain continues to increase in complexity • Psychosocial development § Solitary play § Manipulation of toys Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Box 21 -2 Infant Reflexes Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Table 21 -1 Examples of Motor and Social Development in Infancy Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: • Weight § Doubles by 5 mo § Triples by 12 mo • Length § Gains 13. 75 cm (5. 5 in. ) by 6 mo § Additional 7. 5 cm (3 in. ) by 12 mo. Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: (cont'd) • Head and Chest Circumference § Head > chest at birth § Head = chest 9 10 mo. § Head < chest after 1 yr. Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: (cont’d) • Anterior fontanel closes between 9 and 18 mo. • Posterior fontanel closes between 2 and 3 mo. Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Sutures and Fontanels Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: (cont'd) • Vision § Birth blinks in response to bright light § 1 mo focus on objects § 4 mo almost complete color vision, follows object in 180° arc § 5 mo reaches for objects § 6 10 mo focus on object and follow in all directions § 12 mo depth perception developed Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: (cont'd) • Hearing § Intact at birth • Moro reflex to loud noises § 2 3 mo vocalize to sounds and voices § 3 6 mo looks for sounds, pause to listen, responds to angry/happy voices Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: (cont'd) • Hearing § 6 9 mo may look at named objects/people § 9 12 mo understands some words, uses gestures, say one or two words § 12 mo responds to simple commands Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: (cont'd) • Smell and Taste § Intact at birth • Touch § Well developed at birth § Poor temperature regulation § Diffuse response to pain Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Infants (Birth to 1 Year), continued • Psychosocial development § Personality and temperament • Differences in responses to environment • Nursing assessment identifies personality characteristics § Communication • • Express comfort by soft sounds, cuddling Nonverbal methods Nursing assessment identifies delays Denver II developmental test Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Development (Erikson) • Neonates and Infants § Trust versus mistrust Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cognitive Development (Piaget) • Sensorimotor Phase § Perceptual recognition (4– 8 mo. ) § Responds to new stimuli, remembers objects, looks for them (6 mo. ) § Concept of both space and time develops (12 mo. ) Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Toddlers (1 to 3 Years) • Physical growth and development § Rate of growth slows § Gross motor activity develops rapidly § Milestones • Cognitive development § Sensorimotor to preoperational stage § Early language § Rudimentary problem solving Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: • Lose the “baby look” by age 2 • Gain 3– 5 kg (7 – 10 lb) between ages 1 and 3 • Height spurts between ages 1 and 2, then slows • By 24 mo. , head circumference 80% adult size Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: (cont'd) • Vision continues to mature; 20/40 at age 2 • Hearing, taste, smell, and touch increasingly developed • Fine and gross motor skills improve Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Toddlers (1 to 3 Years), continued • Psychosocial development § § Motor skills changing Parallel play Physical skills Personality and temperament • Retains most characteristics from infancy • Some changes • Increasing independence Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Toddlers (1 to 3 Years), continued • Psychosocial development § Communication • Capacity for language skill development greatest • Receptive speech far outpaces expressive speech • Vocabulary of almost 1, 000 words • Expressive jargon • Tantrums • Parents promote communication Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Development (Erikson) • Toddlers § Autonomy versus shame Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cognitive Development (Piaget) • Completes Sensorimotor Phase § Trial and error problem solving § Solving problems mentally • Preconceptual Phase (2 yr) § Learn sequence of time § Develop some symbolic thought Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Preschool Children (3 to 6 Years) • Physical growth and development § Growth steady, slow § Physical skills continue to develop § Milestones • Cognitive development § Preoperational thought Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: • Body appears out of proportion as extremities grow more quickly • Weight gain generally slow • Doubles birth length by age 5 • 20/30 normal vision at age 5 Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: (cont'd) • Hearing at optimal levels • Shows taste preferences • Motor abilities strengthen as child begins to master physical activities Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Preschool Children (3 to 6 Years), continued • Psychosocial development § More independent in establishing relationships § Interacts closely with children, adults § Play • Interactive, associative • Large and fine motor activities • Dramatic play Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Preschool Children (3 to 6 Years), continued • Psychosocial development § Personality and temperament • Characteristics observed in infancy tend to persist • May need assistance in new situations • Encourage parents to see children as individuals • May not learn in same way Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Preschool Children (3 to 6 Years), continued • Psychosocial development § Communication • • Vocabulary increases to over 2, 000 words Complete sentences of several words Sophisticated speech Concrete visual aids Allow time for child to integrate explanations Verbalize frequently to child Drawings, stories to explain care Accurate names for bodily functions Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Development (Erikson) • Preschoolers § Initiative versus guilt Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cognitive Development (Piaget): • Intuitive Thought Phase § Still egocentric, but subsiding • • Learn through trial and error Think of one idea at a time Do not understand relationships 5 yr – count pennies, reading skills develop Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

School Age Children (6 to 12 Years) • Physical growth and development § § § Boys, girls close in size, proportions Rapid increases in size Nutritional needs increase dramatically Loss of deciduous teeth Milestones Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: • Major weight gain § age 9– 12 (girls) and 10– 12 (boys) • Growth spurt § age 10– 12 (girls) and 12– 14 (boys) • 20/20 vision established between ages 9– 11 • Well developed senses of hearing and touch Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: (cont’d) • Increased perspiration and other prepubertal changes • Motor abilities well developed during this period Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

School Age Children (6 to 12 Years), continued • Cognitive development § Concrete operational thought at about age 7 § Learns concept of conservation § Understands that healing will occur Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

School Age Children (6 to 12 Years), continued • Psychosocial development § Play • • Understands team roles Cooperates Increasing desire to spend time with friends Separation from playmates (hospitalization) can lead to feelings of sadness Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

School Age Children (6 to 12 Years), continued • Psychosocial development § Personality and temperament • Enduring aspects of temperament continue • Child classified as "difficult" may have difficulty in classroom § Communication • Learns how to correct lingering pronunciation, grammatical errors • Communication strategies Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

School Age Children (6 to 12 Years), continued • Psychosocial development § Sexuality • Need information about bodily changes • Interested in sexual issues • Friends, media common sources of misinformation • Appropriate, inappropriate touch • Encourage child to go to more than one person if inappropriate touch occurs Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Development (Erikson) • School age Children § Industry versus inferiority Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cognitive Development (Piaget) • Concrete Operations Phase § § § Cooperative interactions Intuitive reasoning Cause and effect Concepts of money and time learned Reading skills well developed Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Adolescents (12 to 18 Years) • Physical growth and development § § § § Puberty Growth spurt Male, female patterns of fat distribution Sweating, odor to perspiration Body organs fully mature Adult doses of medications Milestones Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: • Body parts reach adult size, beginning with head, hands, and feet • Rapid growth in height and weight for boys, slower in girls • Glandular changes cause increased sweat and acne • Primary and secondary sexual characteristics develop Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Adolescents (12 to 18 Years), continued • Cognitive development § Formal operational thought § Develops ability to reason abstractly § Thinks and acts independently • Rebels against parents • Psychosocial development § Sports, school activities § Quiet activities § Increasing communication, peer interaction Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Adolescents (12 to 18 Years), continued • Psychosocial development § Activities • • • Drive, ride buses, bike independently Participation in sports Hanging out Peers important Same sex interactions predominate § Personality, temperament • Characteristics remain stable • Support teen's uniqueness Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Warning Signs of Suicide • The following warning signs often occur for at least a month before suicide is attempted: Decrease in school performance Withdrawal Loss of initiative Loneliness, sadness, and crying Appetite and sleep disturbances Verbalization of suicidal thoughts Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Adolescents (12 to 18 Years), continued • Psychosocial development § Communication • • All parts of speech used, understood Increasingly leaves home base Has need to leave past, be different Breaks rules Privacy Give opportunity to ask questions alone Choice about parental presence Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Adolescents (12 to 18 Years), continued • Psychosocial development § Communication • • Teen rooms in hospitals Peer support Choices Guidelines • Written, verbal • Safe exploration of topics Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Adolescents (12 to 18 Years), continued • Psychosocial development § Sexuality • Maturation of body • Growing interactions with members of opposite sex • Needs clear information about body, sexuality • Alternatives, support for decisions • Sexual minority groups Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Development (Erikson) • Adolescents § Identity versus role confusion Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cognitive Development (Piaget) • Formal Operations Phase § Thinking beyond the present § Idealistic thinking § Abstract thinking Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Young Adults • Young adult 18– 25 years § § Peak of physical development Psychosocial stressors Physical assessment Health history Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development: • Prime physical years • Musculoskeletal system well developed and coordinated • Other body systems functioning at peak efficiency • Weight and muscle mass may change as a result of diet and exercise Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development (cont'd) • Physical changes in pregnant and lactating women Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Changes Lifestyle Career Sexuality Childbearing cycle Types of families Parenthood Alternative family structures and parenting Singlehood Emotional health Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Development • Erickson’s stages of development: § Intimacy vs. isolation Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cognitive Development • Piaget’s formal operations stage not last stage • Postformal thought § Creativity § Intuition § Ability to consider information in relationship to other ideas § Understanding of the temporary Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cognitive Development: (cont’d) • Postformal thought § Proceed from abstract thinking to practical consideration § Problems have more than one cause, more than one answer, and some solutions will work better than others § Comprehend and balance arguments Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Middle Adults • Middle adult 40– 65 years § Similar physical status, function to that of young adult § Physical assessment § Health history Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development Appearance changes Skeletal muscle bulk decreases Thinning of intervertebral discs Calcium loss from bone Blood vessels lose elasticity and become thicker • Decline in visual acuity • Presbyopia • • • Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Development (cont'd) • Presbycusis • Decreased taste sensation • Gradual decrease in tone of large intestine may lead to constipation • Urinary system affected as glomerular filtration rate decreases • Hormonal changes take place in both men and women Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Changes • • • Expected events Sandwich generation Career transition Sexuality Family psychosocial events: § § Marital changes Singlehood Family transitions Care of aging parents Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Development • Erikson’s stage § Generativity vs. stagnation Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cognitive Development • Little change in cognitive and intellectual abilities • Reaction time § Diminishes later part of the middle years • Maintain memory and problem solving • Continues learning § Enhanced by motivation Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Older Adults • Older adult § Further divided • Young old 65– 74 • Middle old 75– 84 • Old old 85+ § Normal physiological changes § This population increasing more rapidly than any other age group Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Physical Changes Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition 81 Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Integumentary Changes • • • Skin dryness, pallor, fragility Wrinkling and sagging Age spots Decreased perspiration Thinning, graying of body hair Slower growth and thickening of nails Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Neuromuscular Changes • • Decreased speed and power of muscles Slowed reaction time Loss of height Loss of bone mass Joint stiffness Impaired balance Greater difficulty with complex learning/abstraction Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Sensory Perceptual Changes • Loss of visual acuity • Increased sensitivity to glare • Decreased ability to adjust to darkness • Arcus senilis • Presbycusis • Decreased sense of taste and smell • Increased threshold for pain, touch, and temperature Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Pulmonary Changes • Decreased ability to expel accumulated matter • Decreased lung expansion • Less effective exhalation • Reduced vital capacity • Increased residual volume • Dyspnea with exertion Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cardiovascular Changes • • • Reduced CO and SV Reduced elasticity Increased rigidity of arteries Increased DBP and SBP Orthostatic hypotension Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Gastrointestinal Changes • Delayed swallowing time • Increased indigestion • Constipation Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Urinary Changes • • • Reduced filtering Impaired renal function Less effective concentration of urine Urgency and frequency Nocturia Retention Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Genital Changes • Prostate enlargement • Atrophy of vulva, cervix, uterus, fallopian tubes, ovaries • Reduction in vaginal secretions • Changes in vaginal flora • Changes in sexual functioning Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Immunological Changes • • Decreased immune response Lowered resistance to infection Poor response to immunizations Decreased stress response Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Endocrine Changes • Increased insulin resistance • Decreased thyroid function Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Psychosocial Changes • • • Retirement Economic change Grandparenting Relocation Maintaining independence and self esteem Facing death and grieving Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Cognitive Abilities • End with formal operations (Piaget) • Intellectual capacity § § Perception Cognitive agility Memory Learning Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Developmental Tasks • Erikson § Ego integrity versus despair Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved