1. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 19 Conception Through Young Adult

2. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Three Stages of the Fetus Preembryonic stage—conception to third week –Three distinct cell layers—endoderm, mesoderm, and ectoderm Embryonic stage—fourth to eighth week –All basic organs established Fetal stage—ninth week to birth –Body organs and systems continue to grow

3. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Physical Characteristics of a Normal Neonate (Birth to 28 Days) Reflexes develop (moro, stepping, grasp, hand to mouth, sucking, etc.) Body temperature responds quickly to environmental temperature Senses used to respond to environment Stool and urine eliminated Active crying and quiet alert state exhibited

4. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflexes of the Neonate

5. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflexes of the Neonate

6. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Physiologic Development of the Infant (1 Month to 1 Year) Brain grows to half of adult size Body temperature stabilizes Motor abilities develop Eyes begin to focus Heart doubles in weight Deciduous teeth begin to erupt Birth weight usually triples by one year (average 22 lbs.)

7. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychosocial Development of Infant In oral stage, immediate gratification of needs Develops trust (Erikson) Meets developmental tasks (Havighurst) (taking food, walking, talking)

8. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Considerations for the Infant Attachment and bonding Play Temperament –Easy, slow to warm, difficult

9. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Healthcare Issues for the Infant Accidental injuries Colic SIDS Failure to thrive Child abuse

10. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Physiologic Development of Toddler (1 to 3 Years) Rapid brain growth, increase in bone length and muscle growth Uses fingers to pick up small objects Walks, runs, kicks, climb, rides tricycle, drinks from cup Four times birth weight Bladder control during the day, sometimes at night Turns pages in book, and by age 3 draws stick people

11. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Cognitive Development of Toddler In Piaget’s last two stages of sensorimotor development Understands self as separate from others Beginning perception of body image Sense of gender identity Language begins, at two years, uses short sentences

12. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychosocial Development of Toddler Freud—anal stage, toilet training is major focus Erikson—autonomy versus shame and doubt Havighurst—tasks of learning to control elimination process, learn sex differences, form concepts, learn language, and distinguish right from wrong

13. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Solitary or Parallel Play of the Toddler

14. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Physiologic Development of Preschooler Head is close to adult size by 6 years old Body is leaner and more coordinated Motor abilities include jumping, skipping, throwing a ball, printing letters and numbers Full set of 20 deciduous teeth Average weight 45 pounds

15. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Cognitive Development of Preschooler Egocentrism increases Play more related to real-life events Basic curiosity results in constant questions and improved reasoning ability Language development more elaborate

16. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychosocial Development of the Preschooler Freud—phallic stage, biologic focus is genital Erikson—initiative versus guilt, conscience develops Havighurst—four developmental tasks –Learn sex differences and modesty –Describe social and physical reality in language and concept formation –Get ready to read –Distinguish right from wrong

17. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Physiological Development of School-Age Child (6 to 12 Years) Brain reaches 90% to 95% of adult size, nervous system almost mature by age 12 Motor abilities progress to writing in script and in sentences by age 12 Sexual organs grow but are dormant until late in this period All permanent teeth present except for 2nd and 3rd molars by age 12 Height increases 2 to 3 inches and weight increases 3 to 6 pounds a year

18. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Cognitive Development of School-Age Child In Piaget’s concrete operational stage, organizing facts and problem-solving Uses inductive reasoning to solve new problems Thinks logically and develops concepts of measurement Generalizes about people, places, and things Develops classification systems, understands reversal of events Has an awareness of other’s feelings

19. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychosocial Development of School-Age Child Freud—latency stage, strong identification with own sex Erikson—industry versus inferiority stage, focus on learning useful skills, self-identity emerges Havigurst—tasks of learning physical games, appropriate social roles, developing writing, reading, and calculating skills, avoiding personal independence, developing conscience, morality, and values

20. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Issues for School-Age Children Accidents Communicable conditions Attention deficit hyperactivity disorder Learning disabilities Chronic illnesses Enuresis

21. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Physiologic Development of the Adolescent Feet, hands, and long bones grow rapidly; there is an increase in muscle mass Primary and secondary development occurs (puberty) Sebaceous and auxiliary sweat glands become active Full adult size is usually reached

22. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Three Stages of Puberty Prepubescence –Secondary sex characteristics begin to develop –Reproductive organs do not function yet Pubescence –Secondary sex characteristics continue to develop –Ova and sperm begin to be produced Postpubescence –Reproductive functioning and development of secondary sex characteristics reach adult maturity

23. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Cognitive Development of Adolescent/Young Adult Piaget—formal operations –Deductive, reflective, and hypothetical reasoning are possible –Abstract concepts can be used –Long-term goals can be set –Concepts of time, its passage, and future become real

24. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychosocial Development of Adolescent/Young Adult Freud—genital stage, capable of full sexual function Erikson—identity versus role confusion; self-concept is stabilized; peer group has most influence Havighurst—masculine or feminine social role developed; set of values and ethical system internalized Levinson—early adult transition: making initial career choices, establishing personal relationships, and selecting personal values and lifestyles Gould—theory of transformation: young adults establish their own control as adults separate from family

25. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Achieving Relationships in Adolescence

26. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Issues for Adolescents/Young Adults Injuries Substance abuse Suicide Pregnancy Nutritional problems Sexually transmitted diseases Developmental and situational stressors

27. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question In which stage of prenatal development is the fetus especially vulnerable to any factor that might cause congenital anomalies (e.g., alcohol, tobacco, drugs)? A. Preembryonic stage B. Embryonic stage C. Fetal stage D. Neonatal stage

28. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: B. Embryonic stage Rationale: The fetus is most vulnerable in the embryonic stage (4th–8th week) because it is a period of rapid growth and change and differentiation of the cell layers takes place.

29. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Attachment is a process that occurs during a sensitive period in the first few hours after birth and is necessary for a later process known as bonding. A. True B. False

30. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: B. False Bonding is a process that occurs during a sensitive period in the first few hours after birth and is necessary for a latter process known as attachment.

31. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. The most essential role of the nurse in promoting health of the infant is teaching family members and caregivers. A. True B. False

32. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: A. True The most essential role of the nurse in promoting health of the infant is teaching family members and caregivers.

33. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question According to Kohlberg’s preconventional phase of development, what is the focus that dominates the behavior of the preschooler? A. Obeying rules to avoid punishment or receive a reward B. Developing peer relationships to determine status, skill, and personableness C. Beginning to learn sex differences, form concepts, and distinguish right from wrong D. Stabilizing self-concept with the peer group acting as the greatest influence

34. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: B. False Downy pubic hair first appears in the prepubescence stage of adolescent sexual development.

35. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Downy pubic hair first appears in the pubescence stage of adolescent sexual development. A. True B. False

36. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: A. Obeying rules to avoid punishment or receive a reward Rationale: Kohlberg’s preconventional phase of moral reasoning dominates the preschool age. Developing peer relationships is a major task of the school-aged child. Beginning to learn sex differences, form concepts, and distinguish right from wrong occurs in the toddler stage. Stabilizing self-concept, with the peer group acting as the greatest influence, occurs in the adolescent stage.