Chapter 9 Life Span Development Jeanelle F. Jimenez RN, BSN, CCRN

Chapter 9 Life Span Development Jeanelle F. Jimenez RN, BSN, CCRN
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Health Promotion across the Life Span
Life Expectancy This is the average number of years an individual will probably live. Life expectancy in the United States at the beginning of the twentieth century was 47.3 years. Today, average life expectancy at birth in the United States is 77 years. There are currently 18 countries that have a life expectancy greater than that of the United States. Females outlive males by an average of 6 years.

Health Promotion across the Life Span
Development Begins at conception and ends with death The study of life span development is the study of how and why persons change over time, as well as how they remain the same. The eight stages of life span development Infancy, toddler, preschool, school age, adolescence, early adulthood, middle adulthood, and late adulthood

Growth and Development
Refers to an increase in size of the whole or its parts Development Refers to function or the gradual process of change and differentiation from simple to complex Cephalocaudal Growth and development that proceed from the head toward the feet Proximodistal Growth and development that proceed from the center toward the outside

Growth and Development
The Beginnings Development begins with conception. After fertilization, the zygote has 23 pairs of chromosomes, for a total of 46 chromosomes. One of each pair has been contributed by the mother and one by the father. Teratogen Any substance, an agent, or a process that interferes with normal prenatal development, causing the formation of one or more developmental abnormalities in the fetus

The Family The family is the basic unit of society.
Families are composed of two or more people who are united by marriage, blood, adoption, emotional bonds, and/or social roles. The individuals of the family usually share ties that often last a lifetime. Types of families Nuclear, extended, single-parent, blended, social contract family and cohabitation, homosexual, adoptive, and foster

The Family Family Patterns
Refers to the way in which family members relate to each other Types of family patterns Autocratic Patriarchal Matriarchal Democratic

The Family Stages of Family Development Engagement/commitment stage
Begins when the couple acknowledges to themselves and others that they are considering marriage Establishment stage Extends from the wedding up until the birth of the first child Expectant stage Begins with conception and continues through pregnancy

The Family Stages of Family Development Parenthood stage
Begins at birth or adoption of the first child Disengagement stage of parenthood Period of family life when the grown children depart from the home Senescence stage Last stage of the life cycle, which requires the individual to cope with a large range of changes

The Family Causes of Family Stress Common signs of stress in children
Mood swings Acting out behavior Change in eating or sleeping patterns Frequent stomachaches, headaches, or other unexplained somatic complaints Excessive clinging to parents Thumb-sucking Bed wetting Return to behavior typical of an earlier stage of development

The Family Causes of Family Stress Chronic illness Working mothers
Abuse Divorce

Stages of Growth and Development
Infancy: 1 to 12 Months Physical characteristics Gains about 1.5 lb. per month until 5 months Doubles birth weight by 4 to 6 months By 1 year of age, birth weight triples Vital signs At 2 months, the average apical rate is about 120 beats per minute. At 12 months, average resting respirations is about 30 breaths per minute and blood pressure will gradually increase to 90/60.

Infancy: 1 to 12 Months Motor development 2 months: Holds up head 4 months: Holds head up steadily to a degree angle 6 months: Balances head 7 months: Sits up easily without support and crawls 9 months: Creeping 8 to 15 months: Standing with support and walking

Infancy: 1 to 12 Months Dentition Teething begins at about 5 to 6 months Signs of teethingirritability, edematous red gums, excessive drooling, change in stoolsusually begin 3 to 4 weeks before appearance of tooth. Oral hygiene consists of offering sips of clear water and wiping and massaging the infant’s gums. Tooth brushing should begin after the first teeth appear.

Infancy: 1 to 12 Months Psychosocial development Basic trust versus mistrust Cognitive and intellectual development Infant uses senses to learn about self and the environment. Infant learns through exploration of objects and events and through interaction. Infants are in the sensorimotor stage of cognitive development; knowledge occurs primarily through sensory impressions and motor activities.

Infancy: 1 to 12 Months Nutrition Both human breast milk and commercially prepared formula are available to meet the nutritional needs of the infant. Foods that should be avoided in the first 6 months of life are citrus fruits, egg whites, wheat flourall frequently identified as allergy-producing substances. Rules for solid foods: introduce only one new food at a time; introduce cereals first, then fruits and vegetables, and meat last.

Infancy: 1 to 12 Months Sleep, play activity, and safety Newborns and infants sleep 18 of 24 hours. Toward the end of the first 3 months, definite sleep patterns emerge. By the end of the first year, the infant will sleep 12 hours at night and take one nap during the day. Play is important for learning. Accidents are the leading cause of injury and death in infants and young children.

Toddler: 1 to 3 Years Physical characteristics Rate of growth is slower in the toddler than in infancy. In the beginning of this stage, the toddler’s body proportions result in a top-heavy appearance, but by the end they have a more proportionate body appearance. Toddlers have an exaggerated lumbar lordosis and protruding abdomen. By 2.5 years, all 20 deciduous teeth are present.

Toddler: 1 to 3 Years Vital signs Pulse: 90 to 100 beats per minute Blood pressure: 100–80/64 Temperature: 98º to 100º F Respirations: 20 to 30 breaths per minute Neuromuscular development Walking, climbing, hopping, running, pulling, holding on tight skills Scribble and copy a circle

Toddler: 1 to 3 Years Toilet training Children do not reach the physiologic or psychological maturity necessary to be toilet trained until 18 to 24 months of age. Nighttime control may be achieved after daytime control is established. Success should be praised and accidents should be ignored.

Toddler: 1 to 3 Years Psychosocial development The toddler is an uninhibited, energetic little person always seeking attention, approval, and personal goals. Autonomy versus shame and doubt Use of the word “no” gives a sense of control. Possessiveness and a desire to have things go their way are characteristic. Ritualistic behavior and repetitive rituals Temper tantrums are common.

Toddler: 1 to 3 Years Cognitive and intellectual behavior The period from 12 to 24 months is the last phase of the sensorimotor development. Preoperational thought stage The child focuses on the use of language as a tool to meet needs. The child has the emerging ability to think mentally. Toddlers are constantly absorbing new ideas, widening their cognitive world, and expanding their memory.

Toddler: 1 to 3 Years Nutrition One serving of meat, two or more servings of vegetables, at least two servings of fruit, cereal or bread Twenty-four ounces of milk per day Bite-size pieces, finger foods, and smaller portions

Toddler: 1 to 3 Years Sleep, play activity, and safety Toddlers expend a high level of energy in daily growing, playing, and exploring. They require 12 hours of sleep each night plus a daytime nap. Parallel play: play alongside of, but not with, peers Running, jumping, and climbing help develop their growing bones and muscles. More than half of all childhood deaths are caused by accidents, many of which are motor vehicle accidents.

Preschooler: 3 to 5 Years Physical characteristics Maturation of nervous system and mastery of skills Growth slow and steady; taller and thinner Average weight gain less than 5 lb. per year Linear growth about 2 to 2.5 inches per year Vital signs Heart rate: 70 to 110 beats per minute Respiratory rate: 23 breaths per minute Blood pressure: 110/60 Temperature: 97° to 99° F

Preschooler: 3 to 5 Years Psychosocial development First, learns to function independently Then, begins to use imagination to explore Initiative versus guilt Pretends to be grown up by trying a variety of roles Superego functions as a censor of behavior Typical development includes gender identity Strong sibling bonding established

Preschooler: 3 to 5 Years Cognitive and intellectual development Uses symbols to represent objects Trial and error to discover new traits and characteristics Begins to think logically Sees things as absolute; either good or bad Time associated with weekly and seasonal events Needs trust and guidance to distinguish truth from fantasy

Preschooler: 3 to 5 Years Communication and language By age 3 years, children can carry on a conversation; language becomes more adult-like. Pronunciation problems continue. Nutrition They need high levels of proteins. Calcium and phosphorus are important for bones and teeth. Food habits, likes, dislikes, and appetites vary greatly from child to child.

Preschooler: 3 to 5 Years Sleep, play activity, and safety They need 11 to 12 hours of sleep at night. The child begins to share, take turns, and interact with playmates. Through dramatic play, the child tries different roles and identifies with adult models. Child can learn to ride a bicycle with training wheels. Discipline and limit setting are needed. They learn to function independently and explore the imagination.

School Age: 6 to 12 Years Physical characteristics Growth is usually gradual and subtle. Most obvious change involves long bones of the extremities and development of the facial bones. Height and weight increases by about 2 inches and 4.5 to 6.5 lb. per year. Vital signs Pulse rate: 55 to 90 beats per minute Respiratory rate: 22 to 24 per minute Blood pressure: 110/65

School Age: 6 to 12 Years Psychosocial development Become more aware of rules, socialization skills, and expectations Beginning skills of compromise and competition Industry versus inferiority Learns to master skills that produce satisfaction as the result of work Develop their own goals and direct their efforts toward mastery of these goals

School Age: 6 to 12 Years Cognitive and intellectual development Thoughts become increasingly logical and coherent, so the child is able to classify, sort, and organize facts while still being incapable of generalizing or dealing with abstractions. They view the world more realistically, and they are capable of understanding the views of others. They begin to develop logical socialized thought.

School Age: 6 to 12 Years Communication and language Good command of sentence structure Vocabulary becomes more extensive and includes slang and swear words Printing becomes clearer and smaller Nutrition Dietary habits and food preferences are strongly established. Childhood obesity is correlated with obesity in adult years; maintain weight within normal limits.

School Age: 6 to 12 Years Sleep, play activity, and safety Fatigue, irritability, inattention, and poor learning are often signs of inadequate sleep. They need about 10 to 12 hours of sleep at night. They need adequate exercise to enhance muscle development, coordination, balance, and strength. Privacy and a place for their things are important. They may become involved with competitive or team sports. Accidents are the leading cause of death.

School Age: 6 to 12 Years Sleep, play activity, and safety There appears to be an increase in school violence in many locations. Children must feel comfortable discussing their feelings and concerns with parents and teachers. They need to be taught constructive ways to handle their impulses; may resort to unacceptable behavior. Dentition Permanent teeth develop rapidly.

Adolescence: 12 to 19 Years Physical characteristics Adolescence Transition from childhood to adulthood Begins at puberty Second major growth period Females grow 2 to 8 inches and gain 15 to 55 lb. Males grow 4 to 12 inches and gain 15 to 65 lb. Females begin menarche; males begin sperm production. Sexual interests increase markedly in vigor and intensity; usually focus on members of the opposite sex.

Adolescence: 12 to 19 Years Vital signs Pulse rate: 70 beats per minute Respiratory rate: 20 breaths per minute Blood pressure: 120/70 Psychosocial development Identity versus role confusion Requires major reorganization of the personality, resolution of childhood insecurities, and acceptance of adult responsibilities Value of peers significant

Adolescence: 12 to 19 Years Cognitive development Higher process that permits abstract reasoning and systematic scientific problem solving Thinks beyond the present Moral development Young people search for a moral code that preserves their personal integrity and guides their behavior, especially in the face of strong pressure to violate the old values.

Adolescence: 12 to 19 Years Nutrition Increase in caloric needs Protein needs increased Likely to be deficient in calcium, iron, and zinc Sleep, play activity, and safety There is an increased need for hours of sleep to restore energy levels. Caution must be taken to prevent injuries related to exercise and sports. Accident prevention is vital. Different moods are common.

Early Adulthood: 20 to 40 Years Physical characteristics Body is at its optimal level of functioning. Strength, energy, and endurance are now at their peak. Females usually reach maximum height by 16 to 17 years of age; males may continue to grow until 18 to 20 years of age. Diet plays an important role throughout. Sexual maturity is reached.

Early Adulthood: 20 to 40 Years Psychosocial development About 95% of Americans marry at some point. Dual-career lifestyle has affected both the home and workplace. Decision to start a family Family development and harmony are major goals. Early intimacy versus isolation Resolve conflicting demands of intimacy, competitiveness, and distance; develop an ethical sense.

Early Adulthood: 20 to 40 Years Cognitive development Actively developing the formal operational approach to learning and problem solving Nutrition Few total number of calories needed Rest and Sleep Most adults function with 7 to 9 hours of restorative sleep.

Early Adulthood: 20 to 40 Years Physical health Annual physical and dental examinations are recommended. Testicular examinations, prostate-specific antigen (PSA), Pap smears, monthly breast self-exams, mammograms Safety Accidents are the leading cause of disability and death; injuries commonly result from work, vehicles, sports, and violence.

Middle Adulthood: 40 to 65 Years Physical characteristics Bone mass decreases skeletal growth cells. Slight changes in height occur. Changes in muscle strength may be related more to level of activity than to age. Body shape and contour changes occur related to a redistribution of body weight. Changes in vision and loss of hearing occur. Changes occur in the appearance of the skin. There is a higher incidence of periodontal disease.

Middle Adulthood: 40 to 65 Years Physical characteristics Hormonal changes include the woman’s inability to produce estrogen and progesterone. Signs of menopause: irregular menstrual periods, flow changes, excess fluid retention, breast tenderness, hot flashes, flushes, palpitations, night sweats, and irritability and mood swings Male climacteric: decreased libido, loss of body hair, and delayed erection

Middle Adulthood: 40 to 65 Years Psychosocial development Generativity versus stagnation Accepting responsibility for and offering guidance to the next generation Encourages productivity, continuity, and creativity May become stagnantinactive and lifeless Role of grandparenting often begins No longer responsible for children in the home; relationships with spouses change Most adults not prepared for the increased responsibility of caring for aging parents

Middle Adulthood: 40 to 65 Years Nutrition They need fewer calories. Of the population, 25% are overweight. Regular exercise is important. A reduced intake of fat is recommended. Physical and dental examinations They should have regular physical and dental examinations. Sleep and rest They sleep less and have more awakenings.

Late Adulthood: 65 Years and Older Ageisma form of discrimination and prejudice against the older adultdefinitely exists. Theories of aging Autoimmunity theory Free radical theory Wear and tear theory Biological programming theory Disengagement theory Activity theory Continuity theory

Late Adulthood: 65 Years and Older Physical characteristics Gradual decline in weight Decrease in trunk length as a result of the increase in spinal curvature Abnormal postures and contours Kyphosis Barrel chest

Late Adulthood: 65 Years and Older Psychosocial development Older years should be viewed as a time of satisfaction and pleasure. Ego integrity versus despair Evaluate one’s life and accomplishments and find satisfaction and meaning in life. Retirement is a major adjustment.

Late Adulthood: 65 Years and Older Family roles change with time Today’s grandparent may be working and highly active. Caring for grandchildren may be a full-time responsibility. Couples may need to adjust to increased time together, companionship, and closeness. The impact of the death of a spouse is traumatic; being widowed is more common for women than for men.

Figure 9-16 (From Leahy, J.M., Kizilay, P.E. [1998]. Foundations of nursing practice: a nursing process approach. Philadelphia: Saunders.) A loving relationship with a spouse is an example of a positive influence during older adulthood.

Late Adulthood: 65 Years and Older Cognitive and intellectual development Older adults in good health and nurturing environments will have the capacity to maintain or increase their level of functioning. Memory Some older adults notice some changes; benign forgetfulness. There appears to be a greater loss of recent memory over remote memory.

Late Adulthood: 65 Years and Older Nutrition Older adults should have a diet of foods higher in quality and lower in quantity while maintaining the basic nutrient content. Most frequently recommended are diets that are low in saturated fats and carbohydrates and high in fiber. Psychosocial factors: economic factors, loneliness; inability to shop for and prepare meals Adequate fluid intake is important.

Late Adulthood: 65 Years and Older Activity Exercise is crucial to general well-being. Sleep More rest but less actual sleep is required. Safety Most accidents are preventable. The key to prevention is knowledge and recognition of the contributory factors that place the person at greater risk.

Chapter 9 Life Span Development Jeanelle F. Jimenez RN, BSN, CCRN

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Chapter 9 Life Span Development Jeanelle F. Jimenez RN, BSN, CCRN

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