1. Young and Middle Adult, Older Adult

2. YOUNG ADULT Physical growth stabilizes during young adulthood (the developmental stage from the ages of 21 to approximately 40 years). The young adult continues to experience physical and emotional changes at a slower rate than adolescents. Young adulthood is a time of transition from an adolescent to a person capable of assuming adult responsibilities and making adult decisions.

4. Pregnancy, a time of transition and lifestyle adjustment, is experienced by many young women

5. Nursing Implications Usually, young adulthood is the healthiest time in a person’s life. Consequently, concern for health is low among people in this age group and wellness is taken for granted by many young adults. Preventive measures for young adults focus on two primary areas: 1. Avoidance of accident, injury, and violence 2. Development of health-promoting behaviors. The nurse plays an important role in each of these areas of health promotion by teaching and counseling. Other topics that are developmentally appropriate for the nurse to address are vocational counseling and establishing relationships.

6. Wellness Promotion Decision making by young adults affects their health status. Since young adults tend to take excessive risks, they are at greater risk for death from accident, suicide, or homicide (Edelman & Mandle, 1997). For example,driving recklessly, driving while intoxicated, engaging in unprotected sex, and participating in gang activities are examples of the lack of a sense of fear demonstrated by many young adults.

7. Sexually transmitted disease Sexually transmitted disease Sexually transmitted disease is a leading cause of Infection with resultant reproductive dysfunction in young adults. The information presented about STDs in the discussion of safety considerations for adolescents is also applicable to young adults. Nurses should teach women how to perform a monthly breast self-examination (BSE). Men need to learn how to perform a testicular self-examination (TSE).

9. STD’s.. Gonorrhea is a bacterial infection caused by the organism Neisseria gonorrheae (also known as gonococcus bacteriae) that is transmitted by sexual contact. Gonorrhea is one of the oldest known sexually transmitted diseases. It is estimated that over one million women are currently infected with gonorrhea. Among women who are infected, 25%-40% also will be infected with chlamydia, another type of bacteria that causes another STD. (Chlamydia infection is discussed later in this article.)

10. Chlamydia (Chlamydia trachomatis) is a bacterium that causes an infection that is very similar to gonorrhea in the way that it is spread and the symptoms it produces. It is common and affects approximately 4 million women annually. Like gonorrhea, the chlamydia bacterium is found in the cervix and urethra and can live in the throat or rectum. Both infected men and infected women frequently lack symptoms of chlamydia infection. Thus, these individuals can unknowingly spread the infection to others. Another strain (type) of Chlamydia trachomatis, which can be distinguished in specialized laboratories, causes the STD known as lymphogranuloma venereumChlamydiaChlamydia trachomatis lymphogranuloma venereum

11. STD’s.. SyphilisSyphilis is an STD that has been around for centuries. It is caused by a bacterial organism called a spirochete. The scientific name for the organism is Treponema pallidum. The spirochete is a wormlike, spiral-shaped organism that wiggles vigorously when viewed under a microscope. It infects the person by burrowing into the moist, mucous-covered lining of the mouth or genitals. The spirochete produces a classic, painless ulcer known as a chancre.spirocheteTreponema pallidum

12. STD’s Genital herpes, also commonly called "herpes," is a viral infection by the herpes simplex virus (HSV) that is transmitted through intimate contact with the mucous-covered linings of the mouth or the vagina or the genital skin. The virus enters the linings or skin through microscopic tears. Once inside, the virus travels to the nerve roots near the spinal cord and settles there permanently.

13. Safety Considerations Because vehicular accidents are a major cause of health problems for young adults, providing information about driving safety is a must. Another activity that poses a health risk for many young adults is sunbathing. Exposure to direct sunlight with the resultant radiation or use of tanning salons is directly linked to skin cancer. Nurses can be influential in decreasing the occurence of skin cancer through teaching and by role modeling safe behaviors.

14. MIDDLE ADULT Middle adulthood (the developmental stage from the ages of 40 to 65 years) is characterized by productivity and responsibility. For most middle-aged adults, the majority of activity revolves around work and parenting, and success and achievement are measured in terms of career accomplishments and family life. Physiological changes that affect many of the body systems occur during middle adulthood.

17. When an individual successfully resolves this developmental conflict, acceptance of age-related changes occurs. Achievement of the developmental task is indicated by the following: Demonstrating creativity Guiding the next generation Establishing lasting relationships Evaluating goals in terms of achievement The evaluation of goals often leads to a midlife crisis, especially if individuals feel they have accomplished little or not lived up to earlier self-expectations.

18. Nursing Implications A large proportion of the United States population consists of middle-aged adults (Edelman & Mandle, 1997). Individuals of the baby-boom generation have entered their midlife stage and will require more nursing care to maintain wellness and cope with illness. Nurses have the opportunity to help middle-aged clients improve their health status (and thus quality of life) by identification of risk factors and early intervention. The major risk factors for adults in the middle years can be changed because they are primarily environmental and behavioral. Assisting the middle- aged client to change unhealthy behaviors can be done through one-to-one intervention or in group settings.

19. Wellness Promotion As health educators, nurses can encourage middle-aged adults to assume more responsibility for their own health Self-care education topics appropriate for the middle-aged adult include: Acceptance of aging Nutrition Exercise and weight control Substance abuse prevention Stress management Recommendations for health screening (cholesterol screening, prostate examination, mammogram, Papanicolaou

20. Safety Considerations Automobile accidents, especially those involving the use of alcohol, are a serious health problem for middle-aged adults. Another significant problem is occupational health hazards such as exposure to environmental toxins. Middle adulthood is also the time when a lifelong accumulation of unhealthy lifestyle practices, such as smoking, sedentary habits, inadequate nutrition, and overuse of alcohol, begins to exert adverse effects. Most middle-aged individuals have increased leisure time. Consequently, there is an increased risk for recreational accidents, such as, boating accidents, sports related injuries, and jogging mishaps

21. OLDER ADULT Older adulthood is the developmental stage occurring from age 65 and beyond. Therefore, this section only highlights the concepts of growth and development as they relate to the older adult.

25. Nursing Implications Professional nursing care is important in assisting aging people to develop a sense of well-being (Eliopoulos, 1996). Nurses who work with the elderly must be especially sensitive to their own feelings, attitudes, and beliefs about aging and be aware of the effect of these responses on their care of older clients. When assessing the older adult for health-related needs, the nurse needs to learn about the client’s background, family history, work history, hobbies, and achievements

26. Clients should be encouraged to talk about their life experiences. When planning care, it is important to build on the client’s lifelong interests. By recognizing each client’s unique experiences and assets, the nurse is more likely to individualize care. When clients express dissatisfaction and regrets about the past, the nurse should listen in a nonjudgmental manner and avoid trying to convince them that things are really better than they remember or perceive. It is important, however, to help clients put disappoint ments into perspective by balancing them with accomplishments and achievements. Nurses should encourage families to engage in a positive life review with elderly clients. Most nursing interventions for the elderly center around introspection and reflection on their lives. Life review (or reminiscence therapy) promotes a positive self- concept in older people

27. Wellness Promotion Health promotion activities should be implemented with the elderly to maintain functional independence. Health promotion activities are aimed at maximizing the elder’s abilities and strengths. Specific topics that are developmentally appropriate for older clients are: use of leisure time, increased socialization, engaging inregular physical activity, maintaining a positive mental attitude, and developing and maintaining healthy lifestyles.

28. KEY CONCEPTS Growth is the quantitative changes in physical size of the body and its parts. Development refers to behavioral changes in functional abilities and skills. Maturation is the process of becoming fully grown and developed and involves both physiological and behavioral aspects of an individual. During each developmental stage, certain developmental tasks must be achieved for normal development to occur. Growth and development of an individual are influenced by a combination of factors, including heredity, life experiences, health status, and cultural expectations.

29. Piaget’s theory states there are four stages of cognitive development: sensorimotor, preoperational, concrete operations, and formal operations. Each stage is characterized by the ways in which the child interprets and uses the environment. Kohlberg’s theory describes six stages of moral development through which individuals determine amoral code to guide their behavior. Gilligan states that women’s moral judgment revolves around three issues: a concern with survival, a focus on goodness, and an understanding of others’ need for care. Fowler’s theory states that there are six distinct stages of faith development and, even though individuals will vary in the age at which they experience each stage, the sequence of stages remains the same. Providing care to the whole person is a basic concept of professional nurses, and knowledge of growth and development concepts guides holistic care of clients.

30. According to Freud, certain developmental tasks must be achieved at each developmental stage; failure to achieve or a delay in achieving the developmental task results in a fixation at a previous stage. Erikson stated that psychosocial development is a series of conflicts that occur during eight stages of life. Sullivan stated that personality development is strongly influenced by interpersonal relationships. The stages of the life cycle are the prenatal, neonate, infant, toddler, preschooler, school-age child, preadolescent, adolescent, young adult, middle adult, and older adult. Nurses have important roles in promoting the health and safety of individuals at each stage of the life cycle.