NCSBN Lesson 3B: Growth & Development Questions with Answers Study Guide,100% CORRECT

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NCSBN Lesson 3B: Growth & Development Questions with Answers Study Guide Piaget’s Theory of Cognitive Development Piaget's theory o ... f cognitive development (first published in 1952) includes four distinct stages: sensorimotor, pre-operational, concrete operational and formal operational. All children move through these specific periods at different rates but in the same sequence. A child assimilates and accommodates knowledge by organizing past experiences that serve as a basis for understanding new knowledge Cognitive Development Basic Information Characteristics Nursing Considerations Sensorimotor Stage Birth – 2 years 6 substages: 1. Reflexes 2. Primary circular reactions 3. Secondary circular reactions 4. Coordination of reactions 5. Tertiary circular reactions 6. Early representational thought • Children use the skills and abilities they were born with (such as sucking, grasping and listening) to learn about the environment • Reflexes are used to achieve equilibrium • Repetitive acts help establish patterns of behavior • Active experimentation is used • The concept of object permanence begins (learning that an object still exists even when it is out of sight) • There's an egocentric view of the world • Infants and very young children explore and learn about their environment, especially using their mouth. • They cannot use logic to protect themselves and are concerned by sensations and actions that affect them directly. • Separation from a parent or caregiver is less important to infants under the age of 6 months. Pre-operational Stage 2 – 7 years old • Object permanence becomes more established • There's still an egocentric view of the world • Use of language increases • Increased magical thinking and imagination (animism) • Perceptions rule thinking and reasoning • Short attention span • Children in this stage of development learn best if they are actively involved in the learning process. They relate well to information about what they will see and feel, which is why visual and tactile learning works well. • However, children have many fears, especially separation from a parent or • Thinking is non-logical • The child has a better concept of time as he or she approaches school age caregiver (which peaks around 2-3 years). • Illness and hospitalization frighten toddlers and preschoolers because they lack the cognitive ability to grasp these experiences. • Although older children are capable of some reasoning, they will use fantasy and magical thinking in their attempt to understand illness. Younger or preoperational children think everyone sees the world as they do. Concrete Operational Stage 7 – 11 years old • Thinking shifts from total egocentrism, but egocentric thinking still predominates • The conscience develops • Perception no longer dominates reasoning; cause-and-effect relationships are recognized • Understands basic concepts of numbers, classifications and other concrete ideas • The attention span increases • Mental actions are reversible and problem-solving occurs by trial and error • School age children can use reasoning, but it is limited to their own experience. They understand cause and effect and can think creatively. A concern for moral and social issues begins to develop and there is less egocentric thinking. Formal Operational Stage 11 + • Think more logically than ever before and can see new logical relationships • Analyze situations and engage in problem solving • More creative due to the ability to think abstractly • Increased concern for moral and social issues • Adolescents start to think more like adults. They understand adult vocabulary and can be taught health concepts at higher levels. Kohlberg’s Theory of Moral Development Lawrence Kohlberg modified and elaborated on Piaget's work, believing that most moral development occurs through social interaction. Kohlberg's theory identifies six stages of reasoning at three major levels. Each level represents a shift in the social-moral perspective of the individual. Kohlberg believes that moral development is sequential and orderly. Level 1 Pre-Conventional/Premoral Morality - The child's behavior is motivated by anticipation of pleasure or pain. Level 2 Conventional/Role Conformity - The child behaves appropriately in order to please others. Level 3 Post-conventional Morality Stage 1 Punishment and Obedience Orientation • Egocentrism • Inability to consider the perspectives of others Stage 2 Naively Egocentric Orientation • This stage values the right action, is that which is instrumental in satisfying the self's needs and occasionally others. In other words, children in this stage view morally right action as that which increases their personal rewards. Stage 3 Good Boy-Nice Girl Orientation • Orientation to approval, to pleasing and helping others • Relativism of values to each other's needs and perspectives • Naive egalitarianism, orientation to exchange and reciprocity Stage 4 Law and Order Orientation • Orientation to "doing duty" and to showing respect for authority and maintaining the given social order for its own sake • Regard for the earned expectations of others • Differentiates actions out of a sense of obligation to rules, from actions springing from generally nice or natural motives Stage 5 Social Contract Orientation • Norms of right and wrong are defined in terms of laws or institutionalized rules which seem to have a rational basis. • When conflict arises between individual needs and law or contract, though sympathetic to individual needs, the individual believes the law or contract must prevail because of its greater functional rationality for society, the majority will and overall welfare. Stage 6 Universal Ethical Principle Orientation • Orientation not only toward existing social rules, but also towards the conscience as a directing agent, mutual trust and respect, and principles of moral choice involving logical universalities and consistency. • Action is controlled by internalized ideals that exert a pressure to act accordingly regardless of the reactions of others in the immediate environment. • If one acts otherwise, self-condemnation and guilt result. INFANCY: 1 Month – 1 Year Assessments Nursing Considerations/Teaching Growth Baby rolling over Posterior fontanel closes @ 6-8 weeks of age Anterior fontanel closes @ 12-18 months of age 1st tooth appears @ 5-6 months 6 – 8 teeth by 1 years old Infancy is a period of very rapid growth. The growth rate doubles at six months and triples at one year. By one year the birth length has increased by almost 50% (mainly in trunk) and the head circumference has increased by almost 33%. Motor Development Baby crawling 6 – 8: months - can sit without support and around the same time the infant can roll over. 6 – 7 months: - Begin crawling 9 – 11 months: - Pincer grasp develops, needed for infants to feed themselves 10 – 12 months: - Can stand alone 12 – 15 months: - start cruising (walking by holding onto something) Play in infancy is solitary. Suggested toys include mobiles, unbreakable mirrors, rattles and music boxes 6 – 12 months: blocks, nesting boxes or cups, simple take apart toys, large balls, large puzzles, jack in the box, floating toys, teething toys, activity boxes and push-pull toys 10 months: can play peek-a-boo and pat-a-cake Cognitive Development Piaget’s sensorimotor period Erikson’s: trust vs. mistrust - based on the dependability and quality of the infant's caregivers (being fed). - This stage of development lays the foundation for all other developmental tasks Common fears from birth-three months include sudden movements, loud noises and loss of physical support. 4-12 months: - infants fear strangers, strange objects, heights; there is also anxiety due to anticipation of previous uncomfortable situations. Language Development 3 months - smiles and coos 6 months - produces chained syllables 8 months - distinct vocalizations 1 year - able to say 2 or + words, understand the meaning of no and can follow simple directions Threats to Health and Safety Threats to health and safety include suffocation, falls and burns. Nursing Care Identify family structures and roles of family members (such as adoptive, blended and nuclear) and recognize cultural and religious influences that may impact family functioning Identify the expected physical, cognitive and psychosocial stages of development Provide care and education for the infant and family, modifying approaches to care according to the client's developmental stage Evaluate the client's achievement of expected developmental milestones TODDLER/EARLY CHILDHOOD 1-3 Years Assessments Nursing Considerations/Teaching Growth WEIGHT:1.8 – 2.7 kg (4-6lbs) per year HEIGHT: 7.5 cm (3 inches) per year, mainly legs 1-2 years: head circumference is usually equal to chest circumference Lordosis and potbelly are characteristics of this stage of development Motor Development Boy plays with blocks 3 years - Toddlers can build a tower of 8 blocks At the end of stage - They can copy a circle on a piece of paper Play is parallel Suggested toys include: - push-pull toys, finger paints, thick crayons or chalk, riding toys, balls, blocks, puzzles, simple tape recorder, housekeeping toys, puppets, cloth picture books, large beads to string, a toy telephone, water toys, sand box and clay. Walking improves and toddlers can run, climb and walk up and down stairs. They can dress themselves in simple clothing. Toilet training begins in this stage. Bowel training is usually accomplished before bladder control. Cognitive Development Piaget’s period of preoperational thought Erikson’s: autonomy vs. shame and doubt Kohlberg’s: stage of moral development is preconventional or premoral level Common fears include the dark, being alone, separation from parents, some animals and loud machines. Discipline: Toddlers are ritualistic, needing to maintain sameness and reliability. Negativism or persistent negative response to requests is common and the words "no!" and "mine!" are favorites. Frustration may result in temper tantrums or regression. Discipline becomes necessary in this stage. The main purpose of discipline is to teach children: • Self-control • The difference between right and wrong • Appropriate versus inappropriate behavior • How to respect others Discipline provides safe boundaries for children Parents need anticipatory guidance in discipline Good discipline: • Is consistent • Is timely • Fits the "crime" Setting limits for behavior • Benefits: - Helps the child maintain control over internal urges - Helps the child feel secure • Rules must be clear and simple: - No hurting others - No hurting self - No destruction of equipment Parent must be consistent about following through on consequences when child misbehaves (remember, discipline should be consistent, timely and fit the "crime") Types of discipline • Corporal, i.e., spanking, slapping • Change the setting, i.e., if the child misbehaves in church, then take him or her to the church nursery • Redirect, distract or divert attention • Reasoning (not appropriate for toddlers, age 1 to 3 years old) • Rewarding (a type of behavior modification) • Time-out: - Gives children time to calm themselves while reflecting on their behavior - Gives the parent a chance to calm down and respond more rationally - A good guide is "one minute of time-out per year of age" • Restricting activities and freedom (works best with older children and adolescents) Language Development 15 months - 4 to 6 words 2 years old - 300 words - Can use multi-word sentences The ability to understand speech is much greater than the number of words the child can say. Threats to Health & Safety Threats to health and safety includes poisoning, choking, falls, burns, drowning and injuries due to playground or street-related activities. Nursing Care Identify the expected physical, cognitive and psychosocial stages of development Provide care and education for the toddler and family, modifying approaches to care according to the client's developmental stage Evaluate the client's achievement of expected developmental milestones Identify family structures and roles of family members (such as adoptive, blended and nuclear) and recognize cultural and religious influences that may impact family functioning Preschool: 3 – 6 years Assessments Nursing Considerations/Teaching Growth WEIGHT: 2 – 3kg (5 lbs) per year HEIGHT: Increase 6.75 – 7.5 cm (2.5 – inches)/year (mostly in the legs). Motor Development Pre-school children running out of school Very active and previously learned motor skills are further refined They can hop on one foot and pedal a tricycle. They can draw a person with typically one body part. Play often involves fantasy and imitating adults in dress up games Suggested toys include tricycles, gym and sports equipment, sandboxes, blocks, books, puzzles, computer games, dress-up clothes, blunt scissors, picture games, construction sets, musical instruments, cash registers and simple carpentry tools Cognitive Development Piaget’s period of preoperational though Erikson’s: initiative vs. guilt - Begin to assert their power and control over the world through play and other social interactions Kohlberg’s: Punish and obedience and naïve egoistic orientation They begin to express sexual curiosity Common fears include body mutilation, animals, supernatural beings, monsters, ghosts, unfamiliar routines, separation from trusted adults and abandonment. Language Development 5 years old - Vocab of about 2,100 words - Know their name and address - Constantly asking questions and “why” has become their favorite word They often use fantasy when telling a story Threats to Health & Safety Threats to health and safety are the same as for the toddler and includes poisoning, choking, falls, burns, drowning and injuries due to playground or street-related activities. Nursing Care Identify the expected physical, cognitive and psychosocial stages of development Provide care and education for the preschool child and family, modifying approaches to care according to the client's developmental stage Evaluate the client's achievement of expected developmental milestones Identify family structures and roles of family members (such as adoptive, blended and nuclear) and recognize cultural and religious influences that may impact family functioning SCHOOL AGE: 6 – 12 years old Assessments Nursing Considerations/Teaching Growth Growth is now slow and steady until the growth spurt associated with adolescence. WEIGHT: - growth averages 2-3 kg (4.5-6.5 pounds) per year HEIGHT: - an average of 5 centimeters (2 inches) per year. 9 – 10 years old: - brain growth is complete School-age children lose their deciduous teeth and acquire permanent teeth. Motor Development Girls playing soccer in a park School-age children are full of energy. They tend to prefer friends of the same sex and engage in cooperative activities, joining clubs, playing games and sports. Peer approval is a strong motivator. As puberty approaches, school-age children often become more awkward. Rules are important, but this is also the time when cheating may begin. Hero worship also develops. Fine motor skills continue to be refined and school-age children can write in cursive. Suggested toys and activities include board or computer games, books, collections, scrapbooks, sewing, cooking, carpentry, gardening and painting. Psychosocial Development Piaget’s period of concrete operations Erikson’s: Industry vs. Inferiority Kohlberg’s: conventional morality and good boy- nice girl orientation - children develop a moral code and follow social rules. - They do not consider rules as dictates from authority, but as a necessary principle of life. However, rules are flexible and can change depending on the situation. Language Development Approx 14,000 words Reading skills improve dramatically Threats to Health & Safety Topping the list of safety threats are automobile-related injuries (for example, not wearing proper safety restraint devices), drowning and sports-related injuries (such as not wearing proper equipment, including bicycle helmets, shin guards and other pads, mouthguards). Nursing Care Identify the expected physical, cognitive and psychosocial stages of development Provide care and education for the school age child and family, modifying approaches to care according to the client's developmental stage Evaluate the client's achievement of expected developmental milestones Identify family structures and roles of family members (such as adoptive, blended and nuclear) and recognize cultural and religious influences that may impact family functioning ADOLESCENCE: 12 – 19 Years Assessments Nursing Considerations/Teachings Growth 8 – 13 years old - Signs of puberty begin Girls tend to begin puberty earlier than boys. The physical changes take approximately three years to complete. Development of pubic hair and axillary hair. Girls develop breasts and menarche begins. In boys, the testes and scrotal sac become larger, their voices deepen, the shoulders widen, and they develop facial hair. Dentation is complete and by late adolescence, wisdom teeth emerge Physical changes are the result of hormonal changes when the hypothalamus begins to produce gonadotropin-releasing hormones. These hormones stimulate the ovaries to produce estrogen and testicular cells to produce testosterone. Motor Development Gross motor skills and fine motor abilities improve. "Play" centers around social interactions, including dating and using the phone to communicate with friends. Recreation includes sports and cultural activities. Peers are more important at first, but group values become less significant in later adolescence. There's an increase in risk-taking behaviors during adolescence. Psychosocial Development Piaget’s: Stage of Formal Operations Erikson’s: identity vs. role confusion - Explore their independence and begin to develop a sense of self Kohlberg’s: consolidating moral development - They understand that rules are not absolutes and that cooperative agreements can be changed to fit the Nursing care includes assessing the client's reactions to expected age-related changes. situation. - Their sense of right and wrong develops as they apply personal values to daily decisions and they begin to judge themselves by internalized ideals. Language Development Language and cognitive skills increase. Threats to Health & Safety Eating disorders, including anorexia nervosa (restrictive eating) and bulimia nervosa (binge eating followed by purging) Injuries due to sports, but also homicide and suicide Substance abuse, including tobacco use, underage drinking and illicit drug use Sexual behavior, including the number of sex partners, not using contraception, unintended pregnancy and exposure to sexually transmitted infections Talking/texting while driving Nursing Care Identify the expected physical, cognitive and psychosocial stages of development Provide care and education for the adolescent child and family, modifying approaches to care according to the client's developmental stage Evaluate the client's achievement of expected developmental milestones Identify family structures and roles of family members (such as adoptive, blended and nuclear) and recognize cultural and religious influences that may impact family functioning Evaluate the impact of expected body image changes on client and family Male Tanner Stage Female Tanner Stage Stage: Tanner 1 (Prepubertal) Stage: Tanner 1 (Prepubertal) A. Height increases at basal rate: 5-6 cm/year B. Testes 1. Smaller than 4 ml or long axis <2.5 cm C. Pubic Hair 1. No coarse, pigmented hair D. Penis Stage 1. No growth A. Height increases at basal rate: 5-6 cm/year B. Breast 1. Papilla elevation only C. Pubic Hair 1. Villus hair only 2. No coarse, pigmented hair Stage: Tanner 2 A. Height increases at basal rate: 5-6 cm/year B. Testes 1. Size 4 ml or long axis 2.5 to 3.2 cm 2. Age 11.5 years (age 9.5 to 13.5 years) C. Pubic Hair 1. Minimal coarse, pigmented hair at base of penis 2. Age 12.0 years (age 9.9 to 14.0 years) D. Penis Stage 1. Earliest increased length and width 2. Age 11.5 years (age 10.5-14.5 years) Stage: Tanner 2 A. Height increases at accelerated rate: 7-8 cm/year B. Breast (Thelarche) 1. Onset of secondary Breast development (marks the start of Puberty) 2. Breast buds palpable and areolae enlarge 3. Age 10.9 years (8.9-12.9 years, typically 10.2 to 11.3 years) 4. Precedes Menarche by 24 months C. Pubic Hair (Pubarche) 1. Minimal coarse, pigmented hair mainly on labia 2. Age 11.2 years (9.0-13.4 years) D. Modifications based on increasingly earlier Puberty 1. White: Stage 2 changes may appear one year earlier 2. Black: Stage 2 changes may appear two years earlier Stage: Tanner 3 (Adrenarche) Stage: Tanner 3 A. Height increases at accelerated rate: 7-8 cm/year B. Testes 1. Size 12 ml or long axis 3.6 cm 2. Age 14.0 years (11.5-16.5 years) C. Pubic Hair 1. Coarse, dark curly hair spread over the pubis 2. Age 13.1 years (11.2-15.0 years) D. Penis Stage 1. Increased length and width 2. Age 12.4 years (10.1-14.6 years) E. Other Changes 1. Gynecomastia may occur (age 13.2 years) 2. Voice breaks (age 13.5 years) 3. Axillary hair (age 14.0 years) 4. Acne Vulgaris (age 14.3 years) 5. Body Odor 6. Muscle mass increases A. Height increases at peak rate: 8 cm/year (age 12.5) B. Breast 1. Elevation of Breast contour; areolae enlarge 2. Age 11.9 years (9.9-13.9 years) C. Pubic Hair 1. Dark, coarse, curly hair spreads over mons pubis 2. Age 11.9 years (9.6-14.1 years) D. Other changes (Adrenarche) 1. Axillary hair develops (13.1 years) 2. Acne Vulgaris develops (13.2 years) 3. Body odor Stage: Tanner 4 A. Height increases at peak rate: 10 cm/year (age 13.8) B. Pubic Hair 1. Hair of adult quality 2. Not spread to junction of medial thigh with perineum 3. Age 13.9 years (12.0-15.8 years) C. Penis 1. Continued growth in length and width 2. Age 13.2 years (11.2-15.3 years) D. Testes Stage: Tanner 4 A. Height increases at 7 cm/year B. Breast 1. Areolae forms secondary mound on the Breast 2. Age: 12.9 years (10.5-15.3 years) C. Pubic Hair 1. Hair of adult quality 2. No spread to junction of medial thigh with perineum 3. Age: 12.6 years (10.4-14.8 years) 1. Length 4.1 to 4.5 cm E. Other Changes 1. Voice changes (age 14.1 years) Stage: Tanner 5 A. No further height increases after age 17 years B. Pubic Hair 1. Adult pubic hair distribution (15.3 years) 2. Pubic hair spreads to medial thigh 3. No hair spread to linea alba C. Penis 1. Mature genital size by 16.5 years D. Testes 1. Length >4.5 cm E. Secondary sexual characteristics 1. Facial hair present on sides 2. Mature male physique 3. Gynecomastia disappears Stage: Tanner 5 A. No further height increases after age 16 years B. Breast 1. Adult Breast contour 2. Areola recesses to general contour of Breast C. Pubic hair 1. Adult distribution of hair 2. Pubic hair spreads to medial thigh 3. Pubic hair does not extend up linea alba Exam: Testicle Size (typical ranges) A. Birth to 6 months 1. Size: 1.5 cm long and 1.0 cm wide B. Child <6 years 1. Size 2 cm long and 1.2 cm wide C. Adult: 1. Size 4-5 cm long and 3.0 cm wide and 3.0 cm deep (AP) Exam: Other Milestones A. Adrenarche: Age 6 to 8 years B. Menarche: Age 12.7 years (10.8-14.5 years) 1. Delayed >1 year if low body fat (e.g. athlete) 2. Testicle length <3.5 cm is considered small for an adult Exam: Growth in Boys A. Peak height velocity: Age 13.5 (11.7-15.3 years) 1. Peak growth: 9.5 cm/year 2. Occurs during Tanner Stage 3 to 4 in boys B. Basal growth occurs up until Tanner Stage 3 1. Basal Growth rate: 5.0 to 6.0 cm per year from age 4 years to Puberty (similar to girls) C. Pubertal Linear Growth (typically completed by age 17 years in boys) 1. Boys who mature average time: 9.5 (7.1-11.9) cm/yr 2. Boys who mature early: 10.3 (7.9-12.5) cm/yr 3. Boys who mature late: 8.5 (6.3-10.7) cm/yr Exam: Growth in Girls A. Peak height velocity: 11.5 years (9.7-13.3 years) 1. Peak growth: 8.3 cm/year 2. Occurs during Tanner Stage 2 to 3 in girls B. Basal growth occurs up until Tanner Stage 2 1. Basal Growth rate: 5.0 to 6.0 cm per year from age 4 years to Puberty (similar to boys) C. Pubertal Linear Growth (typically completed by age 15 years in girls) 1. Girls who mature average time: 8.3 (6.1-10.4) cm/yr 2. Girls who mature early: 9.0 (7.0-11.0) cm/yr 3. Girls who mature late: 7.5 (5.4-9.6) cm/yr EARLY ADULTHOOD: Post-adolescence through age 40 YO. Assessments Nursing Consideration/Teaching Growth Although the effects of aging begin around age 20, the young adult is typically healthy and free from acute or chronic illness 20s years old - Brain cell development peaks - Continues to develop higher levels of cognitive functioning - Is able to think abstractly - generally, more realistic, objective and can consider many different points of view. 20 – 30 years old - reproductive system is fully mature and the optimal reproductive time 25 years old - Musculoskeletal is complete 30 years old - Height may increase slightly by about 3-5mm - Peak strength of the cardiovascular system occurs 30 + years old - digestive juices decrease and the average person tends to gain weight. Optimal physical function Psychosocial Development Erikson’s: intimacy vs. isolation - explores personal relationships, especially love relationships. When living on their own, young adults may question previous life choices. Typically, life becomes more orderly. Becoming involved in the community is a new focus. Nursing care includes providing care and education for the young adult and assessing the client's reactions to expected age-related changes. Threats to Health & Safety Eating disorders, as well as the onset of obesity Injuries due to motor vehicle accidents, occupational hazards, homicide and suicide Substance abuse, including the use of tobacco, alcohol and illicit drugs Sexual behavior, including sexually transmitted disease and unintended pregnancy Stress, due to changing roles, marriage, beginning a new family, starting a new job and depression Nursing Care Identify expected physical, cognitive and psychosocial stages of development Assist client to cope with life transitions (such as marriage and parenting) Assess impact of change on the family system (such as one-parent family, divorce, ill family member) MIDDLE ADULT: 40 – 65 Years Old Assessments Nursing Consideration/Teachings Growth Experience a redistribution of pigment in their hands ("age spots") Middle adulthood is when the signs of aging appear. There's a subtle and gradual decline in most body systems. The hair begins to gray There's a progressive decrease in skin turgor The anteroposterior diameter of the chest increases Visual acuity decreases and they may develop presbyopia. Female reproductive system - the ovaries gradually atrophy causing a drop-in estrogen In perimenopause - the menstrual cycle and flow become more variable. Women may experience hot flashes, headache, palpitations, mood swings, insomnia and vaginal dryness. - After having no period for 12 months, the woman is officially in menopause. - Complications of menopause include osteoporosis, cystocele or rectocele, uterine prolapse and an increased risk of heart disease. Libido remains consistent in males, but sperm count may be reduced, and the penis may be slower to achieve an erection. Prostatic enlargement is common. Psychosocial Development Erikson’s: generativity vs. stagnation - "sandwich" generation, middle-aged adults are not only caring for their children but also for their aging parents This is the peak of intellectual development. Towards the end of this stage, individuals no longer view themselves as invincible and have developed a sense of when and how to choose their battles. - often leads to financial and interpersonal struggles. Being involves in the community continues to be important. Threats to Health & Safety Diet and weight gain Lack of exercise Substance abuse Lack of preventative health care Stress, related to work, family obligations, divorce and aging Nursing Care Assist the client to cope with life transitions (such as marriage and parenting) Assess the impact of change on the family system (such as one-parent family, divorce, ill family member) Provide care and education for the adult and assessing the client's reactions to expected age-related changes OLDER ADULTHOOD: 65 + Assessments Nursing Care/Teachings Expected Physical Changes One of the most common thoughts that aging is programmed into our body's systems and the changes that occur are due to the accumulation of damage. In addition to programmed senescence, we know that there are many factors that can accelerate the buildup of damage or decrease the capacity for repair Psychosocial Development Erikson’s: Integrity vs. despair - reflect on and reminisce about the past and adjust to all the changes in their lives - adjusting to retirement and possibly living on a reduced income, coping with the death of a spouse and redefining relationships with children. - Health issues often impact an older adult's quality of life and his ability to live independently. - Nursing care includes providing care and education for the older adult and assessing the client's reactions to expected age- related changes. Threats to Health & Safety Lack of exercise Substance abuse Suicide Injuries, due to falls and burns Using multiple medications Nursing Care Identify the expected physical, cognitive and psychosocial stages of development and expected body image changes associated with aging Assist client to cope with life transitions Health Promotion Health refers to a state of mental and physical well-being. Physical health involves pursuing a healthy lifestyle to decrease the risk of disease and injury. Mental health includes our ability to enjoy life, achieve balance, adapt to adversity and feel safe and secure. Health care combines science, informatics and a culture of continuous improvement with best practices and evidence-based care. The goal is to provide better care experiences and better health for individuals and society at lower costs. • Health Promotion Model o The Health Promotion Model (proposed by Nola Pender in 1982 and revised in 1996) defines health as a positive dynamic state and not merely the absence of disease. The model notes that unique personal characteristics and experiences affect health-seeking behaviors, which can be modified through nursing actions. In addition to perceived barriers to action, other factors that impact wellness, illness and health-care seeking behaviors include religious beliefs, economics, political and sociocultural factors and interpersonal influences. Access to care, costs, wait time and other deficiencies in health care also impact wellness. The desired outcome is based on behaviors that result in improved health, enhanced functional ability and a better quality of life. • Client & Family-centred Care o Client- and family-centered care emphasizes respect for and being responsive to the preferences, needs and values of patients and their families. o Although the nursing process demands a scientific and clinical approach to client care, you must apply this knowledge in a compassionate, nonjudgmental and culturally-sensitive manner. o Understanding and honoring your clients' (and their family's) goals and preferences can lead to better health outcomes and an enhanced quality of life. • Levels of Health Care o One of the goals of health care is to reduce the risks or threats to health. There are three different levels or categories of health care: primary, secondary and tertiary. ▪ Primary • includes measures to prevent disease or injury o Preventing exposure to hazards…through legislation and enforcement to ban or control the use of hazardous products (such as lead paint or asbestos) or to mandate safe and healthy practices (such as the use of seat belts and bicycle helmets) o Altering unhealthy or unsafe behaviors…through education about diet, exercise and smoking cessation ▪ Secondary o Increasing resistance to disease or injury…through immunizations against infectious diseases • Secondary care seeks to reduce the impact of a disease or injury that has already occurred. This is accomplished by: o Detecting and treating the disease or injury…through regular exams and screening tests o Encouraging personal strategies to prevent reinjury or recurrence…such as changing a client's diet and/or exercise program o Implementing programs that enable clients to reach an optimal level of health and functioning…through reasonable accommodations in the workplace ▪ Tertiary • Tertiary care involves helping clients to manage long-term and complex health issues and injuries in order to improve their: ability to function, quality of life and life expectancy. • Examples of tertiary care include cardiac and stroke rehabilitation programs, support groups and vocational rehabilitation programs to retrain workers. • Modifiable & Non-modifiable Factors Affecting Health o Non-modifiable risk factors that can increase the probability of acquiring a particular health problem include genetics, age, race, ethnicity and sex. Modifiable lifestyle choices, such as smoking, poor diet, lack of exercise and sun exposure, increase the risk of acquiring health problems. o Occupation and the environment are potentially modifiable risk factors, although changing jobs or moving to a different location is not always feasible for many clients. Furthermore, some clients may simply be resistant to change and unable to alter habitual behaviors. o The nurse will identify risk factors that may impact health and provide information for prevention and treatment of high risk health behaviors, such as smoking cessation, safe sexual practices and needle exchange programs. [Show More]

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