Growth & Development Notes

Growth & Development for Adults Erikson’s Stages of Development Overview: *Includes cultural & social influences. *Development is a continuous process. * Distinct stages *Range from birth to death. Young Adult- 20-39 Activities/concerns Select a mate Intimacy vs Isolation Learning to live with marriage partner. -Make commitments to others. Start family- rear children -Unite with others- friends or spouse Manage a home. Start an occupation Failure=isolation & loneliness Take on civic responsibility Find congenial social group Middle Adult 40-65 Accept & adjust to physical changes Generativity vs Stagnation Involved with friends Attain/maintain occupational performance Concern for next generation Assist children to become responsible adults Contribute to society/ world Relate to spouse as a person Failure= self-absorption, obsession with own needs. May Adjust to aging parents regress to earlier level of coping. Achieve adult social & civic responsibility. Older Adult (Later Adulthood) >65 Adjust to decreasing physical strength & health Ego Integrity vs Despair Reminiscence about life Find a sense of fulfillment & purpose Failure= beliefs about life = missed opportunities or failures dense of despair. Adjust to retirement & decreased income Adjust to death of spouse Establish relationship with age group Adjust/adapt social roles Establish satisfactory living arrangements. Discuss how theory of G&D can be incorporated into the nursing process when planning care. Know stage of G&D. Plan activities that promote achievement. Patient centered: Not everyone goes through all tasks in the same way at the same time. Respect & expect uniqueness! Possibility of regression in response to stressors. Culture & society influence greatly! These are not distinct stages. Individuals may have characteristics from more than one stage. Family relationships influence achievement of tasks. Need a healthy family. Family may need nursing care during times of crisis. Develop a POC for a young adult. Leaving puberty. Developing physically, emotionally, & spiritually. Special Events: Career - must decide career path; college/vocational training. Tied to educational choices. Career choice may be influenced by desire to be independent. Need to believe that he/she is functioning to capacity & making a contribution to society. Establish a Family Pregnancy = developmental crisis Affects both parents (> female). May involve conflicting emotions (planned vs unplanned; effects on career, etc). Physical changes. Taking on a new role (mother). Expecting father must prepare for role. Support the mother. Explore personal feelings about fatherhood & the developing child. Moral & Spiritual development: Concerned with maintaining societal & personal moral expectations (if previous levels mastered)> Value conformity, loyalty, & social order. May make moral judgments based on universal beliefs. Can think abstractly- may question spiritual beliefs of childhood. Reflection- discover meaning of values. May abandon traditional religious practices- usually temporary. Heath Concerns: Injuries- leading cause of death. MVA most common cause. Homicide = #2 (10-24 yrs). Substance Abuse- smoking, alcohol, & illicit drugs. Risk taking. Use of addictive drugs Suicide- 3 rd cause of death (15-24) & 2 nd (25-34). Females attempt more; males more successful. May be associated with depression. Nutrition- fad diets, fast foods. Severe eating disorders > females (anorexia nervosa, bulimia). 4% college age females have bulimia. 15% people with eating d/o are male. Obesity- increasing. Sexually Transmitted InfectionsGreatest in individuals with multiple partners; unprotected sex. Causes- knowledge deficit, immaturity emotionally, embarrassment, denial… Stressors- due to choices (lifestyle, occupation, relationships). Can be due to family issues (+ or -) Stress can cause mental & physical health problems. Ineffective coping strategies increase negative effects. Choosing to remain single. Delaying or difficulty having a child. Divorce. Plan care for the middle adult: Physical changes: Require modification of self-image & self-concept. May include: Change in fat deposits Drying of skin Wrinkles begin to appear. Graying of hair begins Decreased cardiac output. Decrease muscle mass & tone Peri-menopausal issues- decreased estrogen- loss of bone mass. Visual & auditory changes: presbyopia & presbycusis. Psychosocial changes: EmploymentCareer change in response to need for increased job satisfaction. Begin a career after children are grown. Begin to think about retirement. Relationship with SpouseMay see a change- can be + or – More security/stability- stronger emotional commitment. Or negative feelings- changes in appearance. Failure to achieve goals may result in stress on marriage leading to affairs &/or divorce. Widowhood. Relationship with grown children &/or aging parents: Empty nest syndrome Need to provide physical, emotional, &/or financial assistance to parents. Health Issues: Often related to lifestyle choices, genetics, & environment. Recovery from acute illnesses takes longer. Chronic illnesses become an issue. Leading causes of death: cancer, CV disease, accidents, DM, CVA. Other health problems: obesity, alcoholism, & depression. Health promotion/maintenance strategies can delay or prevent the onset of these illnesses. Plan care for the older adult who is successfully aging. Needs of Older Adults: Functional Assessment - ability to care for self. Age related changes, illness, effects of medications, etc can decrease the ability to perform self-care satisfactorily. Physiologic Changes: (p. 1 91 ) General- changes in the ability to maintain homeostasis less resilient to illness or other stressors. Integ umentary loss of subQ tissue, decreased oil secretion bruising, skin tears, sunburn, intolerance to heat limit solar exposure, dress for weather, use oil based lotions, minimize baths/ shower instead. CV- ? cardiac output fatigue maintain activity/exercise, low salt/low fat diet, control weight, and monitor BP. Respiratory ? lung volume, gas exchange, cough… SOB, ? risk for infection avoid smoking, flu & pneu monia vaccines . MS loss of bone density, muscle strength, cartilage kyphosis, pain, decreased strength/flexibility, risk of fractures exercise, high-calcium diet &/or supplements. GU BPH; pelvic muscle weakness urinary retention; stress incontinence empty bladder frequently, avoid bladder irritants, Kegel exercises. GI decreased sense of thirst, smell, & taste. ? salivation risk of dehydration, poor nutrition, dry mouth ice chips, dental care, high fiber, low fat diet. Nervous reduced nerve conduction slower response time, learning takes longer, confusion pace teaching, assess for confusion. Psychosocial Aspects Adapt to changes in physical, social, emotional issues. Retirement & reduced income Health of spouse Living arrangements.