NR 222 Unit 6 Health and Wellness Notes
NR222 Unit 6 Health and Wellness Notes
Health and Wellness Notes
1. Overview of growth and
... [Show More] development
2. Growth
a. Quantifiable change in structure
b. In the body, this change means an increase in the number and/or size of the cells, resulting in an increase in the size and weight of the whole, or any of its parts
c. During childhood, physical changes in height, weight, and head circumference, or growth parameters, are measured and charted regularly
d. also refers to the increases (and as we age, decreases) in the size of specific organs and systems
e. genetic factors, prenatal and postnatal exposures, nutrition, environmental factors, emotional health as well as traditional cultural practices that influence childrearing, lifestyle, and health care practices influence growth
3. Growth patterns
a. Growth is not steady throughout life
b. The periods of extremely rapid growth (prenatal, infancy, and adolescence) are contrasted with slower rates of growth (toddler, preschool,and school-age periods)
c. Different parts of the body increase in size at different rates
d. during early life the head is the fastest growing section (1/4 of length vs 1/9 in adults), followed by the trunk, and then the arms and legs
4. Growth charts
a. Accurate growth assessment depends on precise measurement of growth parameters using proper equipment, correct and consistent techniques, careful plotting of measurements, and thoughtful interpretation of the data
b. Use 2006 WHO growth charts for 0-24months
c. Use 2000 CDC growth charts for 2-20 years
d. growth charts describe weight-for-age, length (or stature)-for-age, weight-for-length, and BMI-for-age, and include the 5th and 95th and the 3rd and 97th percentiles
e. a single measurement taken at one point in time, although helpful in providing a baseline, does not allow for the best assessment of a child’s growth
f. instead, Serial measurements, plotted on a growth chart over time, best reflect a child’s pattern of growth
g. Slowed growth, plateaus, or decreases in height, weight, and head circumference, as well as rapid increases, raise questions for health care providers about the adequacy of a child’s nutritional intake, syndromes or disease states, neglect, or emotional problems
5. Concept of development
a. Development refers to gradual change and expansion of ability and advance in skill from a lower to a more-advanced complexity
b. is a qualitative change, so is more challenging to describe because can’t use units
6. Developmental patterns
a. one stage of development building on and leading to the next
i. early developmental pattern:
1. Cephalocaudal- head to toe (Infants gain neck and head control before controlling the movements of the extremities)
2. Proximodistal- midline to periphery (Infants’ central nervous systems develop before peripheral nervous systems)
3. Differentiation- follows a pattern simple to complex, and general to specific (Infants use a whole-hand grasp before learning the finer control of the pincer grasp, and they coo or babble before they speak)
b. Although the sequence of development is predictable, the exact timing of the sequencing is individual because individuals develop at their own rate, on their own schedule
c. Denver Developmental Screening Test is a screening tool that assists health care providers in monitoring children’s development in each of these areas from birth to 6 years of age
d. Social expectations can influence when developmental tasks are learned, but cultural expectations can determine which developmental tasks are learned
e. Learning is the process of gaining specific knowledge or skills that result from exposure, experience, education, and evaluation
f. Maturation is an increase in competence and adaptability that reflects changes in the complexity of a structure that makes it possible for that structure to begin to function or to function at a higher level
g. Learning cannot occur unless the individual is mature enough to understand and control behavior (toilet training can’t be learned until sphincters have matured)
7. Theories of Development
a. Psychosocial Development Theory (Erik Erikson)
i. development of identity of the self through successive stages that unfold throughout the life span
ii. based on the need of each person to develop a sense of trust in self and others and a sense of personal worth
AGE GROUP PSYCHOSOCIAL STAGE LASTING OUTCOMES
1. Infancy Basic trust versus basic mistrust Faith and hope
2. Toddler stage Autonomy versus shame and doubt Self-control and willpower
3. Preschool stage Initiative versus guilt Direction and purpose
4. School age Industry versus inferiority Method and competence
5. Adolescence Identity versus role confusion Devotion and fidelity
6. Young adulthood Intimacy versus isolation Affiliation and love
7. Middle adulthood Generativity versus stagnation Production and care
8. Older adulthood Ego integrity versus despair Renunciation and wisdom
iii. based on critical stages, each requiring resolution of a conflict between two opposing forces
iv. Each stage depends on the preceding stage, which must be accomplished successfully for the person to proceed
v. acknowledges the influence of other people and the environment but maintains that it is ultimately the individual who must master each of the conflicts
b. Cognitive Development Theory (Jean Piaget)
i. viewed children as biological organisms interacting with their environment, and his theory contends that cognitive development reflects children’s attempts to make sense of their worlds
ii. major criticism of his work is that he underestimated children’s capabilities and gave little or no consideration for cultural differences
iii. concerned primarily with structure rather than content, with how the mind works rather than with what it does
iv. Each person is striving to maintain a balance, or equilibrium, between assimilation and accommodation
v. Through a natural unfolding of ability, the child acquires sequentially predictable cognitive abilities; given adequate environmental stimuli and an intact neurological system, the child gradually matures toward full ability to conceptualize
vi. believed that development preceded learning
STAGE AGE CHARACTERISTICS
Sensorimotor Birth to 2 years Begins with a predominance and reliance on reflexes that permit the body to learn
Reflexes decrease and voluntary acts develop
Imitation predominates
Thought is dominated by physical manipulation of objects and events
Develops the concept of object permanence and the ability to form mental representations
Preoperational 2 to 7 years Advancing use of language and movement
Development of egocentric, animistic, and magical thinking
Uses representational thought to interpret and learn, not in terms of general properties, but in terms of the relationship or use to them
No cause-and-effect reasoning
Thought is dominated by the senses—what is seen, heard, or experienced
Concrete operations 7 to 11 years Mental reasoning processes assume logical approaches to solving concrete problems, including cause and effect
Collecting; mastering facts
Can consider other points of view
Thought influenced by social contacts
Language is perfected
Formal operations 11 to 15 years True logical thought and manipulation of abstract concepts emerge
Morality established
c. Cognitive Development Theory (Vygotsky)
i. proposed that learning precedes development
ii. while learning may be similar among children at certain times or phases of development, it is not identical in all children because of their differing social and cultural experiences
iii. There are no predetermined levels of development; rather, experience is in the front, leading and expanding development in unlimited ways
iv. zone of proximal development is the distance between the actual and potential developmental level, where children are pulled toward new learning through their interaction with others and the environment
v. all people need to understand not only the way in which an individual learns and develops but also the social, cultural, and political context in which that learning and development takes place
d. Moral Development Theory (Lawrence Kohlberg)
i. Based on interviews that focused on hypothetical moral dilemmas (Should a man steal an expensive drug that would save his dying wife?)
ii. three stages of moral development (preconventional, conventional, and postconventional) are based on Piaget’s theory of cognitive development and emphasize ethics of justice
iii. progression generally takes place during the school-age, adolescent, and young-adult years
A. GROWTH AND DEVELOPMENT: Kohlberg’s Stages of Moral Development
STAGE GOAL
Preconventional Avoiding punishment
Gaining reward
Conventional Gaining approval
Avoiding disapproval
Postconventional Agreeing upon rights
Establishing personal moral standards
Achieving justice
e. Moral Development Theory (Carol Gilligan)
i. suggests that there is a different process of moral development in women in society
ii. women often scored lower in Kohlberg’s subsequent investigations (women were not inferior in their moral development, just different)
iii. concluded that the transitions between stages are based on changes in one’s sense of self rather than on changes in cognitive development
iv. reported that women think more in terms of caring and relationships than men do, who are more inclined to think in terms of rules and justice
B. GROWTH AND DEVELOPMENT: Gilligan’s Stages of Moral Development (for Women)
STAGE CHARACTERISTICS GOAL
Preconventional What is practical to others and best for self, realizing connection to others Individual survival
Conventional Sacrifices wants and needs to fulfill others’ wants and needs Self-sacrifice is goodness
Postconventional Moral equal of self and others Principle of nonviolence, do not hurt self or others
Edelman: Ch 21 (515-532)
1. Adolescent
a. defined as beginning with the onset of puberty, around age 11 to 13 years (many use 10-24 years)
b. refers to the psychosocial, emotional, cognitive, and moral transition from childhood to young adulthood
c. puberty refers to the development and maturation of the reproductive, endocrine, and structural processes that lead to fertility
2. Biology and Genetics
a. experience accelerated growth that dramatically alters their body size and proportions
b. most noticeable changes in adolescence involve physical and sexual growth, including the appearance of secondary sexual characteristics
c. physical changes are mediated primarily by the hormonal regulatory systems in the hypothalamus (releases gonadotropin-releasing hormone (GnRF), which stimulates the anterior pituitary), pituitary gland (release the gonadotropin hormones luteinizing hormone (LH) and follicle-stimulating hormone (FSH) for ovarian development and estrogen production in females and LH results in testicular enlargement and the development of Leydig cells in the testes to produce testosterone and FSH stimulates the development of the seminiferous tubules of the testes, leading to spermatogenesis), gonads (produce estrogen and testosterone and sperm and egg), and adrenal glands (releases adrenal androgens to stimulate axillary and pubic hair growth)
d. Estrogen (for women) produces all secondary sexual characteristics except axillary and pubic hair
e. Menarche (the onset of menses in females) usually occurs late in puberty as the growth spurt is subsiding
f. Adolescents who do not follow the normal sequence or who have not begun pubertal development by age 14 years, for males, and age 13 years, for females, should have an endocrine evaluation
g. Before growth spurt, increase in fat, and then decrease after
h. Heart grows in size and strength
i. Respiratory rate decreases through childhood (for males: Respiratory volume and vital capacity increase, and larynx and vocal cords grow, producing the characteristic voice changes of puberty)
j. Both the sweat and sebaceous glands become more active (sebaceous glands on the face, neck, shoulders, upper back, chest, and genitals can become clogged and inflamed, leading to acne)
k. Acne
i. sebaceous glands increase production of sebum, a primary factor in the pathogenesis of acne
ii. Intervention should include teaching the individual about the pathophysiological nature of acne
iii. Washing with soap and water two or three times a day is the best way to remove dirt and oil; Vigorous scrubbing should be discouraged, because the skin can become irritated, leading to follicular rupture; should not attempt to remove the pustules and papules that form; Squeezing the lesion can result in further irritation of the gland and permanent injury to the tissue; benzoyl peroxide cause drying and peeling; make ups with a fat base prevent adequate exposure to air and light; stress can make worse; dietary restrictions are unnecessary
l. Scoliosis
i. common skeletal deformity found in adolescents is a lateral S-shaped curvature of the spine
ii. Classifications: secondary or functional, congenital, neuromuscular, constitutional, and idiopathic, which has an infantile, juvenile, or adolescent onset
iii. curves greater than 15 degrees are abnormal and can progress to significant curvature during the growth spurt
iv. Idiopathic scoliosis is most common and is more prevalent in females
v. can result in disfigurement, impaired mobility, and cardiopulmonary complications
vi. bracing and surgical correction may be necessary and early referral to an orthopedic surgeon is important
m. Gender
i. Primary sexual characteristics involve the organs necessary for reproduction, such as the penis and testes in boys and the vagina and uterus in girls
ii. Secondary sexual characteristics are external features that are not essential for reproduction (breast development, facial and pubic hair growth, and lowering of the voice)
iii. Sexual maturity rating (Tanner staging) is used widely to assess and monitor the degree of maturation of an adolescent’s primary and secondary sexual characteristics
iv. The first sign of puberty in males is a thinning of the scrotal sac and enlargement of the testicles
v. Ejaculation is considered a milestone of male puberty and precedes fertility by several months
vi. For females the first sign of puberty is the appearance of breast buds, followed by the growth spurt
vii. Menarche occurs approximately 2 years after the appearance of the breast buds and near the end of the growth spurt
n. Genetics
i. genetic disorders frequently are discovered during the assessment of an adolescent with delayed or irregular pubertal development (family history helps)
ii. Turner syndrome (XO)
1. female disorder in which only one X chromosome is present instead of two
2. short stature, a webbed neck, a low posterior hairline, low-set ears, a shield-shaped chest with widely spaced nipples, and gonadal-ovarian dysgenesis, resulting in a lack of sexual development and menses during puberty
3. administration of growth hormone, to increase height, and estrogen therapy to help develop secondary sexual characteristics and menses
4. Always sterile
iii. Klinefelter syndrome (XXY)
1. Males have an extra X chromosome
2. typically are tall, initially thin, and do not develop secondary sexual characteristics
3. often have gynecomastia
4. associated with learning or behavior problems during childhood
5. management typically involves androgen therapy and counseling
6. always sterile
7. need ongoing assessment and support to promote development of positive self-esteem
3. Gordon’s functional health patterns
a. Health perception- health management pattern
i. have fewer acute illnesses than do younger children and fewer chronic illnesses than adults
ii. sense of invincibility with experimentation and risk-taking behaviors to produce deleterious health care choices and outcomes
iii. in the process of developing health habits and patterns of problem-solving that are likely to last a lifetime
iv. cognitive and psychological changes that they experience can affect their adherence to health-promotion and disease-prevention strategies
v. treat them as joint partners in planning the care
vi. include respect for individual differences, support for the adolescent’s emerging autonomy, a developmental approach, and a focus on the individual’s strengths
b. Nutritional-Metabolic Pattern
i. may choose dietary intake as a mechanism to gain control over their changing bodies, exert independence, or experiment with a new identity or cause, such as becoming a vegetarian
ii. Gymnasts, runners, body builders, rowers, wrestlers, dancers, and swimmers are particularly vulnerable to eating disorders because their sports necessitate weight restriction
iii. overwhelming desire to “fit in” with their peers, which often prevails and can lead to unhealthy dietary practices
iv. eating disorders
1. anorexia nervosa
a. typically female, perfectionists, and high achievers with families that tend to be achievement oriented and experiencing marital discord
b. Symptoms include a relentless pursuit of thinness, self-starving with significant weight loss, lack of menstruation (in females) and decreased sexual interests (in males), compulsive physical activity, preoccupation with food, portioning food carefully, eating only small amounts of only certain foods, a distorted body image brittle hair and nails, dry yellowish skin, growth of fine hair over the body, constipation, mild anemia and muscle weakness, and often complains of feeling cold
c. response to low self-esteem and real or imagined obesity
2. bulimia nervosa
a. affects females more than males
b. typically binge on huge quantities of high-caloric foods and then purge by self-induced vomiting and/or laxatives
c. Binge episodes may alternate with diets, resulting in dramatic weight fluctuations
d. Results in dehydration, sometimes fatal electrolyte imbalances, and erosion of teeth enamel
3. Binge eating disorder (compulsive overeating)
a. frequently consumes large amounts of food while feeling a lack of control over eating, but don’t purge
4. Obesity
a. consumes too many calories for the amount of energy expended
b. strong correlation between inactivity
c. depression as one of the strongest predictors
d. increases the risk of and occurrence of type 2 diabetes mellitus
e. Diabetes is a group of diseases marked by high levels of glucose in the blood, which left unattended lead to blindness, kidney failure, amputations, heart disease, and stroke
c. Elimination pattern
i. renal and gastrointestinal systems are functionally mature by adolescence, and elimination patterns are consistent with those found in adults
ii. Abnormal variation can occur in teens with eating disorders
d. Activity-Exercise Pattern
i. alterations in body composition and growth of lean muscle mass allow the teen to experience increased physical strength and endurance
ii. Frequent injuries, stress fractures, secondary amenorrhea, extreme dietary measures to gain or lose weight, exclusion of other activities, deteriorating school work, and chronic pain are a few of the signs of overuse, overexertion, or overinvestment
e. Sleep-Rest Pattern
i. amount of time needed each night for sleep declines in comparison to earlier childhood needs
ii. need at least 8 hours of sleep per night
iii. Too little sleep also might contribute to mood swings and behavioral problems
f. Cognitive-perceptual pattern
i. Piaget’s Theory of Cognitive Development
1. Formal operations
2. used the term formal to represent the emergence of ability to focus on the “form” of thoughts, objects, and experiences rather than on the exact content, which in turn lays the groundwork for abstract thinking
3. because of their new ability to “think about their thinking,” adolescents become highly introspective
4. As introspection increases, they develop an internalized audience that provides them with a means to evaluate questions such as “Who am I?” “How do others see me?” and “Where am I going?”
5. Introspection also combines with a reemergence of egocentrism, leading to their sense of being the primary focus
6. Being exceptional to the adolescent means being the exception, giving rise to the risk-taking behaviors for which they are well-known
7. intolerance of things as they are (able to conceptualize things as they might or could be, rather than how they are, and can think of elaborate means for achieving these changes)
8. constantly challenge the ways things are and challenge themselves [Show Less]