NUR 205 WEEK 4

Development-the sequence of physical, psychosocial, and cognitive developmental changes

that take place over the human life span

Types of Development

 Physical/Physiological Development
o Growth and changes in body tissues and organ systems and the resultant
changes in body functions and proportions
o Includes cellular proliferation, differentiation, and maturation that occurs in each
organ and system that allows integrated human functioning necessary for life
o Occurs from head to toe direction (cephalocaudal), hence why infants have a
disproportionately larger head-to-body ratio than adults
 Motoric Development
o Gross motor- involves use of large muscles to move about in the environment
1. i.e. sitting, standing, maintaining balance, cruising, walking, running, and
complex skills like playing soccer
o Fine motor- involves use of small muscles in an increasingly coordinated and
precise manner
1. i.e. batting at an object, reaching and holding an object, transferring an
object from hand to hand, holding a pencil in a refined grasp, making
marks with a pencil, writing letters and words, creating masterful artwork

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 Social/Emotional
o The development of self-understanding, understanding others, and
understanding social interactions
o Develops in this order
1. Self
2. Others
3. Social interaction
 Cognitive Development
o Relates to working memory capacity, cognitive self-regulation, and the
processing and use of information about the environment, and the objects in the
environment
o Individuals have an increased understanding of relationships between self-
understanding and information over time
o Underlies the development of critical thinking skills and executive functioning
1. Learning
2. Forming concepts
3. Understanding problem solving
4. Reasoning
5. Remembering
6. Thinking abstractly
 Communication Development
o Communication is a process that requires both receptive and expressive skills
o Three components of speech
1. Articulation- refers to the pronunciation of sounds
2. Voice- refers to the production of sound by the vocal chords
3. Fluency- refers to the rhythm of speech
o Examples of development
1. Starts with “utterances of consonants
2. Increases to include vowels
3. Single words are formed
4. Then two or three word combinations
5. Resulting in development of meaningful phrases and sentences
 Adaptive Development
o Refers to the acquisition of a range of skills that enable independence at
home and in the community
o Adaptive skills are learned and include self-care activities such as
 Dressing/undressing
 Eating/feeding
 Toileting
 Grooming
 Management of one’s immediate environment
 Functional behaviors within the community

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Stages of Development (young adulthood to older adulthood)

Young Adult- late teens to mid/late thirties also referred to as emerging adulthood
 Physical Changes
o Completed physical growth by age 20
o Experience less severe illnesses
o Assessment findings are normally within normal ranges
 Cognitive Changes
o Critical thinking habits increase
o Identifying an occupational direction is a major task in this stage
 Psychosocial
o Sexuality-sexuality is an important milestone of early adulthood as secondary
sex characteristics develop and come to maturity in this stage
o Childbearing Cycle
o Singlehood
o Parenthood
 Health Risks
o Personal Hygiene habits
o Violent death and injury
o Intimate partner violence
o Human trafficking
o STIs
o Occupational factors
o Unplanned pregnancies
o Stress
Middle Adult- ages thirty five to sixty four
 Physical changes
o Perimenopause and menopause
 Cognitive changes
o Cognitive change is rare in middle adults except for traumatic events
 Psychosocial Changes
o Career Transitions
o Sexuality
o Family psychosocial factors
 Singlehood
 Marital changes
 Family transitions
 Care of aging parents
 Health Risks
o Obesity
o Forming positive health habits

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 o Early onset dementia
o Depression
 Older Adult- sixty five years+
o Physical Changes
 Integumentary system- Skin loses resilience and moisture
 Head and Neck- visual acuity declines, salivary secretion is reduced
 Thorax and Lungs- respiratory muscles decrease in strength
 Heart and Vascular System- decreased cardio output
 Breasts- estrogen production diminishes, milk ducts are replaced by fat
 Reproductive system- reduced responsiveness in ovaries to pituitary
gland, testosterone diminishes sometimes leading to lowered libido
 Urinary system- hypertrophy of the prostate gland, urinary incontinence
can occur
 Musculoskeletal system- muscle fibers become smaller, muscle strength
diminishes
 Neurological system- decrease in number and size of neurons
o Cognitive Changes
 Common misconception that aging and cognitive impairment are
widespread
 Three common conditions that affect cognition
I. Delirium – potentially reversible cognitive
impairment usually due to electrolyte imbalance or
untreated infection
II. Dementia
III. Depression
o Psychosocial Changes
 Retirement
 Housing and Environment
 Social Isolation
 Death
o Health Risks
 Heart disease
 Cancer
 Chronic Lung disease
 Stroke
 Smoking
 Alcohol use
 Nutrition
 Dental problems
 Exercise
 Falls
 Pain
 Sensory impairment

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End of Life (near death)
Death-occurs when all vital organs and body systems cease to function, respirations generally
cease first, then heartbeat stops a few minutes later, brain death occurs when cerebral cortex
stops functioning or is irreversibly damaged
 Physical
o Metabolism reduced
o Blurred vision
o Decreased sense of taste and smell
o Decreased pain reception
o Loss of blink reflex
o Rapid, slow, shallow, irregular respirations
o Heart rate and BP lowers
o Skin cools and extremities become pale
o Urinary output and GI motility decreases
o Gradually loses ability to move
o Difficulty speaking and swallowing
 Psychosocial
o Fears associated with death
 Fear of pain
 Fear of loneliness and abandonment
 Fear of being meaningless

Erikson’s theory of psychosocial development (young adulthood to older adulthood)

 Focuses on psychosocial development of an individual across the life span
 11-18 years- identity vs role confusion
 18-25 years – intimacy vs isolation
 25-65 years- generativity vs stagnation
 65- death- integrity vs despair

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Interrelated Concepts
 Functional ability
 Nutrition
 Culture
 Family dynamics
 Mood and cognition

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Fatigue-distressing, persistent, subjective sense of physical, emotional, or cognitive tiredness or

exhaustion, interferes with usual functioning

Causes of Fatigue

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Classifications of Fatigue
 Physiological
o Caused by imbalance of exercise, other activity, sleep and diet
o Usually not caused by underlying medical condition
 Secondary
o Caused by underlying medical condition or treatment
o Usually resolves if underlying condition is addressed
 Unknown Etiology
o Chronic Fatigue Syndrome
o Idiopathic Fatigue

Risk Factors
 Populations at risk
o Older adults
o Women
 Individual Risk Factors
o Genetic Predisposition
o Underlying Conditions
o Treatment-related factors
o Nutritional status
o Lifestyle Choices

Assessing Fatigue
 History
o Personal description of the fatigue by the patient
o Onset and Course of fatigue
o Duration and daily pattern of the fatigue
o Factors that alleviate or exacerbate fatigue
o Impact on daily life
o Other physical, emotional, and cognitive symptoms that accompany the fatigue
 Examination Findings
o Inspection- individual’s general appearance
 Are they alert?
 Are they displaying psychomotor agitation or impairment?
 Does he or she appeared slumped?
o Palpation and Auscultation
 Palpate for presence of lymphadenopathy, thyroid nodules, or goiter
Primary Prevention
 Healthy lifestyle-good nutrition, exercise, getting adequate sleep and managing stress
Secondary Prevention
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  Nurses can screen patients for risk of fatigue related to health concerns such as post-
partem and

Collaborative Prevention
 Managing physiological fatigue
 Managing secondary fatigue
 Exercise and rest therapy
 Pharmacological agents

Interrelated Concepts
 Mood and Effect
 Nutrition
 Pain
 Gas Exchange
 Perfusion
 Cellular Regulation
 Sleep
 Stress and Coping
 Mobility
 Cognition
 Functional Ability

Exemplars
 Cancer-related fatigue- due to chemotherapy and cancer treatments
 Diabetes
o Can result in muscle and tissues not receiving adequate energy due to sugar
remaining in bloodstream rather than entering body’s cells
 Mononucleosis
 Pregnancy
 Chronic Obstructive Pulmonary Disease (COPD)
o Chronic condition associated with airway obstruction making it difficult to move
air out of the lungs, leading to dyspnea and hypoxemia
 Chronic Fatigue Syndrome- unknown etiology, affects women more
 Idiopathic Chronic Fatigue- literally means they don’t know the etiology