Exam 1

• Theories of Aging


  • Genetic
  • Neuroendocrine and immunity
  • Stochastic
  • Wear and tear
  • Cross-linkage
  • Free radical
• Genetic theory


  Focuses on genetic inheritance
• Immunity theory


  Focuses on the functions of the immune system
• Cross-linkage theory


  Focus is a chemical reaction damaging the DNA and causing cell death
• Development of the Middle Adult

  • Physiologic: gradual internal and external physiologic changes occur
  • Cognitive: little change from young adulthood; increased motivation to learn
  • Psychosocial: time of increased personal freedom, economic stability, and social relationships
• It is the role of the older adult to adapt to, and face, already completed tasks.
• Choosing a vocation and developing an ethical system as a guide to behavior are developmental tasks for adolescents and young adults
• Psychosocial Development #1


  • Generativity versus stagnation (Freud)
  • Learned behaviors arising from maturation, personal motives and values, and civic responsibility (Havighurst)
  • Accept and adjust to physical changes
  • Maintain a satisfactory occupation
  • Assist children to become responsible adults
  • Adjust to aging parents
  • Relate to one's spouse or partner as a person
• Psychosocial Development #2


  • Either continue established lifestyle or reorganize (Levinson)
  • Ages 35–43: adults look inward
  • Ages 43–50: adults accept their lifespan as having definite boundaries and have a special interest in their spouse/partner, friends, and community
  • Ages 50–60: adults experience increased feelings of self-satisfaction, value the spouse/partner as a companion, and become more concerned with health
• Adjusting to Changes of Middle Adulthood

  • Employment
  • Spousal relationships
  • Relationships with children and aging family members
• Moral and Spiritual Development of Middle Adulthood

  • May remain at conventional level or move to the post-conventional level (Kohlberg)
  • May become less rigid in their spiritual beliefs, recognize paradoxes in life, appreciate symbolism, engage in mutual perspective-talking during the paradoxical-consolidative state of spiritual development if they reach it (Fowler)
• Common Health Problems in Middle Adulthood

  • Malignant neoplasms
  • Cardiovascular disease
  • Injury
  • Depression; Suicide
  • Diabetes mellitus
  • Chronic lower respiratory disease
  • Cerebrovascular causes
  • Liver and/or kidney disease
  • Obesity
  • Alcoholism
  • arthritis
• Role of the Nurse: Health of the Middle Adult

  • Health-related screenings, examinations, and immunizations are important
  • Teach the dangers of substance use, smoking, and alcohol consumption
  • Teach adults to eat a diet low in fat and cholesterol
  • Teach the importance of regular exercise
• Variation in Life Expectancy—Older Adulthood

  • Socioeconomic and race/ethnicity factors
  • Behavioral and metabolic risk factors
  • Health care factors
• Common Myths of the Older Adults (Ageism)

  • Old age begins at 65 years
  • Most older adults are in long-term care facilities
  • Older adults are sick, and mental deterioration occurs
  • Older adults are not interested in sex
  • Older adults do not care how they look and are lonely
  • Bladder problems are a problem of aging
  • Older adults do not deserve aggressive treatment for illnesses
  • Older adults cannot learn new things
• Physiologic Changes of Older Adults

  • General status
  • Integumentary system
  • Musculoskeletal system
  • Neurologic system
  • Special senses
  • Cardiopulmonary system
  • Gastrointestinal system
  • Dentition
  • Genitourinary system
• Cognitive Development in Older Adulthood

  • Intelligence increases into the 60's and cognition does not change appreciably with aging
  • Response/reaction times may increase
  • Mild short-term (recent) memory loss is common
  • Long-term memory usually remains intact
  • Dementia, Alzheimer's disease, depression, and delirium may occur and cause cognitive impairment
• Psychosocial Development of the Older Adult

  • Self-concept is relatively stable throughout adult life
  • Disengagement theory: An older adult may substitute activities but does disengage from society
  • Erikson: Ego integrity versus despair and disgust; life review
  • Havighurst: Major tasks are maintenance of social contacts and relationships
• Adjusting to Changes of Older Adulthood

  • Physical strength and health
  • Retirement and reduced income
  • Spouse or Partner Health
  • Relating to one's age group
  • Social roles
  • Living arrangements
  • Family and role reversal
• Moral and Spiritual Development of Older Adults

  • Kohlberg: Older adults have completed their moral development and most are at a conventional level
  • Spiritually, an adult may be at an earlier level, often at the individuative–reflective level
  • Many adults demonstrate conjunctive faith and trust in a greater power
  • Self-transcendence is characteristic of later life
  • Gerotranscendence: describes the transformation of a person's view of reality from a rational, social, individually focused, materialistic perspective to a more transcendent vision
• Health of the Older Adult

  • Most older people are not impaired
  • More vulnerable to physical, emotional, or socioeconomic problems
  • Probability of becoming ill increases
  • Chronic health problems or disability may develop
  • Polypharmacy
  • Diversity and chronic illness: structural racism
  • Accidental injuries
  • Dementia, delirium, and depression
  • Elder abuse
• Causes of Accidental Injuries in Older Adults

  • Changes in vision and hearing
  • Loss of mass and strength of muscles
  • Slower reflexes and reaction time
  • Decreased sensory ability
  • Combined effects of chronic illness and medications
  • Economic factors
• Elder Abuse


  • Experienced by 1 in 10 community-dwelling, older adults ages 60 years and older living in the United States (CDC, 2021)
  • Environmental, social, financial, educational, and employment-based inequities increase risk
  • World-wide, rates of elder abuse have increased during the COVID-19 pandemic
  • Elder abuse includes physical abuse, sexual abuse, psychological or emotional abuse, financial abuse or exploitation, and neglect (Hall et al., 2016)
  • Compared with women, men have higher rates of death by homicide and experiencing nonfatal assaults (CDC, 2021)
• SPICES


  • S—Sleep disorders
  • P—Problems with eating or feeding
  • I—Incontinence
  • C—Confusion
  • E—Evidence of falls
  • S—Skin breakdown
• Nursing Actions to Promote Health in Older Adults

  • Physiologic function
  • Cognitive function
  • Psychosocial needs
  • Nutrition
  • Sleep and rest
  • Elimination
  • Activity and exercise
  • Sexuality
  • Meeting developmental tasks
• Three Stages of the Fetus

  • Pre-embryonic stage: conception to 3rd week
  • Embryonic stage: 4th to 8th week
  • Fetal stage: 9th week to birth
• Pre-embryonic stage


  Three distinct cell layers: endoderm, mesoderm, and ectoderm
• Embryonic stage


  All basic organs established
• Fetal stage


  Body organs and systems continue to grow
• Physical Characteristics of a Normal Neonate (Birth to 28 Days)


  • Reflexes present (moro, stepping, grasp, hand to mouth, sucking, swallowing, blinking, sneezing, yawning)
  • Body temperature responds quickly to environmental temperature
  • Senses used to respond to environment
  • Stool and urine eliminated
  • Active crying and quiet alert state exhibited
• Health of the Neonate

  • Inherited immunity from infections resulting from maternal immunoglobulins that cross the placenta
  • Breastfeeding provides further immunity and is recommended exclusively for the first 6 months
  • Difficulties related to birth, congenital abnormalities, respiratory difficulties may be present
  • Premature neonates or those delivered by cesarean are more vulnerable to respiratory distress syndrome
• Physiologic Development of the Infant (1 Month to 1 Year)

  • Brain grows to half of adult size
  • Body temperature stabilizes
  • Motor abilities develop
  • Eyes begin to focus and fixate
  • Heart doubles in weight, heart rate slows, and blood pressure rises
  • Deciduous teeth begin to erupt at 4 to 6 months
  • Birth weight usually triples by 1 year (average 22 lb)
• Psychosocial Development of Infant

  • In oral stage, immediate gratification of needs (Freud)
  • Develops trust (Erikson)
  • Meets developmental tasks (Havighurst; taking food, walking, talking)
• Special Considerations for the Infant

  • Attachment and bonding
  • Play
  • Temperament: easy, slow to warm, difficult
  • Health of the infant
  • Infant colic
  • Failure to thrive
  • Accidental injuries
  • SIDS; sudden unexpected infant death
  • Child maltreatment
• Role of the Nurse in Infancy

  • Promoting health
  • Teaching family members or guardians and caregivers
  • Safety
  • Nutrition and elimination
  • Hygiene
  • Growth and development
  • Promoting health and preventing illness
  • Administering immunizations
• Physiologic Development of Toddler (1 to 3 Years)

  • Rapid brain growth, increase in bone length, and muscle growth
  • Uses fingers to pick up small objects.
  • Walks forward and backward, runs, kicks, climb, rides tricycle
  • Drinks from cup and uses a spoon
  • Four times birth weight
  • Bladder control during the day, sometimes at night
  • Turns pages in book, and by age 3 draws stick people.
• Cognitive Development of Toddler

  • In Piaget's last two stages of sensorimotor development
  • Beginning to understand object permanence
  • Follow simple commands
  • Anticipating events
  • Understands self as separate from others
  • Beginning perception of body image
  • Sense of biologic sex identity
  • Language begins; at 2 years, uses short sentences.
• Psychosocial Development of Toddler

  • Anal stage, toilet training is major focus (Freud)
  • Autonomy versus shame and doubt (Erickson)
  • Negativism (saying "no")
  • Regression
  • Separation anxiety
  • Tasks of learning to control elimination process, learn sex differences, form concepts, learn language, and distinguish right from wrong (Havighurst)
• Nurse's Role: Health of the Toddler


  • Accidents represent the highest risk for toddlers
  • Nurses promote health by primarily teaching
  • Caregivers encourage independence and set firm limits
  • Safety, nutrition, hygiene, elimination, growth and development, promoting health and preventing illness
• Industry versus inferiority stage

  • Focus on learning useful skills, self-identity emerges (Erikson)