Ch09 Life Span Development.docx

Chapter 9 Life Span Development Unit Summary After students complete this chapter and the related course work, they will have a fundamental understanding of the physiological and psychosocial differences of each phase of human development. The students will be able to discuss adaptations and strategies they might apply to better assess and manage patients. National EMS Education Standard Competencies Life Span Development Integrates comprehensive knowledge of life span development. Knowledge Objectives 1. Understand the terms used to designate the following age groups: infants, toddlers, preschoolers, school-age children, adolescents (teenagers), early adults, middle adults, and late adults. (pp 401, 405, 407, 408, 409, 410) 2. Describe the major physiologic and psychosocial characteristics of an infant’s life. (pp 401-405) 3. Describe the major physiologic and psychosocial characteristics of a toddler and preschooler’s life. (pp 405-407) 4. Describe the major physiologic and psychosocial characteristics of a school-age child’s life. (pp 407-408) 5. Describe the major physiologic and psychosocial characteristics of an adolescent’s life. (pp 408-409) 6. Describe the major physiologic and psychosocial characteristics of an early adult’s life. (p 409) 7. Describe the major physiologic and psychosocial characteristics of a middle adult’s life. (pp 409-410) 8. Describe the major physiologic and psychosocial characteristics of a late adult’s life. (pp 410-414) Skills Objectives There are no skills objectives for this chapter. Readings and Preparation Review all instructional materials including Chapter 9 of Nancy Caroline’s Emergency Care in the Streets, Seventh Edition, and all related presentation support materials. • Review the following web links This American Academy of Pediatrics (AAP) web site includes resources for further reading on health and safety issues relating to child/adolescent developmental stages. http://www.healthychildren.org The National Mental Health Information Center discusses how reactions to disasters differ between children and adults. http://mentalhealth.samhsa.gov/publications/allpubs/ken01-0101/default.asp The Federal Emergency Management Agency (FEMA) web site has information to help instructors and students learn more about how to help children cope with disaster. http://www.fema.gov/rebuild/recover/cope_child.shtm The Geriatric Mental Health Foundation web site highlights the needs and responses of older adults in disasters. http://www.gmhfonline.org/gmhf/consumer/disaster_prprdns.html Support Materials • Lecture PowerPoint presentation • Case Study PowerPoint presentation Enhancements • Direct students to visit the companion web site to Nancy Caroline’s Emergency Care in the Streets, Seventh Edition, at http://www.paramedic.emszone.com for online activities. • Web links This link contains many easy-to-understand details on the changes that might be found during assessment of the older adult patient. http://consultgerirn.org/topics/sensory_changes/want_to_know_more This Centers for Disease Control and Prevention (CDC) short video discusses normal and abnormal developmental milestones in children. http://www.cdc.gov/ncbddd/actearly/video.html This New York Times opinion editorial has an interesting chart that students can use as a reference for assignments. http://www.nytimes.com/interactive/2009/12/14/opinion/20091214_opart.html Learn more about the development of children. http://www.pbs.org/parents/childdevelopmenttracker/ • Content connections: Many age-related issues may be raised during discussions and activities from this chapter’s lessons. Inform students that some topics can be addressed in more depth in specific chapters including the chapter on Pediatric Emergencies and the chapter on Geriatric Emergencies. Material learned in this chapter will be directly applied in the chapter on Patient Assessment, chapters covering specific medical conditions, and other chapters. • Cultural considerations: Help students express their own and/or familial views of age-related issues. Open these discussions up to the whole group in order to share cultural beliefs and help dispel myths. Some cultures have great respect for elders while other cultures may tend to marginalize or minimize the input of the very young or very old, preferring instead to have a family spokesperson. Teaching Tips Many people, particularly young people, may have preconceived ideas about development ages. Discuss ageism and other notions with students to increase awareness of misconceptions so these can be addressed and dispelled during lectures and activities of this chapter. Unit Activities Writing activities: Assign students a topic to compare between two distinct developmental groups. For example: Research and prepare a poster or short paper comparing and contrasting falls among toddlers and falls among the elderly. How do the possible causes differ? What types of injuries are more likely to be seen after a fall of a 16-month-old female compared to an 85-year-old female? Remind students to take several aspects of both physical and psychological/social development into account. Student presentations: Have students research or interview someone who has been injured or ill. What direct connections can they infer based on the patient’s age/developmental stage? Present findings to the class. For additional group-to-group interaction, do not have each group reveal the patient’s age. Open up discussion at the end of each presentation and allow groups to determine the age of each “patient.” Group activities: Every group has a patient with the same general complaint, but the patient’s age in every group is different. Give the groups a set amount of time (15 minutes suggested) to prepare a skit to show how speaking and examining the patient might differ. Each group member should have one of the following roles: patient, paramedic, caregiver/parent or friend, and narrator or reporter. Roles can be combined to suit group size. Present each skit to the class. Visual thinking: Collect or have students collect magazine/Internet pictures of people at all different developmental stages and organize them into categories of similar ages. Attach each group of pictures to a poster board. An alternative is to collect representative pictures from online resources and prepare a PowerPoint slide series of only the pictures. Based on students’ general impression of age in each photo, have groups compile lists of expected behaviors and possible illnesses/conditions/injuries of each “patient.” Pre-Lecture You are the Medic “You are the Medic” is a progressive case study that encourages critical-thinking skills. Instructor Directions Direct students to read the “You are the Medic” scenario found throughout Chapter 9. • You may wish to assign students to a partner or a group. Direct them to review the discussion questions at the end of the scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions and the Patient Care Report. • You may also use this as an individual activity and ask students to turn in their comments on a separate piece of paper. Lecture I. Introduction A. Humans evolve as people over their life spans. 1. Paramedics must be aware of the changes that occur at each stage of life. Changes will be: a. Obvious and subtle b. Physical and mental 2. These changes may alter the approach to patient care. II. Infants A. An infant is a person aged 1 month to 1 year. 1. Babies younger than 1 month are called newborns or neonates, depending on their age. B. Physical changes 1. Vital signs a. The younger a person, the faster their pulse rate and respirations. b. Blood pressure corresponds with a person’s weight, typically increasing as the infant gets older. 2. Weight a. Infants generally weigh between 6 and 8 pounds at birth. b. Due to fluid loss, infants lose 5-10% of their body weight in the first week. c. Infants begin gaining weight again during the second week of life. i. Grow at a rate of 30 g per day ii. Their weight doubles by 4 to 6 months. iii. Their weight triples by age 1 year. 3. Cardiovascular system a. Prior to birth, fetal circulation occurs through the placenta. b. Postbirth, infants experience physiologic changes to enable independent circulation through their own vasculature. 4. Pulmonary system a. A newborn’s first forceful breath inflates the lungs for the first time. b. Infants under 1 month are nose breathers; those under 6 months are prone to nasal congestion i. Can cause viral upper respiratory infections ii. Check to ensure nasal passages are clear if called for a choking infant c. When compared to an adult, infants have the following characteristics: i. Less rigid rib cages ii. Horizontally oriented ribs, which results in diaphragmatic breathing iii. Immature accessory muscles, which may cause fatigue iv. Proportionally larger tongue and proportionally shorter, narrower airway may cause occlusion more easily than an adult v. Fewer alveoli, which decreases surface area for gas exchange vi. Fragile lungs are easily damaged by excessive force or volume when providing respirations with a bag-mask (a) Barotrauma is trauma from pressure. 5. Renal system a. The inability of an infant’s kidneys to produce concentrated urine may cause dehydration. b. The high percentage of water in infant urine may cause electrolyte imbalances. 6. Immune system a. Infants have a passive immunity acquired from their mothers that continues during the first year of life. i. Breastfed infants receive additional antibodies via milk. 7. Nervous system a. An infant’s nervous system continues to evolve following birth. i. Motor and sensory development are most developed in the cranial nerves. ii. Newborns cannot localize and isolate a particular response to sensation, which control blinking, sucking, and gag reflexes. b. Infants are born with the following four reflexes: i. Moro reflex (startle reflex), or the ability to open arms wide and spread fingers, seeming to grab at things, when startled ii. Palmar grasp, or grasping an object that is placed in the hand iii. Rooting reflex, or when touched on one cheek, turning the head toward that touch iv. Sucking reflex, or starting to suck when the lips are touched c. Many of these reflexes are tested when feeding. d. Fontanelles i. Allow the head to be molded (for example, when passing through birth canal) ii. Three or four bones of the skull iii. Eventually fuse to form suture joints by age 18 months iv. A sunken anterior fontanelle may indicate dehydration. e. Debate exists among physicians on ways to help an infant establish a sleep pattern. i. Some advocate waking infants every few hours to feed and protect against sudden infant death syndrome (SIDS). ii. Others advocate leaving infants alone to establish a circadian rhythm. 8. Musculoskeletal system a. Growth plates located at each end of the bones to help lengthen them i. Epiphyseal (secondary bone-growing) plates are also present. b. Bones grow in thickness by building on themselves. c. An infant’s muscles account for 25% of his or her total weight. d. Growth charts i. Track the growth of infants and children . ii. Provide percentiles comparing child’s growth to growth expected for an average child of that age. 9. Dental system a. Teething generally begins between ages 4 to 7 months. i. Some children have teeth erupt as early as 1 month. ii. Some may wait as long as 1 year. iii. Teeth erupt in a predetermined order. iv. Most children have all of their teeth by age 3. b. Permanent teeth start to come in around age 6. C. Psychosocial changes 1. An infant’s psychosocial development begins at birth. a. Evolves as infant interacts with and reacts to the environment 2. Infants typically have their own timetable for becoming attached to their family. 3. Bonding: Formation of a close, personal relationship a. Usually based on a secure attachment, which occurs when an infant understands that parents or caregivers will be responsive to his or her needs i. Encourages a child to explore b. Anxious avoidant attachment i. Observed in infants who are repeatedly rejected ii. These children become isolated. 4. Most infants use crying as the primary method of communicating distress. a. Infants will cry to express anything. b. Parents can usually tell what an infant needs by the tone of an infant’s cry. c. Infants use a less common alarming distress cry when something unexpected (situational crisis) occurs. i. Example: Separation anxiety is a normal reaction to the idea or reality of being separated from a parent (a) Peaks at 10 to 18 months and involves clingy behavior and fear of the unfamiliar 5. For infants, a reaction to a situational crisis follows three phases: a. Protest phase i. Can start immediately ii. Usually lasts about a week iii. Includes loud crying, irritability, restlessness, and rejection of other caregivers’ efforts b. Despair phase i. Involves monotonous wailing because the infant believes the situation will not resolve c. Withdrawal i. Occurs when the infant becomes almost apathetic and appears bored by his or her surroundings 6. Developing infants need a predictable environment to feel secure. a. If an infant’s environment is too unpredictable, he or she may withdraw. b. Trust and mistrust i. Stage of development from birth to about 18 months ii. Infant gains trust when caregivers provide a planned, organized, and stable environment. iii. The infant develops behavioral problems if he or she believes caregivers will not provide an organized environment. c. Infants respond well to scaffolding. i. Instructional technique in which a person builds on what has already been learned 7. Temperament a. Easy children have normal body function, have low-intensity reactions, and adjust readily to their surroundings. b. Difficult children have intense reactions and do not acclimate well to new surroundings. c. Slow to warm up children have low-intensity reactions, but usually exhibit a negative mood. 8. You should adjust your approach to an infant based on the patient’s developmental age. a. Allow caregivers to hold infant, and allow the infant to hold a toy. b. Allow caregivers to hold the infant during physical assessment except: i. In cases of respiratory failure ii. The need for spinal immobilization iii. Reduced level of consciousness c. Distract the child. d. Save the hardest part of the assessment or treatment for last. III. Toddlers and Preschoolers A. Physical changes 1. A toddler is a person ages 1 to 3 years, whereas a preschooler is a person ages 4 to 5 years. 2. As compared to infants, vital signs in this age group are as follows: a. Pulse rate and respiratory rate are slower than infants. b. Systolic blood pressure is higher than infants (approximately 100 mm Hg). c. Weight gain levels off. 3. A toddler’s cardiovascular system is similar to adults; note the following considerations: a. This age group is developing more lung tissue (bronchioles, alveoli). b. They still lack well-developed lung musculature, preventing sustained, long-term deep or rapid respirations. 4. Toddlers lose their passive immunity and begin to develop “colds.” a. Exposure to others helps them acquire their own immunity. 5. Toddlers/preschoolers experience numerous types of neuromuscular growth, including: a. The development of gross motor skills, such as grabbing an object with the full palm b. The development of fine motor skills, such as holding a crayon c. A preschooler’s brain weighs 90% of its final adult weight. d. Muscle mass and bone density increase. 6. Renal system changes include bladder control. a. The average age for toilet training is 18 months. b. Psychologically, the child may not be ready until 18 to 30 months. 7. Baby teeth will emerge through the teething process, and may include pain and fever. 8. Sensory development makes tickling fun. B. Psychosocial changes 1. Separation anxiety peaks between ages 10 to 18 months. 2. Average children master basic language by age 36 months, understanding and using complete sentences. 3. Toddlers begin interacting with peers, which results in: a. Learning about control, following rules, and competitiveness through game playing b. Modeling their behavior on that of friends, TV characters, or others in the environment c. Recognizing sexual differences by observing others 4. Paramedics should consider the following when caring for toddler/preschool patients: a. Always include a parent/caregiver in the treatment. b. Position yourself at the child’s eye level. c. Explain what you plan to do ahead of time, giving the child choices whenever possible. d. Save the hardest part for last. e. Do not reason with a child about why a procedure must be done; explain it, ensure their safety, and proceed. C. Other factors also affect the psychosocial development of toddlers and preschoolers. 1. Three approaches to parenting affects a child’s development. a. An authoritarian style expects complete obedience, disregards a child’s personal freedom, and may lead to a child having self-esteem issues. b. An authoritative style sets and enforces rules, balancing parental authority with a child’s personal freedom, allowing children to develop into independent, well-socialized, easy going adults. c. A permissive style does not impose any rules on the child and tolerates all behaviors, including socially unacceptable ones; may be subdivided into: i. Indifferent, or parents who do not care ii. Indulgent, or parent who are excessively lenient, giving the impression of “spoiled” children 2. Although not uncommon in the United States, divorce has a profound effect on a child’s self-esteem and sense of well-being. a. Children question if the divorce was their fault and experience pain from the changing environment. b. Most children adapt easily if parents maintain their children as their priority. IV. School-Age Children A. Physical changes 1. A school-age person is age 6 to 12 years. 2. The following physical changes affect patients in this age group: a. Vital signs and physical body approach those of an adult. b. Children at this age grow approximately 4 lb and 2 ½" each year. c. Brain function develops in both hemispheres. d. Permanent teeth arrive. e. Puberty may begin as early as age 10. B. Psychosocial changes 1. Children develop three stages of reasoning: a. Preconventional reasoning involves acting to avoid punishment and get what they want. b. Conventional reasoning involves acting to obtain approval from peers and society. c. Postconventional reasoning involves making decisions guided by conscience. 2. Children develop self-concept, or their perception of themselves. 3. Children develop self-esteem, or their feelings about themselves and how they feel they fit in with their peers. 4. Paramedics should use the same techniques employed for preschoolers. a. Note that gaining (or losing) trust is the biggest issue with this age group i. Be direct, assertive, and open. V. Adolescents (Teenagers) A. Physical changes 1. Adolescents are people ages 13 through 17 years. 2. Vital signs level off to within adult ranges: a. Systolic blood pressure is between 90 and 110 mm Hg. b. Pulse rate is between 60 and 100 beats/min. c. Respirations are in the range of 12 to 20 breaths/min. 3. This age group undergoes a rapid, 2- to 3-year growth spurt as muscle and bone grows and blood chemistry changes. a. Begins with the hands and feet, then moves to the extremity long bones, and finally finishes at the torso. b. Although boys generally experience rapid growth later than girls, they end up taller and stronger. 4. Patients in this age group undergo reproductive system changes. a. Secondary sexual characteristics develop in both males and females, including: i. Enlargement of external sex organs ii. Pubic and axillary hair iii. Voice deepening/changing b. Females develop breasts and begin menstruation, although the first period (menarche) may occur in some school-age girls. c. Both sexes secrete hormones associated with reproduction. i. Females release follicle-stimulating hormone and luteinizing hormone, to increase estrogen and progesterone production. ii. Males release gonadotropin to produce testosterone. iii. Acne may result from hormone secretion. d. Midadolescents of both genders are physically capable of reproduction. B. Psychosocial changes 1. Conflict marks the relationship between teenagers and their families. a. Privacy becomes more important. b. Self-consciousness increases as teenagers struggle to fit. i. Adolescents may struggle to create their own identity. c. Rebelliousness may increase as a part of finding an identity. d. Peer pressure is a major factor. e. Self-destructive behaviors may begin, including: i. Antisocial behavior ii. Eating disorders iii. Smoking iv. Drinking v. Experimenting with drugs 2. Some teens show more interest in sexual relations. 3. Teens begin to develop their own code of personal ethics, based on parents, peers, and environment. 4. Patients in this age group are at greater risk than other age groups for depression and suicide. 5. Paramedics should provide discretion, respect, and privacy to this age group. a. Speak to a patient in an area that is separate from parents/caregivers, if possible. VI. Early Adults A. Physical changes 1. Early adults are people ages 18 to 40 years. 2. Vital signs do not vary greatly throughout adulthood. a. Pulse rate will stay around 70 beats/min. b. Respiratory rate will stay in the range of 12 to 20 breaths/min. c. Blood pressure will be approximately 120/80 mm Hg. 3. The human body functions at its optimal level between the ages of 19 to 25 years; the following physical changes occur after this age: a. The spinal disks settle, causing “shrinking.” b. Fatty tissue increases and leads to weight gain. c. Muscle strength decreases. d. Reflexes become slower. 4. Accidents are common cause of death. B. Psychosocial changes 1. Work, family, and stress define this age group. a. Early adults do everything they can to “settle down.” b. This age group tends to seek and find romantic love and have babies. c. This is considered one of the most stable periods of life, with fewer psychological problems related to well-being. VII. Middle Adults A. Physical changes 1. Middle adults are people ages 41 to 60 years. 2. Despite the body’s high level of functioning, patients in this group are vulnerable to the following physical changes: a. Vision and hearing loss b. Cardiovascular disease c. Weight gain due to lower metabolism d. Cancer rates increase. e. Women begin menopause in 40s and 50s, causing possible bone density loss (fractures) and cardiac problems. B. Psychosocial changes 1. People in this age group focus on meeting life’s goals. a. Some must adjust to living without their grown-up children (“empty nest” syndrome). b. Some have financial worries as they face retirement planning and meeting daily needs. c. May people now see crisis as a challenge to be overcome, rather than a threat. VIII. Late Adults A. Physical changes 1. Persons in this group are ages 61 and older. a. Life expectancy, or the average amount of years a person can be expected to live, is now approximately 78 years; the maximum is 120 years. 2. Vital signs depend on the person’s overall health status, medical conditions, and medications. 3. Cardiovascular system a. Atherosclerosis is caused by the build-up of cholesterol and calcium (plaque) within the walls of blood vessels. i. Leads to a partial or complete blockage of blood flow within the vessel ii. Can contribute to the development of an aneurysm (a) An aneurysm is a weakening or bulging of a blood vessel wall that may rupture. b. In general, people in this age group have hearts that are less able to deal with exercise or disease as a result of the following: i. Decreased pulse rate ii. Declining cardiac output iii. Inability to elevate cardiac output to match the body’s demands c. Overall, the vascular system becomes “stiff,” resulting in the following changes: i. Increased diastolic blood pressure ii. Decreased cardiac output related to the thickening and stiffening of the left ventricle iii. Impeded blood flow into and out of the heart and heart murmur related to stiffening of heart valves iv. Reduced elasticity of the peripheral vessels of up to 70% related to decreased amounts of elastin and collagen v. Reduced ability to compensate for blood pressure changes d. Fatty tissue begins to replace bone marrow, resulting in the production of fewer blood cells. i. This hinders body’s ability to heal after trauma. ii. It also decreases functional blood volume. 4. Respiratory system a. The following structural changes make breathing more difficult for patients in this age group: i. The size of the airway increases, while surface area of alveoli decreases. ii. Lungs become less elastic, forcing people to use intercostal muscles to breathe. iii. The calcification of the ribs to the sternum makes chest more rigid; this can also lead to fracture. iv. Muscle strength of intercostal muscles and diaphragm decreases. b. Changes in the mouth and nose leave the upper airway less protected and the chances of aspiration and obstruction more likely. i. It is more difficult to clear secretions. ii. Cough and gag reflexes decline. iii. Decline in cilia in airways makes structures less responsive to smoke, dust, and so on. c. Weakening of the smooth muscles in the upper airway may lead to collapse and inspiratory wheezing and low flow rates. d. Persons age 75 and older will likely have a vital capacity that is only 50% of the vital capacity noted in young adulthood; this is caused by: i. Loss of respiratory muscle mass ii. Increased stiffness of the thoracic cage iii. Decreased surface area available for air exchange e. While vital capacity decreases, residual volume increases and causes stagnant air to hamper gas exchange in the alveoli; this may cause: i. Hypercarbia, or increased carbon dioxide in the bloodstream ii. Acidosis 5. Endocrine system a. Reduced physical activity and declining endocrine system lead to weight gain. i. Body cannot produce the additional insulin needed to control blood glucose, leading to diabetes mellitus. ii. Higher blood glucose levels may cause mental status changes. b. Changes in the reproductive system occur for both men and women: i. Males still produce sperm, but lose penis rigidity. ii. Females experience atrophy of uterus and vagina related to menopausal decrease in hormone production. iii. Both genders may experience less sexual desire. 6. Renal system a. The following structural and functional changes occur in the kidneys: i. Filtration function declines by 50% between the ages of 20 to 90. ii. Kidney mass also decreases by 20% over the same time frame. iii. Number of nephrons (capillaries that filter waste) declines between the ages of 30 and 80. (a) More abnormal glomeruli are present in the nephrons. b. Aging kidneys respond less efficiently to hemodynamic stress, which means: i. Body has decreased ability to eliminate wastes ii. Body has decreased ability to conserve fluids when needed 7. Gastrointestinal system a. Functional changes may inhibit nutritional intake and utilization, resulting in vitamin and mineral deficiencies; these changes include: i. Decreased sensation of taste buds ii. Weaker teeth make chewing harder. iii. Decreased saliva production makes processing complex carbohydrates more difficult. iv. Slower gastric motility lead to constipation, making person feel fuller than they are in reality. v. Gastric acid secretion diminishes. vi. Decreased blood flow (by up to 50%) to mesentery membranes decreases ability to extract nutrients from digested food. b. Other changes that affect patients in this age group include: i. Increased chance of gallstones ii. Loss of anal sphincter elasticity may cause fecal incontinence. (a) This is of great concern to many patients and requires understanding by paramedic. (b) Always ask about bowel habits during interview. 8. Nervous system a. Central nervous system changes may include the following: i. Brain weight loss of between 10-20% by age 80 ii. Loss of between 5-50% of neurons, with shrinkage of existing neurons iii. Loss of as much as 20% of frontal lobe synapses iv. Slower motor and sensory neural networks v. Note that the brain’s metabolic rate remains the same. b. The sleep patterns of an older adult will change, and may become biphasic (two-phased). c. The noted brain changes make the brain more at risk for injury as a result of a trauma; this is a result of: i. Additional room between the brain and outermost layer of meninges due to brain shrinkage allows the brain to move when stressed. ii. Bridging veins can tear if brain moves, causing bleeding and an undetected subdural hematoma. d. Peripheral nervous system changes may include the following: i. Overall diminished sensation ii. Diminished proprioception may increase likelihood of falls and trauma. iii. Deteriorated nerve endings cause loss of skin sensitivity to heat, cold, sharpness, and wetness, leading to injury. 9. Sensory changes a. While the senses are affected by aging, many patients in this age group see and hear well. b. General eye and vision changes may include the following: i. Restricted pupillary reaction as pupils become smaller and sluggish in response to light; visual acuity also diminishes. ii. Restricted ocular movements iii. Increased visual distortions iv. Decreased ability to focus at close range related to lens thickening v. Narrower peripheral fields of vision, with greater sensitivity to glare c. Hearing loss related to structural changes is four times more common than the loss of vision in this population. i. Loss of high-frequency hearing ii. Deafness d. Eating becomes less pleasurable due to the loss of both taste bud sensation and olfactory perception. B. Psychosocial changes 1. Paramedics should value the chance to learn from the wisdom of late adults. a. Five years before death, most retain a high level of brain function. b. The terminal drop hypothesis theorizes that a person’s mental function begins to decline five years before death. 2. General statistics related to this population include the following: a. 95% live at home. b. Most of this percentage are active, healthy, and independent, although they may receive some assistance or support from family, friends, or home care. c. The number of assisted living facilities is increasing; they allow residents to live in communities and maintain an active life style. d. Many have financial concerns related to paying for health care and basic necessities. i. More than 50% of women age 60 or older live below the poverty line. 3. Late adults must come to terms with their own mortality, which may prove difficult as family members and friends die. IX. Summary A. Developmental stages of life include infant, toddler, preschool age, school age, adolescence, early adulthood, middle adulthood, and late adulthood. B. Each developmental stage is marked by different physical and psychological changes and characteristics. C. The vital signs of toddlers (ages 1 to 3 years) and preschoolers (ages 3 to 5 years) differ somewhat from those of an infant. D. From ages 6 to 12 years, the school-age child’s vital signs and body gradually approach those observed in adulthood. E. The vital signs of adolescents (ages 13 to 17 years) begin to level off within the adult ranges. F. Vital signs do not vary greatly through adulthood; however, the vital signs of late adults do vary depending on each person’s health. G. Infants (ages 1 month to 1 year) develop at a startling rate, experiencing specific developmental milestones during every month of the first year of life. H. Two important points regarding an infant’s airway are that an infant’s tongue can more easily occlude the airway, and the lungs are fragile. I. Infants are classified as an easy child, difficult child, or slow to warm up. Their primary means of communication is crying. J. Toddlers and preschoolers learn to speak and express themselves. Toilet training is usually accomplished around age 28 months. K. A child’s development is affected by the parenting style employed by his or her parents. Parenting styles include authoritarian, authoritative, and permissive. Divorce may begin to affect children when they are toddlers. L. School-age children (6 to 12 years) develop self-esteem and reasoning abilities and receive their permanent teeth. M. Adolescents (13 to 17 years) undergo significant reproductive development, focus on creating their self-image, are self-conscious, and may engage in self-destructive behavior. N. Early adults (18 to 40 years) focus on work and family. The body should function at an optimal level, and lifelong habits are developed. O. Middle adults (41 to 60 years) focus on achieving life goals. Medical problems such as diabetes, hypertension, and cancer become more common. P. Late adults (61 years and older) undergo significant physical changes. They also focus on their mortality. Suicide and depression are concerns in this age group. Post-Lecture This section contains various student-centered end-of-chapter activities designed as enhancements to the instructor’s presentation. As time permits, these activities may be presented in class. They are also designed to be used as homework activities. Assessment in Action This activity is designed to assist the student in gaining a further understanding of issues surrounding the provision of prehospital care. The activity incorporates both critical thinking and application of paramedic knowledge. Instructor Directions 1. Direct students to read the “Assessment in Action” scenario located in the Prep Kit at the end of Chapter 9. 2. Direct students to read and individually answer the quiz questions at the end of the scenario. Allow approximately 10 minutes for this part of the activity. Facilitate a class review and dialogue of the answers, allowing students to correct responses as may be needed. Use the quiz question answers noted below to assist in building this review. Allow approximately 10 minutes for this part of the activity. 3. You may want to ask students to complete the activity on their own and turn in their answers on a separate piece of paper. Answers to Assessment in Action Questions 1. Answer: B. birth through 1 month of life Rationale: “Infant” is the commonly accepted term to refer to a baby from time of birth to 1 year of life. In medicine, an infant is categorized into one of two other classifications depending on its age: newborn and neonate. Newborn refers to the time of birth through 1 to 2 hours after birth. A neonate refers to the period of time between birth and 1 month of life. 2. Answer: B. The head Rationale: The fontanelles are tissue located between the cranial bones at the top of the infant’s head. This allows the cranium to change shape to facilitate the normal birth process and allow rapid expansion of brain tissue during growth. The fontanelles are an important assessment area that should not be overlooked. Since the tissue is flexible, pulse pressure may be visible. The opening will also allow assessment of changes in pressure. A bulging fontanelle will usually indicate an increase in cranial pressure. A sunken fontanelle will usually indicate dehydration or malnutrition. The fontanelles will usually completely close during the first year of life. 3. Answer: D. 100 to 180 beats/min Rationale: The younger the person, the faster the pulse rate and respirations. At birth, a pulse rate of 100 to 180 beats/min is considered normal. After about half an hour, an infant’s heart rate often drops to around 120 beats/min. 4. Answer: C. 30 to 60 breaths/min Rationale: The younger the person, the faster the respirations. At birth, a respiratory rate of 30 to 60 breaths/min is considered normal. After about half an hour, the respiratory rate adjusts to between 30 to 40 breaths/min. Tidal volume in infants starts at 6 to 8 mL/kg. By age 1 year, the volume increases to 10 to 15 mL/kg. 5. Answer: A. nose breathers Rationale: Infants are primarily “nose breathers” for the first month of their lives. Infants younger than 6 months are particularly prone to nasal congestion, which can cause viral upper respiratory infections. If you receive a call for a baby choking, always make sure the infant’s nasal passages are clear and unobstructed by mucus. Additional Questions 6. Rationale: You can gain important information from the sound of an infant’s cry. Family and caregivers can typically tell what the infant is expressing through his or her cry. The sound of a grouchy infant is different from the sound of an infant who is in pain. Does the cry sound strong or weak? Always ask the persons present for their interpretation of the sound of the crying. Remember: the only form of expression for an infant is its cry. 7. Rationale: The term “belly breather” refers to the pronounced use of the diaphragm in the respiratory effort of the infant. This is partly the result of lack of musculature in the chest wall. Additionally, the ribs are pliable and provide limited support. Infants who are experiencing a respiratory problem will tire quickly as a result of limited muscle use. Because infants rely of their diaphragm to breathe, it is vital to avoid gastric distention. Gastric distention will compete with pressure in the chest cavity and quickly succeed in replacing the infant’s small vital capacity. Assignments A. Review all materials from this lesson and be prepared for a lesson quiz to be administered (date to be determined by instructor). B. Read Chapter 10, Principles of Pharmacology, for the next class session. Unit Assessment Keyed for Instructors 1. Compare and contrast the two types of attachment an infant may develop. Answer: A secure attachment occurs when an infant understands that parents or caregivers will be responsive to his or her needs. Anxious avoidant attachment is observed in infants who are repeatedly rejected. These children develop an isolated lifestyle in which they do not have to depend on the support and care of others. (p 404) 2. An infant’s reaction to a situational crisis is classified into three phases. List these phases in order, including some characteristics of each. Answer: The protest phase can start immediately and usually lasts about a week. It is easily recognized by loud crying, irritability, restlessness, and rejection of other caregivers’ efforts. The despair phase follows, which is characterized by the monotonous wailing indicating that the infant begins to believe the situation is not going to change. Withdrawal eventually happens, and the infant becomes almost apathetic and appears bored by his or her surroundings. (p 404) 3. What are the three parenting styles that may be observed in the caregivers of toddlers and preschoolers? Describe each style, including behaviors that may develop in children raised in each manner. Answer: An authoritarian parenting style demands absolute obedience from a child no matter what the situation. This style of parenting shows no regard for the child’s personal freedoms. Children who are raised in this manner often develop self-esteem problems; females are more likely to become shy, and males are more likely to become argumentative or hostile. Authoritative parenting is based on respect for parental authority and balance with individual freedom of the child. These parents regularly respond to the personal needs of the child. They set rules and enforce them fairly; however, they believe that children need certain freedoms and attempt to maintain a balance between the two. This style can allow children to develop into adults who are independent, well-socialized, and easy going. Permissive parenting does not impose many rules, if any, on the child. The child is in control and the parent takes a very tolerant approach to the child’s behavior, including socially unacceptable behaviors. Permissive parenting is broken into two subcategories—indifferent and indulgent. The former style describes parents who just do not care; the latter style describes parents who are excessively lenient. Permissive parents rarely, if ever, punish their children, and therefore their children may grow up to be considered spoiled. These children often become adults who are immature, irresponsible, and lack self-control. (pp 406-407) 4. Define the three types of reasoning school-age children learn. Answer: In preconventional reasoning, children act almost purely to avoid punishment and to get what they want. In conventional reasoning, they look for approval from their peers and society. In postconventional reasoning, children make decisions guided by their conscience. (p 408) 5. What should you consider when talking with adolescent patients? Answer: When you are working with adolescents, be respectful and discreet. Privacy is important to adolescents. If possible, have your partner speak with the parent in a separate area while you talk with the patient. (p 409) 6. List some of the psychosocial changes associated with early adulthood. Answer: During early adulthood, humans strive to create a place for themselves in the world, and many do everything they can to “settle down.” As early adults struggle to find stability in their careers,and stress on the job becomes high. Along with this natural tendency to settle come the experiences of romantic and affectionate love. Childbirth is most common in this age group. (p 409) 7. What are some health issues that arise as people reach middle adulthood? List at least four. Answer: Middle adults are vunerable to vision and hearing loss along with other varying degrees of degradation. There are also higher incidences of cardiovascular disease in this population. It is more difficult for middle addults to control their weight, and they experience a greater incidence of cancer. Women develop a higher risk for fractures and cardiac problems due to menopause. (pp 409-410) 8. What is atherosclerosis, and how is it related to aneurysm? In what age group does atherosclerosis commonly appear? Answer: Atherosclerosis most commonly affects coronary vessels; cholesterol and calcium build up inside the walls of blood vessels, forming plaque. The accumulation of plaque eventually leads to partial or complete blockage of blood flow. More than 60% of people older than age 65 have atherosclerotic disease. Atherosclerosis can contribute to development of an aneurysm , or weakening and bulging of the blood vessel wall; an aneurysm may potentially rupture if it is subjected to high stretching forces. (pp 410-411) 9. Define the terminal drop hypothesis. Answer: Until about 5 years before death, most late-stage adults retain high brain function. In the 5 years preceding death, however, mental function is presumed to decline, a theory referred to as the terminal drop hypothesis. (p 413) 10. Which two age groups are at the highest risk for depression and suicide? Answer: Adolescents and late adults are at a higher risk than other populations for suicide and depression. (pp 409, 416) Unit Assessment 1. Compare and contrast the two types of attachment an infant may develop. 2. An infant’s reaction to a situational crisis is classified into three phases. List these phases in order, including some characteristics of each. 3. What are the three parenting styles that may be observed in the caregivers of toddlers and preschoolers? Describe each style, including behaviors that may develop in children raised in each manner. 4. Define the three types of reasoning school-age children learn. 5. What should you consider when talking with adolescent patients? 6. List some of the psychosocial changes associated with early adulthood. 7. What are some health issues that arise as people reach middle adulthood? List at least four. 8. What is atherosclerosis, and how is it related to aneurysm? In what age group does atherosclerosis commonly appear? 9. Define the terminal drop hypothesis. 10. Which two age groups are at the highest risk for depression and suicide?