Human Growth and Development

What are the three prenatal stages and their main features?

Zygote (0–2 wks): implantation.

Embryo (3–8 wks): organogenesis (ecto/meso/endo).

Fetus (9 wks–birth): growth/maturation; viability ≈22–28 wks.

What maternal factors increase prenatal risk?

Malnutrition (↓folate → neural tube defects), teratogens (ETOH, certain meds/infections), extremes of maternal age.

Key features of the newborn (0–28 days) period?

Apgar scoring; physiologic flexion; lanugo + vernix; RR 30-60 / min, HR 110-160 bpm; immature thermoregulation; primitive reflexes present.

Major physical milestones in infancy (1–12 mo)?

Weight doubles by 5 mo, triples by 12 mo; gross→fine motor progression; first teeth ≈ 6 mo; sleep consolidates.

Developmental features of toddler-preschool years?

Stable gait; bowel before bladder control; play evolves (parallel→associative→cooperative); rapid language growth.

Key traits of school-age children?

Steady growth, ↑coordination/strength, loss of deciduous teeth, peer/industry focus.

Characteristics of adolescence?

Puberty and growth spurt; secondary sex traits; prefrontal cortex still maturing → risk-taking.

Physiologic changes in young/middle adulthood?

Peak fitness in 20s, gradual decline; ↓skin elasticity, redistribution of weight, ↓bone mass; menopause/andropause.

Normal aging changes in older adults?

↓height, muscle, bone density, reflexes, renal/hepatic function, vision/hearing; ↑SBP; slower reaction time; fragmented sleep; ↑fall risk.

Piaget's sensorimotor stage (0-2 yrs)

Object permanence and separation anxiety develop.

Preoperational (2-7 yrs) stage features

Egocentrism, symbolic play, lack of conservation.

Concrete operational (7-12 yrs) stage features

Conservation, classification, and logical thinking about concrete events.

Formal operational (12 + yrs) stage features

Abstract and hypothetical reasoning; adolescent egocentrism (imaginary audience/personal fable).

Cognitive aging patterns

Crystallized knowledge stable; slower processing, divided attention, new learning; not dementia.

Erikson's stages (crisis → virtue) — list in order

Infant (18 m/o)- Trust vs Mistrust → Hope

Toddler( 18-3 y/o) - Autonomy vs Shame → Will

Preschool( 3-5 y/o) - Initiative vs Guilt → Purpose

School-Age (5-13) - Industry vs Inferiority → Competence

Adolescent(13-21) - Identity vs Role Confusion → Fidelity

Early Adult (21-39) - Intimacy vs Isolation → Love

Middle Adult (40-65) - Generativity vs Stagnation → Care

Late Adult( 65+) - Integrity vs Despair → Wisdom

Kohlberg's levels of moral reasoning

Preconventional (4-10): punishment→reward.

Conventional (≈10-adult): approval→law/order.

Postconventional (adolescence-adult): social contract→universal ethics.

Nursing priorities for prenatal clients

Folic acid ≥400 mcg/day, avoid teratogens, vaccine education, prenatal screening guidance

Nursing priorities for pediatric clients

Growth tracking, immunizations, injury prevention, caregiver education, abuse vigilance (mandatory reporting).

Nursing priorities for adolescents

Risk-reduction counseling (sex/substance/helmets/seatbelts), mental-health screening, body-image support.

Nursing priorities for adults

Screen for BP, lipids, diabetes, cancers; promote diet/activity; prevent chronic disease.

Nursing priorities for older adults

Fall prevention, polypharmacy review, vaccines (flu, zoster, pneumococcal, COVID), social connection, advance-care planning.

Tennessee Child Restraint Law

Children <1 or any child weighing 20 lbs or less - rear facing

Children 1-3 and weighing > 20 lbs - safety seat, forward facing,

4-8 and < 4'9" - booster seat

Types of child maltreatment

Physical, emotional, sexual abuse, and neglect.

Red flags for abuse or neglect

Injuries inconsistent with history, patterned bruises/burns, frequent ED visits, poor hygiene, fearful or withdrawn behavior.

What does TN law require nurses to do?

Mandatory reporting—any suspicion must be reported to DCS or law enforcement; confidentiality protected.

Common neurological changes

Slower processing, mild short-term memory lapses (not dementia).

Cardiovascular & respiratory changes

↑SBP/PP, ↓baroreflex, ↓lung elasticity/vital capacity → orthostasis and dyspnea risk.

Renal & hepatic changes

↓GFR and drug clearance → ↑polypharmacy risk.

Musculoskeletal changes

Sarcopenia, ↓bone density, kyphosis, slower gait.

Sensory changes

Presbyopia, presbycusis, ↓taste/smell/proprioception.

Integumentary & sleep changes

Thinner, drier skin; ↓turgor; easy bruising; fragmented sleep, early waking.

Home safety education points

Remove rugs/clutter, secure cords, nightlights, grab bars, non-slip mats, sturdy railings, items within reach.

Vision/footwear recommendations

Supportive shoes, yearly eye/hearing checks, clean lenses, functional hearing aids.

Medication & hydration teaching

Watch for sedative or hypotensive effects, rise slowly, stay hydrated, monitor BP/glucose if indicated.

Key traits of delirium

Acute, fluctuating attention/LOC, medical cause (infection, meds, electrolytes).

Care: Treat cause, reorient, maintain routine/sleep, mobilize, avoid restraints.

Key traits of dementia

Chronic progressive memory & executive decline; alert but impaired; possible sundowning.

Care: Routine, safety, cues, caregiver support, non-pharm for behaviors first.

Key traits of depression in older adults

Persistent low mood, sleep/appetite change, may mimic dementia ("pseudodementia").

Care: Screen (PHQ-9), therapy, meds if needed, suicide risk check.

Assessment priorities

Cognition (MMSE/MoCA), function (ADL/IADL), behavior, nutrition, pain, caregiver strain.

Environmental modifications

Consistent routine, reduce noise/clutter, visual cues, lock hazards, ID bracelet, door alarms.

Communication tips

One-step directions, allow time, use validation/redirection—not confrontation.

Safety & behavioral care

Fall prevention, med supervision, driving cessation, advance directives; identify unmet needs before using meds.

What does a comprehensive geriatric assessment include?

Hx/PE, meds (Rx + OTC/herbals), nutrition, mood, cognition, function, gait/falls, pain, continence, vision/hearing, sleep, social support, finances, advance care planning.

Preventive nursing roles for older adults

Immunizations (flu, zoster ≥ 50, pneumococcal, COVID), chronic disease mgmt, lifestyle counseling, fall/home safety, psychosocial support, goals-of-care planning

Nursing care for a client with Alzheimer's disease

Assist with patient self-care including daily activities such as hygiene, eating, toileting, and exercise. Provide care with these daily activities for patients that have significant cognitive impairment or deficits in motor functioning. Assess patient safety and avoid risk of injury due to disorientation or confusion.

Assessing an aging adult

Functional ability, physical health, socioeconomic health, nutrition, balance/fall prevention, hearing, vision, mental health

What is health literacy?

A client's ability to obtain, process, and understand basic health information to make appropriate healthcare decisions.

What methods can nurses use to assess a client's health literacy?

Use the teach-back method (have client repeat instructions in their own words).

Watch for difficulty reading or understanding labels.

Use tools like the Newest Vital Sign (NVS) or REALM test.

Why is assessing health literacy important in older adults?

It ensures education is tailored to the client's reading level, culture, and learning needs—reducing medication errors and promoting safe self-management.

What are the three domains of learning in Bloom’s taxonomy?

Cognitive (thinking): Knowledge and understanding.

Affective (feeling): Attitudes, emotions, and values.

Psychomotor (doing): Physical or motor skills.

Give an example of the cognitive domain in nursing education.

Teaching an older adult to identify medication side effects.

Give an example of the affective domain in nursing education.

Encouraging a client to accept lifestyle changes or new medications.

Give an example of the psychomotor domain in nursing education.

Teaching a client how to correctly use an insulin pen or pill organizer.

Why should nurses include all three domains of learning when teaching?

Because older adults may need cognitive understanding, emotional support, and hands-on practice to manage multiple medications effectively.

How does polypharmacy affect learning in older adults?

Multiple medications increase confusion and risk for interactions.

Nursing tip: Use Brown Bag Review and Beers Criteria to simplify regimens.

How do physiological changes in older adults affect learning about medications?

Kidney and liver function decline with age, changing how drugs are processed.

Nursing tip: Teach importance of dosage adjustments and lab monitoring.

How do cognitive challenges impact medication learning?

Memory loss or confusion can interfere with proper use. Nursing tip: Use clear instructions, visuals, and teach-back.

What problem does lack of clinician expertise create?

Few providers have geriatric training, leading to unsafe prescribing.

Nursing tip: Encourage collaboration and regular medication reviews.

How does low health literacy affect medication management?

Clients may misuse or skip doses due to poor understanding.

Nursing tip: Provide written materials at a 5th–6th grade reading level.

Role of the nurse in client education.

Prevent, Maintain, Promote, Restore, Facilitate

What is primary prevention?

Prevents disease or injury before it occurs through activities like immunizations, health education, and promoting healthy lifestyles.

What is secondary prevention?

Focuses on early detection and prompt treatment to stop or slow disease progression—examples include screenings and early interventions.

What is tertiary prevention?

Aims to reduce complications, prevent disability, and restore function after a disease develops through rehab, therapy, or chronic illness management.

What are modifiable risk factors?

Risk factors that can be changed or controlled through lifestyle or behavior choices.Examples: diet, physical activity, smoking, alcohol use, stress, weight.

What are non-modifiable risk factors?

Risk factors that cannot be changed or controlled.Examples: age, gender, family history, genetics, race/ethnicity.

What are Social Determinants of Health (SDOH)?

The conditions in which people are born, grow, live, work, and age that affect overall health and quality of life.Examples: income, education, neighborhood, access to healthcare, social support, and environment.