NURS 123 quiz 2

6 principles of Growth and Development 

1. Continuous and uneven (you don't develop everything at same time) 

2. Interactions between genetics and environment 

3. Head-down and body outwards (patterns of growth) 

4. Simple to complex and general to specific 

5. Sequence is predictable, but timing and duration vary 

6. Sensitive periods ( reach a level of biological thing before you can accomplish it, ex. Potty training) 

Developmental stages 

1. INFANCY: birth to 1 of age. Period of rapid growth; high level of dependance on parent 

2. TODDLER: 1-3 years of age. Rapid development of motor skills and language; period od exploration and limit testing 

3. PRESCHOOL/EARLY CHILDHOOD: 3-6 years of age. Rate of physical growth slows; new experiences in outside world teach social skills 

4. SCHOOL AGE/MIDDLE CHILDHOOD:6-12 years of age. Increase in cognitive and social skills’ increased physical agility; peer relationships become more important 

5. ADOLESCENCE: 13-19 years of age. Puberty and development of physical and sexual maturity’ establish personal identify and values; risk taking behaviours may occur as limits are tested 

6. YOUNG ADULTHOOD: 20-35 years of age. Establishment of career; development of own lifestyle, including intimate relationships and beginning of family. 

7. MIDDLE ADULTHOOD: 39-65 years of age. Career and family well established but several lifestyle changes occur such as children leaving home, aging parents, planning for retirement 

8. LATE ADULTHOOD: begins at 65 years of age (young (65-75), middle (75-85), old-old (85+)). Time of reflection past and finding satisfaction with life; adaptation to series or losses; increased dependency on others 

Key theoretical traditions 

• Organicism: development is a result of biologically-driven behavior and a person’s adaptation to their environment. Biophysical and cognitive-moral theories of development are included os this tradition 

• Psychoanalytic and psychosocial: describe the development of personality, thinking, behaviour, and emotions. This development is thought to occur with varying degrees of influence from internal biological forces and external societal and cultural forces 

How do we develop

• Physical growth/biophysical developmental theories: maturation, idea of developmental milestones/patterns of growth

• How the body grows and changes 

• Maturation → have to mature biologically before you can do things (ex. Cant run before you can walk) 

Developmental Stages and Tasks of Infancy, Childhood, and Adolescence 

Eriksons Psychosocial Stages of Adulthood

Week 4: birth to adolescence (part 1) 

*fundamentals pg. 756-759, 765-767, 770-779 

*HA pg. 915-922

A little review 

Developmental theories 

1.  Organicism 

• Biophysical, moral development  

• What are the anticipated patterns of growth? 

• How does an individual think, reason, perceive and makes sense of their environment? (Piaget) 

2. Psychoanalytical & Psychosocial 

•  Pleasure seeking vs Societal pressures (Freud) 

• Task mastery moves us forward and encourages success (Erikson)

Developmental age periods 

• Infancy: birth-12 months (newbornfirst 30 days of life) 

• Toddler: 12-15 months, up to 3 years of age

•  Preschool & School-Age ( Early Childhood (3-5 years), Middle Childhood (6-8 years), Late Childhood (8-12 years)

•  Adolescence: 13-19 years of age

Infancy- growth & development 

• Physical Growth & Development 

• period of rapid growth (larger head compared to body) 

• 0-4 months: crude reflexes, rolls over

•  4-7 months: sits, grasps/picks up objects (eyehand coordination developing) 

• 8-12 months: progresses from crawling to standing to walking (once you can walk you are a toddler) 

• Infant brain doubles in size in the first year (is why fontanelles are so important) 

•  triple body weight by 12 months; length increases by 50% 

• 0-1 month is a neonate 

• Special enses: vision is bad (no depth perception, cant focus on objects) 

• Psychosocial Development 

•  Trust vs Mistrust (can I trust my caregiver? Can I feel safe?) 

• consistency builds trust and feelings of safety

•  importance of attachment

• a trusting child will venture outward vs. clinging 

• Will cry, smile to elicit care from others 

• Begin to fear strangers around 8 months (is a good thing shoes attachment) 

• Psychosexual 

• oral satisfaction (suckling, chewing) 

• Cognitive Development 

• Piaget: Sensorimotor stage until preschool

•  learning through body sensations and interactions with environment 

• self-initiated mouthing of fists, grasping, hitting as simple repetitive behaviors

• Communication 

• social smile around 2 months 

• vocalizations: gurgling, fussing, cooing, crying 

• babbling begins around 6 months, 2-3 words by 12 months

Infancy - health assessment 

• Newborn Assessments 

• APGAR 

• screening completed at birth to assess 5 components: heart rate, respiratory rate, muscle tone, reflex irritability, and color (each component scored 0-2 for max of 10) 

• Expected score: 8-9 immediately after birth and 8-10 after 5 minutes. 

• Helps to identify infants at risk of impaired respiratory or cardiac function (important for premature)

•  Infant reflexes (shows brain development, ex. Bavunski reflex, foot curl) 

• Tests if the baby is ready for the outside world?

******IMPORTANT 

infancy - health assessment 

• How do expected vital signs in infants and children differ from those of adults? (Hint: Table 6-2 in health assessment text) 

• Assessing physical growth 

• Growth charts- monitor growth within “expected limits” (length, weight, head circumference); what are percentiles? 

• Developmental screening

•  developmental milestones provide a guide for expected development and help with early identification of concerns

•  How do you assess a patient that is unable to communicate verbally? (talk to the caregivers)Who is your source of health history information? 

Infancy - health promotion 

• Focus on teaching and encouraging parents 

• Importance of forming warm attachments (why?)

•  Encourage family involvement in care when in hospital 

• Encourage sensory stimulation to promote cognitive development (read to baby, talk to baby, toys they can play with, they can look at and interact with) 

•  Nutrition

•  immature digestive system 

• education and assistance related to breastfeeding and/or formula feeding

•  initial weight loss in breastfed infants 

• at what age should solid foods be introduced?

•  at what age is it considered safe for a child to have cow’s milk? (9-12 months) Honey? (1 year) 

• GI system hasn't matured yet 

• Breast fed babies need vitamine D it is not in the milk 

•  Sleep 

• help parents identify behaviors that indicate settling to sleep; sleep routines

• what is the safe sleeping position and location for an infant? 

• Safety 

• “childproofing” the home- why is this important? 

• SIDS - sudden infant death syndrome, no known clinical cause for dealth. Safe sleeping helps alot to prevent  

•  Immunizations

•  own immunity continues to develop

•  first immunizations at 2 months (see Table 28.6 in Fundamentals text)

Infancy - what is “failure to thrive” 

• potential cause of delays in physical development, often characterized by a deceleration or loss in weight 

• may be due to organic or nonorganic causes

•  organic- eg: malabsorption syndromes; GI malformations 

• nonorganic- eg: inappropriate or dysfunctional feeding processes, parental neglect, and stressful home  

• may also be the result of emotional stress related to social isolation (neglect) or mental health challenges (depression) 

• Don't ignore your gut when it comes to the child's safety (better safe than sorry) 

Toddler- Growth and Development (12-36 month) 

• Physical Growth & Development 

• growth in motor skills is greater than physical growth 

•  walking → running → riding bike 

• from stacking blocks to simple drawings 

• Safety: easily distracted, poor depth perception, must be supervised in water, will reach for heights and objects

•  brain is 75% adult size by age 2 

• bladder and bowel control developing (*impacts readiness for toilet training)

•  20 deciduous teeth have erupted 

• Psychosocial Development 

• Autonomy vs Shame/Doubt 

• develop independence and self-confidence through self care and exercising choice ○ expanding social circle 

• Egocentrism (self focused, everyone is thinking the same thing as them) 

• Psychosexual Development 

• anal-urethral: defecation brings pleasure (toilet training) 

• Cognitive Development

•  Piaget: sensorimotor development until preschool (preconceptual ages 2-4 years) 

• Curious- touching, tasting, looking, listening

•  Object permanence (recognizing things/self and others as separate, when mom leaves for work she isnt gone forever 

• Understand basic cause & effect; very basic reasoning skills

•  imitate others (symbolic play) 

• Communication 

• approx 50 word vocabulary at 18 months, 200 words at 24 months, 900-1000 words at 36 months 

• 2 word sentences 

• self-oriented communication, autonomy = toddlers saying no 

• Receptive communication is bigger than expressive communication 

Toddler - health assessment 

• Continued monitoring of physical growth and achievement of developmental milestones

• Developmental screening tools (Refer to page Fig 28.9 (Fundamentals text) 

• Early identification of developmental delays 

• delayed physical development, cognitive development, psychosocial development, global developmental delay (development outside of expected) 

• Developmental regression - they were able to do something and now they are unable to 

• How can parents monitor their child’s development?

Toddler- health promotion 

•  Educating parents about… 

• negativism (not personal rejection of parent) —> autonomy 

• exploring and exerting autonomy; navigating temper tantrums 

• toys to enhance motor skills; safe exploration

•  Nutrition 

• picky eaters 

•  encourage breast milk or cow's milk

•  encourage self-feeding (why?) → autonomy and fine motor skills 

•  Toilet training 

• child-oriented approach and anticipatory guidance 

• encourage patience and celebrations (Why?) 

• Physical, neurological readiness 

• Page 754 Fun.

• Safety 

• increased mobility and curiosity → increased safety risks 

• Given that a toddler is building motor skills, what are some potential threats to their health? (Hint: Fundamentals pp.775-776)

Early to late childhood: health assessment 

• Assessing for learning challenges once child enters school (vision, hearing, speech)

• Assessing for speech and language difficulties 

• delayed speech development may be a sign of auditory concern or other developmental challenges

•  What about vision and hearing? 

• visual acuity is expected to be 20/20 by age 5 

• Importance of using age-appropriate language and assessment tools

Early to late childhood: health promotion 

*776-779 fun

Preschool Period (3-5 yrs):

•  encourage social exposure through play groups and social settings; encourage outdoor/active play 

• strategies to cope with fears as social world expands (p. 776)

•  Nutrition (varying appetite with growth spurts,role model good eating habits,importance of social aspect of meals)

• Safety-educating parent/child about street safety & parent role modeling 

• School readiness-pre-kindergarten vs kindergarten 

School-Age Period (6-12 yrs): 

•  encourage opportunities to interact with sameage peers; reassure parents re: impact in child’s life

•  Illness Experiences 

• offer clear descriptions of health issues

•  providing meaningful activities and structure; negotiate treatment timings 

• Obesity*

•  parental role modeling; “unplugging” and maintaining a healthy lifestyle, think socioeconomic position, encourage healthy habits 

• education re: healthy food choices 

• Rates are increasing and is not good 

• Safety 

• bicycle safety; risk of sports-related injuries; car safety

•  internet safety* 

• Sex Education 

• sexual development; normalize feelings 

• sexual curiosity → open communication 

Lets talk about bullying 

• Bullying impacts children of all ages as well as adolescents and even adults.(1 in 3 kids in Canada report bullying (Rousseau & Raymond, p. 777)

•  Bullying may be physical, verbal, social, or cyberbullying 

• What are the potential impacts of bullying on health and wellness?

•  What are the potential impacts of bullying on growth and development?

• Bullying is a repeated behavior that intends to hurt, or harm someone 

• At school, online, sports team 

• Bullying affects self-esteem, self confidence, self worth 

Impacts of technology on G&D

• How much screen time is too much? 

• How has the increased accessibility and use of technology influenced the cognitive, psychosocial, and moral development of school-aged children? Consider both the positive and negative effects.

•  How can nurses guide parents/educators to support healthy technology use in school-aged children? Can we look at this from a strengths-based perspective?

• Addictive property - instant gratification 

Week 5 - birth to adolescence (part 2) 

Health and wellness in adolescence 

• Adolescence: 13 -19 years of age; begins at puberty

•  Review the following textbook pages: 

• Fundamentals: pp. 759-760, 767, 779-781 

• Health Assessment: pp. 962-971

Adolescence : growth and development 

Physical Growth & Development 

•  11-14 yrs - period of rapid growth; secondary sex characteristics develop (earlier for females) 

• 15-17 yrs - 95% adult height; secondary sex characteristics well advanced

•  18 - 20 yrs - body is physically mature

•  Peers will vary greatly in size and appearance with varying onset of puberty

• Start at puberty and can vary from person to person 

• Puberty is the onset of sexual maturation 

Psychosocial Development 

•  Who am I? What do I believe? How do I feel about this? 

 Identity vs Role Confusion

•  gender identity- changes during puberty can either help this or hurt it 

•  group identity- why do I fit with? Where do I belong?

•  family identity- what is my role with these people. Role as a daughter? Role as a wife? 

• vocational identity- pressure to have everything planned out, it is never set in stone 

• moral identity- what I feel may or may not be align with the people that are around me  

• health identity- feeling of wellbeing  

• social demands & fitting in 

• working through conflicts: independence vs dependence on family

Adolescence: growth and development 

Psychosexual Development 

• Puberty is beginning of adult sexuality, pressures & conflicts

• Final stage of cognitive development 

 Cognitive Development

•  Formal operations: abstract, theoretical, philosophical thinking more established in later adolescence 

• hypothetical thinking; comprehensive view of problems, recognize others’ views

• increased introspective thinking, long-term thinking

• Reflective thinking, can present as self absorption → you have to spend time on yourself 

Communication/Language Development 

• wide variety of communication techniques; wide range of vocabulary; less open communication with parents; may have own vernacular (slang)

• This is a period when teens are trying to distance themselves from parents 

• Important that confidentiality and privacy is a priority for the nurse 

What about moral development 

Level 1: Preconventional

•  Self-centered; what is in it for me? All consequences are to punish me 

• Absolute obedience & obeying authority figures → relativism (I can hear you, but…)

• Illness is my own doing… 

Level 2: Conventional (most people stay here) 

• How will my actions affect others? What do others expect of me? Am I loyal? 

• “Good boy/Nice girl”- good motives, keep the peace

•  Societal maintenance- citizen’s duty; population health concerns 

• Shared decision making around illness management 

Level 3: Post-conventional (werdios) 

•  My rights vs societal obligations (conforming to my group vs rules and regulations)

• Social contracts, differing interpretations of rules & basic rights of all

• Universal ethics: democratic beneficence and social justice 

• Look after your own health AND champion for others

• KOHLBERG: Not age specific,Where do the age groups fall in your eyes? → review!

Adolescence: health assessment 

• Transitioning from dependence to independence 

• Privacy, confidentiality (know when it is okay to share) and a trusting therapeutic relationship are essential

•  Assessing holistic wellbeing 

• Risk assessment; Strengths-based assessment

• Are hesitant to connect with others 

• Remember that your client is the teen not the parent 

• Mental health assessment → risk taking behaviours (HA. 961)

Sexuality

• Physical changes associated with sexual maturation occur in adolescence; further development of gender identity and sexual identity commonly occur as well 

• Remeber the importance of peer connection (do they feel different) 

• The desire to connect with others can head to unsafe choices 

• What is sexuality? 

• encompasses sex, gender identities and roles, sexual orientation, intimacy and reproduction; sexual development influenced by biology, society, family, culture, and other factors 

• What is sexual health? 

•  “A state of physical, emotional, mental, and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as…safe sexual experiences, free of coercion, discrimination and violence.” (Goebel, 2025, p226) 

• Nurse’s role in promoting sexual wellbeing: 

• Focus on promoting healthy choices and healthy sexual behavior 

• importance of education and open discussion 

• Eg: building healthy relationships, risks of unprotected sex, setting boundaries,etc.

•  “Nurses can promote sexual health by emphasizing that it is part of each individual’s identity and a normal part of growing toward adulthood” (Rousseau & Raymond, 2020, p.779) 

Adolescence: health promotion 

• Body image concerns

•  diversity is “normal” 

•  encourage healthy eating & exercise patterns 

• Illness experiences 

• consider: teen vs parent, who is my client/patient?

•  what is age-appropriate communication and care?

•  Health risks 

•  nutrition- obesity, eating disorders

•  risky behaviors- can lead to accidents, injuries, unsafe sexual practices ○ what can you do as a nurse? (Fundamentals pp. 780-781) 

• Sexual health

•  safe sex practices

•  education related to pregnancy and sexually transmitted infections (STIs)

Spotlight: vaping 

• While considered less harmful than regular tobacco smoke, vaping is not without health risks.

•  Vaping rates for 15-17 year olds are 4x higher than those for 12-14 year olds. 

• 89.3% of 15-19 year olds who report vaping use e-liquids containing nicotine (Rotermann & Gilmar, 2022)

Adolescence and mental health

•  Anxiety disorders are the most common mental health concerns in Canadian adolescents.

•  What factors might place an adolescent at increased risk of anxiety, depression, or other mental health concerns? 

• How does mental wellbeing impact the achievement of developmental tasks in adolescence and beyond? 

• Anxiety and depression has increased after COVID 

Spotlight: eating disorder 

• What is the role of the nurse in promoting healthy eating habits among adolescents?

• Providing healthy food options wont solve the problem (importance of holistic approach) 

Week 6- planetary health 

What is planetary health?

• Planetary Health: The Future is Now (Planetary Health Alliance, 2019)

•  Planetary health is a rapidly developing field of study and collective movement that aims to protect the health and wellbeing of humans, animals and ecosystems. (CNA,2024)

• Planetary health focuses on understanding the way disruptions to the earth’s natural systems impact human health. (LeClair & Potter, 2022)

• Bigger idea than climate change- not the problem, is the solution/intervention 

Planetary health: a few terms to know

• ANTHROPOCENE- term used to refer to a biological age characterized by human impacts on the environment and the ramifications of those impacts. We are in a geological time where we are seeng planetary change because of human behaviours 

• BIODIVERSITY- refers to the diverse forms of life that are found in an area; fundamental to human health. How would a loss of biodiversity impact human. Climate change, habitat loss, overexposure  

• CLIMATE CHANGE- long term shifts in temperatures and weather patterns primarily driven by human activities 

• CLIMATE JUSTICE/ENVIRONMENT JUSTICE- a movement to address the social, racial, economic and environmental justice issues associated with climate change. People who have the least effect on the environment are the ones being impacted the most. What are we doing to help the people who are most affected 

How is the health of the planet changing? 

Changes have been noted in numerous areas, including:

•  Disruption of global climate & climate change

•  Widespread pollution of air, water, and soil 

• Rapid biodiversity loss

•  Resource scarcity 

• LeClair & Potter (2022) refer to nine planetary boundaries within which humanity can thrive, these boundaries have been exceeded, leading to various climate-related disasters

•  Planetary health efforts aim to address the “triple threat” of climate change, biodiversity loss, and pollution (CNA, 2024)

•  Increased rates of severe weather events (drought, fires, floods, etc)

Why does it matter?

• Climate change is the greatest health threat facing the world in the 21st century (Lancet, 2015) 

• The World health organization predicts that climate change will be responsible for approximately 250,000 additional deaths annually in the years 2030-2050. (KellyWeeder, 2023)

• Pressure on mental health 

How does planetary health impact human health 

•  Impacts on human health related to air quality, food production, disease exposure, extreme weather events, access to freshwater, and more. 

Health impacts include (but are not limited to):

•  Increased rates of malnutrition 

• Increased exposure to infectious disease (e.g. increased malaria rates at higher altitudes as global temperatures increase, increased exposure to parasites due to damming and limited access to fresh water)

•  Increased rates of certain non-communicable diseases (e.g. Increasing severity of respiratory disease with air pollution, increased cardiovascular risks associated with increased global temperatures)

•  Displacement and conflict in response to resource scarcity

•  Negative impacts on mental health

What is climate anxiety 

• aka Eco-Anxiety (may be PTSD, loss of livelihood, overall distress) 

•  Rising numbers of people are reporting negative emotional and mental health impacts connected to climate change and the impacts on health and the environment

•  May be related to experience of disaster, impacts on livelihood, environmental conditions, and fear related to what the future holds and eco-related concerns

•  May involve feelings of helplessness and/or grief related to ecological losses

Planetary health and vulnerable populations 

• Who is at increased risk? Why?

•  Consider the relationship between of health and the risks posed by climate change, biodiversity loss, and pollution?

•  Ethical issues to consider: The populations that have contributed the least to these problems are subject to the most significant impacts.

• Developed countries are causing the problems but not experiencing the consequences 

Planetary health and the nurses role 

•  Research 

• Education 

• Advocacy

•  Individual practice 

• Population health practice

Week 6: young to middle adulthood (

 What does it mean to become an adult 

• Traditional view: attainment of adulthood includes establishing an independent household, finishing school, full-time employment, marriage, and parenthood 

• Contemporary view: adulthood involves assuming responsibility for self, independence in decision-making, and financial independence 

Young adulthood (20-35)

Physical development

• Physical changes peak (height, muscle mass, internal/reproductive organs) 

• Brain continues to develop into mid-20s 

Cognitive development 

• Possess full range of cognitive skills (formal operational development completed in adolescence) 

• Variations in reasoning and thinking 

• Sharpening skills as one adapts to their living/learning environment 

• Cognitive skills permit us to grow psychosocially and morally 

Psychosocial development

• Intimacy vs isolation- primary task is to form close personal relationships 

• Love, friendship and community 

• Lifestyle choices and career have often been chosen 

• Challenge of responding to external, societal and cultural 

Young adulthood: psychosocial changes 

• Career

• Sexuality 

• Singlehood 

• Marriage 

• Child bearing cycle 

• Parenthood 

Young adulthood: health risks

• Lifestyle (poor diet, smoking) 

• Family history 

• Accidental injuries and death 

• Unplanned pregnancies 

• Substnce abuse 

• Sexually transmitted infections (syphilis, child burying can be affected by STI)

• environmental/occupational factors 

Young adulthood: health concerns/ areas for health promotion

• Infertility 

• Pregnancy 

• Routine health screening 

• Exercise and nutrition 

• Family stress 

• Job stress

• Onset of chronic illness 

• Relationship stress 

Younger adults: stress and mental health 

Stress 

• What are the physical signs of stress?

• How can stress impact an individuals overall health and wellness 

Mental health 

• Depression, anxiety, and serious psychiatric disorders are most prominent between the ages of 15-24, suicide is the 2nd leading cause of death in this age group 

• What are some signs of depression and/or suicidal ideation to be aware of 

• Chronic stress weakens the immune system 

• Watch for self-neglect, changes in sleep, increase in alcohol and substance abuse 

Transitioning into adulthood 

 Things that may inhibit you 

• Your upbringing (being coddled as a child) 

• Economics (lack of awareness or just the economical state of the world at the moment) 

• Developmental delays (diagnosed) 

• Success in navigating eriksons stages of development 

• Health issues 

This that may push you into it 

• Pregnancy 

• A big loss (parent, finance) 

• Becoming a caregiver 

• Culture 

Family planning and reproductive health 

• What is prenatal health and how does it impact health across the lifespan?

• What is the role of the nurse in providing care related to reproductive health?

• Many individuals are postponing childbearing into their 30s or later - what are the potential challenges related to this? 

• First trimester: week 1-12, weeks 4-6 are when major organs form 

• Second trimester: week 13-26 organs keep maturing, mother will start tp show 

• Third trimester: week 27-40, muscles form, lungs finish developing, massive weight gain, in the last 4 weeks the mom gives the baby antibodies 

• Pre-conceptual care (health 3 months before pregnancy) is not the same as prenatal care (fertilization and birth, for both mom and baby)

• teratogens= things that harm a fetus 

• Smoking and alcohol is bad, developmental delays in babies (FASD) 

Middle adulthood (week 7) 

Middle adulthood 

Physical development 

• Age related changes in appearance; acceptance of aging (not easy for some people) 

• Consider body image, self-esteem, and impact on wellbeing 

•  Menopause- permanent cessation of menses (late 40s-50s) hormonal changes (estrogen and progesterone not produced by ovaries) 

• Decreased hearing and visual acuity 

• Onset of chronic illness 

Cognitive development

• Formal development 

• Cognitive changes are rare; can continue to learn new skills and information 

• Slower rates of cognition, memory los, usually due to trauma, illness 

Middle adulthood: psychosocial development 

• Erikson: generativity vs stagnation/self-absorption 

• Making your mark, creating a family, contributing to the next generation 

• Failing to find a way to contribute. Isolated. Uninvolved 

• Nurturing the things that will outlast them

Middle adulthood: psychosocial changes 

• Sandwich generation - working and caring for aging parents and children at the same time; balancing multiple demands. Is not a specific age group. Needs of 2 different of people squished together 

• Career transitions - retirement vs continued employment?

• Personal choice vs economic pressures?

• Family and relationship changes - singe? Divorce? Adult children leaving home (empty nesters) 

• Generativity vs. self absorption 

• “Mid-life crisis”

• Reciprocity - you get something back that you are putting in (not one sided) feel like you are needed 

• Adherence - being told what to do, maybe she doesn't know how to care for herself 

• Stress- from grief, weight gain, smoking cessation

Middle adulthood: health and wellness concerns 

• Chronic stress

• Obesity 

• Personal health habits - very hard to change habits that they have had for so long 

• Potential chronic physical illnesses

• depression/anxiety (lifespan impact -10 to 20 years) 

Sexuality and sexual development in middle adulthood 

• Menopause (lower sexual drive, changes in relationship, body image) 

• Impacts on sexual relationships: dryness, painful intercourse, erectile changes 

• Changes to libido 

Childbearing in middle adulthood 

• An increasing number of individuals are having children after the age of 35

• Is called :advanced maternal age

Health promotion in middle adulthood 

• Primary prevention: how can we prevent illness and injury and prmote health in middle adulthood?

• Secondary prevention: when routine screening programs start. 

• Tertiary prevention: prevent progression of disease