Download Chapter 9: Life Span Development

Chapter 9
Life Span Development
National EMS Education
Standard Competencies
Life Span Development
Integrates comprehensive knowledge of life
span development.
Introduction
• Humans evolve over their life span.
− Paramedics must be aware of the changes that
occur at each stage of life.
− Paramedics may need to adjust care based on
patient’s life stage.
Infants
• Age 1 month to 1
year
− Newborns
− Neonates
© Johanna Goodyear/ShutterStock, Inc.
• Younger than 1
month:
Infants
Infants
• Weight
− Generally 6–8 pounds at birth
− Lose 5–10% of body weight in week 1
− Begin weight gain during week 2
• Cardiovascular system
− Switch to own vasculature system
Infants
• Pulmonary system
• First breath inflates lungs for first time
• Under 1 month, nose breathers
• Under 6 months, prone to nasal congestion
Infants
• Pulmonary system
(cont’d)
− When compared to
adults:
• Softer rib cages
• Horizontally oriented ribs
• Immature accessory
muscles
• Larger tongue
• Shorter, narrower airway
• Fewer alveoli
• Fragile lungs
Courtesy of Marianne Gausche-Hill, MC, FACEP, FAAP
Infants
• Renal system
− Consider:
• Dehydration
• Electrolyte
imbalances
• Immune system
− Passive immunity
helps protect up to 1
year
• Nervous system
− Continues to evolve
following birth
− Born with:
• Moro reflex
• Palmar grasp
• Rooting reflex
• Sucking reflex
Infants
• Nervous system (cont’d)
− Fontanelles allow the head to be molded.
− Sleep patterns vary.
Infants
• Musculoskeletal
system
− Growth and
epiphyseal plates help
bones grow.
− Muscles account for
25% of weight.
− Growth charts track
growth.
• Dental system
− Teething begins at
4–7 months.
• Baby teeth are in by
age 3 years.
• Permanent teeth
come in around
age 6.
Infants
• Psychosocial
development
begins at birth.
− Evolves as infant
interacts with and
reacts to the
environment
Infants
• Infants typically have their own timetable for
development.
− Bonding based on a secure attachment
− Anxious avoidant attachment based on rejection
• Most infants use crying as the primary
method of communicating distress.
Infants
• For infants, a reaction to a situational crisis
follows three phases:
− Protest phase
− Despair phase
− Withdrawal
• Infants go through trust and mistrust phase.
Infants
• Children may
be:
− Easy
− Difficult
− Slow to warm
up
− Let caregiver
hold infants
whenever
possible!
Courtesy of Howard E. Huth, III, BA, EMT-P.
Toddlers and Preschoolers
• Toddlers are ages
1–3 years.
• Preschoolers are
ages 4–5 years.
• Vital signs
− Slower pulse and
respiratory rates
than infants
− Higher systolic
blood pressure
© Kevin Levit/ShutterStock, Inc.
© Maxim Bolotnikov/ShutterStock, Inc.
Toddlers and Preschoolers
• Cardiovascular system
− Similar to adult’s, but lacks well-developed lung
musculature
• Immune system
− Passive immunity loss leads to acquired
immunity.
• Neuromuscular
system
− Development of
gross and fine
motor skills
− Brain weighs 90%
of final adult weight
© EML/ShutterStock, Inc.
Toddlers and Preschoolers
Toddlers and Preschoolers
• Renal system
− Begin bladder control
• Teething process may be painful and
include fever.
• Sensory development makes tickling fun.
Toddlers and Preschoolers
• Psychosocial changes
− Separation anxiety peaks.
− Language development occurs.
− Peer interactions result in:
• Learning control, following rules, competitiveness
• Modeling behavior
• Recognizing sexual differences
Toddlers and Preschoolers
• Tips for paramedic:
− Always include caregiver!
− Position yourself at eye level.
− Explain what you are going to do.
− Save the worst for last.
Toddlers and Preschoolers
• Development is a reflection of parents
− Styles:
• Authoritarian: expects complete obedience
• Authoritative: balances authority with freedom
• Permissive: no imposition of rules
− Divorce may affect self-esteem and well-being.
School-Age Children
• Ages 6–12 years old
• Vital signs, physical
body approaching
those of an adult
• Puberty may start as
early as 10 years
© Trout55/ShutterStock, Inc.
• Grow approximately
4 lbs, 2½″ per year
School-Age Children
• Psychosocial changes
− Three stages of reasoning
• Preconventional: avoid punishment
• Conventional: obtain approval
• Postconventional: conscience
− Self-concept develops
− Self-esteem develops
School-Age Children
• Tips for paramedics:
− Use same techniques as for preschoolers.
− Gaining (and losing) trust is a huge issue.
− Be direct, assertive, and open!
Adolescents (Teenagers)
• Ages 13–17 years
• Vital signs level off
to adult ranges.
• Reproductive
changes
− Secondary sex
characteristics
− Hormone secretion
© Jamie Wilson/ShutterStock, Inc.
• Growth spurt
Adolescents (Teenagers)
• Psychosocial
changes
− Family conflict
related to:
• Privacy
• Selfconsciousness
• Rebelliousness
• Peer pressure
• Self-destructive
behavior
© SW Productions/Jupiterimages
Adolescents (Teenagers)
• Tips for
paramedics:
− Provide discretion
and respect to
patients.
− Speak with patient
separately from
caregivers,
whenever possible.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
• Ages 18–40 years
• Vital signs remain
constant.
• Body functions at
optimal level
between ages
19–25.
• Accidents are
common cause of
death.
© Rubberball Productions
Early Adults
Early Adults
• Psychosocial changes
− Work, family, and stress are main focus
• Want to “settle down”
• Seek and find love
− One of the most stable life periods, with less
psychological problems than other stages
Middle Adults
• Ages 41–60 years.
• Physical changes:
− Vision/hearing loss
− Cardiovascular
disease
− Lower metabolism
− Cancer rates increase
• Menopause/bone
density loss, fractures
© Photodisc
Middle Adults
• Psychosocial changes
− Focus on meeting life goals
• “Empty nest” syndrome
• Financial worries related to retirement
• May see crisis as a challenge, not a threat
Late Adults
• Ages 61+
− Life expectancy
approximately
78 years
• Vital signs depend
on:
− Overall health
status
− Medical conditions
− Medications
© Photodisc
Late Adults
• Cardiovascular system
− Atherosclerosis leads to blood vessel blockage.
• May lead to aneurysms
− Hearts are less able to deal with exercise or
disease due to:
• Decreased pulse rate
• Declining cardiac output
• Inability to elevate cardiac output
Late Adults
• Cardiovascular system (cont’d)
− Vascular system becomes stiff due to:
• Increased diastolic blood pressure
• Decreased cardiac output
• Impeded blood flow
• Reduced elasticity of peripheral vessels
• Reduced ability to compensate for changes
Late Adults
• Respiratory system
− Changes make breathing more difficult:
• Larger airway; smaller alveoli
• Reduced lung elasticity; increased use of intercostal
muscles
• Rigid chest as ribs calcify to sternum
• Decrease in intercostal muscle strength
Late Adults
• Respiratory system (cont’d)
− Changes in mouth and nose leave airway less
protected.
• Difficult to clear secretions
• Cough and gag reflexes decline
• Less responsive to smoke and dust due to decline
in cilia
Late Adults
• Respiratory system
(cont’d)
− Weakening of
smooth muscles
may lead to:
• Collapse
• Inspiratory
wheezing
• Low flow rates
Late Adults
• Respiratory system (cont’d)
− Vital capacity only 50% of younger adult’s
• Loss of respiratory muscle mass
• Increased stiffness of thoracic cage
• Decreased surface area for air exchange
− Residual volume increases causing air to
hamper gas exchange in alveoli.
Late Adults
• Endocrine system
− Diabetes related to weight gain
− Males lose penis rigidity; females experience
atrophy of uterus and vagina
Late Adults
• Renal system
− Functional changes of the kidneys:
• Declining filtration function
• Decreasing kidney mass
• Declining number of nephrons
− Decreased response to hemodynamic stress
Late Adults
• Gastrointestinal system
− Decreased sense of taste, weaker teeth
− Decreased saliva production
− Slower gastric motility
− Diminishing acid secretion
− Decreased ability to extract nutrients
− Fecal incontinence
Late Adults
• Nervous system
− Central nervous system changes:
• Brain weight loss of 10%–20%
• Loss of 5%–50% neurons
• Loss of 20% frontal lobe synapses
• Slower motor and sensory neural networks
− Change to biphasic sleep patterns
Late Adults
• Nervous system (cont’d)
− Brains have increased risk for injury.
• Smaller brain may lead to movement.
• Bridging veins may tear.
Late Adults
• Nervous system (cont’d)
− Peripheral nervous system changes:
• Diminished sensation
• Diminished proprioception
• Deteriorated nerve endings
Late Adults
• Sensory changes:
− Vision changes
• Pupils less responsive to light
• Diminished visual acuity
• Restricted ocular movement
• Increased distortions
• Decreased ability to focus at close range
• Decreased peripheral vision
Late Adults
• Sensory changes (cont’d):
− Hearing changes
• Loss of high-frequency hearing
• Deafness
− Loss of taste bud sensation and olfactory
perception
Late Adults
• Psychosocial changes
− Up until five years preceding death, most late
adults retain high-level brain function
• Terminal drop hypothesis
Late Adults
• Psychosocial
changes (cont’d)
− 95% live at home.
− May live in
assisted living
facility
− Financial concerns
related to health
care
− Patients face own
mortality
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Summary
• Developmental stages of life include infant,
toddler, preschool age, school age,
adolescence, early adulthood, middle
adulthood, and late adulthood.
• Each developmental stage is marked by
different physical and psychological
changes and characteristics.
• The vital signs of toddlers and preschoolers
differ somewhat from those of an infant.
Summary
• From ages 6 to 12 years, the school-age
child’s vital signs and body gradually
approach those observed in adulthood.
• The vital signs of adolescents begin to level
off within the adult ranges.
• Vital signs do not vary greatly through
adulthood; however, the vital signs of late
adults do vary depending on each person’s
health.
Summary
• Infants develop at a startling rate.
• 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.
• Infants are classified as an easy child,
difficult child, or slow to warm up. Their
primary means of communication is crying.
Summary
• Toddlers and preschoolers learn to speak
and express themselves. Toilet training is
usually accomplished around age 28
months.
• A child’s development is affected by the
parenting style employed by his or her
parents. Parenting styles include
authoritarian, authoritative, and permissive.
Summary
• School-age children develop self-esteem
and reasoning abilities and receive their
permanent teeth.
• Adolescents undergo significant
reproductive development, focus on
creating their self-image, are self-conscious,
and may engage in self-destructive
behavior.
Summary
• Early adults focus on work and family. The
body should function at an optimal level.
• Middle adults focus on achieving life goals.
Medical problems become more common.
• Late adults undergo significant physical
changes. They also focus on their mortality.
Credits
• Chapter opener: © digitalskillet/ShutterStock, Inc.
• Backgrounds: Blue—Courtesy of Rhonda Beck;
Gold—Jones & Bartlett Learning. Courtesy of
MIEMSS; Red—© Margo Harrison/ShutterStock,
Inc; Purple—Courtesy of Rhonda Beck.
• Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for
Emergency Medical Services Systems, or have
been provided by the American Academy of
Orthopaedic Surgeons.