Chapter 19
Conception Through Young Adult
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Three Stages of the Fetus
• Preembryonic stage—conception to third week
– Three distinct cell layers—endoderm, mesoderm, and
ectoderm
• Embryonic stage—fourth to eighth week
– All basic organs established
• Fetal stage—ninth week to birth
– Body organs and systems continue to grow
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Characteristics of a Normal
Neonate (Birth to 28 Days)
• Reflexes develop (moro, stepping, grasp, hand to mouth,
sucking, etc.)
• Body temperature responds quickly to environmental
temperature
• Senses used to respond to environment
• Stool and urine eliminated
• Active crying and quiet alert state exhibited
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reflexes of the Neonate
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reflexes of the Neonate
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiologic Development of the Infant (1
Month to 1 Year)
• Brain grows to half of adult size
• Body temperature stabilizes
• Motor abilities develop
• Eyes begin to focus
• Heart doubles in weight
• Deciduous teeth begin to erupt
• Birth weight usually triples by one year (average 22 lbs.)
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Psychosocial Development of Infant
• In oral stage, immediate gratification of needs
• Develops trust (Erikson)
• Meets developmental tasks (Havighurst) (taking food,
walking, talking)
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Special Considerations for the Infant
• Attachment and bonding
• Play
• Temperament
– Easy, slow to warm, difficult
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Healthcare Issues for the Infant
• Accidental injuries
• Colic
• SIDS
• Failure to thrive
• Child abuse
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiologic Development of Toddler (1 to
3 Years)
• Rapid brain growth, increase in bone length and muscle
growth
• Uses fingers to pick up small objects
• Walks, runs, kicks, climb, rides tricycle, drinks from cup
• Four times birth weight
• Bladder control during the day, sometimes at night
• Turns pages in book, and by age 3 draws stick people
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cognitive Development of Toddler
• In Piaget’s last two stages of sensorimotor development
• Understands self as separate from others
• Beginning perception of body image
• Sense of gender identity
• Language begins, at two years, uses short sentences
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Psychosocial Development of Toddler
• Freud—anal stage, toilet training is major focus
• Erikson—autonomy versus shame and doubt
• Havighurst—tasks of learning to control elimination
process, learn sex differences, form concepts, learn
language, and distinguish right from wrong
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Solitary or Parallel Play of the Toddler
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiologic Development of Preschooler
• Head is close to adult size by 6 years old
• Body is leaner and more coordinated
• Motor abilities include jumping, skipping, throwing a ball,
printing letters and numbers
• Full set of 20 deciduous teeth
• Average weight 45 pounds
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cognitive Development of Preschooler
• Egocentrism increases
• Play more related to real-life events
• Basic curiosity results in constant questions and
improved reasoning ability
• Language development more elaborate
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Psychosocial Development of the
Preschooler
• Freud—phallic stage, biologic focus is genital
• Erikson—initiative versus guilt, conscience develops
• Havighurst—four developmental tasks
– Learn sex differences and modesty
– Describe social and physical reality in language and
concept formation
– Get ready to read
– Distinguish right from wrong
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiological Development of School-Age
Child (6 to 12 Years)
• Brain reaches 90% to 95% of adult size, nervous system
almost mature by age 12
• Motor abilities progress to writing in script and in
sentences by age 12
• Sexual organs grow but are dormant until late in this
period
• All permanent teeth present except for 2nd and 3rd
molars by age 12
• Height increases 2 to 3 inches and weight increases 3 to
6 pounds a year
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cognitive Development of
School-Age Child
• In Piaget’s concrete operational stage, organizing facts
and problem-solving
• Uses inductive reasoning to solve new problems
• Thinks logically and develops concepts of measurement
• Generalizes about people, places, and things
• Develops classification systems, understands reversal of
events
• Has an awareness of other’s feelings
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Psychosocial Development of
School-Age Child
• Freud—latency stage, strong identification with own sex
• Erikson—industry versus inferiority stage, focus on
learning useful skills, self-identity emerges
• Havigurst—tasks of learning physical games, appropriate
social roles, developing writing, reading, and calculating
skills, avoiding personal independence, developing
conscience, morality, and values
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Health Issues for School-Age Children
• Accidents
• Communicable conditions
• Attention deficit hyperactivity disorder
• Learning disabilities
• Chronic illnesses
• Enuresis
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physiologic Development
of the Adolescent
• Feet, hands, and long bones grow rapidly; there is an
increase in muscle mass
• Primary and secondary development occurs (puberty)
• Sebaceous and auxiliary sweat glands become active
• Full adult size is usually reached
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Three Stages of Puberty
• Prepubescence
– Secondary sex characteristics begin to develop
– Reproductive organs do not function yet
• Pubescence
– Secondary sex characteristics continue to develop
– Ova and sperm begin to be produced
• Postpubescence
– Reproductive functioning and development of
secondary sex characteristics reach adult maturity
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cognitive Development of
Adolescent/Young Adult
• Piaget—formal operations
– Deductive, reflective, and hypothetical reasoning are
possible
– Abstract concepts can be used
– Long-term goals can be set
– Concepts of time, its passage, and future become
real
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Psychosocial Development of
Adolescent/Young Adult
• Freud—genital stage, capable of full sexual function
• Erikson—identity versus role confusion; self-concept is
stabilized; peer group has most influence
• Havighurst—masculine or feminine social role developed;
set of values and ethical system internalized
• Levinson—early adult transition: making initial career
choices, establishing personal relationships, and selecting
personal values and lifestyles
• Gould—theory of transformation: young adults establish
their own control as adults separate from family
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Achieving Relationships in Adolescence
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Health Issues for
Adolescents/Young Adults
• Injuries
• Substance abuse
• Suicide
• Pregnancy
• Nutritional problems
• Sexually transmitted diseases
• Developmental and situational stressors
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
In which stage of prenatal development is the fetus
especially vulnerable to any factor that might cause
congenital anomalies (e.g., alcohol, tobacco, drugs)?
A. Preembryonic stage
B. Embryonic stage
C. Fetal stage
D. Neonatal stage
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. Embryonic stage
Rationale:
The fetus is most vulnerable in the embryonic stage
(4th–8th week) because it is a period of rapid growth
and change and differentiation of the cell layers takes
place.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false.
Attachment is a process that occurs during a sensitive
period in the first few hours after birth and is necessary
for a later process known as bonding.
A. True
B. False
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. False
Bonding is a process that occurs during a sensitive period
in the first few hours after birth and is necessary for a
latter process known as attachment.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false.
The most essential role of the nurse in promoting health
of the infant is teaching family members and caregivers.
A. True
B. False
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: A. True
The most essential role of the nurse in promoting health
of the infant is teaching family members and caregivers.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
According to Kohlberg’s preconventional phase of
development, what is the focus that dominates the
behavior of the preschooler?
A. Obeying rules to avoid punishment or receive a reward
B. Developing peer relationships to determine status,
skill, and personableness
C. Beginning to learn sex differences, form concepts, and
distinguish right from wrong
D. Stabilizing self-concept with the peer group acting as
the greatest influence
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. False
Downy pubic hair first appears in the prepubescence
stage of adolescent sexual development.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false.
Downy pubic hair first appears in the pubescence stage
of adolescent sexual development.
A. True
B. False
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: A. Obeying rules to avoid punishment or receive
a reward
Rationale:
Kohlberg’s preconventional phase of moral reasoning
dominates the preschool age.
Developing peer relationships is a major task of the
school-aged child.
Beginning to learn sex differences, form concepts, and
distinguish right from wrong occurs in the toddler stage.
Stabilizing self-concept, with the peer group acting as the
greatest influence, occurs in the adolescent stage.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins