Page 1 - Health Promotion and Maintenance Study Guide for the NCLEX-PN Exam
To be able to relay information to clients about healthy lifestyles and practices, you’ll need to be fluent in the stages of human growth and the things that are important at each stage. You’ll also need to know the things clients can do to keep themselves out of the doctor’s office and hospital for illness and accident-related visits. About 6% to 12% of the questions on the NCLEX-PN® cover this field of knowledge, which is outlined here. If there is anything here that still causes you concern, be sure to seek further information from other sources.
When caring for clients, it is important to know the developmental stages and be able to provide care for clients at each stage. There are different considerations for each stage.
Know the Stages
Infant and Toddler: Less Than 1 Month Old, Up to 2 Years
After the baby is born, care during the infancy stage will focus on keeping the baby safe and monitoring feeding and physical growth. This is also the stage where the baby will develop trust vs. mistrust with parents and caregivers. In the toddler phase, the child will begin to walk and talk and develop independence. Additional safety measures may need to be implemented as the child is more mobile.
Preschool, School-age and Adolescents: Ages 3 Through 17 Years
Preschool children go through the stage of initiative vs. guilt as they become more independent but also understand consequences. When children reach school age, they are in the stage of industry vs. inferiority. The child should be praised for accomplishment and supported as they learn new skills.
In adolescence, the child is in the stage of identity vs. role confusion. The child will value their social relationships and should be given a sense of autonomy in their choices.
Adults: Ages 18 Through 64 Years
Young adults will be in a stage of intimacy vs. isolation, and they will hopefully develop successful relationships. In middle adulthood, the focus is on generativity vs. stagnation. These adults will be focused on creating or developing things that will outlast them, whether it be children or work accomplishments.
Adults: Ages 65 Through 85 Years and Over
A mature adult will reflect on the stage of ego integrity vs. despair as they approach the end of life. As they look back on their lives, they will either feel a sense of satisfaction or failure. As adults age, they also will begin to ponder the aging process and death. As their peers also approach death, the stages of grief may be present in their lives.
Use the Stages
When caring for clients, the nurse should use the stages identified to determine what is appropriate and may also identify cause for concern if milestones are not met.
Approaches to care will need to be modified in accordance with the client’s developmental stage. For example, when the client is struggling with trust vs. mistrust, a consistent caregiver can help establish a relationship. When the client is developing autonomy, he or she may benefit from more direct involvement in decisions and care needed.
When assessing and interacting with clients, the nurse should attempt to identify irregularities between the client’s actual behavior and development and the expected behavior and development. If the client is struggling in areas of development, the nurse can suggest altering the care plan to encourage progress in specific areas.
Compare Client Development to Norms
The client’s development, including cognitive, psychosocial, and physical development, should be compared to the norms for the client’s age. Physical development is an objective assessment, but the cognitive and psychosocial development deviations may require an in-depth, more subjective evaluation.
Report Client Deviations
Any deviations from expected growth and development should be reported and thoroughly documented. Some deviations may require immediate intervention and others may require continual monitoring.
Client education is extremely important during all types of care. The client’s developmental stage should be taken into account to determine the best method of communication.
First, Check for Adequate Communication
When interacting with the client and providing education, the nurse should first ensure that the type of communication is adequate. For young children, this may involve physical aids, as they may not be able to comprehend verbal instructions and education.
Barriers to Communication— Some clients may have barriers to communication. These may include a language difference that requires a translator or a hearing deficit that may require supplemental information such as written materials to assist with client education. Whenever possible, the client’s family should not be used for translating.
Barriers to Learning— The client may also have barriers to learning, such as altered mental status. If the client is sedated due to medications, he or she will not be able to absorb information. If there is chronic mental instability, the appropriate resources should be involved to ensure the client is receiving adequate care.
Helping the Client
In addition to client education, the interventions the nurse performs should take into account the client’s developmental stage and progression. As the client begins to want to make his or her own choices, the nurse may involve the client more in the process.
Making Choices— When helping the client make choices, the nurse should encourage age-appropriate and stage-appropriate activities. For example, when caring for an adolescent client that is in a stage where friends are of high importance, the nurse can offer different group activities to foster socialization.
Intense Stages— While all of the developmental stages are important, there are intense stages that may require additional resources. When caring for a pregnant client, the client and family may require assistance preparing for upcoming changes. Further, when clients near the end of life, resources to assist with coping should be provided.
Between Stages: Aging and Transitions
Some of the most critical stages for the client are when they are aging and transitioning between stages.
The nurse can help the client anticipate the changes and transitions as they get older and assist in setting the appropriate expectations. When caring for children, the parents may need to be involved so that they can foster the appropriate environment for their child to develop as they transition from one stage to another.
Assess the Client
The nurse should assess the client’s current knowledge of the aging process and expected changes to determine whether additional education should be provided. The nurse should also assess the client’s coping mechanisms, support system, and environment to ensure it is safe and adequate.
Assist with Transitions
The nurse can assist the client with transitions from one stage to another. For example, the nurse should encourage attachment when caring for a newborn and their parents and provide additional resources on parenting. When clients are approaching retirement, they may need assistance if they do not seem to be coping with this life change appropriately.
In many situations, the client’s body may change or be altered due to health. The nurse should assess the client’s body image and how changes impact this.
Identify Probable Changes
Some changes to the body are probable, such as changes during puberty or pregnancy. The nurse should help the client set realistic and healthy expectations. Education on the anticipated changes can help the client track progress and determine if there are any issues.
Assess the Client
While the client is going through changes, the nurse should assess the impact of these changes on the client and the client’s ability to accept these changes. If the body alteration is unexpected, such as a traumatic amputation, the client may require additional resources to psychologically cope with this change.