Page 2 Health Promotion and Maintenance Study Guide for the NCLEX-RN® exam

Developmental Transitions and Stages

In each developmental phase, there are normal expectations for physical, cognitive, social, and emotional growth. This next section will include normal developmental milestones, primary needs, and concerning deviations from the expected development for each indicated group. ### Infants
Age: 1 month to 12 months

Developmental Expectations:

  • Suckle reflex and rooting reflex
  • Grasping reflex which develops into pincer grasp with thumb and finger
  • Focus eyes on object (short period of time)
  • Ability to vocalize, “coo”
  • Respond to spoken words or loud noises (albeit sometimes selectively)

Normal Appearance Variations:

  • Swollen breasts or genitalia—residual estrogen from mother during pregnancy or with breastfeeding
  • Milia (white acne bumps on face)
  • Slightly misshapen heads that round with age

Needs:

  • Forming bonds with parents and caregivers

Warning Signs:

  • Not rolling from tummy to side by 10 months old
  • Not transferring toys/objects from hand to hand by 9 months old

Preschool

Age: 1 to 4 years

Developmental Expectations:

  • Dress and undress himself/herself
  • Use and manipulate small objects with their hands and fingers
  • Progressive control over bowel movements and bladder
  • Increasingly aware of limits
  • Voice opposition to activities by saying “no”
  • Vocabulary of 500–3,000 words
  • Short, 3–4 word sentences
  • Draw with a pencil
  • Eager to please

Needs:

  • Consistency with environments and set boundaries
  • Increased need to feel secure
  • Close supervision to avoid dangerous settings
  • Unstructured playtime
  • Independence

Warning Signs:

  • Not walking by 18 months
  • Vocabulary less than 15 words
  • Not able to follow simple commands, imitate words, or imitate simple actions
  • Not interested in playing or engaging in “pretend” play
  • Excessive focus on violence or other mature subject matter

School-age

Age: 5 to 12 years

Developmental Expectations:

  • Coordination more advanced
  • Perform activities that require a combination of motions (i.e., jumping rope, riding a bicycle, skipping)
  • Follow more complicated, multi-step commands
  • Ability to retain information
  • Recall their full name, their address, and how old they are (school-age children)
  • Identify self as boy or girl
  • Emulate their same-sex parent

Needs:

  • Early intervention for those with vision and/or hearing problems
  • Monitoring for scoliosis or lateral curvature of the spine

Warning Signs:

  • Continued bed-wetting (nocturnal enuresis)
  • Verbalization or showing signs of anxiety about school and/or home life

Adolescents

Age: 12 to 18 years

Developmental Expectations:

  • Try to find self-identity
  • Strong peer relationships
  • Engage in somewhat risky behavior
  • Natural sense of immortality
  • Awareness and increasing concern with physical appearance
  • Development of secondary sexual characteristics
  • Increased hormone levels
  • Growth spurts

Needs:

  • Education and mental preparation for physical changes of puberty
  • Guidance and discussions regarding sex, alcohol, and drugs
  • Understanding and expectation of labial mood and personality shifts

Warning Signs:

  • Excessive aggressiveness
  • Persistent misbehavior, especially at school
  • Monitor for dramatic changes including excessive weight gain or loss, changes in behavior, changes in peer groups and how that may impact the adolescent
  • Persistent depressed mood, despair, hopelessness, withdrawal, and comments about suicide or suicide ideation

Adults (Working Adults)

Age: 19 to 64 years

Developmental Expectations:

  • Erikson’s Theory of Psychosocial Development: (age 19–34 intimacy versus isolation; age 35–64 generativity versus stagnation)
  • Seek meaning or purpose in life
  • Builds work, family and other relationships
  • Prime age 25–35 years old
  • As age increases, increase in chronic medical conditions
  • Need for lifestyle modifications to address development of chronic concerns

Needs:

  • Healthy coping mechanisms to manage demands of long-term relationships, marriages, workplace relationships, and politics
  • Preventative healthcare strategies to reduce the incidence of chronic illness as age increases

Warning Signs:

  • Substance abuse—alcohol, medication, or illicit drugs
  • Feeling that life is meaningless or better without them in it

Older Adults (Retirement Aged)

Age: 65 to 85 years

Developmental Expectations:

  • From Erikson’s Theory of Psychosocial Development: Resolve the conflict of ego integrity versus despair. This means that they either look back on their lifetime and accomplishments with a sense of satisfaction, or they feel despair if they don’t feel a sense of meaning or purpose from their lives.
  • Demonstrate slow decline in physical functioning
  • Likely will retire from the workforce
  • Reminiscent over life’s accomplishments or regrets
  • Experience changes in interpersonal relationships
  • Increasing incidence of illness, decline of function, and death

Needs:

  • Support during difficult transitions to life away from the workplace
  • Struggle with changes in loss of close personal relationships

Warning Sign:

Sense of despair or regret about life

Very Old Adults (Elderly)

Age: 85+ years

Developmental Expectations:

  • Progressive decline of physical functioning
  • Progressive decline of cognitive functioning
  • Likely to experience heavy loss of interpersonal relationships

Needs:

  • Need help learning to accept and find meaning in their lives
  • Assistance in daily activities if unable to perform
  • May need to change living environments to adapt to increasing needs

Warning Signs:

  • Suicidal thoughts or behavior