paramedic care: principles & practice volume 2: paramedicine fundamentals chapter fourth edition...

Paramedic Care: Principles & Paramedic Care: Principles & PracticePractice

Volume 2: Paramedicine FundamentalsVolume 2: Paramedicine Fundamentals

CHAPTER

Fourth EditionFourth Edition

Human Life Span Development

2

©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.

Multimedia Directory

Slide 6Treatment Across the Life Span VideoSlide 73Pharmacology and the Older Adult VideoSlide 75Nutrition and Aging Video


Standard

• Life Span Development


Competency

• Integrates comprehensive knowledge of life span development.


Introduction

• People change over span of lifetime.

• Changes in size, appearance, vital signs, body systems, psychosocial development.

• Some changes make it necessary to adjust treatment of patients.


Treatment Across the Life Span Video

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Introduction

• Developmental Stages– Infancy: birth to 12 months– Toddler: 12 to 36 months– Preschool age: 3 to 5 years– School age: 6 to 12 years– Adolescence: 13 to 18 years– Early adulthood: 19 to 40 years– Middle adulthood: 41 to 60 years– Late adulthood: 61 years and older


People change over the span of a lifetime.


Infancy

• Physiologic Development– Greatest changes in range of vital signs are in pediatric patients.


Normal Vital Signs


Normal Vital Signs (continued)


Infancy

• Physiologic Development– Younger the child, more rapid pulse and respiratory rates.

– At birth, heart rate 100 to 180 beats per minute; settles at 120 beats per minute.


Infancy

• Physiologic Development– Initial respiratory 30 to 60 breaths per minute; drops to 30 to 40 breaths per minute.

– Tidal volume initially 6 to 8 mL/kg; increases to 10 to 15 mL/kg by 12 months of age.


Infancy

• Physiologic Development– Normal range for blood pressure related to age and weight of infant; tends to increase with age.

– Systolic blood pressure increases from 60 to 90 at birth; 87 to 105 at 12 months.


Infancy

• Physiologic Development– Normal birth weight: 3.0 to 3.5 kg.– First week of life, drops by 5 to 10%.

– During first month, infants grow at 30 grams per day.

– Double birth weight by 4 to 6 months and triple it at 9 to 12 months.

– Infant's head equal to 25% of total body weight.


Infants double their weight by 4 to 6 months old and triple it by 9 to 12 months. (© Michal Heron)


Infancy

• Physiologic Development– Shortly after birth, ductus venosus constricts.

– Blood pressure changes; foramen ovale closes.

– Ductus arteriosus constricts after birth.


Infancy

• Physiologic Development– Once closed, blood can no longer bypass lungs by moving from pulmonary trunk directly into aorta.

– Leads to increase in systemic vascular resistance; decrease in pulmonary vascular resistance.


Infancy

• Physiologic Development– First breath infant takes is forceful.

– Lungs of fetus secrete surfactant.– Surfactant: chemical that reduces surface tension; holds moist membranes of lungs together.

– After first breath, lungs expand; breathing becomes easier.


Infancy

• Physiologic Development– Airway shorter, narrower, less stable, more easily obstructed.

– “Nose breather” until 4 weeks of age.– Important nasal passages stay clear.– Lung tissue fragile; prone to barotrauma.

– Rapid respiratory rates lead to rapid heat and fluid loss.


Infancy

• Physiologic Development– Chest wall less rigid than adult's.

– Ribs positioned horizontally, causing diaphragmatic breathing.

– Kidneys not able to produce concentrated urine.

– Easily become dehydrated; develop water and electrolyte imbalance.


Infancy

• Physiologic Development– Fetus acquires some of mother's active immunities against pathogens.

– Breast-fed baby receives antibodies.

– Sensation present in all portions of body at birth.

– Lacks ability to localize pain and isolate response to it.


Infancy

• Physiologic Development– Moro reflex (startle reflex): when baby is startled, he throws his arms wide, spreading his fingers and then grabbing instinctively with arms and fingers. Should be brisk and symmetrical.


Infancy

• Physiologic Development– Palmar grasp: strong reflex in full-term newborn. Elicited by placing a finger firmly in infant's palm; grasp weakens as hand becomes less continuously fisted.


Infancy

• Physiologic Development– Rooting reflex: causes hungry infant to turn his head to the right or left when hand or cloth touches his cheek.

– Sucking reflex: stroking infant's lips causes sucking movement.


Infancy

• Physiologic Development– Fontanelles

Allow for compression of head during childbirth.

Rapid growth of brain during early life.

Diamond-shaped soft spots of fibrous tissue at top skull; bones eventually fuse together.


Infancy

• Physiologic Development– Newborn sleeps 16 to 18 hours daily.

– Periods of sleep and wakefulness evenly over 24-hour period.

– Infants sleep through night within 2 to 4 months.

– Normal infant easily aroused.


Infancy

• Physiologic Development– Extremities grow in length from growth plates located on ends of long bones.

– Factors affecting bone development and growth: nutrition, exposure to sunlight, growth and thyroid hormones, genetic factors, general health.


Infancy

• Physiologic Development– Rapid changes during first year of life.

– 2 months: tracks objects with eyes; recognizes familiar faces.

– 3 months: moves objects to mouth with hands; displays primary emotions.

– 4 months: drools without swallowing; reaches out to people.


Infancy

• Physiologic Development– 5 months: sleeps through night without waking for feeding; discriminates between family and strangers.

– 5 to 7 months: teeth appear. – 6 months: sits upright; makes one-syllable sounds.

– 7 months: fear of strangers; moods shift from crying to laughing.


Infancy

• Physiologic Development– 8 months: responds to word “no”; can sit alone; plays “peek-a-boo.”

– 9 months: responds to adult anger; pulls to standing position; explores objects by mouthing, sucking, chewing, biting.

– 10 months: attention to name; crawls.


Infancy

• Physiologic Development– 11 months: attempts to walk without assistance; shows frustration about restrictions.

– 12 months: walks with help; knows name.


Infancy

• Psychosocial Development– Begins at birth; develops as result of instincts, drives, capacities, interactions with environment.

– Key component is family.– Reciprocal socialization: child's active role in own development.


Infancy

• Psychosocial Development– Crying: newborn's only means of communication.

– Bonding based on secure attachment; infant's sense that needs will be met by caregivers.

– Anxious resistant attachment: uncertain whether or not caregivers will be responsive or helpful when needed.


Infancy

• Psychosocial Development– Anxious avoidant attachment: infant has no confidence he will be responded to helpfully when he seeks care.

– Trust vs. mistrust: develops trust based on consistent parental care; if irregular and inadequate care, develops anxiety, insecurity, mistrust.


Infancy

• Psychosocial Development– Scaffolding: building on what they already know.

– Easy child: regular body functions; low or moderate intensity of reactions; acceptance of new situations.

– Difficult child: irregular body functions; intense reactions; withdrawal from new situations.


Infancy

• Psychosocial Development– Slow-to-warm-up child: low intensity of reactions; somewhat negative mood.

– First stage of parental-separation reaction is protest.

– Second stage is despair.– Last stage is detachment or withdrawal.


Toddler and Preschool Age

• Physiologic Development– Toddlers (12 to 36 months)

Heart rate: 80 to 110 beats per minute.

Respiratory rate: 24 to 40 breaths per minute.

Systolic blood pressure 95 to 105 mmHg.


A toddler beginning to stand and walk on his own.



• Physiologic Development– Preschoolers (3 to 5 years old)



Systolic blood pressure: 75 to 110 mmHg.

Rate of weight gain slowing dramatically; gains 2.0 kg per year.


In the preschool-age child, exploratory behavior accelerates. (© Dr. Bryan E. Bledsoe)



• Physiologic Development– Capillary beds better developed.– Hemoglobin levels approach normal adult levels.

– More surfaces for gas exchange to take place in lungs.

– Immature chest muscles; cannot sustain excessively rapid respiratory rate for long.



• Physiologic Development– Kidneys well developed.– Passive immunity lost; susceptible to respiratory/gastrointestinal infections.

– Brain 90% of adult weight.– Muscle mass/bone density increased.– All primary teeth by age 36 months.– Visual acuity 20/30; hearing reaches maturity at 3 to 4 years.



• Psychosocial Development– 1 year: grasps that words mean something.

– 3 to 4 years: has mastered basics of language.

– 18 to 24 months: understands cause and effect; develops separation anxiety.

– 24 to 36 months: “magical thinking”; engages in play-acting.



• Psychosocial Development– Exploratory behavior accelerates.– Plays simple games; follows basic rules.

– Play provides emotional release.– First-born child often finds it difficult to share attention of parents with younger sibling.



• Psychosocial Development– Younger children often see apparent privileges extended to older children.

– Peers provide information about other families and outside world.

– Interaction with peers are opportunities for learning skills, comparing oneself to others, feeling part of group.



• Psychosocial Development– Authoritarian parents: demanding and desire instant obedience from child. Leads to children with low self-esteem and low competence.

Boys often hostile; girls often shy.



• Psychosocial Development– Authoritative parents: respond to the needs and wishes of their children. Leads to children who are self-assertive, independent, friendly, cooperative.



• Psychosocial Development– Permissive parents: tolerant, accepting view of children's behavior (aggressive and sexual behavior). Leads to impulsive, aggressive children who have low self-reliance, low self-control, low maturity, lack responsible behavior.



• Psychosocial Development– Half of today's marriages end in divorce.

– Child's physical and psychological way of life often changes.

– Toddlers and preschoolers express feelings of shock, depression, fear parents no longer love them.

– Parent's ability to respond to child's needs greatly influences effects.



• Psychosocial Development– Television violence increases levels of aggression; increases acceptance of use of aggression by others.

– Parental screening helps to avoid these outcomes in toddlers and preschoolers.

– Modeling: recognize sexual differences; incorporate gender-specific behaviors observed in parents, siblings, peers.


School Age

• Physiologic Development– 6 and 12 years of age




Gains 3 kg per year; grows 6 cm per year.


School Age

• Psychosocial Development– Has developed decision-making skills.

– Is allowed more self-regulation.– Development of self-concept.– Develops self-esteem; negative self-esteem damaging to further development.


School Age

• Psychosocial Development– Moral development begins.– Preconventional reasoning:

Stage one: punishment and obedience.

Stage two: individualism and purpose.


School Age

• Psychosocial Development– Conventional reasoning:

Stage three: interpersonal norms; seeking approval of others.

Stage four: develop social system's morality.

– Postconventional reasoning: Stage five: community rights as opposed to individual rights.

Stage six: universal ethical principles.


School-age children are allowed more self-regulation and independence as they grow older.


Adolescence

• Physiologic Development– Adolescents (13 to 18 years)




Rapid 2- to 3-year growth spurt.


Adolescence

• Physiologic Development– Girls finished growing by 16; boys 18.– Both males and females reach reproductive maturity.

– Secondary sexual development occurs.– Development of external sexual organs.– Females: menstruation begins.– Muscle mass/bone growth nearly complete.


Children reach reproductive maturity during adolescence.


Adolescence

• Psychosocial Development– Adolescent strives for autonomy; parents strive for continued control.

– Biological changes cause inner conflict.

– Privacy becomes extremely important.– Increase in idealism.– Try to achieve more independence.– Self-consciousness and peer pressure increase.


Adolescence

• Psychosocial Development– Interested in opposite sex.– Identity development depends on how well they are able to handle crises.

– Antisocial behavior peaks around eighth or ninth grade.

– Body image is great concern.


Adolescence

• Psychosocial Development– Eating disorders common.– Self-destructive behaviors begin.– Depression and suicide more common.

– Develop personal code of ethics.


Early Adulthood

• 19 to 40 years– Heart rate: 70 beats per minute.– Respiratory rate: 12 to 20 breaths per minute.

– Blood pressure: 120/80 mmHg.– Develop lifelong habits and routines.

– Peak physical condition: 19 to 26.– End of this period, body begins slowing process.


Peak physical conditions occur in early adulthood.


Early Adulthood

• 19 to 40 years– Accidents leading cause of death.– Highest levels of job stress.– Love develops (romantic/affectionate).

– Childbirth common.– Not associated with psychological problems related to well-being.


Middle Adulthood

• 41 to 60 years– Heart rate: 70 beats per minute.– Respiratory rate: 12 to 20 breaths per minute.

– Blood pressure: 120/80 mmHg.– Body still functions at high level.– Vision and hearing changes.– Cardiovascular health becomes concern.


People in middle adulthood still function at a high level.


Middle Adulthood

• 41 to 60 years– Cancer concerns. – Weight control difficult.– Women late 40s to early 50s, menopause commences.

– More concerned with “social clock.”– “Empty-nest syndrome.”– Financial commitments for elderly parents and young adult children.


Late Adulthood

• Human beings: maximum life span approximately 120 years.

• Life expectancy: average number of additional years of life expected for member of a population.

• Human beings almost always die of disease or accident before they reach their biological limit.


Late Adulthood

• Physiologic Development– 61 years of age and older

Heart and respiratory rate, blood pressure: depends on physical health status.

Cardiovascular system changes: affect its overall function.

80 years of age: 50% decrease in vessel elasticity.


Late Adulthood

• Physiologic Development– Heart shows disease in heart muscle, heart valves, coronary arteries.

– Functional blood volume decreases.– Increased likelihood for older adults to develop lung disease and progressive declines in lung function.

– Smoking produces greatest amount of disability.


Late Adulthood

• Physiologic Development– Decrease in glucose metabolism and insulin production.

– Age-related dental changes; false teeth.

– Swallowing takes 50 to 100% longer.– 1 of 3 people over 60 has diverticula.

– Constipation when narcotics ingested.


Pharmacology and theOlder Adult Video

Click here to view a video on the topic of pharmacology and the older adult patient.

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Late Adulthood

• Physiologic Development– Changes occur in metabolism and absorption.

– 25 to 30% decrease in kidney mass.– Kidney's hormonal response to dehydration reduced.

– Taste buds diminish.– Smell declines rapidly after age 50.– Appetite often declines.


Nutrition and Aging Video

Click here to view a video on the topic of nutrition and aging.

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Late Adulthood

• Physiologic Development– Response to painful stimuli, visual acuity, reaction time diminished.

– Changes in organs of hearing; affect hearing.

– Changes in memory function. – Sleep-wake cycle disrupted.


Late Adulthood

• Psychosocial Development– Ability to learn and adjust continues throughout life.

– Influenced by interests, activity, motivation, health, income.

– Terminal-drop hypothesis: decrease in cognitive functioning over 5-year period prior to death.


The ability to learn and adjust continues throughout life.


Late Adulthood

• Psychosocial Development– Home-care services: assistance with household chores; perform personal care tasks.

– Health care services: in home by nurses and physical or speech therapists.

– Eligible for these services under Medicare.


Late Adulthood

• Psychosocial Development– Assisted living: facility that offers combination of home care and nursing home facilities.

– 95% of older adults live in communities.

– Challenges: maintaining sense of self-worth; feeling of declining well-being.


Late Adulthood

• Psychosocial Development– Retirement usually means decrease in income and in standard of living.

– Decreasing level of interest in work is natural.

– 22% of older people live in households below poverty level.

– 50% of all single women above age of 60 live at or below poverty level.


Late Adulthood

• Psychosocial Development– Grief follows death; when advance warning, grief may precede death.

– Death or impending death of companion leads to fear for our own lives.

– Everyone must deal with each of the stages of grieving before process ends.


Summary

• Some stages (birth through preschool) changes seem to occur daily.

• Infant through adolescent constitutes pediatric population.

• Know typical developmental characteristics of each age.

• You will be better prepared to evaluate a sick or injured pediatric patient.


Summary

• Compare child's current state to established norm; determine if there is significant difference.

• Not every person develops at same rate and in same way.

• Established norms are only guidelines.

• They should never take the place of thorough assessment and history.


Summary

• Only through experience will you feel comfortable dealing with patients at each of stage of life.

• No matter what stage of development, a thorough assessment, patience, and sincere desire to help will guide you to make right emergency care decisions for each patient.

paramedic care: principles & practice volume 2: paramedicine fundamentals chapter fourth edition...

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