Alexander ch09 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 9
Life Span
Development
and Cultural
Considerations

• The Advanced EMT applies fundamental
knowledge of the EMS system, safety/well-being
of the Advanced EMT, and medical-legal and
ethical issues to the provision of emergency care.
• The Advanced EMT applies fundamental
knowledge of life span development to patient
assessment and management.
Advanced EMT
Education Standard

1. Define key terms introduced in this chapter.
2. Identify the age ranges associated with each of the
following age classifications: neonatal, infancy,
toddlerhood, preschool age, school age, adolescence,
early adulthood, middle adulthood, and late adulthood.
3. Describe the physiologic adaptations that occur
immediately after birth.
4. Discuss the key physical and psychosocial
characteristics and concerns of individuals in each age
classification.
Objectives (1 of 2)

5. Describe reactions to loss, death, and dying, including
stages of grief.
6. Demonstrate awareness of health beliefs of different
cultures.
7. Adapt communication strategies to patients of different
cultural backgrounds.
8. Display cultural sensitivity in interactions with patients of
different ethnicities.
Objectives (2 of 2)

• Culture with which each person identifies with
shapes their?
– Beliefs
– Values
– Expectations for behavior of others
• Health care providers must understand how
psychosocial development and culture affect how
patients interpret actions.
Introduction (1 of 2)

• Variations among people affect interactions with
them and assessment and differential diagnosis
processes.
• Differences based on gender, size, and age.
Introduction (2 of 2)

• What communication strategies will be most
helpful for Jeremy and DeeAnn in gaining Emma’s
trust and cooperation?
• What do you anticipate Emma’s greatest concerns
might be?
• How do you expect Emma’s vital signs to compare
with those of an adult?
Think About It

• Is the psychological maturation that takes place
through their experiences
• Relationship between person and social
environment at different points in life span
Psychosocial Development (1 of 6)

• Aspects include
– How information perceived
– Mental operations performed to make sense of
information
– How we communicate with others
– How we decide things are right or wrong

• Piaget’s theory
– divides childhood development into four stages based
on how a child understands the world.
 Sensorimotor
 Preoperational
 Concrete operational
 Formal operational

• Erikson’s theory
– Personality develops throughout life
– Shaped by resolution of basic psychosocial conflicts
• Erikson’s eight stages
– Trust vs. mistrust
– Autonomy vs. shame
– Initiative vs. guilt
– Industry vs. inferiority

• Erikson’s eight stages (continued)
– Identity vs. role confusion
– Intimacy vs. isolation
– Generativity vs. stagnation
– Integrity vs. despair

• Kohlberg’s theory explains reasoning behind
moral decisions at various stages of development.
– Level I: Preconventional morality
– Level II: Conventional morality
– Level III: Postconventional morality

• Life expectancy 77.9 years on average in the
United States.
• Life expectancy affected by gender, genetics,
environment, and behavior.
• Physical and physiological changes occur
throughout a life span.
Physical Development (1 of 10)

Table 9-5
Normal Vital Signs for Each Age Group
Age Group Respiratory Rate
(per minute)
Heart Rate
(per minute)
Systolic Blood
Pressure (in mmHg)
Temperature
(in °F)
Newborn 30 to 60 100 to 180 70 to 90 98 to 100
Infant 25 to 40 100 to 160 70 to 90 98 to 100
Toddler 24 to 30 80 to 130 72 to 100 98.6 to 99.6
Preschooler 22 to 34 80 to 120 78 to 104 98.6 to 99.6
School-age
child
18 to 30 70 to 110 80 to 115 98.6
Adolescent 12 to 20 60 to 105 88 to 120 98.6
Adult 16 to 20 60 to 100 ≤120 98.6

Figure 9-1
A neonate.

• Neonate (newborn) is a child from birth until one
month of age.
– Birth weight: 6.6 to 7.7 pounds
– Immature body systems
– Head disproportionately large
– Bones softer and less well formed
– Two fonatanelles beneath scalp
Physical Developmental (2 of 10)

Table 9-6
Developmental Milestones
Birth 3 Months 7 Months 12 Months 24 Months 36 Months
Reflexes: startle
(moro),
grasping,
rooting, sucking
Has a social smile
Raises head when
lying on stomach
Supports upper
body with arms
when lying on
stomach
Stretches out legs
and kicks
Watches faces
and recognizes
familiar objects
from a distance
Reaches for toys
Turns head
toward sounds
Enjoys social play
Responds to
others’ emotions
Interested in
mirror images
Struggles to get
objects out of
reach
Responds to
name and no
Babbles chains
of sounds
Rolls over
Sits without
Support
Shy or anxious
around strangers
Cries when
separated
from parents
Crawls
Walks (alone or
with help)
Says “mama” and
“dada”
Feeds self finger
foods
Begins to use
objects
(hairbrush,
telephone,
etc., correctly)
Uses a pincer
grasp
Bangs objects
together
Excited about
company of other
children
Imitates behavior
Demonstrates
more
independence;
some defiant
behavior
Sorts objects
Begins make-
believe play
Uses simple
sentences
Pulls toys
Kicks a ball
Scribbles
Affectionate
Plays
make-believe
Puts together
simple puzzles
Climbs
Pedals a tricycle
More developed
language and
fine motor skills

Figure 9-2
An infant.

• Neonates and infants
– Have greater surface area to volume ratio.
– Immune system immature; less able to fight infection.
– Fewer alveoli in lungs and lungs are fragile.
– Respiratory failure/respiratory arrest can occur quickly.

• Poor feeding, vomiting, diarrhea, and fever can
result in dehydration.
• Childhood immunizations provide immunity
against life-threatening illnesses.
• Crying is a newborn’s and infant’s only way of
communicating.

Figure 9-5
A toddler.

Figure 9-6
A preschooler. (Photo © Daniel Limmer)

• Toddler is one to three years of age. Preschoolers
are three to six years of age.
– Head is still proportionally large
– More social and curious about world
– Ear infections and respiratory tract infections common
– Toilet training completed
– Language skills and vocabulary develop

Figure 9-7
School-age child.

• School-age years are from 6 through 12 years old.
– Physical proportions more adult-like
– Develop relationships outside family
– Self-esteem and identity develops
– Modesty and need for privacy develop

Figure 9-8
Adolescents.

• Adolescents are between 12 and 18 years old.
– Physical growth nearly complete; complete puberty
– Interest in opposite sex/romantic relationships
– Want to be regarded as adults
– Adult judgment not completely developed; risky
behaviors
– Self-conscious and concerned with appearance and
body image

• Young adulthood is from 19 to 40 years old.
– Peak physical condition
– Leading cause of death is trauma
– Romantic relationships develop
– Childbirth common
– Job stress can be high

• Middle adulthood is from 41 to 60 years old.
– Age-related changes become apparent
– Changes in vision
– Cardiovascular disease and risk factors increase
– Weight control becomes more difficult
– Menopause occurs in women
– Financial pressures

Figure 9-9
Older adults.

• Late adulthood is from age 61 years onward.
– Body systems decline (respiratory, cardiovascular,
renal function)
– Pain perception decreases
– Cognitive decline
– View of aged varies by culture

Table 9-7 (1 of 2)
Physiologic Changes Associated with Aging
System Change
Cardiovascular system Heart valves become calcified with narrow openings (stenosis).
Hypertension is common.
Maximum heart rate decreases.
Decreased cardiac output and ability to compensate for loss of volume or
vascular tone.
Cardiac dysrhythmias.
Arteriosclerosis.
Decreased sensitivity of baroreceptors.
Respiratory system Diminished cough and gag reflexes, weaker coughing effort.
Decreased gas exchange.
Increased incidence of respiratory infections.
Nervous system Decreased brain mass.
Degenerative changes (such as plaques) may occur.
Slowed cognitive responses.
Slowed reflexes.
Decreased pain perception.
Disturbances in sleep–wake cycles.
Depression is common.
Senses Diminished senses of vision, especially night vision and near vision; cataracts.
Decreased hearing acuity, especially for higher pitched sounds.
Decreased senses of taste and smell.

Table 9-7 (2 of 2)
Physiologic Changes Associated with Aging
System Change
Gastrointestinal system Decreased appetite.
Decreased nutrient absorption.
Constipation is common.
Decreased liver function.
Renal system Decreased efficiency due to loss of nephrons; may contribute to drug toxicity.
Musculoskeletal system Loss of bone mass.
Decreased skeletal muscle mass and strength.
Integumentary system Thin, fragile skin.
Slow healing.
Loss or thinning of hair.
Brittle nails.
Endocrine system Decreased hormone amount and target organ sensitivity impairs water and
electrolyte balance, glucose metabolism, sleep, and thyroid and other functions.
Immune system Decreased defenses against infection.
Fever may not be present, even with severe infection.

Cultural Differences (1 of 3)
• Things you take for granted may be seen as rude
or disrespectful in other cultures.
– Bias, stereotypes, lack of understanding by health care
providers contribute to disparities
– Respect and deference to elders
– More holistic view of health and medicine
– Same-sex health care providers
– Importance of prayer

• Hispanic/Latino Americans,
– comprising 15% of U.S. population.
– 46.9 million
• African Americans
– comprise 13.5% of U.S. population.
• American Indian and Native Alaskan tribes in the
United States
– 562 federally recognized.

• 15.5 million Asian Americans and Pacific Islanders
in the United States.
• Islam is the most common religion for people from
Western Asia and the Middle East.

• People can die at any age.
• People suffer losses and death of loved ones
throughout their life span.
– Bereavement
– Grief
– Mourning
Grief, Dying, and Death (1 of 7)

• Elisabeth Kübler-Ross’ five stages of dying
– Denial
– Anger
– Bargaining
– Depression
– Acceptance

• Before age six, children do not understand
permanence of death.
• Often, the death of a pet is a child’s introduction to
death process.
• May react to death by becoming anxious at
separation from loved ones.
• May have feelings of abandonment, insecurity,
and fear.

• Diverse cultures have differing rituals surrounding
death.
– Heavily influenced by religious beliefs.
• Hindus
– Strive to achieve freedom from eternal reincarnations
that result from karma
• Judaism branches
– Orthodox, Conservative, and Reform; period of
mourning called shivah

• Buddhism
– Requirements for attaining Nirvana
• Islam
– Qur’an does not provide strict guidance on matters of
illness, death, and burial
• Christianity
– Belief that Jesus Christ is the Son of God; everlasting
life after death

• Death in the field
– Once patient has died, well-being of family becomes
AEMTs’ priority.
– Helpful to ask if family needs to make phone calls and
anything they may need at the moment.
– Always follow your EMS system’s protocols and
procedures.

• Hospice recent addition to health care.
– Assist terminally ill patients and families in preparation
for patient’s death.
• Palliative care is to make patient as comfortable
as possible.
– Pain medication; medications for nausea.

Chapter Summary (1 of 2)
• Understand cognitive, psychosocial, and physical
characteristics of patients from birth to old age.
• People of different ages have different fears and
concerns.
• Children are smaller; differently proportioned
bodies that also work differently.

Chapter Summary (2 of 2)
• Elderly less able to compensate for illness or
injury.
• Health issues and expectations differ by cultural
and ethnic backgrounds.
• Cardiovascular disease, cancer, and stroke are
leading causes of death in the United States
among all ethnicities.
• Attitude of seeking to understand other person’s
expectations is universally important.

Alexander ch09 lecture

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Alexander ch09 lecture