Full transcript
0:02The next chapter we're going to discuss
0:03is lifespan development. After you
0:05complete this chapter and related
0:07coursework, you will have a fundamental
0:08understanding of the physiologic and
0:11psychosocial differences of each phase
0:13of human development. You will be able
0:15to discuss adaptations and strategies
0:17that you may need to apply to better
0:19assess and manage
0:21patients under the national EMS
0:23education standard competencies for
0:24preparatory. Again, this applies
0:26fundamental knowledge of the EMS system,
0:28safety, well-being of the EMT, medical,
0:30legal, and ethical issues to the
0:32provision of emergency care. For
0:34lifespan development specifically, you
0:36will be able to apply fundamental
0:37knowledge of lifespan development to
0:39patient assessment and
0:43management. Human beings evolve not just
0:47as a species, but as people over their
0:48lifespan. You must be aware of the
0:51physical changes a person underoses at
0:52various stages in life and this may
0:55alter your approach to patient
1:00care. We'll start with infants. An
1:03infant is age 1 month to one year and
1:05they develop at a startling
1:07rate. Neonates birth to one month. We'll
1:11cover specifically in chapter 31
1:13obstetrics and neonatal care.
1:17Some of the physical changes that we see
1:19with infants are their vital signs. We
1:21have to understand that the younger the
1:22person, the faster the heart rate and
1:24respirations. At birth, a heart rate of
1:2690 to 180 and a respiratory rate of 30
1:28to 60 are considered normal. Shortly
1:31after birth, the pulse often drops to
1:33100 to 160 and the respiratory rate
1:35drops between 25 and 50.
1:43By one year, the rate slows to 20 to 30
1:46breaths a minute for
1:49respiration. Blood
1:51pressure directly corresponds to a
1:53patient's weight. So, it typically
1:55increases with age. The average systolic
1:58pressure is between 50 and 70 for a
2:00neonate and 70 to 95 by age
2:041. A neonate usually weighs 6 to 8 lbs
2:07or 3 to 3 12 kg at birth. They grow
2:10about an average of 30 gram a
2:14day and the head accounts for 25% of its
2:17body
2:19weight. By the end of the first year,
2:22the weight will actually
2:26triple. At 4 to 6 months, it will
2:28probably have doubled. The
2:30cardiovascular system at birth, a
2:32neonate makes the transition from fetal
2:34to independent circulation.
2:36The pulmonary system in infants younger
2:38than 6 months are prone to nasal
2:40congestion. Their rib cage is less rigid
2:42and they can more easily olude their
2:45airway. The reason for this is their
2:47proportionately large size of the tongue
2:49and a proportionately shorter narrower
2:53airway. If we're utilizing bag mask
2:55ventilation, we have to remember that an
2:57infant's lungs are fragile. If we
2:58ventilate too forcefully, it can result
3:00in trauma from pressure or bar trauma.
3:03Respiratory problems are quickly to
3:05become life-threatening. Infants who are
3:07struggling to breathe can quickly tire,
3:09become overheated, and even dehydrated.
3:12An infant's nervous system evolution
3:14continues after birth. Neonates are born
3:17with certain reflexes. The moro or
3:20startle reflex happens when a neonate is
3:22caught off guard. The neonate opens the
3:24arms wide, spreads the fingers, and
3:25seems to grab at things. The palmer
3:28grasp occurs when an object is placed
3:30into their palm. The rooting reflex
3:32takes place when something touches the
3:34neonate's cheek. The neonate will
3:37instinctively turn his or her head
3:38toward the touch. The sucking reflex
3:41occurs when a neonate's lips are
3:42stroked. This and the rooting reflex are
3:44often tested when
3:47feeding. A neonate spontane allow the
3:50head to be molded through the birth
3:53canal. The three or four bones of the
3:55skull eventually bind together and form
3:57suture joints. Generally the posterior
4:00fontineel will fuse at about 3 months
4:02and the anterior fontineel which is on
4:04the top of the head usually fuses
4:06between 9 and 18 months of age. Their
4:08immune system maintains some of the
4:10mother's immunities and infants can also
4:12receive antibodies via breastfeeding
4:14which further bolsters their immune
4:18system. Here you see examples of the
4:20fontails. This is the anterior fontineel
4:22and it allows the skull plates to
4:23overlap during the travel travel through
4:25the birth canal. The posterior fontineel
4:28is smaller, closes more
4:31quickly. Psychosocial changes begin at
4:34birth for neonates. They evolve as the
4:36infant interacts with and reacts to the
4:39environment. Crying is the main
4:43method of communicating
4:47distress. The key to having a happy,
4:49healthy infant is spending time with a
4:51child. Bonding or the formation of a
4:53close personal relationship is based on
4:55a secure attachment. A secure attachment
4:58occurs when an infant understands that
4:59parents or caregivers will be responsive
5:01to their needs and a child can reach out
5:03and explore knowing that the parents
5:05will provide a safety net for
5:08them. Another type of attachment an
5:11anxious avoidant attachment is found in
5:13infants who are repeatedly
5:15rejected. Children show little emotional
5:18response to their parents or caregivers
5:19and treat them as they would strangers.
5:21Separation anxiety is common in older
5:24infants and the normal reaction peaks
5:26between 10 and 18 months. It involves
5:28clingy behavior and fear of unfamiliar
5:30places and people. Trust and mistrust
5:33refers to the stage of development from
5:35birth to about 18 months which involves
5:36an infant's needs being met by his or
5:38her parents and caregivers. When
5:40caregivers and parents provide an
5:42organized routine environment, the
5:43infant gains trust in those individuals.
5:46If the environment is not perceived as
5:48secure by the infant, a sense of
5:49mistrust will
5:53develop. Toddlers and preschoolers. A
5:56toddler is considered age 1 to three.
5:59Some of the changes that we see
6:01physically, pulse rate 90 to 150 beats a
6:04minute. Respiratory rate is 20 to 30
6:06breaths a minute. Systolic blood
6:07pressure is 80 to 100 millm of mercury.
6:10And their temperature is generally 96.8
6:13to 99.6. A toddler's lungs continue to
6:16develop more terminal bronchioles and
6:19alvi. For preschoolers age 3 to 6 years,
6:22the pulse rate is 80 to 140 beats a
6:24minute. The respiratory rate is 20 to 25
6:27breaths a minute. The systolic blood
6:29pressure is 80 to 100 millm of mercury.
6:31And their weight gain should level off.
6:33Although toddlers and preschoolers have
6:35more lung tissue, they do not have
6:37well-developed
6:39lung musculature.
6:43This anomaly prevents them from
6:45sustaining deep or rapid respirations
6:46for an extended period of time. The loss
6:49of passive immunity is possibly the most
6:51obvious development at this stage of
6:53human
6:56life. Colds often develop that may
6:59manifest as GI distress or upper
7:00respiratory
7:01infection. Neuromuscular growth also
7:04makes considerable progress at this age.
7:06Toddlers and preschoolers spend a great
7:08deal of time finding out exactly how to
7:10use their expansive nervous system and
7:12the muscles it controls by walking,
7:14running, jumping, and playing catch. At
7:16this point, preschoolers will have a
7:18brain that weighs 90% of the final adult
7:20weight. Physiologically, todd toddlers
7:23have the neuromuscular control capable
7:25for bladder control by 12 to 15
7:27months. However, the child may not be
7:30psychologically ready until 18 to 30
7:32months of age. And the average age for
7:35completion of toilet training is about
7:3628
7:37months. Teething also occurs in this
7:40time
7:40frame. Psychosocial changes that occur.
7:44This period of development is often
7:45exciting for parents. Toddlers or
7:47preschoolers learn to speak and express
7:49themselves. By 36 months of age, basic
7:52language is mastered. Interaction and
7:55playing games with other children begin.
7:57And by 18 to 24 months, cause and effect
8:00begin to become understood. Children
8:03learn to recognize sexual differences by
8:05observing their role
8:06models. Schoolaged children aged 6 to 12
8:11years. From 6 to 12 years, a school-aged
8:13child's vital signs and body gradually
8:15approach those observed in adulthood.
8:17The pulse rate is approximately 70 to
8:19120. The respiratory rate is 15 to 20
8:22and blood pressure is 80 to 110 mm of
8:26mercury.
8:28Obvious physical traits and body
8:30function changes become apparent. Growth
8:32of 4 lb and 2 and 1/2 in in every year
8:37happen. Permanent teeth start to come in
8:39and brain activity increases in both
8:43hemispheres. Psychosocial changes.
8:46Children learn various types of
8:47reasoning. The first is preconventional
8:49reasoning. They act almost purely to
8:51avoid punishment and get what they want.
8:53Conventional reasoning, children look
8:55for approval from their peers in
8:57society. Postconventional reasoning,
8:59children make decisions guided by their
9:01conscience. Conscience and self-concept
9:04and self-esteem is developed.
9:06Self-concept is our self-perception and
9:08self-esteem is how we feel about
9:10ourselves and how we fit in with our
9:12peers. Adolescence or teenagers. General
9:16age here is 12 to 18 and vital signs are
9:18now beginning to level off within the
9:20adult ranges. The heart rate is
9:21generally 60 to 100 and the respiratory
9:23rate is 12 to 20. Systolic blood
9:25pressure is between 90 and
9:27110. Adolescence experience a 2 to
9:30threeyear growth spurt and increase in
9:32muscle bone growth as their body
9:34changes. Girls will finish by 16 and
9:36boys by
9:3818. When this growth spurt finishes,
9:40boys are generally taller and stronger
9:42than girls. Their reproductive system
9:44will begin to mature and secondary
9:46sexual development takes place. The
9:48external sex organs enlarge. Pubic hair
9:51and axillary hair begin to
9:54appear. Voices start to change. In
9:57females, breasts and thighs increase in
9:58size as adapost fat tissue is deposited.
10:01Ministration begins and by the middle of
10:04adolescence, boys are able to produce
10:06sufficient sperm and girls are able to
10:08develop eggs. Acne can also occur due to
10:11hormonal changes.
10:13Psychosoccially, adolescence and their
10:15families often deal with conflict as
10:16adolescence try to gain control of their
10:18lives from their parents. Privacy
10:20becomes an issue. Self-consciousness
10:22increases. Adolescence may struggle to
10:25create their own identity. And they
10:27often want to be treated like
10:31adults, yet cared for like younger
10:36children. Antisocial behavior and peer
10:39pressure tend to peak at age 14 to 16.
10:41Smoking, elicit drug use, and
10:43unprotected sex are problems that may
10:45arise, and eating disorders can arise in
10:47adolescence from an attempt to gain
10:48self-control through what they
10:51eat. Adolescence may show a greater
10:53interest in sexual relations. A code of
10:56personal ethics develops based partly on
10:58parents ethics and values and partly on
11:00the influence of their
11:02environment. Adolescence are at a higher
11:04risk than other populations for suicide
11:06and depression.
11:08Early adults. These are individuals in
11:11age range from 18 sorry 19 to 40 years.
11:15Their vital signs don't vary greatly
11:17from those seen through adulthood. The
11:19heart rate will average around 70 beats
11:20a minute and range between 60 to 100.
11:23The respiratory rate will stay in the
11:24range of 12 to 20 breaths a minute.
11:27Systolic blood pressure will vary
11:28between 90 and 140 mm of mercury. From
11:32the age of 19 to shortly after 25, the
11:34body should be functioning at its
11:35optimal level. Lifelong habits are
11:38solidified and the body is working at
11:40peak efficiency. But as early adulthood
11:42continues, subtle erosion
11:45begins. Discs in the spine begin to
11:47settle and height sometimes shrinks.
11:50Fatty tissue and weight increase and
11:52muscle strength decreases and reflexes
11:54slow. Psychosocially, life centers on
11:57work, family, and stress. During this
11:59period, adults strive to create a place
12:01for themselves in the world and many do
12:03everything they can to settle down.
12:06Along with this comes love and
12:08childirth. And despite all of this
12:10stress and change that this is one of
12:12the more stable periods of
12:15life. Middles are age 41 to 60.
12:18Physically their vital signs remain the
12:20same. Heart rate averages at 70 ranges
12:23between 60 and 100. Respiratory rates
12:25still 12 to 20. Blood pressure remains
12:28between 90 and 140 millm of mercury
12:30systolic. Middle adults are vulnerable
12:33to vision and hearing loss.
12:35Cardiovascular health starts becoming an
12:37issue. The incidence of cancer will
12:41increase. Menopause takes place in women
12:43in the late 40s or early 50s. Diabetes,
12:46hypertension, and weight problems are
12:48common. Exercise and a healthy diet can
12:50diminish some of these aging effects.
12:53Psychosoccially, the focus is on
12:55achievement of their life goals. Middles
12:58must readjust their lifestyle as their
12:59children leave home. Finances become a
13:02worrisome issue. Generally, people of
13:04this age have the physical, emotional,
13:06and spiritual reserves to handle life's
13:08issues. Middles can find themselves
13:10caring for children, leaving for
13:12college, and caring for their aging
13:13parents as
13:14well. Late adults, age 61 and up, also
13:19known as 65, is our geriatric
13:22population. Life expectancy is
13:24constantly changing. Physically, in the
13:27early 1900s, life expectancy was 47
13:29years. It is now approximately 78 years
13:31with maximum life expectancy estimated
13:33at 120 years. The age to which a person
13:36will live is based on many factors
13:38including the year of their birth and
13:39the country in which they
13:41live. Their vital signs depends on their
13:43overall health, medical conditions, and
13:45medications that they take. Older adults
13:48are often able to overcome numerous
13:50medical problems. They may need multiple
13:52medications to do so.
13:56Cardiovascularly their function declines
13:58with age largely due to
14:01atherosclerosis. Cholesterol and calcium
14:03build up inside the walls of blood
14:05vessels forming plaque. The accumulation
14:07of plaque eventually leads to partial or
14:09complete blockage of blood
14:12flow. More than 60% of people older than
14:1565 have atherosclerotic heart disease.
14:18Their heart rate and cardiac output
14:20decrease. Cardiac output no longer meets
14:23the body's demands.
14:25The vascular system becomes stiff and
14:28diastolic blood pressure will increase
14:29with age. The heart must work harder to
14:32move the blood effectively and the
14:34ability to produce replacement blood
14:35cells declines as does blood
14:38volume. The respiratory system airway
14:41size increases and surface area of alvei
14:43decrease. The natural elasticity of the
14:46lungs also decreases. Intercostal
14:48muscles are used more to breathe and
14:50breathing becomes more labor intensive.
14:53The changes in the respiratory system
14:54are often gradual and go unnoticed until
14:56a severe life-threatening condition
14:58occurs. And within the mouth and nose,
15:00there is a gradual loss of the
15:02mechanisms that protect the upper
15:03airway. This leads to a decreased
15:05ability to clear secretions as well as
15:07decreased cough and gag reflexes.
15:09Aspiration and obstruction become more
15:11likely in this age
15:20group. As the smooth muscles of the
15:23lower airway weaken with the age, strong
15:25inhalation can make the walls of the
15:26airway collapse inward and cause
15:28inspiratory wheezing. The cells of the
15:30immune system are less functional. And
15:32by age 75, vital capacity may amount to
15:35only 50% of the vital capacity of a
15:38young adult. Factors include loss of
15:40respiratory muscle mass, increased
15:42stiffness of the thoracic
15:44cage, decreased surface area available
15:47for the exchange of air, and residual
15:49volume will increase with age. A
15:51lifetime of breathing, especially
15:53breathing air with high levels of
15:54pollution, causes the accumulation of
15:56pollutants in the lungs. The endocrine
15:59system, insulin production drops off and
16:01metabolism
16:06decreases. As we are in this age group,
16:08people tend to slow down their physical
16:10activity. They tend not to decrease
16:12their food intake. However, the pancreas
16:15may not be able to produce enough
16:16insulin for the person's body size,
16:18which can lead to diabetes. The
16:20reproductive system changes to some
16:23extent. Men are able to produce sperm
16:26long into their 80s, but the rigidity of
16:28the penis tends to decrease over time.
16:30And women have a decrease in the size of
16:32their uterus and vagina. Hormone
16:34production for both sexes gradually
16:36decreases as they age, and sexual desire
16:38may diminish with age, but certainly
16:39does not cease.
16:44The digestive system changes in gastric
16:46and intestinal function may inhibit
16:48nutritional intake and utilization in
16:50older adults. Your taste sensations
16:52decrease. Saliva secretion decreases.
16:55The ability of the intestines to
16:57contract and move food diminishes.
16:59Gastric acid secretion diminish
17:00diminishes. Gallston stones become
17:02increasingly common. The anal sphincter
17:04changes and that can produce fecal
17:06incontinents.
17:08The renal system filtration function
17:10declines by 50% from age 20 to 90.
17:13Kidney mass decreases 20% over this t
17:15same time span. This is due in part to
17:18the decreased effectiveness of the blood
17:20vessels that supply blood to the
17:21nephrons. Nephrons are sophisticated
17:24capillaries that perform filtering
17:25within the
17:27kidney. There is decreased ability to
17:29clear waste from the body and there is
17:31decreased ability to conserve fluids
17:32when needed. The nervous system. In the
17:36central nervous system, the brain weight
17:37may shrink 10 to 20% by age 80. Motor
17:40and sensory neural networks become
17:42slower. Neurons are lost, but this does
17:44not mean there is a loss of knowledge or
17:45skill. Sleep patterns will change. The
17:48brain which is surrounded by the
17:50meningis takes up almost all the space
17:52in the skull. Unfortunately, age-
17:54related shrinkage creates a void between
17:56the brain and the outermost layer of the
17:58meningis which provides room for the
18:00brain to move when stressed.
18:02peripheral nerve sensation is
18:04diminished. Increased reaction times
18:06cause longer delays between stimulation
18:08and motion. The resulting slowdown in
18:10reflexes and decreased kinesthetic sense
18:13may contribute to the incidence of falls
18:14and
18:17trauma. You can see here the difference
18:19in the
18:23brain. Sensory. Most late adults can see
18:26and hear well. They may need glasses or
18:28hearing aids and it is wrong to assume
18:30that they're blind or deaf. Visual
18:32distortions are common and hearing loss
18:34is four times more common than vision
18:36loss. Psychosocially, until about five
18:38years before you die, most people retain
18:40high brain function. In the 5 years
18:43preceding death, however, mental
18:44function is presumed to decline, a
18:46theory referred to as the terminal drop
18:48by the terminal drop hypothesis. As the
18:51elderly population continues to grow, we
18:54have the responsibility to accommodate
18:55their needs during the last 20 to 40
18:57years of life.
18:59Statistics show that 95% of the elderly
19:02live at home and the increasing number
19:04of elderly in the United States as a
19:05result of the baby boom of the 40s and
19:0750s has produced a need for additional
19:09assisted living facilities. Financial
19:12limits may restrict access to healthcare
19:13or medications. Today, more than 50% of
19:16all single women in the United States
19:17who are 60 years of age or older are
19:19living at or below the poverty level.
19:26elderly um face the issue of their own
19:29mortality. This is one of the important
19:31things that we deal with and isolation
19:33and depression can become challenges for
19:35them. In summary, whereas each
19:38developmental stage is marked by
19:39different physical and psychosocial
19:40changes and characteristics, infants one
19:42month to one year develop at a startling
19:46rate. The vital signs of toddlers ages 1
19:49to 3 years and preschoolers aged 3 to 6
19:51years differ somewhat from those of an
19:53infant. During this stage, children
19:55learn to speak and express themselves.
19:57From age 6 to 12 years, the school age
19:59child's vital signs and body gradually
20:02approach those observed in adulthood.
20:04During this stage, children develop
20:09self-esteem. From
20:13ages, as I said, from ages 6 to 12
20:15years, self-esteem is developed and
20:17their vital signs and body change
20:19generally to approach adulthood. Vital
20:21signs of adolescence age 12 to 18 begin
20:24to level off within the adult ranges.
20:26Adolescence focus on creating their
20:28self-image. Early adults are age 19 to
20:3140 and they focus on work and
20:34family. Middles are 41 to 60 and they
20:38focus on achieving their life
20:40goals. Late adults are aged 61 and older
20:43and late adults focus on their own
20:45mortality and the mortality of friends
20:46and loved ones.
20:48Vital signs do not vary greatly
20:50throughout adulthood. Thanks for
20:52listening to this lecture and tonight in
20:54class we'll discuss some of these
20:55things. Please bring any questions you
20:56may have.