Growth and development

Anthony P. Olalia Jr.

 Infancy: Birth to 18 Months
• Ego Development Outcome: Trust vs. Mistrust
• Basic strength: Drive and Hope
• Oral Sensory Stage
• major emphasis is on the mother's positive and loving care for the
child, with a big emphasis on visual contact and touch.
• If we pass = we will learn to trust that life is basically okay and
have basic confidence in the future.
• If we = we may end up with a deep-seated feeling of
worthlessness and a mistrust of the world in general.
• Incidentally, many studies of suicides and suicide attempts point to
the importance of the early years in developing the basic belief
that the world is trustworthy and that every individual has a right
to be here.
• Not surprisingly, the most significant relationship is with the
maternal parent, or whoever is our most significant and constant
caregiver.
 Early Childhood: 18 Months to 3 Years
• Ego Development Outcome: Autonomy vs. Shame
• Basic Strengths: Self-control, Courage, and Will
• we learn to master skills for ourselves.
• we are learning finer motor development as well as the much
appreciated toilet training.
• we have the opportunity to build self-esteem and autonomy as we
gain more control over our bodies and acquire new skills, learning
right from wrong.
• And one of our skills during the "Terrible Two's" is our ability to
use the powerful word "NO!" It may be pain for parents, but it
develops important skills of the will.
• It is also during this stage, however, that we can be very
vulnerable. If we're shamed in the process of toilet training or in
learning other important skills, we may feel greatshame and
doubt of our capabilities and suffer low self-esteem as a result.
• The most significant relationships are with parent
 Play Age: 3 to 5 Years
• Ego Development Outcome: Initiative vs. Guilt
• Basic Strength: Purpose
• copy the adults around us and take initiative in creating play
situations.
• We make up stories with Barbie's and Ken's, toy phones and
miniature cars, playing out roles in a trial universe,
experimenting with the blueprint for what we believe it
means to be an adult.
• We also begin to use that wonderful word for exploring the
world—"WHY?”
• we usually become involved in the classic "Oedipal struggle"
and resolve this struggle through "social role identification." If
we're frustrated over natural desires and goals, we may easily
experience guilt.
• The most significant relationship is with the basic family.
 School Age: 6 to 12 Years
• Ego Development Outcome: Industry vs. Inferiority
• Basic Strengths: Method and Competence
• called the Latency,
• we are capable of learning, creating and accomplishing
numerous new skills and knowledge, thus developing a
sense of industry.
• This is also a very social stage of development and if we
experience unresolved feelings of inadequacy and
inferiority among our peers, we can have serious
problems in terms of competence and self-esteem.
• most significant relationship is with the school and
neighborhood.
• Parents are no longer the complete authorities they
once were, although they are still important
 Adolescence: 12 to 18 Years
• Ego Development Outcome: Identity vs. Role Confusion
• Basic Strengths: Devotion and Fidelity
• development mostly depends upon what is done to us.
• development depends primarily upon what we do. And while adolescence
is a stage at which we are neither a child nor an adult, life is definitely
getting more complex as we attempt to find our own identity, struggle with
social interactions, and grapple with moral issues.
• Our task is to discover who we are as individuals separate from our family
of origin and as members of a wider society.
• Unfortunately for those around us, in this process many of us go into a
period of withdrawing from responsibilities, which Erikson called a
"moratorium." And if we are unsuccessful in navigating this stage, we will
experience role confusion and upheaval.
• A significant task for us is to establish a philosophy of life and in this process
we tend to think in terms of ideals, which are conflict free, rather than
reality, which is not.
• The problem is that we don't have much experience and find it easy to
substitute ideals for experience. However, we can also develop strong
devotion to friends and causes.
• It is no surprise that our most significant relationships are with peer groups.
 Restraints
• Restraints are methods used by caregivers to limit movement of a patient.
• to protect the health and safety of the restrained patient, other patients,
and caregivers.
• are used only when other methods to control behavior have not worked.
• mechanical restraint. This is an object that limits a patient’s movement and
cannot be easily removed by the patient.
• Chemical restraint . the use of medicines to calm a patient, limit his
movement, or both.
• Environmental restraint means putting a patient into a limited area, such as
a locked room, for a period of time.
• to control behavior that is violent or self-destructive. This may be
dangerous behavior caused by mental illness or substance abuse (drugs or
alcohol).
• Restraints may also be needed when behavior is non-violent or non-self-
destructive. For instance, restraints may help keep a patient from removing
a feeding tube or a tube that helps him breathe.
• Restraints can help caregivers provide medical care and keep patients safe.
 Guidelines for the medical use of
restraints:
• The Joint Commission (TJC) is one of many medical
organizations that provide guidelines for the medical
use of restraints. General guidelines for the use of
restraints include:
• Restraints are used only when other methods to
control behavior have not worked.
• Restraints are used only when there is a risk of a
patient harming himself or others.
• Restraints are not used for punishment, to make a
patient easier to care for, or to make a patient do
something. They are not used because of a patient’s
past restraint use, or a patient’s behavior history
 Caregivers must do the following
before restraints are used
• Caregivers may
• ask about the patient’s health history and do a
physical exam.
• learn the cause of a patient’s behavior to help avoid
the use of restraint.
• However, if the patient is at risk of harming himself
or others, caregivers may need to apply restraints
first. Caregivers will work with the patient to find
ways to avoid using restraint. Caregivers may try
any of the following:
 iolent or self-destructive behavior
management:
• De-escalation is when caregivers use methods to help calm a patient and
help the patient better control his behavior.
• learn what may cause a patient to become upset and possibly violent.
• begin as soon as signs that a patient may lose control of his behavior are
noticed. Caregivers may do the following:
• Speak to the patient calmly and with respect. Caregivers may also offer the
patient food or drink.
• Listen to the patient’s concerns and try to understand them. Caregivers may
ask what is bothering the patient or making him anxious or agitated.
• Explain what may occur if the patient cannot calm himself, and help the
patient identify ways to avoid the use of restraints.
• Direct the patient's attention away from what is causing him stress.
• Put the patient in a time-out. This is when the patient stays in an unlocked
room for 30 minutes or less.
• Caregivers may also provide a calm environment to help prevent agitation in
patients with dementia. This may include lowering noise levels and
providing music or massage. It may also include allowing patients to keep
familiar items such as photos of loved ones.
 Non-violent or non-self-destructive
behavior management:
• Caregivers may do the following to avoid the use of
restraints:
• Explain to the patient why certain treatments are
needed. For instance, explain why a feeding tube is
used and when it will be removed. This may help
prevent the patient from removing the tube on his
own.
• Observe the patient to learn his needs. This may help
prevent behaviors that can require restraint. For
instance, a toileting schedule may help keep the patient
from wandering to the bathroom on his own and
risking a fall
 Caregivers will do the following when
using physical and mechanical restraint:
• tell the patient the type of restraint that may be used and the reason for it.
• tell the patient what he needs to do to avoid the use of restraint.
When the restraint process begins,
• Explain what will happen. This caregiver protects the patient’s head while other
caregivers each manage an arm or leg. The patient may be restrained on his back or
side. If the patient is restrained on his stomach, he is positioned so he can move his
head to the side to make breathing easy.
• Caregivers will monitor the restrained patient at all times.
• Caregivers will do an assessment of the restrained patient every 15 minutes.
This includes checking the patient’s vital signs, such as blood pressure, pulse (heart
rate), and breathing. Caregivers will check to make sure the restraints are on the
patient correctly and that they are not too tight. Caregivers will check whether the
patient needs to change positions, which helps prevent skin sores. Caregivers also
will check whether the patient needs food, water, medical care, or to use the
toilet.
• An order of restraint can last up to four hours. Restraint use will be stopped as
soon as the patient behaves as required by caregivers. This may include the
patient agreeing to act in a safe manner or no longer making threats against others.
• When the restraint order ends, the caregiver who ordered the restraint will
examine the patient.
 Caregivers will do the following when
using chemical restraint:
• Caregivers need to know what medicines a patient
currently takes. They need to make sure these
medicines are safe for use together with medicines
used for restraint.
• Medicines used for chemical restraint are commonly
offered to the patient in pill form first.
• If the patient refuses, medicines may be given as a shot
or in an IV. An IV is a small tube put into a vein to give
medicines or liquids.
• After the medicine is given, the patient’s health is
monitored. Heart function may be checked using an
EKG (electrocardiogram). Vital signs are checked often
until the medicine wears off.
 Caregivers will do the following when
using environmental restraint:
• The patient will be observed constantly by caregivers. This
may be done in person or with a video camera.
• Caregivers will make sure the seclusion room is safe and calm.
• Furniture in the room is heavy and not easy to move. There
should be windows with unbreakable glass so caregivers can
monitor the patient.
• The space should have clear exits and may have panic buttons
(buttons to press for immediate help).
• Personal objects may be kept by the patient if they do not
increase the risk of harm to the patient or caregivers. These
personal objects may include clothing and jewelry.
• Caregivers will review the need for seclusion every two hours.
• Seclusion ends as soon the patient behaves as caregivers have
requested. This may include stopping violent behavior that
risks harm to other
 Consenting to the medical use of
restraints:
• Trained caregivers usually decide when the use of
restraints is needed.
• Caregivers will always tell the patient what is going
to happen before applying restraints. In some cases,
a patient may give permission for restraint use. This
may occur when a patient understands the need for
treatment and how restraints can help keep him
safe.
• Some patients may have a behavioral health
advance directive. This is a document that describes
how the patient wants his care or restraint to be
handled when he acts out violentl
 Actions that caregivers must take
after restraints are removed:
• Within 24 hours, caregivers meet with the patient
to talk about the restraint event.
• They discuss why restraint was needed and how
restraint use could have been avoided.
• They also discuss how restraint use can be avoided
in the future.
• During this meeting, caregivers ask if the patient’s
physical and mental needs were met while
restrained. If needed, a mental health caregiver
helps the patient cope with the restraint event.
 How the patient's family or significant
others should be involved when restraints
are considered or used:
• Caregivers will ask the patient if he wants his family to be told
about or involved with the use of restraint. If the patient says yes,
the patient’s family is asked if they want to be involved. With
consent from the patient and his family, caregivers:
• Tell the family when restraints are used.
• Explain to the family the rules on the use of restraint.
• Ask family members about any physical disability that may
increase the patient’s risk if restraints are used. Caregivers may ask
about past health care, health problems, or physical abuse. They
may also ask about ways to help the patient control his behavior.
• Ask family members to help calm the patient and help him
understand how he can avoid restraint.
• Involve the family in the discussion that takes place after the
restraint use.
• FIRST AID FOR POISONING
• Poison is any substance: solid, liquid or gas, that
tends to impair health or cause death when
introduced into the body or onto the skin surface. A
poisoning emergency can be life threatening.
Causes:
• Common in suicide attempts.
• Occasional accidental poisoning.
Ways in which poisoning may occur
• ingestion- by mouth
• inhalation- by breathing
• injection- by animal bites, stings, syringes
• absorption- by skin contact
• Common Household Poison
• Sleeping pills
• Pain relievers
• Insect and rodent poisons
• Kerosene
• Denatured alcohol
• Lye and acids including boric
• Poisonous plants
• Contaminated water
• Fume
• Signs and Symptoms
• Altered mental status.
• History of ingesting poisons.
• Burns around the mouth.
• Odd breath odors.
• Nauseas, vomiting.
• Abdominal pain.
• Diarrhea
• INGESTED POISON is one that is introduced into
the digestive tract by way of the mouth. One
form of ingestion poisoning is food poisoning, a
general form that covers a variety of conditions.
Suspect food poisoning if:
• the victim ate food that "didn't taste right" or
that may have been old, improperly prepared,
contaminated, left at room temperature for a
long time, or proceesed with an excessive
amount of chemicals.
• several people who ate together become ill.
Instances when vomiting should not be
induced
• If unresponsive.
• Cannot maintain an airway open.
• Has ingested an acid, a corrosive lye, or a
petroleum product such as gosoline or
furniture polish.
• Has a medical condition that could be
complicated by vomiting, such as heart
attack, seizures and pregnancy.
• First Aid
• Try to identify the poison.
• Place the victim on its left side.
• Save any empty container, spoiled food
analysis.
• Save any vomitus and keep it with the victim if
the person is taken to an emergency facility.
• INHALED POISON is a poison breathed into the lungs.
• Signs and Symptoms
• History of inhaling poisons.
• Breathing difficulty.
• Chest pain.
• Cough, hoarseness, burning sensation in the throat.
• Cyanosis (bluish discoloration of skin and mucous
membranes).
• Dizziness, headache.
• Seizures, unresponsiveness (advance stages).
• First Aid
• Remove the victim from the toxic environment
and into fresh air immediately.
• Seek medical attentio
• ABSORBED POISON, also known as contact poison is a
poison that enters the body through the skin.
Signs and Symptoms
• History of exposures.
• Liquid or powder on the skin
• Burns.
• Itching, irritation.
• Redness, rashes, blisters.
First Aid
• Remove the clothing.
• With a dry cloth, blot the posion from the skin. If the
poison is a dry powder, brush it off.
• Flood the area with copious amount of water.
• Conrinually monitor the patient's vital sign
• INJECTED POISON is a poison that enters the body
through a bite, sting, or syringe.
1. Bee sting
• Signs and Symptoms
• Stingers may be present.
• Pain
• Swelling
• Possible allergic reaction
First Aid
• Remove stinger.
• Wash wound.
• Cover the wound.
• Apply a cold pack.
Spider bite
Signs and Symptoms
• Nite mark
• Swelling
• Pain
• Nausea and vomiting
• Difficulty breathing or swallowing.
First Aid
• Wash wound.
• Apply a cold pack.
• Get medical care to receive antivenin.
• Get local emergency number, if necessary.
Marine Organisms
Signs and Symptoms
• Possible marks.
• Pain
• Swelling
• Possible allergic reaction.
First Aid
• If jellyfish- soak area in vinegar
• If sting ray- soak in nonscalding hot water until pain
goes away.
• Clean and bandage the wound.
• Call emergency number, if necessar
• Snake bite
• Signs and Symptoms
• Bite mark
• Pain
• First Aid
• Wash wound.
• Keep bitten part still, and lower than the heart.
• Call local emergency number.
• 5. Dog bite
• Signs and Symptoms
• Bite mark
• Bleeding
• First Aid
• If bleeding is minor- wash wound.
• Control bleeding.
• Apply antibiotic ointment.
• Cover the wound.
• Get medical attention if wound bleeds severly or if you suspect animal has
rabies.
• Call local emergency nunber or contact animal control personnel.
• General Care for Poisoning
• Survey the scene.
• Remove the victim from the source of the poison.
• Do a primary survey.
• Care for any life threatening condition.
• If the victim is conscious, do a secondary survey.
• Do not give the victim anything by mouth unless advised by medical
professionals.