Chapter two

Concepts of growth
and development

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 Concepts of growth and development

The two terms are used interchangeably.

Both are dynamic process.
Growth: is physical change/ increase in size.
Indicators of growth: Ht, Wt, bone size and
dentition.
Development: is an increase in the complexity of
function and skill program or it is the behavioral
aspect of growth.
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 Principles of growth and development
• Growth and developments are continuous,
orderly and sequential process.
• All humans follow same pattern of G and D.
• The sequence of each stage is predictable.
• Each development stage has its own
characteristics.
• Development proceed from simple to complex.
• Development becomes increasingly differentiated.

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 Factors influencing G and D
• Genetic factors
• Temperament (the way individuals respond to
internal and external environment)
• Family conditions
• Nutrition
• Environment
• Health status
• Culture
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 G and D theory
 Biophysical theory / genetics/
 Psychosocial theory
 Behavioralism theory
 Social learning theory
 Ecologic theory
 Moral theory
 Spiritual theory

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 Concepts of stress
Stress: is a condition in which the person
experiences changes in the normal balanced
state.
Stressor: is any event or stimulus that causes an
individual to experience stress.
Coping strategies: when a person faces
stressors, the response he/she shows.

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 Sources of stress
1. Internal: from within a person. Eg: infection
2. External: from out side Eg: move to a new
area
3. Developmental: Eg: pregancy, …
4. Situational: unpredictable life process Eg:
death, illness

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 Effects/ consequences of stress
 Physical: physiologic homeostasis change
 Emotional: negative/positive
 Intellectual: problem solving ability (decrease)
 Social: R/ship with others
 Spiritual: challenges/beliefs

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 Indicators of stress
1. Psychological indicators: Anxiety, Fear ,
Anger Depression
2. Physiologic indicators
 dilated pupils
 sweat production
 increased cardiac output and HR
 dry mouth, decreased urine output

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 Levels of anxiety
1. Mild anxiety: slight arousal state
-enhance perception
2. Moderate: perceptual abilities are narrowed
-focused attention
3. Severe: decreased perception
- inability to focus
4. Panic: perception highly distorted
-frightening levels of anxiety
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 Coping
 It is the technique of dealing with changes
successfully.
 Coping mechanism: is a natural or learned
way of responding to a changing environment
or specific situation.
 It is a cognitive and behavioral effort.

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 Coping mechanism can be:
1. Problem focused:
o improving a situation by making changes
o taking actions
2. Emotion focused:
 doesn’t improve situatuation
 a person feels better
 includes thought and actions that reflects
emotions
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 Coping mechanism can also be:
1. Long term coping
 constructive and realistic
 digs more about the case
Includes changes in life style
2. Short term coping
 reduce stress to a tolerable levels
 ineffective way
 may have a destructive effect
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 Coping mechanisms based on tolerance are

o Adaptive: helps the person to deal with

situation effectively.
o Maladaptive: result in unnecessary distress
for the person

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 Factors affecting coping
 Number, duration and intensity
 Past experience
 Support systems available
 Personal qualities

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 Loss, grieving and death
Loss: is an actual, potential situations in which
something that is valued is changed.
Loss can be actual or perceived
o Actual: can be recognized by others
o Perceived: not perceived by others

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 Sources of loss
Loss of one aspect of one self: body part
Loss of an object external to self
Separation from accustomed environment
Loss of a loved or valued person

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 Grief
Is a total response to the emotional experience
related to loss
Is manifested in thought, feeling or behavior
Grief can be: abbreviated or anticipatory
• Abbreviated: occurs when the lost object is not
much important or replaced by another.
• Anticipatory: occurs for future events eg: scars
remained on the body after operation
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 Stage of griefing
• Shock and disbelief
• Developing awareness
• Resitution/ mourning
• Resolving the loss
• Idealization
• outcome

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 Factors affecting loss and grief
 Age
 Significance of loss
 Culture
 Spiritual disbelief
 Gender
 Socioeconomic status
 Support system
 Cause of loss
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 Pain
Is unpleasant and highly personal experience
that may be imperceptible
Type of pains:
1. Based on location:
 Headache
 Chest pain
 Knee pain
 Visceral pain
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 Pain con’t…
2. Based on Duration
 acute pain
 chronic pain
3. Based on Intensity:
 Mild pain
 Moderate pain
 Severe pain

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 Causes of pain
Physiological pain: trauma,
Somatic pains: skins, muscles
Neuropathic pain: damaged nerves
Pain thresh hold: is a least amount of stimuli
needed to make a pain
Pain tolerance: is maximum amount of pain an
individual tolerate

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 Responses to pain
 Results in fight or flight
 BP & PR increase
 Short and shallow breathing
 Change in activity of most systems

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 Factors affecting pain experience
 Ethnic and cultural values
 Developmental stages
 Environment and support systems
 Past pain experience
 Definitions of pain

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 Nursing mgt of pain
• Assess:
• Pain Hx
• Location of pain
• Intensity
• Precipitating factors
• Alleviating factors
• Associated symptoms
• Coping resources
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 Key strategies in pain mgt
o Acknowledge possibility of pain
o Listen to what client is saying
o Convey what you want to ask
o Attend to clients need assisting support
systems

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 Pharmacologic mgt
• Opoids
• NSAIDS

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