1. Paramedic Care: Principles & Practice Volume 2: Paramedicine Fundamentals CHAPTER Fourth Edition Human Life Span Development 2

2. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Multimedia Directory Slide 6Treatment Across the Life Span Video Slide 73Pharmacology and the Older Adult Video Slide 75Nutrition and Aging Video

3. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Standard Life Span Development

4. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Competency Integrates comprehensive knowledge of life span development.

5. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

6. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Treatment Across the Life Span Video Click here to view a video on the topic of treating patients of different ages.here Back to Directory

7. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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

8. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. People change over the span of a lifetime.

9. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Infancy Physiologic Development –Greatest changes in range of vital signs are in pediatric patients.

10. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Normal Vital Signs

11. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Normal Vital Signs (continued)

12. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

13. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

14. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

15. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

16. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Infants double their weight by 4 to 6 months old and triple it by 9 to 12 months. (© Michal Heron)

17. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Infancy Physiologic Development –Shortly after birth, ductus venosus constricts. –Blood pressure changes; foramen ovale closes. –Ductus arteriosus constricts after birth.

18. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

19. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

20. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

21. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

22. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

23. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

24. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

25. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

26. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

27. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

28. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

29. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

30. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

31. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

32. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Infancy Physiologic Development –11 months: attempts to walk without assistance; shows frustration about restrictions. –12 months: walks with help; knows name.

33. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

34. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

35. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

36. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

37. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

38. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

39. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. A toddler beginning to stand and walk on his own.

40. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age Physiologic Development –Preschoolers (3 to 5 years old)  Heart rate: 70 to 110 beats per minute.  Respiratory rate: 22 to 34 breaths per minute.  Systolic blood pressure: 75 to 110 mmHg.  Rate of weight gain slowing dramatically; gains 2.0 kg per year.

41. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. In the preschool-age child, exploratory behavior accelerates. (© Dr. Bryan E. Bledsoe)

42. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age 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.

43. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age 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.

44. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age 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.

45. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age 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.

46. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age 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.

47. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age 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.

48. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age Psychosocial Development –Authoritative parents: respond to the needs and wishes of their children.  Leads to children who are self-assertive, independent, friendly, cooperative.

49. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age 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.

50. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age 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.

51. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Toddler and Preschool Age 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.

52. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. School Age Physiologic Development –6 and 12 years of age  Heart rate: 65 to 110 beats per minute.  Respiratory rate: 18 to 30 breaths per minute.  Systolic blood pressure: 97 to 112 mmHg.  Gains 3 kg per year; grows 6 cm per year.

53. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

54. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. School Age Psychosocial Development –Moral development begins. –Preconventional reasoning:  Stage one: punishment and obedience.  Stage two: individualism and purpose.

55. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

56. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. School-age children are allowed more self-regulation and independence as they grow older.

57. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Adolescence Physiologic Development –Adolescents (13 to 18 years)  Heart rate: 60 to 90 beats per minute.  Respiratory rate: 12 to 26 breaths per minute.  Systolic blood pressure: 112 to 128 mmHg.  Rapid 2- to 3-year growth spurt.

58. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

59. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Children reach reproductive maturity during adolescence.

60. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

61. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

62. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Adolescence Psychosocial Development –Eating disorders common. –Self-destructive behaviors begin. –Depression and suicide more common. –Develop personal code of ethics.

63. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

64. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Peak physical conditions occur in early adulthood.

65. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

66. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

67. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. People in middle adulthood still function at a high level.

68. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

69. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

70. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

71. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

72. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

73. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Pharmacology and the Older Adult Video Click here to view a video on the topic of pharmacology and the older adult patient.here Back to Directory

74. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

75. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Nutrition and Aging Video Click here to view a video on the topic of nutrition and aging.here Back to Directory

76. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

77. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

78. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. The ability to learn and adjust continues throughout life.

79. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

80. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

81. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

82. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

83. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

84. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.

85. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. 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.