AGE SPECIFIC CARE

NEONATE (1 – 28 days)
Developmental Task = Trust versus Mistrust * Cuddle and hug (It promotes neural development and facilitates development of trust) * Risk-prevention * Position on the back for sleep, to prevent suffocation. * Initiate Sudden Infant Death Syndrome (SIDS) preventive interventions. * Use extreme caution in administering medications and assess potential influence of maternal medications on the neonate. * Position properly during feeding and burp the neonate. * Touch gently over the anterior and posterior fontanels, which are still soft. * Assess body temperature and maintain constant environmental temperature. * Assess fluid balance. * Protect from stressors such as lights, noise, and excessive handling. * Recognize that the neonate’s behavior is largely reflex in nature. * Facilitate bonding with the parents, especially the mother.

INFANT (29 days – 2 years)
Developmental Task = Trust versus Mistrust * Mistrust may result in failure to thrive. * Give familiar objects for comfort. * Limit number of strangers present. * Promote bonding to parents. * Keep parents in infant’s line of vision. * Assess carefully and use mother or primary caregiver’s insights to interpret behavior. * Minimize stressors: strangers, loud noises, bright lights, and sudden environmental changes. * Risk-prevention * Prevent choking or other injury due to foreign objects in the mouth. * Protect from upper respiratory infection and aspiration. * Protect from infection. * Assess respiratory status carefully. * Assess fluid balance carefully. * Assess nutritional needs. * Provide visual, auditory, and tactile stimulation to support development.

TODDLER (1-3 years)
Developmental Task = Autonomy versus Shame or Doubt * Give attention and approval to build pride in self. * Expect “No” as a negative expression of autonomy. * Expect exaggerated response to pain, frustration and changes in the environment. They are impulsive and their moods change quickly. * Use firm, direct approach. * Assess status regarding toilet training. Illness or injury may cause regression. * Give one direction at a time. Toddlers have a short attention span. * Prepare toddlers with information immediately before procedures. Their sense of time is the immediate present and their sense of distance includes only what they can see. * Use play to prepare for and explain procedures. * Provide support and comfort during procedures. Use least intrusive approach possible. * Loss of control and restriction of movement are very threatening to toddlers. * Support relationship with parents. A major fear of toddlers is separation from parents. * Separation anxiety may be intense. * Hospital, strangers, and procedures may cause a terror response. * Toddlers engage in magical thinking and may perceive machines as living things. * Risk-prevention * Provide a safe environment and supervision. * Protect against infection. * Provide for rest and sleep. Toddlers need 10 – 12 hours of sleep nightly and a daytime nap. * Provide opportunities for solitary play. * Provide support and comfort. Toddlers have limited ability to think and reason. Will not be consoled by explanations. * Assess nutritional needs, including food preferences. Growth spurts increase nutritional needs. Iron intake is required to maintain red blood cell levels. * Assess growth status. Prolonged or serious illness may retard growth. * Assess carefully. The toddler’s ability to describe discomforts is limited.

PRESCHOOL (3 - 5 years)
Developmental Task = Initiative versus Guilt * The preschooler explores and seeks answers. * Set limits to balance exploration with needed limits on behavior. * Procedures involving the genitalia are especially anxiety producing. * If appropriate and safe, provide opportunity to interact with other children. * Offer snacks to meet nutritional needs related to high level of activity. Respect food preferences. * Explain when parents will return. * Assess the preschooler’s interpretation of the hospital environment * Preserve home rituals and habits to the greatest extent possible. * Support the preschooler when fearful. Fear of the unknown, the dark, mutilation, bodily injury, and being left alone are prominent. * Preschoolers can ask for help. They are eager to please and understand simple directions. Older preschoolers exhibit some control over painful experiences and can accept logical reasoning. * Preschoolers conceptualize death in terms of separation and lack of movement.

SCHOOL AGE (6-12 years)
Developmental Task = Industry versus Inferiority. * Allow child to participate in care to the greatest extent possible; the child may resent forced dependence. * Living up to expectations of others is very important to the school-aged child. * Give permission to display fear or pain. * Educate using play, games, rewards and praise. * Assure that information and patient education is understood. Ask the child to tell you his understanding. * Include a more mature concept of time in communication. * Early in this stage, the children view death in terms of a dark magical force that would remove them from their parents. Later they view death as a permanent state and by the end of the school-age years have an adult concept of death. * Offer support in fearful situations. Major fears of the school-aged child include bodily injury, mutilation, separation, and death. * Ask the child questions as a part of the assessment process. * Use least intrusive approach possible. * Respect need for privacy. * Support relationships with friends. * School-aged children may question parental authority and rebel against authority figures. * Assess and provide for nutritional needs. Increasing height, weight, muscle mass and dental developments require adequate calories, iron, calcium, and vitamins A and B.

ADOLESCENT (13-18 years)
Developmental Task = Identity Formation vs. Identity Confusion (Diffusion). * Assess and meet menarche needs (11 – 13 years) in girls. Address other learning needs related to the development of secondary sex characteristics. * If you work with adolescents, maintain an updated knowledge base about acne causes and treatments. * Assess nutritional needs. Growth spurts last two to three years. * Encourage peer visitation if possible. In early adolescence same sex friends predominate; later, opposite sex relationships are more important. * Assess illicit substance use and sexual activity in private * Risk-prevention * Seek follow-up referral or resources if you identify indications of depression or suicidal thoughts. Suicide is the third most frequent cause of death in this age group. * Provide support, information, and encouragement related to threats to body image * Expect that many adolescents are emotionally labile.

ADULT (19 years and Older)
Young adults (20-40 years)
Developmental Task = Intimacy versus Self-isolation * Assess developmental stage, especially among young adult patients * Young adults often face challenges to rearrange childrearing responsibilities during illness, injury, or hospitalization.

Middle-aged adults (40-65 years)
Developmental Task = Generativity versus Self-absorption * Respect the fact that most middle-aged adults are at the peak of their influence and authority. They may be distressed by forced dependency in the patient role. * Middle-aged adults experience changes of aging to varying degrees depending upon the individual. Assess to detect risk for: * Skin breakdown due to dryness and decreased subcutaneous tissue. * Hypertension and hyperlipidemia, which may not be the cause of hospitalization, but may be detected during hospitalization. * Sleep apnea * Skeletal injury due to diminished bone density and osteoporosis, especially in women * Obesity due to decreased basal metabolic rate. Assess and address nutritional needs. * Assess middle-aged female patients for menopausal status and distress associated with menopause. Be prepared to offer credible resources related to symptom relief and hormone replacement therapy. Health teaching for middle-aged adults includes clarifying information about screening tests such as regularly scheduled mammograms and bone density tests for women and prostate-specific antigen (PSA) prostate cancer screening for men. * Presbyopia is likely among middle-aged patients. * Middle-aged persons are in the so-called sandwich generation – sandwiched between responsibilities and concerns related to their children and also to their aging parents. Major tasks during these years include achieving financial and emotional security and preparing for retirement.

For all adults: * Provide options for communication and work as appropriate. Assess the patient’s physical and cognitive ability to work and communicate with co-workers, family, and friends. Offer encouragement and reassurance as needed to assist the patient in setting realistic achievable goals for communication, work, and other pursuits during hospitalization. * Assess impact of hospitalization/illness on family, work, and body image. * Involve spouse or significant other in care.

ELDERLY (60 years and older)
Developmental Task = Ego Integrity versus Despair, the acceptance of life and of the self as they are. * Older Adulthood Health & Safety Issues (60-79) * Health: monitor health closely; promote physical, mental, social activity; guard against depression, apathy; update immunizations. * Teach stress reduction strategies * Safety: promote home safety, especially preventing falls. * Common Fears of Older Adults : Loneliness ;Becoming a burden for loved ones ;Pain * Older Adulthood Health & Safety Issues (60-79) * Health: monitor health closely; promote self-care; ensure proper nutrition, activity level, rest; reduce stress; update immunizations. * Poor dental care can contribute to GI problems by poor mastication of food. * Each of the five senses becomes less efficient with age, interfering in varying degrees with safety, normal activities of daily living and general well being. * Safety: prevent injury; ensure safe living environment; clearly visible markings on stove and other appliances; adequate, non glaring lighting, access to light before getting out of bed; remove throw rugs or highly polished floors, cords, clutter or other obstacles in pathways; grab bars in bathroom, toilet, tub/shower; Sturdy, non-skid shoes; encourage and make sure individuals use aids (eyeglasses, hearing aids, canes, etc.) * Daily/Weekly medication trays if needed for individuals with visual impairments * Ensure individual has adequate clothing and blankets, when cold.