NCLEX Review Guide: Growth & Development, Care of the Older Client, Mental Health Concerns

Developmental Theories

• Erikson's Psychosocial Stages: Each life stage presents a crisis that must be resolved for healthy development. Trust vs. Mistrust (infancy), Autonomy vs. Shame (toddler), Initiative vs. Guilt (preschool), Industry vs. Inferiority (school-age), Identity vs. Role Confusion (adolescent), Intimacy vs. Isolation (young adult), Generativity vs. Stagnation (middle adult), Integrity vs. Despair (older adult).
• Piaget's Cognitive Development: Sensorimotor (0-2 years), Preoperational (2-7 years), Concrete Operational (7-11 years), Formal Operational (11+ years). Children progress through these stages sequentially and cannot skip stages.
• Kohlberg's Moral Development: Preconventional (punishment avoidance), Conventional (social approval), Postconventional (universal principles). Most adults operate at conventional level.

Normal Aging Changes

• Cardiovascular: Decreased cardiac output, increased blood pressure, arterial stiffening. Monitor for orthostatic hypotension - change positions slowly.
• Respiratory: Decreased lung elasticity, reduced cough reflex, diminished respiratory muscle strength. Increased risk for pneumonia and respiratory infections.
• Musculoskeletal: Bone density loss, muscle mass reduction, joint stiffness. Fall risk increases significantly - implement fall prevention protocols.
• Neurological: Slower processing speed, mild short-term memory changes. Dementia is NOT a normal part of aging.

Medication Considerations

1. Assess for polypharmacy - multiple medications increase interaction risk
2. Monitor for adverse drug reactions - older adults metabolize medications slower
3. Review Beers Criteria - potentially inappropriate medications for older adults
4. Assess medication adherence and understanding

Common Mental Health Disorders

• Depression: Persistent sadness, hopelessness, loss of interest, sleep disturbances, appetite changes. Assess suicide risk with every encounter.
• Anxiety Disorders: Excessive worry, physical symptoms (palpitations, sweating), avoidance behaviors. Panic attacks involve intense fear with physical symptoms.
• Dementia: Progressive cognitive decline affecting memory, judgment, and daily functioning. Alzheimer's disease is most common type.
• Delirium: Acute onset confusion, fluctuating consciousness, attention deficits. Often reversible when underlying cause treated.

Therapeutic Communication

1. Use active listening - maintain eye contact, avoid interrupting
2. Employ open-ended questions - "How are you feeling?" vs. "Are you sad?"
3. Practice reflection - "It sounds like you're worried about..."
4. Avoid blocks to communication - giving advice, false reassurance, changing subject