NCLEX Review Guide: Growth & Development, Care of the Older Client, Pain

Developmental Milestones

• Infant (0-12 months): Trust vs. mistrust, gross motor skills like rolling over at 4-6 months, sitting without support at 6-8 months, walking at 12-15 months.
• Toddler (1-3 years): Autonomy vs. shame, parallel play, language explosion with 2-word phrases by age 2, toilet training readiness at 18-24 months.
• Preschooler (3-5 years): Initiative vs. guilt, magical thinking, cooperative play emerges, fine motor skills develop for drawing and writing.
• School-age (6-12 years): Industry vs. inferiority, concrete operational thinking, peer relationships become important, follows rules and structure.
• Adolescent (12-18 years): Identity vs. role confusion, abstract thinking develops, risk-taking behaviors, body image concerns.

Age-Related Changes & Nursing Considerations

• Cardiovascular: Decreased cardiac output, increased blood pressure, reduced vessel elasticity requiring careful medication monitoring and fall prevention.
• Respiratory: Decreased lung capacity and cough reflex, increased risk for pneumonia requiring deep breathing exercises and vaccination.
• Musculoskeletal: Bone density loss, muscle mass reduction, joint stiffness leading to increased fracture risk and mobility issues.
• Neurological: Slower processing speed, potential memory changes, increased fall risk requiring safety modifications and cognitive assessments.
• Sensory: Vision and hearing impairments affecting communication and safety, requiring adaptive equipment and environmental modifications.

Pain Assessment & Management

• Pain is subjective: Patient's self-report is the most reliable indicator; use appropriate pain scales (0-10 numeric, FACES for children, behavioral scales for non-verbal patients).
• Acute vs. Chronic pain: Acute pain serves protective function and is time-limited; chronic pain persists beyond healing time and affects quality of life.
• Pharmacological management: WHO pain ladder approach - start with non-opioids, add weak opioids, then strong opioids as needed for cancer pain.
• Non-pharmacological interventions: Heat/cold therapy, massage, positioning, distraction, relaxation techniques, and TENS units provide adjunctive pain relief.

Pain Assessment Steps

1. Ask about location, quality, intensity, timing, and aggravating/relieving factors
2. Observe for non-verbal cues: grimacing, guarding, restlessness, vital sign changes
3. Use appropriate pain scale based on patient's age and cognitive ability
4. Document findings and reassess after interventions