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Medications

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

Growth & Development Across the Lifespan

Developmental Theories

  • Erikson's Psychosocial Development: Eight stages from trust vs. mistrust (infancy) to integrity vs. despair (older adult). Each stage builds on successful completion of previous stages.
  • Piaget's Cognitive Development: Sensorimotor (0-2), preoperational (2-7), concrete operational (7-11), formal operational (11+). Children progress through stages sequentially.
  • Kohlberg's Moral Development: Preconventional (punishment avoidance), conventional (social approval), postconventional (universal principles). Not all individuals reach highest level.

Memory Aid: Erikson's Stages

TAILS IGIG: Trust, Autonomy, Initiative, Industry, Identity, Intimacy, Generativity, Integrity

Key Points

  • Developmental delays require early intervention and family education
  • Each stage has specific tasks that must be mastered for healthy progression
  • Regression to earlier stages is normal during stress or illness

Pediatric Growth Milestones

  • Gross Motor: Rolling over (4-6 months), sitting without support (6-8 months), walking (12-15 months), running (18-24 months)
  • Fine Motor: Pincer grasp (9-12 months), scribbling (12-18 months), copying circles (3-4 years), writing name (4-5 years)
  • Language: First words (10-14 months), two-word phrases (18-24 months), 3-word sentences (2-3 years), clear speech (4-5 years)

Clinical Scenario

A 15-month-old is not walking independently. The nurse should assess for developmental delays and refer for early intervention if no underlying medical cause is found.

Care of the Older Client

Normal Aging Changes

  • Cardiovascular: Decreased cardiac output, increased blood pressure, reduced elasticity of blood vessels leading to slower circulation and healing
  • Respiratory: Decreased lung capacity, reduced cough reflex, increased risk of pneumonia and respiratory infections
  • Musculoskeletal: Bone density loss, muscle mass decrease, joint stiffness increasing fall risk and mobility limitations
  • Sensory: Vision changes (presbyopia, cataracts), hearing loss (presbycusis), decreased taste and smell affecting nutrition

Normal Aging vs. Pathological Changes

Normal AgingPathological
Mild forgetfulnessSevere memory loss (dementia)
Slower processingConfusion, disorientation
PresbyopiaSudden vision loss
Mild hearing lossSudden hearing loss

Key Points

  • Aging is individual - chronological age doesn't determine functional ability
  • Multiple chronic conditions are common but not inevitable
  • Maintain dignity and independence whenever possible

Safety Considerations

  • Fall Prevention: Remove throw rugs, ensure adequate lighting, use assistive devices, regular vision/hearing checks
  • Medication Safety: Polypharmacy risks, drug interactions, altered metabolism requiring dose adjustments
  • Cognitive Assessment: Regular screening for dementia, depression, delirium using standardized tools
  1. Assess fall risk using standardized scale (Morse, Hendrich)
  2. Implement appropriate interventions based on risk level
  3. Educate patient and family on safety measures
  4. Document and communicate risk factors to team

Medications in Special Populations

Pediatric Medication Administration

  • Dosage Calculations: Always based on weight (mg/kg) or body surface area (mg/m²), never adult doses scaled down
  • Absorption Differences: Faster gastric emptying, different protein binding, immature liver metabolism affecting drug effectiveness
  • Safety Measures: Double-check calculations, use appropriate measuring devices, never estimate doses

Critical Safety Alert

Always verify pediatric doses with another nurse - calculation errors can be fatal in children due to their smaller body size and different metabolism.

Geriatric Medication Considerations

  • Pharmacokinetics: Slower absorption, altered distribution, decreased metabolism, reduced excretion leading to drug accumulation
  • Polypharmacy: Multiple medications increase interaction risks, adverse effects, and medication errors
  • Beers Criteria: Guidelines identifying potentially inappropriate medications for older adults

Memory Aid: Medication Changes in Aging

ADME: Absorption (slower), Distribution (altered), Metabolism (decreased), Excretion (reduced)

Pediatric vs. Geriatric Medication Considerations

PediatricGeriatric
Weight-based dosingLower doses due to decreased clearance
Rapid metabolismSlower metabolism
Limited communicationMultiple medications
Growth considerationsComorbidity interactions

Common Medication Errors to Avoid

  • Look-alike/Sound-alike: Celebrex/Celexa, Humalog/Humulin - always verify with two identifiers
  • Decimal Point Errors: Always use leading zeros (0.5 mg not .5 mg), never trailing zeros (5 mg not 5.0 mg)
  • Route Confusion: Verify intended route, especially with medications available in multiple formulations

Key Points

  • Always follow the "Six Rights" of medication administration
  • When in doubt, don't give the medication - verify with prescriber
  • Patient education prevents medication errors at home

Study Tips & Quick Checks

NCLEX Success Strategy

Focus on safety first, then comfort. Remember that development is predictable but individual, aging changes are normal but not limiting, and medication safety requires constant vigilance.

Quick Check Questions

□ Can you name the eight stages of Erikson's theory?
□ What are three normal aging changes vs. pathological findings?
□ How do you calculate pediatric medication doses?
□ What are the Beers Criteria used for?

Common Pitfalls

  • Don't confuse normal aging with disease processes
  • Never assume developmental delays without proper assessment
  • Always double-check pediatric and geriatric medication calculations

You've got this! Remember that understanding growth, development, and safe medication practices across the lifespan demonstrates your commitment to providing excellent nursing care. Trust your knowledge and clinical judgment!

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