hello class and welcome to chapter 7 lifespan development of the emergency care and transportation of the sick and injured 12th edition do you complete this chapter in the related coursework you will have a fundamental understanding of the physiological and psychosocial differences of each phase of human development you will be able to discuss adaptations and strategies that might work to better assess and manage patients okay so let's get started so humans develop throughout their lives and emts must be aware of the physical changes a person undergoes of various stages because they may alter the approach to patient care so neonates and infants and remember neonates is birth to one month okay so and it's covered in chapter 33 obstetrics and neonatal care and infants that is one month to a year in the develop at a startling rate the weight so a neonate usually weighs between six to eight pounds at birth the head accounts for 25 of its body weight after week two infants grow at a rate of about one ounce per day so they double their weight by four to six months and triple it by the end of the first year the cardiovascular system of a neonate in an infant so at birth the neonate becomes makes the transition from fetal circulation to independent circulation okay so the pulmonary system prior to birth a neonates lungs have never been inflated the first breath is facilitated in part of the chest passage through the birth canal and it increases that inner thoracic pressure so infants younger than about six months are particularly prone to nasal congestions infants have proportionately larger tongues and proportionately shorter narrow airways and some airway obstructions are more common in infants okay so the rib cage is less rigid and the ribs sit horizontally for bag valve mass ventilation remember that the infant's lungs are very fragile so forceful ventilations can result in trauma from pressure or barotrauma so respiratory muscles are immature and they there are fewer alveoli in the lungs and respiratory problems can quickly become life-threatening in neonates and infants okay so the nervous system of neonates and infants the nervous system continues to evolve after birth and neonate is born with certain reflexes so that the neonate is born with a moro reflex and that's basically a startle reflex when a neonate is caught off guard it opens its arms wide and spreads its fingers and seems to grab at things then they are born with the palmer grasp and that occurs when an object is placed into the neonate's palms then there's a rooting reflex and when something touches the neonic's cheeks it will turn its head towards that touch then there's the succulent reflex and that occurs when the neonates lips are stroked and neonates fontanelles are the spaces between the bones that will eventually fuse to form the skull the posterior fontanelle fuses at about three months the anterior fontanelle fuses at nine to 18 months of age a depressed fontanel may indicate dehydration and a bulging fontanelle is indicative of inner increased intracranial pressure this figure shows a great picture of the fontanelles of infants okay so a little bit more about neonates and infants nervous system by two months of age infants can track objects with their eyes and recognize familiar faces in that six months they can sit upright and they begin to make cooing and babbling sounds by 12 months of age an infant can walk with minimal assistance and knows his or her name and their immune system so infants and neonates immune system maintains some of the mother's immunities infants can also receive antibodies via breast and this fosters further boosters their immune system okay so the psychosocial changes of infants and neonates and they begin at birth and evolve as the infant interacts with and reacts to the environment and there's a slide of the noticeable characteristics of the various ages okay so crying is the main method of communicating distress of infants and neonates they bond is in its based on a secure attachment so anxious avoidant attachment is found in infants who are repeatedly eject rejected and children show little emotional response to their parents or caregivers and treat them as they would strangers also separation anxiety is common in older infants trust and mistrust refers to a stage of development from birth to about 18 months which involves an infant's needs being met by his or her parents or caregivers okay so let's move on now we're into the toddler in preschool and so their toddler in preschool uh toddlers remembers about one two three years and preschool is three to six years and the physical changes so the cardiovascular system of a toddler preschool is not dramatically different from an adult preschoolers ages three to six years the pulse rate is 80 to 140 beats per minute the respiratory rate is 20 to 25 breaths per minute and the systolic blood pressure is 80 to 100 milligrams of mercury toddlers and preschoolers have not well developed lung musculature and are unable to sustain deep or rapid respirations for an extended period of time weight gain should level off and the loss of passive immunity is one of the most impactful physiological changes at this stage of the human's life neuromuscular growth makes considerable progress at this age and toilet training is usually completed around 28 months of age okay so some psychosocial changes the challenge for this group is sometimes referred to as autonomy versus shame and doubt so at 36 months of age basic language is mastered interaction and playing games with other children begins and by 18 to 24 months this cause and effect begins to become understood so children learn to recognize gender differences by observing role models school age children this is going to be the next group and this is 6 to 12 years physical changes so from ages 6 to 12 a school-aged child's physical traits and functions continue to mature at a rapid rate growth of four pounds and two to five inches each year permanent teeth come in and brain activity increases in both hemispheres so some psychosocial changes so children learn various types of reasoning and we're going to talk about three of those types of reasoning pre-conventional reasoning conventional reasoning and post-conventional reasoning okay so pre-conventional reasoning is how children act almost purely to avoid punishment and get what they want conventional reasoning is when children look for approval from their peers in society and then post-conventional reasoning this is when children make decisions guided by their consequences okay so children begin to develop their self-concept and self-esteem at this age now we're going to get into the adolescents and we call them teenagers sometimes this is from 12 to 18 years vital signs begin to level off within the adult ranges so the pulse rates you're going to notice are the same as the adults and this is 60 to 100 beats per minute respiratory rate is 12 to 20 and systolic blood pressure is between 90 and 110 millimeters of mercury adolescents experience a two to three year growth spurt an increase in muscle and bone growth and body changes girls generally finish their growth spurt at about 16 and boys at about 18 years of age the endocrine and reproductive system matures and secondary sexual development takes place so pubic hair and auxiliary axillary hair begin to appear voices start to change and menstruation begins okay so some psychosocial changes so adolescents and their families often deal with conflict as as i'll let adolescents try to gain control their lives from their parents so privacy becomes an issue and self-consciousness increases adolescents may struggle to create their own identity with multiple options for gender exists and many are fixated on their public image okay so they often want to be treated like adults yet cared for like younger children anti-social behavior and peer pressure tend to peak at age 14 to 16 so smoking illicit drug use and unprotected sex are problems that may arise and eating disorders can arise in adolescence from their attempt to gain self-control through what they eat a code of personal ethics develops based partially on parents ethics and values and partially by peers and personal experience adolescents have a high risk for suicide and depressant depression okay so the next group we're going to talk about 19 to 40 year olds are the early adults and that's the range 19 to 40 and their physical changes so their vital signs do not vary from those that we've seen that will be seen through adulthood and the pulse rate of course will average around 70 beats per minute and once again that range will be 60 to 100 beats per minute the respiratory rate will stay in the range of about 12 to 20 and the systolic blood pressure once again will be between 90 to 120 millimeters of mercury from age 19 to shortly after 23 the body should be functioning at its optimal level lifelong habits are solidified and the body is working at peak efficiency but in the late latter years of early adulthood the effects of aging gradually become evident so some psychosocial changes life centers on work family and stress and during this period adults strive to create a place for themselves in the world and many do everything they can to settle down despite the amount of stress and change this is one of the more stable periods of life now let's talk about middle age so middle age or middle adults are between 41 to 60 physical changes so the vital signs remain about the same middle adults are vulnerable to vision and hearing loss cardiovascular health becomes an issue and cancer the incidence of cancer increases so menopause takes place in the late 40s and early 50s diabetes hypertension and weight problems are common exercise and healthy diet can diminish the effects of aging so some psychosocial changes there's a focus on achieving the goal life's goals middle adult must readjust their lifestyle as children leave home finances can become a worrisome issue and generally people at this age have physical emotional and spiritual reserves to handle life's issues so middle adults can may find themselves caring for children leaving for college and caring for their aging parents as well then there's older adults so older adults include those ages 61 years and up so physical changes life expectancy is constantly changing now it's about 78 years old so it's determined in part by the birth year in the country of residents they are often able to overcome numerous medical conditions but may need multiple medications the cardiovascular system in older adults so cardiac function declines with age largely due to atherosclerosis heart rate in cardiac output decreases cardiac output can no longer meet the demands of the body and the vascular system becomes stiff the heart must work harder to overcome that vascular resistance okay and the ability to prove to provide replacement blood cells decline as as does the blood volume the respiratory system in older adults so the size of the airways decrease or increase and the surface area of the alveoli decreases okay so the elasticity and the strength of the intercostal muscles and diaphragm decreases and breathing becomes more labor intensive by age 75 the vital capacity may amount to only 50 of the vital capacity of a young adult so the chest becomes more rigid and fragile and the cough and gag reflexes diminish along with the ability to clear secretions so older adults are at a greater risk of aspiration and airway obstruction smooth muscles of the lower airway weaken causing airway collapse on inhalation this produces inspiratory wheezing lower flow rates and air trapping in the alveoli older adults are more susceptible to lung infections the endocrine system in the older adults so insulin produces drops off and metabolism decreases the product the reproductive system changes to some extent as well and so you have hormone reproduction for both sexes is going to gradually decrease as they age okay and sexual desire may diminish with age but does not cease then the digestive system in older adults so there's some changes in the gastric and intentional intestinal function and it may inhibit natural intake in utilization in older adults okay so tooth loss may makes chewing difficult and tastes and sensations decrease saliva secretion decreases and this reduces the body's ability to produce complex carbohydrates the ability of the intestines to contract and move food through diminishes in gastric acid acid secretion diminishes diminishes gallstones become increasingly common and decrease elasticity of the anal sphincter causes fecal incontinence the renal systems in the older adults so the filtration function declines by 50 from age 20 to 90. kidney mass decreases 20 over the same span and there is a blood supply reduction in the kidneys okay so there is decrease ability to remove waste and to conserve fluids when needed the nervous system in the older adult so the brain weight may shrink from about 10 to 20 percent by the age of uh 80. motor and sensory neutral networks become slower and neurons are lost but that does not mean that there is a loss of knowledge or skill and then sleep patterns change okay age-related shrinkage creates a void between the brain and the outermost layer of the meninges which provides room for the brain to move when stressed okay then the peripheral nerves slow with age in the older adults so sensations become diminished and may be misinterpreted immerse interpreted increased reaction time causes longer delays between stimulation and motion and prolonged reaction times and slower reflexes contribute to a higher incidence of falls then you have sensory changes so pupillary reaction and ocular movements become restricted visual distortions are common peripheral fields of their a vision narrow hearing loss is four times more common than vision loss and loss of high frequency hearing or deafness occurs then the psychosocial changes until about five years before death most people retain high brain function statistics may indicate that 95 percent of the elderly live at home and they may need assistance from family friends or home health care increased need for assisted living facilities and financial limits may restrict the access to health care or medications today more than 50 percent of all single women in the united states who are 60 years or age or older are living at or below the poverty level one of the important issues that an elderly needs to face is their own mortality isolation and depression changes can be challenges okay so we that concludes chapter seven um so we're going to go through these uh review questions and see how much we learned okay so number one when providing bag valve mask ventilations to an infant what is the most important thing to remember and i think that it's b and the infant's lungs are fragile yep that's it you see an infant capable of reaching out to people and drooling she is most likely what do we think see she's most likely four months of age okay an infant who is repeatedly rejected experiences what type of attachment and it's going to be the anxious avoided attachment and this is observed in infants who are repeatedly rejected so it's b why do colds develop so easily in toddlers and preschoolers i think it's d yeah all of the above so toddlers experience that loss of passive immunity they do not have well-developed lung musculature and they are spending a lot of time around their playmates and classmates so all of the above all right the pulse rate of a toddler is slightly higher than the adults right so b the pulse rate is 90 to 150 beats per minute a school-aged child looking for approval from his peers and society is demonstrating what type of reason okay so is it pre-convention convention or post and we think that this is going to be conventional thinking right so conventional punishment that's that pre and guided by their decisions that's post self-concept what a self-concept self-concept is how we perceive ourselves and why should you be concerned about a 16 year old patient who seems depressed and i would say if c adolescents are at a higher rate for suicide okay they're they're struggling to create their own identity but are caught between two worlds so c and why do finances become an issue during middle adulthood what do you think i would think it would be a because we're supporting or they're supporting the children and their parents yes and it's a um the parents of adults in this group are getting older and now need care so let's say okay and why is breathing more labor-intensive for the elderly and i think it's going to be all of the above and that's correct all three of the factors make breathing more labor-intensive for the elderly so this concludes chapter seven lifespan development of the new um the new edition of the emt book and thank you for joining me today and if you like this lecture uh go ahead and look around and listen to some more thanks