Growth, Development, and Aging Across the Lifespan

Must-know rules

Erikson is king. Trust → Autonomy → Initiative → Industry → Identity → Intimacy → Generativity → Integrity. Know the stage, know the age, know the conflict.
Piaget drives your teaching. Sensorimotor (senses) → Preoperational (play/magic) → Concrete (facts/logic) → Formal (abstract/hypothetical).
Stranger anxiety at 8–10 months is NORMAL. So is separation anxiety at 18 months, "no!" at 2 years, imaginary friends at 4, and identity questioning at 15.
Regression is always a red flag. Loss of previously acquired skills at any age requires immediate referral. Screen for autism with M-CHAT at 18 and 24 months.
Normal aging ≠ disease. Presbyopia is normal; sudden vision loss is not. Slower memory is normal; acute confusion is not. The NCLEX tests this distinction constantly.
Acute confusion in older adults = investigate. UTIs, medications, dehydration, and metabolic disturbances are common causes of delirium. Treat the cause, not the confusion.
Pharmacology + aging = caution. Decreased renal and hepatic function means drugs last longer. Start low, go slow, and always review the med list.
Know the milestone ages. Walking by 15 months. First words by 12–14 months. Two-word phrases by 24 months. If a child misses these: refer.

FOUNDATIONS OF GROWTH & DEVELOPMENT THEORY

DOJO RULE

When the NCLEX gives you an age, think Erikson first. A 15-month-old who insists on feeding themselves = autonomy (Erikson).

PRESCHOOL, SCHOOL-AGE & ADOLESCENTS: AGES 3–17

PRESCHOOL (3–5 YEARS)

Erikson: Initiative vs. Guilt. The child explores, asks "why?" constantly, takes on new activities
Piaget: Preoperational. Magical thinking: believes thoughts cause events ("I was mad at Mommy
Motor: Rides tricycle (3 yr), hops on one foot (4 yr), skips and ties shoes (5 yr).
Language: 3-4 word sentences (3 yr) → full sentences (4-5 yr). Vocabulary 1,500+ words by age 5.
Play: Associative play: plays WITH other children but without organized rules.

SCHOOL-AGE (6–12 YEARS)

Erikson: Industry vs. Inferiority. The child takes pride in accomplishments: school work, sports, hobbies
Piaget: Concrete Operational. Logical thinking about tangible, concrete things.
Kohlberg: Conventional Morality. Rules are followed to gain approval ("good boy/good girl") and maintain...
Motor/Physical: Steady growth (~2 inches/year, ~5 lbs/year). Permanent teeth replace primary teeth.
Play: Cooperative play with organized rules: board games, team sports, structured activities.

ADOLESCENT (13–17 YEARS)

Erikson: Identity vs. Role Confusion. The central task: "Who am I?" The adolescent experiments with roles
Piaget: Formal Operational. Abstract thinking, hypothetical reasoning, idealism.
Kohlberg: Transitioning to Postconventional. Begins to question rules and consider individual rights and...
Physical: Puberty: growth spurt, secondary sex characteristics, menarche (girls avg 12.5 yr)
NCLEX focus: Risk-taking behaviors (MVAs, substance use, unprotected sex, self-harm).

DOJO RULE

Preschoolers think magically. School-age children think concretely. Adolescents think abstractly. This dictates how you explain procedures and illness: for a preschooler

OLDER ADULTS: AGES 65+

Erikson: Integrity vs. Despair. The older adult reflects on their life.

DOJO RULE

Normal aging ≠ disease. Some memory decline is normal; dementia is not. Slower reaction time is normal; sudden confusion is not. Presbyopia is normal; sudden vision loss is not.

PHARMACOLOGY & AGING

Decreased renal clearance + decreased hepatic metabolism = drugs last longer and accumulate faster. Older adults need lower starting doses, slower titration, and closer monitoring.

EVALUATING DEVELOPMENT & RECOGNIZING DEVIATIONS

DOJO RULE

When the NCLEX asks "which finding requires further evaluation?": look for the child who has MISSED a milestone for their age. A 10-month-old who isn't walking.

FINAL DOJO RULE

Development is a story, and the nurse reads every chapter. The infant building trust, the toddler asserting autonomy, the adolescent forging identity, the adult creating legacy

Memory hooks

Erikson's 8 stages Infant Trust vs mistrust · Toddler Autonomy vs shame and · Preschool Initiative vs guilt · School-age Industry vs inferiority · Adolescent Identity vs role confusion · Young adult Intimacy vs isolation · Middle adult Generativity vs stagnation · Older adult Integrity vs despair

Some People Can Fly S Sensorimotor (0 to 2) · P Preoperational (2 to 7) · C Concrete operational (7 to · F Formal operational (11+)