Theory 3 Summary Erikson Growth and Development Slides-2

8/18/2019 Theory 3 Summary Erikson Growth and Development Slides-2

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Erikson:Although these stages are distinct as described by Erikson, they're also fuid, with thepotential or some overlap!

•

trust versus mistrust "inants, newborn to age #$ % eet my needs, and ( will trustyou and others or a lietime)

• autonomy versus shame and doubt "toddlers, ages * to +$ % ('m my own person,but ( know my parents are there when ( need them)

• initiative versus guilt "preschoolers, ages + to $ % ( can do it by mysel-- .how me

how, let me do it, and praise me or trying/ then help me make sure ( did it right!)

• industry versus ineriority "school0age children, ages to #*$ % ( need successes inschool, play, and amily to support my development)

• identity versus role conusion "adolescents, ages #+ to #1$ % 2et me be me- 3ithappropriate parental supervision or saety, ( can become an independent adult)

Erikson presents each stage as having a positive and negative psychosocial confict!3hen we support the positive aspect o each stage, children successully progressthrough that stage!

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(nancy4 @rust and mistrust "90#$

•oster trust by giving them what they need4 to be ed,warm, clean, sae, pain0ree, loved, and respond to theircries

•Ater they're mobile, threats to their saety and well0

being increase astronomically 0 provide parents withanticipatory guidance on developmental milestones andassociated haBards e!g! covering electrical outlets,locking cabinets and doorsC!

•Assessing inants "and all children$ or potential abuse orneglect includes assessing interactions with caregiverswhich can provide vital inormation about the saety othe child's home environment

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@oddlers4 Autonomy, shame, and doubt "#0+$

• Autonomy is about independence ".upervise at all times$

• Allow toddlers to make decisions and carry out tasks ontheir own 0avoid shaming them

• Emotionally over the top, due partly to their lack o

vocabulary to epress their eelings and partly to theirlack o sel0control

• Response i very likely to be F) "learning they have avoice$ 3ould you like me or ommy to give you yourmedicine7) works better than a yes no uestion such asHan you take this medicine or me7)

• Hlinging and regression common or eeling protecteduntil eels sae % encourage parents to be empatheticand gentle encouragement to support positives workbest F@E4 regression possible at any age when a childeels stressed



?reschoolers4 (nitiative and guilt "+0$

• .upport this stage by giving preschoolers an opportunityto initiate their own care by perorming a task such asbrushing their teeth

• ?reschoolers can eperience real or imagined ears %bumps head on table so believes the obIect hurt them,so they are angry with it

• 2iteral and ear body mutilation % e!g! an (J is distortingtheir arm so eplain as the arm is thirsty and the (J is astraw or ( need to measure your blood pressure so thecuK will give your arm a tight hug "measure and cuK are

non0threatening$• Hannot understand cause and eKect so view painul

procedures as punishment % reassure its not their ault,they are sick and need to have the procedure done toget better, reward with stickers etcC!





Adolescence4 (dentity and role conusion"#+0#1$

• Desire or independency is so strong that theymay make poor decisions and engage in riskybehaviours resulting in inIury, eacerbation o achronic illness or even death

• ay make decisions to get attention or or peeracceptance "need to Mt in e!g! drugs, recklessdriving, se$

• ?rovide opportunity to ask about sensitive issuessuch as .@Ds and birth control



Erikson stage o developmentuiB• http455psychology!about!com5library5uiB5

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ental Nealth Review

• urse0Hlient Relationship is oundational4 genuine, respect,empathetic, holistic care, sensitivity to culture and values,deMned limits and boundaries, encourage epression oeelings and thoughts, assist to develop problem solving 5healthy coping skills

•

?hases o the relationship are #$ pre0interaction "nurseeplores her own values, biases, stereotype's$, *$ introductory"acceptance, trust , boundaries established, epectationsdiscussed 5 contracted, goals deMned, termination discussed inadvanced % remember time0limited therapy 5 relationship, +$working phase "eplore, ocus on, evaluate then encourage

independence and ready or terminiation$ and O$ termination"evaluate progress and goal achievement, identiy response totermination, identiy strengths, identiy need or and arrangeollow0up care, reer to community supports as needed$

• @herapies

• (nvoluntary vs! Joluntary admissions



Aniety

• .ubIective response that occurs as a result othreats "normal, acute or chronic$

LEVELS:

• ild "associated with everyday lie, perceptual

Meld is increased 0 can be motivating and producegrowth, creativity and enhance learning$

• oderate "ocus on immediate concerns, narrowsperceptual Meld, selective inattentiveness,

problems with learning and problem solvingoccur$

( or ild to oderate levels o aniety4 identiyaniety, encourage to talk about eelings andconcerns, identiy trigger, encourage to problem

solve, encourage gross motor eercise



Aniety continued

• .evere "eels something bad is going to happen,signiMcant narrowing o perceptual Meld0 ocus on verysmall and scattered details, all behaviour ocused onrelieving the aniety, learning and problem solving arenot possible, the individual needs direction to ocus$

• ?anic "associated with dread and terror, sense oimpending doom, disorganiBed, unable to communicateor unction eKectively, increased motor activity, cannotconcentrate, can lead to ehaustion and even death$

( or severe aniety and panic4 always remain with the

client, reduce aniety uickly, use a calm manner,provide clear simple statements, low0pitched voice, takecare o physical needs, provide gross motor activity ,administer aniolytics as prescribed



?osttraumatic stress disorder

• Response to threat o lie "physical or psychological$ %prone to re0eperience in the orm o dreams or fashbacks

• Data4 emotional numbness, detachment, depression,aniety, sleep disturbance 5 nightmares, fashbacks,hypervigilance, guilt about surviving the event

• ursing (nterventions4 recogniBe the trauma eperience,nonIudgmental, supportive, reassure reactions are normal,address eelings o loss o control and anger, assist withhealthy coping development 5 use, encourage supportgroups, assist with relaation techniues, encourage to

establish and re0establish healthy relationships, note thathypnotherapy or systematic desensitiBation may be usedas orms o treatment "therapy is progressive and done byan eperienced individual % coping skill enhancement isimportant$



Fbsessive compulsive disorders

• Fbsession4 preoccupation with persistent intrusive thoughts and ideas

• Hompulsion4 perormance o rituals or repetitive behaviours to preventsome event, divert unacceptable thoughts, and decrease aniety

• Fbsessions and compulsions oten occur together and may disruptnormal daily activities or ability to unction

• Aniety occurs when one resists obsessions and 5 or compulsions androm being powerless to resist obsessions and5or compulsions

• Hompulsive behaviours decrease the aniety, are associated withobsessive thoughts, the patterns neutraliBe the thought, ritualisticbehaviour increases with stress, deense mechanisms includingrepression, displacement and undoing may be used

(4 ensure basic needs are met "ood, rest$, identiy precipitating

situations, be empathetic, do not interrupt the compulsive behavioursunless saety in IeopardiBed, allow time to perorm task but set limits iintereres with physical well0being, distract rom behaviours, contract todecrease reuency o behaviour, recogniBe and reinorce positive non0ritualistic behaviours



?hobias

• (rrational, persistent ear o obIects or situations %panic level may occur i the obIect, situation oractivity cannot be avoided

• Deense mechanisms include repression and

displacement(4 identiy basis o the aniety, allow verbaliBationo eelings, teach relaation techniues,desensitiBation



ood disorders

• Lipolar disorder characteriBed by highs and lows"mania and depression$, lithium is oten used"monitor serum levels$, other meds used arevalproic acid, olanBapine, tegretol

( or ania4 remove haBards rom environment,assess closely or atigue "promote sleep5 providerest periods$, private room i possible, encourageventing o eelings, assist with ocusing inconversations, ignore grandiosity, present reality,

do not arge, limit group activities "monitortolerance o interacting and promote one0to0oneactivities with the nurse or structure activities$,reduce stimuli, set limits, provide physical activitiesespecially gross motor, avoid competitive games,provide simple direction and eplanations,



ood disorders continued

Dealing with inappropriate behaviours4

• Aggression4 help identiy rustration, encourage to talkrather than act out, describe conseuences to sel andothers, assist in identiying previous eKective coping,help with problem solving

• De0escalation techniues4 maintain saety or pt, othersand sel "ensure you are not dealing with a potentialviolent situation by yoursel$, maintaining large personalspace, use non0aggressive posture, calm approach,clear assertive tone "not aggressive$, determine what

client needs, avoid power struggles, give clear options• anipulative behaviour4 clear, consistent, realistic and

enorceable limits and epectations, be clear about theconseuences "not manipulative$, non0Iudgmental, non0threatening, avoid power struggles



ood disorders continued

( or depressed patients4 assess or suicidality,provide saety i suicidal, assist with activities odaily living, gentle encouragement to participate inown AD2 and unit activities, understand not ready

to make decisions, monitor sleep, monitor nutrition"intake and weight$, provide achievable activities,ocus on strengths "remind o accomplishments$,spend time "conveys they have value 5 worthspending time with$, respond to anger

therapeutically



.chiBophrenia?sychotic eatures, disorganiBed thoughts, and disrupted interpersonal

relationships with disturbances in aKect, mood, behaviour andthought process

Data4 physical "un0kept, body image distortions, preoccupied withsomatic complaints, may neglect hygiene, eating, sleeping andelimination$, motor activity "catatonic holding biBarre postures or

long periods or totally immobiliBed$, inability to respond,repetitive movements, agitated motor activity seen by pacing,inability to sleep, loss o appetite, impulsiveness, inability to initiateactivity$, emotional "mistrust, eels threatened 5 unsae, ambivalent ,helpless, aniety, guilt, depression that may be a response tohallucinations, delusions or grie due to loss o health$, compulsiverituals, over-compliance, afective disturbances "fat or

incongruent or inappropriate$, altered thought process, abnormalthought processes "impaired reality, ragmented thoughts, thoughtblocking, loos associations, echolalia, distorted perception oenvironment, inability to conceptualiBe word meaning, inability tologically organiBe acts$, delusions "loss o reerence %believesrelated directly to sel, persecutions, grandeur, somatic$



.chiBophrenia continued

ursing (nterventions4 assess needs, set limits,maintain a sae environment, time limited one0to0ones and progress to small groups as tolerated"reuent brie contacts are usually best or sit in

silence i needed$, monitor altered thought, avoidtouching and an overly warm approach "neutral isless threatening$, establish daily routines, do notmake alse promises, assist with AD2s as needed,provide simple concrete activities, reorient as

needed, establish what is real and unreal, stay withthem i they are rightened, remove rom others ibecomes too biBarre or disturbing or dangerous, setrealistic goals, provide music etcC i needed orsleep, eplain whatever is going on, monitor or

suicide, decrease ecessive stimuli, assist with



Delusions

alse belie held to be true regardless o opposingevidence

@ypes4 Grandeur "belie that one is powerul andimportant$

Pealousy "oneQs partner is cheating$?ersecution "being singled out or harm by

others$

ursing (nterventions4 Ask about delusion so you

understand it ully and encourage to discusseelings the delusions generate, be open andhonest to reduce suspiciousness, discuss realitybased topics rather than delusions and set limits ithe client obsesses about it, do not dispute or try to

convince that the delusion is alse, validate anyart o the delusion that is real



Nallucinations

• A sense "one o the Mve senses$ perception orwhich no eternal stimuli eists "organic orunctional$

• ote4 Hommand hallucinations that direct the

person to take action may be harmulursing (nterventions4 Ask about hallucinationsdirectly, avoid reacting as though they are real,decrease stimuli, do not negate the eperience,attempt to engage with concrete activities, respondverbally when client talks about anything real,avoid touching, monitor or aniety or agitation"may be a sign o increasing hallucinations$



Eating disorders

Disturbed eating habits a$ anorexia nervosa "onset usuallyrelated to a stressul event, intense ear o obesity, distorted bodyimage and sel0concept, can be lie threatening, death can occurrom starvation, suicide, cardiomyopathies or electrolyte imbalance,b$ bulimia nervosa "binging ollowed by purging, most remain atnormal weight but eel their lives dominated by the eating confict$

ursing (nterventions4 asses status and severity o any medicalissues, contract regarding the nutritional plan, assist in identiyingprecipitants, be accepting and nonIudgmental, acilitate eplorationo sel0concept 5 identity, implement behaviour modiMcationtechniues, supervise during meals and or speciMc periods atermeals, set a time limit or each meal, provide a pleasant relaed

eating environment, record (&F, weigh daily at the same time aterthe client voids, monitor elimination patterns, assess and limitactivity level, assess suicide potential, administer antidepressants iprescribed, encourage psychotherapy and support groups



Alcohol Abuse

Alcohol is a H. depressant "physical dependence is a biological need toavoid withdrawal symptoms whereas psychological dependence is thecraving or the subIective eKect$

Risk actors4 biological "amilial 5 genetic predisposition$, depressed,highly anious, low sel0esteem, poor sel0control, history orebelliousness' 5 poor school perormance or delinuency, poor parental

relationshipsData4 slurred speech, uncoordinated, unsteady, restless, belligerent,conused, sneaking drinks, drinking in the morning, eperiencingblackouts, arguments about drinking, missing work, increased tolerance,intoication, psychological symptoms "depression, hostility,suspiciousness, rationaliBation, irritability, isolation, decreasedinhibitions, decreased sel0esteem, denial that a problem eists

Homplications4 Jitamin deMciencies "vitamin L causing peripheralneuropathies and thiamine causing orsakoKQs syndrome$, memoryproblems, 3ernickeQs encephalopathy "degenerative brain conditioncausing conusion, ataia, and abnormal eye movements$, cirrhosis othe livier, esphagitis and gastritis, pancreatitis, anemias, immune systemdysunctions, brain damage, peripheral neuropathy , cardiac disorders



Alcohol abuse continued• Early signs o alcohol withdrawal4 anoreia, ausea and vomiting, aniety easily

startled, hyper0alertness, hypertension, insomnia, irritability, Ierky movements,possibly hallucinations or vivid nightmares, shaky inside, seiBures ";0O1 hoursater last during$, tachycardia, tremors

• 2ibrium most commonly used or acute alcohol withdrawal although anybenBodiaBepine will decrease symptoms and vitamin L# "thiamine$ inIectionsollowed by several days o oral to prevent 3ernicke0orsakoKQs syndrome

• 3ithdrawal delirium usually peaks in O10;* hours and lasts *0+ days"maniestations o alcohol withdrawal delirium are agitation, anoreia, aniety,delirium, diaphoresis, disorientation with fuctuation levels o consciousness,ever, hallucinations, delusions, insomnia, tachycardia, hypertension$

ursing (nterventions4 on0Iudgmental, monitor closely J. as oten as #:min withone0to0one supervision, uiet non0stimulating environment, orient reuently,eplain all treatments simply, administer anticonvulsant and sedating meds as

prescribed and provide care during seiBures, administer vitamins, assist with AD2,allow to epress ears,

( conQd4 direct the client to ocus on the abuse problem, identiy precipitatingsituations, set limits on manipulative or abusive behaviours, hold them toreasonable limit with conseuences or breaking rules, hold them accountable orall behaviours, encourage to ocus on strengths when losing control, encourage

participation in groups "therapy and support$

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Theory 3 Summary Erikson Growth and Development Slides-2