Introduction to Medical-Surgical Nursing, 6th ed.
10
Lesson Plans for
Developmental Processes
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 10.1:
2. Identify the health problems specific to the adult age-groups.
3. Discuss the health care needs of young, middle-aged, and older adults.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to the developmental tasks, health concerns, and health
care needs of young, middle-aged, and older adults.
2 Chapter 10 Developmental Processes ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) A developmental task for young adulthood is __________.
a) preparation for retirement
b) implementing measures to prevent chronic illness
c) establishing financial independence
d) adjusting to the physical changes
2) The formulation of a meaningful life philosophy begins in __________.
a) young adulthood
b) middle adulthood c) older adulthood
d) the elder years
3) Routine screening for the middle-aged adult should include a screening for __________.
a) glaucoma
b) joint atrophy c) blood pressure
d) suicide risk
4) A patient admitted to the hospital with presbycusis needs which of the following nursing
interventions?
a) Adequate lighting
b) Blood pressure checked every shift c) Nonskid slippers when up
d) Speaking in a clear and distinct voice
5) Middle-aged adults are often referred to as the “sandwich generation” because they __________.
a) are caught between two chronic disease states
b) experience changes in hearing and sight
c) experience happiness and sadness with an “empty nest”
d) are caring for children and their aging parents
6) The estimated number of middle-aged Americans is __________.
a) 1 out of 3
b) 1 out of 4 c) 1 out of 5
d) 1 out of 6
7) Women begin experiencing bone loss when they are __________.
a) young adults
b) middle-aged adults c) older adults
d) elderly
8) Psychological age includes __________.
a) cognitive function
b) condition of major organs c) societal role
d) activities of daily living
9) An important developmental task for the older adult is to __________.
a) care for aging parents
b) find a new and satisfying mate
c) manage a time schedule and life stresses
d) establish a satisfactory living arrangement
10) An ideal beginning exercise for the older adult is __________.
a) running
b) walking c) shuffle board
d) water polo for seniors
________________________________________________________ Chapter 10 Developmental Processes 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: A 58-year-old man is taken to the hospital by his son for sudden onset of chest pain and
shortness of breath while playing basketball. He requires emergency cardiac catheterization, and stents
are placed in two blocked coronary arteries. The physician states that the heart damage was minimal,
and the patient is reassured that he can soon return to his normal activities. He is also prescribed
medication for newly diagnosed elevated blood cholesterol and hypertension. While reviewing the
patient’s medications, a nurse determines that the patient is quiet and withdrawn. Why might the patient
be quiet and withdrawn? What other information could assist the nurse in caring for the patient?
Answer: Based on his chronological age, the patient is a middle-aged adult with specific developmental
Question: A 33-year-old nurse has been married for 4 years and has a 1-year-old baby. Lately, she has
become very tired as she balances work and home life. She is stressed because her house is a mess and
she and her husband do not have enough time to spend together. After she nearly passed out one
morning, a colleague takes the nurse’s blood pressure and finds it to be rather low. The nurse is sent to
the employee health nurse for further assessment. The employee health nurse asks the nurse when she
last saw a doctor. The patient is unable to remember, because it has been years since she has been sick.
How often should a young adult, like this nurse, have a physical?
Answer: Young adults in their 30s should be thinking about chronic disease prevention. These
4 Chapter 10 Developmental Processes ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
Instructor Preparation
Textbook Objectives Covered
2. Identify the health problems specific to the adult age-groups.
3. Discuss the health care needs of young, middle-aged, and older adults.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: geriatric nurse practitioner
• Student performance evaluation of all entry-level skills required for student comprehension of
developmental processes, including:
Materials and Supplies
Key Terms
• psychological age (p. 133)
• Part IIIF: 2-3 (p. 50)
Assignments 2 hours
1
READ – Textbook (pp. 129-134)
REVIEW
• Table 10-1: Erikson’s adult developmental tasks (p. 130)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 3, 5 (p. 135)
ANSWER – Study Guide
• Part IA: 1-3 (p. 49)
2
READ – Textbook (pp. 129-134)
REVIEW
• Figure 10-1: Middle age is a time of relatively good health (p. 131)
ANSWER – Study Guide
• Part IC: 1, 2 (pp. 49-50)
• Part ID: 1-4 (p. 50)
• Part IIIF: 8 (p. 51)
________________________________________________________ Chapter 10 Developmental Processes 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
3
READ – Textbook (pp. 129-134)
REVIEW
• Table 10-2: Harmful health practices, effects on health in the later years (p. 131)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7, 8, 9, 10 (pp. 135-136)
ANSWER – Study Guide
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 10
Developmental Processes
1
Slide 2
Young Adulthood
• Physical growth ends and social expectations begin
• Occurs during a person’s 20s, 30s, and 40s
TALKING POINTS:
• What living arrangements are people in this age-group expected to have?
lonely, and self-absorbed.
Slide 3
Young Adulthood (cont.)
• Many young people have extended their education and have prolonged the time that they
continue to live at home
• A job loss, divorce, or other stressor may precipitate a move back home as well
TALKING POINTS:
• The entire family must then adjust to a young adult living at home by redistributing roles
and responsibilities, maintaining adequate communication, and reallocating budget and
space.
• Why is this situation especially difficult for parents?
Developmental Tasks
• Accept self and stabilize self-concept and body image
6 Chapter 10 Developmental Processes ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
Developmental Tasks (cont.)
• Become established in a vocation or profession
TALKING POINTS:
• What is the purpose of becoming involved in a profession?
• What made you choose nursing as a profession?
Developmental Tasks (cont.)
• Find congenial social and friendship group
TALKING POINTS:
• What three things do the developmental tasks of a young adult focus on?
• A young adult does not need to marry to be well-adjusted and achieve the identified
developmental tasks.
2
Slide 7
Health Problems
• Relatively few health problems
• Major causes of death in the young adult
• Vehicular accidents, other accidents, suicide, and homicide
TALKING POINTS:
• As young adults progress into their late 30s and early 40s, what are the primary causes of
death?
Slide 8
Health Problems (cont.)
• Typical health problems related to stress on the job or in social interactions, lifestyle, and
childbearing
TALKING POINTS:
• May work hard and party enthusiastically.
• Meals may be eaten on the run, and the diet may consist primarily of junk foods.
• What are the caloric requirements compared with the requirements during adolescence?
Slide 9
Health Problems (cont.)
• Smoking and alcohol/drug abuse common
• As young adults enter their 30s and early 40s, their focus is directed mainly toward
raising a family and furthering their career
TALKING POINTS:
• How can smoking and alcohol/drug abuse cause problems in later years?
________________________________________________________ Chapter 10 Developmental Processes 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
3
Slide 10
Health Care Needs
• Related to promoting optimal health
• Health screenings should be initiated and repeated at regular intervals
• Mammograms, clinical breast exams, breast and testicular self-examination, pelvic
examinations, and Pap smears
• Routine dental and eye examinations
TALKING POINTS:
• When should women begin having annual Pap smears?
Slide 11
Health Care Needs (cont.)
• Young women should have a Pap smear every 3 years
• Periodic physical examinations
• Usually recommended at ages 30 and 35, and then every 3 years
• By age 40, women should begin annual mammograms and clinical breast exams
TALKING POINTS:
• Women may be taught breast self-examination, but they should be told that it does not
Health Care Needs (cont.)
• Between ages 30 and 45, should begin to think about the prevention of chronic illness,
particularly cancer and heart disease
TALKING POINTS:
• What should health promotion and disease prevention programs focus on for the 30– to
35-year-old?
• What are some of the most effective ways to prevent oral cancers?
1
Slide 13
Middle Years
• Ages 45-65 years
• More than 40 million Americans are considered middle–aged
• They earn most of the money, pay most of the taxes, and have most of the power in
business and government
• A time of relatively good health for most
TALKING POINTS:
• What is the life expectancy of a child born in 2003?
• A woman who reaches the age of 50 today free of cancer and heart disease can expect to
8 Chapter 10 Developmental Processes ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
who are trying to maintain continued involvement both at work and at home.
Middle Years (cont.)
• Experience a new personal freedom and enjoy maximum command of themselves and
influence over others
TALKING POINTS:
• What does the term “sandwich generation” mean?
Slide 15
Developmental Tasks
• Help growing/grown children become happy and responsible adults
• Balance work and other roles
• Prepare for retirement
• Role reversal with aging parents
Developmental Tasks (cont.)
• Accept and adjust to the physical changes of middle age
• Establish and maintain a healthy lifestyle
TALKING POINTS:
• Middle-aged persons who successfully master developmental tasks begin to accept their
age and gradually come to value the wisdom gained from living and experience rather
than the physical power and strength that accompany youth.
• What two things may increase the ability to change and adapt to new situations and to be
open to others?
________________________________________________________ Chapter 10 Developmental Processes 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
2
Slide 17
• Bone mass begins to decrease
• Muscle reduced due to decreased muscle fiber
• Why do women in the group have an increased risk of osteoporosis?
• The clue to developing presbyopia is that the middle-aged adult begins to hold reading
material at a distance to focus on it better.
Health Problems
• Continue to be relatively healthy
• Health problems
• Cardiovascular disease (major cause of death)
• Cancer
• Pulmonary disease
TALKING POINTS:
• Respiratory conditions are a frequent cause for days absent from work in women; injuries
are a frequent cause for men.
3
Slide 18
• Early diagnosis of illness helps prevent later complications.
• When may a women decrease the frequency of Pap smears?
Health Care Needs
• Regular assessment of health status is important for maintaining good health
• A complete physical examination is recommended every 3 years; should include routine
blood pressure screening and cholesterol and glucose testing
• Women should continue to have an annual mammogram and clinical breast exam
TALKING POINTS:
Slide 19
Health Care Needs (cont.)
• Women usually enter a perimenopausal period between the ages of 45 and 50
• The permanent cessation of menstruation typically occurs between the ages of 45 and 55
TALKING POINTS:
• What symptoms may a women experience during the menopausal years?
• Many women take estrogen to relieve some of the symptoms of menopause.
1
Older Adults
• Age 65 is commonly thought of as the beginning of old age
• People are entering old age in better health than in the past
TALKING POINTS:
• In America today, 8 in 10 people will live past their 65th birthday.
• What are the three markers that may be more accurate than chronologic age to define
older age?
10 Chapter 10 Developmental Processes ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
Older Adults (cont.)
• Psychological changes include:
• Social changes include:
Slide 22
Developmental Tasks
• Adjust to decreasing physical strength and health change
• Adjust to retirement
• Adjust living standards to retirement income
• Establish satisfactory living arrangements as a result of role changes
• Maintain an interest in people outside the family and in the community
• Maintain maximum level of health
• Learn to adjust to the loss of physical strength, illness, and one’s own mortality
Developmental Tasks (cont.)
• Emotional satisfaction in relationships with spouse, children, grandchildren, others
• Establish affiliation with members of own age-group
Slide 24
Developmental Tasks (cont.)
• Cope with the death of parents, spouse, and friends
• Learn to combine new dependency needs with the continuing need for independence
TALKING POINTS:
• What is the focus of developmental tasks in the older adult?
2
Slide 25
• Benign or malignant enlargement of the prostate is common in older men
• Breast cancer is common in older women
Health Problems
• Major causes of death:
• Related to chronic illness, specifically cardiovascular disease
• Cancer
• Diabetes mellitus
• Accidents, including falls, are the fourth leading cause of death in this age-group
• Most common illnesses:
• Arthritis
3
Slide 26
Health Care Needs
• Manage chronic illnesses; maintain and prolong period of optimal physical, mental, social
activity
• Important to help older adults maintain their independence as long as possible
• Physical examinations should be yearly
• Dental examinations and treatment should also be continued into older age
________________________________________________________ Chapter 10 Developmental Processes 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
Slide 27
Health Care Needs (cont.)
• Periodic evaluation and treatment of the feet by a podiatrist recommended to promote
mobility
• Influenza vaccination is recommended yearly for people older than 65 years
Slide 28
Health Care Needs (cont.)
• Proper nutrition, especially a low-fat, high-fiber diet with a large amount of complex
carbohydrates, helps maintain energy, promote intestinal motility, and decrease
susceptibility to some chronic illnesses
• Exercise can benefit older adults, even the very old who begin an exercise program for
the first time
TALKING POINTS:
• What is the ideal exercise for the older adult?
Slide 29
Question 1
• Which of the following is NOT a developmental task that must be achieved by older
adults?
A. Accept self and stabilize self-concept and body image
B. Recognize the aging process and adjust to decreasing physical strength and health
changes
C. Adjust to retirement; adjust living standards to retirement income
D. Establish satisfactory living arrangements as a result of role changes
Slide 30
Question 2
• Which of the following is NOT one of the four major causes of death in the young adult
age-group?
A. Vehicular accidents
B. Cancer
C. Suicide
D. Homicide
12 Chapter 10 Developmental Processes ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss Erikson’s developmental tasks as
outlined in Table 10-1 (p. 130). Consider the
nursing interventions that would be indicated
for the nursing assessments recommended.
• Discuss the ways in which the focus of the
developmental tasks changes over time and
the importance of shifting focus at each
developmental level.
• Divide the class into small groups and
present the following scenarios:
• A 22-year-old has dropped out of
college twice and has held five jobs in 2
years. He lives with a friend but has not
been able to keep up with the rent
payments.
• A 34-year-old single mother places her
children in day care while she works as
a waitress. She attends business school
at night while a friend watches the
children.
For each scenario, have each group discuss
whether the young adult has achieved the
appropriate developmental tasks and
present its findings to the class.
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
• Post the following discussion topic online
and have students comment. Create a list of
developmental tasks of middle adulthood.
Which of these tasks do you think is most
critical? Explain.
• Post the following discussion topic online
and have students comment. Lead the
students in a discussion of each
developmental task for young adults listed
on p. 129-130. Ask students to identify ways
for young adults to achieve the
developmental task of middle adulthood. Ask
students to identify ways to achieve the
developmental tasks for this phase.
• Post the following discussion topic online
and have students comment. Lead students
in a discussion of the developmental tasks
for older adulthood. Ask students to identify
ways that older adults can achieve the
developmental tasks for their phase, and
write these findings on the board.
• Post the following discussion topic online
and have students comment. In your own
words, how would you define biologic age,
physiologic age, and social age?
________________________________________________________ Chapter 10 Developmental Processes 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
1
• Divide the class into small groups and assign
each group two or three developmental tasks
for older adulthood. Have each group identify
three interventions to assist an older adult
successfully achieve each of the
developmental tasks. Then, have each group
share its findings with the class.
2
DISCUSS
• Discuss the harmful health practices outlined
in Table 10-2 (p. 131) and their effects on
health. Review the preventive measures that
can be taken to address each behavior.
• Discuss the role of nursing education in
promoting prevention.
• Discuss the health problems commonly
• Discuss the health problems commonly
encountered in the middle years.
• Divide the class into small groups. Present
following scenario to the class:
• A 64-year-old obese woman works full-
time as an accountant and was recently
diagnosed with type 2 diabetes mellitus
and uncontrolled hypertension. She has
a history of osteoporosis but has neither
increased her calcium intake nor taken
her prescribed medication.
• Have each group identify five nursing
interventions with rationales for this patient.
Ask each group to develop a teaching plan.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Outline the
major task of young adulthood.
• Post the following discussion topic online
and have students comment. What are
some patient education materials that would
be most appropriate when teaching a group
chronic condition?
• Post the following discussion topic online
and have students comment. Review the
National Institute of Health Guidelines for
routine exams for older adults. What are
common examinations that should be
performed on older adults?
14 Chapter 10 Developmental Processes ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
3
DISCUSS
• Discuss the differences in health care needs
of the young, middle-aged, and older adult.
Consider the focus, scope, and complexity
• Lead a class discussion on common health
care needs and screening programs for
young adults. Ask students to identify
nursing interventions, and outline the patient
teaching needed to encourage good health
practices among young adults.
• Discuss the role of the nurse in assisting
patients in the middle years meet their
health care needs.
• Divide the class into three groups and
assign each group one of the following
topics:
• Exercise
• Stress management
• Smoking cessation
• For their assigned topics, have the groups
• Ask the class to answer the following
questions and give rationales:
• How often should an older adult have a
physical examination?
• Should older adults continue to seek
dental care when they lose their dental
insurance?
• Why would an older adult want to visit a
podiatrist?
• Should all older adults receive the influenza
vaccine?
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Young adults
are most at risk, in relation to health, from
middle-aged adults to address common
health issues. Create an outline of the
teaching sessions.
• Post the following discussion topic online
and have students comment. What
immunizations does the Centers for Disease
Control (CDC) recommend for individuals
over age 65?
________________________________________________________ Chapter 10 Developmental Processes 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 10.1
Critical Thinking Question
A 72-year-old grandfather loves to be busy. His wife of nearly 50 years died 2 years ago, so
he increased the number of hours he volunteers at a halfway house. He started dating again
and has a date almost every night. Many nights he is up very late eating dinner, watching
movies, or playing cards. His granddaughter notices that her grandfather seems to be more
forgetful lately. He forgets to change his underwear, do laundry, and buy groceries. The
grandfather says it’s because he is so busy. However, he has agreed to let his
granddaughter take him to the doctor for a checkup to rule out Alzheimer’s disease. During
the appointment, the granddaughter asks the nurse if she should be worried about her
grandfather’s condition. How should the nurse respond?
Discussion Guidelines: The nurse should explain that forgetfulness is not always a sign of
Alzheimer’s disease, although it is a good idea to see a physician whenever there is a marked
Instructor Notes/Student Feedback
16 Chapter 10 Developmental Processes ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
10
Assessments for
Developmental Processes
CHAPTER OBJECTIVES
Lesson 10.1:
2. Identify the health problems specific to the adult age-groups.
3. Discuss the health care needs of young, middle-aged, and older adults.
Assessments by Lesson & Objective
1
Study Guide
• Part IA: 1-3 (p. 49)
• Part IB: 1-3 (p. 49)
• Part IIE: 1 (p. 50)
• Part IIIF: 2-3 (p. 50)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 1, 3, 4, 8
• Prioritization: 1, 3, 4
2
Study Guide
• Part IC: 1, 2 (pp. 49-50)
• Part ID: 1-4 (p. 50)
• Part IIIF: 8 (p. 51)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 2, 5, 9
3
Study Guide
• Part IIE: 2-4 (p. 50)
• Part IIIF: 1, 4-7 (pp. 50-51)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 6, 7, 10
• Prioritization: 2
Instructor’s Notes/Student Feedback