Flashcards in Life Span & Special Populations Deck (112):
A child 12 to 18 years of age.
Decompensatory Respiratory Distress
Increased respiratory effort caused by impaired respiratory function.
Compensated Respiratory Distress
When the respiratory compensatory mechanisms have begun to
fail and respiration becomes inadequate
The "soft spot" on the top of an infant's head where the bony plates of the skull have not yet fused together
A child from birth to 1 year; during the first month, referred to as a neonate.
A child from birth to 1 month of age.
Insufficient attention or provision of respect to someone who has
a claim to that attention.
Improper or excessive action taken that injures or causes harm.
A child 3 to 6 years of age.
A child 6 to 12 years of age.
Sudden Infant Death Syndrome (SIDS)
The sudden and unexpected death of an infant or young child in which an autopsy fails to identify the cause of death; typically occurs while the neonate/infant is asleep
- Experts report an increased risk factor in premature infants, babies that sleep on their back and/or on a soft surface, and babies exposed to secondhand smoke
A child 1 to 3 years of age.
Normal range of vitals for Neonate/Infant
- HR: 140- 160 per min
- Respiratory volume: 7-8 mL/kg at birth increasing to 10-15 mL/kg at 1 year
- RR: 40-60 at birth, 30-40 soon after birth
- Systolic BP: 70 mmHg at birth, 90 mmHg at 1 yr
Special considerations for infants
- Head is 25% of weight at birth
- Newborns weight drops by 10% at first, then increases at 5-6 oz per week after 2nd week
- Shorter, narrower, softer airway/trachea
- Lung tissue is fragile
- Infections and stress cause an increase in respiration --> infants more susceptible to dehydration and loss of body heat
- More diaphragmatic breathing
- Increased pressure in the heart as connections to mother's bloodstream close slowly, heart tissue is weaker
- Infants gain antibodies (& therefore immune system) from mother --> "Passive immunity"
- Fontanelle is sensitive and depresses with dehydration and bulges with head injury & crying
-At first sleep 16 to 18 hours per day, decreases to 14 to 16 hours per day
- 25% of infant weight is muscle
- Only bones in fingers are hard, the rest are soft (mostly cartilage)
- Infants bond with people who meet their needs
- Communicate by crying
The amount of antibodies infants received from their mother while in the uterus.
Rounded end of a long bone, where these bones grow
Stroking the sole of the infant’s foot should produce the following: toes spread outward and upward
- This reflex usually goes away after the first several months
With the infant lying supine, press on his/her palms. The infant’s mouth should open and the eyes close.
- This reflex eventually goes away.
While near the infant, make a loud noise. Infants should stretch their arms and legs, spread their fingers, and then hug themselves.
- This reflex usually goes away after the first several months of life
Palmar grasp reflex
Place an object in the palm of the infant’s hand. The fingers should curl around the object.
- This reflex usually goes away after the first several months of life.
Touch the infant’s cheek or near the lips. The infant should turn toward the stimulation (side you are touching) and pucker the mouth.
Hold the infant upright at the waist with the infant’s feet touching a solid surface. The infant should make stepping motions, as if walking.
Touch the infant’s mouth with a nipple. The infant’s lips should begin to pucker and start sucking.
Tonic neck reflex
If you place the infant in the supine position, the infant turns his or her head and extends the arms and legs on the side of the body toward which the head is turned.
Activities associated with 2 months of age
- Tracks objects with eyes
- Focuses on objects 8 to 12 inches away
- Recognizes familiar faces
- Displays primary emotions and facial expressions (such as smiling occasionally)
- Hears and recognizes familiar sounds and voices
- Moves in response to stimuli
Activities associated with 6 months of age
- Sits upright in a highchair
- Makes one-syllable sounds
- Raises the head when placed on the stomach
- Grasps and shakes hand toys
- Pushes the legs and feet down when held on a firm surface
- Follows moving objects with the eyes
- Recognizes familiar objects at a distance
- Babbles and attempts to imitate familiar sounds
Activities associated with Twelve months of age
- Walks with assistance
- Knows his/her name
- Sits upright without assistance
- Crawls on hands and feet
- Puts objects into containers
- Pokes objects with fingers
- Responds to simple requests and “no”
- Says "mama" and "dada"
- Imitates words and facial expressions
- Begins to use objects such as combs and cups correctly
- Finger feeds himself/herself
Toddler development characteristics
- By 18 months, exhibit separation anxiety. They might tend to be more attached to a caregiver and might have a difficult time separating from this person
- By 2, Start developing unique personality traits and moods. They know what they like and dislike.
- By 2, should be able to say simple words and phrases.
- By 2, start following directions
- By 2, nervous system is almost completely developed
- By 2, muscle mass and bone density increase, so most toddlers walk very well.
- By 2, renal system is well developed, giving toddlers the ability to control their bladder and bowel functions
- Most toddlers might be physiologically capable of toilet training by 12 to 15 months, but most are not psychologically ready until they reach 18 to 30 months (average age, 28 months)
- Basic language is usually acquired around three years of age
- Start recognizing the difference between male and female, and start modeling themselves after adults of their own sex
- Increase production of growth hormones, insulin, and corticosteroids. On average, the toddler gains approximately 6.5 pounds per year
- Preschoolers can recite their first and last name, and their speech is understandable to strangers.
- Preschoolers can complete short sentences and questions, and love to hear stories and tell stories.
- Separation anxiety is typically gone by preschool age (although some preschoolers have a difficult time separating from their caregivers).
- The cardiovascular system continues to develop.
- The capillary beds become more prominent, which assists in the body’s thermoregulation.
- Hemoglobin also increases to near adult levels.
- Within the pulmonary system, the terminal airways continue to branch and alveoli continue to increase.
- Passive immunity is no longer present and the preschooler is susceptible to infections and common pathogens.
- Preschoolers begin to develop their own immunity (known as “active immunity”).
- The weight of a preschooler’s brain is about 90% that of an adult.
- Like toddlers, a preschooler gains an average of 6.5 pounds per year.
Developmental characteristics of child at age 3
- Walks alone and begins to run
- Pulls or carries several toys when walking
- Climbs up or down furniture or stairs with minimal support
- Scribbles and plays with toys
- Recognizes names, faces, voices, objects, and body parts
- Finds hidden objects
- Sorts objects by shape and color
Developmental characteristics of child at age 5
- Stands on one foot for more than 10 seconds
- Hops, jumps, swings, climbs, and does somersaults
- Dresses and undresses without assistance
- Uses forks, spoons, and sometimes knives appropriately
- Counts 10 or more objects
- Traces and draws pictures
Involuntary bed-wetting at night
Musculoskeletal, Nervous, Renal, and Reproductive development for School- Aged children
- The musculoskeletal system continues to grow, with the bones becoming larger and stronger.
- In some children, this might cause some discomfort (“growing pains”).
- Baby teeth are replaced by permanent teeth.
- About 95% of skull growth is completed by age 10.
- Brain function increases in both hemispheres.
- Children are normally able to read and write.
- Although the renal system is completely developed and school-age children are far past potty training, some might still have an accident at night, even after the age 10.
- The reproductive system becomes active as the child reaches puberty.
- Sex hormone levels increase before any external signs appear (such as underarm hair in males and breast development in females).
- Females typically start puberty before males (anywhere from 8–13 years, with males starting from 13–15 years).
Challenging issues facing adolescents
- Depression and suicide are common in this age group.
- Adolescents compare themselves with others and are very conscious about how they look.
- In some, this level of self-consciousness might lead to disorders such as anorexia and bulimia.
- Some might take herbs and other over-the-counter (or illegal) drugs to lose weight.
- These stimulants can cause problems such as tachycardia, among others.
Physical growth in adolescents
- Organs such as the liver, spleen, kidneys, and heart increase in size.
- Growth of bone and muscle mass is nearly completed during the 2-to 3-year growth spurt.
- The adolescent’s growth spurt begins distally, with enlargement of the feet and hands, and progresses along the extremities.
- The final stage is enlargement of the torso.
- Typically, females finish growing by the age of 16 and males by the age of 18.
Puberty in females
- A change in breast tissue begins with what is known as a “breast bud.”
- Months later, pubic hair and underarm hair begin to grow, and the breasts enlarge.
- Approximately two years after breast budding, menarche usually occurs.
- The endocrine system changes and begins to release gonadotropin, luteinizing hormone, and follicle-stimulating hormone.
- These hormones produce estrogen and progesterone.
- Progesterone increases breast development and the start of the menstrual cycle.
- Estrogen causes development of secondary sex characteristics such as underarm and pubic hair, widened hips and buttocks, and smaller waist.
Puberty in males
- Gonadotropin promotes the production of testosterone, a hormone produced by the testes.
- Changes in the scrotum occur, and there is an increase in size of the testes and penis.
- The male’s voice starts to deepen
- Facial hair, pubic hair, and axillary hair begins to develop.
- The penis has erections, and ejaculation occurs from stimulation and during sleep.
- Body muscles become stronger, and shoulders broaden.
- In both sexes, the appearance of secondary sex characteristics marks the last period of rapid growth.
Early adulthood characteristics
- Early adulthood (young adults) is the period between 20 and 40 years of age.
- At the early onset of adulthood (19–26 years), individuals are at their physical peak. They are usually involved in high-risk activities, with accidents the leading cause of death.
- It is at this time that young adults develop lifelong habits and routines that directly affect their quality of life.
- After they reach their physical peak, metabolisms start to slow down. Fat is stored, weight is gained, and muscle tone increases.
- Psychosocially, this age group has developed the ability to love. New bonds and families increase stress.
- Young adults typically gain independence and leave home to begin a life of their own.
- Childbirth is very common in this age group.
- In addition, young adults typically experience the highest levels of stress in the workplace
Middle adulthood characteristics
- Middle adulthood is the age group from 41 to 60 years of age.
- Physiological changes can occur from different disease processes (such as cardiovascular disease).
- Choices in early adulthood might become apparent, such as smoking, drinking alcohol, or gaining excessive weight from eating unhealthy foods.
- Certain high-risk activities such as contact sports might start taking their toll on the body.
- Cancer is also common in this age group.
- Menopause occurs in women.
- Vision and hearing changes occur.
- During this time, parents might experience the “empty nest syndrome” as children begin leaving home.
- Finances might also be tight because of extra expenses (such as college tuition) and retirement plans (and other life-long goals).
- Additional stressors might also be placed on adults at this age—from taking care of elderly parents to providing care for a grandchild.
- However, people in middle adulthood also experience great joy during this time period, for some of the same reasons (grandchildren, time alone with spouse, and so on).
Late adulthood characteristics
- Body systems begin to deteriorate.
- Hair color changes (typically to gray)
- Hearing decreases
- Taste and smell are diminished
- Joints become stiff
- Bones become brittle
- Tissue elasticity is lost (which causes skin to wrinkle and sag
- Height decreases (in some, as much as three inches).
Vital signs for toddlers
Heart rate: 80 to 130 BPM
Respiratory rate: 20 to 30 BPM
Systolic blood pressure: 70 to 100 mmHg
Vital signs for preschoolers
Heart rate: 80 to 120 BPM
Respiratory rate: 20 to 30 BPM
Systolic blood pressure: 80 to 110 mmHg
Vital signs for school-aged children
Heart rate: 70 to 110 BPM
Respiratory rate: 20 to 30 BPM
Systolic blood pressure: 80 to 120 mmHg
Vital signs for adolescents
Heart rate: 55-105 BPM
Respiratory rate: 12-20 BPM
Systolic blood pressure: 100 to 120 mmHg
Vital signs for adults
Heart rate: 70 BPM
Respiratory rate 16 to 20 BPM
Blood pressure: 120/80 mmHg
In geriatric patients, Heart rate, respiratory rate, and blood pressure are dependent on the level of activity throughout life, diseases, and medications.
Maximum life span
120 years (what the whaaat)
Changes in body systems in the Development of the Elderly
- Brain changes with age
- Clinical depression common
- Altered mental status common
- Hypertension common
- Changes in HR & rhythm
- Cough power is diminished
- Increased tendency for infection
- Less air and less exchange of gases due to general decline
- Constipation common
- Deterioration of structures in mouth common
- General decline in efficiency of liver
- Impaired swallowing
- Malnutrition as a result of deterioration of small intestine
- Drug toxicity problems common
- General decline in efficiency
- More susceptible to incontinence.
- UTIs are also more likely in the geriatric patient, and increase if a Foley catheter is in place.
- Osteoporosis common
- Osteoarthritis common
- Perspires less
- Tears more easliy
- Heals slowly
- Fever often absent
- Lessened ability to fight disease
Anatomical differences in children
- Infants breathe through noses
- Head is large in proportion to body
- Tongue is large in proportion to mouth
- Muscles between ribs are immature
- Abdominal breathing is common
- Trachea is thin & flexible
- Neck muscles are immature
- Nose does not have as much supporting cartilage (Nasal flaring is early sign of respiratory distress)
- Chest and ribs of pediatric patients are more pliable with less muscle mass
- Lung tissue is less developed and more susceptible to damage
- Abdomen has less muscle development
- Bones are more pliable, resulting "greenstick" fractures
Components of Pediatric Assessment triangle
- Work of Breathing
- Circulation to Skin
- In respiratory distress, work of breathing will increase
- In respiratory failure, appearance will be abnormal and work of breathing will increase. Cap refill may be normal or abnormal
Croup (S&S, care)
A viral disease (but might also be bacterial) involving the upper airway that results in inflammation, edema, and narrowing of the larynx, trachea, and bronchioles.
- Croup is most common in children between 6 months and 4 years of age.
- Cold like symptoms for several days
- Development of a barking or seal-type cough
- Stridor, and signs of respiratory distress
- Fever is usually present, with symptoms worse at night.
- Humidified oxygen via a non-rebreather (NRB) and in some cases the cool night air can decrease the upper airway swelling/edema associated with croup.
- Keep the child calm and allow him/her to stay with the caregiver/parent if possible to minimize stress.
- Stress might exacerbate breathing and result in greater respiratory distress/hypoxia.
Epiglottitis (S&S, care)
A rare but serious upper respiratory infection.
- Vaccinations of infants against the bacteria Haemophilus influenzae type B have decreased the incidents of epiglottitis,
-Difficulty and pain swallowing (which is why drooling is commonly seen)
- High temperature (102–104 °F)
- Change in voice and pain upon speaking
- Tripod position
- Inspiratory stridor, and respiratory distress
- Do not place anything in the child's mouth. This might increase swelling and cause laryngospasm.
- Have the patient sit upright and lean forward.
- Provide oxygen 15 lpm via NRB, consider ALS, and transport.
Asthma (S&S, care)
A reactive airway disease that causes airway obstruction resulting from bronchospasm, increased mucous secretion, and mucosal edema.
- Respiratory distress
- chest tightness
- nonproductive cough.
- Apply humidified oxygen 15 lpm via NRB.
- If the child has a prescribed metered-dose inhaler (MDI), follow protocol to assist the child in using the inhaler.
- If the patient has status asthmaticus (unresponsive to bronchodilators), ensure that ALS has been contacted.
Bronchiolitis (S&S, care)
A viral infection of the lower respiratory tract that typically affects pediatric patients younger than two years.
- It is often caused by the respiratory syncytial virus (RSV), which is commonly seen in the winter months.
- Destroys the lining of the bronchioles, increases secretions, and causes severe bronchoconstriction.
- Low-grade fever
- Chest tightness
- Shortness of breath (SOB).
Apply humidified oxygen via NRB 15 lpm, place the patient in a position of comfort, and monitor vital signs and respiratory status.
A bacterial, viral, or fungal infection of the lung. It results in cellular destruction and an inflammatory response in the airways.
- As the infection progresses, cellular debris, inflammation, and mucus result in airway obstruction and respiratory distress/compromise.
- Chest tightness
- Diminished breath sounds
- Dry, hacking, productive cough.
- It is typical to see pediatric patients lying on their side with their knees drawn up in an effort to decrease plueritic pain and improve ventilation.
- Elderly patients often exhibit altered mental status, rapid decline in patient's ability to do normal activitites, many are afebrile, & are tachypneic
Apply humidified oxygen at 15 lpm via NRB, place the patient in a position of comfort, and transport.
Accompanying symptoms & prehospital care for fever (in childhood)
- Other S&S include a decrease in appetite, nausea, vomiting, and possible syncopal episodes.
- If the child is dehydrated, he/she might have a fast heart rate and may appear weak and pale, and the eyes might look sunken.
- Mucous membranes are dry and there is positive tenting of the skin when pinched.
- Fevers that spike to temperatures greater than 104 to 105°F might result in febrile seizures.
- If protocol allows, lower the child’s temperature in tepid water, apply high-concentration oxygen, remove excess layers of clothing, and transport.
- If the child has a core temperature greater than 106°F, take caution in cooling the child. A quick cool down might result in seizure.
Congenital Heart Disease
- Congenital heart disease (CHD) presents at birth and can appear to be respiratory distress, infection, and shock.
- Inadequate pulmonary blood flow resulting in cyanosis and hypoxia
- Excessive pulmonary blood flow resulting in congestive heart failure
- Respiratory distress with or without signs of shock or cyanosis.
- Ensure patent airway and provide oxygen via NRB 15 lpm.
- Support the respiratory and cardiovascular systems as necessary.
- Ensure that advanced life support (ALS) is on the way or can intercept.
Meningitis is an infection of the lining of the brain and spinal cord resulting from bacteria or a virus.
- If a child younger than three months of age has a fever, consider meningitis until proved otherwise.
Signs and symptoms:
- Recent ear infection
- Recent respiratory infection
- If the infant is dehydrated, the fontanelle is sunken.
- If the infant has increased intracranial pressure, the fontanelle bulges.
- If you suspect meningitis, wear a mask, gown, and gloves.
- Provide oxygen,
- treat for shock if present
- provide rapid transport to the appropriate facility.
Most common cause of diarrhea in child
Gastritis (lining of stomach is inflammed)
Appendix is obstructed by fecal matter, resulting in inflammation. If the appendix ruptures, it results in a severe infection in the abdominal cavity.
- Appendicitis typically causes pain around the umbilicus, described as a diffuse, cramping pain.
- Nausea and vomiting associated with a low-grade fever are common
- Right lower quadrant pain as the appendicitis worsens.
- Septic shock can result if the appendix ruptures and is not recognized.
Place the patient in position of comfort, apply oxygen, and transport.
How often to reassess pediatric trauma patients
Every 5 minutes
Leading cause of death in infants between 1 month and 1 year of age
Stereotyping or discriminating against the elderly.
Disease process that causes loss of elasticity in the vascular
walls from thickening and hardening of the vessels.
Inflammation of the lungs caused by the aspiration of vomitus or
other foreign matter.
An increase in the size of the heart caused by a thickening of the heart wall without a parallel increase in the size of the cavity.
Congestive Heart Failure
A cardiac disease in which the heart cannot pump blood
sufficiently to meet the needs of the body.
A mental and physiological state of arousal that is usually characterized by extreme strength and endurance, tolerance to pain, hostility, and hyperactive behavior; might result in sudden
cardiac death; also called excited delirium.
Chronic condition resulting in the malfunctioning of normal cerebral processes.
An adverse or toxic reaction to a drug or drugs.
- The elderly take approximately one-third of all prescribed medications and also consume the greatest number of over- the-counter medications.
- Therefore, they are susceptible to drug toxicity
Irregular contractions of the myocardium secondary to electrical
disturbances in the heart.
Abnormal curvature of the spine with convexity backward; also called slouch.
Any disease of the nerves; peripheral neuropathy is a syndrome
in which weakness, numbness, tingling, or other neuropathic
symptoms are experienced in the extremities, especially the
hands and feet.
A degenerative bone disorder associated with an accelerated
loss of minerals, primarily calcium, from the bone.
Silent heart attack
A myocardial infarction (heart attack) that does not cause chest pain or discomfort.
Abnormal narrowing of a blood vessel or other tubelike structure.
Common Geriatric Emergencies
- Heart Attack
- Congestive Heart Failure
- Pulmonary Edema
- Pulmonary Embolism
ACS & MI in geriatric patients
- 1/3 patients over 74 do exhibit symptoms of coronary artery disease
- 1/2 males, 1/3 females over 74 suffer silent MI
- Incidence of chest pain decreases with age
- Common symptoms are syncope, confusion, dyspnea
Pulmonary embolism in the elderly
- 90% of emboli originate in deep vein clots in lower extremities near pelvis
- Elderly are more prone due to immobility or reduced activity, CHF, tumors, surgery
- Common S&S are SOB, chest pain, cough, tachycardia, tachypnea
Stroke in the elderly
- Head pain may indicate bleeding within brain or skull, tumors, infection, shingles, metabolic disorders
- Headache/migrane, are less common in elderly, may be significant finding
Common Causes of Dyspnea in Elderly
- Heart Attack
- Pulmonary Edema
- Pulmonary Embolism
- Chronic Bronchitis
Common Causes of Altered Mental Status in Elderly
- Cardiac dysrhythmias, ACS
- Delirium, dementia, Alzheimer's
- Medications, drug toxicity
- Shock, severe dehydration
- Hypoxia & respiratory disorders,
- Hypothermia, hyperthermia
- Stroke, TIA
- Blood glucose abnormality
- Head Injury
Considerations when taking vitals for Elderly Patients
- Resting RR is normally higher in elderly than younger adults
- Resting HR is normally higher than 90
- Skin is dry & less elastic
- Fever is less common in elderly
- Systolic BP will increase in elderly, making blood loss or dehydration less detectable
- Pupils are more sluggish to respond to light. Eye drops patient may be taking may cause pupil dilation & fixation
Acute renal failure
A rapid loss of renal function that results in poor urine
production, electrolyte disturbance, and fluid balance
Device that monitors breathing and emits a warning signal if
Medical management of obese patients. Patients who are 20% or more over their ideal body weight are considered obese.
A BiPAP device provides back pressure, higher during inhalation and lower during exhalation, to keep bronchioles open and improve ventilation and oxygenation.
A variation from normal structure or function that is present at birth.
Clouding of the lens of the eye from pathological changes in the lens
Central intravenous catheter
A mechanism that delivers medication into the central circulation of the body.
Chronic kidney disease (CKD)
A progressive loss of kidney function over a period of months to years.
Continuous positive airway pressure (CPAP)
A CPAP device provides a constant level of back pressure during inhalation and exhalation to keep bronchioles open and improve ventilation and oxygenation.
Damage to the small blood vessels of the eye from the long-term effects of diabetes mellitus
An artificial process used to remove water and waste substances from the blood when the kidneys fail to function properly
Defective speech caused by impairment of the tongue or other muscles necessary for speech, or from damage to nerve pathways from the brain to muscles in the larynx or mouth.
Provision of nutrition through a tube inserted through the nose,
the mouth, or a surgical opening in the abdomen into the
An abnormal increase in intraocular pressure that damages the
optic nerve, resulting in loss of peripheral vision and, eventually,
A philosophy of care that provides relief of symptoms for patients
and support for their families during the late stages of a terminal
A tube surgically placed in a ventricle of the brain that extends to
a blood vessel in the neck, the heart, or the abdomen, or to an
external collector to drain excess cerebrospinal fluid from the
brain and keep intracranial pressure at an acceptable level.
A pouch or bag attached outside the body to collect feces that
are removed from the body through an opening in the abdominal
Paralysis from the neck down
A surgical opening into the neck and trachea; see also tracheostomy
Surgically implanted medication delivery devices
Medication administration devices placed surgically beneath the skin outside the rib cage; also referred to as totally implantable venous access system (TIVAS)
A device used to divert urine out of the bladder.
Vascular Access Device (VAD)
A medical device used when a patient needs ongoing intravenous medications.
A surgical opening in the trachea.
Cerebral palsy is a group of disorders caused by damage to the cerebrum in utero or by trauma during birth. There are three main types of cerebral palsy:
1. Apastic paralysis (forces muscles into a state of permanent stiffness and contracture)
2. Athetosis (causes involuntary writhing movements)
3. Ataxia (problems with coordination of gait and balance)
Types of Abuse
1. emotional abuse (pain or distress through verbal or nonverbal acts)
2. financial exploitation (illegal or improper use of assets)
3. neglect (failure to meet a person’s basic needs), 4. physical abuse (use of force that causes bodily harm or pain)
5. sexual abuse (nonconsensual sexual contact of any kind)
Signs of child abuse
- child doesn’t mind if the parents leave the room
- if the parents are present, does not look at them for reassurance
- cries hopelessly or very little during care
- is apprehensive
- is wary of physical contact (assessment)
- constantly asks for something to eat, for a comfort item (such as a blanket), or for favors.
Signs of elder abuse
- caregivers who cannot explain or give information about the patient’s condition
- elderly patients who are malnourished and dehydrated
- exhibit untreated pressure sores
- open wounds
- welts, cigarette burns
- bite marks
- unexplained fractures
- poor personal hygiene
Phases of domestic abuse
1. Phase 1 involves arguing and verbal abuse.
2. Phase 2 progresses to violence and/or sexual abuse.
3. Phase 3 consists of denial and apologies.
Sources of oxygen found in home setting
1. oxygen cylinder
3. liquid oxygen