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Chapter 21 Adolescent

Martha Driessnack

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Age and Physical Changes


11 to 13 18 to 21 years Adolescence vs. puberty

Gender difference Accelerated growth spurt Most noticeable: secondary sexual characteristicsmediated by hormonal regulation Menarche (females) late in puberty

Physical growth

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Age and Physical Changes


(contd)

Acne

increased activity, sweat and sebaceous glands; clogged/inflamed Soap/water; topical medication; stress management

Scoliosis

S-shaped curvature of spine More common in females Screening to identify, if >15 degree = referral
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Acne medications can make acne appear worse at first.

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Age and Physical Changes


(contd)

Gender

Primary sexual characteristicsessential for reproduction Secondary sexual characteristicsnonessential for reproduction Tanner staging: sexual maturity rating Signs of puberty Male: thinning scrotal sac, enlargement of testes Females: breast buds, growth spurt

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Who matures physically soonermales or females (pay attention to the answer details)?

Females begin puberty about 2 years before males.

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Genetics (There WILL be questions about this on the test)

Turner syndrome: female (X0)

Short stature, webbed neck, low-set ears, lack of sexual development, cardiac/renal anomalies, learning disabilities Hormonal therapy, infertile
Tall, thin, lack of sexual development, gynecomastia, learning/behavior problems Hormonal therapy, sterile

Klinefelter syndrome: male (XXY)


Ongoing assessment/support needed


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Health-Perception-Health-Management Pattern

Less acute illness than younger children Less chronic illness than adults Negative health choices/outcomes

Sense of invincibility Adolescent experimentation Risk-taking behaviors


Support autonomy Focus on strengths
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Partnering approach in care


Can you identify behaviors that are reflective of a teenager?

Driving without seatbelts, riding without helmets, unsafe sexual practices etc.

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Nutritional-Metabolic Pattern

Competing factors

Ideal body Fast foods, soda pop, sweets, alcohol Peer pressure Activities requiring weight restriction Increased needs with growth spurt

Dietary intake: way of gaining control, exerting independence 10% of females have eating disorders 62% females & 20% males participate in fad dieting
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Nutritional-Metabolic Pattern
(contd)

Eating disorders:

Anorexia nervosa Bulimia nervosa Binge eating disorder Overweight and obesity

Diabetes type 2

Increasing prevalence Risk increases with obesity, inactivity

Individual wellness plans and reassurance about teens bodies needed


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What percentage of adolescent females suffer from an eating disorder in the United States?

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Sleep-Rest Pattern

Need at least 8 hours sleep per night Risk of sleep deprivation

Multiple activities and responsibilities Help adolescents cope with balancing responsibilities

Nurses

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True or false? If a teenager takes a nap every day, it is normal and no cause for concern.

It may be normal, but the nurse should ask some follow up questions, such as the teenagers schedule. What might be cause for concern? Signs that sleeping is part of a response to depression.
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Cognitive-Perceptual Pattern

Piagets stage of formal operations


Lays groundwork for abstract thinking Adolescent behaviors and characteristics Introspection and egocentrism Intolerance of status quo

Eriksons theory of psychosocial developmentidentity vs. role confusion


Restaging of each previous stage development Threats to identity can result in delinquent behavior and mental health issues
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These developmental stages and tasks can be met or unmet. A person can exhibit behaviors that indicate they may not meet their task. For example, someone exhibiting certain behaviors like robbing a bank may indicate to the nurse that he may be headed towards role confusion versus meeting his task of identity.

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Cognitive-Perceptual Pattern
(contd)

Time orientation

Ability for future orientation Able to delay immediate gratification Increased cognitive skills and understanding language Receptive and expressive vocabulary increase Slang, electronic communication

Language

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Self-PerceptionSelf-Concept Pattern

Self-perception and body image

Influenced by expectations Individual Peer Societal

Goal: develop healthy self-perception/healthy body image

Assessment, anticipatory guidance, education, counseling

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CopingStress Tolerance Pattern

Ability to cope tested in adolescence Depression


Major depressive and dysthymic disorders Depressed/irritable mood or diminished interest and pleasure Assess for s/s depression; refer for treatment

Suicide

Third leading cause death in 15- to 19-yearolds Recognition of warning signs and prevention essential
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Chapter 22 Young Adult


Elizabeth C. Kudzma

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Age and Physical Changes

18 to 35 years Health promotion needs


Developing behaviors to promote healthy lifestyle Decreasing incidence of accidents, injuries, violence Healthiest period, optimal muscle strength (age 25 to 30), manual dexterity peaks

Young adulthood at a glance

Gender differences

Full growth Women: age 17; men age 21 Longevity: women > men Health care seeking: women > men
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What is the number 1 cause of death for young adults?

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Health-PerceptionHealthManagement Pattern

Behavioral health history

Risk factors for unintentional injuries

Preventive care

Maximize health status, detect problems early Age 18: full health appraisal Repeat history/physical every 2 years Screenings: BSE, testicular exam, PAP smear Over age 25: focus on coronary risk factors Cholesterol, diabetes, smoking, hypertension, metabolic
syndrome

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Health-PerceptionHealthManagement Pattern (contd)

Decision making, and risk taking


Risk-taking behavior Leading causes of death: unintentional injuries, homicide, suicide

Communicable disease

Threats: changes travel, social, sexual behaviors Drug resistance; new strains emerging Disease examples: Immunizations: Rubella, HPV (women), hepatitis B TB, HIV, Lyme disease
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Nutritional-Metabolic Pattern

Obesityepidemic proportions

Basal metabolic rate declines More intake than energy requirement = weight gain Obesity rates vary by ethnicity Factors Increasing portion size, eating out, sedentary lifestyles Teaching Increased activity, low fat, more fruits/vegetables, limit
portions

Assessment BMI, waist circumference, BP, cholesterol Iron, folic acid, calcium
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Nutritional needs/common deficiencies

Bob is a 28 year-old male with a total cholesterol of 205 and an LDL of 110. What does this indicate?
He needs counseling about cardiac disease risk factors
Hed better check himself in-he has heart disease

Hes good-no problems


Hes at risk, but its very low risk

He eats 3 meals a day from Taco Bell

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Think about it
An obese client is interested in weight reduction options and is being counseled. List the options in the order they should be utilized (remember what I told you comes first??)

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For the test also

Know the implications of metabolic syndrome-what does it indicate risk for? What do nurses usually do? Meningitis is a serious infection which is sometimes more prevalent on college campuses. We went over a question about this in class.

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Activity-Exercise Pattern

Exercise recommendations:

Aerobic exercise of moderate intensity for 30 minutes, 5 days a week Barriers: lack of time, access to facilities, safe environments

Sun/radiation exposure

Avoid excessive UV: Use sunblocks, sun-protective clothing, IF someone is going to tan, what are some safety tips for them to minimize risk of damage from UV rays?
Recreational activity history guides education Helmets for bicycles, motorcycles Mosby items and equipment for sports Protectivederived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Sports

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Sleep-Rest Pattern

Subject to fatigue

Work Stress Inactivity

Recommendations:

Changing activity or stressors Trying out new tasks or physical activities

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Cognitive-Perceptual Pattern

Piaget: formal operations

Analysis of all combinations of possibilities and constructs hypotheses; more perceptive/insightful Recall performance and memory: peaks in 20s
Increased sense of competency/self-esteem Learns to develop reciprocal intimate relationships (requires mutual trust) Define rights and morality in terms of self-chosen principles derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and

Intellectual growth

Erikson: intimacy vs. isolation


Postconventional moral reasoning

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Self-PerceptionSelf-Concept Pattern

Western culture: adulthood


Financial and residential independence Explore and experiment vs. firm commitments Pay differentials by gender Variance in benefits, occupational hazards Stress of employment Childbearing choices; child care issues Increased job burden with decreased job security

Employment issues

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Roles-Relationships Pattern

Maturing relationships and roles


Development of enduring friendships Formation of intimate relationships Decisions about life/career directions Formation of family units Multiple decisions related to child-bearing, finances,
roles/relationships Self and family development

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Roles-Relationships Pattern (contd)

Separation/divorce

Affects children, families of couple Reevaluation of basic values, strengths, personality Depression commonsupportive counseling/services

Violence

80% of violence is individual acts (homicide, suicide) Homicide: 2nd leading cause of death in15- to 24-yearolds Associated: guns, alcohol, drug abuse, crimes Intimate partner violence Crosses all demographic boundaries Underreported; women report higher lifetime violence Appropriate assessment, detection, treatment needed
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Sexuality-Reproductive Pattern
(contd)

Prenatal care

Insufficient for high-risk and minority women Leading cause of infection (high-risk age group) Screening for chlamydia recommended Multiple STDs increases risk of HIV Treatment/prevention needs of chronically ill Effective strategies to prevent new infections/improve case finding Counsel on risk-reduction behaviors Education of individuals and general public
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STDs

HIV challenges

CopingStress Tolerance Pattern

Stress

Assess for stress-related complaints Assess for signs of achievement stress Listen, offer support; referrals as needed Suicide: leading cause of death Cause: unable to cope with stressful circumstances or events More women attempt suicide; more men succeed Assess for depression and suicidal ideation
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Suicide and depression


Which of the following do YOU think indicates achievementoriented stress (hint only one of these is right

Eating too much Sleeping too much Sleeping too little Skipping meals Calling in sick every 2 weeks Expressing fear of layoffs Dancing while playing Guitar hero while at work
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Environmental Processes
(contd)

Occupational hazards/stressors

Young adults work in hazardous jobs Vocational training needed to avoid hazards Periodic assessment, counseling for risks
Drug useinjury, disability, violence, social problems Alcohol useaccidents, future chronic conditions; binge drinking Tobacco useleading cause preventable death Synergistic effect with asbestos, dust, radiation exposures
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Chemical agents

Chapter 23 Middle-Age Adult


Helene Dixon

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Age and Physical Changes


35 to 65 years Examples of general body changes:


Thinning, graying hair Skin drier, wrinkles, coarsening facial features Fat disposition, decreased muscle mass/bone density, osteoarthritis Hormonal changes Leading causes: heart disease and cancer Morbidity and mortality: influenced by lifestyle behaviors

Mortality

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Age and Physical Changes

Gender and marital status


Men: Higher mortality rate Heart disease: Number 1 cause of death Life expectanciesFemale: 80.4; Male: 75.2 Married people generally have better health Black Americans and Latino/Hispanic Americans Disproportionally low SES, less access to health care,
more likely not to have health insurance Higher probability of cancer, heart disease, diabetes, HIV

Race

Genetics

Middle adult at higher risk for genetics-associated conditions


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A nurse conducting a community education program knows that the leading cause of death in middle adults is:

Automobile Accidents
Homicide

Malignant disease
Suicide

Falling meteorites

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What medication is recommended to preserve cardiovascular health in women? Aspirin


Folic Acid

Estrogen
NSAID

Vesicare

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Health-Perception-HealthManagement Pattern

Habits: self-destructive

Smoking, alcohol, overeating Now start seeing Visible consequences Age, gender, race, personal risks Health promotion needs Health screening of diseases/behaviors Stop self-destructive behaviors Exercise

Risk factors: behavioral/environmental


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Nutritional-Metabolic Pattern

Obesity (BMI >30; overweight: BMI 26 to 29)


Substantially increased risk of chronic cardiovascular disease, diabetes, cancer Risk increases with less education, low incomes, ethnicity Prevention/management: Fewer calories Exercise 30 minutes/day; 3 to 5 days a week Social support groups

High saturated fat diet

Effect on cardiovascular/cerebrovascular morbidity/mortality Recommend total cholesterol is <200mg/dl Lifestyle modifications, medications if needed
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Nutritional-Metabolic Pattern

Calcium

Recommendations: nonpregnant adults: 1000mg; postmenopausal women without hormones: 1500mg Absorption enhanced by vitamin D

Caffeine

Readily accessible Stimulant; be aware of addiction potential Controversy over health effects of moderate consumption
Role in hypertension; increases fluids, increases vascular resistance
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High-sodium diet

What do you think a community-based education series for middle adults should focus on in order to have the highest impact

Of course there are other issues, but obesity is a major risk factor for heart disease, diabetes, and other illnesses.

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How should the nurse respond to a 40 year old client asking if adding iron will help her energy levels?
Tell me about your diet and activity
Sure, iron wont hurt and may help

Youd better ask the doctor Here are some exercise classes to consider Are you still menstruating

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Nutritional-Metabolic Pattern

Alcohol abuse

Depressant, chronic use produces tolerance Moderate drinking: <1 drink/day for women, <2 drinks/day men Increases risk of MVA, liver disease, cancer, heart disease, pancreatitis Early detection/intervention can decrease long-term sequelae Labs indicative but not sensitive/specific for ETOH abuse Treatment complex

Oral health

Gingivitis: teeth brushing/flossing needed Dental hygiene/decay: check-ups, water fluoridation, sealants
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Points to Ponder

Who has a higher death rate from complications of alcoholism, men or women? Whats considered moderation?

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Activity-Exercise Pattern

Exercise benefits

Prevent/manage chronic illness (heart, diabetes, osteoporosis, depression, cancer) Significant increase in life expectancy/quality of life
30 minutes, 5 or more days/week Continuous, rhythmic exercise (e.g., walking, jogging, swimming, bicycling) Choose activities enjoyed in past (if appropriate) Consider potential for injury, proper equipment Exercise testing if high-risk
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Exercise recommendations:

Initiating exercise program


Sleep-Rest Pattern

Compared to young adults


Less time in deep sleep Less sleep overall

Healthful guidelines

Regularly scheduled Quality sleep Occasional napping

Cognitive-behavioral therapy for problematic sleeping

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A middle-aged adult getting only 6 hours of sleep should: (hintcareful, were talking about MIDDLE adult)
Never nap during the day
Ask a doctor about a sleep aid

Examine how they feel during the day


Have a sleep screening

All of the above

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Cognitive-Perceptual Pattern

Intellectual ability

Continues to accumulate learning intelligence Formal operations: complex problems of reasoning

Piagets theory of cognitive development

Blooms hierarchy of cognitive levels of the adult learner

1) knowledge; 2) comprehension; 3) application; 4) analysis; 5) synthesis and evaluation Focus on involvement, absence of chronic disease, flexibility, family, complexity, favorable SES, personal satisfaction
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Schaies factors that maintain cognitive function:

Cognitive-Perceptual Pattern
(contd)

Perceptual changes

Presbyopia (farsightedness) Glaucoma Increased intraocular pressure Decreased visual sensitivity and peripheral vision Cataracts Decreased opacity of lens Diabetic retinopathy Presbycusis Loss of higher frequency hearing Diminished sense of taste

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A 62 year old female states that she is losing her peripheral vision. She most likely has:

Glaucoma
Presbyopia

Cataracts
Diabetic Retinopathy

Amblyopia

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Self-PerceptionSelfConcept Pattern

Levinsons theoryindividual life structures

Age-associated seasonsmidlife transition Generativity: sense of productivity, creativity, desire to care for others Stagnation: lack of accomplishment, self-absorption Affects on self-esteem: graying hair, wrinkles, body shape Perimenopause and menopause Mood swings, nervousness, fatigue, depression Hormonal therapy: indications and controversy Alternative products: little scientific data on benefit
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Eriksons theorygenerativity vs. stagnation


Physiological changes

Roles-Relationships Pattern

Midlife crisis

Time of reassessment, turmoil, change


Family life cycle Families with children (ages 13 to 20) Families launching young adults Families from empty nest to retirement Multiple responsibilities and stresses Children, aging parents, job and civic responsibilities Single parent families, adult children at home Empty-nest syndrome

Family

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Roles-Relationships Pattern
(contd)

Work

Plays major role in level of wellness, self-esteem 10 million work-related injuries yearly Role changesfamily stress factors Reentering workforce Job-related travel Nontraditional female/male roles Nature of parental work environment Retirement planning/midcareer changes Elements of work-site health promotion programs
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Two-or-more-job family

Roles-Relationships Pattern
(contd)

Caring for aging parents

Additional demands of caring for parents and children (sandwich generation) Changing parental living arrangement Guidance: discussing issues before crisis

Divorce

Multiple family member adaptations needed Potential psychological effects on children


Spouse: grief for loss of companionship, loss of future Increased awareness of finite nature of life Midlife review common
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Death

Sexuality-Reproductive Pattern

Pregnancy

77% pregnancies unintended Higher risk of maternal death, fetal complications

Changes in reproductive system

Slower arousal, orgasms less intense, long refractory between erection and ejaculation, vaginal dryness, decreased libido

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Sexuality-Reproductive Pattern (contd)

Health issues

Men: sexual dysfunction (impotence, premature ejaculation, retrograde ejaculation) Women: abnormal genital bleeding and secondary amenorrhea Both: STDs HPVcauses 90% cervical cancers HIV/AIDSadults >50 hidden risk group

Less knowledgeable Less likely to discuss sexual behavior with provider

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What should the nurse stress when talking with middle age adults about sexuality?

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CopingStress Tolerance Pattern

Factors related to coping with stress and health outcomes


Stress hardinesscontrol, commitment, challenge Tranquilizer use <50 Maturity of defenses against stress Framingham study: worry, conflict, anger, ambitiousness affect BP

Coping with death of a parent

Preparation helps feelings of control Examples: living will, advanced directive, durable power of attorney
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Values-Beliefs Pattern

Beliefs formed early; reviewed during crisis Middle-age moral transitions: valuing others, having relationships, being responsible to others Developmental theories

Erikson: caring as middle-age adult virtue Kohlberg: conventional and postconventional phases Gilligan: gender differences in moral development Women: selfishness vs. responsibility, avoid hurting others Men: justice, fairness, rights of individuals
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Environmental Factors: Physical Agents

Ionizing radiation

Cancer caused by medical test/procedures


Benzene, chlordane Auto emissions, burning fuels, industry Potentiates hearing loss

Water pollution

Air pollution

Noise pollutionoccupational hazard

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Biological Agents

Transmitted through air or food/water Enter respiratory or gastrointestinal tract Examples:


Hepatitis A Fecal-oral transmission; poor sanitation Hepatitis B Blood-borne pathogen Occupational hazard: health professionals

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Chemical Agents

Contaminants from workplace or close to industry Tobacco


Middle age: may have 30+ packs per year history Risk of heart/lung disease/cancer increased 2000 known chemicals in cigarettes Tar, cyanide, formaldehyde, carbon monoxide

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Social Processes

Culture and ethnicity


Different interpretations of health/illness Immigrants: poverty, poor living conditions Net income may be at highest level; also have greater financial responsibilities

Economics

Health care delivery system


Official agenciesstate and federally funded Voluntary agenciesAmerican Cancer Society, American Lung Association Service organizationsYMCA, hospice
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Nursing Interventions

Assess

Individual health history Baseline health (employment physicals) Environmental hazards; workplace safety Target group health trends

Screen for disease, health risks, behaviors Educate


Emphasize self-health promotion Safety (fall prevention, fires, firearms, driving) Organizational health promotion programs

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Chapter 24 Older Adult


Meredith Wallace

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Gerontology

The study of the effects of normal aging and age-related diseases on human beings.

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The fastest growing segment of the population is:


Children under age 12
Young Black American adults

Non-white older adults


White middle-age adults

Toddlers

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Demographic Profile of Older Adult Population


Clinical delineation is 65 years of age or older. Older-old adults are 85 or older. By the year 2030, the number of older adults in the United States will reach 70.2 million.

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Characteristics of the Older Adult Population


Rapidly growing. Although many stereotypes and myths are associated with aging, elders are in fact very diverse in their characteristics.

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Age and Physical Changes

Challenges in older adult health promotion

Misconceptions about benefits Differentiating normal changes from pathology Large prevalence of chronic disease Limits daily activities for 39% >65 years old Impairs ability/motivation to learn health behaviors Varying practices by cultural background Increasing health-promotion programs Decreasing morbidity/mortality

Healthy People 2010 goals


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Theories of Aging

Debate about old age

Questions of physiological, social, psychological reasons why people die

Research into theories of aging


No single theory Factors under study Genetics: predict development of disease Diet: calorie-restriction Antioxidants: binding free radicals

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Health-Perception-HealthManagement Pattern

Motivation: most important in maintaining health Nursing role: help older adults understand importance of health factors

Maintaining healthy weight/diet Staying active Fall prevention Maintaining relationships Keeping regular medical appointments

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Which client will benefit most from health promotion strategies?

Having something or someone to live for or to improve our health for is the single most important factor.

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Nutritional-Metabolic Pattern

Malnutrition factors

Access to food Decline in GI absorption, metabolism, elimination Deterioration of senses High frequency of dentition problems Cultural food preferences Living environment (e.g., institutions) Anorexia due to disease Medications

Nutritional Assistance

Food stamps, federally supported nutrition programs


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This will be on the test:

Most older adults not aware of food assistance programs. Older adults living in long-term care institutions are more likely to be malnourished. Older adults lose part of their taste; therefore, they may want more high fat, high sugar, and high salt foods.

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Elimination Pattern
Elimination Issues

Health Strategies

Constipation Urinary Incontinence

Stress Urge Overflow

Exercise Increase fiber/fluid Lifestyle modifications: weight loss, exercise, diet Voiding schedules Prompted voiding Incontinence devices Kegel exercises
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Yep, this will be on the test:

Know the difference between Stress, Urge, and Overflow incontinence

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Activity-Exercise Pattern

Increasingly important to reduce, stop, or reverse physical decline Teach benefits of exercise Find culturally acceptable exercises Popular activities

Walking Aquatic

Pre-exercise health evaluation important

Need gradual increase in activity

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Sleep-Rest Pattern

High prevalence of sleep disorders


Decrease in total hours required Increase in nocturnal awakenings, shorter periods of sleep, decrease in slow-wave activity

Nursing interventions

Teach about normal changes in aging sleep Increasing physical activity Pain management Environmental adjustments (lights/sound) Short-term sleep medications

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Cognitive-Perceptual Pattern

Mild cognitive impairment

Memory loss Language difficulties Impaired judgment/reasoning


Multi-infarct dementia: death of brain tissue Alzheimers disease

Dementia: chronic or progressive


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Cognitive-Perceptual Pattern

Screening: Mini-Mental State Examination (MMSE)


30-point scale <23 indicates cognitive impairment Medications, vaccine research, encourage stimulation, routines

Treatment

Older adults can continue to learn

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Cognitive-Perceptual Pattern: Sensory Factors

Vision

Decreased visual acuity, color discrimination, pupil size, peripheral vision; cataracts/glaucoma Safety concernsdriving Annual eye exams needed

Hearing

Inner-ear atrophy, cell degeneration Hearing and cognitive impairment correlated Annual audiology testing

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Cognitive-Perceptual Pattern: Sensory Factors

Taste/smell

Loss of taste buds Decreased acuity of olfactory nerve Changes result in large amount of salt/sugar in food Food safety issues Dental health important Should see dentist twice a year

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Cognitive-Perceptual Pattern: Sensory Factors (contd)

Skin changes

Thinner Wrinkled Fragile Safety concerns Risk of decubitus ulcer Position changes, nutrition

Chronic diseasemay decrease sensation


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WARNING WARNING WARNING!! This will be on the test!!

What is the HIGHEST priority Nursing Diagnosis related to urinary incontinence? ANSWER: There are several good ones, but PICK THE ONE THAT HAS PHYSIOLOGICAL IMPLICATIONS. LIKE, OH, SAY, IMPAIRED SKIN INTEGRITY OR SOMETHING.

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Self-PerceptionSelf-Concept Pattern

Ego integrity vs. despair


Successful: ego integrity Honest acceptance of life at peace Unsuccessful: fear of death/despair Feeling that life was lived in vain

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Pick the patient who has successfully met this developmental task

80 y/o man who tells his children he has made funeral arrangements 78 y/o female who schedules her 3rd face lift 72 y/o male reluctant to retire because work is everything to me 67 y/o female depressed because she has not been promoted for past 10 years.

Which did you pick?


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Self-PerceptionSelf-Concept Pattern
(contd)

Expansion of developmental stage


Ego differentiation vs. work-role preoccupation Body transcendence vs. body preoccupation Ego transcendence vs. ego preoccupation

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Roles-Relationships Pattern

Loss of former roleschild, sibling, spouse Grandparenting: new role

Frequently brings joy and happiness Grandparents raising children Stress issues Counseling, support groups, education may help coping

Retirement

Influences: health, more time with family, wanting to do other things, not liking work Challenges: lower income, loss of friends, disease, disability, leaving home, widowhood Resources: federal/state programs; bereavement groups, and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items volunteering opportunities

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Sexuality-Reproductive Pattern

Predictors of sexual activity: enjoyment and frequency of sex at younger age Continued need to touch and be touched Disabling medical conditions, normal aging affect expression of sexuality Nurses: help older adults compensate for normal aging/medical conditions STIs and AIDS: issue for older adults

Teach safe sexual practices


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Ability to cope

CopingStress Tolerance Pattern

Key factor in self-concept and integrity Ruminating and catastrophisizing vs. positive reappraisal

Depression

Older adult at highest risk Medical conditions, losses, physical changes

Suicide

Highest in elderlyserious illnesses, social isolation, alcohol abuse, bereavement Physician-assisted suicide/euthanasia ANA position: nurses should refuse to participate Challenge: promote value in life, alleviate suffering
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What is the ANA position on physician-assisted suicide?


You will be asked a question with a situationwhat should the nurse do? Remember, ANA is not saying refuse to take care of the patient but they are saying what?

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Values-Beliefs Pattern

Sense of spirituality

Influences motivation and lifestyle Different from religiousness Process of meaning-making

Nursing role

Promote spiritual health Spiritual assessment tools Open-ended questioning to encourage discussions

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The following slides (101104)

Contain content which may or may not be on the test, but are important elements of older adult G&D.

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Pathological Processes: Accidents

Falls

Leading cause of morbidity/mortality Causes: neuromuscular dysfunction, osteoporosis, stroke, sensory impairment Risk assessment and prevention are essential Risk factors include small thin frame, white, family history, inactivity, low calcium intake

Osteoporosisbrittle bones

Impaired heat/cold perception Preventing injury

Driving considerations
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Pathological Processes: Biological Agents

Influenza

Major cause of morbidity/mortality Recommendation: yearly vaccination Vaccination advised: booster if first vaccination before age 65 and >5 yrs Incidence rising Risk factors: poverty, homelessness, substance abuse, AIDS Assess for s/s TB; medication adherence
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Pneumococcal infections

Tuberculosis

Drug Use

Effects of aging

Drug absorption, metabolism, excretion

Side effects of medication Drug-drug interactions


Good medication history Start with lowest effective dose

Ability of older adults to self-administer Medication affordability Use of illegal drugs

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Polypharmacy

The problem of clients taking numerous prescription and over-the-counter medications for the same or various disease processes, with unknown consequences from the resulting combination of chemical compounds and cumulative side effects.

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