Adolescent, Young, Middle, Older

Chapter 21 Adolescent
Martha Driessnack
Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
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


(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
Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 3
Acne medications can make acne appear worse at first.

(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
Who matures physically soonermales or females (pay attention to the answer details)?
Females begin puberty about 2 years before males.
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

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
Partnering approach in care

Can you identify behaviors that are reflective of a teenager?
Driving without seatbelts, riding without helmets, unsafe sexual practices etc.
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
(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

What percentage of adolescent females suffer from an eating disorder in the United States?
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
13
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.
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
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.
(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

17
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
18
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
Chapter 22 Young Adult

Elizabeth C. Kudzma
Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate Elsevier Inc. Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of of Elsevier Inc.
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
What is the number 1 cause of death for young adults?
22
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
23
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
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
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
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??)
27
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.
28
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
29
Sleep-Rest Pattern
Subject to fatigue

Work Stress Inactivity
Recommendations:
Changing activity or stressors Trying out new tasks or physical activities
30
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
31
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

32
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
33
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
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
STDs

HIV challenges

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
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
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
Chemical agents

Chapter 23 Middle-Age Adult

Helene Dixon

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

40
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

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

Folic Acid
Estrogen
NSAID
Vesicare
43
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

44
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
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
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.
47
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
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
Points to Ponder
Who has a higher death rate from complications of alcoholism, men or women? Whats considered moderation?
50
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
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
52
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
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
Schaies factors that maintain cognitive function:
(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
55
A 62 year old female states that she is losing her peripheral vision. She most likely has:
Glaucoma
Presbyopia
Cataracts
Diabetic Retinopathy
Amblyopia
56
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
Eriksons theorygenerativity vs. stagnation

Physiological changes

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
58
(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
Two-or-more-job family
(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
Death

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
61
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
62
What should the nurse stress when talking with middle age adults about sexuality?
63
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
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
65
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
66
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
67
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
68
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
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
70
Chapter 24 Older Adult

Meredith Wallace
Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate Elsevier Inc. Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of of Elsevier Inc.
Gerontology
The study of the effects of normal aging and age-related diseases on human beings.
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
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.
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.
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

76
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
77
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
78
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.
79
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

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.
81
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
82
Yep, this will be on the test:
Know the difference between Stress, Urge, and Overflow incontinence
83

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
84
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
85
Mild cognitive impairment
Memory loss Language difficulties Impaired judgment/reasoning

Multi-infarct dementia: death of brain tissue Alzheimers disease
Dementia: chronic or progressive

86
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
87
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
88
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
89
Cognitive-Perceptual Pattern: Sensory Factors (contd)
Skin changes

Thinner Wrinkled Fragile Safety concerns Risk of decubitus ulcer Position changes, nutrition
Chronic diseasemay decrease sensation

90
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.
91
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
92
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?

(contd)
Expansion of developmental stage

Ego differentiation vs. work-role preoccupation Body transcendence vs. body preoccupation Ego transcendence vs. ego preoccupation
94

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
95

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

Ability to cope
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
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?
98
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
99
The following slides (101104)
Contain content which may or may not be on the test, but are important elements of older adult G&D.
100
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
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
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
103
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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Chapter 21 Adolescent

Age and Physical Changes

11 to 13 18 to 21 years Adolescence vs. puberty

Age and Physical Changes

Acne medications can make acne appear worse at first.

Age and Physical Changes

Females begin puberty about 2 years before males.

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

Turner syndrome: female (X0)

Klinefelter syndrome: male (XXY)

Ongoing assessment/support needed

Sense of invincibility Adolescent experimentation Risk-taking behaviors

Partnering approach in care

Can you identify behaviors that are reflective of a teenager?

Increasing prevalence Risk increases with obesity, inactivity

Individual wellness plans and reassurance about teens bodies needed

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

Piagets stage of formal operations

Eriksons theory of psychosocial developmentidentity vs. role confusion

Self-perception and body image

Influenced by expectations Individual Peer Societal

Goal: develop healthy self-perception/healthy body image

Assessment, anticipatory guidance, education, counseling

CopingStress Tolerance Pattern

Ability to cope tested in adolescence Depression

Chapter 22 Young Adult

Age and Physical Changes

18 to 35 years Health promotion needs

Young adulthood at a glance

What is the number 1 cause of death for young adults?

Behavioral health history

Risk factors for unintentional injuries

Health-PerceptionHealthManagement Pattern (contd)

Decision making, and risk taking

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

Nutritional needs/common deficiencies

Hes good-no problems

He eats 3 meals a day from Taco Bell

For the test also

Work Stress Inactivity

Changing activity or stressors Trying out new tasks or physical activities

Piaget: formal operations

Erikson: intimacy vs. isolation

Postconventional moral reasoning

Western culture: adulthood

Maturing relationships and roles

Roles-Relationships Pattern (contd)

CopingStress Tolerance Pattern

Suicide and depression

Chapter 23 Middle-Age Adult

Age and Physical Changes

35 to 65 years Examples of general body changes:

Age and Physical Changes

Gender and marital status

Middle adult at higher risk for genetics-associated conditions

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

Risk factors: behavioral/environmental

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

High saturated fat diet

Initiating exercise program

Compared to young adults

Less time in deep sleep Less sleep overall