Ch. 23 Adult Women and Men Community Final

Name the 3 major Chronic lower respiratory diseases

Chronic lower respiratory diseases: 3 major conditions: -Emphysema -Chronic bronchitis -asthma

Does CVD affect more men or women? Any ethnic disparities?

*CVD affect more women then men, but there are also ethnicity disparities*

Cigarrette smoking is a major risk factor for COPD and other Chronic Lower Respiratory Diseases. What are some other factors that affect?

*Environmental exposure* -Contact with dust, chemical fumes, and vapors increase the risk of developing chronic bronchitis (coal mining, textile manufacturing, grain handling, livestock farming, work in nail salons)

What is Genitourinary syndrome of menopause? What are symptoms of it?

*Genitourinary syndrome of menopause: group of sx r/t this loss of estrogen and other endogenous steroids* -*Sx include* genital dryness, irritation, burning, sexual sx such as inadequate lubrications and painful / impaired sexual functioning -*Includes sx s/a* urinary frequently, urgency, painful urination, and frequent UTIs

One reason why the US has lower life expectancy is because of health literacy ability. What is health literacy? What does low health literacy contribute to?

*Health literacy*: the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health-related decisions -*low health literacy contributes to health disparities* [certain racial and ethic groups have issues in US]

What is the Longest running study related to women's health in the world?

*Nurses' Health Study I* -Longest running study related to women's health in the world - investigates factors that influence the health of women.

Sadly, the US is in 10th place behind even Korea for life expectancy - 4 years behind! What is one issue that causes this to be the case?

*Well Health Literacy* is one issue - low health literacy contributes to health disparities and has been documented among certain racial and ethic groups over age of 65 in the US

Ethnic disparities in CVD: -Black & Hispanic / Latino women -Black Americans -Mexican Americans -Asian Americans

-*Black & Hispanic / Latino women are at higher risk* of death from CVD (and are less likely to recognize sx) -Black Americans are more likely to have a 1st stroke earlier and more likely to die from stroke complications than whites -Mexican Americans both male and females have a lower risk than whites -In Asian Americans, CVD causes more deaths then all forms of cancer combined (within this group)

Cancer: -Caused by internal and external factors. Name some internal and external factors

-*Internal*: inherited gene mutations, hormones, immune conditions, gene mutation that occur from metabolism -*External*: tobacco / alcohol use, chemicals, radiation, infectious organisms, and poor lifestyle choices

Adult Men (35-65) - *Prostate Health:* -Can experience prostate enlargement (BPH) or infection (Prostatitis). -Prostate CA most frequently dx CA in men -Occurs more in black men -Recommended screening at 45 for black men or those who have a father / brother with prostate CA before 65 -Men with 2 or more close relatives should screen at 40 -Treatment includes surgery (remove all or part of prostate), radiation, and hormone therapy

Adult Men (35-65): -*Physical, emotional, financial demands*[children in college, bear burden of family finances, may lose loved ones, may be suffering with illness/disease] -*Midlife crisis* [Reappraisal of values, priorities, and personal relationships can occur at this time] -*Retirement* [where men can decide their retirement goals]

Adult Men (35-65): -*Reproductive health* [may choose permanent birth control through vasectomy. Erection problems can be common and erectile dysfx (aka impotence). May take Viagra to help] -*Heart disease & men* [About 1 in 2 adult men have some form of CVD and it is the leading cause of death among males in most racial / ethic groups. Educate men on modifying risk factors for CVD and discuss S&S of MI and how to access emergency medical treatment]

Adult Women (35 to 65) - *Chronic fatigue & Immune dysfunction syndrome aka Myalgic Encephalomyelitis*: -Characterized by *persistent and debilitating fatigue and additional nonspecific sx* (sore throat, HA, painful muscles, joint pain, difficulty thinking, and loss of short-term memory) -Rest does not relive the fatigue and sx may wax and wane and can last for months or years -No specific cause found or treatment - *treatment focused on supportive care*

Adult Women (35 to 65) - *Chronic fatigue & Immune dysfunction syndrome aka Myalgic Encephalomyelitis*: -The PHN can *assess activity level, degree of fatigue, emotional response to illness, and coping ability* -PHN can *refer women to mental health counseling or local support groups* [since anxiety and depression is associated with any kind of chronic illness]

Adult Women (35 to 65) - Cancer: -Most common cancer among women? - Deadliest cancer for women? -To promote breast health: (5)

Adult Women (35 to 65) - Cancer: -*Breast CA is the most common* among women - but *more women die from lung CA* -*To promote breast health*: clinical breast exams, mammograms, eating diet low in fat and high in fruits / veggies, breast-feeding if possible, and avoiding prolonged use of menopausal HT

Adult Women (35 to 65) - Cancer: -CA 2nd leading cause of death for women -Genetic mutations play a role, but *only a small % of CA though are hereditary* -Most CA occur in persons 55 and older -PHN can *seek opportunities for education and screening in this population* -*Screening has reduced deaths for CA of breast, colon, rectum and cervix*

Adult Women (35 to 65) - Heart Disease: -*Heart disease, CVD number one killer of women* -Women have *higher mortality rate after heat attack and poorer outcomes than men* (most likely due to a delay in treatment) [partially due to women having different sx than men] -*"Go red for women"* is a public awareness program to help increase awareness that women also have heart disease and even more of a killer than for men.

Adult Women (35 to 65) - Osteoporosis: -*Gradual loss in bone density* -Bone density peaks at age 25 and over time bones become fragile and easily fracture -US estimates 1 in 5 women have osteoporosis -PHN *need to stress importance of strong bones early* -*Bone density influenced by* heredity, race/ethnicity, physical activity, and nutrition

Adult Women (35 to 65) - Osteoporosis: -*Meds used are* bisphosphonates (to help build bone mass), selective estrogen receptor modulators (slow rate of bone loss), calcitonin (slows rate of bone loss), and teriparatide (helps build up new bone) -*Women >65 should be screened for osteoporosis with normal risk* [women with high risk factors will be screened earlier]

Adult Women (35 to 65) Menopause: -Menopause is a *cessation of menstrual activity for 12 months or longer* -During this time there is a *dramatic drop in hormone levels* which is responsible for many of the unpleasant sx women may experience -*Can have natural menopause or surgical menopause* (found when ovaries are removed (sudden loss of estrogen) such as in radical hysterectomies) -*Menopause sx may last from months to years and range in severity from woman to woman*

Adult Women (35 to 65): -*Health choices: Good or Bad* [health choices are either paying off or creating health issues - still time to change!] -*Undetected diseases* [women are still dying prematurely due to these]

COPD is a major cause of disability in the US. What is COPD comprised of? Major risk factor for COPD?

COPD = emphysema and chronic bronchitis. -Cigarette smoking is the major risk factor for developing COPD

Cancer: ___ leading cause of death in the US -This type of CA is the #1 cause of cancer and death among adults [and 3 reasons why]

Cancer: -*2nd* leading cause of death in US -*Lung CA* is the #1 cause of cancer and death among adults [*3 reasons why*: 1: Cigarette smoking is the predominant risk factor 2: Occupational / environmental exposer to secondhand smoke, radon, asbestos, genetic susceptibility (disease at an early age) and hx of TB follow 3: Low-dose spiral CT scans and molecular markers in sputum have great results in detecting lung CA at earlier and more treatable levels of lung CA]

Colon and rectal CA is *3rd* most common cancer in adults: -90% of all rectal CAs are dx at ______ years or older -Several *modifiable risk factors*: obesity, physical inactivity, diet high in red or processed meat, alcohol consumption, long-term smoking, low intake of whole grains, fruits, and vegetables -Others: inherited genetic mutations, personal / family hx of polyps or colorectal CA, and personal hx of chronic inflammatory bowel disease -Screening should begin at age ____ for men and women who are at average risk

Colon and rectal CA is 3rd most common cancer in adults: -90% of all rectal CAs are dx at *50* years or older -Several modifiable risk factors: obesity, physical inactivity, diet high in red or processed meat, alcohol consumption, long-term smoking, low intake of whole grains, fruits, and vegetables -Others: inherited genetic mutations, personal / family hx of polyps or colorectal CA, and personal hx of chronic inflammatory bowel disease -*Screening should begin at age 50 for men and women who are at average risk*

Coronary Artery Disease & Stroke: -Cardiovascular mortality has declined by 50% [Attributed to? (3)] -Still an issue however!

Coronary Artery Disease & Stroke: -Cardiovascular mortality has declined by 50% [Attributed to EBP, lifestyle and environment changes as well as early recognition of sx] -Still an issue however!

Diabetes Mellitus: -_____ leading cause of death in US -DM is a chronic health condition that puts a person at risk for other serious health conditions such as (6)

Diabetes Mellitus: -*7th* leading cause of death in US -DM is a chronic health condition that puts a person at risk for other serious health conditions such as *heart disease, CVA, HTN, blindness, kidney disease, and nervous system diseases such as neuropathy*

Differences between Female & Male: -After heart disease and cancer, what is the 3rd leading cause of death for men/women?

Differences between Female & Male: -Cerebrovascular disease (Stroke) is the 3rd leading cause of death in women -Unintentional injuries were the 3rd leading cause of death in men

What causes asthma?

Exact cause of asthma is unknown but believed to be *both genetic and environmental factors* -18.9 million adults dx with asthma in US, highest among 18-24 year olds. -Prevalence *higher in women* (10.7%) then men (8.1%) -*Higher rates occur in multiracial* (15.1%) and Black adults (10.8%) then white adults (8.7%)

Young Adult (18-35) - HIV and Men: -Despite advances in prevention and treatment this disease still *disproportionately effects men* in the US -2012 stats show men for 75% of all dx among adults and adolescents and 69% of those males were men who had sex with men -Race / Ethnicity: *new HIV infections among black men are 6.5x higher* than white men and 2x higher than Hispanic / Latino men -*Alcohol and illicit drug use decrease inhibitions and increase risk of transmission of HIV* -*Issue with sharing needles* and other injection equipment -PHN must remain nonjudgmental and educate men on substance abuse, safety, and sexual relationships

HIV and Men: -Despite advances in prevention and treatment this disease still *disproportionately effects men* in the US -2012 stats show men for 75% of all dx among adults and adolescents and 69% of those males were men who had sex with men -Race / Ethnicity: *new HIV infections among black men are 6.5x higher* than white men and 2x higher than Hispanic / Latino men -*Alcohol and illicit drug use decrease inhibitions and increase risk of transmission of HIV* -*Issue with sharing needles* and other injection equipment -PHN must remain nonjudgmental and educate men on substance abuse, safety, and sexual relationships

Heart Disease: -Some areas of the US have this as more of a problem -lots of reasons for those differences (cultural. Dietary norms, level of physical activity in the area, ect). -*it's important to know where you're working to know what tends to be the most prominent issues in physical health* (for instance heart disease rates in Alabama vs Colorado makes one state an issue for heart disease and not much of an issue in the other)

Hormone Replacement Therapy (HRT): -Treatment can be estrogen alone, estrogen plus progesterone or estrogen plus progestin -Controversy?

Hormone Replacement Therapy (HRT): -Treatment can be estrogen alone, estrogen plus progesterone or estrogen plus progestin -Controversy d/t 2002 *study finding increased rate of breast CA, ovarian CA, heart disease and CVA* in healthy women who were taking combined estrogen and progestin HRT

What is Hormone Replacement Therapy (HRT) and how can it help with menopause?

Hormone Replacement Therapy (HRT): -can *reduce the sx of menopause, as well as overall fat mass reduction, increased insulin sensitivity, and lower rates of type II DM*

In place of HRT some women have choose Bioidentical Hormone Therapy (Bio-Chemical Hormones): -In a study of those taking *BCH (bio-chemical hormones) vs HRT - both reported relief of sx, but BCH had better relief of sexual sx*. -However it was found that BCH has similar risk factors to HRT -So both *HRT and BCH are a risk/benefit choice for women and some doctors chose to just treat symptoms individually instead of doing hormone replacement]*

In place of HRT some women have choose Bioidentical Hormone Therapy (Bio-Chemical Hormones): -*Chemically similar hormones derived from plants* -*Some of these meds are approved and others are not* as they are not always scientifically based - however used for marketing purposes -There are also bioidentical hormones prepared by a compounding pharmacist (BCH)

In place of HRT some women have choose Bioidentical Hormone Therapy: -*Chemically similar hormones derived from plants* -*Some of these meds are approved and others are not* as they are not always scientifically based - however used for marketing purposes -There are also bioidentical hormones prepared by a compounding pharmacist (BCH)

Life Expectancy: -Has increased steadily -Globally, the US trails many countries in longevity -Differences in life expectancy between whites and blacks for both genders?

Life Expectancy: -Has increased steadily -Globally, the US trails many countries in longevity Differences in life expectancy between whites and blacks for both genders: -White male 4.4 years greater than black male -White female 2.8 years greater than black female

Men's Health - Differences: -Gender is one of the many factors that influence health -*More male neonates die at birth* and *men are more likely to die earlier* from a chronic illness than women -*Women survive an average of 5 years longer than men*

Men's Health: -Men are *socialized to be independent and conceal vulnerability*. Due to this they are *less likely to access the health care system* with issues involving health - both physical or mental -They *practice more hazardous activity* and as a result have a *high death rate from unintentional injuries* -There is a *lack of health programs for men and a lack of male gender-specific research*

Adult Women (35 to 65) Menopause: Menopause sx may last from months to years and range in severity from woman to woman. Name symptoms of menopause (a ton)

Menopause Symptoms: -Hot flashes, nervousness / anxiety, chills excessive sweating (often at night), excitability, fatigue, mood disorders (apathy, mental depression, crying episodes, insomnia, palpitations, vertigo, HA, numbness, tingling, myalgia, urinary disturbances, and vaginal dryness - may also have issues with sexual function

Nurses' Health Study I: investigates factors that influence the health of women Nurses' Health Study II: Represented women who started using oral contraceptive in adolescence Nurses' Health Study III: Still on-going

Obesity / Substance Abuse: -Obesity defined as a BMI over? -BMI over ____ = severe obesity -What is a clinically and cost-effective intervention for obesity? [what is needed to do this?]

Obesity / Substance Abuse: -*Obesity defined as a BMI >30* -BMI >40 = severe obesity -*Bariatric surgery* is a clinically and cost-effective intervention [Careful consideration must be given, need a LIFE change and commitment]

Prescription drug abuse or misuse is one of the fastest-growing forms of drug abuse - 3 Most common abused types of meds: -*Males more likely than females to abuse* rx drugs

Prescription drug abuse or misuse is one of the fastest-growing forms of drug abuse -Most common: *opioids* (for pain), *CNS depressants* (to treat anxiety / sleep disorders), *stimulants* (treat ADHD) -*Males more likely than females to abuse* rx drugs

Risk factors include both personal and hereditary factors -Gender, age, race/ethnicity, cholesterol level, DM, obesity, physical inactivity, HTN, and cigarette smoking -The most *modifiable are cholesterol, HTN, cigarettes smoking, obesity and physical inactivity* [so PHN's want to focus our attention here]

Role of the Community Health Nurse: *Primary Prevention*: -Focus on? (2) -PHN work mostly as educators - spending time working with individuals and encouraging routine health exams, healthy eating habits, adequate sleep, moderate drinking, and no smoking -PHN can focus on needs for services & programs to keep population health such as flu clinic, teaching sexual responsibility, and preventing STIs

Role of the Community Health Nurse: *Primary Prevention*: -*Focus on education and a health lifestyle* -PHN work mostly as educators - spending time working with individuals and encouraging routine health exams, healthy eating habits, adequate sleep, moderate drinking, and no smoking -PHN can focus on needs for services & programs to keep population health such as flu clinic, teaching sexual responsibility, and preventing STIs

Role of the Community Health Nurse: *Secondary Prevention*: -Focus on? -PHN must assessing needs and the plan, implement, and evaluation programs that focus on early detection -*Examples*: ?

Role of the Community Health Nurse: *Secondary Prevention*: -Focus on *screening for early detection and treatment* -PHN must assessing needs and the plan, implement, and evaluation programs that focus on early detection -*Examples*: mammography clinics, teaching breast and TSE (testicular self-exam), BP, Blood glucose, BMI, and cholesterol screenings

Role of the Community Health Nurse: *Tertiary Prevention*: -Focus on? -Example of organization for this? -This level can become complicated due to the many body systems involved! -Willingness to change may be complicated d/t social systems (family expectations, roles within the family, expected behaviors) -PHN must work in the community and helping those that can be or wants to be motivated.

Role of the Community Health Nurse: *Tertiary Prevention:* -Focus on *rehab and preventing further damage* to an already compromised system -*Focus on VA* - as many veterans are affected by smoke-related illnesses (began smoking in military) -This level can become complicated due to the many body systems involved! -Willingness to change may be complicated d/t social systems (family expectations, roles within the family, expected behaviors) -PHN must work in the community and helping those that can be or wants to be motivated.

Stroke (CVA) is 4th among all causes of death in the US: -On average someone in the US has a stroke every 40 seconds -*Women have a higher risk* of stroke then men (55,000 more women have a CVA then men every year) -Risk of having a first stroke is *twice as high for blacks* than whites and blacks are more likely to die following a stroke as compared to whites -The *southeastern US is considered "the stroke belt"* where death rates are higher than in any other part of the country [demographics show that obesity and diet norms are very fatty foods there which cause the issue]

Name the Top 10 leading causes of death for all people

Top 10 leading causes of death for all people: 1: Heart disease 599,711 2: Malignancy 582,623 3: Chronic lower resp diseases 143,489 4: Cerebrovascular diseases (Stroke) 128,546 5: Accidents (unintentional) 127,729 6: Alzheimer's Disease 83,637 7: Diabetes mellitus 73,932 8: Influenza & Pneumonia 50,636 9: Nephritis (and other kidney diseases) 45,622 10: Intentional self-harm (suicide) 40,600

Unintentional Injuries: -Drugs are to blame for the majority of poisoning deaths in the US [*Prescription OD*]. The majority are what meds?

Unintentional Injuries - Prescription OD: -*Majority were opioid analgesics* including hydrocodone, morphine, and oxycodone, fentanyl, and methadone

Unintentional Injuries: -_____ leading cause of death overall Top 3 causes:

Unintentional Injuries: -*5th* leading cause of death overall Top 3 causes: -*MVC* -*Poisoning* -*Falls*

Young Adult Women (18-35) Eating Disorders: -Anorexia nervosa, bulimia nervosa, and binge eating are common in this age group -History of abuse, family hx of eating disorder, and with emotional distress are factors playing into each

Was just in notes: Substance Abuse (includes alcohol and drug) -Moderate drinking defined as 1 drink/day for women and up to 2 drinks/day for men -Binge drinking defined as 5 or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days -Heavy drinking defined as 5 or more drinks on the same occasion for each of 5 or more days in the past 30 days [heavy drinking has a physical consequence along w/ the psycho/social ones]

Women's Health Initiative: -What did it address?

Women's Health Initiative: -*Addressed CVD, CA, and osteoporosis* and was one of the largest prevention studies of its kind in the US starting in 1991 and spanning 15 years

Women's Health Initiative: 3 major components: -*Randomized control trial* that showed promising but unproven approaches to prevention -*Observational study* to identify predictors of disease -*Study of community approaches to developing healthful behaviors*

*Women's' Health Study*: -Was a randomized, double-blind placebo controlled clinical trial to study the use of low-dose aspirin to prevent heart attack & stroke in women 45 years of age and older -What did it find?

Women's' Health Study: -Was a randomized, double-blind placebo controlled clinical trial to study the use of low-dose aspirin to prevent heart attack & stroke in women 45 years of age and older -Found that *low-dose asa did not prevent 1st heart attacks or death from CVD* diseases, however *was found to decreases CVA by 17%*

Young Adult (18-35) - *Testicular Cancer*: -Occurs *most often in men 20-34 and only a few risk factors have been identified* (personal history of undescended testicle, family hx, race / ethnicity (white), age, and tall stature) -*Detected early - it is highly curable* and the American Cancer Society urges that young men know how to *perform a TSE (testicular self exam!!!)*

Young Adult Men (18-35): -Training, education for personal or financial career -Select a lifetime companion like women and establish a home -*May or may not experiment with sex and drugs* like tobacco, alcohol or illicit drugs throughout college, military or working at a full time job -*Men engage in behaviors or take risks often times without thinking of the consequences* (drag racing, binge drinking, fast driving)

Young Adult Men (18-35): -Young men *may question their sexuality* at this stage and experiment with men, women or both. As well, transgender males may present themselves at this time. -*Risk for STI are due to sexual experimentation* - PHN need to encourage safe sex, limiting sexual partners, using condoms and monogamy (sex with only one partner) as well as abstinence

Young Adult Women (18-35) Reproductive health: -By 25 y/o at least 50% of childbearing women have given birth once -Community health nurses have been spearheading reproductive health for decades - *advocating for clients and influencing public policy to improve access to care for women* -*Sexual health are also important*, including the protecting from STIs. -2 most common are Chlamydia & Gonorrhea -If treatment is delayed, women can develop PID (pelvic inflammatory disease), chronic pelvic pain, ectopic pregnancy, and infertility

Young Adult Women (18-35): -There are major developmental tasks to form _________ and develop _________ -As a young adult a woman can choose a spouse, build a family and establish a home Personal philosophy's are developed -Typically healthy, though risky behaviors (unprotected sex, physical inactivity, poor eating) can occur

Young Adult Women (18-35): -There are major developmental tasks to *form identity and develop intimacy* -As a young adult a woman can *choose a spouse, build a family and establish a home* Personal philosophy's are developed -*Typically healthy, though risky behaviors* (unprotected sex, physical inactivity, poor eating) can occur

Ch. 23 Adult Women and Men Community Final

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