adult

palliative care

-A program that provides supportive care to a client who has serious medical condition; focuses on pain and symptom relief. -Palliative care focuses on providing quality of life to the client with a serious medical condition and their family while the client undergoes treatment. Some serious medical conditions where palliative care is often part of the health care team include heart failure, Parkinson's disease, dementia, cancer, and chronic obstructive pulmonary disease. The palliative care team is composed of different health care professionals, including physicians, nurses, nutritionists, chaplains, and social workers. Palliative care can start at the beginning of the client's treatment or may be added when the client's condition and resources indicate the need.

caregiver considerations

-Advantages of family or friends as caregivers: Familiar with client, Familiar with home May live close to client, Availability at off-hours, Cost savings -Disadvantages of family or friends as caregivers: Not trained in detecting health changes, May not be able to make time commitment, May prefer to remain in family/friend role, Stress of care may cause health problems for caregivers

manifestations of stress for caregivers

-Depression: Slowed responses, not enjoying usual activities. -Burnout: Exhaustion, not wanting to perform tasks. -Guilt: Inappropriate feelings of blame. -Isolation: Not wanting to commune with others socially

caregiver roles

-Maintaining safety (e.g., fall prevention) -Fixing meals -Dressing client, appropriate to weather -Cueing or assisting client with hygiene (bathing, brushing teeth) -Giving medications at the correct time -Providing companionship -Going grocery and other shopping -Doing light housework (laundry, making bed) -Providing transportation to health care appointments -Preventing elopement (leaving) if client is confused -Other duties, as needed

Medicare vs Medicaid

-Medicare: National insurance program for people aged 65 years and older and those who are disabled. -Medicaid: National program that provides health coverage to low-income people.

end of life care

-The last stage of life brings many complexities and losses. The nurse should ensure that, just as the client is empowered to make informed health decisions throughout life, the end-of-life decisions are informed, safe, and appropriate. The nurse's ability to assess the condition of the client (such as loss of smell, vision, or hearing), the safety of the environment (such as the risk of falls and dangerous neighborhoods), the abilities of caregivers (such as predatory relatives or living alone), and progression of chronic illnesses (such as diabetes or hypertension) are all vital in providing individualized client care.

eligible for medicare or not matching

-eligible: 67 yo need mammogram, 39 yo w kidney failure, 45 yo bling man -not: 40 yo tourist from canada, 8 yo needing vaccine, 23 yo lgbt person

modifiable and non

-modifiable: lack of exercise, drug use, smoking -nonmodifiable: gender, age, race

prevention levels matching

-primary: immunization, exercise -secondary: mammogram, low dose aspirin -tertiary: caregivers support group, physical therapy

definitions

-queer: A person who is not heterosexual or is not cisgender. This term should only be used to self-identify and not used to describe or refer to another person. -questioning: A person who is questioning gender identity or sexual orientation. -intersex: A person who was born with a combination of male and female biological traits. -asexual: A person who is not sexually attracted to others -two spirit: A term used to define indigenous people who express their sexual orientation in non-Western ways or associate themselves as part of the LGBTQIA in a native context.

case study

A few hours later, the nurse admits a 75-year-old client who was released from the hospital the day before and is very concerned about the medical bills from their recent hospital stay.

sandwich generation

A generation that is taking care of both their parents and children/grandchildren.

health disparities of the population

A goal of Healthy People 2030 is to address health disparities and promote health equity. Health disparities can be linked to race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location. Nurses are responsible for identifying these issues in caring for clients in all environments as it can impact the ability of the client to adhere to the prescribed care regimen. -According to the Centers for Disease Control and Prevention, health equity will be achieved when everyone has the opportunity to reach their full potential, and no one is disadvantaged from not meeting that potential because of their social position or some other socially determined circumstances. For example, people who do not have a lot of money will still be able to have access to quality health care.

health disparities

A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.

durable

A person a client selects in advance to make future medical decisions for them if they are unable to do so.

mortality

A term related to the number of deaths caused by the health event under investigation.

acute and chronic illness

An illness can be either an acute illness or a chronic illness. However, both acute illness (e.g., injuries, strokes, heart attacks,) and chronic illnesses (e.g., diabetes, Alzheimer's) can affect client health. Research has demonstrated that there is a link between the presence of health disparities and the occurrence of many chronic illnesses including heart disease, cancer, chronic lung disease, stroke, Alzheimer's disease, diabetes mellitus, and chronic kidney disease. Morbidity and mortality are major factors in life expectancy. Life expectancy for men is 75.1 years and 80.5 years for women. However, health disparities increase both morbidity and mortality.

disability

An impairment (physical or mental) that in some way limits at least one major life activity.

A client who is in hospice is confused and has been experiencing constipation for three days. Which of the following nursing actions is the most appropriate? A Obtain a prescription for a barbiturate. B Call the health care provider. *C* Administer laxatives to treat constipation. D Inform the family members that the client needs more water.

Administration of laxatives will help to alleviate constipation. Barbiturates will not help at this stage because the client is terminally ill, and confusion is an expected finding. While increasing fluid intake can help with constipation, it is not the best option for this client as forcing fluids can lead to fluid overload. Calling the health care provider is not needed yet unless this is a new episode or there is no improvement following laxative administration.

adult day care and older adult health center

Adult day care provides assistance and support for older adults to increase socialization and engagement and promote an active lifestyle during the day. These services help the family and caregivers of older adults to be able to take care of other responsibilities such as work, personal business, and health. Adult day care is a good alternative to long-term care (e.g., a nursing home) because it is a safe but affordable option for many people with health disparities. Adult day health care or older adult health centers offer care for those who have serious medical conditions (like pressure ulcers) that require more intensive care or nursing home care.

What is the difference between adult day care and an older adult health center? (Submit your response to compare it to an expert response.)

Adult day cares keep the older adult engaged and able to have an active lifestyle while an older adult health center offers care for those who have serious medical conditions.

hospice care

Aging clients may already be receiving home health because they are homebound and need a visiting nurse or allied health professional for care. However, toward the end of the client's life (last six to 12 months), hospice care may be more appropriate. Hospice care focuses on providing comfort to those who are near the end of life and their families. Clients who have serious medical conditions that cannot be cured or clients who declined further treatment can qualify to have hospice care. The different options for hospice care (such as visiting nurses, aides, chaplains, and medications) may be discussed by the clients with their health care provider. Hospice care can be offered by either nursing visits to the home, in a hospital, or at a specific hospice center. The client can withdraw from hospice at any time and resume as needed.

more

Aging is a factor that can predispose a client to develop either acute or chronic illnesses/conditions. Throughout the client's lifespan, the client may be more or less likely to get certain diseases. For example, diabetes mellitus type 2 is rare in children, as it is a chronic illness. However, toddlers and older adults may be more likely to fall than older children and young and middle-aged adults. Falling can cause an acute injury, especially for an older adult. Disability is another identified health disparity characteristic. Examples of disabilities include visual or hearing impairments, mental health conditions, and intellectual or physical deficits.

health equity

Attainment of the highest level of health for all people.

A client who has a brain injury is told not to look at a computer for several weeks. The client, who works full-time on a computer, asks the nurse what options they have regarding staying home while they heal. Which of the following is the most appropriate nurse's response? *A* "You can use FMLA that is available to your job." B "You can self-medicate and continue fulfilling your computer obligations." C "You can have your assistant read your screen to you." D "Ask your children to do your work for now."

Because the client has a full-time job, FMLA can be used to preserve the job while the brain heals. The other responses imply that the client should continue to work, despite having a brain injury, or are dismissive of the client's needs.

A client who is using a birth control pill is concerned about developing clots due to long-term use of this type of contraceptive. What should the nurse discuss with this client related to adverse events that may occur as a result of long-term use of birth control pills? (Submit your response to compare it to an expert response.)

Birth control pills can predispose a client to develop clots. Any woman who is 35 years or older, smokes, or has a history of blood clots or breast cancer needs further advice from their health care provider and alternative contraceptive options should be discussed. The nurse should teach the client about modifiable risk factors.

more

Caregivers often feel the stress of caring for clients, even if they love them dearly. The Mayo Clinic lists these as potential signs of caregiver stress: feeling tired or overwhelmed, abusing alcohol or drugs, worrying constantly, gaining or losing weight, having head or body aches, sleeping too much or too little, losing interest in activities they used to enjoy, feeling sad, or becoming easily irritated or angry. The nurse should suggest to caregivers that they get rest, set realistic goals, connect with others, and accept help and support from others.

Which of the following steps should the nurse take when asked by a client about their medical bills? A Determine if the client has funds to pay out of pocket. *B* Consult the social work or nurse case manager. C Verify what health insurance coverage the client has. D Ask if the client has medical power of attorney.

Case managers work with insurance to verify coverage and obtain approval for prescribed care. Consulting with a social work or nurse case manager will help clarify what is covered and what is out of pocket. Determining the client's ability to pay for care and verifying health insurance coverage are important but is not part of the nurse's responsibility. A medical power of attorney makes decisions about care but is not relevant to answering the client's questions about their bills.

advance directives

Client states their wishes about their care in advance, directing desires for care if unable to make decisions in the future.

more

The case management team should carefully consider if this is the best option. Especially if the caregiver is an older adult or has a health condition, additional care responsibilities could exacerbate depression, obesity, insomnia, and fatigue. Additionally, the proposed caregiver may not be capable of doing some important tasks. The nurse can share the responsibilities and effects of caregiving with clients to help make the best decision for the client.

other chronic illnesses-male

Erectile dysfunction can cause significant concern to clients. The Cleveland Clinic estimates that one in 10 adult males has erectile dysfunction chronically. The nurse should realize that it may be difficult for a client to discuss erectile dysfunction or low testosterone with others, and they may not seek treatment until the situation has become profound. Benign prostatic hyperplasia is found commonly in male clients. Medications, UroLift devices, and surgery are used to treat this condition. However, men who live with health disparities may not get routine checks to determine the need for these treatments. However, male clients who experience health disparities may not get routine checks to determine the need for these treatments.

Which of the following activities is an example of a health promotion factor that the nurse should share with a caregiver? *A* Schedule a time to exercise. B Sleep for at least four to five hr a night. C Work for 40 hr a week only. D Educate about how to become thrifty.

Exercise is important to improve blood circulation and prevent the development of an illness or disease process. Four to five hours of sleep per night is very little. Being thrifty, while laudable, is not a health promotion factor. The caregiver may not be able to work only 40 hr per week.

more

Family members may choose to assume the caregiver role in order to spend quality time with their family members. In some cultures, family caregiving is the norm. A family caregiver can be beneficial because they are familiar with the client's preferences and needs. Family members may be able to provide round-the-clock care. Alternatively, the family caregiver can be available in the evening and access supportive services such as adult day care during working hours. While family members may be eager to be caregivers, especially if compensated well, the family member might not be best suited for the role. Family caregivers are often not trained health care providers and may miss early signs and symptoms of changes in health conditions. The nurse should be observant of signs and symptoms of stress in caregivers.

heart healthy diet

For a heart-healthy diet, follow these tips: limit saturated and trans fats, limit sodium, include foods rich in vitamin A, vitamin C, protein, iron, calcium, and dietary fiber

female health

Gender can create some unique health disparities for clients. The nurse needs to be aware that the way the client is welcomed, even in a busy emergency department, can affect the way the client view health care providers and the chance they will access care in the future in a timely manner.

disparities at end of life

Health care disparities affect people in all walks of life and across the health care continuum, but clients at the end of life are especially vulnerable. Care needs at the end of life, regardless of the client's age, are often complex and require a multidisciplinary team approach for the best care outcomes. Advance directives provide guidance for the care team when the client is not able to voice their desires at this vulnerable time in their life. For example, one study reported that most underepresented clients who had ovarian cancer received intensive and invasive end-of-life care. This and other similar studies report that the level of end-of-life care, such as palliative and/or hospice care, varies among racial and ethnic groups, with underrepresented groups being less likely to access services. A similar study of end-of-life care in New Hampshire found that clients from underrepresented racial/ethnic groups were less likely to complete advance directives, Clients who are Black were less likely to use hospice services before death, clients who are Black or Hispanic were more likely to be hospitalized at the end of their lives, and clients from underrepresented racial/ethnic groups experienced higher incidents of unrelieved pain at the end of their lives. Nurses, especially those who care for clients who belong to underrepresented racial and ethnic groups, need to reinforce the benefits of hospice and palliative care services for all clients, families, and caregivers.

health disparities

Health disparities can be linked to racial discrimination, ethnocultural issues, sociocultural factors, and aging. Ethnicity is one way people identify themselves. Ethnicity is different from race. Cultural factors such as physical characteristics, language, diet, religion, and ancestry are associated with ethnic identification.

more...

Health disparities that influence these risks are related to economic hardship, insufficient primary disease prevention, structural factors, difficulty managing chronic disease over time, and the effects of discrimination-related stress. Nurses should reach out to community centers, places of worship, and other places to educate individuals on how to reduce these risks, as accessing health care facilities may be difficult. Among the 54 million older adults, more than 6 million have Alzheimer's disease, and 22 million have arthritis. People of color have a higher incidence of Alzheimer's disease. Clients who have low SES may not have access to safe housing, transportation, or caregivers when they have Alzheimer's disease, which can affect their safety, mortality, and morbidity. Older adult clients who have arthritis may not be able to manage transportation and even access facilities to receive health care. Nurses should consider these needs when case managing older adult clients with health disparities.

health disparities among older adults

Health disparities vary based on race and ethnicity. The link between these factors and health is closely tied to the presence of structural racism. Statistics show people of color experience increased incidents of diabetes mellitus, heart disease, and stroke. Diabetes mellitus is a condition in which glucose builds up in the blood stream. Research has shown that clients who are Black American, Hispanic, Asian-American, Indigenous, and Pacific Islander have higher incidents of this disease. Clients from these races especially should be taught to monitor their glucose levels, eat a healthy diet, and maintain an ideal weight. Heart disease is often a chronic problem caused by high blood pressure, obesity, smoking, high cholesterol, diabetes, an unhealthy diet, and lack of exercise. A stroke is a vascular event in the brain.

Which of the following information should be included in health teaching for a client who wants to improve overall health? (Select all that apply.) *A* Exercise 30 min a day, five times a week. B Use electronic cigarettes instead of cigars. *C* Practice meditation to help relieve stress. *D* Avoid foods that are high in sugar. *E* Drink 4 liters of water a day.

Healthy lifestyle habits include exercising 30 min per day, five times a week, practicing meditation to relieve stress and increase energy, eating a variety of fruits and vegetables, and ensuring adequate water intake. Electronic cigarettes, like tobacco products, have significant health risks.​​​​​​​

heart disease

Heart disease includes coronary artery disease (CAD); arrhythmia, a change in the electrical impulses of the heart; heart valve disease; and heart failure. Prevention and treatment of heart disease focus on lifestyle changes such as smoking cessation; a healthy diet that includes fruits, vegetables, fiber, and low sugar; exercise; and achieving or maintaining a healthy weight. In addition, pharmacotherapy is also recommended to lower cholesterol (statins) and blood pressure, prevent blood clots, and reduce chest pain. Access to pharmaceuticals, healthy foods, and places to exercise may be limited by health disparities.

Which of the following is the primary purpose of hospice? A Allow the client to die at home. B Provide better quality of care. C Promote care coordination with the client and the family. *D* Provide comfort and support for clients who are terminally ill and their families.

Hospice care provides comfort and support at the end of life of a client. Although the other items are roles of hospice, the primary purpose is comfort and support for the clients and their families when they are terminally ill.

caregivers

In 2020, there were 53 million caregivers in the United States. Client caregivers are important collaborators in the health care case management team. Some of these caregivers have informally taken on the role because they are neighbors, spouses, friends, or relatives. Some are professionals who have chosen to care for others as a career. There was an increase of 9.5 million caregivers from 2015 to 2020. Most caregivers are women who work outside the home in addition to caring for an elderly or loved one with a disability. Twenty-four percent of American caregivers care for more than one person, while 26% had challenges in coordinating care. Twenty-one percent of American caregivers reported that their health was poor. Poor health conditions among caregivers can affect not only the caregiver but also their recipient of care. Harmful psychological effects of caregiving can range from perceiving that caregiving is merely stressful to experiencing profound depression/anxiety, which can impair the caregiver's quality of life. However, many caregivers enjoy spending time with their loved ones at the end of their lives.

structural racism

Inequities in access to services and opportunities based upon policies, practices, and accepted limitations on the basis of an individual's race.

Which of the following are signs/symptoms of caregiver stress? (Select all that apply.) *A* Gaining weight *B* Losing weight C Wanting to be with friends *D* Sleepiness *E* Insomnia

It is normal to want to be with others. However, gaining or losing weight, and/or sleeping too much or too little may be signs of caregiver stress. Wanting to be with friends is a healthy response to stress.

lgbt disparity stats

Keep in mind the concerning statistics below when caring for LGBTQIA clients. -LGBTQIA youth have more attempted suicides (two or three times) than their heterosexual and cisgender peers. -LGBTQIA youth are more likely to be without housing than their heterosexual and cisgender peers. -Clients who identify as lesbian are less likely to access health care services to prevent cancer. -The risk of HIV and other STDs is higher for individuals identifying as gay, especially for people of color. -Clients who are bisexual females and those that identify as lesbian and have higher rates of obesity or overweight. -There is a higher prevalence of, mental health issues, HIV/STDs, victimization, and suicide among transgender people. They are also less likely to have health insurance than other clients. -Older adult LGBTQIA individuals have further barriers to health care due to isolation, insufficient social services, and too few culturally competent providers. -Substance use disorder rates are highest in LGBTQIA populations.

male health

Male clients can experience acute illnesses related to jobs, sports, or lifestyle behaviors just as female clients do. For example, they may take risks that lead to injuries or work at jobs that involve risk or through activities that increase the risk for injuries.

caregiver stress and adverse outcomes of family caregiving

Many factors can cause stress for family or friend caregivers, such as depression, feelings of burnout, guilt, isolation, challenges in finding time for their spouse, children, parents and self, and work schedules. The financial burden stress occurs when the caregiver needs reduced working hours to be able to take care of their family member or when the family caregiver needs to pay some of the out-of-pocket costs for their loved ones or hire another caregiver. Some Medicaid recipients are qualified to pay a family caregiver who is not their spouse or legal guardian to provide care to them. However, this benefit varies from state to state.

medicaid

Medicaid is a federal assistance program that varies from state to state. Although some federal matching funds are available, each state legislature decides who qualifies for Medicaid and how much of the state budget should be allocated to care for residents who live below the poverty line. For example, in one state, a certain income will qualify a client for Medicaid, but in another state, the same income will not. In some states, a male who does not have children may not receive any benefits. The eligibility is based on income and family size. Therefore, it serves those who have low incomes, pregnant individuals, clients with disabilities, and older adults. A client may not be elderly or have a disability but may have low income in proportion to the size of their family, and thus they qualify for the Medicaid support. Sometimes this aid will only be used temporarily until income can be increased. -Clients who qualify for Medicaid and Medicare, by definition, have more needs and fewer resources than most people. They are either older adults and/or have disabilities and do not have the income to pay for insurance and quality health care. These clients are truly vulnerable to health disparities. The taxpayer-funded Medicare and Medicaid systems seek to make sure that these most vulnerable members of our society are cared for. The nurse must be careful not to stigmatize clients who have these insurance programs.

medicare

Medicare is a federally funded insurance program for most Americans aged 65 and older and those who have disabilities living in the United States. Medicare is regulated by the Centers for Medicare and Medicaid Services. The rationale for providing a health insurance plan for people over 65 was that most people this age are no longer working, and thus were not being eligible for employer-associated insurance, putting them at risk for health disparities. Medicare coverage is divided into four parts: A, B, C, and D. -Medicare Part A covers inpatient hospital service and inpatient facilities that provide nursing care, except long-term care, hospice and home health care. The coverage depends on federal, state, and local coverage legislation. Medicare Part B covers medically necessary (as defined by Medicare) and preventive services. It covers clinical research, ambulation, medical equipment, mental health, and a limited list of prescription drugs. Medicare Advantage Plans or Medicare Part C is offered by approved private insurance companies. Medicare Advantage Plans can involve out-of-pocket costs for the client and may vary each year. Part C covers both Medicare Part A and B. Part D covers Medicare prescription drugs. For some clients, going on Medicare is the first time they have had continuous health care coverage. Thus, they may have chronic or severe illness at a time when their bodies are aging, because they have not had access to preventative screening and treatment. Older clients receiving Medicare are not necessarily low income, but they may not be working and able to find insurance through their employer.

mental illness

Mental illnesses, such as schizophrenia and depression, are chronic diseases that can persist over time. The American Psychological Association is keenly aware of how health disparities have affected mental health in America and advocates for health care equity for all. Service members, veterans, and their families have a higher incidence of major depression, PTSD, and suicide than do non-military families.

Which of the following is a primary prevention of diabetes mellitus? A Sleep eight or more hours per day. *B* Exercise. C Smoke using a hookah. D Eat more pasta.

One of the primary prevention measures for diabetes mellitus is to exercise. Sleeping eight or more hours will not impact blood sugar. Studies show smoking hookah increases the risk of diabetes. Eating carbohydrates increases blood sugar.

A 70-year-old client's health improved in a span of three months while in a hospice care unit. Which of the following should the nurse tell the client and the family? A The client cannot leave hospice care. B The client needs to continue for a year in hospice care. C The client is not eligible for curative management. *D* The client can withdraw from hospice care and can receive other care management if desired.

Since the client has an improvement while in the hospice care unit, the client can withdraw from hospice care and explore other management of care options. The client may leave hospice care at any time, does not need to continue for an entire year, and is still eligible for curative management if desired.

ses

Socioeconomic status (SES) is frequently measured by a combination of education, income, and occupation. SES affects society through access to food, employment, education, financial security, health resources and care, and the way people view themselves in relation to others. While clients who have a higher SES may have easier access to quality health care and to the resources to pursue it, factors such as rurality of residence or lack of time to seek health care may hinder them. Clients who have low SES may not be able to afford insurance or have access to it, may lack transportation, or may lack funds to purchase medications, for example. However, access to health resources and care is not only affected by socioeconomic status. The geographical region of residence can impact health outcomes and lead to disparities. Rural and inner-city communities have worse health outcomes and less access to health care than many of their suburban neighbors. In addition to health disparities, the nurse must consider that some risk factors for disease can be modified, and some cannot. For example, if the client's ancestors lived in an area where sickle cell disease is endemic, such as the Middle East, Mediterranean, or South Asia, the client themselves may develop this disorder regardless of where they live, as this disorder is a genetically recessive trait. However, the client can change lifestyle behaviors (smoking, lack of exercise) that can lead to disease. The nurse should focus teaching on modifying these behaviors to decrease risk. -Nurses need to be good role models for clients. A client who sees a nurse smoking outside the office will not appreciate smoking cessation instruction from the nurse later during an office visit. Nurses need to consider making changes in their own lifestyles, not only to preserve their own health

Recommendations for Mental Health Advocacy

The APA advocates for the following changes to improve mental health equity in America. Specifically, attention should be directed to: -Facilitate partnerships with health care providers, community leaders, government agencies, educators, and families to create and implement culturally and linguistically competent and evidence-based prevention and treatment. -Increase the availability of culturally and linguistically competent mental and behavioral health services accessible to underrepresented racial and ethnic communities. Increase research on the intersections and complexities of health care equity. -Foster positive relationships and programs within underrepresented racial and ethnic communities, increasing awareness of issues that place individuals at risk. -Increase funding for training mental and behavioral health professionals, ensuring cultural and linguistical competence. -Create and execute policy and programs based on psychological and behavioral research ensuring that underrepresented racial and ethnic communities are empowered. -Advocate for local, state, and national funding agencies to incorporate culturally and linguistically competent guidelines into proposals for programs for children, youth, and families of underrepresented racial and ethnic communities. -Increase collaboration across federal funding organizations involved in research on the resiliency of underrepresented racial and ethnic communities.

family and medical leave act

The Family and Medical Leave Act (FMLA) is a law that allows an employee who is sick or taking care of a loved one who has a serious medical condition or just had a child (childbirth or child from foster care) to take time away from their job. However, FMLA leave is an unpaid and job-protected leave. Because the leave is unpaid, groups that are most vulnerable to health disparity consequences may not have the resources to utilize FMLA. Many vulnerable populations cannot afford to support their families if they take unpaid leave, so they do not always access these benefits.

patient self-determinant act

The Patient Self-Determination Act (PSDA) was amended in 1990. It mandates that all hospitals, skilled nursing facilities, and other health care settings may not discriminate against any clients and requires the agencies to respect the health care decisions of the clients. Asking for a copy of advanced directives enables the provision of care based on the individual's wishes. PSDA projects across the United States promote awareness of the client's rights related to their health care decisions and providers' responsibility to execute advanced directives. -A law securing the right of client to make their own health care decisions.

more...

The health disparities among gay and bisexual men lead to higher rates of sexually transmitted infections, HIV/AIDS, and viral hepatitis. In addition, anal and testicular cancers are also common among men who are gay and bisexual. Furthermore, breast, cervical, and ovarian cancers are more prevalent in lesbian or bisexual women than they are in heterosexual women. According to the Office of Disease Prevention and Health Promotion, individuals who are lesbian, gay, bisexual, or transgender (LGBTQIA) have some social determinants that affect their health: legal discrimination in access to health insurance, employment, housing, retirement, adoption, and marriage benefits; lack of social programs; lack of laws protecting against bullying; and a shortage of health care providers who are culturally competent and knowledgeable about their needs. The nurse should be sure that the physical environment at the facility is welcoming to LGBTQIA clients. Asexual clients experience considerable mental health challenges (e.g., depression and anxiety) due to the expectations other people place on them.

erectile dysfunction

The inability to achieve and keep an erection to achieve intercourse.

lgbt health

The lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual (LGBTQIA) community is recognized as having health disparities that may be due to a variety of factors, including delayed access to health care, oppression, and discrimination. Indigenous Peoples may also identify as Two Spirit. These populations can experience challenges with access to health care, feeling comfortable relaying concerns to their health provider and, as a result, carry higher risk of certain diseases such as cancer, depression, and HIV/AIDS. Research can focus on the challenges experienced by clients who identify with this community, with the hope of identifying opportunities for improvement across the health care continuum. LGBTQIA clients may not seek health care. They may be concerned about being stigmatized or mistreated by health care providers due to bad experiences with previous health care providers. Removing clothing or answering personal questions may trigger strong emotions in them. These clients may struggle in relationships due to stressors that are not usually placed on cisgendered clients, such as not being able to marry or visit a sick loved one in the hospital. They may not feel the need to use birth control methods and thus risk contracting sexually transmitted infections. As is true with cisgender clients, they may use substances to cope with stressors, and thus develop substance use disorders.

case study

The nurse admits a 28-year-old client to a room in the emergency department. The client identifies their pronouns as "they, them, their." The client's chief concern is bloating and gas pain that has been increasing in intensity for the last few weeks. Upon admission, the nurse obtains vital signs and completes the client's health history record. While discussing the client's health history and waiting to be seen by the health care provider, the client mentions being part of an intimate relationship with a lesbian. Current vital signs: Blood pressure of 123/80 mm Hg, pulse of 92 beats/min, SpO2 of 95% on room air, oral temperature of 98.1° F, Resp 16 breaths/min.

case study

The nurse notes that the caregiver for a client who has Alzheimer's disease seems fatigued, looks thin, and falls asleep while the client is being examined.

case study

The nurse receives a report from a paramedic who just transferred a client receiving palliative care for cancer. The paramedic states that the client is nauseous and experienced an episode of vomiting while being wheeled into the emergency department. Following the report from the paramedic, the nurse goes into the room to assess the client, who confirms feeling nauseated and experiencing frequent bouts of vomiting over the past two days. The client is accompanied by their partner.

What other professionals might be involved in this client's palliative care should the nurse consult? (Submit your response to compare it to an expert response.)

The nurse should consult with the palliative care team, which probably includes physicians, nurses, nutritionists, chaplains, and social workers.

sandwich generation and special needs fam members

The sandwich generation is a group of people who are taking care of the generations before them (aging parents) as well as after them (children or grandchildren). Taking care of their parents and their children can take a toll on the health of the caregiver which can lead to burnout and create a self-care deficit. An example of a sandwich generation caregiver is a 45-year-old who works full time to make the ends meet while taking care of their mother who has Alzheimer's disease and their 10-year-old son. If this person has a lack of access to insurance, health care, transportation, or money, the situation is further compounded when trying to seek health care.

morbidity

The state of being symptomatic or unhealthy for a disease or condition.

advnced directives/living wills

Throughout their lives, clients should have made advance directives or living wills. Nurses can help clients process health care decisions but should refrain from giving them advice about which decisions to make. For example, they can describe what hospice or intensive care is like. Ultimately, though, the client must make their own decision about what they want to be done on their behalf if they are unable to answer questions or process information in the future. The client can appoint a family member, friend, or attorney to act as a durable medical power of attorney. This should be someone who is familiar with the client and the client's wishes. The advance directive or living will should be written and witnessed. In most states, an attorney is not needed to execute the living will or advance directive. This document should be placed in the client's record.

cancer-female

The types of cancer that females commonly present with are colorectal, skin, lung, and reproductive cancers. The most commonly seen cancer in female clients is breast cancer, and risk increases with age. Modifiable risk factors for breast cancer include lifestyle-related factors such as sedentary lifestyle, drinking alcohol, obesity, or being overweight. Additional factors in the development of breast cancer include pregnancy after age 30, not breastfeeding, use of birth control, and hormone therapy after menopause. In contrast, the risk factors that are non-modifiable for those who can have breast cancer are biological sex (female), familial and personal history of breast cancer, aging, inherited gene changes, race and ethnicity (white and African-American females experience higher incidents of breast cancer), dense breast tissue changes, benign breast conditions, early menstrual periods, menopause after 55 years of age, exposure to DES (diethylstilbestrol), and radiation therapy to chest area. The American Cancer Society recommends that females get mammograms for screening on a timetable that varies with age and conditions, as well as frequent clinical and self-breast exam. For clients at high risk, an annual mammogram and MRI are recommended. Similar to breast cancer, ovarian cancer can occur at any age, but the risk increases with age for females who have never been pregnant or who were pregnant after age 35, take estrogen without progesterone, have a family history of ovarian cancer, and a personal or family history of breast cancer. Endometrial cancer affects the inner lining of the uterus. The risk factors are aging, use of estrogen without progesterone, tamoxifen for breast cancer treatment, infertility, or never being pregnant. On the other hand, cervical cancer risk factors include a chronic infection by the

cancer-male

The types of cancers that are common in male clients are prostate, colorectal, lung, testicular, and skin cancers. Black males and those clients who have a family history of prostate cancer have the highest risk for developing prostate cancer and should be screened at 40 years of age. Males without one of these risk factors can wait until 50 years old for initial screening. Screening is recommended every two or three years for male clients who have an average risk for developing prostate cancer. Screening can be done by a simple blood test for prostate-specific antigen (PSA) and by a digital rectal exam. Testicular cancer occurs most commonly in males between the ages of 20 and 34 years but can occur at any age. The risk factors include family history or cryptorchidism. The screening for testicular cancer includes testicular self-exams and reporting any swelling, lumps, or unevenness of size of the testicles.

cancer

There are five main types of cancer: carcinomas, sarcomas, melanomas, leukemias, and lymphomas. The most common type of cancers are carcinomas, which originate in the breasts, lungs, pancreas, skin, or other glands/organs. Sarcomas come from bone, muscle, cartilage, blood vessels, fat, or connective tissue. Lymphomas are cancers of lymph tissue, leukemias are blood cancers, and melanomas are skin cancers. Cancer is common in all genders and people of all races and ethnicities. Lung cancers can be caused by exposure to chemicals and particles in the air. The risk factors include smoking (first- or secondhand smoke) and exposure to radon, arsenic, asbestos, and cancer-causing agents in the workplace. Furthermore, skin cancer can occur in anyone, but those with fairer skin are at a greater risk. Clients who work outdoors (e.g., construction, roofing, gardening, farming) may be at increased risk for cancer due to ultraviolet ray exposure. Basal and squamous cell skin cancers are caused by ultraviolet rays from sunlight or tanning beds. Melanoma is a more dangerous type of skin cancer and is usually caused by ultraviolet rays from sun exposure. Nurses should teach clients to cover up their skin, wear sunscreen, stay away from tanning beds, and inspect their skin often. Incidents of colorectal cancer has increased over the years and is now the 3rd leading cause of deaths related to cancer. Colorectal cancer screening should occur after the age of 45 years. Stool-based tests, colonoscopy, and sigmoidoscopy are common screening tools. Some risk factors for developing colorectal cancer include physical inactivity, obesity, a diet high in processed and red meats, smoking, heavy alcohol use, and family history. Nurses should review risk factors with all adult clients and recommend activities and behaviors that limit the risk for

services available for older adult

There are multiple services available for older adults that fall into three categories: primary, secondary, and tertiary prevention. The CDC's National Center for Chronic Disease Prevention and Health Promotion provides funding to health care providers to improve health of older adults. Nurses should promote health education for the prevention of disease (primary prevention) by creating infographics, brochures, and educational activities for distribution to communities at risk for illness. A nurse, for example, can create a brochure to encourage health screenings, with addresses and phone numbers of local resources that provide free or low-cost services. For example, older adults who have dementia are encouraged to remain active, independent, and involved in the community. In addition, nurses should support caregivers to maintain their own health so they can take care of their family members or others. Nurses can increase engagement with older adult clients and their caregivers by using sensitivity when communicating, especially if memory is declining. In addition to therapeutic communication, it is important to conduct frequent screenings, including blood pressure measurements, blood glucose testing, and cancer screenings in which clinical services can be provided to improve quality of life outcomes. The CDC works with the National Diabetes Prevention Program to reduce the incidence of type 2 diabetes mellitus. Furthermore, promoting lifestyle modification and reducing risks for dementia, arthritis, pain, and falls are all vital aspects of health promotion and disease prevention in the older adult population.

life expectancy

There were 49 million older adults in the United States in 2016. By 2060, it is expected that the elderly will comprise 25% of the population. Increased numbers of older adults can affect the economy, work and retirement, family function, the ability of the government and community to provide resources to older adults, and the number of clients with chronic disease and disability. By 2060, it is expected that the elderly will comprise 25% of the population. Increased numbers of older adults can affect the economy, work and retirement, family function, the ability of the government and community to provide resources to older adults, and the number of clients with chronic disease and disability. Healthy People is an initiative that focuses on health challenges by addressing the health and well-being of all people. In addition, the Healthy People initiative aims to promote health and well-being and disease prevention encompassing the physical, mental, and social health dimensions. This initiative is a responsibility shared across national, state, and tribal communities that include public, private, and nonprofit institutions.

more...

When primary prevention does not prevent illness or injury, secondary prevention will focus on further illness or injury. For example, the nurse could teach an injured client how to stay safe and prevent further injury. Or, for a client who has had a stroke, the nurse could teach them how to prevent another stroke. In a rehabilitation facility, the nurse can be instrumental in helping the client to regain strength and function with tertiary prevention and offer support and training to caregivers.

What questions should the nurse ask the client before the provider interviews the client? (Submit your response to compare it to an expert response.)

When was the the last bowel movement? Does bloating occur or worsen after eating? Do specific foods make the bloating worse? Has the client noticed whether stress or anxiety make the pain and bloating worse or more frequent? How would they rate their pain on a 0-to-10 pain scale? Can they describe the characteristics of the pain? What makes the pain better? What is the client's sexual identity? Is the client sexually active? What is the client's previous surgical history? Was the client recently abused or exposed to intimate partner violence? Does the client have any needs? Does the client have a support network?

other chronic illnesses-female

females are also affected by chronic illnesses like osteoporosis (porous bones), endometriosis, and hormonal fluctuations and cessation (menopause). Because health care can be difficult to access, by the time the nurse sees the client, the client may have advanced illness. When caring for female clients, it is important to consider the sociocultural factors that can have a disproportionate impact such as income. When planning care, it is important to consider the unique health disparities related to females.

benign prostatic hyperpla

noncancerous tissue growth in prostate

ethnicity

shared cultural connections