Unit II-D Growth and Development objectives
Physiological concerns (OA)
(see Table 14-1,p.177) -- 90% of adults>65 have at least one chronic health condition -- Chronic conditions are 4x more common among older adults than other age groups -- Chronic conditions affect well being and independence -- Besides heart disease, cancer, and stroke other concerns include: Smoking Alcohol Abuse Nutrition Dental problems Arthritis Sensory impairments Pain Medication use Exercise (or lack of) Falls (Box 14.7, pg 188)
Cognitive Developmental Theory
* Focus is on how people learn to think and make sense of their world * Jean Piaget (focused on how children learn to think, reason and perceive their world) * Research on adults began in 1970s with several theorist studying the continuing cognitive development in adults
A nurse is completing a health history with the daughter of a newly admitted patient who is confused and agitated. The daughter reports that her mother was diagnosed with Alzheimer's disease 1 year ago but became extremely confused last evening and was hallucinating. She was unable to calm her, and her mother thought she was a stranger. On the basis of this history, the nurse suspects that the patient is experiencing: 1. Normal aging. 2. Delirium. 3. Depression. 4. Worsening dementia
Answer: 2. Hallmark characteristics of delirium are acute confusion, hallucinations, and agitation. These symptoms are not part of the normal aging process. As dementia worsens, there is a gradual rather than sudden change in memory, usually not accompanied by hallucinations. Depression does not present with acute confusion and agitation.
Cherise explores Ms. Scott's diet and cooking habits. Preparing meals is an example of an activity of daily living (ADL). A. True B. False
Answer: B Rationale: Preparing meals is an example of instrumental activities of daily living (IADLs).
Carol is reviewing the psychoanalytical/psychosocial theories. Which stage of psychosocial development as defined by Freud focuses on delayed gratification? A. Oral B. Latency C. Phallic D. Anal
Answer: D Rationale: The anal stage focuses on the toilet-training process in which the child delays gratification to meet parental and social expectations.
Cognitive Changes (OA)
Delirium- Acute confusional state Dementia- Generalized impairment of intellectual functioning - Alzheimers is the most common form of dementia Depression- affects 20% of older adults See comparison chart Table 14.2, page 181
Generativity vs. Stagnation (middle adulthood)
Erikson's theory of psychosocial development where: successfully nurturing others and providing legacies brings feelings of accomplishment and usefulness OR failure, shallow world involvemenbt
Discuss given developmental theories and their importance in the care of the young, middle, and older adult.
The developmental theories help nurses have a greater understanding of normal growth and development, thereby, enabling us to anticipate, prevent, and detect any deviations from the norm. *The theories help nurses to examine, describe, and appreciate human development There is not one theory that can explain human growth and development. Potter and Perry presents 4 groups of developmental theory: * Biophysical Development * Psychoanalytic/ Psychosocial Development * Cognitive Development * Moral Development
Health Concerns of the Older Adult
3 most common causes of death= heart disease (HT, CAD), cancer, chronic lung disease (COPD) stroke *Physiological concerns *Psychosocial Health Concerns Interventions addressing psychosocial health concerns
Elizabeth, who is having unprotected sex with her boyfriend, comments to her friends, "Did you hear about Kathy? You know, she fools around so much; I heard she was pregnant. That would never happen to me!" This is an example of adolescent: 1. Imaginary audience. 2. False-belief syndrome. 3. Personal fable. 4. Sense of invulnerability
Answer: 1, 2. A person using conventional reasoning sees moral reasoning based on his or her own personal internalization of societal and others' expectations. A person wants to fulfill the expectations of the family, group, or nation and also to develop a loyalty to and actively maintain, support, and justify the order.
A nurse conducted an assessment of a new patient who came to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the assessment. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing: 1. Dementia. 2. Depression. 3. Delirium. 4. Anxiety
Answer: 2. Factors that often lead to depression include presence of a chronic disease or a recent change or life event (such as loss). Patients are alert but easily distracted in conversation.
Functional Changes (OA)
Includes ADLs within physical, psychological, cognitive, and social domains. A decline is often linked to illness/ disease and it's degree of chronicity Functional status refers to the capacity and safe performance of ADLs --- This is a sensitive indicator of health and illness in the older adult
Childbearing Family
Pregnant woman's body undergoes: * Physical changes * Psychosocial changes: (Table 13-2, pg 167) --- Body Image --- Role changes --- Sexuality --- Coping mechanisms --- Stresses *Education Needs: --- Pregnancy, labor, delivery, breastfeeding, life with a newborn
Health Risks (YA)
Violence Substance Abuse Unplanned pregnancies STIs Occupational, environmental risk factors (see Table 13-1)
Physiological Changes (OA)
Virtually every body system has some type of change w/ aging (Table 14.1, page 179)
Physiological changes (MA)
(major changes come between ages 40-65) * Gray hair, wrinkled skin, increased weight, balding, menopause and climacteric (reproductive changes) * Also see Table 13-3, pg 168 Abnormal Physical Assessment Findings
Cognitive (YA)
* Critical thinking abilities increase with experiences * Develop problem solving skills --- Education, life experiences, working in the world, etc, will all help develop critical thinking and problem solving skills * Identifying occupational goals and aspirations is a major task (people who still live with parents will have different ability to problem solve and care for themselves
Psychoanalytic/ Psychosocial
* Describes human development from the perspective of personality, thinking, and behavior * Freud (5 stages of psychosexual development) and Erikson (8 stages of psychosocial development)
Physiological (YA)
* Few maturational changes- completes physical growth by age 20 ---The exception is the pregnant/ lactating woman who has extensive physical, cognitive, and psychosocial changes * Experience severe illness less- tendency is to ignore symptoms * Physical changes occur as middle age approaches --- Changes in weight/ muscle mass can occur as a result of diet, exercise, lifestyle
Theories of Aging
* Multiple Theories trying to explain aging -- Psychosocial- tries to explain behavior, roles, and relationships that come with aging -- Biological- no one theory accepted * Stochastic Theories -- Aging is a result of random cellular damage that occurs over time (damage= physical changes) * Nonstochastic Theories -- Genetic physiological mechanisms control the process of aging
Middle Adult Years
*38% of U.S. adults fall in the middle adult range * Often are involved in helping/ supporting others * Good at using what they've learned: called crystalized intelligence and it keeps getting better with age * Likely to be more agreeable and happier, less inclined to get angry * More in tune with other people's emotions in your 40s than at any other time of life * Scientists are unsure why this happens, one theory is that we get better at controlling our emotions and focus on making the most of life Middle Adult Growth and Development Physiological changes Cognitive development Psychosocial changes
Psychosocial (YA)
*Emotional health r/t ability to resolve personal/ social tasks ---Caught between wanting the freedom of adolescence and assuming adult commitments/ responsibilities *Predictable trends --- 23-28- Refining self-perception and ability for intimacy --- 29-34- Directs energy toward achievement and mastery of surrounding world --- 35-40- Examining life goals and relationships (mid-life crisis) * Potential area of stress come with the changes in the traditional role expectations of both men and women in young adulthood --- Stressful learning to balance work (two-career families), relationships, family needs and socialization
Young Adults
22-24% of pop. * First "always connected generation" * Digital technology and social media are a major component of their lives * Adapt well to new experiences * More ethnically/ racially diverse than previous generations Growth and Development of the Young Adult Physiological Cognitive Psychosocial
During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings place him at risk for an adverse drug event? (Select all that apply.) 1. Taking two medications for hypertension 2. Taking a total of eight different medications during the day 3. Having one physician who reviews all medications 4. Patient's health history of renal disease 5. Involvement of the caregiver in helping with medication administration
Answer: 2, 4. The patient is at risk for an adverse drug event (ADE) because of polypharmacy and his history of renal disease, which affects drug excretion. Taking two medications for hypertension is common. Having one physician review all medications and involving a family caregiver are desirable and are safety factors for preventing ADEs
According to Piaget's cognitive theory, a 12-year-old child is most likely to engage in which of the following activities? (Select all that apply.) 1. Using building blocks to determine how houses are constructed 2. Writing a story about a clown who wants to leave the circus 3. Drawing pictures of a family using stick figures 4. Writing an essay about patriotism 5. Hanging out with a best friend
Answer: 2, 5. As adolescents mature, their thinking moves to abstract and theoretical subjects. They have the capacity to reason with respect to possibilities. They typically have a close friend and enjoy spending time with friends.
A nurse is assessing an older adult brought to the emergency department following a fall and wrist fracture. The patient is very thin and unkempt, has a stage 3 pressure injury on her coccyx, and has old bruising to the extremities in addition to her new bruises from the fall. She defers all of the questions to her caregiver son, who accompanied her to the hospital. What is the nurse's next step? 1. Call social services to begin nursing home placement. 2. Ask the son to step out of the room so that she can complete her assessment. 3. Call adult protective services because you suspect elder mistreatment. 4. Assess the patient's cognitive status
Answer: 2. The assessment leads you to suspect elder mistreatment, but the nurse needs more information directly from the patient before calling social services or the adult protective services or telling the patient she cannot return home. The nurse will best get this information by asking the son to leave so that she can privately ask the patient direct questions. If the son refuses to leave, this will be another indication that elder mistreatment may be occurring. Cognitive testing will be important but is not the priority.
The nurse teaches parents how to have their children learn impulse control and cooperative behaviors. This would be during which of Erikson's stages of development? 1. Trust versus mistrust 2. Initiative versus guilt 3. Industry versus inferiority 4. Autonomy versus sense of shame and doubt
Answer: 2. Toddlers are learning that parents and society have expectations about behaviors and that they must learn to control their behavior.
A nurse is completing an assessment on a male patient, age 24. Following the assessment, the nurse notes that his family history is not significant for chronic illnesses, and his physical and laboratory findings are within normal limits. Because of these findings, nursing interventions are directed toward activities related to: (Select all that apply.) 1. Instructing him to return in 2 years. 2. Instructing him in secondary prevention. 3. Instructing him in health promotion activities. 4. Instructing him about routine screenings. 5. Instructing him about proper vaccinations.
Answer: 3, 4, 5. While young adults generally have a minimum of major health problems, lifestyles such as tobacco or alcohol abuse, risky sexual activity, obesity, and lack of physical activity put them at risk for health problems. Instructing young adults in health promotion activities can decrease the risk for lifestyle-related health issues in the young adult. Proper vaccinations (e.g., flu vaccines and boosters to routine childhood vaccinations, such as tetanus) and regular health screenings are also important to maintain health.
A 50-year-old woman has elevated serum cholesterol levels that increase her risk for cardiovascular disease. One method to control this risk factor is to identify the patient's current diet trends and describe dietary changes to reduce the risk. This nursing activity is a form of: 1. Referral. 2. Counseling. 3. Health education. 4. Stress-management techniques
Answer: 3. Health teaching offers dietary information to the woman to enable her to make decisions about her dietary health practices in an attempt to lower her cholesterol
Which factor affects a middle-age adult's adherence to a treatment plan? 1. Gender 2. Lifestyle 3. Motivation 4. Family history
Answer: 3. Motivation plays a key role in adherence with a prescribed course of therapy. Motivation can be influenced by a variety of factors, including age, experience, family history, social support, and pressure by health care providers.
Older adults frequently experience a change in sexual activity. Which best explains this change? 1. The need to touch and be touched is decreased. 2. The sexual preferences of older adults are not as diverse. 3. Medication side effects often impact sexual functioning. 4. Frequency and opportunities for sexual activity may decline
Answer: 4. As a result of loss of a loved one or a chronic illness in themselves or their partner, opportunities for sexual activity may decline. Aging does not change the need for touch, and older adults are diverse. Only select medications impact sexual functioning
Dave reports being happy and satisfied with his life. What do we know about him? 1. He is in one of the later developmental periods, concerned with reviewing his life. 2. He is atypical, since most people in any of the developmental stages report significant dissatisfaction with their lives. 3. He is in one of the earlier developmental periods, concerned with establishing a career and satisfying long-term relationships. 4. It is difficult to determine Dave's developmental stage since most people report overall satisfaction with their lives in all stages.
Answer: 4. Each of the life stages can be achieved successfully and result in satisfaction, including old age.
When preparing a 4-year-old child for a procedure, which method is developmentally most appropriate for the nurse to use? 1. Allowing the child to watch another child undergoing the same procedure 2. Showing the child pictures of what he or she will experience 3. Talking to the child in simple terms about what will happen 4. Preparing the child through play with a doll and toy medical equipment
Answer: 4. Preschoolers are in the preoperational stage of cognitive development and learn more easily when play is used to teach.
A 34-year-old female executive has a job with frequent deadlines. She notes that when the deadlines appear, she tends to eat highfat, high-carbohydrate foods. She also explains that she gets frequent headaches and stomach pain during these deadlines. After receiving health education from the nurse, the executive decides to try yoga. In this scenario yoga is used as a(n): 1. Outpatient referral. 2. Counseling technique. 3. Health promotion activity. 4. Stress-management technique
Answer: 4. Relaxation techniques, such as imagery, biofeedback, and yoga, help recondition the patient's response to stress. Yoga is an ancient practice of controlling body and mind by which there is a physical and mental harmony. It is frequently used as an effective intervention for stress and stress-related physical symptoms.
The nurse is aware that preschoolers often display a developmental characteristic that makes them treat dolls or stuffed animals as if they have thoughts and feelings. This is an example of: 1. Logical reasoning. 2. Egocentrism. 3. Concrete thinking. 4. Animism
Answer: 4. This is the belief that inanimate objects have lifelike qualities; it is a component of magical thinking evident in preoperational thought.
Mr. Sampson is 5 feet 11 inches and weighs 238 pounds. Wayne teaches Mr. Sampson that obesity is linked to which of the following illnesses? (Select all that apply.) A. Type 2 diabetes B. High cholesterol C. Asthma D. Joint problems E. Urinary tract infections
Answer: A, B, C, D Rationale: Obesity is linked to the development of type 2 diabetes, hypertension, high cholesterol, asthma, joint disorders, psoriatic arthritis, and poor health status
Cherise teaches Ms. Scott about the physiological changes of the gastrointestinal system that occur in older adults. Which of the following changes may occur in the older adult's gastrointestinal system? (Select all that apply.) A. Delayed gastric emptying B. Constipation C. Increased peristalsis D. Diarrhea
Answer: A, B, D Rationale: Gastrointestinal changes in the older adult include slowing of peristalsis, alterations in secretions, food intolerance, delayed gastric emptying, constipation, flatulence, and diarrhea.
Carol is 21 years old. Which phase of Erikson's theory of psychosocial development is Carol experiencing? A. Identity versus role confusion B. Intimacy versus isolation C. Trust versus mistrust D. Initiative versus guilt
Answer: B Rationale: As a young adult, Carol is in the intimacy-versus-isolation phase, in which her capacity to love is deepened and she searches for meaningful friendships and an intimate relationship with another person
As Wayne is talking to Mr. Sampson about his addictions, Mr. Sampson tells Wayne that he suspects he may have a sexually transmitted infection (STI) since he is experiencing discharge from his penis. Wayne informs the health care provider, who then orders an STI panel. Wayne knows that which of the following diseases will be tested for in the panel because of its high rate of incidence in men Mr. Sampson's age? A. Genital herpes B. Syphilis C. AIDS D. Gonorrhea E. Chlamydia
Answer: E Rationale: Men ages 20 to 24 had a higher rate of chlamydia than any other group in 2008; this was a 12.6% increase over the 2007 incidence.
Ms. Scott tells Cherise that she always adds table salt to her meals. Ms. Scott most likely adds table salt to her meals because of her ________________________.
Answer: diminished sense of taste Rationale: Older adults experience a diminished sense of taste that may precipitate them to add extra salt and sugar to foods.
Carol knows that the _____________ _________ _______________ phase of Erikson's theory of psychosocial development is when older adults review their lives.
Answer: integrity-versus-despair Rationale: Integrity versus despair is a time when many older adults review their lives with a sense of either satisfaction or failure
Mr. Sampson is a member of the ___________ generation
Answer: millennial Rationale: The millennial generation includes young people between the ages of 18 and 29.
A nurse sees a 76-year-old woman in the outpatient clinic. She states that she recently started to notice a glare in the lights at home. Her vision is blurred, and she is unable to play cards with her friends, read, or do her needlework. Which of the following nursing interventions are appropriate? (Select all that apply.) 1. Refer her to an ophthalmologist. 2. Suggest large-print books and playing cards. 3. Reassure her that this is part of normal aging. 4. Suggest lower-wattage light bulbs to decrease glare. 5. Assess her home environment for safety.
Answer: 1, 2, 5. This patient most likely has cataracts and should be referred to an ophthalmologist. While common, cataracts are not considered to be part of normal aging. In the meantime, using large-print books or playing cards and reducing home safety hazards would be beneficial. Lower-wattage light bulbs would not be helpful
When Ryan was 3 months old, he had a toy train; when his view of the train was blocked, he did not search for it. Now that he is 9 months old, he looks for it, reflecting the presence of: 1. Object permanence. 2. Sensorimotor play. 3. Schemata. 4. Magical thinking
Answer: 1. He is now in Piaget's later stage of sensorimotor thought and has learned that objects exist even though he cannot see or touch them.
A nurse is caring for a man who is recently retired and who appears withdrawn. He says he is "bored with life." The nurse helps this individual find meaning in life by: 1. Encouraging him to reflect on his relationships with others. 2. Encouraging relocation to a new city. 3. Explaining the need to simplify life. 4. Encouraging him to adopt a new pet.
Answer: 1. You can enhance feelings of integrity by encouraging older adults to reflect upon meaningful relationships, such as relationships with a higher power, family members, or the community
A nurse is participating in a health and wellness event at the local community center. A woman approaches and relates that she is worried that her widowed father is becoming more functionally impaired and may need to move in with her. The nurse asks about his ability to complete activities of daily living (ADLs). ADLs include independence with: (Select all that apply.) 1. Driving. 2. Toileting. 3. Bathing. 4. Daily exercise. 5. Eating
Answer: 2, 3, 5. Activities of daily living are self-care tasks that measure function and are markers for the ability to live independently. Although driving and daily exercise are important to quality of life and health maintenance, they would not necessarily impact a person's ability to live independently.
A patient's family member is considering having her mother placed in a nursing center. The nurse has talked with the family before and knows that this is a difficult decision. Which of the following criteria does the nurse recommend in choosing a nursing center? (Select all that apply.) 1. The center needs to be clean, and rooms should look like a hospital room. 2. Adequate staffing is available on all shifts. 3. Social activities are available for all residents. 4. The center provides three meals daily with a set menu and serving schedule. 5. Staff encourage family involvement in care planning and assisting with physical care.
Answer: 2, 3, 5. Adequate staffing, provision of social activities, and active family involvement are essential. Meals should be high quality with options for what to eat and when it is served. A nursing center should be clean, but it should look like a person's home rather than a hospital.
Restorative Care
Convalescence from acute care Interventions should continue supporting what was started in acute, should address holistic needs Functioning w/ chronic conditions Interventions should focus on promoting health, independence, stabilizing chronic conditions
Biophysical Developmental Theories
Explain how the physical body grows and changes from infancy to adulthood allow us to know how the body will differ between age groups
Freud's Psychosexual Stages
the childhood stages of development (oral, anal, phallic, latency, genital) during which, according to Freud, the id's pleasure-seeking energies focus on distinct erogenous zones
Erikson's 8 stages of psychosocial development
trust vs mistrust autonomy vs shame and doubt initiative vs guilt industry vs inferiority identity vs role confusion intimacy vs isolation (young adult) generativity vs stagnation (middle age) integrity vs despair (old age) stage theory of psychosocial development, lifespan consists of eight dilemmas that must be solved correctly in order to solve the next dilemma
Young Adult (late teens to mid to late thirties) (GROWTH AND DEVELOPMENT) J.J.,is a 20 year-old male who was in an MVA last night with 2 other friends. He had emergency surgery, which resulted in a spleenectomy. In addition, he had a brain concussion. The blood alcohol levels of J.J. and his friends was strongly positive; the young men confirmed they had been at a party that evening and were drinking and were "buzzed." J.J.'s history includes: lives with parents, attends school part time and works part time at a fast food restaurant, he smokes 3-4 cigarettes/day, and has no other medical history. Using your book and the lecture power point, complete the following chart for Young Adults, then highlight items that are specific to JJ.
Physiological Changes Cognitive Changes/ Tasks Psychosocial Changes/ Tasks Health Concerns/ Risk Factors Education Needs
Psychosocial Health Concerns
Social isolation Elder mistreatment (Table 14.3, pg 190) Cognitive impairment Stresses due to life changes
Developmental Tasks for Older Adults
Tasks are associated w/ varying degrees of change and loss. (Box 14-1, pg.174) Common losses: - Health - Significant others - Sense of usefulness - Socialization - Income - Independent living - Physical changes of aging
intimacy vs isolation stage (young adult)
according to Erikson, a period during early adulthood that focuses on developing close relationships
Special Concerns of the Older Adult
Acute Care Restorative Care
Lifestyle Concerns (YA)
Alcohol Job/ Family Stress Exercise patterns/ Obesity Personal hygiene Familial history Infertility Pregnancy/ Prenatal Care/ Childbearing Family
Cognitive development (MA)
Change rare, if any, due to illness or trauma
Psychosocial Changes (OA)
Involves changes in roles and relationships Retirement Social Isolation Sexuality Housing and Environment Death
Chronic illness (e.g., diabetes mellitus, hypertension, rheumatoid arthritis) may affect a person's roles and responsibilities during middle adulthood. When assessing the health-related knowledge base of both the middle-age patient with a chronic illness and his or her family, the assessment should include which of the following? (Select all that apply.) 1. Medical course of the illness 2. Prognosis for the patient 3. Coping mechanisms of the patient and family 4. Socioeconomic status 5. Need for community and social services
Answer: 1, 2, 3, 5. When assessing the patient with a chronic illness, it is important that the nurse know how much the patient and his family know about how the illness has progressed and the long-term prognosis for the patient. This includes understanding the patient and families' ability and readiness to accept the illness and the outlook for the patient. Understanding the coping mechanisms used by the patient and family will assist the nurse in determining how to proceed to teach and counsel the patient and family regarding the patient's treatment regimen and whether there is a need and acceptance for community or social services to assist the patient and family.
A 36-year-old patient newly diagnosed with type 1 diabetes shares with you that he is frustrated with the time it takes to prepare meals and monitor his exercise and blood sugar. He also is having trouble understanding his insulin schedule. Which of the following suggestions would be most appropriate? (Select all that apply.) 1. Provide patient education materials that are easy to read. 2. Refer this patient to a diabetes support group. 3. Refer the patient to his endocrinologist. 4. Suggest that the patient make an appointment with a registered dietitian. 5. Suggest ways to modify his schedule
Answer: 1, 2, 4, 5. Adults are often impatient with the time and energy requirements that a chronic health problem requires for proper management. Patient-centered educational materials and support groups often help patients deal with these challenges. Working with a dietitian will help the patient identify ways to modify his eating habits. Helping the patient incorporate nutritional and exercise health behaviors into his schedule is also important.
Which of the following are examples of the conventional reasoning form of cognitive development? (Select all that apply.) 1. A 35-year-old woman is speaking with you about her recent diagnosis of a chronic illness. She is concerned about her treatment options in relation to her ability to continue to care for her family. As she considers the options and alternatives, she incorporates information, her values, and emotions to decide which plan will be the best fit for her. 2. A young father is considering whether or not to return to school for a graduate degree. He considers the impact the time commitment may have on the needs of his wife and infant son. 3. A teenage girl is encouraged by her peers to engage in shoplifting. She decides not to join her peers in this activity because she is afraid of getting caught in the act. 4. A single mother of two children is unhappy with her employer. She has been unable to secure alternate employment but decides to quit her current job. 5. A young man drives over the speed limit regularly because he thinks he is an excellent driver and will not get into a car accident.
Answer: 1, 2. A person using conventional reasoning sees moral reasoning based on his or her own personal internalization of societal and others' expectations. A person wants to fulfill the expectations of the family, group, or nation and also to develop a loyalty to and actively maintain, support, and justify the order.
A 45-year-old woman who is obese tells a nurse that she wants to lose weight. Which assessment findings may be contributing factors to the woman's obesity? (Select all that apply.) 1. The woman works in an executive position that is very demanding. 2. The woman says that she has little time to prepare meals at home and eats out at least four nights a week. 3. The woman works out at the corporate gym at 5 am three mornings per week. 4. The woman says that she tries to eat "low-cholesterol" foods to help lose weight. 5. The woman says that she vacations annually to reduce stress
Answer: 1, 2. Demanding and stressful work environments can lead to frequent "stress" eating of non-nutritious foods. Frequently eating away from home and eating fast food have been identified as contributing factors to obesity
Intimate partner violence (IPV) is linked to which of the following factors? (Select all that apply.) 1. Alcohol abuse 2. Marriage 3. Pregnancy 4. Unemployment 5. Drug use
Answer: 1, 3, 4, 5. IPV is linked to harmful health behaviors such as alcohol abuse and drug use. Other risk factors include unemployment and pregnancy.
Which are examples of positive health habits that may prevent the development of chronic illness later in life? (Select all that apply.) 1. Routine screening and diagnostic tests 2. Unprotected sexual activity 3. Regular exercise 4. Consistent seat belt use 5. Excess alcohol consumption
Answer: 1, 3, 4. Routine screening and diagnostic tests (i.e., laboratory screening for serum cholesterol or serum glucose levels, mammography or colonoscopy) will provide early detection of health issues. Regular exercise helps maintain weight and improve musculoskeletal functioning. Seat belt use saves lives and reduces the extent of injury in motor vehicle accidents
A nurse is completing an assessment on a 27-year-old female patient. Which questions best assess the psychosocial aspects of this young woman's health? (Select all that apply.) 1. Do you feel safe in your home and at work? 2. How many fruits and vegetables do you typically eat every day? 3. Describe your relationship with your family. 4. Have you had the vaccine to prevent HPV? 5. What are your long-term career goals?
Answer: 1, 3, 5. Young adults need physical and emotional resources and support systems to meet the many challenges, tasks, and responsibilities they face. Asking assessment questions such as feeling safe at home and at work, satisfaction with family relationships, and identifying long-term career goals provides information about the young adult's psychosocial health that supports successful maturation in this developmental stage. Assessment questions about the intake of fruits and vegetables and the HPV vaccine do not assess the patient's psychosocial health.
A 71-year-old patient enters the emergency department after falling down stairs at church. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable at 130/70. The patient does not exercise regularly and states that he experiences weakness in his legs when climbing stairs. He is alert, oriented, and able to answer questions clearly. What are the fall risk factors for this patient? (Select all that apply.) 1. Impaired vision 2. Residence design 3. Blood pressure 4. Leg weakness 5. Exercise history
Answer: 1, 4, 5. Risk factors for falling include sensory changes such as visual loss, musculoskeletal conditions affecting mobility (in this case weakness), and deconditioning (from lack of exercise). The mere presence of a chronic disease is not a risk factor unless it is a condition such as a neurological disorder that alters mobility or cognitive function. The patient's blood pressure is stable, and there is no report of orthostatic hypotension. A one-floor residence should not pose risks.
A 9-year-old child has a difficult time making friends at school and being chosen to play on the team. He also has trouble completing his homework and, as a result, receives little positive feedback from his parents or teacher. According to Erikson's theory, failure at this stage of development results in: (Select all that apply.) 1. Feelings of inadequacy. 2. A sense of guilt. 3. A poor sense of self. 4. Feelings of inferiority. 5. Mistrust.
Answer: 1, 4. School-age children need to feel real accomplishment and be accepted by peers to develop a sense of industry. Without proper support for learning new skills, or if skills are too difficult, they develop a sense of inadequacy and inferiority
A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are the major concerns for this patient? (Select all that apply.) 1. The loss of his work role 2. The risk of social isolation 3. A determination on whether the wife will need to start working 4. How the wife expects household tasks to be divided in the home in retirement 5. The age the patient chose to retire
Answer: 1, 4. The psychosocial stresses of retirement are usually related to role changes with a spouse or within the family and to loss of the work role. Often there are new expectations of the retired person. This patient is not likely to become socially isolated because of the size of the family. Whether the wife will have to work is not a major concern at this time, nor is the age of the patient.
Psychosocial changes (MA)
Career transition Sexuality Marital changes Family transitions Care of aging parents (sandwich generation)
Acute Care
Comfort Safety Nutrition/ hydration Skin Integrity Adverse events (delirium, dehydration, malnutrition, nosocomial infections, urinary incontinence, falls)
Myths/ Stereotypes
Older adults are: forgetful, confused, rigid, bored, unfriendly, unable to understand or learn new information. * Ranges from many are affluent to many are poor What gerontolgic specialists say about centenarians: * Optimistic outlook on life, good memories, broad social contacts/ interest, tolerance for others, & despite vision, hearing, and energy level changes, they are life-long learners
Integrity vs. Despair (late adulthood)
Older adults assess their lives and develop a sense of integrity if they find their lives have been meaningful, and a sense of despair if their lives do not seem meaningful.
Middle Adult Health Concerns
Physiological *Health promotion and stress reduction * Obesity * Forming positive health habits (prevent chronic illness) Psychosocial Anxiety related to physiological and psychosocial changes * Depression * Early-onset dementia- <65 years old
Middle Adulthood (Beginning around age 35, lasts through late 60's) (GROWTH AND DEVELOPMENT) Ms. R.M. is a 45 year-old aged female who is coming to her primary physician to discuss her chronic problem of migraine headaches. She states that she has been getting 2 migraines a week and has been trying to treat herself with Advil, which has been ineffective. Her medical history is simple, she does not smoke and drinks only socially, she is slightly overweight, vital signs are WNL, she wears glasses to read, she has no other medical problems except, she had a total hysterectomy 2 years ago for her problem with a fibroid uterus. She still has her ovaries, so she hasn't been on any hormones, however, she states she is beginning to have "hot flashes," for about the last 6 months. She takes vitamins only occasionally and until the migraines started wasn't taking any other medications. She is married, has 2 children, 1 child is still living at home and the other child recently moved away to go to college. She has a full time job, as a financial analysis, with a local bank. In addition, her parents have not been in the best of health and she spends at least 4 days a week helping her parents with meals, doctor's appointments, and their finances. Using your book and the lecture power point, complete the following chart for Middle Adults, then highlight items that are specific to R.M.
Physiological Changes Cognitive Changes/ Tasks Psychosocial Changes/ Tasks Health Concerns/ Risk Factors Education Needs
Older Adulthood (Age 65 traditionally viewed as the beginning of old age) (GROWTH AND DEVELOPMENT) L.P. is a 75-year-old female widow who is admitted to the hospital today after having a complaint of chest pain. She has a history of hypertension that is usually controlled, she is around 15 pounds overweight, has hypothyroidism, degenerative joint disease (DJD), and has had a history of high cholesterol and triglyceride levels. She wears glasses, has both upper and lower dentures, has a hard time getting around because of the DJD, she doesn't drink except for a little Brandy each night before bedtime, and she has never smoked. She takes meds for her thyroid, hypertension, DJD, and a med to lower cholesterol. She lives alone, but her son and his family live 2 blocks away and visit often, she has 2 small dogs which are her "babies," she is able to get around in her home (her DJD causes her some discomfort but she doesn't let it stop her from working a bit around her house and garden), for meals she does not like to cook for herself so she sometimes will do simple things like cold cereal. Her son has her over at least 2 times a week for dinner. . Using your book and the lecture power point, complete the following chart for Older Adults, then highlight items that are specific to L.P.
Physiological Changes Cognitive Changes/ Tasks Psychosocial Changes/ Tasks Health Concerns/ Risk Factors Education Needs
Older Adulthood
There was a 33% increase in older adults between 2006 to 2016- --Older adults= 15.2% of the population -- Expected to grow to 21.7% by 2040 * Not only are numbers growing, diversity is also growing (nurses must be diversity minded) * Living arrangements(2017): -- Living independently w/spouse or partner= 59% -- Living alone= 28% -- Living in an institution= 3.1% (1%=65-74 y/o & 9% of those 85 y/o live in institutions)
Interventions addressing psychosocial health concerns
Therapeutic communication Touch Reality orientation (communication technique that makes an older adult more aware of time, place, and person) Validation therapy (Accepts the description of time and place as sated by the confused older adult) Reminiscence (Recalling the past) Body Image interventions
