Chapter 23: Adult Women and Men (FINAL EXAM)

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Explain how Cancer is affected by 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) OVERVIEW* •Physical, emotional, financial demands •Midlife crisis •Retirement •Reproductive health •Heart disease & men •Prostate Health

*Adult Women (35 to 65)* •Health choices: Good or Bad •Undetected diseases •Menopause & HRT •Osteoporosis •Heart disease •Cancer (BSE) •Chronic fatigue & Immune dysfunction syndrome (Myalgic Encephalomyelitis)

What is the most common cancer amounf women? and how can we prevent this?

*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 AND SCREENING

What are top 3 unintentional injuries?

*MVCs, poisoning, falls* (One person every 3 minutes dies from unintentional injury)

*Major Health Issues of Adults* Going to be looking at differences between genders and ethnicities, and even different areas of the country and what interventions we can do in community health nursing. BELOWWWW

Why do men have less likely to access to healthcare?

*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 (There is a lack of health programs for men and a lack of male gender-specific research)

*Men's Health OVERVIEW* •Gender influences health •Socialization: independent / conceal vulnerability •Hazardous activity •Lack of health programs and research

What is the is one of the fastest-growing forms of drug abuse?

*Prescription drug abuse or misuse* •Most common: opioids (for pain), CNS depressants (to treat anxiety / sleep disorders), stimulants (treat ADHD) •Males more likely than females to abuse rx drugs

*SLIDE 8* Shows where the highest stroke death rates are (note the stroke belt)

*Young Adult (18-35)* Major health concerns in this age group are (5)?

-eating disorders -reproductive health and STIs -physical activity -mental health -mood disorders and substance use

What is done to treat erectile dysfx?

Drugs can be used to treat this as well as lifestyle changes, smoking cessation, weight loss, and increased physical activity •*Viagra* is the first FDA approved pill to treat ED (1998), but since several more have been approved - they are called phosphodiaserase type 5 inhibitors >>Relax the smooth muscles in penis during sexual stimulation to allow increased blood flow >>Low dosing rather than on-demand dosing has been found to be more beneficial

*WHAT IS BEING DESCRIBED BELOW?* •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

Osteoporosis

PHN can do what specifically for Adult Men (35-65)?

PHN can help anticipatory guidance with health, balance between work and home, eating balanced meals, exercise and self-care skills

*WHAT IS BEING DESCRIBED BELOW?* •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 "" self exam

Testicular Cancer (young adult)

*SLIDE 4 Life Expectancy at Birth for Selected Countries by Sex 2012* -Sadly, *the US is in 10th place behind even Korea for life expectancy* >> 4 years behind! *-Issues? *

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 >>>>Health literacy "is 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"

How does a PHN determine the needs of a man?

determine the needs of men at various stages to best meet their needs through their lifespan

*Cancer & Chronic Lower Respiratory Diseases OVERVIEW* *Cancer* •2nd leading cause of death in US •Internal / External factors •Lung CA •Colon / Rectal CA *Chronic lower respiratory diseases* 3 major conditions >>Emphysema >>Chronic bronchitis >>asthma •Cigarette smoking •Environmental exposure

*Coronary Artery Disease & Stroke OVERVIEW* •Cardiovascular mortality has declined by 50% •Every 34 secs / Every 60 secs •CVD affect F>M •Ethnic disparities •Risk factors: Personal and Hereditary •CVA 4th leading cause of death for all in US

____________ are to blame for the majority of poisoning deaths in the US.

*Drugs* •81% were unintentional drug poisoning, 12% were suicides and 6% were undetermined •Majority were opioid analgesics including hydrocodone, morphine, and oxycodone, fentanyl, and methadone

*Eating Disorders* •Anorexia nervosa, bulimia nervosa, and binge eating are common in this age group •History of (3) are factors playing into each

*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

Describe the differences between Nurses' Health Study I, II, III?

*Nurses' Health Study I* •Longest running study related to women's health in the world - *investigates factors that influence the health of women.* •The first was a prospective study that began in 1976 and enrolled 122,000 RNs age 30-55 from 11 states •Every 2 years participants would have follow-up questionnaires with questions including smoking, hormone use, and menopausal status *Nurses' Health Study II* •Represented women who started using *oral contraceptive in adolescence* •Ages were 25-42 and 116,686 women enrolled and followed. •Every 2 years follow up questionnaires surveying abuse diseases and health related topics •Women also received nutrition and quality-of-life assessments later in the study *Nurses' Health Study III* •Recruitment began in 2010 and continues until 100,000 nurses are enrolled (22-45) •As of 2015 the outcomes from phases I & II have spawned 1,200 professional publications

*OVERVIEW* *Unintentional Injuries* •5th leading cause of death overall •Top 3 >>MVC >>Poisoning >>Falls Prescription OD *Diabetes Mellitus* •7th leading cause of death in US •Chronic health conditions *Obesity / Substance Abuse* •BMI >30 •Bariatric Surgery •Alcohol •Tobacco •Prescription drugs

*Role of the Community Health Nurse--OVERVIEW* *Primary* •Healthy lifestyle •Education *Secondary* •Screening for early detection / treatment •Mammography, TSE, Health screenings *Tertiary* •Rehab / prevent further damage •VA

*SLIDE 3* -If you look at heart disease death rates the *darkest reds show the highest amounts of heart disease death rates.* There are lots of reasons for those differences (cultural. Dietary norms, level of physical activity in the area, ect). -This *shows how 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)

*STROKE* Face Drooping Arm Weakness Speech Difficulty Time to Call 911

What activities make them have higher death rate?

They practice more hazardous activity and as a result have a high death rate from unintentional injuries

*Top 10 leading causes of death for all people* •Heart disease 599,711 •Malignancy 582,623 •Chronic lower resp diseases 143,489 •Cerebrovascular diseases (Stroke) 128,546 •Accidents (unintentional) 127,729 •Alzheimer's Disease 83,637 •Diabetes mellitus 73,932 •Influenza & Pneumonia 50,636 •Nephritis (and other kidney diseases) 45,622 •Intentional self-harm (suicide) 40,600 >>>>Named top 4 leading cause of death (men and women have different leading death) (and mentioned the difference in life expectancy in races=shows there's a difference in access)

*Women's Health: Significant Studies* •Women's Health Initiative •Womens Health Study •Nurses' Health Study I •Nurses' Health Study II Nurses' Health Study III

*Young Adult (18-35) OVERVIEW* -Forming identity and intimacy -Spouse & family -Typicall healthy, though risky behaviors -Eating disorders -Reproductive health

*Young Adult (18-35) OVERVIEW* •Education, career, family •Experimentation (drugs / sex) •Risky behaviors •Question sexuality •HIV & Men •Testicular CA (TSE)

In place of Hormonal Replacement Therapy some women have choose to do what? AND EXPLAIN?

*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) •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]

What has happened to cardiovascular mortality in the US? explain?

*declined by 50%!* -*Attributed to EBP, lifestyle and environment changes as well as early recognition of sx* -Although this is awesome, 31.3% of deaths in US remain from CVD disease with more than 85.6 *million adults living with one or more types of CVD* (over half are >60 years old) -Taken down further, every 34 seconds an American will have a coronary events and every 60 seconds someone dies from a heart-related disease

*Adult Women (35 to 65)* •Women in this group have usually established themselves •This is when the years of health choices are resulting in what? and explain?

*either paying off or creating health issues.* •There is still a time to change health habits and make better lifestyle choices •With undetected diseases however, women are still dying prematurely

*Young Adult (18-35)* •There is no argument that young women have different focuses and goals then older women •There are major developmental tasks to form identity and develop in intimacy •As a young adult a woman can choose a spouse, build a family and establish a home Personal philosophy's are developed •Women are typically healthy in this age group, however during this time period >>WHAT CAN HAPPEN?

*unhealthy habits can begin* (unprotected sex, physical inactivity, poor eating)

*How does CVD affect genders differently? and races? ( hints below)* -what gender has increased risk for CVD? -What race has higher death from CVD? -What race has more likely to have 1st stroke earlier and diet from stroke complications? -Which race have lower risk than whites? -Which race, CVD caused more death then all cancer combined within this group?

-*CVD affect more women* -*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)

*INCREASE RISK FOR CLRD (Chronic Lower Respiratory Diseases)* -___________ more vulnerable to lung damage from smoke due to smaller lungs as well as the role estrogen plays in worsening the disease -Chronic Bronchitis can happen at any age, but more frequently at what age? (note: can even happen just with someone living with a smoker) -Contact with (3) increase the risk of developing chronic bronchitis (coal mining, textile manufacturing, grain handling, livestock farming, work in nail salons)

-*Women* more vulnerable to lung damage from smoke due to smaller lungs as well as the role estrogen plays in worsening the disease -Chronic bronchitis can happen at any age, but more frequently *>45* (note: can even happen just with someone living with a smoker) -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 are the 3 major components of the Women's Health Initiative?

-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 (More than 616 publications have been associated with the study that have researched coronary artery calcium, breast CA risk, colorectal cancer and much more)

*___________________ is a clinically and cost-effective intervention for obesity.* -Careful consideration must be given, need a LIFE change and commitment [need to change how and what you eat as well as supplements you'll need to take for rest of your life] -Average costs is $20,000-$25,000 [requires extensive counseling, so not everyone can get this]

Bariatric surgery

*WHAT IS BEING DESCRIBED BELOW?* •emphysema and chronic bronchitis. "" is a major cause of disability in the US (24 million) •Cigarette smoking is the major risk factor for developing "" and accounts for 85-90% of all cases (includes pipe, cigar, and other types of tobacco also contribute) (note: "she said it will be interesting what we find out about vaping since they are still breathing in toxins,etc) •The rest of cases are attributed to environmental exposures and genetic factors

COPD

*WHAT IS BEING DESCRIBED BELOW?* -2nd leading cause of death in US -Internal / External factors

Cancer

*WHAT IS BEING DESCRIBED BELOW?* •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) •Red 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 •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]

Chronic fatigue & Immune dysfunction syndrome aka Myalgic Encephalomyelitis

is 3rd most common cancer in adults •90% of all "" 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

Colon and rectal CA

*WHAT IS BEING DESCRIBED BELOW?* •7th leading cause of death in the US •Of those 20 years old and older 13.4 million (11.2%) are women and 15.5 million (13.6%) are men •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

Diabetes Mellitus

*________________________ of menopause is a group of sx r/t this loss of estrogen and other endogenous steroids* •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

Genitourinary syndrome

*WHAT IS BEING DESCRIBED BELOW?* •Despite advances in prevention and treatment this disease still disproportionately effects men in the US •CDC estimates in 2012 that 914,826 persons age 13 and older were living with "" •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 "" 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 "" •Issue with sharing needles and other injection equipment

HIV and Men (Young Adult (18-35))

*WHAT IS BEING DESCRIBED BELOW?* •About 1 in 2 adult men have some form of "" and it is the leading cause of death among males in most racial / ethic groups •Estimated in 2010 that 74.9 of all coronary artery bypass surgeries and 67.1% of percutaneous coronary interventions were performed on men •68.7% of all heart transplant recipients were male •70-89% of sudden cardiac events occur in men with 50% of men with no previous sx of the disease •Average first MI for men is 66 years •8.5% white, 7.9% black, and 6.3% Mexican American men have some form of coronary disease •Major risk factors include HTN, hyperlipidemia, tobacco use, DM, obesity/overweight, lack of physical activity, excessive alcohol consumption, stress, low daily fruit and veggie consumption •PHN should educate men on modifying risk factors for CVD and discuss S&S of MI and how to access emergency medical treatment.

Heart Disease ("" = CVD)

•number one killer of women •Women have higher mortality rate after heat attack and poorer outcomes than men WHY?

Heart disease, CVD 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]

*________________ can reduce the sx of menopause, as well as overall fat mass reduction, increased insulin sensitivity, and lower rates of type II DM* •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

Hormone replacement therapy (estrogen alone, estrogen plus progesterone or estrogen plus progestin)

#•1 cause of cancer and death among adults - in 2015 = 27% of all CA deaths were from lung CA. Some reasons are: •Cigarette smoking is the predominant risk factor •Occupational / environmental exposer to secondhand smoke, radon, asbestos, genetic susceptibility (disease at an early age) and hx of TB follow •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 (note: so hope this will decrease amount of deaths)

Lung CA

____________ continue to be an issue due to traffic and unsafe road conditions, however "" have declined due to improvement in road designs, seat belt laws, sobriety checkpoints, and graduated driver licensing systems for teens.

MVC's

*WHAT IS BEING DESCRIBED BELOW?* •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 "" or surgical "" (found when ovaries are removed (sudden loss of estrogen) such as in radical hysterectomies) •"" sx may last from months to years and range in severity from woman to woman •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

Menopause

What is reduced deaths for CA of breast, colon, rectum and cervix?

Screening

____________ have been found to reduce the cancer mortality rate - especially those of breast, colon, rectum, cervix, and lung.

Screenings

_________ is 4th among all causes of death in the US.

Stroke

*__________ use remains a public health problem* •More than 1 x as many US citizens have died prematurely from cigarette smoking than have died in all wars fought by the US in its history •Race / Ethnicity smoking stats: American Indians & Alaska Natives (26.1%), whites (19.4%), Blacks (18.3%), and Hispanics / Latinos (12.1%) - in the US Asians do least (9.5%) •Smoking is responsible for 87% of all ________________ and 79% of ________ cases

Tobacco Smoking is responsible for *87% of all lung cancer* deaths and *79% of COPD* cases

*WHAT IS BEING DESCRIBED BELOW?* •any "" that results from unintended exposure to physical agents, including heat, mechanical energy, chemicals, or electricity •Men more likely to die this way than females •5th leading cause of death overall •Leading cause of deaths for persons 44 years of age / younger

Unintentional Injuries

*WHAT IS BEING DESCRIBED BELOW?* 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

*WHAT IS BEING DESCRIBED BELOW?* •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%

Women's' Health Study

What is impotence? what can it be due to?

a lack of sexual desire or problems with ejaculation or orgasm [may be due to medications] -Can occur from damage to nerves, arteries, smooth muscles, and fibrous tissues (often as a result of disease processes))

*Exact cause of _______ is unknown but believed to be both genetic and environmental factors* •18.9 million "" 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%)

asthma

What are the meds used to tx Osteoporosis?

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]

What can a PHN do to help men with their Prostate Health?

can reinforce or clarify info shared with man by PCP and discuss treatment options and offer support •Occurs more in black men than any other race and less often in Asian and Hispanic / Latino 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

This is a group of CLRD (Chronic Lower Respiratory Diseases)--3 major conditions? (what cause of death?)

chronic bronchitis, emphysema, and asthma >>Is the 3rd leading cause of death in the US

If unhealthy habits continue into later adulthood they can have increased what?

increased morbidity and mortality risk •Diseases of heart & vascular systems, CAs, chronic respiratory disease, and DM

What is "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.

What is important for the PHN to do when caring for a man with HIV?

must remain nonjudgmental and educate men on substance abuse, safety, and sexual relationships

Why implies how difficult this stage of life can be?

•*"Midlife"* is usually the 1st half of this age period 35-49. *Reappraisal of values, priorities, and personal relationships can occur at this time* >>>>>•Midlife crisis implies how difficult these stages can be

*WHAT IS BEING DESCRIBED BELOW?* •2nd leading cause of death for women •Genetic mutations play a role, but only a small % of "" though are hereditary •Most "" occur in persons 55 and older •PHN can seek opportunities for education and screening in this population

•*CANCER* 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

Explain the permanent birth control for Adult Men?

•>>Vasectomy involves removal of all or a segment of the vas deferens to sperm cannot be released - outpatient and takes less than 30 minutes •>>Compared to tubal ligation - vasectomy is equally effective in preventing pregnancy [tubal ligation is more invasive though and increase recovery time]

BMI >30 = BMI >40 =

•A BMI >30 = *obesity* •A BMI >40 = *severe obesity*

*Reproductive Health* •By _____ years old 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..... •Sexual health are also important, including the protecting from _______.

•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

Differences between Female & Male demographics (what is 3rd leading cause of death for each gender?)

•Cerebrovascular disease (Stroke) is the 3rd leading cause of death in women •Unintentional injuries were the 3rd leading cause of death in men

*Cancer* •In 2012 it was estimated that 13.7 million Americans were living with CA •78% are diagnosed at age 55 and older What race more commonly gets cancer? what gender more commonly gets cancer?

•Ethnic stats: *blacks* are more likely to develop and die from cancer [not sure what's causal in this -might be lack of access and aggressive treatment] •*Men* in the US are more likely then women to develop CA

What is the *Primary* Role of the Community Health Nurse? (in general for all ages)

•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

What is the *Tertiary* Role of the Community Health Nurse? (in general for all ages) WHAT IS A SPECIFIC FOCUS IN THIS AGE GROUP?

•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) (also exposure to certain chemicals while in the 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; and these r/t to gender) •PHN must work in the community and helping those that can be or wants to be motivated. (KNOWLEDGE OF DIFFERENT STAGES AND GENDERS IN ADULTS IS IMPORTANT)

What is the *Secondary* Role of the Community Health Nurse? (in general for all ages)

•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

*Men's Health* •Gender is one of the many factors that influence health •More male __________ die at birth and men are more likely to die earlier from a _____________ than women •Women ________ an average of 5 years longer than men

•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

Risk factors for CVD include both personal and hereditary factors? (hint The most modifiable are 5?)

•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]

Explain the life expectancy differences for each gender? (and races)

•Has increased steadily •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 •Globally, the US trails many countries in longevity (concern and we should consider this when doing health promotion)

*Young Adult (18-35)* What experiences does a young male adult experience?

•Have many goals and tasks to meet •Training, education for personal or financial career •Select a lifetime companion like women and establish a home •May or may not experiment with 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) •The *PHN can meet these men were they are - work, college, military bases, health clubs and single adult groups* •*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

Explain the possible prostate health in adult men?

•Men can experience *prostate enlargement (BPH) or infection (Prostatitis)* •*Prostate CA* most frequently dx CA in men and second leading cause of cancer death •1 in 7 men will get prostate CA and 1 in 38 will die from it •Prostate CA is slow growing and does not cause any obvious health problems in men who have them •Prostate CA is rare before 40, but chance of getting it rise after 50

*Obesity* •National health and Nutrition Examination Survey determined that 34.9% of adults were obese and 6.4% were extremely obese •Obesity occurs more in what gender? •Obesity greater among (3) •Is a major risk factor for (5) •Healthy people 20/20 seeks to decrease those who are _______ by 10% (note: so by 2020 we would like to see a decrease)

•National health and Nutrition Examination Survey determined that 34.9% of adults were obese and 6.4% were extremely obese •Obesity occurs in *males* more than females •Obesity greater among *Native Americans (41%), Blacks (36%) and Hispanics / Latinos (32%)* •Is a major risk factor for *CVD and certain types of CA, type 2 DM, OSA (osteoarthritis), and premature death* •Healthy people 20/20 seeks to decrease those who are *obese* by 10% (note: so by 2020 we would like to see a decrease)

*Adult Men (35-65)* What experiences does a young male adult experience?

•Often faced with caring for families, children, and aging parents (parents-in-law) •Physical, emotion. And *financial demands* (children in college, bear burden of family finances) •The later years 50-64 are getting *ready for retirement* •This is the time where men can decide their retirement goals, however *untreated health can also now begin to emerge* •May *lose loved one or peers* may be *suffering from diseases / losses*

*Stroke* •On average someone in the US has a stroke every 40 seconds •what gender has increased risk? •Risk of having a first stroke is twice as high for what race? •The ________________________ 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] when do we consider this?

•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] NEED TO CONSIDER ABOVE THINGS WHEN TRYING TO DECIDE WHAT SHOULD YOU FOCUS ON IN AN AREA IN HEALTH PROMOTION

*Role of the Community Health Nurse* •The PHN works with adults in all age groups using the common levels of prevention •Client ___________ is a major factor in preventing and managing chronic disease •Nurse must have knowledge and access to.....

•The PHN works with adults in all age groups using the common levels of prevention •Client *teaching* is a major factor in preventing and managing chronic disease •Nurse must have *knowledge and access to appropriate community resources to meet and discuss the clients identified needs*

Explain the treatment for prostate cancer? and effects of tx?

•Treatment includes surgery (remove all or part of prostate), radiation, and hormone therapy. •All can potentially disrupt sexual desire and performance either temporarily or permanently •Urinary dysfx and incontinence are commons side effects after surgery or radiation •Rather than immediate treatment, watchful waiting or active surveillance may be an appropriate option for older men with limited life expectancy and or less aggressive tumors.

Explain the Reproductive health of Adult Men (35-65)?

•Usually a mans *family is complete* at this stage - men *may choose permanent birth control* through vasectomy •Erection problems can be common and *erectile dysfx* (aka impotence) is the repeated inability to get or keep an erection firm enough for sexual intercourse •*Impotence* can also describe a lack of sexual desire or problems with ejaculation or orgasm [may be due to medications] •*Comorbidities* s/a as DM, kidney disease, chronic alcoholism, MS, atherosclerosis, vascular disease, and neurologic disorders are primary health risk factors for ED

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