NR222 Ch 13

8. 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.

1, 2

4. 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.

1, 2, 3, 5

3. 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.

1, 2, 4, 5

7. 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

1, 3, 4

6. 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

1, 3, 4, 5

1. 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?

1, 3, 5

35. The greatest cause of illness and death in the young adult population is: 1. Violence 2. Substance abuse 3. Cardiovascular disease 4. Sexually transmitted disease

1. Factors that predispose include poverty, family breakdown, child abuse and neglect, repeated exposure to violence, and access to guns.

37. In planning patient education for Mrs. Smith, a 45-year-old woman who had an ovarian cyst removed, which of the following facts is true about the sexuality of middle-aged adults? 1. Menstruation ceases after menopause. 2. Estrogen is produced after menopause. 3. With removal of the ovarian cyst, pregnancy cannot occur. 4. After reaching climacteric, a man is unable to father a child.

1. Menopause is the disruption of the menstrual cycle primarily because of the inability of the neurohormonal system to maintain its periodic stimulation of the endocrine system.

2. Which factor affects a middle-age adult's adherence to a treatment plan? 1. Gender 2. Lifestyle 3. Motivation 4. Family history

3

5. 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.

3

10. 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.

3, 4, 5

36. Which physiological change would be a normal assessment finding in a middle adult? 1. Increased breast size 2. Reduced auditory acuity 3. Thickening of the waistline 4. Increased anteroposterior diameter of the thorax

3. The most visible changes are the graying of hair, wrinkling of the skin, and thickening of the waist.

Middle adulthood is the period from

35 to 64

9. A 34-year-old female executive has a job with frequent deadlines. She notes that when the deadlines appear, she tends to eat high-fat, 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.

4

Family history (risk factors for young adults):

A family history of a disease puts a young adult at risk for developing it in the middle-or-older adult years. Genomic science identifies people at risk for disease through the use of genetic testing.

Type of families: Parenthood

Availability of contraception, social pressures, economic considerations, general health status, and age all factor into the decision of when and if the young adult wishes to start a family.

Career Transitions (psychosocial development of middle adults):

Changes occur by choice or as a result of changes in the workplace or society (limited upward mobility, decreasing availability of jobs, seeking an occupation that is more challenging).

Singlehood (psychosocial development of middle adults):

Choice and freedom; delayed marriage and delayed parenthood, adoption

Define Climacteric

Climacteric occurs in men in their late 40s or early 50s because of decreased levels of androgens. Penile erection is less firm, ejaculation is less frequent, and the refractory period is longer.

Infertility (how assessed in YA's):

Comprehensive history of both the male and female partners to determine factors that affect fertility as well as pertinent physical findings

Exercise (how assessed in YA's):

Conduct a thorough musculoskeletal assessment and exercise history to develop a realistic exercise plan

Obesity (strategies for mid adults):

Continued focus on the goal of wellness assists patients in evaluating health behaviors and lifestyle that contribute to obesity during the middle adult years. Research shows that the type of diet is not as important as caloric restriction, which is associated with better weight outcomes.

Sexuality (psychosocial development of middle adults):

Couples redefine their relationships and find increased marital and sexual satisfaction. The onset of menopause and the climacteric affect sexual health.

Stress (strategies for mid adults):

Culturally appropriate stress management programs focusing on wellness guide patients to evaluate health behaviors, lifestyle, and environment.

Marital Changes (psychosocial development of middle adults):

Death of a spouse, separation, divorce, and the choice of remarrying or remaining single; need to assess the level of coping

Family Transitions (psychosocial development of middle adults):

Departure of the last child is a stressor, leading to a readjustment phase. Empty nest syndrome describes the sadness and loneliness that accompany children leaving home.

Environmental/occupational (risk factors for young adults):

Exposure to work-related hazards or agents, which can cause disease and cancer

Family Stress (how assessed in YA's):

Family assessment includes a review of environmental and familial factors, including support and coping mechanisms commonly used by family members.

Briefly explain the cognitive development of the period.

Formal and informal educational experiences, general life experiences, and occupational opportunities 298(which is a major task) increase the individual's conceptual, problem-solving, and motor skills

Second Trimester (Physiological changes during pregnancy):

Growth of the uterus and fetus results in some of the physical signs of pregnancy.

Human trafficking (risk factors for young adults):

Human trafficking, runaways, and homeless youth, and nurses in a variety of settings are the first line of health professionals to identify victims

Third Trimester (Physiological changes during pregnancy):

Increases in Braxton Hicks contractions (irregular, short contractions), fatigue, and urinary frequency occur.

Job stress (how assessed in YA's):

Job assessment includes a description of the usual work performed, changes in sleep or eating habits, and evidence of increased irritability or nervousness.

Describe the period of life called emerging adulthood.

Late teens to mid−20

Type of families: Singlehood

Many young adults do not marry until their late 20s or early 30s, or they remain single. Parents and siblings become the nucleus of the family. Close friends and associates may be considered family.

Define menopause

Menopause is the disruption of this cycle, primarily because of the inability of the neurohormonal system to maintain its periodic stimulation of the endocrine system.

"Sandwich generation" (psychosocial development of middle adults):

Middle adults having the responsibility of raising their own children while caring for aging parents

Violent death/injury (risk factors for young adults):

Mortality or health risks can be attributable to poverty, family breakdown, child abuse and neglect, opioid and other drug use, repeated exposure to violence, and access to guns.

Obesity (how assessed in YA's):

Obesity assessment involves a review of diet and physical activity and counsel about the benefits of a healthful diet and physical activity.

Define perimenopause

Perimenopause is the period during which ovulation declines, resulting in a diminished number of ova and irregular menstrual cycles, which usually lasts 1-3 years.

Personal hygiene habits (risk factors for young adults):

Poor hygiene (sharing utensils, poor dental hygiene) is a risk factor.

Prenatal car (physiological changes that occur to pregnant women and childbearing families).

Prenatal care is routine thorough physical examination of the pregnant woman during regular scheduled intervals.

STI's (risk factors for young adults):

Sexually transmitted infections can lead to major health problems, chronic disorders, infertility, or death.

Substance abuse (risk factors for young adults):

Substance abuse health risks include intoxicated MVAs, dependence on stimulant or depressive drugs, opioid abuse crisis, and large amounts of caffeine.

Identify the major physiological changes that occur between 40 and 65 years of age.

The most visible changes are graying of the hair, wrinkling of the skin, thickening of the waist, and decreases in hearing and visual acuity, which may have an impact on self-concept and body image.

Psychosocial patterns of 29-34 yrs

The person directs enormous energy toward achievement and mastery of the world.

Psychosocial patterns of 23-28yrs

The person refines self-perception and ability for intimacy.

Type of families: Alternative family structures and parenting:

There is greater acceptance of cohabitation without marriage. Recent research demonstrates that there is no difference in child health outcomes between same-sex and different-sex parent households.

Psychosocial patterns of 35-43 yrs

This is a time of vigorous examination of life goals and relationships.

Unplanned pregnancy (risk factors for young adults):

Unplanned pregnancies are a continued source of stress that may result in adverse health outcomes for the mother, infant, and family.

First trimester (Physiological changes during pregnancy):

Women commonly have morning sickness, breast enlargement and tenderness, and fatigue.

Summarize the physical changes that occur in young adults.

Young adults usually complete physical growth by age 20 years. An exception to this is pregnant or lactating women. They are active, experience less severe illnesses, ignore physical symptoms, and often postpone seeking health care.

Summarize two psychosocial concerns of middle adults. a. Anxiety: b. Depression:

a. Anxiety can be related to change, conflict, and perceived control of environment, which may motivate the adult to rethink his or her life goals and stimulate creativity or precipitate psychosomatic illness and preoccupation with death. b. Depression is a mood disorder that manifests itself in many ways. Although the most frequent age of onset is between ages 25 and 44 years, it is common among adults in the middle years and has many causes.

34. Bill, a 25-year-old unemployed carpenter, comes to your health center for immunizations so that he can work in a restaurant. During the encounter he states that he has not seen a health care provider since he was in high school. Before you administer his immunizations, you do a thorough history and physical exam. During the history Bill tells you he likes to drink beers with his friends and date lots of women. a. What questions would you ask Bill about his usual health promotion activities? b. How would you ask Bill about his risk for STDs? c. What health screening activities would you suggest to Bill?

a. Ask Bill if he has ever participated in any workplace health fairs or screenings. Young adults need regular dental care—does he have a dentist? When was the last time he saw a dentist? Ask him about his diet; it should have adequate protein, iron, fruits, and vegetables. Perform a thorough psychosocial assessment including history of physical and substance abuse, education, work history, and social support systems to detect personal and environmental risk factors for violence. Need to investigate his intake of alcohol—amount, frequency, and signs of abuse. b. Because Bill is sexually active, you need to explain the rationale for asking questions that he may find embarrassing or intrusive. In a nonjudgmental way the nurse should ask him at what age he became sexually active, how many sexual partners he has had, and were they women, men, or both. How many partners does he currently have and does he use condoms? c. Bill should have a comprehensive physical exam every 5 years, with testicular exam, hearing and vision assessment, and needed immunizations. Personal hygiene habits are risk factors—instruct Bill to not share utensils with someone who has a contagious disease. Visit the dentist annually; poor dental hygiene increases the risk of periodontal disease. Assist Bill in identifying and using personal coping strategies. Identify modifiable behaviors such as smoking, substance abuse, binge drinking, and increased unprotected sexual activity and provide gender - and culturally specific education and support to reduce unhealthy lifestyle behaviors.

Briefly explain the psychosocial development of a young adult in relation to the following. a. Lifestyle: b. career: c. sexuality: d. childbearing cycle:

a. Identification of modifiable factors that increase the risk for health problems and provide gender - and culturally specific patient education and support to reduce unhealthy lifestyle behaviors b. Successful employment offers economic security as well as fulfillment, friendships, social activities, support, and respect from coworkers. c. Young adults who have failed to achieve the developmental task of personal integration sometimes develop relationships that are superficial and stereotyped; encourage young adults to assess their sexual activity and practice safe sex. d. Conception, pregnancy, birth, and the puerperium are the major phases that have complex phases.