NR222 Unit 6 health and wellness REVEIW CHAMBERLAIN

NR222 Unit 6 health and wellness Unit 6 Edelman: Ch 15 1. Overview of growth and development 2. Growth a. Quantifiable change in structure b. In the body, this change means an increase in the number and/or size of the cells, resulting in an increase in the size and weight of the whole, or any of its parts c. During childhood, physical changes in height, weight, and head circumference, or growth parameters, are measured and charted regularly d. also refers to the increases (and as we age, decreases) in the size of specific organs and systems e. genetic factors, prenatal and postnatal exposures, nutrition, environmental factors, emotional health as well as traditional cultural practices that influence childrearing, lifestyle, and health care practices influence growth 3. Growth patterns a. Growth is not steady throughout life b. The periods of extremely rapid growth (prenatal, infancy, and adolescence) are contrasted with slower rates of growth (toddler, preschool,and school-age periods) c. Different parts of the body increase in size at different rates d. during early life the head is the fastest growing section (1/4 of length vs 1/9 in adults), followed by the trunk, and then the arms and legs 4. Growth charts a. Accurate growth assessment depends on precise measurement of growth parameters using proper equipment, correct and consistent techniques, careful plotting of measurements, and thoughtful interpretation of the data b. Use 2006 WHO growth charts for 0-24months c. Use 2000 CDC growth charts for 2-20 yearsd. growth charts describe weight-for-age, length (or stature)-for-age, weightforlength, and BMI-for-age, and include the 5th and 95th and the 3rd and 97th percentiles e. a single measurement taken at one point in time, although helpful in providing a baseline, does not allow for the best assessment of a child’s growth f. instead, Serial measurements, plotted on a growth chart over time, best reflect a child’s pattern of growth g. Slowed growth, plateaus, or decreases in height, weight, and head circumference, as well as rapid increases, raise questions for health care providers about the adequacy of a child’s nutritional intake, syndromes or disease states, neglect, or emotional problems 5. Concept of development a. Development refers to gradual change and expansion of ability and advance in skill from a lower to a more-advanced complexity b. is a qualitative change, so is more challenging to describe because can’t use units 6. Developmental patterns a. one stage of development building on and leading to the next a.i. early developmental pattern: a.i.1. Cephalocaudal- head to toe (Infants gain neck and head control before controlling the movements of the extremities) a.i.2. Proximodistal- midline to periphery (Infants’ central nervous systems develop before peripheral nervous systems) a.i.3. Differentiation- follows a pattern simple to complex, and general to specific (Infants use a whole-hand grasp before learning the finer control of the pincer grasp, and they coo or babble before they speak) b. Although the sequence of development is predictable, the exact timing of the sequencing is individual because individuals develop at their own rate, on their own schedulec. Denver Developmental Screening Test is a screening tool that assists health care providers in monitoring children’s development in each of these areas from birth to 6 years of age d. Social expectations can influence when developmental tasks are learned, but cultural expectations can determine which developmental tasks are learned e. Learning is the process of gaining specific knowledge or skills that result from exposure, experience, education, and evaluation f. Maturation is an increase in competence and adaptability that reflects changes in the complexity of a structure that makes it possible for that structure to begin to function or to function at a higher level g. Learning cannot occur unless the individual is mature enough to understand and control behavior (toilet training can’t be learned until sphincters have matured) 7. Theories of Development a. Psychosocial Development Theory (Erik Erikson) a.i. development of identity of the self through successive stages that unfold throughout the life span . based on the need of each person to develop a sense of trust in self and others and a sense of personal worth AGE GROUP PSYCHOSOCIAL STAGE LASTING OUTCOMES 1. Infancy Basic trust versus basic mistrust Faith and hope 2. Toddler stage Autonomy versus shame and doubt Self-control and willpower 3. Preschool stage Initiative versus guilt Direction and purpose 4. School age Industry versus inferiority Method and competence 5. Adolescence Identity versus role confusion Devotion and fidelity 6. Young adulthood Intimacy versus isolation Affiliation and love 7. Middle adulthood Generativity versus stagnation Production and care 8. Older adulthood Ego integrity versus despair Renunciation and . based on critical stages, each requiring resolution of a conflict between two opposing forces . Each stage depends on the preceding stage, which must be accomplished successfully for the person to proceed a.v. acknowledges the influence of other people and the environment but maintains that it is ultimately the individual who must master each of the conflicts b. Cognitive Development Theory (Jean Piaget) b.i. viewed children as biological organisms interacting with their environment, and his theory contends that cognitive development reflects children’s attempts to make sense of their worlds . major criticism of his work is that he underestimated children’s capabilities and gave little or no consideration for cultural differences . concerned primarily with structure rather than content, with how the mind works rather than with what it does . Each person is striving to maintain a balance, or equilibrium, between assimilation and accommodation b.v. Through a natural unfolding of ability, the child acquires sequentially predictable cognitive abilities; given adequate environmental stimuli and an intact neurological system, the child gradually matures toward full ability to conceptualize . believed that development preceded learning STAGE AGE CHARACTERISTICSSensorimotor Birth to 2 Begins with a predominance and reliance on reflexes that permit the body to years learn Reflexes decrease and voluntary acts develop Imitation predominates Thought is dominated by physical manipulation of objects and events Develops the concept of object permanence and the ability to form mental representations Preoperational 2 to 7 Advancing use of language and movement years Development of egocentric, animistic, and magical thinking Uses representational thought to interpret and learn, not in terms of general properties, but in terms of the relationship or use to them No cause-and-effect reasoning STAGE AGE CHARACTERISTICS Thought is dominated by the senses—what is seen, heard, or experienced Concrete operations 7 to 11 Mental reasoning processes assume logical approaches to solving concrete years problems, including cause and effect Collecting; mastering facts Can consider other points of view Thought influenced by social contacts Language is perfected Formal operations 11 to 15 True logical thought and manipulation of abstract concepts emerge years Morality establishedc. Cognitive Development Theory (Vygotsky) c.i. proposed that learning precedes development . while learning may be similar among children at certain times or phases of development, it is not identical in all children because of their differing social and cultural experiences . There are no predetermined levels of development; rather, experience is in the front, leading and expanding development in unlimited ways . zone of proximal development is the distance between the actual and potential developmental level, where children are pulled toward new learning through their interaction with others and the environment c.v. all people need to understand not only the way in which an individual learns and develops but also the social, cultural, and political context in which that learning and development takes place d. Moral Development Theory (Lawrence Kohlberg) d.i. Based on interviews that focused on hypothetical moral dilemmas (Should a man steal an expensive drug that would save his dying wife?) . three stages of moral development (preconventional, conventional, and postconventional) are based on Piaget’s theory of cognitive development and emphasize ethics of justice . progression generally takes place during the school-age, adolescent, and young-adult years A. GROWTH AND DEVELOPMENT: Kohlberg’s Stages of Moral Development STAGE GOAL Preconventional Avoiding punishment Gaining reward Conventional Gaining approval Avoiding disapproval Postconventional Agreeing upon rightsEstablishing personal moral standards Achieving justice e. Moral Development Theory (Carol Gilligan) e.i. suggests that there is a different process of moral development in women in society . women often scored lower in Kohlberg’s subsequent investigations (women were not inferior in their moral development, just different) . concluded that the transitions between stages are based on changes in one’s sense of self rather than on changes in cognitive development . reported that women think more in terms of caring and relationships than men do, who are more inclined to think in terms of rules and justice B. GROWTH AND DEVELOPMENT: Gilligan’s Stages of Moral Development (for Women) STAGE CHARACTERISTICS GOAL Preconventional What is practical to others and best for self, realizing Individual survival connection to others Conventional Sacrifices wants and needs to fulfill others’ wants andSelf­sacrifice is goodness needs Postconventional Moral equal of self and others Principle of nonviolence, do not hurt self or others Edelman: Ch 21 (515-532) 1. Adolescent a. defined as beginning with the onset of puberty, around age 11 to 13 years (many use 10-24 years) b. refers to the psychosocial, emotional, cognitive, and moral transition from childhood to young adulthoodc. puberty refers to the development and maturation of the reproductive, endocrine, and structural processes that lead to fertility 2. Biology and Genetics a. experience accelerated growth that dramatically alters their body size and proportions b. most noticeable changes in adolescence involve physical and sexual growth, including the appearance of secondary sexual characteristics c. physical changes are mediated primarily by the hormonal regulatory systems in the hypothalamus (releases gonadotropin-releasing hormone (GnRF), which stimulates the anterior pituitary), pituitary gland (release the gonadotropin hormones luteinizing hormone (LH) and follicle-stimulating hormone (FSH) for ovarian development and estrogen production in females and LH results in testicular enlargement and the development of Leydig cells in the testes to produce testosterone and FSH stimulates the development of the seminiferous tubules of the testes, leading to spermatogenesis), gonads (produce estrogen and testosterone and sperm and egg), and adrenal glands (releases adrenal androgens to stimulate axillary and pubic hair growth) d. Estrogen (for women) produces all secondary sexual characteristics except axillary and pubic hair e. Menarche (the onset of menses in females) usually occurs late in puberty as the growth spurt is subsiding f. Adolescents who do not follow the normal sequence or who have not begun pubertal development by age 14 years, for males, and age 13 years, for females, should have an endocrine evaluation g. Before growth spurt, increase in fat, and then decrease after h. Heart grows in size and strength i. Respiratory rate decreases through childhood (for males: Respiratory volume and vital capacity increase, and larynx and vocal cords grow, producing the characteristic voice changes of puberty)j. Both the sweat and sebaceous glands become more active (sebaceous glands on the face, neck, shoulders, upper back, chest, and genitals can become clogged and inflamed, leading to acne) k. Acne k.i. sebaceous glands increase production of sebum, a primary factor in the pathogenesis of acne . Intervention should include teaching the individual about the pathophysiological nature of acne . Washing with soap and water two or three times a day is the best way to remove dirt and oil; Vigorous scrubbing should be discouraged, because the skin can become irritated, leading to follicular rupture; should not attempt to remove the pustules and papules that form; Squeezing the lesion can result in further irritation of the gland and permanent injury to the tissue; benzoyl peroxide cause drying and peeling; make ups with a fat base prevent adequate exposure to air and light; stress can make worse; dietary restrictions are unnecessary l. Scoliosis l.i. common skeletal deformity found in adolescents is a lateral S-shaped curvature of the spine . Classifications: secondary or functional, congenital, neuromuscular, constitutional, and idiopathic, which has an infantile, juvenile, or adolescent onset . curves greater than 15 degrees are abnormal and can progress to significant curvature during the growth spurt . Idiopathic scoliosis is most common and is more prevalent in females l.v. can result in disfigurement, impaired mobility, and cardiopulmonary complications . bracing and surgical correction may be necessary and early referral to an orthopedic surgeon is importantm. Gender m.i. Primary sexual characteristics involve the organs necessary for reproduction, such as the penis and testes in boys and the vagina and uterus in girls . Secondary sexual characteristics are external features that are not essential for reproduction (breast development, facial and pubic hair growth, and lowering of the voice) . Sexual maturity rating (Tanner staging) is used widely to assess and monitor the degree of maturation of an adolescent’s primary and secondary sexual characteristics . The first sign of puberty in males is a thinning of the scrotal sac and enlargement of the testicles m.v. Ejaculation is considered a milestone of male puberty and precedes fertility by several months . For females the first sign of puberty is the appearance of breast buds, followed by the growth spurt . Menarche occurs approximately 2 years after the appearance of the breast buds and near the end of the growth spurt n. Genetics n.i. genetic disorders frequently are discovered during the assessment of an adolescent with delayed or irregular pubertal development (family history helps) . Turner syndrome (XO) .1. female disorder in which only one X chromosome is present instead of two .2. short stature, a webbed neck, a low posterior hairline, lowset ears, a shield-shaped chest with widely spaced nipples, and gonadal-ovarian dysgenesis, resulting in a lack of sexual development and menses during .3. administration of growth hormone, to increase height, and estrogen therapy to help develop secondary sexual characteristics and menses .4. Always sterile . Klinefelter syndrome (XXY) .1. Males have an extra X chromosome .2. typically are tall, initially thin, and do not develop secondary sexual characteristics .3. often have gynecomastia .4. associated with learning or behavior problems during childhood .5. management typically involves androgen therapy and counseling .6. always sterile .7. need ongoing assessment and support to promote development of positive self-esteem 3. Gordon’s functional health patterns a. Health perception- health management pattern a.i. have fewer acute illnesses than do younger children and fewer chronic illnesses than adults . sense of invincibility with experimentation and risk-taking behaviors to produce deleterious health care choices and outcomes . in the process of developing health habits and patterns of problemsolving that are likely to last a lifetime . cognitive and psychological changes that they experience can affect their adherence to health-promotion and disease-prevention strategies a.v. treat them as joint partners in planning the care . include respect for individual differences, support for the adolescent’s emerging autonomy, a developmental approach, and a focus on the individual’s strengths b. Nutritional-Metabolic Patternb.i. may choose dietary intake as a mechanism to gain control over their changing bodies, exert independence, or experiment with a new identity or cause, such as becoming a vegetarian . Gymnasts, runners, body builders, rowers, wrestlers, dancers, and swimmers are particularly vulnerable to eating disorders because their sports necessitate weight restriction . overwhelming desire to “fit in” with their peers, which often prevails and can lead to unhealthy dietary practices . eating disorders .1. anorexia nervosa .1.a. typically female, perfectionists, and high achievers with families that tend to be achievement oriented and experiencing marital discord .1.b. Symptoms include a relentless pursuit of thinness, self-starving with significant weight loss, lack of menstruation (in females) and decreased sexual interests (in males), compulsive physical activity, preoccupation with food, portioning food carefully, eating only small amounts of only certain foods, a distorted body image brittle hair and nails, dry yellowish skin, growth of fine hair over the body, constipation, mild anemia and muscle weakness, and often complains of feeling cold .1.c. response to low self-esteem and real or imagined obesity .2. bulimia nervosa .2.a. affects females more than males .2.b. typically binge on huge quantities of high-caloric foods and then purge by self-induced vomiting and/or .2.c. Binge episodes may alternate with diets, resulting in dramatic weight fluctuations .2.d. Results in dehydration, sometimes fatal electrolyte imbalances, and erosion of teeth enamel .3. Binge eating disorder (compulsive overeating) .3.a. frequently consumes large amounts of food while feeling a lack of control over eating, but don’t purge .4. Obesity .4.a. consumes too many calories for the amount of energy expended .4.b. strong correlation between inactivity .4.c. depression as one of the strongest predictors .4.d. increases the risk of and occurrence of type 2 diabetes mellitus .4.e. Diabetes is a group of diseases marked by high levels of glucose in the blood, which left unattended lead to blindness, kidney failure, amputations, heart disease, and stroke c. Elimination pattern c.i. renal and gastrointestinal systems are functionally mature by adolescence, and elimination patterns are consistent with those found in adults . Abnormal variation can occur in teens with eating disorders d. Activity-Exercise Pattern d.i. alterations in body composition and growth of lean muscle mass allow the teen to experience increased physical strength and endurance . Frequent injuries, stress fractures, secondary amenorrhea, extreme dietary measures to gain or lose weight, exclusion of other activities, deteriorating school work, and chronic pain are a few of the signs of overuse, overexertion, or overinvestmente. Sleep-Rest Pattern e.i. amount of time needed each night for sleep declines in comparison to earlier childhood needs . need at least 8 hours of sleep per night . Too little sleep also might contribute to mood swings and behavioral problems f. Cognitive-perceptual pattern f.i. Piaget’s Theory of Cognitive Development f.i.1. Formal operations f.i.2. used the term formal to represent the emergence of ability to focus on the “form” of thoughts, objects, and experiences rather than on the exact content, which in turn lays the groundwork for abstract thinking f.i.3. because of their new ability to “think about their thinking,” adolescents become highly introspective f.i.4. As introspection increases, they develop an internalized audience that provides them with a means to evaluate questions such as “Who am I?” “How do others see me?” and “Where am I going?” f.i.5. Introspection also combines with a reemergence of egocentrism, leading to their sense of being the primary focus f.i.6. Being exceptional to the adolescent means being the exception, giving rise to the risk-taking behaviors for which they are well-known f.i.7. intolerance of things as they are (able to conceptualize things as they might or could be, rather than how they are, and can think of elaborate means for achieving these changes) f.i.8. constantly challenge the ways things are and challenge themselves to consider the way things can or should bef.i.9. can lead to a rejection of family beliefs, religion, or social causes, which do not appear to the adolescent to be working fast enough to solve the problems of society . Erikson’s Theory of Psychosocial Development .1. central task of adolescence is the establishment of identity, with the primary risk being role confusion .2. Development of trust in self and others, as emphasized in infancy, is encountered again as the adolescent searches for people and ideologies in which to have faith; Toddlerhood, and its search for autonomy, is also revisited as adolescents search for autonomy from their primary family units, but searching for autonomy while avoiding shame and doubt leads to an interesting paradox (would rather be shameless to parents than do something that would bring ridicule from their peers); The preschooler’s challenge, a sense of initiative rather than guilt, resurfaces as the adolescent searches for direction and purpose; The school-age child’s developing sense of industry is carried into the adolescent period also, as teens make choices in social, recreational, volunteer, academic, familial, and occupational activities .3. When the threat of identity confusion is exceedingly great, delinquent behavior and alterations in mental health can occur . Time orientation .1. look at time differently than they did as younger children .2. realize that the response to a problem can, and sometimes should, be delayed to think through the possibilities for approaching the .3. develop a future orientation and are able to delay immediate gratification to gain more satisfaction in the future . Language .1. Formal operations and more abstract thought processes require expression in different words than did the more concrete thoughts of younger children .2. give complex definitions, frequently including all possible meanings or uses g. Self-Perception Self-Concept Pattern g.i. refers to both the description of the self and the evaluation of that description . Body image refers to the picture of and feelings about one’s body . self-perception and body image dominate, influence, and are influenced by individual, peer, and societal norms and expectations . important to praise adolescents for who they are rather than for what they do, value each of them as unique, demonstrate belief in their abilities to grow and develop, and delight in their discoveries of themselves and their unique means of expressing it h. Roles-Relationship Pattern h.i. begins to spend increased time away from the family because want identity and independence . prefer the company of peers and other adults but also begins to question familial beliefs and values . maintain a willingness to listen and demonstrate an ongoing affection for and acceptance of their adolescent, yet still maintain some consistent limits experience more constructive, positive outcomes during this period . .1. often turns from family to peer group to find a safe psychosocial shelter in which to develop .2. peer group is a vehicle for movement out of and away from the family unit and, as such, provides a means of achieving the goals of independence and individualization i. Sexuality-Reproductive Pattern i.i. emergence of secondary sexual characteristics increases adolescents’ awareness of themselves as sexual human beings . fantasize about relationships and sex and gradually experiment with dating and a myriad of noncoital physical contacts, as well as coital contacts . have sex for affection, because of peer pressure, as a symbol of maturity, as spontaneous experimentation, to feel close, because it feels good or right, and at times without their consent . Technology gives a limitless world of unmediated information i.v. Nurses discuss the subject of sex and sexual orientation, contraception, protection against STDs; and be aware of their own limitations, beliefs, and biases . Adolescent pregnancy .1. viewed as a high-risk situation, because of the serious health risks and potential complications for both the mother and the infant .2. need to reinforce reproductive health education efforts and encourage adolescents to build on the strengths in their lives and opportunities available to them j. Coping-Stress Tolerance Pattern j.i. When all of the changes that occur in adolescents are aligned with their need to separate from their parents and gain a sense of their own independence, their ability to cope is put to the test over and over . Depression, suicide, and substance abuse emerge as life becomes overwhelming and the future unimaginable . Depression .1. rate of depression increases with age and the incidence continues to increase during adolescence .2. depressive disorder is defined as a depressed or irritable mood or a diminished interest and pleasure in usual activities .3. dysthymia is a depressed or irritable mood that extends over a year with symptom relief for no more than 2 months .4. symptoms: Change in weight or appetite, Insomnia or hypersomnia, Decreased energy or fatigue, Loss of interest and pleasure in usual activities, Out-of-proportion feelings of selfreproach or guilt, Difficulty concentrating; declining school performance, Preoccupation with death or suicidal ideation .5. refer the adolescent with depression to a mental health specialist .6. teach them effective coping skills and stress-reduction techniques . Suicide .1. when coping mechanisms and social supports are inadequate, suicide may emerge as an outcome .2. third leading cause of death in persons between 10-24 years of age .3. Attempts are three to nine times more common in females, but males are four times as .4. When suspect that an adolescent is suicidal, immediate referral is made to a mental health specialist and never be left alone k. Values-Beliefs Pattern k.i. begin to expand their understanding of good and bad or right and wrong, to include autonomous moral principles that have validity apart from the authority of parent or society and instead are based on the individual’s beliefs . is situational and relational and often is superceded by psychosocial developmental needs and influences . may act contrary to belief due to peer pressure . According to Kohlberg’s theory of moral development, the adolescent begins to make the transition to the postconventional stage, equating what is right with the idea of justice and basing actions on the recognition of the universal principles underlying laws and social agreements k.v. Gilligan proposes that the female adolescent sees “good” as involving selfsacrifice and caring for the relationships in her life 4. Environmental Processes a. choices are particularly sensitive to the immediate physical and social environments b. environmental influences include their family members, friends, and community and their school, neighborhood, and work environments c. Physical agents c.i. Accidents c.i.1. Accidents, along with suicide and homicide, continue to be the leading cause of death and injury during adolescence c.i.2. few adolescents take measures to reduce their risk of injury c.i.3. Nurses talk to teens about the consequences of texting while driving, encourage teens to wear their safety belts, and avoid driving, or riding with someone, under the influence of drugs or alcohol . Sports Injuries .1. particularly vulnerable to sports injuries because their coordination skills are developing, their judgment often immature and inadequate, their epiphyses not yet closed, and their extremities poorly protected by stabilizing musculature .2. can also become obsessed or driven to perform beyond their capabilities or to the exclusion of all other activities .3. nurse advocates for the proper use of protective gear during all activities and a thorough preparticipation sports examination and also monitors for overuse, overexertion, or overinvestment . Violence .1. they test the limits of authority, experiment with a variety of roles, question adult values and authority, and look to peers for affirmation .2. may feel pressure to join gangs or feel threatened by them .3. Many teens report carrying weapons to protect themselves or intimidate others .4. Children and adolescents with fears that remain unresolved have been shown to have an increase in violent behaviors, and fear about others often surfaces as racism .5. Discussing their developing sense of self, their sense of belonging and where that sense is found, and their fears may help to intercept an adolescent who might otherwise turn to violence .6. may also discuss cyberbullying with adolescents; encourage them to talk to a trusted adult if he or she receives harassing text messages and to consider options such as rejecting texts from unknown numbers; and tell them that it is inappropriate to send harassing text messages to others . Biological Agents .1. I.1.a. Infectious mononucleosis is a self-limiting viral infection transmitted by direct contact of oropharyngeal secretions (sore throat, lymph node enlargement, and lethargy) .1.b. STDs: gonorrhea, syphilis, chlamydia, herpes simplex virus, human papilloma virus, Trichomonas,hepatitis B, and human immunodeficiency virus .1.c. inconsistent use of contraceptive and protective devices, increasingly earlier age and more frequent sexual activity, lower self-esteem, depression, social and peer pressure, and an adolescent’s sense of invincibility were related to higher risks of STDs .1.d. self-efficacy, parent-child communications, and sexual knowledge could be significant protective factors to prevent STDs c.v. Chemical Agents c.v.1. Substance use and abuse c.v.1.a. using chemicals such as drugs, alcohol, and tobacco to feel better, look better, act more sociable, stay awake, sleep, be sexy or erect, or lose weight c.v.1.b. Identifying an adolescent with substance use or abuse requires a careful nursing assessment that is conducted in an accepting manner c.v.2. Tobacco Use c.v.2.a. Most teens begin smoking during adolescence, especially if a close friend, sibling, or parent also smokes c.v.2.b. wanting to appear older or wanting to imitate their friends, adult role models, or media images c.v.2.c. prevention focus is on keeping nonsmokers from starting and helping smokers to stopc.v.3. Cancer c.v.3.a. leukemia, osteogenic sarcoma, lymphomas, and central nervous system tumors c.v.3.b. Older adolescents are entering the period of their lives during which cancer of the reproductive and related organs is more common (For females, the focus is on cervical and breast cancer; for males, testicular cancer is of concern) c.v.3.c. Breast self-examination is used to detect breast cancer c.v.3.d. Papanicolaou (Pap) smear is used to detect cervical cancer c.v.3.e. factors that increase the risk for cervical cancer include sexual intercourse before age 20, multiple sexual partners or a sexual partner who has had many partners, any history of STDs or exposure to exogenous hormones, and smoking c.v.3.f. human papillomavirus (HPV) vaccine is used to prevent cervical cancer c.v.3.g. Adolescent males should learn to perform a testicular self-examination to detect testicular cancer 5. Determinants of health: Social factors and environment a. School a.i. must learn to become accustomed to greater anonymity as they navigate the corridors of larger, more impersonal institutions . Schools and peers, as opposed to home and parents, become the primary setting through which expectations are shared and standards communicated . Adolescent peer groups serve as sounding boards against which teens test their ideas and gauge their physical, intellectual, psychological, and moral growthb. Culture and Ethnicity b.i. teens question, modify, or reject these influences, exchanging them for those of their peers or of the dominant cultural group . First-generation adolescents of immigrant parents have to negotiate two cultures, languages, and sets of expectations . may experience discrimination and rejection as they try to fit in to the dominant adolescent culture . Additional stress may also be experienced when their attempts to fit in to the dominant culture are offensive to the values and beliefs of their own culture. 6. Levels of Policy Making and Health a. adolescents, although capable, lack the experience, perspective, and judgment to recognize and avoid choices that might be detrimental to them, so they require protection b. U.S. Supreme Court affirmed the right of all individuals to have equal access to contraceptive service, regardless of age or marital status c. emancipated minor provision of certain laws recognizes that some adolescents become independent from their families at an early age and assume adult responsibilities d. information shared will be kept confidential unless the teens pose a risk to themselves or others or state laws mandate that the information be shared (abuse must be reported, STDs need to be reported, and some states require report of adolescent sexual activity if an age difference of 3 or more years exists between the sexual partners) 7. Economics a. parents and adolescents should negotiate economic questions, with the parents becoming less controlling as the teen gains more experience and expertise in these matters b. family with limited economic resources has fewer choices, and adolescents from these families may feel trapped by their circumstancec. Some adolescents seek employment to earn their own money and have control over it; Others work because their families need the income 8. Health Services/Delivery System a. Teens can continue to see their child health care providers in a pediatric center as they did as younger children b. School-based clinics frequently are available in junior high and high school, and adolescent-focused clinics are available in many communities through both public and private agencies c. Can use family planning clinics d. Effective indirect approach to learning about adolescent concerns, especially about potentially embarrassing or stressful topics, is to say, “Many teenagers ask me about [a topic]. Have you ever thought about this?” or “A lot of young people want to know about [a topic].” e. Asking first about friends and the adolescent’s feelings about them may be a good lead-in approach: “Are any of your friends doing drugs?” “How do you feel about it?” 9. Nursing Application a. Treating the teen in a respectful manner enables the teen to assume more responsibility b. must remain sensitive to the changes the adolescent is encountering and understand the need for guided independence c. Health education topics: proper nutrition, exercise, teen pregnancy, and protection from sexually transmitted diseases d. Drug and alcohol use, injury prevention, violence, and tobacco use are all behaviors that are known to contribute to illness and death among teens e. reinforce research regarding distracted driving, seat belt use, and texting, adjusting the radio, and listening to loud music while driving f. respond better when they feel that they are regarded as young adults and a partner in their health-promotion efforts g. essential to feel that they are treated with respect and regarded as an individualEdelman Ch 22 (536-548) (Skipped Parts after Gordon’s Functional Health Patterns) 1. Young Adult 2. Biology and Genetics a. greater complexity of thinking, further organization of emotional and cognitive development, and decision-making based on impact on others and future consequences b. generally the healthiest time of life c. Nursing goals for individuals of this age group are oriented toward prolonging this period of optimal physical energy; developing the mental, emotional, spiritual, and social potential; encouraging proper health habits; anticipating and screening for and, therefore, being able to treat the onset of chronic disease at an early stage; and treating disease when appropriate d. Full growth for men: 21; for women: 17 3. Gordon’s Functional Health Patterns a. Health Perception Health Management Pattern a.i. In 20s health is taken for granted, but increases in 30s . the young adult age span is split into two age groups (18 to 24 and 25 to 35), according to the preventive services that are required . behavioral health history- focuses on risk factors for unintentional injuries, such as accidents, seat belt use, and alcohol consumption, which are major causes of death and disability in this age group . preventive care .1. maximize the period of optimal health status and detect incipient health problems at an early stage .2. epeat health history and visit at approximately 2-year intervals .3. physical examination includes measurements of height, weight, body mass index (BMI), blood pressure, and blood tests, with an emphasis on the need to avoid inactivity and obesity, which are risk factors for many health .4. also looks for signs of chronic disease (asthma, arthritis, hypertension, cancer, diabetes, and heart disease) .5. After age 25, the preventive emphasis is on modifying coronary disease risk factors .6. Hypertension results from increases in cardiac output or increases in peripheral resistance, or a combination of both, and is the third leading cause of death worldwide .7. Mexican American population has the lowest percentage of high blood pressure individuals and Blacks have the highest .8. metabolic syndrome includes a group of cardiovascular risk factors associated with overweight and obesity, particularly abdominal obesity ( lethal risks of high lipid levels, insulin resistance, and hypertension) .9. Of those diagnosed with diabetes, only a few have their blood pressure, glucose levels, and cholesterol levels sufficiently controlled to avoid or delay vascular disease a.v. Decision-making and risk-taking a.v.1. decision-making of a young adult directly affects health and well-being a.v.2. leading causes of death in individuals 15 to 24 years of age are unintentional injuries, homicide, and suicide a.v.3. Underuse of seat belts and helmets by motorcyclists and bicyclists is a cause of many accidental injuries and deaths . Communicable diseases and adult immunization .1. increased availability of better drug treatments and/or vaccines, improved hygiene and food handling, and provision of cleaner water supplies have promoted prevention and control of infectious disease .2. increase is due to improvements in travel and changes in social, sexual, and other behaviors that expose broader populations of individuals to emerging pathogens (seasonal influenza, drugresistant TB, and Hantavirus pulmonary disease or syndrome) .3. focus of tuberculosis surveillance is moving toward tracking of full completion of drug protocols .4. acute hepatitis B (HB) infection declined in young adults because of vaccination programs aimed at children, adolescents, and adults in high-risk groups .5. Rubella in young adults is generally a minor disease; however, when the disease is contracted during the first trimester of pregnancy, miscarriage, stillbirth, or congenital rubella syndrome (CRS) can result (loss of hearing, ocular defects, retardation) .6. Individuals most at risk for hepatitis C are those who have injected illicit drugs, are undergoing hemodialysis, are seropositive for human immunodeficiency virus (HIV), or have elevated liver function studies .7. young adults living in college/university dormitories or crowded conditions may be more susceptible to meningococcal disease than young adults not living in close settings .8. Genital herpes virus infections occur frequently in young adults because of the escalation of sexual activity .9. HPV is spread through sexual contact, and some forms of the virus in combination with smoking are strongly related to the later development of cervical dysplasia and cancer .10. Tdap (tetanus, diphtheria, acellular pertussis) is an important vaccination because pertussis is terrible for infants b. Nutritional-Metabolic Pattern b.i. Most young adults value slimness, defined muscle tone, and athletic . Physical activity levels are positively influenced by structural environments, such as sidewalks, bike lanes, and parks, and by legislative policies that improve access to physical activity facilities . Increased caloric intake without a corresponding increase in energy expenditure can lead to obesity . new lifestyle behaviors must be practiced, learned, and adopted for nutrition and physical activity b.v. food sources are abundant, portion sizes have increased, and lifestyles are becoming increasingly sedentary . composition of food prepared outside the home promotes weight gain . “celebrity worship” may be an important motivator to seeking change in body shape and plastic surgery alternatives . Health professionals are counseled to investigate weight problems by monitoring waist circumference measurement, blood pressure level, cholesterol levels, and activity levels rather than solely monitoring weight . Those with a BMI of 25 or less should have weight maintenance teaching b.x. a BMI of 30 or greater who have tried diets and exercise may be considered for weight-reducing drugs . BMI of 40 or more meets the criteria for bariatric surgery in psychologically stable individuals . prevalence of anemia in women of childbearing potential was 22.1% . folic acid daily to reduce the risk of fetal neural tube defects (FND), including spina bifida . adult women fail to meet their calcium requirements, placing them at risk for osteoporosis and bone fractures in later life c. Elimination Pattern c.i. Assessment of young adults is directed toward teaching about the common complaints of constipation, hemorrhoids, and occasional . changes in elimination patterns or blood in the stool should be reported to their primary care provider d. Activity-Exercise Pattern d.i. Aerobic exercise, in which oxygen is metabolized to produce energy, develops an optimally functioning cardiorespiratory system . major barriers to increasing physical activity seem to be lack of time, lack of access to exercise facilities, and inability to find safe environments in which to exercise . Radiation and excessive sun exposure .1. educate young adults about the risks of sun exposure and tanning, the preventive use of sun-blocking agents, and the awareness of skin symptoms that might indicate cancer .2. New sunscreens should provide broad-spectrum protection, sun protection factor (SPF) of 30 or greater, and water resistance .3. Best protection is achieved by applying agents 15 to 30 minutes before exposure, and then reapplying every 15 to 30 minutes during exposure to the sun . Sports .1. Bicycling and motorcycling are encouraged by environmentalists to decrease automobile pollution; this trend is also promoted to relieve traffic congestion, avoid the high costs of fuel and car maintenance, and increase interest in healthy exercise .2. Bicycle helmets are believed to be the single most effective preventive measure available to decrease the incidence of brain and head injury .3. Accidental deaths from drowning are also common .4. comprehensive history of recreational activities alerts the nurse to specific needs about safety educatione. Sleep-Rest Pattern e.i. subject to fatigue induced by work, stress, or inactivity . Changes in activity or stressors can help reduce fatigue f. Cognitive-Perceptual Pattern f.i. Physical and mental patterns f.i.1. Vision and hearing peak at age 20; others are stable until 45-50 f.i.2. Factors that an individual young adult may perceive as essential to learn will depend on specific goals, values, attitudes, and practices as influenced by intrinsic (constitutional) and extrinsic (environmental or community) factors f.i.3. Executive decision-making becomes more developed: calculation of risks versus rewards, prioritizing, self-evaluation, self-correction, and long-term planning become more sophisticated . Piaget’s theory .1. formal operational thought evolves from concrete operational thought in adolescence and extends through the reasoning process .2. Achievement of formal operational thinking allows a person to analyze all combinations of possibilities and construct hypotheses that can be tested .3. becomes more perceptive and insightful; issues can therefore be evaluated realistically and objectively . Intellectual growth .1. Evidence shows that recall performance diminishes with age: at its peak in the twenties, memory starts to diminish during the thirties .2. Improved strategies for organization of information, however, can enhance . Erikson’s theory .1. A major goal for young adults is the development of an increased sense of competency and self-esteem .2. In developing self-esteem, the individual learns to be truly open and capable of trust through the formation of intimate relationships that are characteristic of this period .3. this stage is described as a phase of psychosocial development termed intimacy versus isolation and loneliness .4. Erikson’s concept of genuine intimacy extends beyond sexual relations to a broader view of mutual psychosocial intimacy with a spouse or lover, parents, children, and friends .5. Young adults who are unsure of their identity may avoid intimate contact or engage in promiscuous behavior lacking in true intimacy, which can result in isolation and consequent selfabsorption f.v. Moral development f.v.1. Young adults who have successfully mastered the previous cognitive, social, and moral stages are usually able to recognize or use principled reasoning f.v.2. Lawrence Kohlberg identifies this ability as the postconventional level of moral reasoning f.v.3. individual is able to differentiate the self from the rules and expectations of others and to define principles regarding rights in terms of self-chosen principles f.v.4. interests of individuals can be weighed against the needs of society and the state, and violations of law can be justified when individual interests are in accord with principlesf.v.5. Gilligan asserts that their moral judgments reflect less of a “rights” perspective and more of an emphasis on responsibilities in relationships . Self-Perception Self-Concept Pattern .1. During their twenties, young adults yearn to explore and experiment, keeping structures temporary and reversible .2. At the opposite extreme is the urge to prepare for the future by making firm commitments, where they question their value to society, the merit of their accomplishments, their success as sexual beings, and the probability of attaining their unfulfilled goals . Roles-Relationship Pattern .1. Young adult friendships are more enduring than are earlier relationships .2. Social networking services such as Facebook, My Space, and Twitter allow young adults to interact quickly with one another to organize events and share photos, experiences, thoughts, and perceptions .3. understanding the dynamics of the workplace and openness about being “out at work”; sensitivity training about the wording of forms and materials used in the workplace; building a trusting and comfortable health care communication dialogue between health care providers and gay and lesbian persons; and supporting and communicating with a gay or lesbian child .4. Decision-making about life and career directions is the developmental milestone that heralds the transition from adolescence to adulthood (usually by establishing independence from family .5. Family harmony and development are major goals .6. Separation and .6.a. Divorced young adults frequently suffer severe emotional strain and depression .6.b. Some young adults are unable to adjust to role and status changes and to threats of self-concept .7. Male and female risk of violence .7.a. Identification, education, and strategies to prevent bullying, dating violence, and sexual violence among young adults require more dissemination .7.b. Homicide (assault) is the second leading cause of death in the 15-year-old to 24-year-old age group and the leading cause of death for Black men .7.c. Physical assaults by intimate partners decreased in the last decade; this improvement is attributed to increased economic opportunities for women, increasing age at first marriage, and better access to domestic violence services . Sexuality-Reproductive Pattern .1. Irregularities such as painful menstruation, premenstrual syndrome, and prolonged or heavy bleeding need further assessment .2. Reproductive problems .2.a. Infertility is defined as the lack of conception in the presence of unprotected sexual intercourse for at least 12 months .2.b. Infertility has become more of a public issue since the advance of assistive reproductive technologies, such as in vitro fertilization and gamete intrafallopian transfer, which can enable couples with known reproductive problems to conceive .2.c. Common problems of the male reproductive system include orchitis, epididymitis, and varicoceles and hydroceles .3. Unintended Pregnancy .3.a. teen birth rate in the United States has been dropping since 1990 .3.b. Unintended pregnancy is an important public health issue and can be related to increased risks of delayed prenatal care, depression, and other personal and relationship problems .3.c. Family planning is one of the biggest public health achievements of the twentieth century .3.d. current lower pregnancy rates among teens seem to result from more involvement in school activities, contracts between young unmarried couples, effective birth control and pregnancy prevention programs, and expanding job opportunities .3.e. nurse’s role in contraceptive counseling involves helping individuals to choose the method most appropriate to their needs .3.f. two types of intrauterine devices are now available, the ParaGard T 380A (copper) and the Mirena hormonal device (levonorgesterolreleasing), and once inserted they are 99% effective .3.g. Laws and policies in some settings restrict nurses and other health care providers from engaging in certain types of counseling, including providing abortion information .4. Sexually Transmitted D.4.a. Sexually transmitted diseases (STDs) are a leading cause of infection and almost half of the new infections each year affect persons ages 15 to 24 years .4.b. STDs include HIV, Chlamydia trachomatis infections, genital herpes, HPV, genital mycoplasma infections, cytomegalovirus infections, HB, and bacterial vaginitis, in addition to the more widely known diseases of syphilis and gonorrhea .4.c. nurse’s role in intervening for STDs includes providing treatment and education, early diagnosis, and treatment .4.d. When an individual is suspected of having an STD, the nurse obtains a complete history, including sexual history, sexual contacts, previous treatment and test results, any signs or symptoms of a current infection, recent use of antibiotics, and allergic reactions to antibiotics . Coping-Stress Tolerance Pattern .1. Assessment of stress levels .1.a. Stress, the result of forces operating on the individual that disrupt physiological or psychological equilibrium, is an integral part of young adulthood; therefore, a comprehensive health assessment should include questions to determine stress levels .1.b. role of the nurse is to listen, offer support, and demonstrate concern .2. achievement-oriented .2.a. differs from the stress of situational crises in that the stress of an overachiever is derived from internal pressures to succeed as measured by selfdefined goals .2.b. frequently causes workaholic habits, including loss of sleep and omission of meals .2.c. serious physical and emotional consequences can occur, such as nutrition problems or burnout, which, in turn, leads to severe emotional and physical exhaustion .3. suicide and depression .3.a. Suicide is a leading cause of death in the young adult age group .3.b. occurs because many young adults are unable to cope with the pressures .3.c. pressure arises when dealing with interpersonal conflicts such as marital problems, family discord, or the loss of a close relationship; for others, the precipitating event is a lack of personal resources, unemployment, or dissatisfaction with work or school .3.d. Suicide is more common among single, widowed, and divorced individuals .3.e. A quick screening method for young adults who may be depressed requires the nurse to ask two questions. First, the nurse asks whether in the last month the young adult has been bothered by little interest or pleasure in doing things. Second, the nurse asks whether the young adult has felt down, depressed, or hopeless in the last month f.x. Values-Belief Patternf.x.1. Prevention is directed toward altering value and belief patterns that encourage poor health practices, and reorienting them toward those that support optimal health behaviors f.x.2. Nursing interventions are more effective when the nurse can describe, discriminate, identify, and align value and belief patterns consistent with practices known to maximize health Edelman: Ch 23 (Skipped Parts before Gordon’s Functional Health Patterns) 1. Health Perception Health Management Pattern a. nurse performs a health assessment that includes the person’s values and beliefs, lifestyle patterns, general perceptions of health, and health practices b. self-destructive habits of the middle-age adult that have been practiced for years (cigarette smoking, excessive alcohol use, and overeating) begin to have visible consequences c. major risk factors for adults in the middle years are environmental and behavioral d. health-promotion needs of the middle-age adult include acceptance of aging, the need to exercise, weight control, decreasing or stopping cigarette smoking and alcohol consumption can also be identified needs e. Preventive health screening is vital f. Health risks overall are categorized as group (age, gender, race) and personal risks g. Chronic conditions found in the middle-age adult include heart conditions, arthritis, impairments of the back and spine, chronic obstructive lung disease, diabetes, mental and nervous system conditions, and dental disease 2. Nutritional-Metabolic Patterna. Dietary factors are correlated with 5 of the 10 leading causes of death in the United States: coronary heart disease, some cancers, stroke, non– insulindependent diabetes mellitus, and atherosclerosis b. Obesity b.i. body mass index (BMI) of 30 kg/m2 or more, and being overweight is a BMI greater than 27.8 kg/m2 for adult males and greater than 27.3 kg/m2 for adult females . Women with less education and low incomes and Black and Hispanic women are at an increased risk for being overweight c. High saturated fat diet c.i. total blood cholesterol level less than 200 mg/dL as desirable . high cholesterol levels are advised to reduce their intakes of saturated fat, total fat, and dietary cholesterol; normalize their weight; and increase their level of physical activity . Statin drugs have helped reduce LDLs d. Calcium d.i. essential for developing and maintaining bone mass . Also used in muscle contraction and blood pressure regulation . minimal daily intake of 1000 mg of calcium . Pregnant and nursing women need 1200 mg, and postmenopausal women need either 1000 mg (when taking estrogen) or 1500 mg d.v. Vitamin D enhances the absorption of calcium e. Caffeine e.i. link between cancer of the pancreas . Ingestion of 0.5 gram of caffeine (3 to 4 cups of coffee) can increase the basal metabolic rate an average of 10%, and possibly as much as 25% for some people . Long-term stimulation of the central nervous system results in restlessness, sleep disturbances, cardiac stimulation,and withdrawal . assessment should screen for stimulating and addicting substances that may be producing these symptoms f. High-sodium diet f.i. play a significant role in hypertension . result may be an increase in the amount of total body fluids, which increases peripheral vascular resistance g. Alcohol abuse g.i. moderate drinking as no more than one drink a day for women and no more than two drinks a day for men . A woman is more likely to drink excessively if her parents, siblings, or other blood relatives have problems with alcohol; if her partner drinks heavily; if she was abused physically or sexually as a child; if she has a history of depression;or if she is able to “hold her liquor” more than others . associated with motor vehicle accidents, homicides, suicides, drownings, heart disease, cancer, liver disease, pancreatitis, major cause of mental retardation in children and fetal alcohol syndrome . at greater risk for cancer of the larynx, oral cavity, and liver g.v. alcoholic may complain of symptoms such as heartburn and gas, stomach distention, poor eating habits, nausea and vomiting, gastric pain, right upper quadrant pain, and irritation of the mouth, throat, and esophagus . techniques such as assertiveness training and teaching adults to resist persuasion are helpful, more useful approaches might include helping them learn to manage anxiety and increase their self-esteem . CAGE questionnaire is the most popular screening tool used h. Oral health h.i. When inflammation is not adequately treated and controlled, periodontitis, involving bone destruction, can develop in addition to tooth . increasing evidence to show that periodontal, or gum disease is closely linked to diabetes, heart disease, and stroke . vulnerable populations: individuals whose annual income is below the poverty line, others who are chronically ill or disabled, or still others whose medical or psychiatric treatment plans are very complicated . gum disease is three times greater in individuals who smoke cigarettes 3. Elimination Pattern a. Aging brings a gradual decrease of tone in the large intestine b. This change, accompanied by a sedentary lifestyle, lack of fiber in the diet, and inadequate fluid intake, can predispose the adult to constipation (exercise and diet to control problem) c. In the kidneys, degenerative changes in the nephron units gradually increase d. adults do not have any appreciable alteration in kidney function unless the person has experienced repeated infections, trauma, or the long-term effects of diabetes mellitus or hypertension e. Alteration in bladder control (incontinence) can occur because of weakening of the muscles of the pelvic floor, damage to pelvic nerves, giving birth, or prostate cancer 4. Activity-Exercise Pattern a. Exercise helps to prevent coronary heart disease, hypertension, diabetes, osteoporosis, back injury, colon cancer, stroke and depression b. Advanced practice nurses often are instrumental in creating and guiding weight loss programs; nurses working in the community may see local citizens at health fairs or health-promotion events; and other nurses or therapists visit persons at home for care following hospitalization for surgery or acute illness as home health professionals c. calculate target heart rate: subtract age from the value 220 and then multiply this number by 0.75 to determine a heart rate value that is within safe limits 5. Sleep-Rest Patterna. Insomnia is a common because of overstimulation resulting from drinking too many caffeinated beverages, strenuous exercise within 2 hours of bedtime, or failure to have a regular sleep/wake schedule in a 24-hour period b. If insomnia becomes a chronic problem, cognitive-behavioral therapy has also been demonstrated as effective treatment 6. Cognitive-Perceptual Pattern a. theorists conclude that the prime time to be in the learner role is when the developmental task for that role is to be accomplished 9 to balance the responsibilities of caring for children and parents and being employed outside the home, the adult may explore new career options or creative endeavors) b. Havighurst defines developmental tasks as the basic tasks of living that must be achieved for the adult to live successfully c. In addition to career activities, the mature adult has an increased social awareness and often assumes more civic responsibility d. Piaget describes the thoughts of adults as being both flexible and effective; can deal efficiently with complex problems of reasoning, including hypothesis testing e. Bloom developed a hierarchy of cognitive levels in the adult learner e.i. Knowledge (acquisition of info) is the simplest or most basic cognitive level (adult learner defines “high blood pressure” in lay terms) . Comprehension is the second level: learner grasping the meaning of the communicated message and relating the term(s) to other material (individual can state one way that obesity influences high blood pressure) . Application of knowledge: learner demonstrates understanding of ideas and concepts by extending them to describe or relate to real-life situations (individual with hypertension becomes involved in an exercise program) . Analysis: all aspects of learning are united in thought and the individual is cognizant of the relationships and interactions of all the parts (individual considers his or her values and life goals when making decisions about taking action in regard to understanding health care needs)e.v. Synthesis and evaluation is highest order of learning: person is able to combine various elements to form a plan, and then is able to judge the extent to which the actions and results satisfy the original objectives (people may develop plans to improve their health status and increase their disease self-management responsibilities) . next step is to validate the results of ongoing health care programs in relation to their projected expectations f. perceptual changes f.i. Presbyopia (farsightedness) is common; occurs because of the loss of elasticity in the lens of the eye so that the adult cannot focus on objects that are in close range . decreased peripheral vision and decreased visual sensitivity in the dark are a result of the cornea becoming less transparent, and both are slow and insidious in their development . Glaucoma occurs as a result of increased intraocular pressure, which can damage the optic nerve, which is irreversible, but visual loss can be prevented if damage is identified early and treatment is initiated (leading cause of blindness among African Americans) . cataract, opacity of the lens, can develop and cloud the vision; often due to diabetes or diabetic retinopathy, which gradually causes rupture of vessels in the retina, which leak into the eye, causing lack of color differentiation and central vision changes f.v. Macular degeneration is a progressive deterioration of the maculae of the retina and choroid structures of the eye; very serious because it represents the effects of several disorders . presbycusis (impaired auditory acuity), first sounds to be lost are higher frequencies . sense of taste also diminishes, first affecting those located more anteriorly on the tongue, which detect sweet and salt; When the effectiveness of the posterior taste buds declines, detection of bitter and sour flavors is lost (show herbs and