NURS 361: ATI Book (Chapters 23, 24, 34, 43, 44, 50) 💖🥰🤩🫶🏼💋✨❤️‍🔥💌🎀🧸

What are some cognitive development concepts that improve during young adult years?

- critical thinking

- creative thought

In what way do the values and norms of friends or social groups influence young adults during this stage?

The values and norms of friends or social groups are highly relevant during this stage, influencing behavior and decision-making (more flexible).

Young adulthood is considered optimal time for __.

childbearing

According to Piaget, which stage of cognitive development do young adults experience?

Piaget's Formal Operations stage of cognitive development

where individuals develop the ability to think abstractly, logically, and hypothetically

According to Erikson, what is the primary psychosocial task young adults must achieve?

Intimacy vs Isolation

forming close relationships and intimacy.

What factors influence young adults' occupational choices?

Influenced by high goals/dreams and exploration/experimentation.

How does moral development manifest in young adults during this stage?

Moral development allows young adults to reason based on ethical fairness principles (justice) and fairness.

What influences the formation of a healthy self-concept during young adulthood?

- avoidance of substance use disorders

- formation of a family

- interaction frequency with family and friends

- responses to ethical situations

What life transitions do young adults often experience, such as changes in living arrangements and relationships?

- leave home (indepedence)

- intimate relationships 👩‍❤️‍💋‍👨

- becoming part of a new family through marriage or cohabitation.

- parenting 👶

What are some common health risks young adults face during this stage of life?

- substance use disorders

- periodontal disease

- unplanned pregnancies

- sexually transmitted infections (STIs)

- infertility

- work-related injuries

- violent death or injury

What are the recommended preventive actions young adults should take to avoid injuries? 🚗🔫

- avoiding impaired driving

- wearing seat belts

- using helmets

- securing firearms in a safe location

Why is it important for young adults to monitor their calcium intake, especially in females?

Calcium intake is crucial for maintaining bone health, particularly in females during young adulthood, to prevent bone density loss later in life.

In what ways can young adults personalize their values and beliefs?

Young adults can personalize their values and beliefs, basing them on ethical considerations and personal experiences.

Which vaccines should the nurse recommend as routine, rather than catch-up, during young adulthood? 💉

- Influenza

- Tetanus

- Diphtheria

- Pertussis

What health screenings should young adults follow based on age-related guidelines?

select a primary care provider for routine care, and receive education on contraception and physical activity

What physical changes occur in middle adulthood? 👵

Decreases:

- Skin turgor and moisture

- Subcutaneous fat

- Melanin in hair (graying)

- Hair

- Visual acuity, especially for near vision

- Auditory acuity, especially for high-pitched sounds

- Sense of taste

- Skeletal muscle mass

- Height

- Calcium/bone density

- Blood vessel elasticity

- Respiratory vital capacity

- Large intestine muscle tone

- Gastric secretions

- Glomerular filtration rate

- Estrogen/testosterone

- Glucose tolerance

What cognitive development stays intact for middle adulthood?

- memory

- crystallized intelligence remains (stored knowledge)

What cognitive development stays decline for middle adulthood?

- reaction time & speed

- fluid intelligence (how to learn and process new information)

What does the concept of generativity mean for middle adults?

Generativity involves using life as an opportunity for creativity and productivity, and contributing to the well-being of the next generation.

- create work

- contribute to society

- concern for others (new generation)

- parenting is important

How does religious maturity influence middle adults? ✝️

Spiritual beliefs and religion take on added importance, and middle adults often become more secure in their beliefs.

What issues related to self-concept may some middle adults experience?

Issues related to menopause, sexuality, depression, irritability, sexual identity, job performance, and marital changes.

What challenges related to sexuality do some middle adults face?

Decreased sex drive, often due to hormonal changes, chronic disorders, or medications.

How do job performance and ability to provide support affect self-concept in middle adults?

Job performance and ability to provide support are tied to self-worth, with struggles in these areas potentially impacting self-concept.

How do marital changes, such as the death of a spouse or divorce, influence self-concept in middle adults? 💍💒

Marital changes can lead to feelings of loss, identity confusion, and challenges with self-perception.

How does the response to menopausal changes affect the self-concept of some females?

Some females may experience role confusion or a sense of excitement about sexual freedom after menopause.

How does decreasing strength affect self-concept in males?

Decreasing strength can be frustrating or frightening for some men, potentially leading to concerns about aging and self-worth.

What is climacteric, and how does it relate to self-concept in middle-aged males?

Climacteric refers to the period of decreased fertility and strength in men, which can affect self-concept.

What is meant by the "sandwich generation," and how does it affect middle adults?

The sandwich generation refers to middle adults who care for aging parents and adult children, often leading to stress and role strain.

What age-related screening guidelines should middle adults follow?

DXA screening for osteoporosis, eye exams every 2 to 3 years (or annually depending on the provider), and mental health screenings. 👁️👁️👁️👁️

How often should middle adults have an eye examination for glaucoma and other disorders?

Every 2 to 3 years or annually depending on the provider.

How often should middle adults be screened for mental health issues such as anxiety and depression?

Regular mental health screenings are recommended.

How should middle adults ensure they are obtaining adequate protein in their diet?

By consuming sufficient amounts of protein-rich foods, such as lean meats, dairy, or plant-based sources.

What are stressors impacting self-concept?

Physical, spiritual, emotional, sexual, familial, and sociocultural challenges.

What are stressors impacting body image? 👙

- Loss of body parts (e.g., amputation, mastectomy, hysterectomy, hemiplegia)

- Loss of body function (e.g., arthritis, spinal cord injury, stroke)

- Unattainable body ideals

- Media, others' perceptions, and cultural standards

Societal attitudes

THIS INCREASES RISK OF SUICIDE

What affects sexuality? 💊

Diuretics decrease vaginal lubrication, cause erectile dysfunction, and reduce sexual desire. Antidepressant medications can cause erectile dysfunction and reduced libido.

What data should you assess?

- client role

- determine the impact of role loss

- Caregiver burden signs: fatigue, difficulty sleeping, illness (hypertension, mental health issues).

Self-concept is subjective and includes __.

self-identity, body image, attitudes, role performance, and self-esteem

Stressors that affect self-concept include __

unrealistic expectations, surgery, chronic illness, and changes in role performance

physical, spiritual, emotional, sexual, familial, and sociocultural stressors

What body image changes occur among older adults?

changes in mobility, thinning and graying of hair, and decreased visual and hearing acuity can affect body image

Identity is important for maintaining __

intimate relationships 👩‍❤️‍💋‍👨

Sexual health

is physical, mental, emotional, and social well-being regarding sexuality and sexual activity

What should you observe during assessment of older adult?

Posture

Appearance

Demeanor

Eye contact

Grooming

Unusual behavior

PLISSIT assessment tool for sexuality

P: Permission (obtaining permission to discuss this with the client)

LI: Limited information (related to sexual health patterns)

SS: Specific suggestions (using assessment data to make appropriate suggestions)

IT: Intensive therapy (more referral if needed)

Factors to consider in during the assessment?

- Cultural background

- Quality of relationships

- Coping mechanisms helpful in the past

- Evaluation of self-worth

What should encourage when examining self-concept?

- a healthy lifestyle (exercise, diet, stress management).

- verbalize fears or anxieties.

- the use of effective coping skills.

- reinforce successes and strengths.

Role Conflict

Occurs when a person has opposing roles with incompatible expectations (e.g., parents expecting adolescents to do sports and household tasks)

Sick Role

Society's expectations on how one should behave when sick (e.g., care for self while still managing other responsibilities like childcare)

Role Ambiguity

Uncertainty about what is expected in a role, leading to confusion.

Role Strain

Frustration and anxiety from feeling inadequate in a role (e.g., caring for a parent with dementia). Caregiver burden arises from long-term stress.

What are some factors that can alter bowel function? 💩

Interventions like surgery, immobility, medications, and therapeutic diets can affect bowel elimination.

What does QPCC refer to in the context of bowel patterns?

It stands for "Quality, Pattern, Consistency, and Color," which are objective ways to assess a client's bowel pattern.

How do adolescents' bowel patterns change?

Increased secretion of gastric acids and accelerated growth of the large intestine

What happens to bowel elimination in older adults?

Older adults experience decreased peristalsis and relaxation of sphincters.

How much fiber and fluid is required for a healthy diet? 🍒

FIBER: whole grains, legumes, fruit, vegetables

25 to 38 grams per day.

FLUID:

2.7 L/day for females and 3.7 L/day for males.

Which foods are known to cause difficulty in digestion and potentially affect bowel elimination?

Lactose (causing watery stools) and foods like cabbage, cauliflower, and apples (causing gas).

How do medications affect bowel elimination?

Laxatives: Soften stool.

Cathartics: Promote peristalsis.

Opioids: Cause constipation.

Laxative overuse: Leads to chronic constipation by weakening the bowel's response to feces.

How are hemorrhoids related to bowel elimination?

Hemorrhoids are dilated blood vessels in the rectal wall, often caused by difficult defecation, pregnancy, or liver disease. They can be painful, itchy, and bleed after defecation.

For hemorrhoids you should:

- Apply ointments or creams as prescribed.

- Use a sitz bath or ice pack to relieve discomfort.

What is an ostomy, and why is it created?

An ostomy is a surgically created opening (stoma) in the abdominal wall for fecal elimination when normal bowel function is impaired due to disease or surgery.

What are the different types of ostomies?

Colostomies: End in the colon.

Ileostomies: End in the ileum.

End stomas: Created after conditions like colorectal cancer.

Loop colostomies: Temporary, often for medical emergencies.

Double-barrel colostomies: Two stomas (proximal for stool, distal for mucus).

What are the primary causes of constipation?

Frequent use of laxatives, advanced age, inadequate fluid and fiber intake, immobility, sedentary lifestyle, pregnancy, and medication effects.

What are the causes of diarrhea?

Viral gastroenteritis, bacterial gastroenteritis, antibiotic therapy, inflammatory bowel disease, and irritable bowel syndrome.

How can nurses promote regular bowel elimination in clients

- Ensure adequate fiber and fluid intake.

- Encourage regular physical activity.

- Monitor food and fluid intake/output.

- Observe stool characteristics and check for blood or pus.

What is the correct procedure for administering a cleansing enema?

- Warm the enema solution.

- Lubricate and slowly insert the rectal tube.

- Hang the enema bag 30 to 45 cm above the anus.

- Ask the client to retain the solution for the prescribed time.

- Assist with defecation and document the results.

THESE ARE LAST RESULT

What side should you lay for an enema? 🍼

left

What is a colonoscopy used for?

A colonoscopy is used to visualize the colon and lower small bowel, collect tissue samples, or remove polyps.

What are the different types of enema solutions used for cleansing enemas?

Tap water/hypotonic solution: Stimulates bowel movement but can cause water toxicity if overused.

Soapsuds: Irritates the bowel to promote movement, but can cause electrolyte imbalance or mucosal damage, especially in older adults and pregnant women.

Normal saline: Safest option, as it matches the body's osmotic pressure.

Medicated enema: Contains medicine (e.g., antibiotics) and needs to be retained for 1-3 hours.

What do nephrons do in the urinary elimination process?

perform most of the functions of filtration and elimination.

What are the two main types of urinary diversions?

Continent (controlled) and incontinent diversions (uncontrolled)

What is a ureterostomy?

An incontinent urinary diversion where the surgeon attaches one or both ureters via a stoma to the surface of the abdominal wall.

What is a nephrostomy?

An incontinent urinary diversion where a tube is inserted from the renal pelvis via a stoma to the surface of the abdominal wall.

What is a Kock pouch (continent ileal bladder conduit)?

A continent urinary diversion where a reservoir is formed from the ileum, emptied by catheterization.

What is a neobladder?

A new bladder created from the ileum, which attaches to the ureters and urethra, allowing the client to maintain continence.

How does aging affect urinary elimination in older adults?

Older adults may have fewer nephrons, loss of muscle tone in the bladder, inefficient bladder emptying, and increased nocturia.

What are common signs of a urinary tract infection?

Urgency, frequency, fever, burning or painful urination, flank pain, cloudy, foul-smelling urine.

How do you prevent UTIs? 🚽

- clean their perineum front to back

- urinate after intercourse

How should the nurse handle catheter care for an indwelling catheter?

Clean the insertion site at least three times a day and after defecation.

RISK FOR CATHETER-ASSOCIATED UTI

What should the nurse do to prevent CAUTIs in clients with indwelling catheters?

Use aseptic technique, keep the drainage bag below the bladder, and provide regular perineal hygiene.

What is the role of pelvic floor exercises (Kegel exercises) in managing urinary incontinence?

Kegel exercises strengthen pelvic muscles, helping to manage stress incontinence.

How does a nurse implement bladder retraining for clients with urge incontinence?

Use timed voiding, increase urination intervals, and provide positive reinforceme

What should be avoided during bladder-retraining programs for urge incontinence?

Avoid caffeine and alcohol as they irritate the bladder.

When should you drain the urinary drainage bag?

when it is 3/4 full

Why is it important to keep the urinary drainage bag below the level of the bladder?

To prevent backflow of urine, which could increase the risk of infection.

Characteristics of urine include

color, clarity, odor

What is CNS depression, and what should clients avoid when it is likely?

CNS depression is a slowing of brain activity that can lead to sedation. Clients should avoid driving, operating heavy machinery, or participating in activities requiring alertness.

Nursing Action for Gastrointestinal Effects

- Many medications (NSAIDs) cause GI distress.

- Tell clients to try taking the medication with food, unless contraindicated, and to notify the provider about consistent GI effects.

- Encourage clients to increase fluid and fiber intake to reduce constipation.

Nursing Actions Hematologic Effects

- Bone marrow depression can result from anticancer medications and hemorrhagic disorders from anticoagulants and thrombolytics.

- Instruct clients taking an anticoagulant to report bruising, discolored urine or stool, petechiae, and bleeding gums to the provider immediately.

Nursing Actions Hepatotoxicity

- When combining two or more medications that are hepatotoxic, the risk for liver damage increases.

- Liver function tests are essential when a client starts taking a hepatotoxic medication and periodically thereafter.

- Monitor client for abdominal pain, jaundice, dark urine, and fatigue.

Tyramine 🍷

If taking an MAOI, avoid foods high in tyramine

Vitamin K

If taking warfarin, maintain an intake of dietary vitamin K to avoid sudden fluctuations that could affect the action of warfarin.

Dairy

Take tetracycline at least 1 hr before or 2 hr after consuming any dairy products. Follow provider instructions for other medications that should not be taken with dairy.

Grapefruit

Grapefruit juice seems to act by inhibiting presystemic medication metabolism in the small bowel, thus increasing the absorption of some oral medications (nifedipine) a calcium channel blocker. This combination can result in increased effects or intensified adverse reactions.

Caffeine ☕️

Theophylline, a methylxanthine used for asthma control, and caffeine can result in excessive CNS excitation.

Antacids, Vitamin C 🍋‍🍋🍊

taking vitamin C supplements or drinking citrus juices at the same time as medications that contain aluminum.

What should clients taking morphine be cautious of?

Clients with asthma or respiratory dysfunction should take extra precautions with morphine, as it can depress respiratory function.

What are anticholinergic effects, and what do they affect?

Anticholinergic effects result from muscarinic receptor blockade and affect the eyes, smooth muscle tone, exocrine glands, and heart.

What is anaphylaxis, and what are its manifestations?

Anaphylaxis is a severe, systemic allergic reaction. Manifestations include GI cramping, itching, hives, angioedema, respiratory failure, and cardiovascular collapse.

What should a nurse do if a client experiences anaphylaxis?

Administer epinephrine, bronchodilators, and antihistamines, and provide respiratory support. Notify the rapid response team if anaphylaxis is suspected.

What is immunosuppression, and what is the nursing action for clients at risk?

Immunosuppression is a weakened immune response. Monitor for infections in clients taking immunosuppressive medications like glucocorticoids.