NUR 222: Adult Health Promotion

Young adults are often called the "sandwich generation" because it is a time when they are caring for their own children as well as their parents. True or False.

false

The leading cause of death for young adults is:

 A. Cancer

 B. Suicide

 C. Heart disease

 D. Unintentional injury

D.

The "I" in the SPICES assessment tool for older adults stands for:

 A. Insomnia

 B. Incontinence

 C. Immunizations

 D. Instrumental activities of daily living

B.

Poverty only impacts physical and cognitive development during middle adulthood. True or False

false

Which of the following is NOT a normal part of the aging process.

 A. High blood pressure

 B. Vision changes

 C. Hearing changes

 D. Decrease in taste sensation

A.

Considering the leading causes of death in younger young adults, which of the following would be the most appropriate health promotion activity for the nurse to address?

 A. Counseling for preventive care

 B. Screen for cardiovascular conditions

 C. Implementing work site fitness programs

 D. Accident prevention education

D.

When thinking about Piaget's stages of cognitive development as applied to the middle adult, which of the following interventions would be most appropriate for a patient who has been hospitalized following a motor vehicle accident (caused by texting while driving)? 

 A. Encouraging the patient to talk to younger individuals about his experience.

 B. Allow the patient's girlfriend to be present at all times in the hospital.

 C. Asking the patient to identify proactive ways he could prevent himself from texting while driving.

 D. Asking the patient to reflect on his meaningful relationships.

C.

Which of the following is TRUE about Intimate Partner Violence (IPV) and pregnancy?

 A. IPV often escalates during pregnancy.

 B. IPV often decreases during pregnancy.

 C. IPV is associated with early prenatal care initiation.

 D. Instances of IPV tend to stay the same during pregnancy.

A.

Your 82 year-old patient was admitted to the hospital with an abrupt onset of cognitive decline.  In reviewing her history, you realize that she is on multiple medications and has started two more medications one day ago due to back pain.  She does not have a history of mental illness and has not had any recent life changes.  You recognize that she may be experiencing signs of:   

 A. Delirium

 B. Depression

 C. Dementia

 D. Alzheimer's Disease

A.

Which of the following statements is true about elder mistreatment?

 A. Elder mistreatment only occurs in those with low socioeconomic status.

 B. Most perpetrators of elder abuse are health care workers.

 C. Higher rates of elder mistreatment occur when there is a greater reliance on the caregiver.

 D. Elder mistreatment is only reportable if it is an intentional act that causes harm to an older adult.

C.

bones and joints epca

decreased bone density

muscle and body fat epca

loss of muscle mass

eyes epca

lens stiffen and become more dense (vision impaired)

ears epca

high pitched sounds harder to hear

mouth and nose epca

taste buds decrease (affects sweet + salty) and sense of smell diminished

skin epca

skin become thinner, drier, and less elastic; wrinkles

brain and nervous system epca

number of nerve cells and receptors decrease

heart and blood vessels epca

heart and blood vessels stiffen

muscles of breathing and lungs epca

muscles weaken + lungs less elastic, oxygen absorption from air decreased

digestive system epca

stomach less elastic, digestion slower, liver enzymes metabolize drugs/other substances more slowly

kidney and urinary tract epca

kidneys decrease + have less blood flow, filtration decreased (dehydration)

reproductive epca

women: decrease in female hormones (mainly estrogen), menopause

men: decrease in testosterone (sperm + sex drive), erectile dysfunction

immune epca

hormone production and activity decreased (affects muscle mass, salt + water regulation, insulin production)

young adult defined (3)

• ages 18-34

• often defined by social context, not age

  • emerging adult: seeking independence, “always connected”

  • later: marriage + parenthood

• task: identity development

young adult physical changes (4)

• all body systems reach full maturity and peak performance

• reach max growth about 20 yo

• generally healthiest phase of life

• normal changes related to aging begin, but are not yet noticeable

young adult cognitive changes (2)

• greater complexity of thinking

• rely on combination of education, life experiences, and occupational skills to critically think + problem solve

poverty can increase …

memory deficits, physical + psychological stress, helplessness feelings

young adult psychosocial changes (4)

• social, emotional, mental, and spiritual aspects interactions

• balance b/t wanting to prolong adolescent freedom and wanting to assume adult responsibilities

• balance career, friends, and family

• lifestyle, career, gender identity, sexual preferences, sexuality, childbearing/family/singlehood

young adult top causes of death

unintentional injury, homicide, suicide

young adult health concerns (8)

substance abuse, violent death and injury, IPV, family history, human trafficking, unplanned pregnancies, STIs, environmental/occupational hazards

substance abuse care

screen for alcohol, tobacco, illegal drugs, prescription drugs; refer to treatment

violent death and injury care

Evaluate economic status, family dynamic, history of abuse, history/current substance use, exposure to violence, access to guns

IPV care

assess for outward signs, evaluate substance use and relationships, provide opportunity for private disclosure, have plan for safety

family history care

creative ways to encourage routine, preventative care, educate about screenings

human trafficking care

help secure safe living environments + health care/social resources

unplanned pregnancies care

listen; evaluate feelings, support, mental health and coping mechanisms, financial stability; encourage routine prenatal care

STI care

identify those at risk and provide counseling about testing, treatment, and transmission; assess for other co-existing health concerns

environmental or occupational hazards care

ask about exposure + safety precautions

young adult general hp strategies

• conduct psychosocial assessment to evaluate mental health,identify life stressors, and determine coping mechanisms

  • “Have you ever thought about harming yourself?”

• assess presence of high-risk/unhealthy behaviors and educate accordingly

  • Motor vehicle, Smoking, Poor diet, Sun overexposure/no sunscreen

young adult erikson

intimacy vs. isolation

young, middle, older adult piaget

formal operations (11 to adulthood)

• early: prevalence of egocentric thought

  • self conscious, imaginary audience, personal fable, invulnerable:

• later: thinking becomes more abstract + theoretical

  • capacity to reason with possibilities

• nurse: encourage patient to take responsibility in own health

middle adult definition (5)

• ages 35-64

• lasting contributions through involvement with others (help children, mentor YA)

• sandwich generation

• preparing for retirement: find leisure activities

• task: acceptance of physical changes

middle adult physical changes (4)

• expected changes of aging more rapid, may/may not require attention

• graying of hair, wrinkles, waist thickening/weight gain, decreases in visual and hearing acuity, decreased immune function

• physiological: menopause, climacteric

• maintain high self-esteem, favorable body image, and positive attitude towards changes through healthy behaviors (exercise, diet, sleep, hygiene)

middle adult cognitive changes

rare, except illness, trauma, or poverty

middle adult psychosocial changes (3)

• career, sexuality, family relationships

middle adult top causes of death

cancer, heart disease, unintentional injury

middle adult health concerns (5)

• normal vs. abnormal changes of aging

• mental health changes due to life transitions

• obesity

• health literacy

• smoking

normal vs. abnormal changes of aging care

promote regular screenings and examinations for early detection and treatment of anomalies; encourage sleep, healthy diet, regular exercise

mental health changes due to life transitions care

Determine significant life transitions; evaluate current and past mental health status, economic stability, family dynamics, substance use, social support, coping mechanisms, and leisure activities; investigate acceptance of changes of aging

obesity care

discuss diet + activity patterns, work with pt to design personalized plan for diet and exercise

health literacy care

determine health literacy and provide education with return-demonstration, use interpreter if needed

smoking care

ask about at every encounter, initiate 5As of smoking cessation counseling when appropriate

middle adult erikson

generativity vs. stagnation/self-absorption

• engagement with next gen through parenting, teaching, coaching, mentoring

• nurse: help patient acknowledge contributions to younger generations, encourage volunteer work

older adult definition

ages greater than 65 (1 in 6)

tasks:

• adjusting to physical changes

• accepting self as aging person

• adjusting to retirement, including reduced/fixed income

• adjusting to loss of loved ones

• maintaining satisfactory living arrangements

• redefining relationships

• maintaining quality of life

SPICES

S - sleep disorders

P - problems with eating

I - incontinence (bowel or bladder)

C - confusion

E - evidence of falls

S - skin breakdown

older adult physical changes general (3)

• Take place at varying rates, depending on genetic, environmental, cultural, and personal variables

• Functional impairments increase risk of chronic conditions and ability to perform ADLs

• Weakening of the body’s immune system

skin older adult change

loses resilience, moisture and elasticity; spots and lesions; wrinkles; pale

head and neck older adult change

facial bones sharper and more angular; decreased visual and auditory acuity; decreased sense of smell and taste; hair thinning; eyebrows (women lose, men get bushier)

musculoskeletal older adult change

decreased muscle mass and strength; shortening of trunk (height); decreased reaction time

respiratory older adult change

AP diameter increased; chest wall stiffen (lung expansion decreased)

cardiovascular older adult change

decreased contractility of heart muscles (decreased cardiac output, increased HR); increased B/P is COMMON, but not NORMAL

GI older adult change

decreased saliva production, peristalsis, and digestive enzyme production increased indigestion and constipation

reproductive older adult change

Women: decreased estrogen and secretions (vaginal dryness)

Men: decreased testosterone, sperm count, testicular size, firmness of erection

urinary older adult change

decreased renal filtration and efficiency; nocturia

Women: Urgency and stress incontinence from decreased perineal muscle tone

Men: Frequent urination related to prostate enlargement

neuro older adult change

decreased reflexes and responses to multiple stimuli; insomnia and shorter sleep periods

older adult cognitive changes

Some structural and physiological changes occur, but cognitive

functioning remains relatively stable

• Standard assessment forms: Mini-Mental State Exam (MMSE-2), Mini-Cog, clock drawing test

older adult psychosocial changes

• Retirement: affected by feeling fulfilled, daily schedule, health status, sufficient income, and positive expectations

• Social isolation: result of personal decision, actual loss of social support, chronic illness, and/or impaired function/mobility/cognition

• Sexuality: need for intimacy and sexual feelings, plays important role in self-esteem

• Housing and environment: considerations include cost, individual’s functional and cognitive abilities, floorplan, proximity to family, medical/nursing services, safety, and social connectedness = overall ability to “age in place”

• Death: wide variety of attitudes and beliefs about death, but fear of own death is uncommon

older adult top causes of death

heart disease, cancer

older adult health concerns

heart disease, cancer, CVA, COPD, lifestyle factors, injury related to falls and meds

heart disease care

Education/counseling about smoking, weight reduction, exercise, dietary change, stress management, medication compliance, BP monitoring, and recognizing signs/symptoms for need of emergency care

cancer care

Education about risks for cancer, the importance of screening for early detection, how to make healthy style choices, and how to detect signs of cancer

CVA care

Education about risk-reduction strategies and early warning signs; support during recovery

COPD care

smoking cessation counseling + support

lifestyle factors care

Provide smoking cessation counseling and support; recognize risk factors, screen, and refer for alcohol abuse; monitor changes in

weight, assess for barriers to getting proper nutrition, refer to community resources; promote regular exercise

injury related to falls and meds care

Address fall risk factors; review all meds (include OTC and herbal supplements) and counsel about side effects

physical abuse

illness, pain, or injury as result of physical force

ex. hitting, slapping, pushing, kicking

psychosocial or emotional abuse

Verbal and nonverbal behaviors that inflict mental pain, anguish, fear, and/or distress

ex. humiliation, disrespect, threats, harassment, isolation

financial abuse

Illegal taking, misuse, or concealment of money, benefits,

property, or assets

ex. use of elder’s money, benefits, belongings, property, or assets for the benefit of someone other than the older adult

sexual abuse

nonconsensual sexual contact/activity, coercing elder to witness sexual behaviors

ex. unwanted sexual contact/penetration or noncontact acts such as sexual harassment

neglect

refusal/failure by those responsible to meet basic needs

ex. refusal/failure to provide basic needs (food, water, shelter, clothing, hygiene, medical care)

older adult general hp strategies (7)

• Do NOT make assumptions or subscribe to stereotypes (ageism); involve in care decisions

• Remember that age-related changes can mask/blunt/modify typical signs of disease

• Assess housing/environment

• Assist with preparing for/adjusting to retirement

• Assess for social isolation and depression

• Acknowledge the importance of sexuality and need to express sexual feelings throughout lifespan

• Assist with grieving process, use therapeutic communication skills, refer to community resources, be aware of own feelings

older adult erikson

integrity vs. despair

• contemplation and acknowledgement of personal life accomplishments

• nurse: assist pt to reflect on meaningful relationships and life contributions; encourage sharing of advice and wisdom