Substance abuse and smoking prevention

Exam 2 Study Guide (Learning Objectives, Additional Links)

Week 5: Substance Abuse and Smoking Prevention (~15% or 7/8 Questions)

  • Describe resources available to clinicians to assist clients in smoking cessation such as the Ask-Advise-Refer program.
    • 5 Major Steps to Intervention: 5 A’s
      • Ask about tobacco use
      • Advise to quit
      • Assess willingness to attempt quitting
      • Assist in quit attempt
      • Arrange for follow-up
    • “Ask-Advise-Refer” Program is a more brief counseling method
  • Outline interventions to help with the specific aspects of smoking cessation: psychological, sociological, behavioral, and physiological.
    • psychological: psychiatry
    • sociological: mental health peer counselors
    • behavioral: behavioral counseling
    • physiological: cardiology, respiratory care, surgical care
  • Discuss substance abuse screening and prevention in adolescents and adults.
    • Screening
      • Be alert to the major signs!
        • Agitation • Altered sleep • Appetite loss • Blackouts • Depression • Diarrhea • Distorted perception • Drowsiness/lethargy • Dry mucous membranes • Euphoria • Hallucinations • Inability to solve problems • Inability to perform regular work or social activities • Memory loss • Nausea • Poor coordination • Respiratory depression • Unintentional injuries • Weight loss • Withdrawal
      • Use acronym CRAFFT; guides health care providers when they are interviewing adolescents about substance abuse
        • C—Have you ever ridden in a CAR driven by someone, including yourself, who was “high” or had been using alcohol or drugs?
        • R—Do you use drugs to RELAX, feel better about self, or fit in?
        • A—Do you ever use drugs when you are by yourself, ALONE?
        • F—Do you FORGET things you did while using alcohol or drugs?
        • F—Does your family or do your FRIENDS ever tell you that you should cut down on your drinking or drug use?
        • T—Have you gotten into TROUBLE while you were using alcohol or drugs? Two or more affirmative answers suggest a significant problem and warrant referral and follow-up
  • Prevention
    • For adolescent problem drinkers,
      • Alcoholics Anonymous has pamphlets and other resources, including meetings, for youngsters ready to begin recovery
    • In response to the opioid epidemic,
      • communities have supplied school, police, and emergency personnel with naloxone (Narcan) for treatment of overdoses
      • many states are approving legislation directed toward limiting the duration of individual pain medications, instituting prescription monitoring programs, and safe disposal of unused medication
      • insurance companies are allowing patients to choose to receive fewer doses than prescribed and are increasing coverage for substance abuse treatment
      • nurses need advocate for these and other approaches to this issue

Week 6: Immunizations and Disease Prevention (~25% or 12/13 Questions)

  • Compare the three levels of prevention (primary, secondary and tertiary)
    • primary:
      • precedes disease/dysfunction
      • Interventions
        • Health promotion (e.g., education)
        • Specific protection (e.g., immunization, reducing exposure to carcinogens, occupational hazards)
      • Focus: Maintain/improve general individual/family/community health
      • Passive–not personally involved (Public health efforts–clean water/sewer)
      • Active–personally involved (Lifestyle changes)
    • secondary:
      • Screening
        • Goal: Identify individuals in early, detectable stage of disease
      • Treating early stages of disease
      • Limiting disability
      • Interventions similar to primary prevention but applied to individuals/ populations with disease
    • tertiary:
      • Defect/disability permanent or irreversible (e.g., stroke)
      • Minimizing effect to prevent complications/deterioration
      • Objective: Return to useful place in society, maximize remaining capacity
        • Surveillance
        • Maintenance
        • Rehabilitation
      • Discuss screening and its role in secondary prevention and health promotion.
        • screening: an important component of clinical preventive services, because it is a valuable tool for health care professionals to identify chronic conditions and risk factors before the condition becomes costly both in financial terms and in quality of life
          • Primary objective is to detect disease in early stages
          • Empowers individuals to make informed choices regarding their health
          • Early Disease Detection
          • Reduced Disease Progression
          • Early Disease Treatment
          • Reduced Asymptomatic Pathogenesis
          • Reduced Health Care Costs
          • Not diagnostic or curative
            • It is a preliminary step to identify people who need further diagnostic workup
          • Advantages
            • Usually simple and inexpensive
              • Decreased time and cost of healthcare personnel
              • Highly skilled professionals may offer care at diagnostic stage
            • Individual or group screenings
            • Ability to provide one-test/ disease-specific screenings (i.e. BP) or multiple test screenings (blood test for glucose and cholesterol level)
            • Opportunity to provide education to underserved populations
          • Disadvantages
            • Imperfection and margin of errors
            • Anxiety over false positives
            • Cost
            • Follow-up is not guaranteed
            • Difficulty engaging screening and follow up providers
          • Describe the nurses' role in the screening process.
            • Decrease preventable death rates
            • Increase life expectancy and quality of life
            • Ensure health equity through public programming offering:
              • Vaccines
              • Screenings
              • Education
            • Provide health surveillance and protection through:
              • Water quality monitoring
              • Inspection of food service and supply
              • Monitoring of sanitary sewage disposal
              • Inspection and enforcement quality housing standards
            • List examples of screening tools and who, what, when and why of each tool.
              • Breast Cancer
                • Who: women, risk increases with age, nulliparous/women who have never given birth are highest risk, women who had a child before 20 lowest risk
                • What: self-breast exam, clinical breast exams, mammograms, MRI
                • When: from the American Cancer Society-
                  • 20-30’s: clinical breast exams every 3 years, monthly self exam
                  • 40-44: discuss when to begin mammogram screening
                  • 45-54: annual mammograms
                  • 55+: biannual mammograms or annual if agreed upon w/ provider
                  • high risk women (genetics, family hx): annual MRI starting age 30
                • Why: most common cause of cancer among women
              • Cervical Cancer
                • Who: women
                • What: pap test/pap smear
                • When: from the American Cancer Society-
                  • 21-29: every 3 years with HPV testing if pap is abnormal
                  • 30-65: pap test + HPV test every 5 years OR pap test every 3 years
                  • 65+: no testing recommended if regular cervical testing in the past 10 years with normal results
                  • EXCEPTIONS:
                    • Women with a h/o cervical cancer should be tested for at least 20 years after diagnosis – regardless of age
                    • Women w/ total hysterectomy should NOT be tested
                    • Women who are at risk due to DES exposure (diethylstilbestrol), immunocompromised or have HIV infection need to discuss options for the best screening schedule with their provider
                  • Why: tenth most common cancer in women
                • Colorectal Cancer
                  • Who: men and women aged 50+
                  • What: colonoscopy, fecal immunochemical test, other screening methods do not have sufficient evidence or availability is declining in the US
                  • When:
                    • 50-75: annual stool-based test (FIT), colonoscopy every 10 years
                    • 76-85: individual, consider comorbidities and life expectancy
                  • Why: 3rd leading cause of cancer in men and women in US
                • Prostate Cancer:
                  • Who: males aged 50+, African-Americans and those with family hx
                  • What: PSA blood test with OR without digital rectal exam; however, PSA blood tests have high false-positive rates so screening is not recommended
                  • When:
                    • 55-69: PSA test every 1-4 years for 10 years ONLY IF belief that possibility of benefit is more important than risk of harm
                    • EXCEPTIONS:
                      • If patient has a family history or is African-American, discuss testing with provider beginning at age 45
                    • Why:
                      • most commonly diagnosed cancer in males
                      • second leading cause of death in men in US
                      • 1 in 6 men diagnosed, but 1 in 29 will die from prostate cancer
                    • Hyperlipidemia/Cholesterol
                      • Who: men aged 35+, women aged 45+
                      • What: lipoprotein profile
                        • total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) obtained as fasting or non-fasting
                        • TC >200mg/dL: indicates need for lifestyle modifications
                        • HDL-C< 40mg/dL: more sensitive measure
                      • When: every 5 years conduct a lipoprotein profile (total cholesterol, HDL, LDL and triglycerides) and blood pressure screening
                      • Why: major modifiable risk factor for coronary heart disease
                    • Hypertension
                      • Who: men and women aged 18+
                      • What: blood pressure reading
                      • When: periodically
                      • Why:
                        • hypertension is the leading risk factor for congestive heart failure, stroke, heart attack, and renal disease
                        • primary prevention strategy for coronary heart disease, cerebrovascular disease, and peripheral vascular disease
                      • Human Immunodeficiency Virus (HIV)
                        • Who:
                          • range of social, economic, and demographic factors—such as stigma, discrimination, income, education, and geographic region—affect risk
                          • gay sexually active black men are diagnosed at a disproportionate rate compared to their white, latino, heterosexual counterparts
                          • since 2014 the rate of new HIV diagnosis has remained stable in young, black, men who have sex with men
                          • having raw sex or w/o being on medicine that prevent or treat HIV
                          • sharing needles or injection equipment with someone who has HIV
                        • What: blood test, indirect fluorescent antibody (IFA)
                        • When: CDC recommends
                          • everyone 13-64: at least once as part of routine health care, regardless of their perceived risk
                          • EXCEPTIONS:
                            • pregnants should be screened twice (1st and 3rd trimesters)
                          • Why:
                            • AIDS is 5th leading cause of death in persons age 25-44
                            • >1 million are living with HIV in the US
                            • 1 in 8 living with HIV are unaware of their infection
                          • Diabetes Mellitus
                            • Who: adults with comorbidities including hypertension and hyperlipidemia (for type 2 diabetes)
                            • What: blood test, plasma glucose test; >125 mg/dL is at risk
                            • When: screenings should be done at least every 3 years
                            • Why: you just should mkay
                          • Osteoporosis
                            • Who: women AND men aged 50+, age most important fixed risk factor
                              • disease of bone loss more common in women aged 65+
                                • drop of estrogen in menopause moves calcium into bloodstream = weak, brittle bones
                              • other risk factors: small, thin frame, Caucasian or Asian descent, smoking/alcohol use, cortisone drugs and poor intake of calcium
                            • What: bone mineral density test/dual-energy x-ray absorptiometry (DXA)
                            • When:
                              • Women 65+: minimum biannually or at the discretion of pcp
                              • Men 70+: testing based on risk factors
                            • Why: increased risk for fractures
                          • Obesity
                            • Who: children, adolescents, and adults
                            • What: BMI (Body Mass Index)
                              • (Weight in pounds/height in inches/Height in inches) x 703
                            • When: should be screened using BMI at each health provider visit
                          • Phenylketonuria (PKU)
                            • Who: genetically determined by lack of phenylalanine hydroxylase, an enzyme to metabolize an amino acid called phenylalanine
                            • What: metabolic screen/heel prick for blood
                            • When:
                              • Newborn: after 24 hours of oral feedings and after 48 hours of life
                                • Required by the State of Indiana
                                • If parents refuse then a referral to the Neonatologist is generated so that adequate teaching can be done
                              • Why: high levels of circulating phenylalanine result in irreversible brain damage and CNS damage leading to severe developmental delay
                            • Describe the difference between active and passive immunity.
                              • Active and Passive Immunity
                                • active: all or part of disease-causing microorganism or product is injected to make immune system react defensively
                                • passive: injecting blood into a vulnerable person from actively immunized person or animal; provides short immunity for 1-6 weeks
                                  • antibodies are passed through placenta or breast milk for newborns
                                  • used experimentally in the Ebola outbreak
                                • Community or Herd Immunity
                                  • occurs when majority of the population is protected against disease through immunizations
                                  • protects those who are not eligible for certain vaccines (i.e. pregnant women, immunocompromised and infants)
                                • Discuss vaccinations including indications, contraindications and administration.
                                  • Diphtheria, Tetanus & Acellular Pertussis Vaccine (DTap)
                                    • Indications
                                      • Prevention of…
                                      • Diphtheria – breathing problems & paralysis
                                      • Tetanus – (lockjaw) tightening of muscles in jaw
                                      • Pertussis – (whooping cough) coughing spells & pneumonia
                                    • Contraindications
                                      • Epilepsy or nervous system problem of unknown origin, Guillain Barre syndrome, reaction to DTaP (vaccine) or Tdap (booster)
                                    • Administration
                                      • Given as a 5 dose series; given IM in the arm or thigh:
                                        • 2 months, 4 months, 6 months, 15-18 months, 4-6 y/o
                                      • Td & Tdap are given to 11-18 y/o and adults as a one time dose; Tdap recommended with each pregnancy at 27-36 weeks gestation
                                    • Haemophilus influenzae Type B Conjugate (Hib)
                                      • Indications:
                                        • prevents the Haemophilus influenzae bacterium that can cause meningitis, pneumonia, epiglottitis & death; does not cause the flu!
                                      • Contraindications:
                                        • any allergies to Hib vaccine components
                                      • Administration:
                                        • Given as a 4 dose series in children under 5 years; given IM:
                                          • 2 months, 4 months, 6 months and 12-15 months
                                        • Can be combined w/ DTaP and Hep B or given independently
                                      • Hepatitis A
                                        • Indications:
                                          • protects against Hepatitis A viral infection which causes jaundice, illness, diarrhea, fever, and weakness
                                          • those who travel outside of US
                                          • people with chronic liver disease
                                          • encouraged for communities with high rates of Hep A, IV drug abusers, those w/ clotting disorders, or sexually active gay men
                                        • Administration:
                                          • two dose series separated by at least 6 months; given IM
                                          • may be given as early as 12 months of age
                                        • Hepatitis B
                                          • Indications:
                                            • prevents Hepatitis B viral infection transmitted through blood or body secretions which can cause fever, jaundice, liver cirrhosis, liver cancer, liver failure and death
                                          • Contraindications:
                                            • allergy to Hepatitis B vaccine or yeast and the severely ill
                                          • Administration:
                                            • series of 3 injections; given IM in leg (<4 y/o) or arm (4+ y/o):
                                              • at birth, 1 month and 6 months
                                              • series completed by 6-18 months
                                            • Human Papillomavirus (HPV)
                                              • Indications:
                                                • prevention of common, asymptomatic virus that is spread through skin to skin sexual contact
                                                • 40 types of HPV – some lead to cervical cancer and genital warts
                                              • Contraindications:
                                                • pregnancy or a previous allergic rxn to HPV vaccine, yeast or latex
                                              • Administration:
                                                • series of 3 doses; given IM in arm or thigh:
                                                  • 1st dose 11-12 y/o for girls AND boys
                                                  • 2nd dose given 1-2 months after 1st dose
                                                  • 3rd dose given 6 months after 1st dose
                                                • vaccine is licensed to be given as early as 9 y/o to girls AND boys and can also be given to women AND men through 26 y/o if they did not receive it as an adolescent
                                              • Influenza
                                                • Indications: routine for anyone over the age of 6 months
                                                • Contraindications:
                                                  • previous allergic reaction and severe allergy to eggs
                                                  • recommend speaking with physician prior to vaccine if individual has previous diagnosis of Guillain Barre syndrome
                                                • Administration:
                                                  • receive flu shot every season; given as an IM injection
                                                  • inactivated influenza vaccine available in trivalent and quadrivalent vaccine
                                                • Measles, Mumps, Rubella (MMR)
                                                  • Indications:
                                                    • Prevention of… in children under 18 years old
                                                    • Measles – rash, fever, ear infection, pneumonia, seizures, brain damage & death
                                                    • Mumps – fever, headache, deafness, meningitis and death
                                                    • Rubella – rash, fever, arthritis, miscarriage and birth defects
                                                  • Contraindications:
                                                    • allergy to MMR vaccine or neomycin, pregnant women, cancer/HIV patients, steroid therapy, low platelet count, recently received blood products or recently received another live attenuated vaccine (within 4 weeks)
                                                  • Administration:
                                                    • series of 2 doses; given subcutaneously (SQ):
                                                      • 12-15 months and then again at 4-6 years old
                                                    • Meningococcal B
                                                      • Indications: provides short-term protection against most strains of serogroup B meningococcal disease; preferred 16-18 y/o
                                                      • Contraindications: not expected to provide protection against disease caused by all serogroup B strains circulating in the United States
  • Administration:
    • administered to adolescents and young adults aged 16–23 years
    • MenB vaccine should either be administered as a
      • 3-dose series of MenB-FHbp
      • OR 2-dose series of MenB-4C
    • the two MenB vaccines are not interchangeable; the same vaccine product must be used for all doses.
  • Meningococcal Conjugate (MCV-4)
    • Indications:
      • Protects against strains A, C, Y, W-135
      • Bacterial (Neisseria meningitidis) disease that causes meningitis
      • Highest incidence in ages 16-21 years
    • Administration:
      • administer vaccine in 11-12 y/o; given IM
      • booster between 16-18 y/o; given IM
    • Pneumococcal (PCV)
      • Indications:
        • protects against pneumococcal bacterial infection (Streptococcus pneumoniae); causes pneumonia, meningitis, endocarditis & death
        • given to older adults and adults with chronic conditions to protect against pneumococcal disease
      • Contraindications:
        • any allergy to the pneumococcal vaccine OR DTaP/Tdap vaccine
      • Administration:
        • 4 dose series; given IM:
          • at 2 months, 4 months, 6 months, and 12-15 months
        • Polio
          • Indications:
            • polio virus is a highly infectious viral disease that attacks the central nervous system; patient may be asymptomatic; causes fever, nausea, vomiting, fatigue, paralysis or death
          • Contraindications:
            • do not give to those who have an allergy to neomycin, streptomycin or polymyxin B
          • Administration:
            • 4 doses in infants and children; given IM or SQ in arm or thigh:
              • 2 months, 4 months, 6-18 months, and a booster administered at 4-6 y/o
            • polio vaccine is an inactivated form
          • Rotavirus (RV)
            • Indications:
              • prevent rotavirus- virus that causes gastroenteritis, severe diarrhea, vomiting, fever & abdominal pain, dehydration
            • Contraindications:
              • severe immunodeficiency syndrome & allergy to Rotavirus vaccine or latex, cancer, steroid therapy, HIV/AIDS, GI anomaly
            • Administration:
              • 3 dose series; given orally:
                • at 2 months, 4 months, 6 months of age
              • Varicella (Chicken Pox)
                • Indications:
                  • Chicken pox virus is highly contagious; causes rash, fever, headache, loss of appetite, bacterial infections in bone & blood, pneumonia or can lead to infection of brain
                • Contraindications:
                  • HIV, cancer, high-dose steroid therapy, pregnancy or receipt of another live attenuated virus vaccine within the past 4 weeks
                • Administration:
                  • 2 doses to children <13 years; given SQ:
                    • 12-15 months then at 4-6 y/o
                  • 13+ no h/o chickenpox or received vaccine are given 2 doses too
                  • live, attenuated immunization to protect against chicken pox virus

Week 7: Growth and Development - Foundational Concepts and Related Theories

  • Growth and Development
    • the sequence of physical, psychosocial, and cognitive developmental changes that take place over the human lifespan
  • Growth
    • physical or structural changes; things that can be measured/quantifiable
  • Development
    • advance in skill from lower to more advanced complexity
    • Early Developmental Patterns
      • Cephalocaudal: head to toe
      • Proximodistal: midline to periphery
      • Differentiation: simple to complex
    • Development Patterns continued…
      • Learning: gaining specific knowledge or skills that result from exposure experience, education, and evaluation
      • Maturation: increase in competence and adaptability
    • Assessment Tools
      • Early identification of developmental delays is key
      • Growth Charts (CDC)
        • height, weight, and head circumference (infants)
        • serial measurements best reflection of growth
      • Erikson’s Theory of Psychosocial Development
        • Trust vs. Mistrust (Infant: Birth-18 Months)
          • Trust established when comfort needs are met
          • Emotional attachment occurs in this stage
          • Mistrust occurs when gratification of needs is delayed
        • Autonomy vs. Shame and Doubt (Toddler: 18 Months - 3 Years)
          • Expressed by growing self control, wanting to choose and decide for self
          • Encouraged by permitting reasonable free choice and not forcing or shaming child
        • Initiative vs. Guilt (Preschool Child: 3 - 5 Years)
          • New sense of purpose expressed through make believe play
          • Promote initiative, nurture ideas, encourage behaviors for positive self-concept
          • Feelings of guilt, anxiety, and fear: May result from thoughts that differ from expected behavior
        • Industry vs. Inferiority (School-Age Child: 5 - 13 Years)
          • Sense of industry and capacity to work and play with others developed through praise and successes
          • Sense of inferiority develops through negative experiences in working and playing with others
        • Identity vs. Role Confusion (Adolescence: 13 - 21 Years)
          • Need to answer questions “Who am I?” and “What is my place in society?”
          • Must build consistent identity from self perceptions and relationships with others, self chosen values and vocational goals
        • Intimacy vs. Isolation (Young Adult: 21 - 39 Years)
          • Increased sense of competency/self-esteem
          • Learns to develop reciprocal intimate relationships (requires mutual trust)
        • Generativity vs. Stagnation (Middle Adult: 40 - 65 Years)
          • Generativity: Sense of productivity, creativity, desire to care for others
          • Stagnation: Lack of accomplishment, self-absorption
        • Ego vs. Despair (Older Adult: 65+ Years)
          • Successful: Ego integrity
            • Honest acceptance of life “at peace”
          • Unsuccessful: Fear of death/despair
            • Feeling that life was “lived in vain”
          • Piaget’s Theory of Cognitive Development
            • Sensorimotor Stage (0 - 2 Years)
              • Mastering simple coordination activities through senses and motor activity
              • Reflexes
                • Responses following stimulation
                • Rooting and sucking reflex...assists with survival
              • Object permanence
            • Preoperational Stage (2 - 7 Years)
              • Language development is a hallmark
              • Conservation (Fig. 34.3)
              • Egocentrism
            • Concrete Operational Stage (7 - 11 Years)
              • Uses thought processes to experience events and actions
                • Difficulty understanding abstract or hypothetical concepts
              • Develops understanding of relationships between things and ideas
              • Is able to make judgments on the basis of reason (“conceptual thinking”)
              • Develops classification skills
              • Reversibility
              • Mastery of Conservation
              • Logic
            • Formal Operational Stage (11+ Years)
              • Develop ability to think about abstract concepts
              • Logical thought, deductive reasoning & systematic planning emerge during this stage
              • Abstract thought
                • Thinking beyond present
                • Mental manipulation of multiple variables
                • Concern about others’ thoughts and needs
              • Compare Kohlberg’s and Gillian’s Theories of moral development
                • Kohlberg’s Theory of Moral Development
                  • Level 1: Preconventional Morality
                    • Stage 1: Obedience and Punishment Orientation
                    • Stage 2: Individualism and Exchange
                  • Level 2: Conventional Morality
                    • Stage 3: Good Interpersonal Relationships
                    • Stage 4: Maintaining the Social Order
                  • Level 3: Postconventional Morality
                    • Stage 5: Social Contract and Individual Rights
                    • Stage 6: Universal Principles
                  • Gillian’s Theory of Moral Development
                    • Gilligan's theory focuses more on women and asserts that women are not inferior in their moral development (in contrast to Kohlberg)
                  • Define: Schema, Assimilation, Accommodation, and Equilibrium.
                    • schema: term to describe path of action or thought
                    • assimilation: take in
                    • accomodation: modify
                    • equilibrium: balanced use of both assimilation and accommodation

Week 7: Growth and Development - Infant through Adolescent (~60% or 30 Questions)

  • Infant (Birth - 12 Months)
    • Erikson: Trust vs. Mistrust
    • Piaget: Sensorimotor Period
    • Physical:
      • Length
        • First 6 months infant may grow ½ to 1 inch per month
        • From 6-12 months may grow ⅜ inch per month
      • Weight
        • Immediately after birth lose 5-10% of birth weight, and by 2 weeks of age begin rapid weight gain of 5-7 oz per week
        • Birth weight should double by 5-6 months and triple by 12 months
      • OFC (occipital-frontal circumference)
        • Head circumference increases about 1 cm per month from 1st year
      • Developmental Tasks
        • Fine Motor Development
          • Grasping object: Ages 2 to 3 months
          • Transferring object between hands: Age 7 months
          • Pincer grasp: Age 10 months
          • Removing objects from container: Age 11 months
          • Building tower of two blocks: Age 1 year
        • Gross Motor Development
          • Head control
          • Rolling over
            • Age 5 months: Abdomen to back
            • Age 6 months: Back to abdomen
          • Sitting: Age 7 months
          • Locomotion
            • Crawling: Ages 6 to 7 months
            • Creeping: Age 9 months
            • Walking with assistance: Age 11 months
            • Walking alone: Age 1 year
          • Cognitive
            • Birth - 1 Month
              • Innate behaviors, reflexes, sensory functions
                • Crying is primary means of communication
                • Sensory stimulation helps develop cognitive function
              • Exploration of environment with limited motor skills – head turning and sucking
            • 1 Month - 12 Months
              • Exploration of environment with well coordinated reaching, grasping, swiping, and banging by 12 months
              • All of the senses are developing rapidly to assist the infant in learning about the environment
            • Language
              • Cooing by 2 months
              • Babbling at 6 months
              • Starts using single words by 12 months
              • Engages in vocal exchanges and turn-taking games
            • Psychosocial Changes
              • Attachment bond forms within the first month
              • Purposeful smiling: 2-3 months
              • Body Image, by 12 months - separation of self from others
              • Solitary Play (stage 1): First stage of play from birth to around 2 years
            • Nutrition
              • Infant feed frequently around the clock
                • Typically 5-8 times per day, Every 3-4 hours
              • Breastfeeding: the perfect food (box 17-6)
                • Exclusive breastfeeding for first 6 months recommended
              • Introduction of solid foods (Edelman & Kudzma box 17-5 & 17-6)
                • Physiologically and developmentally ready around 6 months
                • Sequence: Cereal, fruits, vegetables, meats
              • By one year, start to eat 3 meals and 2 snacks per day
            • Sleep
              • Sleep needs correlate to rate of growth
                • Around 80% of day is spent sleeping at birth
                • By 12 months sleeping around 12 hours a day including 2-3 naps
              • Risk Factors/Injury/Violence
                • Falls
                • Choking
                • MVA
                  • Child Passenger Safety (applies to infant → school-age)
                  • Indiana has Child Restraint laws
                • Poisoning
                  • Poison Control: 1-800-222-1222
                • SUIDS / SIDS
                • Abuse/Neglect
                  • Indiana law requires anyone who suspects child abuse or neglect to report it to authorities (mostly in professional setting, not personal)
                    • 24-hour statewide hotline is (800) 800-5556
                  • Shaken Baby syndrome (SBS)
                • Health Promotion/Interventions
                  • Newborn
                    • Screening (hearing, newborn screen)
                    • Car seats
                    • Crib safety / safe sleep
                    • Avoid smoking around infant
                  • Infant
                    • Nutrition
                    • Immunizations
                    • Sleep
                  • Toddler (12 Months - 3 Years)
                    • Erikson: Autonomy vs. Shame and Doubt
                    • Piaget: Sensorimotor → Preoperational (around 2 years)
                    • Physical Growth
                      • Grows about 2-4 inches per year
                      • Gains 4-6 pounds per year
                      • Continue to measure head circumference
                    • Motor Development
                      • Fine Motor Development
                        • Grasps crayons and scribbles: Age 12 to 18 Months
                        • Builds 2 cube towers: Age 12 to 18 Months
                      • Gross Motor Development
                        • Creeps up stairs: Age 12 to 18 Months
                        • Walks alone: Age 12 to 18 Months
                        • Runs, Jumps off things, hops: Age 2 to 3 Years
                        • Throws and catches with rigid upper body: Age 2 to 3 Years
                        • Pushes tricycle with feet, little steering ability: Age 2 to 3 Years
                        • Starts to be self sufficient in routines (feeding, dressing, potty training): Age 2 to 3 Years
                      • Cognitive
                        • 12-18 months
                          • Know what ordinary things are (phone, brush, spoon, etc.)
                          • Points to get the attention of others
                          • Points to one body part
                          • Scribbles on his own
                          • Can follow 1-step verbal commands (sits when you say sit down)
                        • By 2 years
                          • Finds things even when hidden under two or three covers
                          • Begins to sort shapes and colors
                          • Completes sentences and rhymes in familiar books
                          • Plays simple make-believe games
                          • Builds towers of 4 or more blocks
                          • Might use one hand more than the other
                          • Follows two-step instructions such as “Pick up your shoes and put them in the closet.”
                          • Names items in a picture book such as a cat, bird, or dog
                        • Language
                          • Level of comprehension increases
                          • Vocabulary grows to about 300 words by 2 years old
                          • 3 word sentences begin to appear
                          • Takes turns speaking in conversations and maintains topics
                          • Reading to the child helps increase their vocabulary
                        • Psychosocial
                          • Gaining a sense of Autonomy (Erikson)
                            • Provide gradual increases in independence
                          • Still attached to their parents, fear separation
                          • Temper tantrums
                          • Parallel Play: Stage 2 of play
                        • Nutrition and Sleep
                          • Continues to eat 3 meals and 2 snacks per day
                          • Sleeps for approximately 12 hours, usually with 1-2 naps per day
                        • Risk Factors/Injury/Violence
                          • Falls
                          • Choking / suffocation
                          • Drowning
                          • Fire/Burns
                          • MVA
                          • Poisoning
                          • Child Abuse/Neglect
                        • Health Promotion/Interventions
                          • Depend on caregiver for health management
                          • Healthy behaviors are part of taught rituals
                            • Brushing teeth
                          • Toilet training
                          • Identify with behavior modeled by caregiver, shapes lifelong habits
                            • Nutrition
                            • Exercise
                          • Preschool Child (3 - 5 Years)
                            • Erikson: Initiative vs. Guilt
                            • Piaget: Preoperational Stage
                            • Physical
                              • Growth slows but continues
                                • 5 pounds and 2 ½ - 3 inches per year
                              • Large and fine muscle coordination develops, have mastery of their bodies
                            • Motor Development
                              • At 3 years old
                                • Should be able to climb, run, pedal a tricycle and climb stairs
                              • At 4 years old
                                • Should be able to hop, pour and cut with supervision, catch a bounced ball most of the time
                              • At 5 years old
                                • Can stand on one foot for 10 seconds or longer, hop, maybe skip, do a somersault, use a fork and spoon to eat, use toilet on own, swing and climb
                              • Cognitive
                                • By 3 years
                                  • Can work toys with buttons, levers, and moving parts
                                  • Copies a circle with pencil or crayon
                                  • Turns book pages one at a time
                                  • Plays make-believe with dolls, animals, and people
                                  • Builds towers of more than 6 blocks
                                  • Does puzzles with 3 or 4 pieces
                                  • Screws and unscrews jar lids or turns door handle
                                  • Understands what “two” means
                                • By 4 years
                                  • Names some colors and some numbers
                                  • Draws a person with 2 to 4 body parts
                                  • Understands the idea of counting
                                  • Uses scissors
                                  • Starts to understand time
                                  • Starts to copy some capital letters
                                  • Remembers parts of a story
                                  • Plays board or card games
                                  • Understands the idea of “same” and “different”
                                  • Tells you what he thinks is going to happen next in a book
                                • By 5 years old
                                  • Counts 10 or more things
                                  • Can draw a person with at least 6 body parts
                                  • Can print some letters or numbers
                                  • Copies a triangle and other geometric shapes
                                  • Knows about things used everyday, like money and food
                                • Language
                                  • Interpret language literally, unable to see another’s point of view
                                  • Vocabulary is expanding
                                  • Improved pronunciation
                                  • Improved sentence formation
                                  • Improved grammatical structures and conversational strategies
                                • Psychosocial
                                  • Expanding influence
                                    • Primary caregivers still most important, peers and older siblings gaining influence
                                  • Imaginary Friends
                                    • Controlled by child, not a threat
                                    • A way to practice social interactions
                                  • Play: the “work” of the child
                                    • Mimic others (adults)
                                    • Associative play (Stage 3)
                                    • Cooperative play (stage 4)
                                  • Nutrition and Sleep
                                    • 3 meals per day, with snacks
                                      • Follow My Food Plate guidelines
                                      • Caloric requirements: Approximately 1400 to 1600 calories/day
                                      • Attention to iron and calcium intake
                                      • Limit fat and sugar
                                      • Food Allergies (awareness)
                                    • Sleeps 8-12 hours per night with nap or quiet time
                                      • Bedtime rituals often prolonged
                                      • Honor reasonable rituals, be firm with routine
                                    • Risk Factors/Injury/Violence
                                      • Falls
                                      • Choking / suffocation
                                      • Drowning
                                      • Fire/Burns
                                      • MVA
                                      • Poisoning
                                      • Child Abuse/Neglect
                                    • Health Promotion/Interventions
                                      • Learn behaviors from their family unit
                                        • Role modeling of healthy behaviors is important
                                      • Becoming more independent in brushing teeth, feeding self
                                        • Check for “accuracy”
                                      • Vision screening usually begins in the preschool years
                                    • School-Age Child (6 - 12 Years)
                                      • Erikson: Industry vs. Inferiority
                                      • Piaget: Concrete Operations
                                      • Physical
                                        • Consistent growth
                                          • Slow and steady until the skeletal growth spurt right before puberty
                                          • 2 inches and 4-6 pounds per year
                                          • Weight almost doubles
                                        • Improved coordination
                                        • Fine motor development occurs
                                      • Motor
                                        • Increased running speed
                                        • Normal skipping and sidestepping
                                        • Vertical jump increases
                                        • Accurate hopping and jumping from place to place
                                        • Increased accuracy with throwing, catching, batting and kicking
                                        • Dribbling ball is smooth and even
                                      • Cognitive
                                        • Overall capacity for knowledge expands and becomes more organized
                                        • Thinks in organized, logical fashion about concrete information
                                        • Can use these skills to solve problems
                                      • Language
                                        • Language growth very rapid during this time
                                        • Masters syllable stress patterns
                                        • Grasps meaning of words based on definition
                                        • Appreciates multiple meaning of words, increasing understanding of metaphors and humor
                                      • Psychosocial
                                        • Family provides sense of security
                                          • Also provide framework for socially accepted behaviors
                                        • Increasing independence and maturity
                                          • Building peer group
                                          • Broaden interests outside of home
                                            • Clubs, sports
                                          • More responsibility in home and community
                                            • Pets, chores, earn allowance
                                          • Nutrition and Sleep
                                            • Eat a well balanced diet
                                              • 1200-1800 Kcal/day
                                              • 3 meals with snacks
                                            • Sleep 8-12 hours per night
                                              • Fewer difficulties going to bed
                                            • Risk Factors/Injury/Violence
                                              • MVA
                                              • Drowning
                                              • Fire/Burns
                                              • Falls
                                              • Firearms
                                              • Child Abuse/Neglect
                                              • Bullying
                                            • Health Promotion/Interventions
                                              • Facilitate health promotion: this age period is critical for the acquisition of behaviors and health practices for a healthy adult life
                                                • Monitor/reinforce preventative practices
                                                • Model health promoting behaviors
                                                • Demonstrate/teach healthy behaviors at home and school
                                                • Screen time concerns
                                                • Screening important; ex: obesity
                                              • Adolescent (13 - 18 Years)
                                                • Erikson: Identity vs. Role Confusion
                                                • Piaget: Formal Operational Stage
                                                • Physical:
                                                  • Accelerated growth spurt
                                                  • Biological differences
                                                    • Menarche (females) late in puberty
                                                    • Primary sexual characteristics—essential for reproduction
                                                    • Secondary sexual characteristics—nonessential for reproduction
                                                      • Tanner staging: sexual maturity rating (fig. 35.3)
                                                      • Signs of puberty
                                                        • Male: Thinning scrotal sac, enlargement of testes
                                                        • Females: Breast buds, growth spurt
                                                      • Cognitive
                                                        • Overall capacity increases at slower pace
                                                        • Memory strategies improve
                                                        • Knowledge continues to expand and become more organized
                                                        • Able to think rationally
                                                          • Solve problems, make decisions
                                                        • Time orientation
                                                          • Ability for future orientation
                                                          • Able to delay immediate gratification
                                                        • Language
                                                          • Increased cognitive skills and understanding language
                                                          • Receptive and expressive vocabulary increase
                                                          • Slang, electronic communication
                                                        • Psychosocial
                                                          • Changing roles—stressful family time
                                                            • Increasing independence for adolescent
                                                            • Parents try to learn to “let go”
                                                          • Peer groups
                                                            • Strong influence on adolescent
                                                          • Self-perception and body image
                                                          • May challenge authority
                                                          • Personality developments and changes
                                                        • Nutrition and Sleep
                                                          • Dietary intake: way of gaining control, exerting independence
                                                          • Eating disorders
                                                            • Anorexia nervosa
                                                            • Bulimia nervosa
                                                            • Binge eating disorder
                                                            • Overweight and obesity
                                                          • Diabetes type 2
                                                            • Increasing prevalence
                                                            • Risk increases with obesity, inactivity
                                                          • Need at least 8 hours sleep per night
                                                          • Risk of sleep deprivation
                                                            • Multiple activities and responsibilities
                                                          • Competing factors
                                                            • Ideal body
                                                            • Fast foods, soda pop, sweets, alcohol
                                                            • Peer pressure
                                                            • Activities requiring weight restriction
                                                            • Increased needs with growth spurt
                                                          • Risk Factors/Injury/Violence
                                                            • Accidents
                                                              • Motor vehicle accidents: 20x more likely than in other age groups
                                                              • Inexperience, drugs/ETOH, distracted driving
                                                            • Sports injuries
                                                              • Vulnerable: Immature coordination, judgment, musculature, epiphyses
                                                              • Performance enhancing substances
                                                            • Violence
                                                              • Risk from carrying weapons, testing limits, witnessing/observing violence, music lyrics
                                                              • Unresolved fear: Increase in violent behavior
                                                            • Suicide
                                                              • The following warning signs often occur for at least a month before suicide is attempted:
                                                                • Decrease in school performance
                                                                • Withdrawal
                                                                • Loss of initiative
                                                                • Loneliness, sadness, and crying
                                                                • Appetite and sleep disturbances
                                                                • Verbalization of suicidal thought
                                                              • Health Promotion/Interventions
                                                                • STIs
                                                                • Substance use and abuse
                                                                  • Chemical use increasing—use precursor to abuse
                                                                • Tobacco use
                                                                  • Most start use in adolescence
                                                                  • Focus on preventing nonsmokers from starting; help smoker to quit
                                                                • Communication
                                                                  • Do not avoid discussion sensitive issues
                                                                    • Ask questions about sex, drugs, and school opens the channels for further discussion
                                                                    • Never ignore warning signs of suicide (box 35-8)
                                                                  • Ask open-ended questions
                                                                  • Look for the meaning behind the teen’s words or actions
                                                                  • Be alert to clues to their emotional state
                                                                  • Involve other individuals and resources when necessary

Week 8: Growth and Development - Young Adult through Older Adult

  • Young Adult (18 - 35 Years)
    • Erikson: Intimacy vs. Isolation
    • Biology and Genetics
      • Healthiest, optimal muscle strength (age 25-30), manual dexterity peeks
      • Gender differences
        • Full growth (women age 17, men age 21)
        • Longevity: women > men
        • Health care seeking: women > men
      • Physical
        • Stable period of physical development
        • Exception: Pregnancy
        • Usually quite active
        • Tend to ignore symptoms
      • Cognitive
        • Critical thinking habits increase
        • Formal and informal educational experiences affect problem solving and motor skills
      • Psychosocial
        • Insecurity with home, work, and the likes which causes stress and rigidity
        • Maturing relationships and roles
          • Development of enduring friendships
          • Formation of intimate relationships
          • Decisions about life/career directions
          • Formation of family units
            • Multiple decisions related to child-bearing, finances, roles/relationships
            • Self and family development
          • Adapting to parenthood is a major change for young adults
        • Separation/divorce
          • Affects children, families of couple
          • Reevaluation of basic values, strengths, personality
          • Depression common—supportive counseling/services
        • Violence
          • 80% of violence is individual acts (homicide, suicide)
          • Homicide: Second leading cause of death in 15- to 24-year-olds
            • Associated: Guns, alcohol, drug abuse, crimes
          • Intimate partner violence
            • Crosses all demographic boundaries
            • Underreported; women report higher lifetime violence
            • Appropriate assessment, detection, treatment needed
          • Nutrition and Sleep
            • Obesity—epidemic proportions
              • Basal metabolic rate declines
              • More intake than energy requirement = weight gain
              • Obesity rates vary by ethnicity
              • Factors
                • Increasing portion size, “eating out,” sedentary lifestyles
              • Teaching
                • Increased activity, low fat, more fruits/vegetables, limit portions
              • Assessment
                • BMI, waist circumference, BP, cholesterol
              • Nutritional needs/common deficiencies
                • Iron, folic acid, calcium
              • Subject to fatigue
                • Work
                • Stress
                • Inactivity
              • Recommendations
                • Change activity or stressors
                • Try out new tasks or physical activities
              • Health Concerns
                • Health promotion needs
                  • Developing behaviors to promote healthy lifestyle
                  • Decreasing incidence of accidents, injuries, violence
                • Preventive care
                  • Maximize health status, detect problems early
                  • Age 18: Full health appraisal
                  • Repeat history/physical every 2 years
                  • Screenings: BSE, testicular exam, PAP smear
                  • Over age 25: Focus on coronary risk factors\
                    • Cholesterol, diabetes, smoking, htn, metabolic syndrome
                  • Injury and Violence
                    • Suicide and depression
                    • Accidents (unintentional fall, overexertion, etc.)
                    • Occupational hazards/stressors
                    • Chemical agents
                    • MVAs
                    • Sexual Assault
                    • Domestic Violence
                    • Rural Risks
                      • In rural areas, motor vehicle crashes, traumatic occupational injuries, drowning, unintentional firearm injuries, residential fires, electrocutions, and suicides are more common
                    • Urban Risks
                      • Higher rates of crime and violence
                      • With the exception of gun violence directed at others, urban areas have relatively fewer accidents, fewer fatal accidents.
                    • Middle Adult (35 - 65 Years)
                      • Erikson: Generativity vs. Stagnation
                      • Biology and Genetics
                        • Examples of general body changes
                          • Thinning, graying hair
                          • Skin drier, wrinkles, coarsening facial features
                          • Fat deposition, decreased muscle mass/bone density, osteoarthritis
                          • Hormonal changes
                        • Mortality
                          • Leading causes: Heart disease and cancer
                          • Morbidity and mortality: Influenced by lifestyle behaviors
                        • Gender and marital status
                          • Men: Higher mortality rate
                          • Heart disease: Number 1 cause of death
                          • Life expectancies—Female: 80.4; Male: 75.2
                          • Married people generally have better health
                        • Race
                          • Black Americans and Latino/Hispanic Americans
                            • Disproportionately low SES, less access to health care, more likely not to have health insurance
                            • Higher probability of cancer, heart disease, diabetes, HIV
                          • Genetics
                            • Middle adult at higher risk for genetics-associated conditions
                          • Physical
                            • Effects on self-esteem: graying hair, wrinkles, body shape
                            • Perimenopause and menopause
                              • Mood swings, nervousness, fatigue, depression
                              • Hormonal therapy: indications and controversy
                              • Alternative products: little scientific data on benefit
                            • Health Issues
                              • Men: Sexual dysfunction (impotence, premature ejaculation, retrograde ejaculation)
                              • Women: Abnormal genital bleeding and secondary amenorrhea
                              • Both: STDs
                                • HPV—causes 90% cervical cancers
                                • HIV/AIDS—adults >50 “hidden” risk group
                                  • Less knowledgeable
                                  • Less likely to discuss sexual behavior with provider
                                • Cognitive
                                  • Continues to accumulate “learning” intelligence
                                  • Abilities for complex problems of reasoning
                                • Perceptual
                                  • Presbyopia (farsightedness)
                                  • Glaucoma (increased intraocular pressure)
                                  • Decreased visual sensitivity and peripheral vision
                                  • Cataracts (decreased opacity of lens)
                                  • Diabetic retinopathy
                                  • Presbycusis (loss of higher frequency hearing)
                                  • Diminished sense of taste
                                • Psychosocial
                                  • “Midlife crisis”
                                    • Time of reassessment, turmoil, change
                                  • Family
                                    • Family life cycle
                                      • Families launching young adults
                                      • Families from empty nest to retirement
                                    • Multiple responsibilities and stresses
                                      • Children, aging parents, job and civic responsibilities
                                      • Single parent families, adult children at home
                                      • “Empty-nest syndrome”
                                    • Caring for aging parents
                                      • Additional demands of caring for parents and children (sandwich generation)
                                        • Changing parental living arrangement
                                        • Guidance: Discussing issues before crisis
                                      • Divorce
                                        • Multiple family member adaptations needed
                                        • Potential psychological effects on children
                                      • Death
                                        • Spouse: Grief for loss of companionship, loss of future
                                        • Increased awareness of finite nature of life
                                        • Midlife review common
                                      • Work
                                        • Plays major role in level of wellness, self-esteem
                                        • 10 million work-related injuries yearly
                                      • Two-or-more-job family
                                        • Role changes—family stress factors
                                          • Reentering workforce
                                          • Job-related travel
                                          • Nontraditional female/male roles
                                          • Nature of parental work environment
                                          • Retirement planning/mid-career changes
                                        • Nutrition and Sleep
                                          • Obesity
                                            • Prevention / Management
                                          • Dietary needs
                                            • Low sat. fat
                                            • Calcium
                                            • Watch caffeine
                                            • Watch sodium
                                          • Compared to young adults
                                            • Less time in deep sleep
                                            • Less sleep overall
                                          • Healthful guidelines
                                            • Regularly scheduled
                                            • Quality sleep
                                            • Occasional napping
                                          • Health Concerns
                                            • Recovering from an injury or illness may take longer
                                            • Chronic illnesses affect roles and responsibilities
                                            • Assessment of Health promotion activities
                                              • Sleep
                                              • Leisure activities
                                              • Regular exercise
                                              • Nutrition
                                              • Smoking cessation
                                              • Screenings
                                            • Injury and Violence
                                              • Six smart risk strategies to manage risk and prevent injuries:
                                                • Look First
                                                • Wear the Gear
                                                • Get Trained
                                                • Buckle Up
                                                • Drive Sober
                                                • Seek Help
                                              • Older Adult (65+ Years)
                                                • Erikson: Ego Integrity vs. Despair
                                                • Biology and Genetics
                                                  • >85 years old fastest growing age group in US
                                                  • Aging does not inevitably lead to disability and dependence
                                                  • Most older people remain functionally independent despite the increasing prevalence of chronic disease
                                                    • Differentiating normal changes from pathology
                                                    • Large prevalence of chronic disease
                                                      • Limits daily activities for 39% >65 years old
                                                      • Impairs ability/motivation to learn health behaviors
                                                    • Myths and Stereotypes of the Older Adult
                                                      • Ill, disabled, and unattractive
                                                      • Forgetful, confused, rigid, boring, and unfriendly
                                                      • Unable to learn and understand new information
                                                      • Not interested in sex or sexual activities
                                                    • Theories of Aging
                                                      • Debate about “old age”
                                                        • Questions of physiological, social, psychological reasons why people die
                                                      • Research into theories of aging
                                                        • No single theory
                                                        • Factors under study
                                                          • Genetics: Predict development of disease
                                                          • Diet: Calorie-restriction
                                                          • Antioxidants: Binding free radicals
                                                        • Physical
                                                          • Functional status in older adults includes the day-to-day activities of daily living (ADLs) involving activities within physical, psychological, cognitive, and social domains
                                                          • Changes are usually linked to illness or to disease and degree of chronicity
                                                          • Performance of ADLs is a sensitive indicator of health or illness.
                                                          • Body changes such as: wrinkles, gray hair, loss of body mass in the extremities, and an increase of body mass in the trunk
                                                            • Skin
                                                            • Vision
                                                            • Hearing
                                                            • Taste/smell
                                                            • Skin changes
                                                            • Musculoskeletal
                                                            • GI
                                                            • GU
                                                            • Impaired heat/cold perception
                                                          • Cognitive
                                                            • Older adults can continue to learn!
                                                            • Keeping active and engaged in daily life can help keep cognitive function
                                                            • Mild cognitive impairment
                                                              • Memory loss
                                                              • Language difficulties
                                                              • Impaired judgment/reasoning
                                                            • Psychosocial
                                                              • Loss of former roles—child, sibling, spouse
                                                              • Grandparenting: New role
                                                                • Frequently brings joy and happiness
                                                                • Grandparents raising children
                                                                  • Stress issues
                                                                  • Counseling, support groups, education may help coping
                                                                • Retirement
                                                                  • Influences: Health, more time with family, wanting to do other things, not liking work
                                                                  • Challenges: Lower income, loss of friends, disease, disability, leaving home, widowhood
                                                                  • Resources: Federal/state programs; bereavement groups, volunteering opportunities
                                                                • Depression
                                                                  • Older adult at highest risk
                                                                  • Medical conditions, losses, physical changes
                                                                • Suicide
                                                                  • Highest risk in elderly—serious illnesses, social isolation, alcohol abuse, bereavement
                                                                • Nutrition and Sleep
                                                                  • Malnutrition factors
                                                                    • Access to food
                                                                    • Decline in GI absorption, metabolism, elimination
                                                                    • Deterioration of senses
                                                                    • High frequency of dentition problems
                                                                    • Cultural food preferences
                                                                    • Living environment (e.g., institutions)
                                                                    • Anorexia resulting from disease
                                                                    • Medications
                                                                  • Nutritional assistance
                                                                    • Food stamps, federally supported nutrition programs
                                                                  • High prevalence of sleep disorders
                                                                    • Decrease in total hours required
                                                                    • Increase in nocturnal awakenings, shorter periods of sleep, decrease in slow-wave activity
                                                                  • Nursing interventions
                                                                    • Teach about normal changes in aging sleep
                                                                    • Increasing physical activity
                                                                    • Pain management
                                                                    • Environmental adjustments (lights/sound)
                                                                    • Short-term sleep medications
                                                                  • Health Concerns
                                                                    • Falls
                                                                      • Leading cause of morbidity/mortality
                                                                      • Causes: Neuromuscular dysfunction, osteoporosis, stroke, sensory impairment
                                                                      • Risk assessment and prevention are essential
                                                                    • Osteoporosis
                                                                      • Risk factors include small thin frame, white, family history, inactivity, low calcium intake
                                                                    • Preventing injury
                                                                      • Driving considerations
                                                                    • Influenza
                                                                      • Major cause of morbidity/mortality
                                                                      • Recommendation: Yearly vaccination
                                                                    • Pneumococcal infections
                                                                      • Vaccination advised: Booster if first vaccination before age 65 and >5 years
                                                                    • Tuberculosis
                                                                      • Incidence rising
                                                                      • Risk factors: Poverty, homelessness, substance abuse, AIDS
                                                                      • Assess for s/s TB; medication adherence
                                                                    • Health Concerns- Delirium
                                                                      • Also known as an acute confusional state
                                                                        • Medical condition that results in confusion and other disruptions in thinking and behavior, including changes in perception, attention, mood and activity level
                                                                        • Delirium is a more abrupt confusion, emerging over days or weeks
                                                                        • Most frequent complication of hospitalization in elderly
                                                                        • The fluctuating mental status is important to identify because it often signals a need for additional treatment
                                                                        • Nurses fail to recognize delirium more than 30 - 50% of the time
                                                                        • Recognize acute confusion as a serious condition
                                                                        • Provide competency in mental status assessment
                                                                        • Utilize CAM (Confusion Assessment Method) Standardized Assessment Tool
                                                                        • Identifies 4 features of delirium that distinguishes it from other forms of cognitive impairment:
                                                                          • status altered from baseline (acute onset or fluctuating)
                                                                          • inattention
                                                                          • disorganized thinking
                                                                          • altered level of consciousness
                                                                        • Health Concerns- Dementia
                                                                          • Dementia is not a specific disease
                                                                            • Overall term that describes a wide range of symptoms
                                                                            • Associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities
                                                                          • While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired for someone to be considered having dementia
                                                                            • Memory: forgetfulness
                                                                            • Communication and language
                                                                            • Ability to focus and pay attention, disorganized thinking, altered levels of consciousness, sleep-wake disorders
                                                                            • Reasoning and judgment
                                                                            • Visual perception
                                                                            • Disorientation
                                                                          • Dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other.
                                                                            • Two main types of dementia exist:
                                                                              • Multi-infarct dementia: death of brain tissue
                                                                              • Alzheimer’s Disease (AD): most common and makes up about 50% of all dementia population
                                                                            • Mini-Mental State Examination (MMSE)
                                                                              • Assess baseline mental status of older adults and evaluate change or decline in mental functioning
                                                                              • Higher the score, the better
                                                                            • No cure, pharmacological and nonpharmacological methods for managing problems associated with dementia
                                                                            • Nurses- encourage older adults with dementia to take classes, read, and engage in stimulating conversations to keep their minds active
                                                                          • Health Concerns- Medications
                                                                            • Effects of aging
                                                                              • Drug absorption, metabolism, excretion
                                                                            • Side effects of medication
                                                                            • Polypharmacy
                                                                            • Drug-drug interactions
                                                                              • Good medication history
                                                                              • Start with lowest effective dose
                                                                            • Ability of older adults to self-administer
                                                                            • Medication affordability
                                                                          • Health Promotions
                                                                            • Participation in screening activities
                                                                            • Regular exercise
                                                                            • Weight reduction, if overweight
                                                                            • Eating a low-fat, well-balanced diet
                                                                            • Moderate alcohol use
                                                                            • Regular dental visits
                                                                            • Smoking cessation
                                                                            • Immunizations
                                                                          • Injury and Violence
                                                                            • Falls
                                                                              • Encourage exercise
                                                                              • Home safety
                                                                              • Review medications for interactions
                                                                            • MVA - Driving considerations
                                                                              • See box 24-10
                                                                            • Abuse and neglect
                                                                              • Adult protective services
                                                                            • Spirituality, Religion, and Culture
                                                                              • Spirituality
                                                                                • “is that which allows a person to experience transcendent meaning in life...whatever beliefs and values give a person a sense of meaning and purpose in life.”
                                                                                • Need to understand the person who has the disease and not merely the disease that the person has
                                                                                • Spirituality is integral to the care of the whole person. It is grounded in person/patient-centered care
                                                                              • Religion
                                                                                • Latin Root-word: To tie, secure, bind, or fasten together to create system of attitudes and beliefs. “Organized” religion may involve:
                                                                                  • Practices
                                                                                  • Adherence to certain beliefs
                                                                                  • Participation in a religious community
                                                                                • Spirituality and Religion
                                                                                  • Spirituality
                                                                                    • Individual
                                                                                    • Non-institutional/not organized
                                                                                    • Where do I find meaning?
                                                                                    • Texts have personal meaning
                                                                                  • Religion
                                                                                    • Organizational
                                                                                    • Institutional/organized
                                                                                    • What is true and right?
                                                                                    • Religious text of tradition
                                                                                  • Spirituality, Religion, and Culture
                                                                                    • Culture frames both spirituality and religion, spirituality frames culture and religion, religion frames culture and spirituality
                                                                                    • All three impact one another
                                                                                  • Religion and Improved Health Outcomes
                                                                                    • Researcher suggests that being involved in religious organization is correlated with improved health outcomes
                                                                                    • For each of the 3 leading causes of death in the US : (heart disease, cancer, and hypertension) people with religious beliefs have lower rates of illness.
                                                                                    • Each of the following offer health benefits:
                                                                                      • Religious affiliation
                                                                                      • Regular religious fellowship
                                                                                      • Religious beliefs
                                                                                      • Simple faith
                                                                                      • Prayer for others
                                                                                    • Healthcare Chaplains
                                                                                      • Chaplains: generic term that refers to any clergy or qualified layperson who assists patients, families and staff in addressing spiritual/religious needs
                                                                                      • Exist in hospitals, prisons, military, mental health institutes
                                                                                      • May come from any religious tradition, they may be certified
                                                                                      • When to Refer to Chaplains
                                                                                        • Grief
                                                                                        • Major Change
                                                                                        • Desire for Comfort
                                                                                        • Decision-Making
                                                                                        • Stress & Distress
                                                                                        • Isolation
                                                                                        • Difficult Ethical Issues
                                                                                        • Desire for Rituals
                                                                                        • Desire for “Sacred”

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