Substance abuse and smoking prevention
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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
- 5 Major Steps to Intervention: 5 A’s
- 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
- Be alert to the major signs!
- Screening
- 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
- For adolescent problem drinkers,
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
- Screening
- 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
- Usually simple and inexpensive
- 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
- disease of bone loss more common in women aged 65+
- 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
- Who: women AND men aged 50+, age most important fixed risk factor
- 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
- Newborn: after 24 hours of oral feedings and after 48 hours of life
- 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
- Given as a 5 dose series; given IM in the arm or thigh:
- 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
- Given as a 4 dose series in children under 5 years; given IM:
- 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
- series of 3 doses; given IM in arm or thigh:
- 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
- series of 2 doses; given subcutaneously (SQ):
- Indications:
- Indications:
- series of 3 injections; given IM in leg (<4 y/o) or arm (4+ y/o):
- Indications:
- Indications:
- Indications:
- Indications
- Diphtheria, Tetanus & Acellular Pertussis Vaccine (DTap)
- Active and Passive Immunity
- Who:
- Breast Cancer
- 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:
- 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
- 4 doses in infants and children; given IM or SQ in arm or thigh:
- 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
- 2 doses to children <13 years; given SQ:
- Indications:
- 3 dose series; given orally:
- Indications:
- Indications:
- 4 dose series; given IM:
- Indications:
- Indications:
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
- Uses thought processes to experience events and actions
- 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
- Level 1: Preconventional Morality
- Kohlberg’s Theory of Moral Development
- Sensorimotor Stage (0 - 2 Years)
- Successful: Ego integrity
- Trust vs. Mistrust (Infant: Birth-18 Months)
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
- Innate behaviors, reflexes, sensory functions
- 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
- Infant feed frequently around the clock
- 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)
- Indiana law requires anyone who suspects child abuse or neglect to report it to authorities (mostly in professional setting, not personal)
- 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
- Gaining a sense of Autonomy (Erikson)
- 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
- Growth slows but continues
- 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
- Learn behaviors from their family unit
- 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
- Consistent growth
- 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
- Changing roles—stressful family time
- 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
- Do not avoid discussion sensitive issues
- The following warning signs often occur for at least a month before suicide is attempted:
- Accidents
- Facilitate health promotion: this age period is critical for the acquisition of behaviors and health practices for a healthy adult life
- Eat a well balanced diet
- Family provides sense of security
- 3 meals per day, with snacks
- Expanding influence
- By 3 years
- At 3 years old
- 12-18 months
- Fine Motor Development
- Newborn
- Sleep needs correlate to rate of growth
- Birth - 1 Month
- Fine Motor Development
- Length
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
- Two main types of dementia exist:
- 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
- Effects of aging
- 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”
- Spirituality
- Latin Root-word: To tie, secure, bind, or fasten together to create system of attitudes and beliefs. “Organized” religion may involve:
- Spirituality
- Falls
- Dementia is not a specific disease
- Also known as an acute confusional state
- Falls
- Malnutrition factors
- Debate about “old age”
- Six smart risk strategies to manage risk and prevent injuries:
- Obesity
- Role changes—family stress factors
- Additional demands of caring for parents and children (sandwich generation)
- Family life cycle
- “Midlife crisis”
- Black Americans and Latino/Hispanic Americans
- Examples of general body changes
- Health promotion needs
- Obesity—epidemic proportions
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