Substance abuse and smoking prevention Sample Assignment

Exam 2 Assignment 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”