Ch14

Health Promotion StrategiesHealth Promotion Strategies
Through the Life SpanThrough the Life Span
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Promotion Strategies Through the Life Span, Eighth Edition
Ruth Beckmann Murray, Judith Proctor Zentner, and Richard Yakimo
Chapter 14
The Young Adult: Basic
Assessment and Health Promotion

Young AdultYoung Adult
 Roughly 25-45 years of age
 Pushed beyond 35-40
– Life span has increased
– Youth delay adulthood to pursue education
– Many maintain young adult characteristics
physiologically

Young Adult GenerationYoung Adult Generation
 Economic growth and related abundance
of material goods and technology
 Changing roles of females and males
 Rapid social changes
 Sophisticated medical care

Family GoalFamily Goal
 Reorganization of the family into a
continuing unity while releasing maturing
young people into lives of their own
– Emancipation may be delayed
– Expenses may be at peak during this period
– Main source of conflict is difference in
philosophy and lifestyle between two
generations

Family AssistanceFamily Assistance
 Help parents realize that children will not
be carbon copies of them
 Help parents realize importance of
acceptance and understanding
 Reinforce parents as they provide a
secure home base
 Remind parents that younger children are
affected by conflict

Family Developmental TasksFamily Developmental Tasks
 Rearrange home physically and reallocate
resources
 Redistribute budget and responsibilities
 Maintain communication
 Enjoy companionship and sexual intimacy
 Widen family circle
 Reconcile conflicting loyalties and
philosophies in life

GrowthGrowth
 Changes in both occur more slowly and in
smaller increments
 Organ reserve is high
 Most people are at their peak for strength,
energy, and endurance

Weight and HeightWeight and Height
 Desirable weight for height determined
using body mass index (BMI)
 Overweight and obesity cause many
health problems
– BMI of 25 or over considered overweight
– BMI of 30 or over considered obese
 50-60% of body weight is intracellular or
extracellular fluid

Body SystemsBody Systems
 Body systems are functioning at peak
 Skin: loses moisture; acne may appear
 Musculoskeletal
– Skeletal growth completed by 25
– Muscle growth completed by 30
 Cardiovascular
– Maximum cardiac output between 20 and 30
– Heart and blood vessels fully mature

Body Systems cont.Body Systems cont.
 Respiratory: breathing becomes slower
and deeper
 Digestive organs function smoothly
 Brain continues to grow and reach
maximum weight and size
 Visual and auditory perceptions at peak
 Endocrine: basal metabolic rate
decreases after 30

SexualitySexuality
 Male
– Sex drive remains high in males
– Assessment includes genital-rectal
examination and history
 Female
– Optimum period for reproduction in females is
20-30
– Assessment includes gynecologic
examination, breast screening, Pap smear,
and history

Education and InterventionEducation and Intervention
 Educate about sex and sexuality as
necessary
– Four main phases of sexual response cycle
Excitement
Plateau
Orgasm
Resolution
– Intercourse during pregnancy and postpartum

Premenstrual SyndromePremenstrual Syndrome
 Group of signs and symptoms a week
before menses
– Associated with hormone changes and fluid
retention
– Symptoms may include swelling, fatigue,
dizziness, irritability, mood swings
 Teach women about measures that can
offset PMS symptoms

Family PlanningFamily Planning
Figure 14-3: Relationship of menstrual cycle
to use of Billing’s Ovulation Method

Female CircumcisionFemale Circumcision
 Female genital cutting or mutilation
 Cultural or religious practice
 Practice has many complications
 Work to educate about the effects of this
practice

Health PromotionHealth Promotion
 Encourage clients to receive
immunizations and maintain records
 Screening tests
– Blood pressure measurement
– BMI calculation
– Blood glucose level and lipid panel
– Dental examination
– Bone density index
– Chest x-ray, EGK, and MRI as needed

Common Health ProblemsCommon Health Problems
 Leading causes of death include motor
vehicle accidents, homicides, and suicides
 Common health problems include heart
disease, complications of hypertension
and diabetes, and cancer
– Skin cancer is most common cancer

Common Health Problems cont.Common Health Problems cont.
 Teach breast self-examination
 Teach procedure for examination of
scrotum and penis
 Teach signs of skin cancer
 Educate how to reduce cancer
– Diet
– Avoiding risky behavior
– Practicing daily healthy habits

Caloric NeedsCaloric Needs
 Occupation
 Amount and duration of physical activity or
mental effort
 Emotional state
 Age and body size
 Climate
 Metabolism and presence of disease

DietDiet
 Food from each of the food groups
 Grain products, fruits, and vegetables
 Moderate amount of protein
 Limited amounts of sugar and salt
 Limited fat, saturated fat, and cholesterol
 Water

Nutrition During PregnancyNutrition During Pregnancy
 BMR increases by the fourth month
 Extra 300 calories daily is needed
 Protein and Omega-3 fatty acid is needed
 Vitamin and mineral supplements are
necessary.

Nutrition During LactationNutrition During Lactation
 Caloric intake should increase 500-650
 Fluid intake is critical
 Foods to be avoided
– Those from sources contaminated with dioxin,
PCBs or mercury
– Alcoholic beverages
– Beverages with caffeine
– Those with allergy history

Nutrition AssessmentNutrition Assessment
Figure 14-4: Form for
assessing eating
habits and
nutritional state

Causes of ObesityCauses of Obesity
 Reduced concentration of the chemical
leptin
 Activity level
 Emotional eating
 Body image
 Socioeconomic level

VegetarianismVegetarianism
 Abstinence from animal products
 Types
– Pure vegetarian or vegan
– Lacto vegetarian
– Lacto-ovo vegetarian
 Educate about supplementary vitamins
 Teach about specific dietary inclusions
and complementary combination

Examples of Culture and NutritionExamples of Culture and Nutrition
 African Americans: lactose intolerance
 Latinos: hot-cold theory
 American Indian: food with religious,
cultural, and family meanings
 Young adults: interest in organic food

Nutrition EducationNutrition Education
 Determining eating patterns by keeping
record of intake for one week
 Information about which foods to avoid
and which to consume
 Food preparation
 Information about supplemental vitamins
and minerals
 Probiotics
 Negative effects of caffeine

Biological RhythmsBiological Rhythms
 Self-sustaining, repetitive, rhythmic
patterns
 Circadian rhythms: 20- to 28-hour period
 Infradian rhythms: Longer, slower cycle
than circadian
 Untradian rhythms: Frequency less than
the circadian rhythm
 Masking: Processes that alter biological
rhythms

Work and Biological RhythmsWork and Biological Rhythms
 Work schedules can affect rhythms
 Increased health risks to shift work
 Educate about physical, mental, and
social consequences of rotating shift work
– Eating habits
– Risk for accidents
– Fatigue

Biological Rhythms and CareBiological Rhythms and Care
 Nursing care should be planned with
biological rhythms if possible
– Therapy
– Diagnostic tests
– Vital sign routine
– Care such as meals and baths
 History should be directed at getting
information about pre-illness or pre-
hospitalization daily patterns

SleepSleep
 Complex biological rhythm
 Amount of sleep needed affected by
– Physical status
– Occupation
– Amount of physical activity
 Young adults should receive between 7-8
hours

Sleep StagesSleep Stages
 Stage I: Transition from wakefulness to
sleep
 Stage II: Beginning of deeper sleep
 Stage III: 30-45 minutes into sleep
 Stage IV: Deepest sleep
 Rapid Eye Movement: REM
– Occurs before descending to deeper stages
– Allows for rest and better learning

Sleep DeprivationSleep Deprivation
 Chronic lack of the required amount of
sleep
 Insufficient time for REM
 Causes may include illness, environmental
conditions, and circadian rhythm
 Effects may include fatigue, confusion,
and hallucinations
 Sleep disorders: primary or secondary

Physical ExercisePhysical Exercise
 Foundation for longevity and better health
 Moderate-intensity sessions for 30-60
minutes for 4-5 days of week
 Aerobic or sustained exercise 3-5 days a
week
 Some exercise routines should be
contraindicated during pregnancy
 Educate clients about exercise

WorkWork
 Plays powerful role in life
 Career-related personality types
– Realistic
– Investigative
– Artistic
– Social
– Enterprising
– Conventional

Work cont.Work cont.
 Job satisfaction may be affected by lack of
job clarity, heavy schedules, or unsafe
environments
 Suggestions for job satisfaction may
include keeping a positive attitude or
identifying priorities
 You may assist employer in understanding
an employee or resolving a problem

LeisureLeisure
 Many American young adults focus on
leisure
 Examples of factors that affect leisure time
include gender, amount of responsibilities,
interest, and income
 Proper balance between work and leisure
needed

Leisure and AccidentsLeisure and Accidents
 Motor vehicle accidents, industrial
accidents, and drownings are major
causes of accidental death
 Accidents may be related to leisure
activities
 Caution young adults about taking safety
precautions
 Educate about home safety and effects of
stress

Emotional DevelopmentEmotional Development
 Increased clarity and coping ability
 Stabilization of self and identity
 Established preferences of interests and
activities
 More appreciation of surroundings
 More responsibility for self and others
 Decrease in illusions and impulsiveness

Stress ReactionsStress Reactions
 May result in illness, disturbed adaptive
behavior patterns, or depression
 Stressors include mate selection,
marriage, childrearing, college, job
demands, or social expectations
 Person must learn to cope with stressors
to protect health

Intimacy Versus Self-IsolationIntimacy Versus Self-Isolation
 Intimacy
– Reaching out and using the self to form a
commitment to an intense, lasting relationship
– Physical satisfaction and psychological
security of another are more important than
own needs
– Steady conviction of self-acceptance and
unity of personality
– Not a lost of personal identity

Isolation or Self-AbsorptionIsolation or Self-Absorption
 Inability to be intimate, spontaneous, or
close with another
 Leads one to become withdrawn, lonely,
and conceited
 Unable to sustain friendship
 Consequences include avoiding real life
issues, living a façade, and acting childlike

LoveLove
 Feeling that is basis for intimacy
 Young adult may have difficulty
determining what love is
 Childhood experience may affect ability to
achieve mature love
 Includes passion, intimacy, and
commitment

Factors Affecting Self-ConceptFactors Affecting Self-Concept
and Body Imageand Body Image
 Self-concept
– Reactions of others
– Self-expectations
– Perceived abilities
– Values and
attitudes
– Habits and lifestyle
– Physical
appearance and
function
 Body image
– Parental and
societal reaction
– Identification with
the bodies of
others
– Objects attached to
the body
– Activities the body
performs

Self-Concept and CareSelf-Concept and Care
 Awareness of what posture and
movement of body can convey
 Ability to view self as others do
 Use information about self-concept and
body image as you promote health
– Self-concept can be difficult to change
– Certain practices can lead to negative self-
concept

Sexual IdentitySexual Identity
 Identity confusion may lead to confusion
over sexual identity
 Sexual orientation exists on continuum
from heterosexual to homosexual

Theories of HomosexualityTheories of Homosexuality
 Lack of chum in preadolescence
 Heredity or physiological bases
 Environmental, psychological, or cultural
trigger may affect expression

HomosexualsHomosexuals
 Same developmental tasks as
heterosexual couples
 Process of coming out
– Recognition of being homosexual
– Getting to know other homosexuals
– Telling friends and family
– Complete openness
 Convey nonjudgmental attitude as you
care and counsel

Sexual Activity Outside MarriageSexual Activity Outside Marriage
 Homosexuality
 Group sexual experiences
 Premarital intercourse
 Cohabitation
 Infidelity

Single PersonSingle Person
 Accomplishes intimacy through emotional
investment of self in others
 May enjoy the opportunity to establish
identity
 May need help resolving feelings about
being single
 May be in emotional isolation

MarriageMarriage
 Formalizes and symbolizes importance of
family and social stability
 Applies Social Exchange Theory
 Gives rights such as psychosocial
attachment and commitment, sexuality,
rearing of child
 Counsel and educate young couple about
marriage

Domestic ViolenceDomestic Violence
 Establishes power and control over
another through fear and intimidation
 Know characteristics of family or female
suffering from abuse
 Identify typical behavior of abusive male
 Identify types of psychological violence
 Identify personality characteristics of the
male abuser

Intervention GuidelinesIntervention Guidelines
 Provide necessary emotional crisis and
emergency physical care
 Establish rapport
 Help client secure help from resources
 Show sensitivity
 Implement crisis and continuing
intervention
 Foster empowerment

Parenthood and Family PlanningParenthood and Family Planning
 May be for couple or single person
 Couples may delay childbearing to late
30s or 40s
 Couples may experience fertility issues
 Couple may choose to have child for
number of reasons
– Sense of pride or joy
– Extension of self or feeling of power
– Religious convictions

Parenthood and Family PlanningParenthood and Family Planning
 Parent Developmental Tasks
– Home and budget
– Roles and communication
– Examining and expanding philosophy
 Pregnancy Developmental Tasks
– Validation
– Fetal embodiment
– Fetal distinction
– Role transition

Responses to ChildResponses to Child
 Father
– Announcement phase
– Moratorium
– Focusing period
 Mother
– Stronger attachment due to pregnancy
 Encourage childbirth education classes
 Teach during postpartum period

DivorceDivorce
 Crisis for all involved and can affect
society as well as physical and emotional
health
 Influences
– Marriage takes place before individual has
developed strong sense of identity
– Partners have inability to satisfy deep mutual
needs in a close demanding relationship
– Emotional deprivation in childhood

Cognitive DevelopmentCognitive Development
 Formal Operations Stage
 Emotional intelligence
 Problem-Finding Stage
 Post-Formal thought
 Dialectual and triarchic thought
 Life-Span Model
– Achieving State
– Responsible Stage

LearningLearning
 Young adult becomes more adaptive and
knowledgeable about self
 Influences
– Level of knowledge in society
– Personal values and perceptions
– Levels of education and opportunities
– Interests
– Participation in the activity and environment
 Males and females use brain differently

Moral DevelopmentMoral Development
 Conventional Level
 Post-Conventional Level of Moral
Development
– Stage I
– Stage II
 Young adult only at Post-Conventional
Level some of the time

Spiritual DevelopmentSpiritual Development
 Young adult may be
– Postreligious
– Concerned with secular existence of
technology/media
– Experiencing more genuine and mature
spiritual awakening

Adaptive MechanismsAdaptive Mechanisms
 Young adult seeks stability while adapting
to new or changing events
 Mature young adult
– Demonstrates control of impulses and drives
– Is in harmony with the superego ideals and
demands
– Can tolerate frustration of needs
– Capable of making choices that seem best for
total equilibrium

Developmental TasksDevelopmental Tasks
 Accept self and stabilize self-concept and
body image
 Acknowledge and resolve conflicts
between self and social order
 Establish independence
 Resolve difficulty of home ownership
 Become established in vocation or
profession
 Update skills as necessary

Developmental Tasks cont.Developmental Tasks cont.
 Learn to appraise and express love
 Establish intimate bond with another
 Manage time schedule and life stresses
 Decide whether or not to have a family
 Resolve changed relationship with
couple’s parental families
 Formulate philosophy of life and reassess
priorities and values

Assessment DataAssessment Data
 Astute observation
 Being sensitive to and noting cultural
differences
 Information from research tools
 Models for specific situations or health
care concerns
 Interviewing and alternatives to face-to
face interviewing

Examples of Nursing DiagnosesExamples of Nursing Diagnoses
 Ineffective health
maintenance
 Sedentary lifestyle
 Anxiety
 Disturbed body
image
 Parental role
conflict
 Sleep deprivation
 Social isolation
 Spiritual distress
 Risk for suicide
 Ineffective role
performance
 Impaired parenting

Role of Health Care ProviderRole of Health Care Provider
 Use cognitive-behavior therapy
 Educate client about self-help or
consumer-operated services
 Teach clients about how to evaluate
Internet-based treatment

Role of Health Care Provider cont.Role of Health Care Provider cont.
 Use therapeutic communication and
relationship principles
 Use counseling
 Educate about healthy lifestyle choices
 Establish rapport
 Foster culturally congruent care

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