Chapter 18

The Adult Client

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Passage Through Adulthood

The changes facing adults are very different from those of the infant, the child, and the adolescent.

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Passage Through Adulthood

Role development and role stress influence the health and well-being of all adults.

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Passage Through Adulthood

Adult relationships are strongly influenced by the experiences of childhood and adolescence.

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Passage Through Adulthood

Healthy independence is reflected in a lifestyle that selects health-promotion activities and illness-prevention strategies.

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The Adult in Society

The nurse must apply what is known about the physiology, psychology, spirituality, morality, and cognitive development of adults in order to assess each person as an individual.

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Ending Adolescence and Beginning Adulthood

May last from two to eight or ten years. Struggles with autonomy versus

attachment with parents reach resolution and maturity.

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Ending Adolescence and Beginning Adulthood

Peer pressure diminishes. Individual identity becomes clearer and is

achieved.

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Ending Adolescence and Beginning Adulthood

Full-time employment and residence outside of the parental home

Assumption of responsibility for one’s own actions and behaviors

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Young Adulthood

Approximately 21 to 40 years. Plans, behaviors, and decisions made

during this period profoundly affect one’s current and future well-being.

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Decision-Making Issues during Young Adulthood

Developing eating behaviors Selecting an appropriate exercise routine Using illicit drugs Moderating alcohol consumption Expressing one’s sexuality Developing adult relationships

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Health Issues and Implications for Nursing during Young Adulthood

Pregnancy Acute Problems Health Promotion and Wellness

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Health Issues and Implications for Nursing

Pregnancy• Changes in self-concept• Physical changes

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Health Issues and Implications for Nursing

Acute Problems• Highest death rates are due to accidents or

suicide.• AIDS is a leading cause of death in persons

25 to 44 years of age.

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Health Issues and Implications for Nursing

Health Promotion and Wellness• Critical time for nurses to teach:

- Dangers of drinking and driving- Risk factors for skin cancer- Breast self-examinations (BSE), testicular self-

examination (TSE)

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Middle Adulthood

Period between 30 and 55 years Some sources state 40 to 65 years

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Health Issues and Implications for Nursing in Middle Adulthood

Cardiovascular disease, cancer, and obesity become a major cause of morbidity and mortality.

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Health Issues and Implications for Nursing in Middle Adulthood

Occupational health hazards Effects of unhealthy lifestyle practices

smoking• Sedentary habits• Inadequate nutrition • Overuse of alcohol

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Developmental Considerations for Middle Adulthood

Generativity versus Stagnation• Generativity is a sense that one is making a

contribution to society.• Stagnation is a sense of nonmeaning in

one’s life.

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Developmental Considerations

Achievement of the generativity versus stagnation task: • Demonstrating creativity• Guiding the next generation• Establishing lasting relationships• Evaluating goals in terms of achievement

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Developmental Considerations of Middle Adulthood

Physiological Changes• Sensory changes may begin.• Muscle tone decreases.• Physical performance and stamina decline.• Cardiovascular and respiratory changes

occur.

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Developmental Considerations of Middle Adulthood

Physiological Changes• Body fat increases.• Hair loss and graying begins.• Skin begins to wrinkle.• Hormonal changes begin.• Incidence of osteoporosis increases.

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Developmental Considerations of Middle Adulthood

Stressors• Relationships with adult children• Increasingly dependent, aging parents• Changes in professional or personal status

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Developmental Considerations of Middle Adulthood

Stress can contribute to: • Cardiovascular disability and disease • Gastrointestinal disorders • Alcohol-related problems• Violence• Vehicular deaths and injury • Depression, suicide

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Middle Adulthood

Stress Management• Stress reduction and relaxation techniques

should be fundamental to a nurse’s practice.• Nurses provide counseling, guidance, and

referrals to outside services.

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Health Promotion and Wellness

Nurses play a key role in helping individuals manage their lives and practice personal wellness.

Nurses can encourage middle-aged adults to assume more responsibility for their own health.

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Health Promotion and Wellness

Regular Checkups Well-Balanced Diet Regular Exercise Program Maintenance of Body Weight

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Health Promotion and Wellness

Resources for Wellness• American Cancer Society• Agency for Health Care Research and

Quality• United States Preventive Services Task

Force• Healthy People 2010 (2003) Initiative