CHAPTER 1: Health Promotion: Past, Present, and Future Answers to Chapter Review Learning Activities Questions 1.
Students may have a variety of examples including seatbelt use, water chlorination, smoking cessation programs or ordinances, health fairs, cardiac risk screening, exercise programs, etc.
2.
Student responses may vary and range from personal involvement as a health-care professional in the health-promotion activity to political activism for or enforcement of a law designed for promoting health.
3.
Students will need to explore the literature for information on nurse coach. Discussing this with peers and relating to personal experience with clients in their area can create new insights in leadership for nurses.
Answers to Chapter Review Multiple Choice Questions 1.
a
2.
a
3.
b
4.
b
5.
d
6.
b
7.
a
8.
a
CHAPTER 2: Nursing Concepts and Health Promotion Answers to Chapter Review Learning Activities Questions 1.
This question can be answered in many ways. The response will be individualized depending on the student’s philosophy (e.g., “Providing nursing care to the ill requires extensive knowledge of the biological sciences”).
2.
Again, this answer depends on the response in question 1 and will be individualized (e.g., “The above fits under the metaparadigm concept of health”).
3.
Possible responses relate to how question one was answered (e.g., “This statement fits in well with the health category because it deals with the notion that health refers only to biological functioning. Health status refers to all domains useful in defining health: physical, psychological, social, spiritual. People are more than the sum of their parts”).
Answers to Chapter Review Multiple Choice Questions 1.
a
2.
c
3.
d
4.
c
5.
d
6.
a
7.
d
8.
a
CHAPTER 3: Theoretical Foundations of Health Promotion Answers to Chapter Review Learning Activities Questions 1.
Individual answers may vary. Definitions of health will address the total holistic functioning of the student.
2.
Health-Promotion Plan: Family
Health-promoting need: Need for health-seeking behavior related to lack of knowledge of screening practices for family members’ ages and risks. Assessment data: Mr. and Mrs. M, ages 25 and 24, respectively, expressed increased desire for control of health and unfamiliarity with screening practices for themselves and their 1month-old infant daughter. Mrs. M is fearful of having breast cancer as a result of her mother’s death from breast cancer 3 years ago. Outcome measure(s): Mother and father will be knowledgeable about screening practices for age and risk. Plan of Action: Objectives
Implementation Resources
Supports/Constraints Evaluation
1. Mr. and Mrs. M
Present and
Packet of
Positive attitude for
will describe
discuss
health-
screenings
information
screening
recommended
appropriate for
on
informati
screenings for
themselves and
recommende
on
age groups and
infant.
d screenings
brochures
genders.
learning
Mr. and Mrs. M will identify
according to age groups and genders 2. Mr. and Mrs. M
Using
5-minute
Mrs. M hesitant to
Mrs. M will
will perform self-
simulated
video on
touch own breasts
describe the
screening for
models,
BSE and
for fear of finding
procedure for
cancer.
describe and
TSE
cancer
performing BSE
demonstrate
Brochures
breast self-
on topic
and will demonstrate
examination
ability to
(BSE) and
perform BSE
testicular
using simulated
self-
models.
examination (TSE)
Mr. M will demonstrate ability to perform TSE and will demonstrate ability to perform TSE using simulated models.
3. Mr. and Mrs. M
Provide praise
Environment
Mr. and Mrs. M
will accept self-
and
conducive to
will verbalize
responsibility for
encourageme
family/group
their perceptions
wellness, including
nt for
discussion
of health and
physical,
accepting
wellness for their
psychological,
self-
family and
intellectual, social,
responsibility
express
and spiritual.
Identify
acceptance of
perceptions
self-
of health and
responsibility for
wellness for
enhancing
the family
physical, psychological, intellectual, social, and spiritual health.
3.
Self-efficacy feelings could relate to any comment regarding having self-confidence or the ability to carry out the required actions to achieve the goal. Prior related factors will be according to the individual and should reflect on the frequency of prior behavior on the same or similar behavior in achieving a goal. Personal and biopsychosocial factors will vary and could include such information as age, heredity, body mass index, selfmotivation, ethnicity, culture, education, and economic status.
Answers to Chapter Review Multiple Choice Questions 1.
c
2.
d
3.
b
4.
d
5.
d
CHAPTER 4: The Role of the Nurse in Health Promotion Answers to Chapter Review Learning Activities Questions 1. Response is individualized but should include situations related to the biological/physiological, psychological, sociological, environmental, political, spiritual, intellectual, or sexual domain. For example, losing a loved one may depress us, and we might neglect to eat, sleep, and otherwise take care of ourselves. 2. The response will be categorized according to the domains. The preceding example could be categorized under the psychological, biological (failure to eat), or spiritual domain. 3. Situation A: Factors to be assessed could include diet, exercise, stress levels, vital signs, and the like. Nursing diagnosis could relate to altered health maintenance or to alteration in nutritional status. Interventions could be directed at assisting the client with making nutritional choices that are healthy, monitoring weight, and so on. Evaluation should relate to the goals set forth by the client and nurse. Situation B: Factors to be assessed relate to her psychological and physiological states such as depression, ability to sleep at night, anxiety, diet, and exercise. The sociological as well as environmental areas should be assessed because these impact Mrs. Smith’s overall status. Nursing diagnoses could relate to alteration in health-seeking behavior or alteration in her physiological and psychological status. Interventions could be directed at her psychological status initially because she may be depressed. Actions that improve her physiological state must also be focused on. Evaluation relates to the goals. 4. Data can be categorized according to domains as follows. Domains influencing health promotion are included.
Biological domain: 35 years old, diagnosed with Type 2 diabetes, gained 30 lb. The biological domain influences health promotion in that Laura is young enough to participate in physical activities, she is not physically handicapped, and her obesity can lead to healthpromotion risks. Psychological and sociological domains: Few hobbies, low self-esteem, does not like to go out with friends, works over 50 hours per week. The psychological domain can influence health promotion in that Laura’s low self-esteem has influenced the types of activities that she is willing to engage in. She does not feel good about herself and will probably not engage in any activities that can improve her health or stimulate her mental disposition. Working so many hours a week will also deplete both physical and mental energy. Political domain: Sole provider for her three children. The political domain influences health promotion because Laura could be eligible to receive financial assistance from her former spouse. The attorney general’s office is available to help Laura receive assistance. Spiritual domain: Does not attend church due to low self-esteem. The spiritual domain can influence a person’s health-seeking behaviors. Laura may be spiritually drained, and as such she has given up on this aspect of her life. Her health may suffer because she is receiving no spiritual support. Intellectual domain: College educated, finance broker, likes to read, is computer literate. Laura’s intellectual domain is actually one of her assets in achieving health and wellness. She is able to understand her illness and is aware of choices in relation to her health. Sexual domain: Divorced, does not go out, has low self-esteem. Laura has a need for intimacy. Her lack of any type of intimacy, including sexual intimacy, can have an impact on her
mental health. Technological domain: Computer literate, has access to email, can research her diagnosis on the Internet. The technological domain data are actually an asset to Laura in her quest for health promotion. She is able to send and receive email to and from family and friends, thus providing her with some social support. Her ability to do research on the Internet will provide her with valuable information that can help her improve her health status. Answers to Chapter Review Multiple Choice Questions 1.
a
2.
a
3.
b
4.
d
5.
a
6.
c
7.
b
8.
d
CHAPTER 5: Communication Answers to Chapter Review Learning Activities Questions 1. Students will discuss examples of verbal and nonverbal communication and how communication was used in a therapeutic manner with the patient. 2. Students will document information obtained from a client regarding health behaviors used to promote health. Following the interview, the students will perform a selfevaluation regarding how they attended to the biological, psychological, sociocultural, spiritual, and environmental domains for enhancement of communication with the client. 3. Students will discuss the definitions of encoder and decoder of a message and identify examples of each. 4. Students will discuss how communication can be hampered or enhanced in various situations and environments. Answers to Chapter Review Multiple Choice Questions 1.
a
2.
a
3.
c
4.
a
5.
d
6.
b
7.
a
8.
a
CHAPTER 6: Cultural Considerations Answers to Chapter Review Learning Activities Questions
1. Responses to this activity are individualized.
2. Responses to this activity are individualized.
3. Responses to this activity are individualized. 4. Response to this question is individualized according to student’s understanding of culture and nursing.
5. Response to this question is individualized.
6. No response required.
Answers to Chapter Review Multiple Choice Questions 1.
a
2.
b
3.
d
4.
c
5.
b
6.
a
7.
a
8.
d
9.
a
10.
d
CHAPTER 7: Environmental Factors Answers to Chapter Review Learning Activities Questions Responses to Learning Activities 1, 2, and 3 will vary with the individual student. Answers to Chapter Review Multiple Choice Questions 1.
a
2.
d
3.
c
4.
b
5.
b
6.
b
7.
c
8.
a
9.
a
10.
d
CHAPTER 8: The Mind-Body-Spirit Connection Answers to Case Study Questions 1. Two major stressors are attending college and being newly divorced. Five conditions contributing to the stressors are: working part-time, child support payments, living alone, taking examinations, losing both parents recently. 2. The autonomic section of the neurological system is responsible for the stress reaction, resulting in the flight-or-fight response. It communicates to and receives communication from the endocrine and immune systems. Psychological factors are known to either inhibit or enhance the effects of the communication system among the neurological, endocrine, and immune systems. 3. Take time out regularly, ideally outdoors, to improve circulation and the delivery of nutrients and oxygen to the brain. Breathe. Deep breathing increases oxygen delivery to the brain. Keep away from stimulants. Avoid relying on stimulants such as caffeine, cigarettes, and drugs. Drink plenty of water (6–8 glasses a day). Dehydration negatively affects brain function. Eat healthy small meals regularly. This stabilizes blood sugar (glucose) levels, which provide fuel for the brain. Use social support. Communicate with family members and friends who can be supportive. 4. Other health risks in Doug’s life that indicate a need for health promotion are family history of hypertension, parents’ deaths related to cardiovascular disease, cigarette smoking, caffeine intake, inadequate sleep, and a diet lacking proper nutrients.
Answers to Chapter Review Learning Activity Questions 1. Student responses will vary depending on the articles selected for review. Responses could include implications for the identification of stressors, stress prevention approaches, and stress management practices. 2. Student responses will be individualized and could include such techniques as listening to music, exercising, talking to friends, using guided imagery, and the like. 3. Students will compare their approaches and learn various ways of dealing with personal stress.
Answers to Chapter Review Multiple Choice Questions 1.
a
2.
c
3.
b
4.
b
5.
d
6.
b
7.
c
8.
d
CHAPTER 9: Promoting Mother, Infant, and Toddler Health Answers to Case Study Questions 1. No Nicole’s mother does not have to be present during Nicole’s history and physical exam. Nicole has the right to decide whether her mother will be allowed to be present. 2. Nicole should be tested for sexually transmitted diseases because she is sexually active. The fact that she is only engaging in oral sex does not preclude contracting an STD. According to the physical exam, she is having a yellowish vaginal discharge that might be significant in terms of an STD. There is also the possibility that Nicole has engaged in intercourse but is too embarrassed to admit it. 3. Questions to ask Nicole include: a) Does your partner verbally or physically hurt you? b) How did you get those bruises on your arms, thighs, and breasts? c) Are you in immediate danger? d) Are you afraid your life may be in danger? e) Has your partner ever threatened to kill you, himself/herself? f) Has your partner ever held you against your will? 4. Nicole is 16 years old so it is important to know that not all 16 year olds have started their menses. In addition, Nicole is very underweight at 5 feet 5 inches and 103 pounds. This low body weight might contribute to the fact that she has not menstruated yet. 5. Women need to be screened for intimate partner violence during every trimester of pregnancy and postpartum. The nurse, using a caring and trusting therapeutic and patient-
centered approach with Nicole, should administer the Abuse Assessment Screen or similar assessment tool adopted by the agency designed to detect abuse in women. If abuse is detected the nurse, can discuss the importance of safety for Nicole and identify resources available for support.
Answers to Chapter Review Learning Activities Questions 1. Responses should include reference to smiling, trust, responsiveness to interaction, and feeding pattern. 3. Discussion should focus on the knowledge that the United States has a high rate of infant mortality and on disparities that exist among various racial and ethnic groups in this country, particularly African Americans and white Hispanics, whose infant mortality rates are higher than those that are white non-Hispanic. 4. Childhood Immunization Schedule (see Chapter 10 for schedule chart) 5. The pamphlet should address the following symptoms: •
Sleep disturbances
•
Lack of interest and/or difficulty concentrating
•
Feelings of guilt
•
Loss of energy
•
Changes in appetite
•
Restlessness or slowed movement
•
Suicidal thoughts or ideas
Answers to Chapter Review Multiple Choice Questions 1.
a
2.
b
3.
a
4.
d
5.
b
6.
c
7.
b
8.
d
CHAPTER 10: The Child Answers to Case Study Questions 1. Shauney was born to an overweight mother who herself may have been Large for Gestational Age. Shauney has been above the 85th–90th percentile in weight-for-age and height-for-age charts all her life. She consumes a high-fat, high-sugar, high-calorie diet and gets very little exercise. 2. Acanthosis nigricans (AN) has been found to be a marker for the presence of insulin resistance. Insulin resistance can cause the development of Type 2 diabetes. Obesity is the most common abnormality associated with AN. 3. Shauney and her family need to make changes in their diet and activity levels. A wholesome, well-balanced, reduced-fat and-calorie diet without high-sugar, high-calorie snacks is needed. Daily activity needs to be increased and sedentary activity such as television and computer time needs to be limited. Answers to Chapter Review Learning Activities Questions 1. The program should address the following: -Incorporating raw vegetables and fruits into snacks and meals in finger-sized pieces. -Using healthy dipping sauces for vegetables such as melted cheese, salad dressings, or yogurt. -Serving foods plain and separated rather than in casseroles, or in stews or creamed. -Introducing new foods even if rejected initially. -Serving at least one food at each meal that the child likes. -Avoiding excessive in-between-meal snacking. -Encouraging participation in meal planning.
2. The brochure should contain reference to role modeling, incorporating fruit and vegetable choices, encouraging healthy snacking, limiting soft drinks, limiting television and computer time, and encouraging physical activity. 3. Positive findings for acanthosis nigricans include symmetrical, velvety, light brown to black, poorly marginated plaques with accentuation of skin markings. Students could arrange to participate in screenings in their local school district conducted by school nurses. Answers to Chapter Review Multiple Choice Questions 1.
c
2.
d
3.
c
4.
d
5.
b
6.
c
7.
b
8.
d
9.
a
10.
d
CHAPTER 11: The Adolescent and Young Adult Answers to Case Study Questions 1. Lisa’s diet is deficient in fruits, vegetables, dairy, protein, and fluids. She needs to increase her dietary fiber to 20–40 g/day. Prunes, bran, beans, broccoli, spinach, carrots, corn, potatoes, apples, and pears with skin will add fiber. Fiber should be gradually introduced to avoid severe cramping and bloating. Decreasing fats, particularly cheese, is important along with increasing fluids to 2 L/day. Daily bowel evacuation can be encouraged by not delaying in responding to the call to defecate and by sitting on the toilet at the same time each day for approximately 10 minutes. This is best after a meal or after drinking a warm liquid to stimulate the gastroileac reflex. Regular exercise also promotes bowel regularity. Constipation is the most commonly occurring gastrointestinal complaint, affecting 10% of the population, and it is more prevalent in women. Chronic constipation may result in the development of an ileus, magacolon, diverticulosis, hernia, hemorrhoids, and fecal impaction. 2. Many students complain of a 5- to 15-lb weight gain during their first year in college. This has been termed the “Freshman Fifteen.” Weight gain during the freshman year is not inevitable, but many students are not aware of how to avoid it. One of the primary causes of this weight gain is extra eating in dining halls or dormitory cafeterias. The variety of foods at buffet-style dining is very tempting. Lisa must learn to navigate the dining room looking for nutritious meals and avoiding second helpings of high-calorie fried foods and desserts. Eating broiled fish, chicken, or meat as well as vegetable dishes reduces calorie intake. Selecting fruit is also helpful. Another cause of weight gain is meal skipping, with
subsequent overeating at the next meal. Lisa needs three meals a day with well chosen snacks. Snacks out of vending machines are notoriously high in calories and fat. Having fruit on hand for late-night snacks is a good idea. Lisa should stay hydrated with plenty of water and may include a few servings of milk or juice, but she should avoid excessive quantities of sweetened cola-type drinks. Finally, Lisa needs regular exercise, 30 minutes 3–4 times a week. 3. Helping Lisa to identify specific areas that are important to her and finding resources to enable her to succeed in those areas will help to improve her self-concept, contributing to self-esteem. Providing support and encouragement are key elements. Lisa’s parents should understand that their influence is extremely important on developing Lisa’s long-range goals, values, and attitudes. They also need to understand that at the present time, however, peer influences may be paramount to Lisa even though these tend to be concerned with external issues and are often short-lived. Peers can influence positive, health-promoting behaviors through peer education and counseling programs available in many communities. Helping Lisa to identify physical activities that she enjoys and encouraging her participation can facilitate improvements in self-esteem through self-efficacy, self-acceptance, self-concept, and physical competence.
Answers to Chapter Review Learning Activities Questions 1. Strategies should include those directed at preventing motor vehicle injury, firearm injury, poisoning, sports injury, drowning, and burns. 2. Crimes involving alcohol, firearms, vandalism, sexual assault, and homicide may be among those reported. Violence prevention strategies discussed may include gun control;
cooperative programs among schools, law enforcement, health-care providers, parents, and adolescents; intimate partner violence; racial/ethnic inequities; substance abuse; and the influence of the media. 3. The presentation should address using sunscreen with an SPF of 15 or higher, avoiding exposure to the sun between the hours of 10 a.m. and 4 p.m., avoiding tanning beds, and wearing protective clothing and sunglasses. Answers to Chapter Review Multiple Choice Questions 1. a 2. b 3. c 4. a 5. d 6. b 7. d 8. a 9. d 10. d
CHAPTER 12: The Middle-Aged Adult Answers to Case Study Questions 1. Her BMI is 25.8, placing her at risk for cardiovascular disease and obesity. 2. A family health history can be prepared in such a way that it summarizes symptoms, diseases, genetic issues, and treatments preferably for 3-4 generations in a family. It is an important tool for Laura’s health care provider to have in order to make appropriate recommendations for her. Family health histories may be constructed in a variety of ways including an elaborate genogram using symbols and diagrams, a form with fill-in blanks, or a basic table. A basic family health history in table format for Laura might appear as follows:
NAME/AGE/ADDRESS
RELATIONSHIP
STILL
AGE AT END
LIVING
OF LIFE AND CAUSE OF DEATH
? 1ST GENERATION
2ND
LAURA,52, MILWAUKEE, WI BEN, 25 GREEN BAY, WI SARA, 23 MILWAUKEE, WI CLAUDE,52
SELF
YES
SON
YES
DAUGHTER
YES
FATHER
NO
GENERATION
HELGA, 73
MOTHER
52 HEART ATTACK
COUNTRY AND/ OR STATE OF ORIGIN USA, WISCONSIN CHICAGO, IL CHICAGO, IL GERMANY
GERMANY
YES
FRED,55 GREEN BAY, WI
BROTHER
YES
USA, NEW YORK
HANS,48
BROTHER
NO
CARL, 50 INDIANAPOLIS, IN
BROTHER
YES
RUTH,42
SISTER
YES
LISA, 39
SISTER
NO
39, CAR
BERTA,66
MATERNAL
NO
ACCIDENT 66 BREAST CANCER
HEALTH CONDITIONS* AND AGE OF OCCURRENCE
ENVIRONMENTAL INFLUENCES (TOXIC EXPOSURES)
HYPERTENSION,
2ND HAND
OVERWEIGHT
CIGARETTE SMOKE
HEALTHY
FARM CHEMICALS
HEALTHY
UNKNOWN
HYPERTENSION, HIGH
WORKED IN STEEL
CHOLESTEROL IN EARLY 40S
MILL CIGARETTE SMOKER
STROKE AT 67 3 MISCARRIAGES AT AGE 22 HIGH CHOLESTEROL,OVERWEI
2ND HAND CIGARETTE SMOKE
FARM CHEMICALS
GHT
3RD GENERATION
AUNT
48 HEART ATTACK
USA, WISCONSIN USA, WISCONSIN USA, WISCONSIN USA, WISCONSIN GERMANY
ALLERGIC TO PENICILLIN
BREAST CANCER WITH MASTECTOMY AT AGE 38
BREAST CANCER ONSET AGE 58
CONSTRUCTION MATERIALS (PAINT, DUST)
*Health conditions include diseases/medical conditions, weight problem, birth defects, developmental disabilities, surgeries and reason for surgery, allergies, miscarriages/still births/infant deaths
3.
Expected outcomes are identified in the accompanying table.
4.
Interventions are identified in the accompanying table.
Nursing
Expected Outcome
Nursing Intervention
Activity
1. On biweekly follow-up, Ms. J
1. Conduct a complete health history
intolerance
indicates adherence to exercise
and physical exam to determine
related to
prescription.
existing physical illnesses, etiologic
hypertensive
2. Ms. J reports increases in her
mechanism for obesity.
cardiovascular
activity levels at a 3-month follow-up
2. Collaborate with Ms. J to develop a
disease and
visit.
plan to gradually increase her activity
3. Ms. J begins an active walking
each day in ways she sees as
program in the next 6 months.
feasible—walking some every day,
Diagnosis
sedentary lifestyle
4. Ms. J does not experience untoward effects from exercise regimen.
taking the stairs, doing yard work, bicycling, etc). 3. By 3 months, plan with Ms. J to begin an exercise plan of brisk walking 3-4 times per week for 30 minutes.
Altered nutrition, 1. Weekly weight checks reflect
1.
more than body
dietitian, analyze eating habits.
requirements
slow but steady weight loss. 2. Diet logs maintained by Ms. J
2.
Together with Ms. J and a
Calculate number of calories
indicate that recommended
needed per day based on level of
calories and proportions of fats,
activity.
carbohydrates, protein, and fiber
3.
are consumed +/–10 percent.
gradual weight loss toward goal of
3. Ms. J indicates willingness to
Plan total caloric intake to achieve
desired weight.
continue with diet plans or negotiates changes to develop a new set of goals for weight loss.
Answers to Chapter Review Learning Activities Questions
1.
Students may work in groups to develop a plan for a health-promotion screening event
for an identified population of adults. Healthy People 2010 objectives to be addressed include cancer, heart disease, diabetes, and chronic and disabling conditions. Resources include collaborative allied health professionals from hospitals or agencies to provide blood chemistry, bone density, skin cancer assessment, and other related services, as selected by the group. Health-promotion recommendations should focus on the following: Cancer 1. Increase the proportion of adults who use at least one method of reducing skin cancer (sunscreen, limiting exposure, etc.). 2. Increase the proportion of adults who have colon cancer screening. Heart Disease
1. Increase the proportion of persons who are aware of the early warning signs of heart attack and stroke and the importance of accessing rapid emergency care by calling 911. 2. Increase the proportion of adults with high blood pressure whose blood pressure is under control. 3. Reduce the mean cholesterol level in adults. Diabetes and Chronic and Disabling Conditions 1. Increase the proportion of adults with diabetes who are identified, have annual eye and foot examinations, and check their blood glucose. 2. Reduce the proportion of adults with osteoporosis. 3. Risk assessment results and health promotion plans will vary.
Answers to Chapter Review Multiple Choice Questions
1.
a
2.
d
3.
b
4.
b
5.
d
6.
c
7.
c
CHAPTER 13: The Older Adult Answers to Case Study Questions 1.
Advanced age, personality traits, diet, history of high blood pressure, and caffeine
intake from coffee, infrequent contact with family, isolation, pain, and sensory perception deficiencies. 2.
Cardiovascular disease in family. Lack of regular health checkups and time lapsed
since last physical. Bruising due to aspirin intake and possible interaction with the coumarin (blood-thinning) side effect of chamomile. She should also be assessed for gastrointestinal bleeding. 3.
Due to its coumarin content, chamomile may theoretically increase the risk of
bleeding. Caution is advised in patients who have bleeding disorders or who are taking drugs that may increase the risk of bleeding. Slight increases in blood pressure from chamomile have been reported. An unattended candle is a potential fire hazard. 4.
Counsel that rest periods during the day are good, but prolonged napping should be
avoided. Improved nutrition can generate greater energy. Her diet is lacking in protein and essential vitamins. She could benefit from adding more protein and vitamins in the diet by eating more meat and vegetables. A nutritional supplement such as Ensure could be helpful. Arrange a meeting with one of her sons and a social worker to explore the possibility of obtaining cooked meals through a community agency or a home health aide through a local home health agency. Also, her home needs to be assessed for proper working phone and appliances, environmental barriers, and general safety.
Advise becoming involved with a community adult day care or center for older adults. Involvement in group activities can be mentally stimulating, and most centers have a physical activity suitable for older individuals. Explore her fears: being alone, night events, environmental concerns (bushes, trees, lack of streetlights, too many streetlights, crime in the neighborhood, etc.), falling. Use the Transtheoretical Model (TTM) by Prochaska and DiClemente as a guide in assessing initiation of an exercise program with Ms. Hernandez specifically Stage 1 of the following 5 stages: Stage 1: Precontemplation Stage 2: Contemplation Stage 3: Preparation Stage 4: Action Stage 5: Maintenance Explore with Ms. Hernandez her beliefs and ideas about exercise. Suggest some benefits that relate specifically to Ms. Hernandez’s health concerns that could be improved through exercise (energy and sleep). Discuss activities that Ms. Hernandez like to do and promote them as a form a physical activity (cleaning, gardening). Suggest incorporating physical activity into her daily activities such as small increments in the distance of walking each day. Advise about proper shoes to wear while walking. Advise to avoid aspirin intake and to take a nonsteroidal antiinflammatory such as ibuprofen for pain before exercising. She could also exercise inside her home by using small 1-lb hand weights or even a 1-lb bag of beans for each hand to do arm curls (3 sets of 10). Have her set aside a definite time each day to exercise in this manner, perhaps as she is watching television.
Advise her to return for regular checkups and to notify her health-care provider of any further health issues. Answers to Chapter Review Learning Activities Questions 1.
Physiologic changes of aging: Skin may be dry and scaly, with decreased elasticity, increased wrinkles and thinning, and decreased perspiration. It may have spotty pigmentation from sun exposure. There may be decreased visual acuity or reduced adaptation to darkness and sensitivity to glare. Up to 30% of older persons have significant hearing loss. There can be decreased sensitivity to odors. Oral mucosa dries; there may be absence of teeth or ill fitting dentures. There may be reduced overall efficiency of ventilator exchange. May have a decreased response to stress and a higher incidence of arrhythmias. Swallowing may become difficult, with increased incidence of constipation. Increased incidence of prostate cancer and colon cancer. Drug dosages and administration may need to be altered due to changes in filtration and excretion There is potential for discomfort during intercourse, potential for sexual dysfunction, and increased risk for sexually transmitted diseases. There is potential for injury related to decreased range of motion and joint motion. May need to alter environment to ensure safety and decrease risks. There can be alteration in pain response and possible cognitive and memory
changes. Creative nursing tips: Creative strategies to suggest Use a moisturizer. Drink plenty of water (skin becomes dry when dehydrated). Encourage the use of sunscreen. Decrease temperature on hot water heater to 120°F. Encourage annual eye exams and use of prescription sunglasses. Review driving tips for older adults (Box 13-3). Encourage routine hearing exams. Encourage use of hearing aids. Install smoke and carbon monoxide detectors strategically throughout the home. Have a dental exam every 6 months. Ensure that dentures fit properly. Encourage the client not to smoke. If the client smokes, provide support and strategies to quit. Warning signs for heart attack may present differently in women than in men (i.e., women may have indigestion or pressure in the chest). Have cholesterol levels checked yearly, exercise regularly, and eat a low-fat diet. Encourage drinking liquids with meals. Increase daily intake of water and fiber. Encourage Kegel exercises. Encourage adequate fluid intake. Use a barrier method of contraception if there are multiple partners. Add a waterbased lubricant to increase comfort during intercourse. Exercise regularly. Encourage elderly to implement recommendations for improving home safety. 2.
Students could work individually or in groups to design a pamphlet.
3.
Physical abuse: Frequent ER visits Unexplained injuries (bruising, bite marks, fractures, black eyes, broken teeth, burns) Physical neglect: Malnourishment Poor hygiene Pressure ulcers Unsafe living conditions Fecal impaction or diarrhea Muscle contractures Hunger for attention Depression Withdrawal Anger Abuser speaks for the abused Not included in decision-making Psychological abuse: Paranoia or depression Fear of strangers or own environment Confusion or disorientation Financial abuse: Utilities turned off
Checks made out by another person without legal authority Purchase of expensive goods Financial neglect: Little food in house Prescribed medications not available Stacks of unpaid, unopened mail No recall of writing checks 4.
Step-free entrances, extra wide doorways, nonslip tile, security alarms, security
lights, smoke alarms 5.
Students can report to class on the information obtained and how they designed a
medication table for the older adult. Answers to Chapter Review Multiple Choice Questions 1.
b
2.
c
3.
b
4.
c
5.
d
6.
c
7.
c
8.
c
CHAPTER 14: Health Promotion Through End-of-Life Answers to Case Study Questions for Discussion 1. Maria’s primary health promotion issue revolved around enhancing the quality of her life at this time. Strategies involving supportive environments, the coordination of resources, and the provision of respect for personal choices and values are important to maximizing health. 2. The family did not have the right to make decisions affecting Maria’s care unless she has given them that right. Maria was rational at the time of her illness. 3. The physicians and nurses should have educated the family members about Maria’s wishes and desires. Options related to her care could have been discussed. The healthcare professionals should have all focused on enhancing the quality of Maria’s life and well-being. 4. An advanced directive would have helped by providing written instructions regarding specific procedures to be followed when Maria became incapacitated at the end of her life. 5. No. She was resuscitated multiple times, and her quality of life did not improve. Her preferences and/or wishes were not respected or considered, and there is no evidence that her spiritual beliefs were addressed. 6. Yes. Hospice care focuses on expert medical care, pain management and comfort, emotional and spiritual support. The care is tailored to the patient’s needs and wishes.
Answers to Chapter Review Learning Activities 1. Responses will be individualized and might include anger, denial, grief, sadness, disbelief, and the like. 2. Personal feelings about the end of life might include anxiety, fear, responses related to personal experiences with death. 3. Advanced planning for the end of life is very important. It provides patients with the choice of what they will experience in terms of health-care treatments at the end of life and will be clear to others. Advanced planning happens during a person’s healthy period when he/she is full lucid and rational. Advanced planning prevents others from making all of the end-of-life decisions for the patient. Answers to Chapter Review Multiple Choice Questions 1.
b
6.
b
2.
c
7.
c
3.
d
8.
d
4.
c
9.
d
5.
True
10.
a
CHAPTER 15: Embracing Proper Nutrition Answers to Case Study Questions 1.
Monica must include foods from the five basic food groups. She needs to include
grains, fruits, vegetables, dairy products, and meat and beans. Fluids are also essential to her diet. Commercially available oral supplements high in calories and nutrients are also recommended. Foods from each food group are needed each day for good health. Fiber is also an important part of her diet. Inclusion of foods high in fiber may eliminate the need for Monica to take a fiber supplement daily. Monica should be informed that daily exercise helps in the absorption and metabolism of nutrients. 2.
Although Monica’s diet preference prior to her illness included foods heavy in fats
and loaded with calories, Monica should avoid foods that contain a lot of saturated fats, oils, and cholesterol. She should also avoid foods that are high in calories but that supply little to no nutritional benefit. Salt is also not recommended for Monica, especially because she has a hypertensive condition. 3.
Many medicines have an interactive effect with each other and may have side effects
that affect appetite. The health-care provider should be aware of the side effects that occur when taking multiple medicines. Monica should be instructed not to take medicines on an empty stomach, especially her multivitamins, because this may cause nausea. She should be encouraged to discuss the effects of her medications with her health-care provider. 4.
A home health nurse should be aware of the resources that exist in the community. It
is highly likely that Monica is lonely and does not like to eat alone. Numerous organizations and community centers provide nutrition to the elderly and entertainment
as well. Answers to Chapter Review Learning Activities Questions Answers for Learning Activities 1–4 are individualized and depend on the students’ dietary habits. Question 5 can include answers such as eating a variety of foods from each food group; selecting foods low in fats; making sure that your plate has food color variety; eating smaller portions of food than normally; abstaining from foods high in calories but low in nutrients like cola or alcohol; using natural spices instead of salt to flavor your food. Answers to Chapter Review Multiple Choice Questions 1.
d
2.
b
3.
c
4.
a
5.
f
6.
c
7.
c
8.
d
CHAPTER 16: Engaging in Physical Fitness Answers to Case Study Questions 1. Marguerite should know that she must start an exercise routine slowly and engage in activities such as walking or swimming to begin. She can gradually build up her stamina but could start by walking or swimming for 15–30 minutes per day. She should also gradually try to do some strength-developing exercises at least twice a week. This might include using hand weights when she does her walking. She must, however, remember to start slowly and not use hand weights that weigh more than 1–2 lb to start with because she has osteoarthritis. Marguerite should also take into consideration her living environment and exercise in the morning if it is hot and wear warm layered clothes if it is cold. Flexibility of joints is also very important to physical fitness, and she should move freely through range of motion exercises. Because she is overweight, Marguerite should focus on a healthy diet that includes fruits and vegetables and proteins and that limits fat and sugars. As Marguerite’s body adapts to the exercise routine, she can increase her activity level. 2. Marguerite can engage in activities to increase her physical fitness when she is at home or alone. She should choose activities that she likes to do and try not to repeat the same activity to reduce chances of boredom. She can do stretching exercises when she watches TV. She can get up to change the TV channels rather than use the remote control. When she shops, she can park as far away from the store as possible. Marguerite can also walk around her neighborhood, or she can do garden work such as planting flowerbeds or raking leaves. Housework such as mopping and cleaning windows can also help in burning extra calories too.
3. Marguerite’s osteoarthritis must be taken into consideration when planning a fitness program for her. She must be careful not to put undue stress on her joints because this might cause injury and possibly a fracture. Many medicines have side effects that can affect concentration and cognition. The health-care provider should be aware of the side effects that occur when taking multiple medicines. Marguerite is taking antiinflammatory meds and medicines for hypertension. The anti-inflammatory meds may cause gastrointestinal upsets that may discourage her from exercising as often as she should. The anti-hypertensive might lower Marguerite’s blood pressure too much and may have to be adjusted. Answers to Chapter Review Learning Activities Questions The answers for questions 1 and 2 will be individualized depending on student fitness levels. Answers to Chapter Review Multiple Choice Questions 1.
d
2.
b
3.
a
4.
d
5.
c
6.
a
7.
a
CHAPTER 17: Controlling Weight Answers to Case Study Questions 1.
There are various ways to calculate Alma’s ideal weight. The ideal weight can be
determined by using the Mahoney Formula. Using this formula, multiply Alma’s height in inches by 3.5. Then subtract 108. Her skeletal frame is large (over 6.5-in. wrists), so you can add 10% to the total. For example, multiply 67 in., (5ft, 7 in.) by 3.5, which equals 234.5. Subtract 108, and that equals 126.5. Because Alma’s frame is large, you can add 10% of the total to arrive at Alma’s ideal weight. Alma’s weight should be 126.5 plus 12.65, which equals 139.15 lb. Another method to calculate ideal weight is to use 100 as Alma’s baseline weight. Multiply 5 lb for every inch over 5 ft. That would equal 135 lb. She has a large frame, so a 10% adjustment can be made. Alma’s ideal weight is 135 plus 13.5, and that equals 148.5 lb. Her ideal weight should be in the range of 135 to 148 lb. You can then divide Alma’s current weight by her ideal weight to see how overweight she is. Alma is 128.3% over her ideal weight, so she is considered obese.
2.
Bariatic surgery is recommended only for those who are considered severely or
morbidly obese (100 lb over ideal weight). Alma is between 45 and 55 lb over her ideal weight. She is not a candidate for this type of surgery. Alma should be counseled about what type of foods she should be eating and given information on what she can do to reduce her weight. Mention should be made of her affinity for mixed drinks. Information on the effects of alcohol on weight control should be given to her. 3.
Alma needs to be told that 160 is probably her set-point weight. The set-point of
weight control theory states that all individuals have a unique, stable, adult body weight that is the result of several biological factors. Alma needs to increase her activity levels when she diets in order to compensate for the set-point of weight control theory.
Answers to Chapter Review Learning Activities Questions Responses to questions 1, 2, and 3 will vary depending on the individual client. Answers to Chapter Review Multiple Choice Questions 1.
c
2.
a
3.
b
4.
b
5.
a
6.
a
7.
d
8
a
9
a
10.
c
CHAPTER 18: Avoiding Tobacco, Alcohol, and Substance Abuse Answers to Case Study Questions 1. Slurred speech, lack of coordination, difficulty with recent memory, unexplained weight loss, dilated pupils 2. Accidents, violence, crime, and family neglect, among others 3. Interventions are identified in the following table. Nursing Diagnosis(es)
Expected Outcomes
Nursing Interventions
Dysfunctional family Processes: Alcoholism
1.
1.
2.
The family will acknowledge the alcohol abuse in the family. The family will set longand short-term goals.
2. 3.
Knowledge deficit related to alcohol abuse and addiction
1. 2. 3.
Client identifies selfdestructive behaviors. Client and family gain insight into behavior. Client able to initiate self-help behavior.
1. 2. 3.
Establish a trusting relationship with family members. Discuss ineffective methods families use. Assist the family to gain insight into behavior. Establish a trusting relationship with client. Assist client to gain insight into behavior. Initiate health teaching regarding community resources and referrals as indicated.
Answers to Chapter Review Learning Activities Questions
1. Drugs are misused when they are taken for purposes other than those originally intended. Drugs are abused when they adversely affect a person’s life physically, psychosocially, or both. 2. Drugs may enter the body by inhalation, instillation, oral ingestion, mucous membrane absorption, intramuscular injection, intravenous injection, subcutaneous
injection, and transdermal absorption. 3. An individual becomes physiologically dependent when the body has developed a tolerance for the drug and requires more to achieve the desired effect. Psychosocial dependence occurs when the individual feels isolated from his or her social group and seeks refuge in drugs to relieve the guilt and isolation. 4. Effects of ETS have been linked to pneumonia, bronchitis, asthma, influenza, ear infections, upper respiratory infections, sinus infections, pharyngitis, eye irritation, and sudden infant death syndrome (SIDS). 5. Nurses can become involved in their places of employment by asking about substance use, advising individuals of the health risks of using, and assisting those who are using and desire to quit. 6. Nurses with substance abuse problems can obtain help through peer counseling and support programs connected with their state board of nurse examiners.
Answers to Chapter Review Multiple Choice Questions
1.
d
2.
d
3.
c
4.
a
5.
b
6.
c
CHAPTER 19: Enhancing Holistic Care Answers to Case Study Questions 1. Nurses need to examine their own perception of what healing is and how that definition relates to holistic healing and care. The nurse’s attitude about what healing is affects all interactions with clients and can help or hinder the client’s personal goals. 2. The framework for helping clients discover their needs can be used. The nurse can ask Charlie to: a. Describe his symptoms, what causes them, why they exist. Charlie’s interest in science is a good indicator that he is probably willing and able to understand the pathophysiology related to arthritis (an immune response causing inflammation in the joints) and to prostatic hyperplasia (enlargement of the prostate that accompanies advancing age). b. Identify his needs. Charlie should be asked about what has helped him in the past with knee pain or other pain. Find out if he feels these can help him now. Find out what nonmedical methods he is familiar with or wants to try. c. Identify his expectations. Charlie should be questioned about what he thinks is going to happen. Does he expect total pain relief? A percentage of pain relief? A “normal” prostate? d. Identify resources for nonmedical interventions. Discuss various options such as biofeedback, guided imagery, therapeutic touch, healing touch, acupuncture, etc. Guide Charlie in identifying personal strengths and abilities. Identify professionals in the area (including the nurse, if trained) who can offer the modality he has chosen. It is good that Charlie is becoming more proficient with the computer. The nurse could
guide him in finding more information on nonmedical interventions for arthritis from such sites as the Arthritis Association at www.arthritis.org or the Association for Applied Pyschophysiology and Biofeedback at www.aapb.org. e. Identify his goals. Assist Charlie in identifying what he would like to happen (learn to use biofeedback), when it would happen (within two weeks), and what it would take to make it happen (practice twice daily). 3. Charlie should be cautioned about Websites and the use of herbal remedies. In regard to Websites, Charlie needs to be aware of Internet claims and scams that propose a miracle cure for arthritis. Charlie needs to know that, while there are no known risks of taking saw palmetto, that does not mean that it cannot be harmful. He should be cautioned that just because a product is labeled “natural” it is not necessarily safe for everyone. If he chooses to use this herb, he should be aware of both the positive and the negative changes in his health status and report them to his health care practitioner. Answers to Chapter Review Learning Activities Questions 1. The answer to this question would be individual but might include love of people, wanting to help them feel better, wanting to pursue self-care and self-growth activities, knowing or wanting to learn different holistic healing modalities. 2. To help them discover what their stressors are, the nurse might ask them to tell what a typical day is like, ask what are the things in your life that you do not like, what are your physical symptoms, and what happens in your life before these symptoms occur. Using Modeling and Role Modeling, the nurse would ask the client the questions in this chapter, focusing on being in the shoes of the client to understand, or model, the client’s life. The nurse would ask what the client thinks needs to heal, or what would have to happen for
life to be the way the client wants it to be. The nurse would help the client find ways to bring about the changes the client needs. 3. This would be somewhat specific to the client. The nurse would discuss the principles of holistic healing with the client. For a comprehensive plan, the client’s emotional life and relationships must be considered, all stressors must be discovered, and a plan for eliminating or managing them created. The nurse can teach the importance of becoming aware of the client’s thoughts and feelings and the role they play in health. Other holistic modalities to include are exercise, nutrition, Relaxation Response, imaging, receiving touch therapies, including massage and/or reflexology and/or acupressure, and receiving energy-based therapies. Assessing the client’s social support system, including friends, pets, religious/spiritual affiliation, and prayer is an important part of the plan. Answers to Chapter Review Multiple Choice Questions 1.
b
2.
a
3.
c
4.
b
5.
c
6.
b
7.
d
8.
c
9.
c
10.
a
11.
a
CHAPTER 20: Concerns of the Health Professional Answers to Case Study Questions Many factors might impact David’s school performance. The following are just a
1. few:
a. David’s work schedule is heavy. Working 8 hours a day in addition to attending school 8 hours a day leaves very little time for David to study adequately. He is not getting enough sleep to maintain his cognitive functioning. b. David does not have enough time to spend at mealtimes or at leisure. He is always in a hurry, running from school to work, and is probably not eating properly. Proper nutrition is essential for cognitive functioning. c. In addition, David is 40 years old, and physiologically he is no longer at his peak. He may not be able to multitask as he did during his 30s. High stress levels are very common for older students returning to school. d. The rash on David’s hands may be related to an allergic response and may cause problems in his clinical functioning. More than likely, based on his allergy history, David is having an allergic response to latex. 2. a. David is eating a lot of fast foods, which are frequently loaded with fats and salts. Drinking so many colas a day is providing David with a lot of calories that cause him to gain weight. The calories obtained from cola drinks are empty calories with no nutritional impact. b. David is also not sleeping 8 hours a night. He is sleeping at most 6 hours a night. Lack of sleep can cause problems with cognition and physical functioning. c. Based on David’s daily schedule, he obviously is not getting enough exercise.
Exercise is essential to appropriate body function. It is a great stress reliever and provides a physiological boost to our muscles and blood supply. 3.
As a nursing student, David is familiar with problem solving by means of a
nursing process plan. David can use his knowledge of this process to assess areas needing improvement and to devise a plan to improve his health. Some strategies that David can use after identifying areas needing improvement are increasing daily exercise; using weekends to relax and go out socially with friends; spending quality alone time with his wife; planning weekly low-fat and low-calorie menus that are simple to make, can be packed for lunch, and include essential nutrients; and staying away from excessive alcohol use (having an occasional drink is fine, but it can become a habit if done on a regular basis). Answers to Chapter Review Learning Activities Questions 1.
Nursing students are exposed to many of the same stressors that professional nurses
are exposed to. Some of these are heavy class and clinical workloads, role ambiguity, juggling of multiple roles, and the need for perfection. 2.
Burnout is the state of complete physical and emotional exhaustion that occurs when
a person depletes her or his adaptive energies. Occupational stress occurs as a result of a person’s job responsibilities. Occupational stress may or may not lead to burnout. 3.
Biological: fatigue, back injury. Psychological: inadequate coping, alcohol and drug
abuse. Spiritual: hopelessness, spiritual distress. Sociocultural: social dysfunction, dealing with change. Environmental: latex allergies, needlestick injuries. Technological: stress related to technological incompetence, lack of self esteem leading to more stress. 4.
Answers will vary.
5.
Answers will vary.
6.
Technological advances may include fat analysis monitors, digital imaging, virtual
practice, and computerized equipment. Answers to Chapter Review Multiple Choice Questions 1.
c
2.
b
3.
d
4.
d
5.
c
6.
d
7.
a
CHAPTER 21: Economic and Quality Concerns Answers to Chapter Review Learning Activities Questions 1 a. Rise in hospital spending b. Changing economic conditions c. Unprecedented health insurance industry profits d. Managed care’s inability to constrain payment rates for hospital-based care e. The role of the consumer f. Individuals who are uninsured 2. An HMO is a type of managed care service that provides health care to members for a fixed, usually monthly payment. A PPO is a type of managed care service that uses provider networks to deliver health care to its members. An EPO is a type of managed care service that requires its members to get their services within the network only. 3. a. Health care is a basic right. b. The development and implementation of health policies that reflect safe and effective patient-centered care will ultimately save health-care dollars. c. A balance must be achieved between high-cost treatments and community-based preventive services. d. A single-payer model is desirable for current health-care reform. e. For health-care delivery to be safe, effective, fair, and affordable, there must be an adequate supply of well educated, well distributed, and well utilized registered nurses. Answers to Chapter Review Multiple Choice Questions 1.
b
2.
d
3.
d
4.
c
5.
c
6.
a
7.
a
CHAPTER 22: Ethical, Legal, and Political Concerns Answers to Chapter Review Learning Activities Questions 1. Answers may vary but should include situations involving decision making that requires use of the values clarification process. 2. Answers and rationales will vary. The following are some possible principles and rationales:
Principle
Rationale
Autonomy
The client has the right to choose treatment and procedures to be done.
Beneficence
By knowing diagnosis, treatment, and prognosis, the client can care for himself or herself and assure the treatment possible.
Veracity
By telling the client the truth, the nurse mobilizes the client’s personal defenses and empowers him or her.
Fidelity
As the clients’ nurse, the nurse has the duty to advocate on their behalf and be faithful in ensuring safe care.
3. Licensure is one indicator of the nurse’s accountability and competency. 4. Answers will vary according to the situation. Steps should include introspection, recognition of individual freedom to choose, understanding of personal choices and that other values may exist, commitment to values, and determination of congruence with value choices. Answers to Chapter Review Multiple Choice Questions 1.
c
2.
d
3.
c
4
d
5.
b
6.
b
7.
c
8.
c
9.
b
10.
d