ANSWERS
ANSWERS
CHAPTER 1
LEARNING ACTIVITIES ANSWERS
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. Examples of health promotion activities or programs will be linked to one or more of the 28 focus areas listed in Healthy People 2010.
3. 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.
True/False Answers
1. F
2. F
3. F
4. F
5. T
6. F
7. T
8. T
9. F
10. T
Multiple Choice Answers
1. D
2. A
3. B
GLOSSARY
Code of Hammurabi The earliest written reference to health that established standards and practices of living for the ancient civilization of Babylonia.
Epidemiology A field of study that examines the relationships among the disease, environment, individual, and community. Epidemiology is basically concerned with the time, place, and person components of disease, defect, disability, or death.
Health Education A tool or mechanism for health-related learning resulting in increased knowledge, skill development, and change in behavior.
Health Promotion Any process directed at enhancing the quality of health and well-being of individuals, families, groups, communities, and nations through strategies involving supportive environments, coordination of resources, and respect for personal choice and values.
Healthy People 2000 A document developed by the U.S. Surgeon General, in conjunction with health care constituents across the nation, that delineates 22 priority areas with 300 specific measurable objectives for health promotion, health protection, and surveillance and data systems for the United States to be achieved by the year 2000.
Healthy People 2010 A national health promotion and disease prevention initiative that brings together national, state, and local government agencies; nonprofit, voluntary, and professional organizations; businesses; communities; and individuals to improve the health of all Americans, eliminate disparities in health, and improve years and quality of healthy life. It is designed to serve as a roadmap for improving the health of all Americans through two major goals and 467 objectives in 28 focus areas.
LaLonde Report A classic document, created by the Canadian Minister of National Health and Welfare in 1974, which was the first to publicly proclaim health promotion as a major disease prevention strategy.
Medicaid Program A 1965 amendment to the Social Security Act designed to provide a share of payments made by state welfare to health care agencies caring for the poor, medically needy, aged, disabled, and their dependent children and families.
Medicare Program A 1965 amendment to the Social Security Act designed to provide hospital insurance and supplement medical insurance for people over age 65, people with disabilities who receive Social Security benefits, and patients in end-stage renal disease.
Mosaic Code Regulations for society developed by ancient Hebrews that included an organized system for disease prevention.
Nursing: A Social Policy Statement The first document, prepared by leaders in the profession, to describe nursing and the profession’s responsibility to society.
Social Security Act Legislation enacted by the U.S. government in 1935 to provide eligible citizens with public aid, social services, and aid to the elderly.
Terrorism The unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.
Yang A principle power of Chinese philosophy that works in opposition of yin to regulate the universe and balance the mind, body, and spirit. Yang is the male element associated with positive energy, action, generativity, the sun, light, and the creativity of life.
Yin A principle power of Chinese philosophy that works in opposition of yang to regulate the universe and balance the mind, body, and spirit. Yin is the female element associated with negative energy, passiveness, destruction, the moon, darkness, and death.
CHAPTER 2
LEARNING ACTIVITY ANSWERS
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 will depend 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 only refers 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).
True/False Answers
1. F
2. T
3. T
4. T
5. F
6. T
Multiple Choice Answers
1. a
2. c
3. d
4. c
GLOSSARY
Adaptation The process of changing behavior in response to external or internal stimuli or surroundings.
Career ladder A degree completion program focusing on transitioning from one educational level to the next.
Concept A generalized notion or idea useful in describing facts or occurrences.
Conceptual framework Concepts, facts, and propositions that are useful for defining nursing and provide a way to shape nursing and nursing practice into a meaningful configuration.
Cultural congruent care Care that is provided to fit with an individual’s, group’s, or institution’s values, beliefs, and lifeways.
General systems theory Focuses on the exchange of energy between the individual and the environment and has as a central concept that a person is whole and more than a sum of parts.
Holistic Refers to a view of people in their complex entirety or totality.
Homeostasis A state of equilibrium within the body.
Metaparadigm Used by an individual discipline to provide a global perspective of the field (e.g. nursing’s metaparadigm describes the concepts specific to nursing).
Needs theory Theory that describes people as whole with many complex needs that motivate behavior.
Paradigm An example that serves as a pattern or model for something.
Theory A set or group of interrelated concepts, facts, definitions, and propositions that specify relationships among variables and are useful in describing, explaining, predicting, and controlling phenomena.
Transcultural nursing theory Theory that focuses on the individual and describes how culture influences and provides meaning to everything a person does, thinks, feels, or hears.
CHAPTER 3
LEARNING ACTIVITIES ANSWERS
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 1-month-old infant daughter. Mrs. M is fearful of having |
|breast cancer as a result of her mother’s death from breast cancer three 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 will describe |Present and discuss |Packet of |Positive attitude for |Mr. and Mrs. M will|
|screenings appropriate for |information on |health-screening |learning |identify |
|themselves and infant |recommended screenings |information | |recommended |
| |according to age groups |brochures | |screenings for age |
| |and genders | | |groups and genders.|
|2. Mr. and Mrs. M will perform |Using simulated models, |5-minute video on|Mrs. M hesitant to touch own|Mrs. M will |
|self-screening for cancer |describe and demonstrate|BSE and TSE |breasts for fear of finding |describe the |
| |breast self-examination |Brochures on |cancer |procedure for |
| |(BSE) and testicular |topic | |performing BSE and |
| |self-examination (TSE) | | |will demonstrate |
| | | | |ability to perform |
| | | | |BSE using simulated|
| | | | |models |
| | | | | |
| | | | |Mr. M will |
| | | | |demonstrate ability|
| | | | |to perform TSE and |
| | | | |will demonstrate |
| | | | |ability to perform |
| | | | |TSE using simulated|
| | | | |models. |
|3. Mr. and Mrs. M will accept |Provide praise and | |Environment conducive to |Mr. and Mrs. M will|
|self-responsibility for wellness,|encouragement for | |family/group discussion |verbalize their |
|including physical, |accepting | | |perceptions of |
|psychological, intellectual, |self-responsibility | | |health and wellness|
|social, and spiritual | | | |for their family |
| |Identify perceptions of | | |and express |
| |health and wellness for | | |acceptance of |
| |the family | | |self-responsibility|
| | | | |for enhancing |
| | | | |physical, |
| | | | |psychological, |
| | | | |intellectual, |
| | | | |social, and |
| | | | |spiritual health. |
Answers to True/False Questions
1. False Theories of human behavior and models helped to form the basis for health promotion theories.
2. False The PRECEDE-PROCEED Model is helpful in designing a health promotion plan for groups, organizations, and communities.
3. True The Pender Health Promotion Model is unique to nursing because of its holistic perspective.
4. False Because of the diverse nature of human beings, one model or theory would not be appropriate. Different models or theories, or a combination of concepts from several, might be more advantageous depending upon the client or group of clients.
Answers to Multiple Choice Questions
1. c
2. d
3. b
GLOSSARY
Consumer Information Processing Model (CIP) Model that incorporates concepts related to the use of information and the motivational effect of using this information in making choices.
Diffusion of Innovations Model Model that addresses how new ideas, products, and social practices spread within a society or from one society to another.
Disease Prevention Measures taken to reduce the occurrence and severity of disease.
Health Encompasses the total functioning of an individual and includes effective physical, psychological, social, cultural, and environmental functioning.
Health Belief Model Model developed by four social psychologists, Hochbaum, Kegeles, Leventhal, and Rosenstock; suggests that a person’s susceptibility to a health threat and its seriousness influence his or her decision to engage in a preventive health behavior.
Health Promotion Plan A plan that focuses on achieving wellness and that along with the client, determines the activities that are necessary to achieve optimal health. The plan examines the client’s vulnerability to health imbalance, assesses client weaknesses and strengths, and determines potential for illness.
Health Protection Frequently used interchangeably with disease prevention and reflects a disease-related focus that is consistent with the medical model supported by the discipline of medicine.
High-level Wellness Describes a step above health that is the dynamic state of wellness which occurs at the individual, environmental, cultural, and social levels. Key to achieving this step are the capability and potential of the individual.
Model A visual representation of the concepts that work together to become a theory.
O’Donnell Model of Health Promotion Behavior Developed by health care administrator Michael O’Donnell, this model is a composite of Ajzen’s Theory of Planned Behavior, the Theory of Social Behavior, the Health Belief Model, and the Pender Health Promotion Model.
Pender Health Promotion Model Developed by nurse researcher Nola Pender, this model integrates concepts from the expectancy-value model of human motivation and social cognitive theory with self-efficacy as a predominant concept. It is unique to nursing because of its holistic perspective.
PRECEDE-PROCEED Model A model to guide the development of health promotion programs for groups and communities. It is multidimensional, multileveled, and broad-based and is focused on outcomes rather than inputs.
Protection Motivation Theory A fear-driven model proposing that a perceived threat to health activates thought processes regarding the severity of the threatened event, the probability of its occurrence, and coping mechanisms.
Self-efficacy Self-conviction or belief that one can be successful in achieving the desired behavior.
Theory of Planned Behavior Developed by Icek Ajzen to explain behavior as on a control continuum with total control at one end and absence of control at the other end. Control is viewed as being influenced by resources, support, skills, and self-efficacy needed for a certain behavior.
Theory of Social Behavior Developed by sociologist Henry Triandis, this theory distinguishes behavior under the individual’s control from behavior that has become automatic or habit.
Transtheoretical Model (TTM) Theory of behavior change developed by Prochaska and DiClemente that explains how changes in health behaviors progress through five distinct stages involving thought, action, and time that are influenced by experiential and behavioral processes.
CHAPTER 4
LEARNING ACTIVITIES ANSWERS
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, etc.
2. The response will be categorized according to the domains listed above. The example above 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, etc. 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, etc. Evaluation should relate to the goals set forth by 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 pounds. 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 health promotion 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 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.
Multiple Choice Answers
1. B
2. B
3. C
True/False Answers
1. T
2. F
3. T
GLOSSARY
Advocate One who takes the client’s side and provides complete information to allow him or her to make decisions concerning individual health care.
Community Refers to a collection of people who interact with each other and who have common interests that form a sense of unity or belonging.
Coordinator of care Assures the appropriate sequence of events in the client’s plan of care.
Culture Broker A go-between who advocates on behalf of individuals, families, or communities, providing an effective approach to community engagement.
Domains Areas of concern affecting optimal health.
Empowerment Process of helping others to help themselves.
Expected Outcomes Measurable goals set by the nurse and the client for the client and derived from the nursing diagnosis.
Interventions Nursing actions that enable the client to achieve the desired goal.
Nursing Diagnosis Consists of the actual identification of a client’s need.
Nursing Process Method for developing an appropriate plan of care and wellness outcomes for clients that includes four phases: assessing and establishing a nursing diagnosis, planning, implementing, and evaluating.
Primary Disease Prevention Level of prevention that includes activities and lifestyle factors that can be changed or maximized with high-level wellness as the goal.
Secondary Prevention Level of prevention that involves health screenings that identify abnormalities within a population.
Spiritual Health A balance between self and others.
Taxonomy A common classification structure that links nursing diagnoses, interventions, and outcomes.
Tertiary Prevention Seeks to address the situation once symptoms have occurred and is directed toward minimizing disease or disability.
CHAPTER 5
LEARNING ACTIVITIES ANSWERS
1. Students will discuss examples of verbal and nonverbal communication and how communication was used in a therapeutic manner with the client.
2. Students will document information obtained from a client regarding health behaviors used to promote health. Following the interview the student will perform a self-evaluation 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 True/False Questions
1. False
2. True
3. False
Answers to Multiple Choice Questions
1. A
2. A
3. C
4. A
5. D
GLOSSARY
Active Listening The act of perceiving what is communicated verbally as well as nonverbally.
Agraphia In a literate person, the inability to coordinate hand muscles sufficiently to produce handwriting.
Alogia An inability to speak in a person who has the ability to think.
Andragogy The education of adults.
Aphemesthesia In a literate person, the inability to understand the spoken or the written word.
Ataxic Aphasia See Motor Aphasia.
Auditory Amnesia See Auditory Aphasia.
Auditory Aphasia (Auditory Amnesia, Word Deafness) Ability to think and hear without the ability to understand the spoken word heard.
Authenticity Being real and genuine, as opposed to hiding behind a mask of professionalism.
Body Language The use of nonverbal communication behaviors that include personal presentation, proxemics, kinesics, and touch.
Caring Having a personal interest in the client; feeling for the client; involves an investment of the self.
Communication The process of conveying ideas, thoughts, opinions, or facts from one person to another.
Context Conditions under which communication occurs.
Decoder The person who receives and is able to interpret an encoded message in order to understand the sender’s original idea, thought, opinion, or fact.
Empathy State-of-being experienced by identifying closely with your client because you are able to imagine yourself in the client’s situation and able to feel the client’s feelings as if they were yours.
Empowerment Process of helping others to help themselves.
Encoder The person who initiates communication by placing a message in a form that is understandable to the person meant to receive it.
Expressive Aphasia The ability to think without the ability to speak.
Feedback The process by which effectiveness of communication is determined. This is the encoding and sending of a message from the receiver back to the original sender in order to let the original sender know how the message was received.
Global Aphasia The inability to express or receive verbal messages in any form in a person who can think.
Kinesics How we move our bodies or body parts, including conscious and unconscious changes in body posture, facial expressions, and gestures.
Message The content (idea, thought, opinion, or fact) one person wishes another person to receive in the process of communication.
Motor Aphasia (Ataxic Aphasia) An ability to think with an inability to coordinate the muscles responsible for speech (alogia) or writing (agraphia).
Nonverbal Communication The conveyance of messages without the use of words. It consists of body language and paralanguage.
Nonverbal Vocalizations Sounds such as grunts, groans, sighs, and sobs that make up one type of paralanguage.
Paralanguage The use of nonverbal components of spoken language.
Pedagogy The education of children.
Personal Presentation How we show ourselves to the world, including how we dress, groom ourselves, and use cosmetics, perfumes, and deodorants to create an identity by which we choose to be known.
Proxemics How we use the personal space around us, including conscious and unconscious changes in the distances we maintain from others and the manner in which we touch and are touched by others.
Sensory Channel Means by which a message is sent. The three primary routes are the visual (sight), auditory (hearing), and kinesthetic (touch) channels.
Therapeutic Communication The use of verbal and nonverbal techniques focused on client needs and with the avoidance of unhelpful or nontherapeutic techniques.
Touch Manner in which we come into bodily contact with others.
Unconditional Positive Regard Demonstrating acceptance and respect for the client as a fellow human being, without imposing any conditions for that acceptance.
Verbal Communication Use of words to convey messages. Most often these words are written or spoken, but they may be formed in other ways, such as by the use of sign language.
Visual Aphasia (Word Blindness) Inability of a literate person to decode the written word.
Word Blindness See Visual Aphasia.
Word Deafness See Auditory Aphasia.
CHAPTER 6
TRUE/FALSE ANSWERS
1. F
2. T
3. F
4. T
Multiple Choice Answers
1. a
2. b
3. b
4. d
5. c
6. c
7. b
GLOSSARY
Acculturation The process of adapting to, adopting, or taking on aspects of another culture; although something may be gained, something is also usually lost in the process; sometimes used interchangeably with assimilation.
Cultural Competence Incorporating emic and etic cultural knowledge into holistic and cultural congruent client care.
Culture Dynamic adaptation; a learned way of life that includes interrelated attitudes, morals, beliefs, values, ideals, knowledge, symbols, artifacts, customs, traditions, and norms of a particular group that are transmitted intergenerationally, guide behavior, and make life meaningful.
Emic Knowledge Subjective view; an insider’s perspective; understanding the emic perspective is considered a prerequisite for cultural competence.
Ethnicity A large group of people classified according to common national, tribal, linguistic, or cultural origin or background and who feel a sense of shared identity.
Ethnocentrism Literally, a belief that one’s ethnic group is better than or superior to someone else’s (inherent is the belief that someone else’s ethnicity is inferior); the term’s usage has been broadened to refer to a belief that one’s particular cultural beliefs, worldview, and way of life are better than someone else’s.
Etic Knowledge Objective view; an outsider’s perspective.
Folk Health Sector The health arena comprised of unlicensed, nonprofessional specialists who are usually members of the local community; “folk” is sometimes used to incorporate “lay/popular,” although it is best to differentiate the terms; “indigenous,” “generic,” and “traditional” sometimes are used interchangeably with both “lay/popular” and “folk” and usually refer to people’s nonprofessional, tried-and-true health practices.
Lay/Popular Health Sector Same as popular health sector; the nonprofessional, nonspecialist health care arena consisting of the individual along with family and friends; “folk” is sometimes used to incorporate “lay/popular,” although it is best to differentiate the terms; “indigenous,” “generic,” and “traditional” sometimes are used interchangeably with both “lay/popular” and “folk” and usually refer to people’s nonprofessional, tried-and-true health practices.
Medicocentrism The belief that professional health care practices are better than lay/popular or folk health care practices, reflecting ethnocentrism by members of the professional health care system.
Nationality In general, refers to country of origin or birth.
Professional Health Sector The formally organized, modern, scientific health community; much more than only medical care; encompasses professional nursing, medicine, pharmacy, dietetics, etc.
Race A Category of humankind that shares certain distinctive physical traits.
Worldview (also world view) Reflects values, norms, expressions, taboos, myths, rituals, rites, and so forth; refers to the way people perceive the world, including health, wellness, illness, sickness, death, human nature, etc.
CHAPTER 7
TRUE/FALSE ANSWERS
1. F
2. T
3. F
4. F
5. T
6. F
7. T
8. T
9. F
10. F
MULTIPLE CHOICE ANSWERS
1. A
2. D
3. C
4. B
5. B
LEARNING ACTIVITIES ANSWERS
Responses to Learning Activities 1, 2, and 3 will vary with the individual student.
GLOSSARY
Anosmia Absence of the sense of smell.
Building-Related Illness A diagnosable illness that can be directly linked to airborne building contaminants.
Carcinogen A substance that can cause or promote the growth of cancer.
Chemical Sensitivity The physiological response to a toxic substance following long-term exposure to low-level chemicals that were not recognized as harmful in the past.
Chi An Asian concept referring to invisible energy and vitality by which all living things, earth, and sky are interrelated cosmically.
Chromotherapy The use of color in therapeutic ways.
Disease Cluster A group of individuals experiencing the same disease in greater numbers than would happen by chance.
Environmental Health Hazard A substance or agent that has the ability to cause any type of adverse health effect. The effect can range from a minor illness to a serious illness to death.
Environmental Health Risk The probability that there will be actual consequences from the potential danger of an environmental hazard.
Ergonomics The science of relationships of furniture and tools to the human body.
Feng Shui An ancient Chinese practice of configuring one’s environment to promote a healthy flow of chi, or vital energy, for health, happiness, and prosperity.
Mutagen A substance that can change genetic material found in chromosomes.
Noise Any loud, discordant, or disagreeable sound or sounds that can decrease body energy or cause auditory damage.
Outgassing The production of a toxic gas from the breakdown of formaldehyde in synthetic products.
Particulate matter Small particles or liquid droplets that can be suspended in the air.
Posttraumatic Stress Disorder (PTSD) The constellation of continuing, long-term detrimental effects resulting from exposure to trauma.
SAD syndrome Seasonal affective disorder believed to be related to increased melatonin levels. Symptoms associated with SAD syndrome include fatigue, increased craving for carbohydrates in the diet, weight gain, lethargy, and severe clinical depression. Physiological problems such as infertility, alterations in menstrual cycles, and premenstrual syndrome may also occur.
Sha An Asian concept that refers to bad chi, which is believed to bring bad luck and poor health as well as family and business difficulties.
Sick Building Syndrome The cluster of vague symptoms that are traced to pollutants in sealed buildings.
Simultaneous Perception A system used to experience our environment by combining the responses of all our senses.
Tao To be connected
Teratogen A substance that can cause birth defects.
Terrorism The unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.
Utter Watchfulness The ability to pay equal attention to everything in the environment at once, emphasizing nothing and omitting nothing.
Volatile Organic Chemicals (VOCs) Gases released from certain solids or liquids.
Weapons of Mass Destruction (WMD) Chemical, biological, and radiological weapons or devices intended to cause death or serious bodily harm to a significant number of people.
Weapons of Mass Effect (WMEs) Term that denotes the motives of terrorists to cause widespread chaos and despair by whatever method used.
CHAPTER 8
ANSWERS TO CASE STUDY QUESTIONS FOR DISCUSSION
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 that exists among the neurological, endocrine, and immune systems.
3. Take time out regularly, ideally outdoors, to improve circulation and 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 include family history of hypertension, parents’ deaths related to cardiovascular disease, cigarette smoking, caffeine intake, inadequate sleep, and diet lacking proper nutrients.
ANSWERS TO LEARNING ACTIVITIES
1. Student responses will vary depending on the articles selected for review. Responses could include implications for 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, etc.
3. Students will compare their approaches and learn various ways of dealing with personal stress.
GLOSSARY
Coping Strategies Techniques used by an individual to deal with situations that are perceived as stressful.
Crisis Situation of severe disorganization resulting when an individual’s coping mechanisms are not effective, or when usual resources are lacking, or a combination of both.
General Adaptation Syndrome (GAS) An adaptational response to stress consisting of three phases, including an alarm reaction, a resistance or adaptation phase, and an exhaustion phase.
Holistic Medicine An approach to health care that uses social, psychological, and spiritual aspects to bring about wellness.
Hypnosis An induced, trance-like state of altered perception and memory resulting in heightened suggestiveness where by the person often will follow instructions given.
Immune Modulation A factor, either physical, emotional, or treatment variable, that alters the degree of immune functioning.
Immunoenhancement A factor that can bring about increased immune function, prevention of disease, and recovery from illness in an individual.
Mind-Body Dualism A philosophy of the separateness of the mind and body, which has existed in medicine at least since 1619 and has allowed investigation and treatment to focus on the illness of the body, with only a few diseases being thought to have a primary cause related to the mind.
Perceptions The process of recognizing and interpreting an illness, a sensation, or an experience in order to gain understanding or give it meaning.
Prospective Studies Research studies that follow subjects without the disease or outcome of interest forward in time. Animal subjects are followed for enough person-years to establish incidence, morbidity, or mortality rates.
Psychoneuroimmunology (PNI) Study of the interrelationship of the mind and body.
Relaxation Techniques A group of strategies involving breathing or mind control used to decrease stress and tension. Relaxation techniques can be used as an active coping strategy and actually result in changes in heart rate, respiratory rate, and metabolism.
Retrospective Studies Research studies that identify subjects with the illness or outcome of interest and evaluate their past experiences for postulated causal factors.
Social Support The presence of a group of interconnected, cooperating significant others who provide assistance and help strengthen the individual.
Stress An emotional and physiological response to a stressor.
Stress Response A set of physical changes the human body makes in response to a stressor or threat.
Stressor An event, a situation, or a life change perceived as a threat to an individual’s physical or psychological well-being.
CHAPTER 9
ANSWERS TO CASE STUDY
1. Women who have had a previous preterm birth, women who are pregnant with twins, triplets, or more, and women with uterine or cervical abnormalities are at greatest risk for preterm labor and birth. Lifestyle and environmental risk factors include late or no prenatal care, smoking, drinking alcohol, using illegal drugs, domestic violence, lack of social support, stress, and working long hours with long periods of standing. Medical conditions that may increase the likelihood of preterm labor include urinary or vaginal infections, diabetes, hypertension, bleeding from the vagina, being pregnant with a single fetus after in vitro fertilization, being underweight before pregnancy, obesity, and short interval between last and current pregnancy.
2. Mary Grace is pregnant following in vitro fertilization. She is an elementary school teacher who is on her feet for long periods of time. Her exercise program might need to be modified to avoid lifting of heavy weights.
3. Mary Grace needs to be aware of the following: contractions every 10 minutes or less, changes in vaginal discharge, pelvic pressure, dull low backache, cramping that feels like menstrual cramping, and abdominal cramps with or without diarrhea.
ANSWERS TO LEARNING ACTIVITIES
1. Responses should include reference to smiling, trust, responsiveness to interaction, and feeding pattern.
2. Discussion should focus on the knowledge that the United States ranks 28th in the world in infant mortality and on disparities that exist among various racial and ethnic groups in this country, particularly African Americans, whose infant mortality rate for 2000 was 11.4 infant deaths per 1,000 live births.
3. Childhood Immunization Schedule
| Vaccine |Age | |
|Activity intolerance |1. On biweekly follow-up, Ms. J indicates adherence to |1. Conduct a complete health |
|related to hypertensive |exercise prescription. |history and physical exam to |
|cardiovascular disease |2. Ms. J reports increases in her activity levels at a three |determine existing physical |
|and sedentary lifestyle |month follow-up visit. |illnesses, etiologic mechanism |
| |3. Ms. J begins an active walking program in the next six |for obesity. |
| |months. |2. Collaborate with Ms. J to |
| |4. Ms. J does not experience untoward effects from exercise |develop a plan to gradually |
| |regimen.1. Weekly weight checks reflect slow but steady |increase her activity each day |
| |weight loss.2. Diet logs maintained by Ms. J indicate that |in ways she sees as |
| |recommended calories and proportions of fats |feasible—walking some every |
| | |day, taking the stairs, doing |
| | |yard work, bicycling, etc). |
| | |3. By three months, plan with |
| | |Ms. J to begin an exercise plan|
| | |of brisk walking 3-4 times per |
| | |week for 30 minutes. |
|Altered nutrition, more |Weekly weight checks reflect slow but steady weight loss. |Together with Ms. J and a |
|than body requirements |Diet logs maintained by Ms. J indicate that recommended |dietitian, analyze eating |
| |calories and proportions of fats, carbohydrates, protein, and|habits. |
| |fiber are consumed +/- 10 percent. |Calculate number of calories |
| |Ms. J indicates willingness to continue with diet plans or |needed per day based on level |
| |negotiates changes to develop a new set of goals for weight |of activity. |
| |loss. |Plan total caloric intake to |
| | |achieve gradual weight loss |
| | |toward goal of desired weight. |
ANSWERS TO LEARNING ACTIVITIES
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 would 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.
2. Risk assessment results and health promotion plans will vary.
TRUE/FALSE ANSWERS
1. T
2. T
3. F
4. F
MULTIPLE CHOICE ANSWERS
1. b
2. d
3. b
4. b
GLOSSARY
Andropause The male climacteric caused by diminished levels of the androgen hormone, testosterone.
Chronic Illness Type of disease or disorder that causes limitation of activity for a prolonged period.
Climacteric Change of life.
Community-Level Intervention Activity that occurs at the community level, rather than the individual or family level, to promote health or reduce illness or injury. For example, fluoridation of the water supply is a preventive community-level intervention. Mandating seat belt use is a community-level intervention to reduce the incidence of injury.
Menopause The cessation of menses; usually considered complete after a year of amenorrhea.
Outcomes The results of nursing intervention with clients, stated in client-centered, measurable terms.
Perimenopause A time of transition from normal menstrual periods to cessation of menses occurring gradually over 2 to 15 years.
Risk factor A characteristic associated with increased likelihood of disease or injury.
Sandwich Generation The middle adult period in which people are “sandwiched” between their children who need nurturance and support and their aging parents, who also need care.
Sensitivity of a Screening Test Ability of a screening test to correctly give a positive result when the individual has the disease or condition being tested for.
Specificity of a Screening Test Ability of a screening test to correctly give a negative result when the individual being screened does not have the disease.
CHAPTER 13
ANSWERS TO CASE STUDY QUESTIONS FOR DISCUSSION
1. Advanced age, personality traits, diet, history of high blood pressure, caffeine intake from coffee, infrequent contact with family, isolation, pain, sensory perception deficiencies.
2. Cardiovascular disease in family. Lack of regular health checkups related to the amount of 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 with 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 would 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 will 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 (See Chapter 3) as a guide in assessing initiation of an exercise program with Ms. Hernandez in regard to Stage 1 of the following 5 stages:
Stage 1: Precontemplation
Stage 2: Contemplation
Stage 3: Preparation
Stage 4: Action
Stage 5 Maintenance
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 anti-inflammatory such as ibuprofen for pain before exercising. She could also exercise inside her home by using small one-pound handweights or even a one-pound bag of beans for each hand to do arm curls (three 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 TRUE/FALSE QUESTIONS
1. F
2. T
3. T
4. F
5. T
ANSWERS TO MULTIPLE CHOICE QUESTIONS
1. b
2. b
3. b
4. c
Learning Activities Answers
1. Physiologic changes of aging:
-Life events of the elderly may involve losses instead of gains.
-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 percent 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 ventilatory 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 excretion changes.
-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:
-Encourage socialization. Suggest they join a church, participate in a community activity, or volunteer.
-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 degrees 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 six 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 elderly to have a yearly physical that includes a rectal exam.
-Encourage Kegel exercises. Encourage adequate fluid intake.
-Use a barrier method of contraception if there are multiple partners. Add a water-based lubricant to increase comfort during intercourse.
-Encourage use of multivitamin with calcium or a calcium supplement. 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.
GLOSSARY
Ageism Prejudice against the elderly
Assisted Living Facility (ALF) A facility designed to provide a special combination of personalized care, supportive services, and healthrelated services for care of the elderly.
Atrophy Muscle wastage
Baby Boomers Adults born between 1945 and 1964.
Centenarian Person who lives past her or his 100th birthday.
Dementia A progressive, organic mental disorder resulting in changes in personality, confusion, and impaired function, memory, and judgment.
Dysomnia Inadequate or dysfunctional sleep patterns.
Elder Abuse Any knowing, intended, or careless act that causes harm or serious risk of harm to an older person, whether physically, mentally, emotionally, or financially.
Empowerment To enable or give power to your client.
Eustress A positive form of stress that mobilizes as to action.
Geriatrics Specialized branch of medicine that facases on the diagnosis and treatment of diseased affeating the elderly.
Gerontology The study of all aspects of aging, including all domains and their impacts on the elderly and society.
Heterogeneity The quality or state of not being the same throughout; diversity.
Polypharmacy The use of many drugs at one time.
Spiritual Well-Being The affirmation of life in a relationship with God or a higher power, self, community, and environment that nurtures and celebrates wholeness.
CHAPTER 14
CASE STUDY ANSWERS
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 since 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, since this may cause nausea to occur. 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. There are numerous organizations and community centers that provide nutrition to the elderly and entertainment as well.
Learning Activities Answers
Answers for learning activities 1 through 4 are individualized and will depend on the students’ dietary habits. Question 5 can include answers such as the following: Eat a variety of foods from each food group; select foods low in fats; make sure that your plate has food color variety; eat smaller portions of food than normally; abstain from foods high in calories but low in nutrients like cola or alcohol; use natural spices instead of salt to flavor your food.
MULTIPLE CHOICE ANSWERS
1. B
2. C
3. A
4. B
TRUE/FALSE ANSWERS
1. T
2. T
3. F
GLOSSARY
Anorexia Nervosa The relentless pursuit of thinness or a prolonged refusal to eat or maintain body weight for age or height.
Basal Metabolic Rate The rate at which the body uses energy to support its involuntary activities that are necessary for life.
Bulimia An eating disorder also referred to as the diet-binge-purge disorder.
Dietary Guidelines Recommendations for healthy Americans 2 years and over regarding food choices.
Dietary Reference Intakes (DRIs) A new system that replaces the Recommended Dietary Allowances and the focuses on the role of certain nutrients in reducing the risk for chronic diseases.
ESADDI The estimated safe and adequate daily dietary intake for some nutrients since not enough information is available to set a specific recommended dietary allowance (RDA).
Essential Nutrients A nutrient is considered essential when the body requires it for growth and maintenance but does not manufacture it in sufficient amounts to meet the body’s needs.
Exchange System A system for classifying foods into numerous lists based on their macronutrient composition and for establishing serving sizes so that one serving of each food on a list contains the same amount of carbohydrate, protein, fat, and energy (calories).
Food Guide Pyramid A guide to the amounts and kinds of foods that we should eat daily to maintain health and to reduce risks of developing diet-related diseases.
MyPyramid Replaces the Food Guide Pyramid and is used as a food guidance system.
Nonessential Nutrients Nutrients that the body can make.
Nutrients Substances found in foods that the body can use for the maintenance of body functions throughout life.
Nutrition Study of food substances or nutrients and their processes essential for health.
Phytochemicals Bioactive compounds of plant origin that can provide protection against heart disease arthritis, and some types of cancer.
RDA Recommended dietary allowance; daily dietary intake that is sufficient to meet the nutrient requirements of 97 to 98 percent of all healthy individuals.
CHAPTER 15
CASE STUDY ANSWERS TO QUESTIONS FOR DISCUSSION:
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 to 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 one to two pounds to start with since she does have osteoarthritis. Marguerite should also take into consideration the environment that she is living in 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. Since 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 that will 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. Can any of Marguerite’s physical problems or medicines affect her ability to do physical activity? 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 since 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 anti-inflammatory 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 readjusted.
Answers to True/False Questions
1. F
2. F
3. T
4. T
Learning Activities Answers
The answers for questions 1, 2, and 3 will be individualized depending on student fitness levels.
Multiple Choice Answers
1. b
2. c
3. a
4. d
5. c
6. a
GLOSSARY
Ballistic Stretching Repeated bouncing.
Body Composition The relative amount of fat in the body compared to fat-free weight such as muscle, bone, and other elements in the body.
Body Mass Index (BMI) A convenient tool that relates height and weight to determine whether the individual is considered overweight or obese.
Cardiovascular Fitness Synonymous with cardiorespiratory fitness, aerobic fitness, or cardiorespiratory endurance, terms that refer to the circulatory system and respiratory system and how effectively and efficiently they function to transport oxygenated blood to working muscles for an extended period of time.
Cooldown Refers to a warm down that is gradual and should be the last 5 to 10 minutes of the completed workout.
Flexibility The ability of a joint or group of joints to move freely through a range of motion.
Heart Rate Reserve The difference between the resting heart rate and the maximum heart rate.
Intensity Refers to how hard a person must work to improve physical fitness.
Maximum Heart Rate The fastest rate the heart can attain under maximal exercise conditions and still receive benefit.
Muscular Endurance The ability of a muscle or group of muscles to perform or sustain a muscle contraction over an extended period of time.
Muscular Strength The ability or capacity to exert force with a muscle against resistance, under maximal conditions in a single effort.
Overload Principle Overload means the body is being forced to do more than it normally does.
Physical Fitness The ability to be physically active on a regular basis.
Plantar Fasciitis Arch pain commonly occurring in walkers and runners.
Principle of Progression Implies that gradually the overload stimulus is increased as adaptations to the existing workload occur.
Principle of Specificity Applies to all types of training and states that one must overload the body systems or the specific fitness component to achieve a specific outcome.
Rate of Perceived Exertion A feeling for the amount of intensity or exertion being attained.
RICE A good modality to use with muscle sprains or strains or other minor discomforts. Refers to rest, Ice, compression, and elevation.
Sprain Injury to a ligament.
Static Stretching Slow and deliberate stretching.
Strain Injury to a muscle.
Target Heart Rate The level or zone one should attain during aerobic activity to obtain training benefit.
Warm-up Consists of stretching and mild exercise to gradually increase the heart rate, circulation, and body temperature.
CHAPTER 16
CASE STUDY ANSWERS TO QUESTIONS FOR DISCUSSION:
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-inch wrists) so you can add 10 percent more to the total. For example, multiply 67 inches (5’7”) by 3.5, which equals 234.5. Subtract 108 and that equals 126.5 Because Alma’s frame is large, you can add 10 percent of the total to arrive at Alma’s ideal weight. Alma’s weight should be 126.5 plus 12.65, which equals 139.15 pounds. Another method to calculate ideal weight is to use 100 as Alma’s baseline weight. Multiply 5 pounds for every inch over 5 feet. That would equal 135 pounds. She has a large frame so a 10 percent adjustment can be made. Alma’s ideal weight is 135 plus 13.5 and that equals 148.5 pounds. Her ideal weight should be in the range of 135 to 148 pounds. You can then divide Alma’s current weight by her ideal weight to see how overweight she is. Alma is 128.3 percent 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 pounds over ideal weight). Alma is between 45 and 55 pounds 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.
Multiple Choice Answers
1. b
2. a
3. a
4. d
5. a
6. a
Learning Activities Answers
Responses to questions 1, 2, and 3 will vary depending on the individual client.
True/False Answers
1. T or F T
2. T or F F
3. T or F T
GLOSSARY
Balance This term implies that the total energy intake into the body in the form of nutrient calories does not exceed the body’s expenditure of energy.
Basal Metabolic Rate The amount of energy required to carry out involuntary bodily activities at rest.
Body Image Disturbance A distorted image that a person has of himself or herself.
Central Obesity A pattern of obesity in which a high proportion of fat is localized around the abdomen and upper body.
Desirable Body Weight Entails achieving a balance between adequate nutrition, proper body fat, and physical activity.
Ideal Body Weight What a person should reasonably weigh as compared to height.
Negative Energy Balance A state that occurs when a person’s energy needs exceed that produced by the foods consumed.
Obesity The condition of being overweight or of being more than 20 percent over the ideal body weight.
Optimal Body Composition The proper balance between body fat, muscle mass, and bone.
Positive Energy Balance A state that occurs when the amount of food consumed exceeds the energy used by the body.
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.
Severe Obesity The state of being 100 pounds or more over normal body weight.
Sleep Apnea A sleep disorder characterized by recurrent periods of absence of breathing for 10 seconds or longer, occurring at least five times per hour.
Weight Control The change, acquisition, and maintenance of a desirable body weight.
Weight Cycling The losing and regaining of weight seen in yo-yo dieting or the repeated practice of dieting.
ChAPTER 17
CASE STUDY ANSWERS TO QUESTIONS FOR DISCUSSION
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: |The family will acknowledge the |Establish a trusting relationship with |
|Alcoholism |alcohol abuse in the family. |family members. |
| |The family will set long- and |Discuss ineffective methods families use. |
| |short-term goals. |Assist the family to gain insight into |
| | |behavior. |
|Knowledge deficit related to alcohol |Client identifies self-destructive |Establish a trusting relationship with |
|abuse and addiction |behaviors. |client. |
| |Client and family gain insight into |Assist client to gain insight into behavior.|
| |behavior. |Initiate health teaching regarding community|
| |Client able to initiate self-help |resources and referrals as indicated. |
| |behavior. | |
LEARNING ACTIVITIES ANSWERS
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.
TRUE/FALSE ANSWERS
1. F
2. T
3. F
4. T
5. T
Multiple Choice Answers
1. d
2. d
3. c
4. a
5. b
GLOSSARY
Addiction A gradual process that occurs when a person has developed both a biological and a psychosocial dependence on the substance of use.
Comorbidity Another disability is present in addition to the substance use/abuse/addiction.
Cross Tolerance Drugs that are similar to each other and produce similar effects on the body and brain.
Detoxification Taking an individual who is using drugs off the drug.
Drug Abuse The use of a drug or drugs inconsistent with social norms for purposes other than those for which they were intended, usually to alter feelings or mood, and without relation to medical or health reasons.
Drug Misuse The use of a drug or drugs inconsistent with social norms for purposes other than those for which they were intended, usually to alter feelings or mood, and without relation to medical or health reasons.
Dual Diagnosis Identification of those with both substance abuse and mental or physical health concerns.
Environmental Tobacco Smoke (ETS) Tobacco smoke in the air; also known as involuntary, sidestream or secondhand smoke.
Half life Half the time it takes for a drug to be metabolized out of the system.
Over-the-Counter (OTC) Drugs Those drugs that can be purchased from pharmacies or supermarkets for use when symptoms are of a minor nature
Polypharmacy The use of multiple medications without the knowledge of a supervising physician or nurse practitioner.
Prescription drugs Medications prescribed by a physician or nurse practitioner and that contain substances that aid in the prevention of disease, the diagnosis of a condition, or the alleviation of symptoms, or help in the recovery from a disease or disorder.
Primary Prevention Prevention for those who have not used tobacco, alcohol, or other drugs with the goal of preventing exposure to and experimentation with drugs.
Protective Factors Situations or conditions or both that build resiliency against substance abuse and increase the likelihood that an individual will resist substance abuse.
Psychotropic Drugs Drugs that modify mental activity and affect psychic function, behavior, or experience and are normally used to treat mental disorders.
Relapse Prevention Prevention of the return to substance use.
Risk Factors Situations or conditions or both that increase an individual’s vulnerability to substance abuse.
Secondary Prevention Strategies aimed at preventing substance abuse by individuals at risk for developing problems and those who are already using substances.
Tertiary Prevention Prevention of death and disability of individuals in long-term treatment.
Tolerance Occurs when more of a drug is required to obtain the desired effects.
Triad Diagnosis Presence of a mental health issue, a physical health issue, and a substance abuse issue simultaneously.
CHAPTER 18
CASE STUDY ANSWERS
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 will affect 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 or the Association for Applied Pyschophysiology and Biofeedback at .
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.
Learning Activities Answers
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 clients 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.
TRUE/FALSE ANSWERS
1. T
2. F
3. F
4. F
5. T
6. T
MULTIPLE CHOICE ANSWERS
1. B
2. B
3. B
4. C
5. B
6. A
GLOSSARY
Ayurveda Form of healing originating in India that focuses on physical health and spiritual growth, using meditation, sound, massage, herbs, the breath, and types of food specific to the individual to help balance the body and its energy field.
CAM Complementary and alternative medicine viewed as a group of diverse medical and health care systems, practices, and products that are not currently considered conventional medicine or that which is practiced by medical doctors or other health professionals, such as physical therapists, psychologists, and registered nurses. Complementary modalities are used as an adjunct to conventional medicine, while alternative modalities are used instead of conventional medicine.
Capacity Building A developmental process that results in independence and self-confidence.
Chakras Spinning wheels of energy that help move healing energy from the universal field through the layers of the individual field (spiritual, mental, emotional, etheric) to the human body, and back to the universal field.
Energy A dynamic quality or power that has the capacity for doing work.
Energy Field A field of energy that is composed of constantly changing vibrational frequencies and that surrounds and connects all matter. All living things are energy fields that affect and are affected by all other forms of energy, creating health and disease.
Grounding Using thought and breath to connect to the Earth as a source of stable, steady energy and to the universal source of healing energy.
Heliotherapy The use of sunlight for healing.
Holistic Care Care in which the client is viewed as an integrated whole whereby the physical, mental, social, emotional, and spiritual needs are considered. The whole is considered to be greater than the sum of the parts. The total inner and outer environments of the client are considered when looking for causes for the imbalances in health and life, and how to correct them.
Holistic Healing Assisting the establishment and maintenance of balance and wholeness in mind, body, and spirit of client and nurse.
Holistic Nursing A view of nursing in which the whole is defined as equal to the sum of the parts.
Imagery Creating and holding a mental picture of what we want to happen in life using all five senses. It is the communication mechanism between perception, emotion, and bodily change. Using imagery regularly can bring about changes in the body, mind, energy field, and spirit.
Learned Helplessness A phenomenon that has negative physical and psychological consequences and that occurs when an individual believes he or she has no control over an experience, whether a negative or positive experience. The individual becomes helpless or quits trying to affect or change the experience. It can be reversed if control is regained.
Meditation A technique (there are many) to interrupt unconscious, rampant thoughts of the mind. This is often done by noticing and observing what we are thinking or replacing thoughts with more beneficial ones. The body and mind become more relaxed, the stress response ceases, and healing is enhanced.
Modeling and Role Modeling A nursing theory developed by Helen Erickson, RN, Ph.D., which says that for people to heal, their needs must be met; to meet their needs, they can look at the stressors in their life and their resources for coping with those stressors.
Nurse Healer A nurse who helps others to heal or remember their inherent state of wholeness by cherishing, nurturing, and promoting their growth and development. Nurse healers are aware that personal presence with the client is a factor in healing.
Phytochemicals Herbs or plants used to promote and maintain health and cure disease.
Presence Being with another in a meaningful way, giving of one’s self in the current moment, listening, and providing unconditional acceptance. Presence involves giving of one’s self and being open to the experience of another through an interpersonal relationship that is reciprocal.
Reflexology A touch therapy using the pad of the thumb to apply pressure to specific points on the feet and hands that correspond to areas of the torso. This technique can enhance relaxation of, stimulate circulation to, and aid healing of the corresponding areas.
Relaxation Response A technique developed by Herbert Benson, M.D., that uses focus on a chosen repetition, such as the breath or a word, to interrupt the stress response and promote relaxation.
Therapeutic Touch A technique developed by Dolores Krieger, RN, Ph.D., and Dora Kunz that uses the hands to perceive and balance the energy field to enhance relaxation, pain relief, and healing.
CHAPTER 19
ANSWERS TO QUESTIONS FOR DISCUSSION
1. Many factors might impact David’s school performance. The following are just a few:
a. David’s work schedule is heavy. Working eight hours a day in addition attending school to attending school eight 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. In addition,
c. 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. Fast foods are frequently loaded with fats and salts. Drinking so many colas a day is providing David with a lot of calories that will cause him to gain weight. The calories obtained from cola drinks are empty calories with no nutritional impact.
b. David is also not sleeping eight hours a night. He is sleeping at most six hours a night. Lack of sleep can cause problems with cognition and physical functioning.
c. Based on David’s daily schedule, it is obvious that he 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 through use 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 include: increasing daily exercise; using weekends to relax and go out socially with friends; Spending quality alone time with his wife; planning weekly low-fat, 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.
Learning Activities Answers
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.
True/False Answers
1. F
2. T
3. T
4. T
5. F
6. T
Multiple Choice Answers
1. A
2. C
GLOSSARY
Burnout The state of physical and emotional exhaustion that occurs when health caregivers deplete their adaptive energy sources.
Ergonomics The study and analysis of human work as it relates to an individual’s anatomy and other human characteristics.
Genogram A tool that diagrams and depicts family relationships over a period of several generations, usually three.
Hardiness Resilience to stress.
Health Behavior Habits Health habits that may relate to physical functioning or to the person’s psychological, spiritual and/or professional lives.
Occupational Stress Stress that is job-related which leads to extreme tension, anxiety, and possibly even to physical symptoms.
Spirituality Concepts that refer to experiences traditionally considered religious as well as to all states of awarness.
Stressors Stress-provoking factors that can impact the health of those who provide health care to others.
CHAPTER 20
LEARNING ACTIVITIES ANSWERS
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. In order 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.
TRUE/FALSE ANSWERS
1. T
2. F
3. T
4. F
5. F
MULTIPLE CHOICE ANSWERS
1. -b
2. -d
3. -d
GLOSSARY
Capitation Type of health care in which the insurer or employer will pay a provider a set fee for all the medical expenses necessary for each member covered under the plan.
Diagnosis-Related Groups (DRGs) The diagnosis classification system created in 1983 that contained 468 diagnoses to be used with the prospective payment system for Medicare to pay hospital costs.
Exclusive Provider Organization (EPO) Type of managed care service that requires its members to get their services within the network only.
Health Maintenance Organization (HMO) Type of managed care service that provides health care to members for a fixed, usually monthly, payment.
Managed Care Method of delivering health care that integrates and coordinates the delivery of health care with the costs of that service.
Managed Care Organization A health plan that provides consumers access to quality health care at a reasonable cost.
Preferred Provider Organization (PPO) Type of managed care service that uses provider networks to deliver health care to its members.
Primary Care Providers Health care providers who the client sees first for health care services. The primary care provider is a physician, usually a family practice physician.
Prospective Payment System (PPS) A fixed predetermined method of payment to hospitals based on the concept that similar medical diagnoses result in the same hospitalization costs.
CHAPTER 21
LEARNING ACTIVITIES ANSWERS
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.
1. 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.
MULTIPLE CHOICE ANSWERS
1. c
2. d
3. c
4 d
5. b
TRUE/FALSE ANSWERS
1. T
2. F
3. T
4. T
GLOSSARY
Accreditation A form of certification or licensure that recognizes demonstrated compliance with established criteria.
Advance Directives Written instructions regarding specific procedures to be followed if the client becomes incapacitated.
Assault Infringement upon the mental security or the tranquility or both of another.
Autonomy Principle based on the right to self-determination; gives an individual the right to choose what will happen to his or her own person.
Battery Involves physically touching a person; a physical violation.
Beneficence A principle that requires nurses to act in ways that benefit the client.
Breach of Duty Deviation in some manner from the standard of care.
Certification Process by which an individual registered nurse who has met certain established criteria or qualifications is granted recognition for competency.
Credentialing A process that recognizes professional achievements such as specialty practice knowledge, educational accomplishments, certification, licensure, and accreditation.
Crime A legal wrong committed against a person or property, punishable by the state and involving jail time.
Deontology A theory of moral or professional obligation.
Equal Protection A guarantee under U.S. law that all similarly situated individuals are entitled to be treated similarly.
Ethical Principles Basic concepts and rules to guide and give direction to nursing practice.
Ethics The branch of philosophy that is related to moral values and actions.
Fidelity The concept of faithfulness and the practice of keeping promises.
Informed Consent A clear explanation of procedures to be had along with associated risks and benefits.
Introspection The ability to look inside oneself and examine thoughts and personal meaning for identified values.
Justice Fair, equitable, and appropriate treatment according to what is due or owed to persons.
Law The sum total of rules and regulations by which a society is governed.
Multistate Licensure Recognition of a single license allowing registered nurses to practice nursing throughout the country.
Negligence Involves failure to provide the care that a reasonable person would provide in similar circumstances.
Nonmaleficence A principle that requires nurses to act in such a way as to avoid causing harm to clients.
Paternalism A system that encourages individuals to make decisions for others.
Registration Listing of an individual’s name and other information on the official roster of a governmental or nongovernmental agency.
Respect for Others Seen as the highest ethical principle and incorporates all the other ethical principles; acknowledges that individuals are capable of making decisions for themselves.
Standard of Best Interest Standard that allows individuals to share in decision making regarding health care.
Teleology An ethical theory that explains phenomena and justifies actions by results, or the doctrine of final causes.
Tort Legal wrong committed against a person or property and settled in civil court.
Values A set of personal beliefs and attitudes.
Values Clarification The process of becoming more conscious of and naming what one values or considers worthy.
Veracity The practice of telling the truth.
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