CHAPTER 13. The Adult Patient
Vallire D. Hooper and Jacqueline M. Ross
OBJECTIVES
At the conclusion of this chapter, the reader will be able to:
1. Identify developmental issues associated with each stage of adulthood.
2. Define health, wellness, and illness.
3. List three types of health and illness behaviors.
4. Identify the effects of the stress response on the body’s adaptation to surgery.
5. List three characteristics unique to the adult learner.
I. DEFINITIONS
A. Growth
1. Increase in body size
2. Change in structure, function, or complexity of body cell content and metabolic and biochemical processes
3. Occurs up to some point of optimum maturity
B. Development
1. Growth responsibility arising at a certain time in the course of development
a. Successful achievement
(1) Satisfaction
(2) Continued success in future tasks
b. Failure
(1) Unhappiness
(2) Disapproval by society
(3) Difficulty with later developmental tasks and functions
C. Maturation and learning
1. Maturation: emergence of genetic potential for changes in
a. Form
b. Structure
c. Complexity
d. Integration
e. Organization
f. Function
2. Learning
a. The process of gaining specific knowledge or skill
b. Acquiring habits and attitude
c. Results from experience, training, and behavioral changes
3. Adequate maturation must be present for learning to occur.
D. Young adulthood
1. Age
a. Young-young adult: 25 to 30 years of age
b. Old-young adult: 31 to 45 years of age
2. Birth date and generation
a. Nexters/Generation Y: born between 1980 and 2000, although dates of generational cohort differ among authors
(1) Racially and ethnically diverse and tolerant
(2) Indulged as children; parents spent more time with children
(3) Blunt with opinions and expressions
(4) Sense of entitlement
(5) Techno-savvy; multitasking
(6) Adaptable to situations and change
(7) College education expected
(8) Defining moments
(a) Oklahoma City bombing—April 19, 1995
(b) Columbine High School shooting—April 20, 1999
(c) World Trade Center (9/11)—September 11, 2001
b. Generation X: born between 1964 and 1979, although dates of generational cohort differ among authors
(1) A very educated group of individuals in the United States
(2) Come from families with the highest divorce rate in the country; drastic increase in single-parent homes
(3) The largest group of latchkey children ever known
(a) Adept at self-management because of lack of attention in childhood
(b) Adept at managing their environments
(c) Comfortable with independent decision-making
(4) Less optimistic about the future; pragmatic
(5) Never feel financially secure
(6) View authority as on same level as self
(7) Value work-life balance
(8) Communicate directly, sometimes almost abruptly
(9) Defining moments
(a) Challenger explosion—January 28, 1986
(b) End of Cold War—1985-1991
(c) Economic turmoil; downsizing and layoffs
(d) Acquired immunodeficiency syndrome (AIDS)—1981
E. Middle age
1. Covers ages 45 to 65
a. Consider the physiologic age and condition of the body
b. Consider psychological age: how old the person acts and feels
2. Age divisions
a. Early middle age: 40 to 55
b. Late middle age: 56 to 64
3. Social class will affect age assignment.
a. Poorer person will perceive prime or midpoint as occurring at an earlier age.
4. Birth date and generation
a. Baby Boomers: born between 1946 and 1964, although definition of years vary among authors
(1) Most were raised in a two-parent home.
(a) Mother’s responsibilities were caring for the children and the home.
(b) Father was the breadwinner, authority figure, and rarely questioned.
(c) Most doted on generation by parents; seek personal gratification; considered the “me” generation
(2) Experienced many social reforms
(a) Civil rights movement
(b) Antiwar protests
(3) Experienced a lot of gains from a thriving economy
(4) Embrace the attitude of “only the best for me”
(5) Classified as workaholics
(a) Take great interest in material rewards
(b) Value promotion and recognition
(6) Committed to making the world a better place; fight for causes
F. Health
1. Defined by the World Health Organization, 1947, as a state of complete physical, social, and mental well-being; not merely the absence of disease
2. Often described on a continuum of wellness and illness
G. Wellness
1. The ability to adapt, relate effectively, and to function at near maximum capacity
2. Need to examine functioning in four areas
a. Physiologic factors: structures and functions of the body
b. Psychological factors: self-concept as affected by various demographic variables
(1) Age
(2) Sex
(3) Race
(4) Education
(5) Economic status
(6) Other
c. Sociocultural factors
(1) Interrelationships with others
(2) Environmental factors
(3) Lifestyle
d. Developmental factors: related to completion of developmental tasks
H. Disease
1. A state of non-health
2. Biological dysfunction present
3. Major focus of the medical model
4. Can be legitimized by the health care provider
I. Illness
1. The patient’s personal perspective of the disease state
2. Related to the psychosocial impact of the disease on the individual
3. Individual influences on perception of illness severity
a. Personality
b. Demographic characteristics
c. Presence of support systems
J. Learning
1. Process of acquiring wisdom, knowledge, or skill
2. Overt changes in behavior may be observed.
K. Teaching
1. Process of sharing knowledge and insight
2. Facilitating another to learn knowledge, insight, and skills
L. Health education
1. Transmits information, motivates, and helps people adopt and maintain healthful practices and lifestyles
2. Is concerned with the environment, professional training, and research to maintain and evaluate the process
3. Traditionally focuses on what the professional thinks is good or needed by the patient
4. Positive approaches generally more effective than fear
II. STAGES OF ADULTHOOD
A. Young adulthood
1. Developmental issues
a. Settling down
b. Must enter and successfully manage multiple new roles simultaneously
(1) Work
(2) School
(3) Marriage
(4) Home
(5) Child rearing
c. Primary tasks
(1) Finding an occupation
(2) Establishing a new family
(a) Often done without extended family in area
(b) Will change jobs and locations more frequently than previous generations
2. Sociocultural issues
a. Consistent positive influences
(1) Abundance of material goods and technology
(2) Rapid social changes
(3) Sophisticated medical care
(4) Accepting of diversity
b. Constant threats
(1) Terrorist attacks
(2) Pollution
(3) Overpopulation
(4) Loss of natural resources
c. Instant media coverage and internet access make the world small and outer space a not-so-distant place.
(1) All information is easily accessible and readily available.
(2) Instant, up close, and continuous coverage of traumatic events may cause psychological stress.
(a) Depression
(b) Panic and anxiety disorders
(c) Posttraumatic stress disorder
(d) Information overload
d. Other influences
(1) Changes in women’s roles
(2) Decreasing birth rates
(3) Increasing longevity
(4) Cultural and ethnic diversity
3. Issues affecting response to ambulatory surgery (Box 13-1)
BOX 13-1
DEVELOPMENTAL ISSUES AS RELATED TO AMBULATORY SURGERY
| Young Adulthood | Middle Age |
|---|---|
|
▪ Little or no insurance coverage
▪ Needs to return to work or school as soon as possible
▪ May need help with care of home, children, or parents
▪ May expect sophisticated medical technology to be able to fix anything with very little “down” time
|
▪ Physical condition often better indicator of surgical/anesthesia response than chronological age
▪ More financially stable
▪ Better insurance coverage
▪ May be balancing many professional, civic, and family responsibilities
|
B. Middle age
1. Developmental and sociocultural issues
a. Becoming one of the largest segments of the population
(1) Earn the most money
(2) Pay a major portion of the bills and taxes
b. Yield much power in
(1) Government
(2) Politics
(3) Education
(4) Religion
(5) Science
(6) Business
(7) Communication
c. Common experiences
(1) Good physical and mental health
(2) Personal freedom
(3) Good command of self and the environment
2. Issues affecting response to ambulatory surgery (Box 13-1)
III. HEALTH, WELLNESS, AND ILLNESS
A. Health care and prevention
1. Levels of health care
a. Health promotion: activities to improve or maintain optimum health
b. Disease prevention: actions to prevent disease or disability
c. Diagnosis and treatment: emphasizes early recognition and treatment of health problems
d. Rehabilitation: designed to limit incapacity caused by health problems as well as to prevent recurrences
2. Levels of prevention
a. Primary prevention: ways to prevent illness
b. Secondary prevention: early identification and treatment of health problems
c. Tertiary prevention: activities designed to return the physically or emotionally compromised person to the highest possible level of health
3. Ambulatory arena now involved in all levels of health care and prevention
IV. HEALTH AND ILLNESS BEHAVIOR
A. Health behavior
1. Activities undertaken by those believing themselves to be healthy
2. Purpose: to prevent disease or detect it in an asymptomatic stage
3. Examples
a. Breast self-exam
b. Regular exercise
c. Prudent heart living
d. Routine checkups
e. Ambulatory procedures
(1) Routine screening colonoscopy
(2) Follow-up cardiac catheterization in nonsymptomatic patient
B. Illness behavior
1. Activities carried out in response to a set of symptoms by those who feel ill
2. Allow individuals to determine their state of health and need for treatment
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