Nursing Exam Notes PDF

CH : 10 Erikson’s stages of adulthood > 5th psychosocial stage of crisis: - Adolescent stage- Social world - Identity vs role confusion: Working through the complexities of truly finding oneself - Crisis resolved with identity achievement, forging own identity taking on new ideals and...

CH : 10 Erikson’s stages of adulthood > 5th psychosocial stage of crisis: - Adolescent stage- Social world - Identity vs role confusion: Working through the complexities of truly finding oneself - Crisis resolved with identity achievement, forging own identity taking on new ideals and keeping some of their parents ideals - Adolescents cope through 1) role confusion, (2) foreclosure, (3) moratorium, and finally (4) achievement > Role Confusion: Adolescents don’t have a commitment to goals or values and are confused about new sexual impulses and triggering the reexamination of traditional values. > Foreclosure: Adopting all of your parent’s beliefs for the sake of avoiding the stress of through the troubles of one’s own identity. > negativity identity is completely rejecting traditional values > Areas of identity according to Erickson : religious, political, sexual and vocational 1. Religious: Likely to adopt the parental beliefs they have grown up with, become more devote, or decrease attendance in religious practice 2. Political: Likely to adopt parent/ peer opinions and those of current events 3. Ethnic identity: Shaped by the social context 4. Gender identity > Sex refers to the phenotypic gender traits > Gender: Culture and Social factors - Adolescents are more likely to use hypothetical thinking to make them question their gender identity - Gender dysphoria: Classified by DSM-5 of individuals being distressed of their gender Close Relationship: - Adolescents are relatively close to their parents as opposed to popular belief - Closeness of the Family: - Paternal Monitoring: Paternal knowledge from the parents about the whereabouts of their child/ activities/ companions - If monitoring comes from a positive environment it will reciprocate well with the child > Familism: The idea that the adolscent should sacrifice their freedom and success to care for the family - High monitoring: Where everyone knows information of each family member > Peer Power: - Selection and Facilitation  - Teens select friends with similar interests/ values - Facilitation: Friends may facilitate constructive or destructive behavior > Peer Pressure: Especially important during early adolescence - Coercive joining results from multiple friends acting together in behavior - Most peer relationships are nonsexual - Sexual Orientation based on erotic desires, gay, les, straight Sadness and Anger: > Trend for Depression: early childhood- early adolescence is towards less confidence - Self esteem usually increases around the age of 15 - Social context most significant influence > Major Depressive Disorder: Deep sadness and hopelessness that disrupts all normal activities - Suicide ideation most common at the age of 15 - Parasuicide: attempt at suicide but unsuccessful, complete suicide : died - Cluster suicide driven by influence - Externalizing and internalizing acts of anger - External: Slamming doors/ Yelling - Internal: Bed rot - Teenage rebellion not something normal but common Breaking the Law: Prevalence (how widespread) and the incidence (how frequent) of criminal actions are higher during adolescence than earlier or later. - One reason is that many behaviors that are legal for adults — buying cigarettes, having intercourse, skipping school — are illegal for adolescents - FALSE CONFESSIONS Determining accurate gender, ethnic, and income differences in - Brain immaturity (delay discounting) makes young people ignore long-term consequences. Instead, they may prioritize protecting family members, defending friends, and pleasing adults — including the police Drug Use and Abuse Most teenagers try psychoactive drugs, that is, drugs that activate the brain. Brain changes in the reward system lead directly to increases in drug abuse, such as binge drinking ( Hormonal surges, the brain’s reward centers, and cognitive immaturity make adolescents particularly attracted to the sensations produced by psychoactive drugs. But their immature bodies and brains make drug use especially toxic. Psychoactive drug excites the limbic system and interferes with the prefrontal cortex. Because of these neurological reactions, drug users are more emotional (varying from euphoria to terror, from paranoia to rage) and less reflective than they would otherwise be. - risk is higher among teenagers because their prefrontal cortex is less able to reign in the limbic system. As you remember, the brain is not fully grown until about age 25. That is one reason that societies try to protect the youth by making the purchase of any drug — including alcohol and tobacco — illegal before adulthood. Age Trends Those laws fight against the adolescent urge to rebel and experiment. Those urges make many teenagers eager to try psychoactive drugs, including tobacco and alcohol. Use increases from age 10 to 25 and then decreases, because adult maturation makes drugs less attractive. Use of legal drugs (alcohol, cigarettes, and marijuana) before age 15 is especially worrisome, because brain damage is more likely at that age. Moreover, early experimentation tends to become addiction. Depression, sexual abuse, and bullying may follow. inhalants (fumes from aerosol containers, glue, cleaning fluid, etc. Cohort differences are evident for every drug, even from one year to the next (based on your age group): legalization of marijuana, e-cigarettes in many flavors, hundreds of deaths from opioids, dozens of deaths from vapies of changes in the adolescent drug scene over the past few years. Harm from Drugs Drug use before maturity is particularly likely to harm growth and predict later addiction. However, few adolescents are aware of when they or their friends move past use (experimenting) to abuse (experiencing harm). Each drug is harmful in a particular way. Tobacco impairs digestion and nutrition, slowing down growth. Since internal organs mature after the height spurt, smoking teenagers who appear to be fully grown may damage their developing hearts, lungs, brains, and reproductive systems. Alcohol is the most frequently abused drug in North America. Drug Use and Abuse Most teenagers try psychoactive drugs, that is, drugs that activate the brain. Brain changes in the reward system lead directly to increases in drug abuse, such as binge drinking (Morales et al., 2018). Hormonal surges, the brain’s reward centers, and cognitive immaturity make adolescents particularly attracted to the sensations produced by psychoactive drugs. But their immature bodies and brains make drug use especially toxic. Every psychoactive drug excites the limbic system and interferes with the prefrontal cortex. Because of these neurological reactions, drug users are more emotional (varying from euphoria to terror, from paranoia to rage) and less reflective than they would otherwise be. That may explain why every hazard — including car crashes, unsafe sex, and suicide — is more common when teens use psychoactive drugs. The same drugs are hazardous in adulthood, but the risk is higher among teenagers because their prefrontal cortex is less able to reign in the limbic system. As you remember, the brain is not fully grown until about age 25. That is one reason that societies try to protect the youth by making the purchase of any drug — including alcohol and tobacco — illegal before adulthood. A Man Now? This boy in Tibet is proud to be a smoker — in many Asian nations, smoking is considered manly. Age Trends Those laws fight against the adolescent urge to rebel and experiment. Those urges make many teenagers eager to try psychoactive drugs, including tobacco and alcohol. Use increases from age 10 to 25 and then decreases, because adult maturation makes drugs less attractive. Use of legal drugs (alcohol, cigarettes, and marijuana) before age 15 is especially worrisome, because brain damage is more likely at that age. Moreover, early experimentation tends to become addiction. Depression, sexual abuse, and bullying may follow. One drug follows another pattern — inhalants (fumes from aerosol containers, glue, cleaning fluid, etc.). Sadly, the youngest adolescents are most likely to try inhalants, because they are easiest to get (hardware stores, drug stores, and supermarkets stock them). Cognitive immaturity means that few understand the risks — brain damage and even death (Nguyen et al., 2016). Cohort differences are evident for every drug, even from one year to the next. Legalization of marijuana, e-cigarettes in many flavors, hundreds of deaths from opioids, dozens of deaths from vaping — these are examples of changes in the adolescent drug scene over the past few years. Adolescent drug use in the United States has declined since 1976 (see Figure 10.4) with one major exception, vaping. Although adults try to limit adolescent drug use primarily by making drugs less available, perception of risk, not availability, reduces use. Most high school students have always said that they could easily get alcohol, cigarettes, and marijuana (Miech et al., 2016). FIGURE 10.4 Rise and Fall By asking the same questions year after year, the Monitoring the Future study shows notable historical effects. It is encouraging that something in society, not in the adolescent, makes drug use increase and decrease and that the most recent data show a continued decline in the drug most commonly abused — alcohol. Availability is notable for e-cigarettes. Although the United States prohibits adolescent purchase, 13- to 17-year-olds often buy them, in stores and on the internet. When laws are strictly enforced, most young users get their e-cigarettes from other adolescents (Braak et al., 2020; McKeganey et al., 2019).  In 2020, 20 percent of high school students and 5 percent of middle school student in the United States report current e-cigarette use (T. Wang et al., 2020). Availability is widespread. Is that a problem? (See Opposing Perspectives.) OPPOSING PERSPECTIVES E-Cigarettes: Path to Addiction or Health? Electronic cigarettes (called e-cigs) are much less damaging to the lungs than conventional cigarettes, because they deliver the drugs by vapor (vaping). Smokers with asthma, heart disease, or lung cancer benefit from vaping if it reduces their smoking of combustible cigarettes (Veldheer et al., 2019). However, the health risk of e-cigs is not zero. In 2018, over 50 people died of a severe lung disease caused by e-cigs. The youngest death occurred in Texas in 2020. He was 15. The deaths are blamed on a particular ingredient (vitamin E) that most e-cigs do not have. However, all of them produce benzene, a known carcinogen (Pankow et al., 2017). Moreover, many e-cigs contain nicotine, which may be more addictive than heroin. Some contain THC, a compound in marijuana. If the choice is between smoking and vaping, vaping is better. But if the choice is between e-cigs and being free of all cigarettes, vaping is worse. Developmentalists fear that e-cigarettes will open the door to other drugs. This notion led to a new U.S. law in late 2019 that banned the sale of tobacco products, including e-cigs, to people under age 21. In early 2020, the Food and Drug Administration announced it would crack down on vendors who sold cartridge-based vaping products in kid-friendly flavors. One company (JUUL) designed e-cigs with a sleek delivery gadget that looks like a USB drive, and advertised on social media. The target consumers were White teenagers (see Figure 10.5). That dramatically increased market share among adolescents, with sales approaching a billion dollars. The executives contend that good business practices and clever advertising, both admired by many adults, have made them successful (Huang et al., 2019). FIGURE 10.5 Getting Better The fact that more than one in five high school students (that’s 3 million people) used tobacco — even though purchase of any kind is illegal — in the past month is troubling. This means that more than 3 million students are at risk for addiction and poor health. The surprise (not shown) is that all of these rates are lower than a year earlier. Is that because laws are stricter, or because teenagers are getting wiser? The arguments from distributors of e-cigarettes are that their products are healthier than cigarettes, that people should make their own choices, and that the fear of adolescent vaping is exaggerated — part of the irrational fear that everything teenagers do is trouble. Yet most public health doctors advise against e-cigs, and pediatricians worry that fetal and infant lungs suffer if the mother uses them (Carlsen et al., 2018). With rats, vaping decreases birthweight, which increases risks for early death and brain damage (Orzabal et al., 2019). The evidence says caution, but caution is scarce at adolescence. The media presents mixed messages: Are strict age restrictions protective or puritanical (Morphett et al., 2020)? Opposing perspectives are apparent: Which perspective is yours? Harm from Drugs Drug use before maturity is particularly likely to harm growth and predict later addiction. However, few adolescents are aware of when they or their friends move past use (experimenting) to abuse (experiencing harm). Each drug is harmful in a particular way. Tobacco impairs digestion and nutrition, slowing down growth. Since internal organs mature after the height spurt, smoking teenagers who appear to be fully grown may damage their developing hearts, lungs, brains, and reproductive systems. Alcohol is the most frequently abused drug in North America. Heavy drinking impairs memory and self-control by damaging the hippocampus and the prefrontal cortex, perhaps distorting the reward circuits of the brain lifelong (Guerri & Pascual, 2010). ​