LS CH 11 Early Adulthood PDF

7589_Ch11_167-182 29/08/17 12:00 PM Page 167 11 CHAPTER Early Adulthood Key Words Chapter Outline aerobic exercise basal metabolic rate carcinogens cholesterol compatibility free radicals gingivitis hypertension insomnia intimacy introspection mammography Mantoux skin test obesity occult blood...

7589_Ch11_167-182 29/08/17 12:00 PM Page 167 11 CHAPTER Early Adulthood Key Words Chapter Outline aerobic exercise basal metabolic rate carcinogens cholesterol compatibility free radicals gingivitis hypertension insomnia intimacy introspection mammography Mantoux skin test obesity occult blood osteoporosis Papanicolaou test presbyopia proximity reaction time reciprocity resistance exercise respectability saturated fats sexuality sun protection factor trans fats unsaturated fats vital capacity Physical Characteristics Height and Weight Bone and Muscle Development Dentition Development of Other Body Systems Vital Signs Developmental Milestones Motor Development Sexual Development Psychosocial Development Choosing and Establishing a Career Establishing a Home and Family Expanding Social Circles Developing Maturity Cognitive Development Moral Development Nutrition Protein Types of Fats Carbohydrates Vitamins and Minerals Sodium Sleep and Rest Exercise and Leisure Safety Health Promotion Exposure to Carcinogens Sensory Impairment Caused by Accidents Obesity Stress Family Planning Summary Critical Thinking Multiple-Choice Questions Learning Objectives A t th e e n d of th i s ch ap te r , y ou s h ou l d b e ab l e to: • • • • • List four goals for the early adult period of development. Describe three physiological changes that occur during early adulthood. Describe the psychosocial task as identified by Erikson for the early adulthood period. Name three nutritional concerns for young adults. Describe two health screening tests important for women in the early adult period of development. 167 7589_Ch11_167-182 29/08/17 12:00 PM Page 168 168 Journey Across the Life Span Early adulthood covers the period from age 20 through the early 40s. This stage of development is generally described as a stable time of growth. Gradual biological and social changes are expected at this stage. As some body systems grow and develop, others begin to show the effects of aging. All early events, experiences, and patterns of growth help shape and prepare individuals for adulthood. Adulthood is a period that most adolescents have anticipated and strived for. Entrance into this stage is usually accompanied by positive feelings, dreams, and aspirations. The goals for this time include choosing and establishing careers, fulfilling sexual needs, establishing homes and families, expanding social circles, and developing maturity. Toward the completion of this stage, adults begin to compare their early dreams with their accomplishments. As this occurs, they must reconcile the differences and accept the reality or institute changes. PHYSICAL CHARACTERISTICS Height and Weight Physical growth is completed in adulthood. Men continue to show growth in the vertebrae until age 30. This growth adds about 3 to 5 mm in height. Women usually attain their full statures before their 20s. Bone and Muscle Development Peak bone mass is attained by age 35. There is a gradual loss of bone mass after this age in women. Although bone growth stops, bone cells are replaced at the site of any injury. Exercise helps to increase endurance, strength, and muscle tone. Actual muscle mass differs in men and women based on nutrition, exercise, and amounts of the hormone testosterone; for this reason, men usually have more muscle mass than women. Increase in muscle mass is not dependent on an increase in the number of muscle cells. Muscle capacity for sports varies with age. The ability to engage in vigorous sports such as tennis and football declines after the first half of adulthood; therefore, interest in other sports such as golf may first begin in the later part of adulthood. Capacity and maximum work rate without fatigue begin to decline after age 35. Injury occurring during this stage best responds to rest and immobilization. Dentition Wisdom teeth erupt toward the end of adolescence or in the early 20s (see Chapter 10). Failure of these teeth to erupt may lead to pain and overcrowding and may require surgery. Gum disease, or gingivitis, affects many adults and is considered preventable. It is the major cause of tooth loss in the adult years. The need for proper care of the teeth and gums cannot be overemphasized. Proper care includes regular brushing, flossing, and limiting excessive consumption of sweets. Good oral health care includes visits to the dentist every 6 months. Development of Other Body Systems All organs and body systems are fully developed and matured by this age. Changes in body shape, growth of body hair, and muscle development slowly continue through the 20s. Maximum cardiac output is reached between ages 20 and 30; after that, cardiac output gradually declines. During the adult years the heart muscles thicken, with fat deposits in the blood vessels producing a decrease in blood flow. Certain practices, including using alcohol and tobacco and eating foods high in cholesterol content, may increase an individual’s risk for cardiovascular disease. The heart and vessels become less elastic with advancing age. This rigidity may contribute to the decreased cardiac output and increased blood pressure commonly seen in later adulthood. The ability of the lungs to move air in and out is known as vital capacity. Vital capacity decreases between ages 20 and 40. Peak respiratory function is age 25 for men and age 20 for women. This gradually declines owing to loss of elasticity in the lungs. Adults who smoke tend to lose elasticity more rapidly than nonsmokers. This loss of elasticity also leaves the individual more susceptible to respiratory infections. Exercise can maintain and maximize lung capacity. Appetite remains unchanged in this stage. After age 30 the gastric secretions and digestive juices diminish significantly. Poor eating habits lead to common gastric discomforts and indigestion. The basal metabolic rate, which is the amount of energy that an individual uses at rest, decreases with advancing age. This change may result in an increase in weight even when dietary habits remain unchanged. Adults need to try to maintain normal bowel elimination with a diet containing roughage or fiber and adequate fluids. A balance of diet and exercise and regular patterns of elimination promote normal bowel functioning. Individuals should report any change in their normal patterns of elimination to 7589_Ch11_167-182 29/08/17 12:00 PM Page 169 Early Adulthood their physician so that that proper medical investigation and treatment can be instituted. Skin cells undergo some changes as a result of exposure to the sun and pollutants in the environment. Excessive exposure to ultraviolet rays may produce skin cancer, particularly in light-skinned individuals. (See “Exposure to Carcinogens” in this chapter.) Adolescent acne usually clears up by adulthood. For the few cases that do not, a number of different treatment regimens can be offered. Both the number of cells in the nervous system and the size of the brain decrease after puberty. Changes in sensation and perception can be recognized during this stage. However, speed and accuracy of these perceptions are not yet affected. Reaction time, the speed at which a person responds to a stimulus, increases noticeably between ages 20 and 30. Visual acuity may decline after age 25 owing to decreased elasticity and increased opacity of the lens. By age 40 there is often a decreased ability to see objects at close distance. This condition, known as presbyopia, advances with age. Corrective lenses can correct vision in the person suffering from this condition. Hearing ability is best at age 20; after that there is a gradual hearing loss, particularly for high-frequency tones. Hearing loss occurring at this point usually has little effect on the individual’s activities of daily living. Excessive exposure to loud noise from music or work may accelerate hearing loss. Most adults learn to compensate for the minor losses. The body system that is actually functioning at peak capacity is the reproductive system. In women, the menstrual cycle is well established. Women should report irregular patterns of menstruation or serious discomfort to their physicians. Generally, men are free of reproductive problems at this stage. One concern that may threaten the couple’s sexuality and emotional well-being is infertility. Approximately 14% of couples experience the inability to conceive. Couples who are experiencing difficulty conceiving should seek counseling and medical supervision. These couples usually experience tremendous stress and anxiety, and often they blame themselves or each other. Those who decide to undergo fertility testing and evaluation frequently encounter expensive medical bills. For some couples infertility treatment may not be successful. These couples need support and time to consider other options. Suggestions to assist in conception include the following: • Determine time of ovulation (using basal temperature measurements or with commercial kits). 169 • Plan intercourse for every other day during fertile period. • Practice deep vaginal penetration using the male superior position. • Avoid using any lubricants or douches. • Have the female remain lying on her back for 20 minutes following intercourse. VITAL SIGNS The normal resting heart rate for the adult ranges from 60 to 90 beats per minute. The normal respiratory rate ranges from 18 to 24 breaths per minute. Normal blood pressure readings range from 110 to 130 systolic and 70 to 90 diastolic. DEVELOPMENTAL MILESTONES The major developmental milestones for this age group include choosing and establishing careers, fulfilling sexual needs, establishing homes and families, expanding social circles, and developing maturity. Motor Development Most individuals have reached peak physical efficiency during this period of development. Muscle strength and coordination peak in the 20s and 30s and then decline gradually between ages 30 and 60. The muscles of greatest strength include those of the back, arms, and legs. Sexual Development Adults must first come to terms with themselves as sexual beings and then become comfortable with their own sexuality. Sexuality is a broad term that includes anatomy; gender roles; relationships; and thoughts, feelings, and attitudes about sex. Many factors influence the development of sexuality: biological development, personality traits, cultural and social influences, and religious and ethical values. Education expands the adult’s knowledge and understanding of sexual behavior, permitting the development of positive feelings. This helps promote communication and openness in intimate relationships. The goal is to enable people to achieve pleasure and sexual satisfaction in their relationships. Part of fulfilling sexual needs is the adult’s ability to experience and share love. Romantic love is a deep emotional experience, with mutual sharing of 7589_Ch11_167-182 29/08/17 12:00 PM Page 170 170 Journey Across the Life Span warm and tender feelings. Unlike many individuals at earlier stages of development, mature adults have the basis for establishing these intense relationships. Romantic love incorporates intimacy and passion. Love is reciprocal and allows for giving and sharing with one another. The mutuality of sharing and the bonds of commitment foster a sense of security between individuals. Love brings people together and is more than just a sexual experience. For most men and women, sexual concerns are usually stable during this stage of development. Most adults by their mid-20s have already established comfortable patterns of sexual behavior, and most feel comfortable with their masculinity or femininity. Many studies have been done on human sexual response. Although feelings and attitudes vary greatly among individuals, basic responses to sexual arousal have common features. The best-known study was by Masters and Johnson, who described the cycle of human sexual response by dividing the response into four distinct stages: excitement, plateau, orgasm, and resolution. The excitement phase begins with feelings and sensations that produce muscle tension and vasocongestion in the reproductive organs. A state of heightened excitement occurs during the plateau phase just before orgasm. During the orgasmic phase, there are rhythmic contractions in the vagina and penis and, in the male, ejaculation (release of semen). The other physiological responses to sexual arousal include increases in blood pressure, respiration rate, heart rate, and muscle tension and engorgement or swelling of the genital tissues. These responses add to the overall arousal state. During the resolution phase, the reproductive organs return to their unaroused state. Men have a brief refractory period during which they cannot have a repeated orgasm. It is possible for women, if they are stimulated and desirous, to have repeated orgasms, one following another. Most recent research in the area of sexual behavior focuses on the importance of integrating the mind and body to achieve a satisfying, healthy sexual experience. Psychosocial Development By the time adults have reached their 20s, they should have developed strong senses of identity. Ego identity or sense of who one is allows adults to accomplish the next task—intimacy—as described by Erikson. Erikson broadly described intimacy as not only sexual intimacy, but also emotional intimacy between lovers, between parents and children, and between friends. This definition of intimacy involves warmth, love, and affection. Individuals must be capable of giving of themselves in an emotional relationship. Introspection, or self-reflection, is the tool that is needed to permit the sharing of innermost thoughts. The individual must learn to be truly open and capable of trust. Intimacy is not just sex, but who we are and how we express ourselves in our male or female roles. These roles are affected by culture and time. A radical change has taken place in the female role since the early 19th century. Today’s women may share with a partner or manage alone the many responsibilities in the home, workplace, and community. Similarly, the male role has changed to encompass not only breadwinner but, in some cases, also homemaker and caregiver. Adults who are uncertain of their identities often shy away from meaningful relationships and enter casual interactions that lack interrelatedness. This may lead to isolation and self-absorption. Without trust and commitment, these relationships are usually unfulfilled and doomed to failure. Choosing and Establishing a Career It is necessary to understand work roles and their meanings to better understand adult life. Events such as being hired, promoted, fired, and retired are considered critical milestones in the work cycle of an adult. Work is one of the major social roles of adulthood. Most adults work. Work makes possible personal, social, cultural, and financial survival. Work roles affect the individual’s sense of identity because in our society people are often judged by what they do for a living and how much they earn. Work has different meanings for different people. For some, it represents prestige and social recognition; for others, it is a source of disappointment. Work may enhance self-worth, respect, and creativity. Work also may represent service to others. Both men and women enter the workforce with hopes of upward mobility—a better job, an increase in salary, or a promotion. Some young adults may seek continuing education or vocational training to succeed and maximize the available economic opportunities (Fig. 11.1). Wages, promotions, and the ability to accumulate expensive possessions are used as measurements of work-role success. Internal and external pressure is placed on all individuals to succeed in their occupations. Unemployment Job security is a concern for many adults in the workforce today. Large companies have been forced to downsize and trim staff at all levels from 7589_Ch11_167-182 29/08/17 12:01 PM Page 171 Early Adulthood FIGURE 11.1 Young adults place importance on education. management to entry-level positions. The escalating costs of retirement plans, salaries, and health care have forced corporations to save money by laying off workers who otherwise would have remained until their later years. This has caused a sense of insecurity and unrest among young adults. Global economic instability also causes great stress for the adult population. Many of the world’s economies have recently endured one of the worst financial crises since World War II. This crisis began in 2008 and was caused by the collapse of the biggest mortgage lenders. A lack of adequate government oversight has been blamed for the collapse. Regardless of the cause, the collapse has resulted in high unemployment numbers. Periods of unwanted unemployment create increased stress for individuals, their families, and their support systems. Prolonged joblessness can cause serious psychological and social problems. Whether it is a permanent or temporary job loss through downsizing, restructuring, or otherwise, the individual suffers from a loss of steady income and, often, a loss of self-worth. Lengthy unemployment may eventually lead to depression and social isolation. Women in the Workforce The experience for women in the workforce may be different from that of men. Women are faced with pressures of family, self, and work. The demands of 171 an occupation may have to be balanced with the demands of marriage, childbearing, and parenting. These conflicts may lead to career obstacles and undue stress. For some women, work allows economic independence and may create less pressure to marry. Many choose marriage for reasons other than economic security. Women’s occupations are also changing. In a recent study, college women indicated that they were pursuing careers in law, business, medicine, and engineering. These careers are no longer dominated by men. The changing roles of women have meant that men need to adjust to women as coworkers and bosses in the workforce and as family providers. Women in the workplace encounter sexual harassment or inequities more frequently than do men. Sexism, like other prejudicial stereotyping, has an adverse effect on society. Sexism refers to all the attitudes, beliefs, laws, and actions that discriminate on the basis of gender and lead to stereotyping and unequal treatment of individuals. One consequence of negative stereotyping is that victims may believe that the portrayal is true; as a result, they may undervalue or further degrade themselves. Box 11.1 lists signs of sexual harassment. Sexism is still evident in the employment status of women. For example, there is still a significant earnings gap between men and women: The U.S. Bureau of Labor Statistics has stated that earnings differ based on race, ethnicity, and gender. In 2013, pay for women was 82.2% of the median weekly earnings of men. There have been attempts to make the public more aware of these issues, and workers and management more sensitive to people’s rights and feelings. Establishing a Home and Family For many, early adulthood is the time to establish a home and family. Families are becoming more diverse both in format and structure. Many young adults choose to leave their families of origin and start homes of their own after their adolescent years. Finding a place to live and call one’s own is an B O 11.1 • • • • X Sig ns o f Sex ual Harassment Continual or repeated verbal abuse of a sexual nature Graphic sexual comments, gestures, or postures Display of sexually suggestive objects Sexual propositions, threats, or insinuations suggesting that if the person refuses to submit sexually, his or her employment, wages, or status will be adversely affected 7589_Ch11_167-182 29/08/17 12:01 PM Page 172 172 Journey Across the Life Span important step for young adults. Where they settle down largely depends on available jobs and income. Some young adults want to remain close to their families of origin. A major decision for an adult is whether to choose a mate or to remain single. In the United States, although the number of marriages is high, many young adults postpone marriage or choose to live alone. In addition there has been a significant increase in the number of unmarried couples living together. Unlike three or four decades ago when couples had three, four, or more children, today’s couples often have only one or two. Today’s couples often delay pregnancy and childbearing until their careers and financial security are achieved. Relationships may be long lasting or short lived, depending in part on each individual’s goals and needs (Fig. 11.2). Adults who have not resolved the conflict of identity usually experience the most difficulty in their close relationships. Adults who are involved in a relationship must establish clearly defined roles to minimize conflicts. The decision to start a family and raise children is an individual choice (Fig. 11.3). Some adults become involved in their careers and delay parenting. Others make the choice to remain childless. Still others choose to raise children as single parents. Chapter 3 has additional readings on family styles and arrangements. Expanding Social Circles Adults tend to select friends on the basis of similarity of life stage, such as age of children, duration of FIGURE 11.2 Meaningful relationships occur at this stage. FIGURE 11.3 The decision to start a family frequently occurs at this stage. marriage, occupational status, or community interests. Adult friendships often last over long periods and survive separation. Young adults share feelings, experiences, and confidences with their friends. Friendships may be either acquaintances or intimate relationships. Characteristics of intimate friendships include reciprocity, compatibility, respectability, and proximity. Reciprocity refers to mutual helping and supporting between friends that allow them the freedom to rely on one another. The central theme of reciprocity is giving and receiving. Compatibility describes the feeling tone of the relationships. The components of compatibility are comfort, ease of the relationship, and friendship. Respectability emphasizes role modeling and valuing. Proximity describes the frequency of interaction and the duration of the relationship; these two factors are more important than geographic location. Adult friendships occur in a variety of settings including the home, work, and community. These relationships are necessary because they provide individuals with emotional support and stability. Developing Maturity Mature adults have developed both internal and external systems of controls and restraints. These allow them to behave in acceptable manners. Mature adults have established philosophies of life that incorporate their beliefs and ethical values and help them make decisions and choices and maintain their senses of individuality. Mature adults have broad perspectives and are open to suggestions but not overly influenced by others. They are capable of living, sharing, caring, and respecting others. Another sign of maturity is an individual’s ability to develop an interest in the community’s needs. Mature adults are able to take responsibility for their actions. They are able to deal with problems or setbacks without losing sight of their goals. 7589_Ch11_167-182 29/08/17 12:01 PM Page 173 Early Adulthood Cognitive Development Unlike persons in earlier stages of development, the adult is no longer primarily egocentric. Adults are therefore capable of being objective and looking at issues from wider perspectives. Cognitive ability draws on an individual’s ability to solve problems and use information. It determines the how and why of knowledge. Most adults are at the level of formal operational cognitive functioning. This permits them to attain an increased amount of learning or function at their peak intellectual levels. Injury or insult to physical or emotional health may adversely affect cognitive development and learning. By drawing on their past experiences, adults have increased abilities to reason, solve problems, and set priorities. Intelligence is a measurement of what a person knows. Most intelligence is measured by testing. Tests usually ask for the recall of a body of knowledge acquired during schooling. This kind of testing may be unfair to those of lower socioeconomic levels who may post lower intelligence scores; research has shown that they would score higher if they were given the same learning opportunities as people in higher socioeconomic levels. Approximately 35% of young adults attend colleges or vocational schools. School helps adults to organize their time, expand their awareness, and sharpen their understanding of the world. Some older adults return to school after many years and find that it takes them a little longer to adjust to the learning environment. One adult learning theorist suggested that the best climate for adult learners is one of mutual respect, trust, support, and caring. Adults learn at different rates because of individual differences. They usually have more than one reason for learning. They are motivated by things that have personal meaning and importance to them. Reinforcement is the force that helps them continue their learning processes. Positive reinforcers for the adult learner include praise, social approval, and recognition. These positive reinforcers are stronger motivators than coercion and force. Moral Development Most adults are in the postconventional stage of moral development. They have the capacity to choose the principles and rules by which they live. For many individuals moral issues are not a matter of absolute right or wrong but need to be viewed in the context in which they occur. For example, adults may know that killing is wrong, yet during war they are able to report to active duty and perform the duties of soldiers and 173 kill if necessary. Under the circumstances of a war, these actions would be considered honorable and moral acts. Highly moral individuals respect the rights of others. Morality is not just a rule but a code of behavior to guide one’s actions. Some views on morality extend beyond love, ethics, and justice to a state in which one finds mutual satisfaction. A true understanding of oneself and others leads to mutual satisfaction. This interpretation of moral development is sometimes described as a feminist perspective of morality. As with other developmental issues, morality is a highly individual matter. Many adults exhibit a strong interest in religion, sometimes returning to the religious teachings of their own upbringing to teach religion to their offspring. In most families the mother’s religious values and beliefs are more likely to be practiced than those of the father. NUTRITION One goal of Healthy People 2020 is to promote health and decrease chronic disease through healthy diet and weight. Nutrition and one’s eating habits play an important role in physical and mental health and development. A sound diet is crucial to a person’s general state of health at any age. Dietary needs in the adult years differ little from those in adolescence. Caloric requirements are based on the adult’s age, body size, amount of physical activity, and gender. Men generally need between 2,700 and 3,000 calories per day, whereas women need only 1,600 to 2,100 calories per day. Each individual must adjust his or her caloric intake based on lifestyle (active versus sedentary) to help maintain a desired body weight. Protein It is recommended that 15% of an adult’s daily caloric intake be in the form of protein. Protein sources include dairy products, meat and fish, legumes, soy products, and nuts. Recent research has shown that adults who consume fish as a part of their diets are at lower risk for heart disease. Certain types of fish, such as salmon, trout, mackerel, and bluefish, are especially recommended because they contain omega-3 fatty acids, which help to lower total serum cholesterol levels. Currently, scientists may recommend fish oil supplements as long as the individual takes the recommended dose and is under medical supervision. Excessive amounts may be harmful. For vegetarians, flaxseed 7589_Ch11_167-182 29/08/17 12:01 PM Page 174 174 Journey Across the Life Span oil may be used as a supplemental source of omega-3 fatty acids. Types of Fat Only a very small amount of fat is needed in the diet to maintain good health. Extra fat only serves to add additional calories and contributes to obesity. A diet high in fat also raises blood cholesterol levels. Cholesterol is a part of many foods in our diets. The liver manufactures and filters out excess cholesterol. Cholesterol is an essential component of cells in the brain, nerves, blood, and hormones. However, an increase in serum cholesterol is considered the major cause of coronary artery disease. People with cholesterol levels less than 200 mg are at least risk for coronary artery disease, whereas those with levels more than 240 mg are at greatest risk. To maintain healthy cholesterol levels, an adult requires only about 30% of total caloric intake from fat. The American Heart Association recommends that women eat no more than 6 ounces of meat per day and that men eat no more than 7 ounces of meat per day. Table 11.1 offers a summary of different types of fats. Trans fats are made by adding hydrogen to vegetable oil, which helps retard food spoilage while enhancing its taste. The U.S. government has begun restricting the use of trans fats in food preparation, as scientific research has directly linked their use to coronary heart disease. Saturated fats, which become solid at room temperature, are found in meat, poultry, and dairy products (butter, cream, whole milk) and in palm oil and cocoa butter. Foods high in saturated fats should be kept to a minimum. Different cuts of meats vary in their saturated fat contents. Meats with visible fat usually have higher saturated fat contents. Trimming the visible fat from the meats and removing the skin from poultry can help reduce the total saturated fat content. Eggs and organ meats (liver, heart, and kidney) are very high in saturated fat and therefore should be used sparingly. Baking and broiling are preferable to frying and sautéing because they render the fat from meat without adding extra oil. Unsaturated fats are likely to be liquid at room temperatures. These fats are derived from plant sources such as corn, cottonseed, safflower, and soybeans. The terms monounsaturated and polyunsaturated refer to the compound’s specific chemical composition. Recent research indicates that a diet low in saturated fat and high in monounsaturated fat decreases the risk of colon and rectal cancers. Carbohydrates The daily caloric intake for adults should contain 50% to 60% carbohydrates. Complex carbohydrates, such as grains (wheat, rice, corn, and oats), peas and beans, and starchy vegetables (potatoes and yams), are rich in vitamins and minerals and high in fiber content. Fiber promotes bowel elimination. Vitamins and Minerals Daily vitamin supplements can be taken but should never be used as a substitute for natural food sources or taken in therapeutic doses unless prescribed by a physician. The young adult must safeguard against rapid bone loss and the development of osteoporosis. Osteoporosis is a disorder characterized by decreased bone mass resulting from the loss of minerals from the bones. This disorder primarily affects women beginning in the fourth decade. There are two main reasons for the high incidence of osteoporosis: (1) Women have proportionately less bone mass than men; and (2) as menopause approaches, women’s estrogen levels decline, causing the rate of mineral resorption to exceed the rate of T A B L E 11.1 Ty pe s of F at i n Di f f er en t F ood s Type of Fat Foods Where Found Saturated fats (high in cholesterol) Liver, kidneys; eggs; shrimp, lobster, oysters; coconut and palm oils; whole milk, butter, cheese; red meat Monounsaturated fats Canola, olive, and peanut oil; avocados; olives; almonds, cashews, and hazelnuts Polyunsaturated fats Corn, cottonseed, safflower, sunflower, sesame, and soybean oils Omega-3 fatty acids Halibut, mackerel, herring, salmon, sardines, fresh tuna, trout, and whitefish; flaxseed oil 7589_Ch11_167-182 29/08/17 12:01 PM Page 175 Early Adulthood bone formation. Adequate calcium intake, regular exercise, and hormone replacement therapy may help decrease the risk of osteoporosis. Calcium and vitamin D are essential for the maintenance of strong bones and teeth. Most women consume far less calcium than the recommended 1,000 to 1,500 milligrams per day. Good sources of calcium and vitamin D include milk and dairy products, meats, dark green vegetables, canned salmon, sardines, and tofu. Free radicals are chemical substances produced during metabolism; it is suspected that they play a role in cellular aging. Vitamins C and E have been identified as antioxidants, or substances that can interfere with the formation of free radicals. Vitamin E can be found in vegetable oils, wheat germ, nuts, legumes, and green leafy vegetables. Vitamin C is found in fruits and vegetables. Vitamin C is not stored in the body and must therefore be supplied daily. Sodium Hypertension, or high blood pressure, is a condition that places an individual at greater risk for heart disease and stroke. It affects many adults. For reasons that are not understood, African Americans have a higher incidence of hypertension than do other ethnic groups. Some studies indicate that foods high in sodium may cause elevated blood pressure. Individuals with a history of hypertension should limit or avoid excessive intake of sodium-rich foods. Sodium is found in many prepared foods, including prepared or cured meats and fish, soups, sauces, condiments, and certain snack foods. SLEEP AND REST Adults need an average of 7 to 9 hours of sleep each night. Adequate sleep helps the adult function with maximum productivity. Some individuals may complain of insomnia, or inability to sleep. Manifestations of insomnia include taking a long time to fall asleep, awakening frequently during the night or too early in the morning, and feeling tired and unrested on awakening. Diet, stress, fatigue, and poor physical health may be contributing factors. Sleep difficulties are sometimes a side effect of medication. The excessive use of caffeine, alcohol, nicotine, sleeping pills, and other drugs can further disturb the body’s natural sleeping patterns. Insomnia that persists beyond a couple of weeks may indicate a medical problem that warrants further attention. H E L P F U L 175 H I N T S Steps to Promote Better Sleep • • • • • Avoid eating large meals before bedtime. Plan regular exercise in the early afternoon. Follow a bedtime routine. Practice relaxation before bedtime. Use the bed only for sleep, not for reading or watching TV. • Establish a schedule to awaken each day at about the same time. EXERCISE AND LEISURE Physical fitness can improve at any age with regular participation in exercise (Fig. 11.4). Aerobic exercise works the large body muscles, elevating cardiac output and metabolic rate. Aerobic exercises help to develop muscle fitness, endurance, power, and flexibility. Aerobic exercise is the best form of exercise for burning calories. Brisk walking, cycling, and running are some examples of aerobic exercises. Resistance exercise, such as weightlifting, burns fewer calories but builds muscle mass and maintains metabolic rate. To improve cardiovascular health, it is recommended that an adult exercise 3 to 5 times a week for at least 30 minutes at each session. After several weeks of training, the person will have achieved maximum cardiac output, thereby increasing speed of oxygen delivery to the tissues. Lack of proper exercise can produce fatigue, headache, backache, and complaints of joint pain. Exercise should be incorporated into the adult’s daily routine. Many social experiences can be built around the adult’s exercise program FIGURE 11.4 Young adults should engage in regular exercise. 7589_Ch11_167-182 29/08/17 12:01 PM Page 176 176 Journey Across the Life Span SAFETY Safety concerns for young adults include care handling firearms and motor vehicle accidents. These concerns are similar to those for the adolescent years, as described in Chapter 10. Adults now need to expand their safety concerns beyond themselves to those of their children and other family members. Safety in the home must always be emphasized and practiced. Fire safety and prevention in the home must be addressed, including the use of fire extinguishers and smoke detectors and proper storage of flammable materials. Batteries in smoke detectors should be changed twice a year to ensure proper functioning. Each family member must be aware of a plan for escape in the event of fire in the home. Adults can best teach safety measures by setting good examples for their children to observe and follow. HEALTH PROMOTION Health assessment during the adult years should consist of a yearly physical examination. As part of the examination a complete blood analysis should be performed so that any early problems or abnormalities can be identified and corrected. Because of the increase in tuberculosis (TB) cases in the United States, adults should receive a Mantoux skin test to screen for TB. The increase in the number of cases has been linked to the development of drugresistant strains of bacteria and the increasing numbers of immunosuppressed individuals. A follow-up chest x-ray must be done if the results are positive. A yearly electrocardiogram (ECG) is useful to provide a baseline cardiac picture. Blood pressure screening and weight assessment must be part of the adult’s yearly health assessment. Early detection of health problems can lead to prompt intervention and ultimately protect against future illness. Gynecological concerns include problems with conception, infertility, and menstrual discomfort or disorders. The Papanicolaou test (also called Pap smear) is used to screen for cancer of the cervix. There are five levels of test results: class 1, the absence of abnormal cells; class 2, atypical but nonmalignant cells; class 3, abnormal cells; class 4, cells that are possibly but not definitively malignant; and class 5, conclusive for cancer. All women should have a yearly Pap smear. If there is a familial history of cervical cancer, this test should be instituted as early as adolescence. All women older than 20 should be familiar with the correct method for performing breast selfexamination (BSE). BSE has been shown to be the single most important examination used to detect early breast disease. It should be performed once a month about 1 week (7 days) after the end of the menstrual period. Box 11.2 outlines the steps in BSE. The test begins in front of the mirror with an inspection of the breasts for gross irregularities. Palpation for lumps or indiscretions can then be done standing up (for example, in the shower) or in a supine position (for example, while lying in bed). Although breast cancer is rare in men, it can occur; therefore, men and women should examine their breasts and report any unusual lumps or growths to their physicians. Mammography, or breast x-ray, should be initiated at age 40 and performed every other year until age 50 and yearly thereafter. If the woman has a family history of breast disease, a mammogram is suggested as early as in her 20s, with a yearly mammogram follow-up. In men, health screenings should include monthly examination of the testicles for early detection of B O 11.2 X B reast Self-E x aminatio n (M o nthly ) While standing in front of the mirror: 1. Keep your arms at your side and then raise them above your head. 2. Look carefully at the size, shape, and contour of each breast. 3. Look for puckering, dimpling, or changes in the skin texture. 4. Note if there is any nipple discharge. While lying down on your right side: 1. With a pillow under your right shoulder, place your right hand behind your head. 2. With the fingers of your left hand, press gently in a circular motion, starting at the outside of your breast and spiraling toward the nipple. Gently feel for any lump or thickening. 3. Examine your underarm and the area below your breast. 4. Repeat for your left breast. While standing in the shower: 1. Raise your right arm and use your left hand to examine your right breast. 2. Using a circular motion, start from the outer area and proceed inward. 3. Gently feel for any lump or thickening. 4. Repeat for the left breast. 7589_Ch11_167-182 29/08/17 12:01 PM Page 177 Early Adulthood tumors or other growths. Box 11.3 describes testicular self-examination. All adults, men and women, should have an annual rectal examination that includes a simple test for occult blood (hidden blood) in the stool. The presence of occult blood may indicate any one of several gastrointestinal diseases. Adults should have a tetanus booster every 10 years and yearly influenza pneumococcal immunization. Additional immunizations may be needed for those who are traveling outside the country or who are in classroom and dormitory settings. Information on needed immunizations may be obtained at the physician’s office or at the local health department. A person’s state of health and life practices may contribute to the development of heart disease. The risk factors that contribute to heart disease include lack of physical exercise, smoking, and elevated blood cholesterol and blood pressure levels. To control these risk factors, individuals must engage in moderate activity, avoid cigarette smoking, manage weight through appropriate diet, and comply with their prescribed medication regimens. Recent statistics have shown a decline in the number of deaths from heart disease in populations with healthier lifestyle practices. Exposure to Carcinogens The National Cancer Institute estimates that about 80% of all cancer cases are related to lifestyle practices. Many cancers can be prevented by avoiding carcinogens (cancer-producing agents) and following healthy practices. Tobacco usage is associated with a number of cancers of the mouth, throat, and respiratory system. Overall mortality among both men and women who smoke in the United States is about three times higher than mortality among similar people who never smoked. Recently, much attention has been given to the harmful effects of secondary exposure to smoking. Exposure to B O 11.3 1. 2. 3. 4. X T es t i c u l ar Sel f - Ex ami n at i on ( M on t h l y ) Stand in front of the mirror. Look at the appearance of the scrotum. Examine each testicle using both hands. Rotate each testicle between the thumbs and forefingers. 5. Report any dull pain in the groin, change in appearance, firmness, lumps, or irregularity to your physician. 177 secondhand smoke causes nearly 42,000 deaths each year among adults in the United States. Many states, as a result, have implemented legislation to limit or ban smoking in public places. Box 11.4 offers suggestions for quitting smoking. Many carcinogens are found in foods, especially those that are pickled, smoked, or cured. Pesticide residues left on fruits and vegetables or in meats may further place an individual at risk for developing cancer. Fat in the diet may act as a cancer promoter, causing cancer of the breast and colon. Fiber is the indigestible material contained in certain foods. It has been shown that a high-fiber diet may help prevent cancer of the colon or rectum. Fiber is found in whole grains, breads, cereals, and vegetables. Excessive alcohol use has been implicated in cancer of the throat, esophagus, mouth, and liver. Viruses may also act as carcinogens. Some of these viruses are spread through sexual contact. Safe sexual practices, including the regular use of condoms, help prevent the spread of these viruses in addition to HIV and human papilloma virus (HPV). Other forms of cancer may be attributed to carcinogens present in today’s industrial society. Many regulatory agencies have worked to help reduce the amounts of toxic materials present in the environment. Household and garden products are two of the groups of substances that must be used just as the manufacturer specifies to avoid undue harm. There are safe, inexpensive, nontoxic substances that can be substituted for common toxic cleaning and insect-control products (for example, boric acid instead of commercial insecticides; baking soda and vinegar products instead of commercial drain cleaners, oven cleaners, and so forth). More than 500,000 Americans develop skin cancer during their lives. The main cause of skin B O 11.4 • • • • • • • • • • X Sug g estio ns fo r Q uitting Smo k ing Behavior modification Hypnosis Cold turkey Individual counseling Nicotine patches Smoking cessation medications, such as buproprion or varenicline Acupuncture Commercial filters that gradually reduce tar and nicotine content Gradual withdrawal Support groups 7589_Ch11_167-182 29/08/17 12:01 PM Page 178 178 Journey Across the Life Span damage and cancer is the ultraviolet rays of the sun. Everyone, especially those who are light skinned, should avoid excessive exposure to ultraviolet light. Clothing and sun-blocking agents offer the best form of outdoor protection. A sunscreen with a sun protection factor (SPF) of 15 or more is generally recommended. The SPF rating is the time in minutes that a person can stay exposed to sunlight without burning. Those planning to be outside for longer than 15 minutes need to use a sunscreen with a higher SPF. Sensory Impairment Caused by Accidents Young adults often take their sensory functions for granted, but lack of care and accidents can lead to sensory losses. For example, 90% of all eye injuries occurring in the workplace could be avoided with the use of protective eyewear. Individuals should wear protective eyewear when doing chores and repairs around the home (for example, trimming hedges, using power tools or chemicals) or engaging in certain sports (for example, baseball, racquetball, tennis). Eye injuries can result from chemical splashes, flying debris, or a ball traveling at high speed. Hearing loss resulting from excessive noise exposure continues to be a concern for young adults both in the home and at work. The same preventive measures are recommended for adults as for adolescents (see Chapter 10). Routine eye and ear examinations can help detect cataracts, glaucoma, and hearing loss. Early detection and prompt intervention can reduce further loss of function. Obesity Approximately 30% of the adult American population is obese. Obesity is defined as having 20% to 30% excess weight. Studies have shown a direct relationship between obesity and mortality. Furthermore, obesity increases the likelihood of developing hypertension, diabetes mellitus type 2 (non–insulindependent diabetes), and high cholesterol levels. High cholesterol may contribute to the onset of heart disease and strokes. Obesity has also been implicated in other conditions, such as gallbladder disease, cirrhosis of the liver, kidney disease, and some cancers. Excessive weight adds stress to the weightbearing joints and may lead to osteoarthritis and back problems. Regular-paced exercise can improve cardiovascular function, promote weight loss, and reduce stress. Weight loss may be accomplished through diet and exercise. Certain foods contain more calories than others: 1 g of fat yields 9 kcal; 1 g of protein or carbohydrate yields 4 kcal. Therefore, people trying to lose weight may benefit from a low-fat diet. Crash diets or very-low-calorie diets are not only ineffective, but also may be harmful to one’s health. Diets of this sort do little to permanently change a person’s eating behaviors. Pounds lost on a crash diet are usually quickly regained. Crash diets may lead to food cravings and bingeing and set the stage for the onset of eating disorders. Crash dieting may lead to weight cycling—large fluctuations in weight. Recent research has shown that weight cycling often leads to a gradual increase in weight over time. Successful weight control programs are based on helping people develop lifelong behavior changes and good eating habits. Stress Common causes of adult stress include work, marital problems, child care concerns, and money worries. Stress reactions are highly individual and develop over years. Adults may develop certain health problems related to stress on the job, in their relationships, or in their lifestyles. Sometimes as people search for career advancement and social acceptance, they may neglect health-promoting activities. Many adults pay too little attention to nutrition and diet. Others “party” and engage in risky behaviors. Unhealthy practices during the adult years can have a direct effect on health in the later years. Stress-management workshops can help individuals learn how to better handle or reduce stress. Most stress-reduction programs are designed to help adults learn how to manage time effectively, say no, and deal directly with the sources of their stress. A sense of humor and the ability to practice relaxation techniques like yoga are helpful in managing stress (see Fig. 11.4). (Refer to Chapter 1 for other stressreducing exercises.) Family Planning Reproductive planning includes decisions about having children. Thanks to modern science and research, many contraceptive choices are available to the individual. Nevertheless, family planning and contraception are controversial subjects in the 7589_Ch11_167-182 29/08/17 12:01 PM Page 179 Early Adulthood United States today. The high numbers of unwanted pregnancies and elective abortions point to the need for better education and reproductive counseling services. Through education and counseling, individuals are better able to make responsible decisions that are right for them and will result in happiness. Contraceptive methods should be based on an individual’s values and beliefs along with knowledge of a given contraceptive product’s reliability, side effects, and impact on sexual satisfaction. The ideal form of birth control is one that is safe, effective, affordable, and acceptable to the parties using it. The common methods of contraception used today include hormonal methods (oral contraception commonly referred to as “the pill” and subcutaneous implants), intrauterine devices, and chemical and barrier methods (condoms, 179 diaphragms, spermicides, and cervical caps). For religious or other reasons, many people choose not to use any birth control devices but instead rely on a natural method of pregnancy prevention called the rhythm method. This method requires that the woman monitor her basal body temperature (resting temperature upon waking) for fertile and infertile periods and that the parties refrain from sexual intercourse on the days of the menstrual cycle when the woman is most likely to conceive. A summary of the common birth control methods and devices is listed in Table 11.2. Sterilization via tubal ligation for women and vasectomy for men are irreversible forms of birth control that should be undertaken only by those individuals who have been counseled and fully understand the permanence of their decisions. T A B L E 11.2 B i r t h C on t r ol M et h od s Method Advantages Disadvantages Natural, calendar, or rhythm method: monitoring basal body temperature, checking cervical mucus for fertile and infertile times; practicing coitus interruptus (withdrawal before ejaculation) Is free, safe, and acceptable to most religions Requires abstinence for 5 days during fertile period; is not very reliable Hormonal: oral contraceptive, implant, or morning-after pill Is almost 100% effective when used properly Can cause weight gain; can cause irregular menses; may cause hypertension, increased risk for strokes, heart disease, and breast cancer Mechanical barrier: condom, diaphragm, cervical cap, sponge Is inexpensive; may prevent transmission of sexually transmitted diseases May tear or dislodge; decreases sensation; increases risk of toxic shock syndrome Chemical barrier: spermicidal cream, jelly, foam, and vaginal suppositories Is easily obtained Is messy; may cause local irritation Intrauterine device: intrauterine progesterone contraceptive, intrauterine copper contraceptive Doesn’t affect hormonal cycle or interrupt sex act May cause infection, hemorrhage, perforation, spotting 7589_Ch11_167-182 29/08/17 12:01 PM Page 180 180 Journey Across the Life Span SUMMARY 1. Early adulthood covers the period from age 20 through the early 40s. This is generally described as a stable period of growth. 2. Physical growth is completed. Most individuals have reached peak efficiency during the early portion of this stage. 3. Muscular strength and coordination peak in the 20s and 30s and then slowly decline between ages 40 and 60. 4. Gingivitis affects many adults and is considered preventable. Wisdom teeth make their appearance from late adolescence through early adulthood. 5. Early changes may be noticed in sensation and perception. After age 40, there may be a decreased ability to see objects at close distance. This condition is known as presbyopia and is treated with corrective lenses. An adult may detect some loss of high-frequency hearing. 6. The reproductive organs are functioning at peak efficiency during this stage. In women the menstrual cycle is usually well established. Women with irregular cycles or menstrual discomfort should seek medical advice. Generally, men are free of reproductive problems during this stage of life. If problems with infertility arise, the couple should be referred to a physician for testing and guidance. 7. Cardiac changes include a gradual decline in cardiac output and loss of elasticity in the muscles and vessels. These changes may contribute to an increase in blood pressure. Respiratory function peaks during the 20s. 8. The major developmental milestones for this age group include choosing and establishing careers, fulfilling sexual needs, establishing homes and families, expanding social circles, and developing maturity. 9. Erikson viewed the psychosocial task for the adult as intimacy. He described a broader meaning of intimacy between lovers, between parent and child, or between friends. 10. Formal operational cognitive functioning develops further during the adult period. Adults are capable of being objective and of looking at issues from a wider perspective. 11. Adults are at the postconventional stage of moral development. As with other developmental issues, moral development progresses at a highly individualized rate. 12. Diet is crucial to health. Caloric intake is based on the adult’s age, body size, amount of physical activity, and gender. Men generally need between 2,700 and 3,000 calories per day, whereas women need 1,600 to 2,100 calories per day. 13. On average, an adult needs 7 to 9 hours of sleep each night. Many factors may contribute to the problem of insomnia, including stress, diet, fatigue, and poor health. 14. Physical fitness can improve at any age with regular participation in exercise. 15. Accident prevention continues throughout the adult years. Improper use or care of the sensory organs can lead to disease or injury. Protection against injury during sports includes training and the use of protective clothing and gear. 16. Young adults are concerned about not only their own safety, but also that of their children and family members. 17. Yearly visits to the physician are recommended. 18. Cancer prevention is important. Many cancers can be prevented by avoiding carcinogens in the environment and by practicing healthy living. Excessive exposure to ultraviolet rays, especially by light-skinned persons, may produce skin cancer. Using sunblock and wearing protective clothing when outdoors may prevent skin cancer. 7589_Ch11_167-182 29/08/17 12:01 PM Page 181 Early Adulthood 19. Weight management is important because obesity can lead to many disorders such as diabetes, heart disease, and stroke. The best approach to weight control is through education that leads to a change in lifetime diet and exercise patterns. 181 20. Stress management can help people learn how to handle stress more effectively through time management, saying no, and dealing directly with the stress. CRITICAL THINKING Exercise #1 Bob and Sue are a married couple in their 30s. They have been married for 4½ years and have decided to start their family. They have been trying to become pregnant for 8 months and have not been successful. Each blames the other person and thinks that they are too stressed for it to happen. They have made an appointment with Sue’s physician for an evaluation. 1. What questions should be asked to better understand this couple’s problem? 2. Could relaxation help aid in conception? 3. Should they consider alternatives to pregnancy and childbirth? Exercise #2 Vivian Andrews is your next-door neighbor. Vivian is 30 years old and is 5 feet, 4 inches tall and weighs about 180 pounds. She works part-time as a receptionist in an office. Her job is located about half a mile from her home; however, she rides the bus to and from work. She confides in you, a licensed vocational nurse, about her history of obesity. She shares with you a weight-reduction diet that she has cut out of the newspaper. The diet consists of fruits and vegetables and only one protein food source each week. She has read that this will guarantee a weight loss of 10 to 15 pounds in 1 week’s time. 1. What would you advise Vivian about this diet? Give reasons to support your advice. 2. Outline a diet for Vivian that would be conducive to healthy weight loss. 3. List several lifestyle changes or modifications that would promote Vivian’s health. MULTIPLE-CHOICE QUESTIONS 1. Cynthia Beckford is a healthy 30-year-old woman. Which of the following are normal age-related physical changes that you would expect her to be experiencing? a. An increase in bone cells b. A decrease in muscle cells c. An increase in new brain cells d. A loss of some elasticity in the lung 3. Andrew Previs, age 40, is having his annual eye examination. He has noted a decline in his visual acuity. The most likely cause of this symptom at this age is: a. Widening of the iris b. Eyestrain c. Opacity of the lens d. Loss of corneal cells 2. The major cause of tooth loss in individuals older than 35 years is: a. Tooth density b. Dental caries c. Gingivitis d. Stomatitis 4. The psychosocial task for the young adult is: a. Identity b. Intimacy c. Introspection d. Egocentrism 7589_Ch11_167-182 29/08/17 12:01 PM Page 182 182 Journey Across the Life Span 5. The psychological outcome of prolonged unemployment is often: a. Job phobia b. Social isolation c. Regressive behavior d. Selflessness 6. A sign of maturity in adulthood is the individual’s ability to: a. Exert excessive self-restraint b. Develop an interest in community activities c. Make life choices based on the advice of others d. Frequently change jobs 8. Foods that contain omega-3 fatty acids include: a. Salmon, trout, and bluefish b. Milk, butter, and cheese c. Shrimp, clams, and lobster d. Eggs, liver, and kidneys 9. Which of the following substances have been identified as a cause of heat disease? a. Proteins b. Carbohydrates c. Omega 3 fish oils d. Trans fats 7. The best time to perfor