LS CH 1 Healthy Lifestyles PDF

7589_Ch01_001-016 29/08/17 12:06 PM Page 1 1 CHAPTER Healthy Lifestyles Key Words Chapter Outline anxiety apathy disease prevention emotions empowerment equilibrium fight-or-flight response general adaptation syndrome health health promotion health restoration holistic life expectancy malnutrit...

7589_Ch01_001-016 29/08/17 12:06 PM Page 1 1 CHAPTER Healthy Lifestyles Key Words Chapter Outline anxiety apathy disease prevention emotions empowerment equilibrium fight-or-flight response general adaptation syndrome health health promotion health restoration holistic life expectancy malnutrition nutrition regression stress substance abuse wellness History of Health Care Healthy People Health Care Delivery The Affordable Care Act Types of Care Plans Comparison of U.S. and Canadian Health Care Systems World Health Organization The Concept of Health Promoting, Maintaining, and Restoring Health Disease Prevention Healthy Lifestyles Nutrition Causes of Obesity Exercise Mental Health Anxiety Stressors Maladaptive Responses to Stress A Healthy Self-Concept Role of the Nurse in Health Promotion 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: • • • • • • Describe the history of health. Describe the model for the nation’s health as proposed by Healthy People 2020. Describe the concept of health. List five healthy lifestyle practices. State the role of the practical nurse in health promotion. List two factors that interfere with people’s abilities to change their personal habits. 1 7589_Ch01_001-016 29/08/17 12:06 PM Page 2 2 Journey Across the Life Span HISTORY OF HEALTH CARE Early civilization was concerned with health and diseases. Illness was often attributed to natural and supernatural forces. Sometimes illness was thought to be the result of some evil wrongdoing. Diseases were often warded off by incantations, magic, or charms or with the use of herb concoctions. At times drastic measures were taken to rid the body of demons, such as beating, torturing, or starving the sick. Other cures relied on magic and folk remedies. Even primitive surgery existed before the advent of Greek medicine. In about the sixth century BC medical schools were established in Greece. Hippocrates was the first physician to believe that treatment should be based on the belief that nature has a strong healing component. Diet, exercise, and hygiene became important to treatment. Throughout the Middle Ages medicine and religion were interwoven. Plagues and epidemics killed millions of people. Understanding of disease processes did not occur until the development of bacteriology, which took place in the 19th century. Louis Pasteur, Robert Koch, and Joseph Lister are some of the important scientists who made a significant impact contributing to the scientific understanding of health and disease during this time. During the 20th century a major cause of death was infectious diseases, but environmental improvements in sanitation, water, and food supply helped to further improve the quality of life. Between the years 1936 and 1954, the discovery and use of vaccines and antibiotics further reduced the number of deaths from infectious diseases. Despite all the improvements toward limiting the incidence and numbers of deaths from infectious diseases, several diseases surfaced and reappeared in the 20th century. Diseases such as tuberculosis and measles have resurfaced, and new infectious diseases such as HIV, AIDS, Ebola virus, and drugresistant strains of organisms (Staphylococcus aureus, Streptococcus pneumonia, and Salmonella) have become the current health challenges facing the population today. Many other achievements have contributed to longevity and health. Improvements and advancements in maternal care have led to decreases in maternal and infant mortality rates. Better nutrition, better hygiene, and improved technology have also greatly reduced the risks to both mothers and infants during the first year of life. Still, the issue of access to health care for all remains a concern. Great numbers of childbearing women do not seek any medical care during pregnancy, increasing the risk for both themselves and their infants. Other areas of improvement include recognition of the risks associated with tobacco use, genetic counseling, motor vehicle safety, and advances in diagnosis and treatment for heart disease and strokes. Improvements in the workplace regarding safety and job-related hazards have helped further reduce mortality rates. The mortality (death) rate today is lower than at any other time in history. Healthy People For three decades, the U.S. Department of Health and Human Services has published a 10-year agenda for improving the nation’s health called Healthy People. Healthy People provides the scientific base for a 10-year projection that addresses national health care goals and objectives. The first volume published was Healthy People 2000, and the aim was to reduce health disparities among Americans. Building on the objectives first identified, Healthy People 2010 was published and continued its belief in a systematic approach to improving health. Healthy People 2010 identified two major national health goals. The first goal was to increase the quality and years of a healthy life. Life expectancy is the average number of years a person is expected to live. Life expectancy has increased from 47.3 years at the beginning of the 20th century to nearly 77 years today. Healthy People 2010 sought not only to extend life expectancy but also to improve the quality of life. The second goal was to eliminate the health disparities among persons that exist according to gender, race, ethnicity, education, income, disability, location, and sexual orientation. Regardless of differences, this initiative was dedicated to making certain that all persons in our nation have equal access to fulfilling their health care needs. Healthy People 2020, launched in December 2010, continues the tradition with a 10-year agenda that promotes health and disease prevention services aimed at improving the health of all Americans. Healthy People 2020 promotes collaboration across communities to disseminate health information needed to empower the individual to make decisions about his or her health. The outcome of these preventative health strategies is also continuously measured and evaluated. The overarching goals of Healthy People 2020 are to improve the quality of life of all Americans and keep them free of preventable diseases, disability, injury, and premature death. Equity in 7589_Ch01_001-016 29/08/17 12:06 PM Page 3 Healthy Lifestyles health care and the elimination of disparities among different groups will improve the health of all Americans. An emphasis must also be placed on a good quality of life and healthy behaviors at all stages of development across the life span for all individuals. The health indicators spotlight the major health priorities for the nation. The Leading Health Indicators are listed in Box 1.1. HEALTH CARE DELIVERY The U.S. health care system in the 19th and early 20th centuries was dominated by physicians and hospitals. In these early times there was a close relationship between patient and doctor. Physicians set fees, billed, or collected payments. Often physicians adjusted fees based on the patient’s ability to pay. For many years the American Medical Association (AMA) fought against having any third party interfere or come between the patient and physician regarding any medical matter. In the early part of the 19th century some individuals had medical insurance from their trade union, fraternal order, or some commercial carrier. This sickness insurance, as it was first known, was simple coverage for lost time during sickness or injury. Years later this coverage was extended to include workers’ dependents and others. Before World War I there was some impetus toward compulsory health insurance following the initiative taken by several European countries. “Industrial” policies were sold by Metropolitan Life and Prudential Life Insurance Companies. This early form of health insurance was low cost but provided for only a small B O 1.1 • • • • • • • • • • • • • • X L ead i n g H eal t h I n d i c at or s Access to health care Clinical preventive services Environmental quality Immunization Injury and violence Maternal, infant, and child health Mental health Oral health Overweight and obesity Physical activity Reproductive and sexual health Social determinants Substance abuse Tobacco use 3 lump sum at the time of death to cover final medical expenses and the cost of funeral and burial. The Great Depression, which started in 1929, changed the financial security of hospitals and physicians. The AMA continued to protest the concept of health insurance, recommending that “persons save for the time of sickness.” In 1935 the Social Security Act was passed by Congress. This act established federal aid to states for public health and assistance. The Social Security Act became the foundation for the growth of Medicare and Medicaid legislation in 1965. Many factors influence the financing of the health care system today, including providers, employers, purchasers, consumers, and politicians. Controlling the rising costs and making provisions for the estimated 48 million Americans who are underinsured or uninsured are the two most pressing concerns today. The Affordable Care Act The U.S. health care delivery system is one of the most complicated and expensive systems in the world. Despite its sophistication, this system has been unable to adequately address the need for universal coverage. On March 21, 2010, the first step in realizing health care reform took place with the passing of President Barack Obama’s reform bill. The goal was to offer health insurance to the millions of Americans who are uninsured and improve the coverage of those who have insurance. The main objectives of the Affordable Care Act (ACA) are to move away from a focus on illness and toward a focus on prevention and wellness, with the goal of creating a more equally accessible system for the population. The act also emphasizes improving the quality of care, improving patient care outcomes, accountability, and cost reduction. The ACA will be phased in over several years. The major change is an expansion of Medicaid coverage, which will begin in 2014. Most of the population will then be covered by Medicaid and by the Children’s Health Insurance Program (CHIP). The federal government will pay 100% of the cost for the delivery of care from 2014 to 2016 and 90% thereafter. Some of the important provisions are as follows: • Families are eligible for certain preventive health services at no cost. • Insurance companies are no longer able to refuse health insurance to individuals with pre-existing health conditions. • Uninsured children will be covered by their parents insurance until age 26. 7589_Ch01_001-016 29/08/17 12:06 PM Page 4 4 Journey Across the Life Span • All companies with 50 or more employees must provide health insurance. • State health care exchange programs will be created to allow consumers who are not covered by their employer or other types of entitlement programs to shop for health insurance coverage. system. Individuals may also choose their own provider at their own financial risk. Official and voluntary public health agencies operate at the state, federal, and local levels. Health promotion, disease prevention, and education are key aspects of these agencies. Types of Care Plans Comparison of U.S. and Canadian Health Care Systems Current health care delivery in the United States is provided by both public and private sector organizations. These organizations own and operate health care delivery facilities. Payment for care is traditionally through health care insurance, the majority of which is provided by the government and the rest by private businesses. The government agencies that pay for health care are Medicaid, Medicare, CHIP, and the Veterans Health administration (VHA). Other individuals pay private insurance companies, and 15% to 16% of Americans remain uninsured. Traditionally, a person entered the health care setting and contracted directly with a health care provider. The provider was then paid a fee for service. In the 1970s, managed health care grew from the belief that costs could be contained by managing health care service delivery. Managed health care has become the dominant form of health care service in the United States today. Under this system a primary care provider (PCP) is assigned to provide basic health care services. The primary health care provider is a physician, nurse, or physician’s assistant. The aim of this system is to reduce the numbers of hospital admissions, costly procedures, and referrals. Health maintenance organizations (HMOs) became the managed care structures responsible for the financing, organization, and delegation of services for their members. The HMO provides a plan that has the provider assume some of the financial risks and uses primary providers as the gatekeepers. Preferred provider organizations (PPOs) established a network of providers that deliver services to the private sector for a discounted fee. The patient assumes the financial burden rather than the provider. Those patients wishing to use providers outside the network can do so but will pay extra. For the PPO to make payment, the PPO must provide prior approval of visits to specialists or for hospitalization. Other plans are available that mimic features found in HMOs and in individual choice systems. In these plans, known as point-ofservice (POS) plans, providers are paid a preset payment based on membership or a risk-based The health care systems of Canada and the United States are often compared. The two countries had somewhat similar systems until the 1970s, when Canada reformed its health care system into a group of socialized insurance plans that offered coverage to all Canadian citizens. This system is publicly funded and covers preventive medical treatment through primary care physicians, hospitals, dentists, and other providers. Most Canadians qualify for coverage regardless of medical history, income, and standard of living. Statistics indicate that Canadians have a longer life expectancy and lower infant mortality rate than Americans. Many factors are believed to have contributed to these statistics, including different racial makeup, alcoholism, and obesity rates. Similarities also exist between the countries, including health care costs that are rising faster than the rate of inflation. World Health Organization The World Health Organization (WHO) is part of the United Nations and exists at the international level. It is concerned with worldwide health promotion, including disease prevention, early detection of disease, and treatment. The WHO also strives to improve access to health care in some local communities, as a lack of access impacts all aspects of a person’s physical, mental, and social health. The organization coordinates global health care efforts against public health threats, such as the severe acute respiratory syndrome (SARS) and H1N1 (swine flu) outbreaks, and emergencies that require humanitarian aid. The WHO monitors global health care issues, such as the re-emergence of infectious diseases like tuberculosis and others, as increased international travel and commerce may contribute to the spread of such diseases. THE CONCEPT OF HEALTH Today’s nurse must be knowledgeable about what constitutes health because one of the primary goals of nursing is to assist the individual in achieving 7589_Ch01_001-016 29/08/17 12:06 PM Page 5 Healthy Lifestyles the highest level of health. In 1947 the WHO defined health as “a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.” The authors here attempt to define for the reader a concept of health that is holistic in its approach. That is, we consider health to include not only physical aspects, but also psychological, social, cognitive, and environmental influences. Physical health is influenced by our genetic makeup, which includes all the characteristics that people inherit from their parents. These characteristics not only include physical features, but also may encompass genetic weaknesses or disease. Genetic inheritance is further explored in Chapter 6. Psychological health refers to how a person feels and expresses emotions. Social health, however, deals with everyday issues of economics, religion, and culture and the interactions of people living together. Cognitive health encompasses a person’s ability to learn and develop. Environmental concerns include such issues as water and air quality, noise, and biochemical pollution. Throughout this text we refer to specific developmental theorists to support the holistic view of growth and development. These theorists include Freud (psychoanalytic theory), Erikson (psychosocial theory), Piaget (cognitive theory), Maslow (human needs theory), and Kohlberg (moral theory). The holistic approach to health, which recognizes individuals as whole beings, promotes consideration of all aspects of a person’s life. This approach helps the practical nurse to understand each person and attach significance, value, and meaning to each life. The holistic view further helps identify similarities and differences among people, allowing decision making from the person’s own unique perspective. Positive nursing outcomes using the holistic approach emphasize patient independence and maximize potential. Throughout this text we use the terms health and wellness synonymously. We believe that health, from the holistic perspective, is a balance of internal and external forces that leads to optimal functioning (Table 1.1). True health produces a state in which individuals are able to meet their needs and interact with their environments in a mutually beneficial manner. Healthy individuals exhibit effective coping patterns and experience a certain degree of comfort and pleasure in their activities. Health may be visualized on a scale or continuum (Fig. 1.1). One end of the continuum depicts optimal health or wellness, whereas the other end shows disease, total disability, or death. Disease refers to an imbalance between the internal and external forces. Individuals find that, 5 T A B L E 1.1 A Ho listic M o d el o f Health Internal Forces External Forces Body systems Mind Neurochemistry Heredity Culture Community Family Biosphere FIGURE 1.1 Exercise at all ages helps maintain health. throughout the life cycle, health is not static but dynamic and can move backward and forward from a state of wellness to illness or disease. Traditionally, health care has focused on an illness model, in which the primary role of the nurse is to relieve pain and suffering. Today, disease prevention is evolving as an area of nursing concern. This change places new demands on the practical nurse, emphasizing his or her role in patient education and health promotion throughout all stages of the life cycle. PROMOTING, MAINTAINING, AND RESTORING HEALTH Health promotion means health care directed toward the goal of increasing one’s optimal level of 7589_Ch01_001-016 29/08/17 12:06 PM Page 6 6 Journey Across the Life Span wellness. Leading a healthy life means having full functional capacity at each stage of the life cycle, from infancy through old age (Fig. 1.2). Promotion of health can occur at any time and relates to individual lifestyles and personal choices. Health promotion allows people to enter into satisfying relationships at work and play. Health means being vital, productive, and creative and having the capacity to contribute to society. The national aspirations for health promotion include three goals: healthy lives for more Americans, elimination of health care disparities among all ethnic and racial groups, and access to preventive services for everyone. The essential component of health promotion begins with the sharing of knowledge. The acquisition of knowledge then influences attitudes and leads to a change in behavior. Health promotion is most successful when placed in a supportive social environment. This environment first begins within the home and extends into the community. The community includes schools, churches, and businesses. Schools provide the location for the dissemination of health information among the young. More than 85% of American adults spend the greater part of the day in the workplace. The workplace, therefore, is another excellent site to continue educating adults on health issues. Health promotion emphasizes nutrition, exercise, mental health, and avoidance of substance abuse. These health promotion issues are addressed throughout the text as they relate to specific age groups. The practical nurse’s first step in promoting health is assessing individuals and families for potential risks. Physical, social, and individual values must be considered essential components of the nursing assessment. Nurses can encourage patients to assume full responsibility for their behavior and to adopt a healthier lifestyle. Empowerment is a form of self-responsibility that encourages people to take charge of their own decision making. The practical nurse can play an important role in educating and guiding patients so that they have enough information to make critical decisions and be informed health consumers. Nurses must develop ways to help patients recognize their own needs, solve their own problems, and access resources that give them a sense of control over their own lives. Acts that empower patients place the nurse in the role of patient advocate. Nurses must be careful not to express their personal opinions, but rather to share enough information so that patients can make informed decisions. An example of the nurse’s role as an empowering agent occurs when a patient newly diagnosed with cancer attempts to choose among the different treatment modalities offered by the physician. The nurse helps to assess the patient’s knowledge level, communicates clear information, and supports the patient’s decision concerning treatment. Throughout this text we discuss health-promoting activities that enable patients to maintain wellness, strive for their full potential, and enjoy a high quality of life. The recent focus on health promotion and disease prevention has resulted in the introduction of alternative therapies as treatment modalities. Many of these therapies originated centuries ago in Eastern civilization. Today in the United States, these therapies are used along with Western scientific medical treatment. Managed care organizations may provide reimbursement for a few selected therapies. Nursing includes the practice of some of these therapies, such as therapeutic touch, acupuncture, and reflexology. Disease Prevention FIGURE 1.2 Health and wellness are promoted through an active lifestyle. Disease prevention comprises three levels: primary, secondary, and tertiary (Table 1.2). Primary prevention occurs before there is any disease or dysfunction. The term health promotion may sometimes be used interchangeably with primary prevention. 7589_Ch01_001-016 29/08/17 12:06 PM Page 7 Healthy Lifestyles 7 T A B L E 1.2 L evel s of Di s eas e Pr even t i o n Primary Prevention Secondary Prevention Tertiary Prevention Immunization Controlling risk factors HIV/AIDS education Screening Treatment Disease control Rehabilitation Physical therapy, diet, exercise, stress reduction Pain control An example of primary prevention includes patient education on basic hygiene, nutrition, and exercise. Other examples of primary prevention include immunizations against infectious diseases, avoidance of substance abuse, and regular dental examinations. The most significant public health achievement in the past century is the reduction in the incidence of infectious diseases. Many factors have helped eradicate infectious diseases. Improvements in basic hygiene, food handling, and water treatment and the widespread use of vaccines have contributed to disease control. Antibiotics have further helped to successfully treat infectious diseases. Infants, older adults, minority groups, and health care workers are at increased risk for infectious diseases. All causative organisms, even those that are presently rare, may pose a potential threat of recurrence long after eradicating the illness. An example of this is the current reappearance of tuberculosis and smallpox. One major national goal is to effectively deliver immunizations to at least 90% of the preschool population. Special efforts should target minority populations, particularly African Americans and Hispanics, who, even today, receive fewer immunizations than the general population. Many illnesses can be prevented worldwide by improving environmental quality. In recent years the United States has effectively moved to ensure clean water, safe food, and proper waste disposal, thus reducing the risk of infectious diseases. We still need to further improve air quality and develop new methods to eradicate other pollutants and environmental hazards. Environmental hazards today have taken on a new meaning since September 11, 2001. Concerns for the safety of air, water, food, and travel have evolved as a result of world terrorism. All persons are responsible for becoming informed and aware of their environment and its hazards. Some people, such as older people, young children, pregnant women, and people with certain health conditions (such as asthma, diabetes, or heart disease), are at increased risk for serious complications from seasonal flu illness. The U.S. Centers for Disease Control and Prevention (CDC) currently recommends the influenza vaccination each year for the following groups (see the CDC website for up-to-date recommendations): • Children aged 6 months and up; adults up to 24 years of age • Pregnant women • People 50 years of age and older • People of any age with certain chronic medical conditions that put them at higher risk for influenza-related complications • People who live in nursing homes and other long-term care facilities • People who live with or care for those at high risk for complications from flu, including: • Health care workers and emergency medical services personnel • Household contacts of persons at high risk for complications from the flu • Household contacts and out-of-home caregivers of children younger than 6 months of age (these children are too young to be vaccinated) Note: Current studies indicate the risk for flu infection among persons older than 65 years of age is less than the risk for persons in younger age groups. In 2009, scientists discovered a new and very different flu virus called novel 2009-H1N1, sometimes referred to as swine flu, which caused many more people to get sicker than a regular flu would. It also caused more hospital stays and deaths than regular seasonal flu. It was first detected in people in the United States in April 2009, with the symptoms resembling those of seasonal flu. The H1N1 vaccine is now included in the influenza vaccine. Personal injury is one of the leading causes of death in the United States. We must each identify and reduce our high-risk behaviors at home, on the job, and when we travel. The different health hazards that exist at each stage of the life cycle are outlined in later chapters. Secondary prevention begins with diagnosis of disease or infectious processes. It focuses on the need for early diagnosis and treatment of disease to prevent permanent disability. Secondary prevention includes all interventions used to halt the progress of an already-existing disease state. It includes 7589_Ch01_001-016 29/08/17 12:06 PM Page 8 8 Journey Across the Life Span screening of all types (for example, breast selfexamination or testing for hypertension and sicklecell disease). In the latter stages of disease, secondary prevention often includes activities that prevent further disability. For example, the practical nurse may help the patient with diabetes prevent ulceration and loss of a limb by teaching and helping the patient to practice good foot care. Tertiary prevention begins when a permanent disability occurs. Tertiary prevention is also referred to as health restoration. Health restoration begins once the disease process is stabilized. Nursing care is directed toward rehabilitation and restoring the person to an optimal level of functioning. The goal of tertiary prevention is to regain lost function and develop new, compensatory skills, possibly with the use of an assistive device such as a cane or hearing aid. Another goal is to help patients, including those with incurable diseases, attain the maximal level of health. To help patients achieve this objective, the nurse may collaborate with other health professionals, such as physical and occupational therapists. The nurse is also responsible for offering psychological support to patients and family members. The practical nurse can help an elderly patient who has had a stroke to achieve optimal functioning by first treating him or her with dignity and respect. Second, the nurse must provide individualized care that maximizes the person’s strengths and minimizes weaknesses. HEALTHY LIFESTYLES In recent years it has become evident that many illnesses are preventable and that certain lifestyles greatly reduce the incidence of heart disease, stroke, and other diseases. There is a strong need to emphasize healthy behavior to reduce our current mortality rates. The overwhelming need is to learn to identify behaviors that place individuals at great risk for acquiring and possibly spreading disease. An individual’s health also depends on his or her access to quality health care. An important goal on a national level is to expand health care opportunities and eliminate any disparities. Health promotion campaigns should target nutrition, exercise, mental health, substance abuse, selfconcept, and disease prevention (Box 1.2). Important to the success of any health promotion plan is the need to motivate and encourage patients to take responsibility for their own actions and health care practices. Involve the whole family in the needed B O 1.2 • • • • • • X Health-P ro mo ting B ehav io rs Sound nutritional practice Chemical avoidance Regular physical exercise Stress management Disease prevention Healthy self-concept changes. The family must demonstrate healthy eating. Get children involved in meal planning and preparation. Nutrition Nutrition is a science that studies the body’s need for foods, how foods are digested, and how food choices relate to health and disease. It is important throughout the life span, from conception to old age, to foster growth and maturation, and it is an important factor in promoting optimal health. Studies have shown that the five leading causes of death associated with poor dietary habits are coronary heart disease, cancer, stroke, non–insulin-dependent diabetes mellitus (type 2 diabetes), and coronary artery disease. Malnutrition is poor dietary practice that results from the lack of essential nutrients or the failure to use available foods. Malnutrition may involve undernutrition, including the symptoms of deficiency diseases, or overnutrition. This text focuses on dietary needs at each stage of growth and development One of the goals of Healthy People 2020 is to promote health and reduce disease by promoting the consumption of a healthy diet and maintaining a healthy body weight. An adequate diet provides sufficient energy and essential fatty and amino acids, vitamins, and minerals needed to support optimal growth and maintain and repair body tissues. It is not possible to design one diet for everyone because individual needs for nutrients vary greatly with age, sex, growth rate, and amount of physical activity, in addition to other factors, including social factors (Box 1.3). Because most nutrients are widely distributed in a variety of foods, it is possible to design a healthy diet or meal plan that satisfies an individual’s personal and cultural preferences and lifestyle needs. This means selecting a variety of foods from the five food groups as listed in the MyPyramid and MyPlate charts, while limiting intake of saturated fats, sugar, and alcohol. MyPlate, introduced in 7589_Ch01_001-016 29/08/17 12:06 PM Page 9 Healthy Lifestyles B O 1.3 • • • • • • • • • X B Soc i al F ac t or s T h at I n f l u en ce Diet Attitude Economic and price structuring Food and agricultural policy Food assistance programs Knowledge Skills Social support Societal and cultural factors Tobacco or drug usage 2011, builds on the basic MyPyramid. These guidelines are developed to help Americans make better food choices and understand that caloric intake must match energy output. See Figure 1.3 for the MyPlate chart. Some of the conditions that are related to an unhealthy diet are obesity, malnutrition, iron deficiency anemia, heart disease, hypertension, type 2 diabetes, osteoporosis, oral disease, constipation, diverticular disease, and some cancers. Food provides the nutrients necessary to maintain health. These nutrients include protein, carbohydrates, fats, vitamins, minerals, and water (Box 1.4). Causes of Obesity Researchers believe that individuals can have a genetic predisposition for obesity. Other factors that can contribute to obesity are medications, fast foods, and a sedentary lifestyle, which might include more than 2 hours a day watching TV. See individual O 1.4 9 X N utrients Proteins Proteins are broken down in the body into amino acids, which are the building blocks needed for repairing the body’s cells and tissue. Sources of protein include meat, fish, eggs, legumes, milk, cheese, and nuts. Carbohydrates Carbohydrates are starches and dietary fiber that provide fuel for energy in the body. Carbohydrates are needed for brain, muscle, and heart function. They are divided into simple and complex forms: Simple carbohydrates are simple sugars found in fruits, while complex carbohydrates come from grains. Other sources for carbohydrates are breads, cereals, and vegetables. The fiber from carbohydrates is very important in lowering blood cholesterol levels. Fats Fats, also called lipids, cushion and provide insulation for the vital organs in the body. Fats also aid in the absorption of vitamins. They are divided into saturated or unsaturated: Saturated fats are those oils that are solid at room temperature, and unsaturated fats are oils that are liquid at room temperature. Unsaturated fats are the best types of fats to eat and cook with. Saturated fats raise the body’s cholesterol levels. Sources of fats include meats, vegetables, and milk. Vitamins Vitamins are organic compounds that assist in building body tissues and are important in all chemical reactions in the body. They are found in a wide range of foods. Vitamin K is made by bacteria in the bowel. Minerals Minerals are inorganic substances that come from the earth and are important in body function. Calcium intake aids in the conversion of foods to energy; strengthens bones, teeth, and muscles; and aids in blood clotting. Iron is needed to make hemoglobin to carry oxygen to tissues. Minerals are found in a wide range of foods. Water Water aids in the regulation of body temperature, lubricates and cushions joints, protects the spinal cord, and eliminates waste from the body via urine, perspiration, and bowel movements. chapters for further information on obesity and ways to counteract this growing health issue in different age groups. Exercise FIGURE 1.3 The MyPlate chart clearly outlines a balanced meal and diet. The MyPlate icon and the ChooseMyPlate.gov web page are from the U.S. Department of Agriculture. Regular exercise improves muscle strength and endurance, increases lung capacity, decreases tension 7589_Ch01_001-016 29/08/17 12:06 PM Page 10 10 Journey Across the Life Span and stress, and helps maintain adequate cardiovascular functioning. Studies have confirmed that regular exercise is useful in preventing heart disease, osteoporosis, diabetes, and other illnesses. The optimal benefits of exercise are seen when physical fitness is maintained throughout the life span (Fig. 1.4). Table 1.3 lists the positive effects of exercise. There are two important points to remember about exercise. First, before beginning an exercise program, the individual should check with a physician. Second, moderation is better than excessive practice. The obstacles that many individuals face when trying to incorporate regular exercise into their daily lifestyles include lack of time and no place to safely exercise. It is recommended that adults get at least 30 minutes of moderate physical exercise daily or on most days. Children should limit inactivity and get at least 60 minutes of physical activity daily. The need for exercise and its applicability to the stages of growth and development are explored in each chapter of the text. Mental Health Mental health is a fluctuating state in which the individual attempts to adjust to new situations, handle personal problems without undue stress, and still contribute to society in a meaningful manner. Mentally healthy individuals see themselves and others realistically. A person’s state of mental health fluctuates from day to day but maintains a certain degree of continuity and consistency. Certain behaviors may be normal in moderation but unhealthy in excess. For example, washing one’s hands as part of everyday hygienic practices is considered acceptable. However, repeated hand washing unrelated to any activity is seen as bizarre and mentally unhealthy. A factor that may affect one’s mental health is stress. Stress may be defined as anything that upsets our psychological or physiological equilibrium, or balance. Responses to stress may be physiological, emotional, or intellectual. All humans experience many emotions. What is interesting is that human emotions are not the same for everyone. One individual may respond differently to a situation than another individual. During the course of a day, individuals experience a large range of different emotions. Emotions are best defined as a feeling state. Our emotions produce both physiological and psychological changes. The physiological changes associated with an emotion are the result of motor, FIGURE 1.4 The health-illness continuum. T A B L E 1.3 P o si t i ve Ef f ec t s of Ex er c i s e System Effects Cardiovascular system Increases blood volume and oxygen content Increases blood supply to muscles and nerves Decreases serum triglycerides and cholesterol levels Reduces resting heart rate Increases heart muscle size Respiratory system Increases blood supply Increases exchange of oxygen and carbon dioxide Increases functional capacity Neurological system Reduces stress Improves mental health Decreases depression Musculoskeletal system Increases muscle mass Reduces body fat Increases muscle tone Improves posture 7589_Ch01_001-016 29/08/17 12:06 PM Page 11 Healthy Lifestyles glandular, and visceral activity. Specific areas of the brain and the autonomic nervous system play a huge role in producing some of the physical changes one associates with an emotion. The areas of the brain known to play this role in a person’s emotional response include the cerebral cortex and the limbic system. The cerebral cortex functions by receiving incoming sensory information. The limbic system of the brain comprises interconnected nuclei that affect memory and emotions. Conduction pathways in the brain produce many changes in the cardiac and smooth muscle contractions and in the secretion of some glands. Anger and fear produce an increased sympathetic activity. Increased heart rate, breathing, and intestinal tightening and cramping are just a few of the physiological reactions to certain emotions. At birth, an infant’s emotional experiences are simple and spontaneous. Most of their emotional responses are the result of their basic needs. For example, when the infant is hungry, his or her emotional response is likely to be crying with intense physical movements. Once satisfied, his or her response is one of pleasure and calm. With maturation and learning, emotional responses become more discriminating and individualized. See Figure 1.5. Older children’s and adults’ emotions are expressed in a wide variety of responses with varying degrees of intensity. In fact, different stimuli produce different emotional responses in individuals. Common emotions include anger, jealousy, happiness, affection, fear, and anxiety. Emotional maturity exists FIGURE 1.5 Infants’ emotional experiences are instant and spontaneous. 11 when individuals are able to control their responses and can express their emotions in socially appropriate ways. Some of the common physiological responses to stress include increased heart rate, respiratory rate, and blood pressure. Emotional responses to stress include irritability, restlessness, and a sense of discomfort. Intellectual responses to stress often include forgetfulness, preoccupation, and altered concentration. Many years ago Hans Selye described three distinct stages of physiological response to stress, known as the general adaptation syndrome (GAS): 1. Alarm stage: Hormones from the adrenal cortex place the body in a state of readiness known as the fight-or-flight response. 2. State of resistance: The body attempts to adapt to the stressors. 3. State of exhaustion: After prolonged exposure to stress, the body’s energy becomes depleted. This may result in disease or destruction. Anxiety Stress is a necessary part of life. It is unrealistic to expect to be able to eliminate all the stress from one’s life, and it would not be healthy to do so. Stress triggers anxiety. Anxiety is the response to a stressful situation. Anxiety may be seen in four different levels: mild, moderate, severe, and panic. Mild anxiety is a part of normal, everyday life. Individuals experience some physical signs of mild anxiety such as restlessness, irritability, and mild discomfort. Mild anxiety sharpens one’s perceptions and prepares the individual to act. Mild anxiety helps the student prepare for an exam. An example of mild anxiety can be demonstrated with the scenario of a young mother driving home with her children as it begins to snow and visibility is slightly hampered. The mother starts to feel tense and tells her kids that she has to concentrate on the road. Moderate anxiety occurs with increasing discomfort. The individual’s perceptions decrease. Persons experiencing moderate anxiety may focus only on certain aspects of what is happening. They tend to tune out what is considered less relevant. Learning can occur at this level of anxiety but not as effectively as at the mild level. Physical symptoms increase at this level, including heart palpitations, increased pulse and respirations, and mild gastric discomfort. The young mother is now experiencing greater difficulty driving through a heavier snowfall. She starts to feel gastric tightness, headache, and 7589_Ch01_001-016 29/08/17 12:06 PM Page 12 12 Journey Across the Life Span marked irritability. She is unable to answer or talk to her kids as she recognizes the need to stay focused on her driving. Severe anxiety decreases one’s perceptions even further. The individual can focus only on one small detail of an event. Learning cannot take place at this heightened level of anxiety. Individuals may appear confused and complain of many physical symptoms. They experience a sense of doom and gloom. At this point the young mother has veered off the road and narrowly missed another car. She is in severe anxiety, and starts to cry and ignores her kids’ responses. The panic level is the most extreme form of anxiety. Individuals are unable to think clearly, reality is distorted, communication may be ineffective, and behavior is nonpurposeful. Physical symptoms are exaggerated. Our young mother has continued on her trip through very heavy snow and skids into another car. Although no one is hurt in either vehicle, the young mother is in a state of panic. When bystanders approach her, she is unable to describe what has happened and does not know how to proceed. Stressors Each of us perceives stressors differently, depending on our learned behavior, age, and personality (Fig. 1.6). For example, some individuals find air travel pleasurable, whereas others find it stressful. Stress may come from internal sources, such as Responses to Stress Conflict on the job “I know I will be fired” “I need to buckle down and be focused” Heightened Stress Tolerable Stress FIGURE 1.6 Responses to stress. illness. It may also come from external sources, such as family, school, or peers. Stress can be acute or chronic. Typical stressors in childhood include such events as birth of a sibling, death of a family member, onset of schooling, illness, and separation anxiety, to name a few. The practical nurse may witness stress or separation anxiety that a young child feels as a result of hospitalization. Separation anxiety may be seen in three phases: protest, despair, and detachment. Protest is evidenced by loud crying, restlessness, and dissatisfaction with substitute caregivers. Despair produces a sense of hopelessness and is seen as a quieter period. Detachment is a state of withdrawal and apathy, or lack of interest in one’s surroundings. The nurse’s awareness of these stages of separation helps both the child and the caregivers cope with and adapt to the stress. Regression, the return to an earlier stage of development, may be another childhood adaptation to stress. The stress of serious illness or hospitalization may cause the youngster to show regressive behaviors. The practical nurse can reassure the parent that bed-wetting after illness in a previously toilettrained child is only temporary. After recovery from the illness, the child will return to the previous level of accomplishment. Typical stressors during adolescence relate to an individual’s search for identity. Decision making and the struggle for independence lead to family discord. Nurses can best assist adolescents in their struggles for independence by being supportive and encouraging decision making. The main stressors of adults relate to their key relationships. According to the Social Readjustment Rating Scale (SRRS), death of a spouse, divorce, and separation are the events adults perceive as most stressful. During old age, life stressors include the loss of a spouse, retirement, and illness or loss of function. Nurses can help older adults cope effectively with stress by identifying and mobilizing their available support systems. For example, when an elderly patient is hospitalized, the family members need to be involved in the plan of care. Family involvement and frequent family contact help reduce stress for all involved persons. Another part of stress management is identifying what is perceived to be overly stressful. After identifying the stressor, a person must either reduce it or learn how to manage it in a healthy way. Healthy ways of adapting to stress include relaxation, exercise, humor, and guided imagery. Box 1.5 describes two techniques for reducing stress. 7589_Ch01_001-016 29/08/17 12:06 PM Page 13 Healthy Lifestyles B O 1.5 X St r es s - R ed u c t i on T ec h n i q u es Practice these techniques several times a day. Relaxation Exercise 1. Assume a comfortable position. 2. Eliminate other distractions. 3. Close your eyes. 4. Regulate your breathing pattern and focus on inhaling and exhaling. 5. Progressively relax your muscles. 6. Refocus on your breathing, as needed. 7. Continue for 10 to 15 minutes. Guided Imagery 1. Take a relaxed position. 2. Close your eyes. 3. Recall an image, event, or place that is pleasurable to you. 4. Focus your energy and thoughts on the image while relaxing your muscles from head to toe. 5. Concentrate on the image for 10 to 15 minutes. Maladaptive Responses to Stress Unhealthy or maladaptive responses to stress include denial, withdrawal, and acting-out behaviors. One example of denial is a surviving spouse who, after a prolonged period of mourning, is unable to change the deceased spouse’s bedroom, leaving clothes and belongings in place as if the person were going to return. A detailed discussion on maladaptive responses to stress can be found in Chapter 5. Substance abuse commonly refers to the abuse of drugs such as alcohol, nicotine, and caffeine, and legal and illegal pharmaceutical preparations. See Chapter 10 for further discussion of substance abuse. A substance abuser has more than a strong desire for the substance. Substance abuse is marked by gradual reduction in awareness, decline in selfesteem, and withdrawal from involvement. Recently, much attention has been given to educating the public about the effects of substance abuse. Tobacco use is one of the most important preventable causes of death in our society today. Recent research shows that every day 3,000 young persons start smoking. The connection between smoking and lung disease has been well documented for more than 40 years. Smoking also contributes to heart disease and fetal and neonatal abnormalities and deaths. Health promotion is aimed at encouraging cessation of smoking and avoiding exposure to secondary smoke. Because all behavior is influenced by role modeling, social education and individual 13 responsibility are needed to further reduce the incidence of smoking in future generations. Although moderate alcohol use may be beneficial in lowering blood cholesterol levels, alcohol abuse presents a serious health problem in our society. Alcohol abuse is not measured according to the specific amount consumed; rather, alcohol abuse occurs when the person cannot curtail the amount of alcohol he or she consumes or when alcohol interferes with the person’s daily functioning. Alcohol use has been documented to begin at an early age. Recent studies have shown that many children ages 12 to 17 admit to drinking. Long-term alcohol use has been linked to liver damage, heart disease, and an increased risk of neonatal disorders. Statistics indicate that alcohol contributes to serious social and health problems, including automobile accidents. Alcohol use is implicated in almost one-half of the deaths caused by motor vehicle crashes. It is also responsible for onethird of all homicides, drownings, and boating deaths. Intravenous drug users and their sexual partners are at increased risk for AIDS and related sexually transmitted diseases (STDs). Drug treatment programs, counseling, education, and frequent testing reduce the many risks associated with drug use. A Healthy Self-Concept Knowing and practicing healthy behaviors and avoiding risky behaviors do not guarantee good health. Many factors influence an individual’s health status, including family and community relationships, perception of various social pressures, and individual temperament. All of these factors cause each person to respond to the environment in a unique and sometimes unpredictable manner. Furthermore, perceptions of the environment, reactions to it, and individual needs are affected by a person’s self-concept. The relationship between the individual and the environment is reciprocal—that is, a person’s selfconcept is affected by the environment in which he or she lives. Self-concept also is affected by the individual’s stage of development. Throughout this text we discuss the stages of development and how they might affect the individual’s health and choices related to a healthy lifestyle. Chapter 5 provides an explanation of several theories related to individual development: psychoanalytical, psychosocial, cognitive, moral, and others. Good health is more than a visit to the doctor. Healthy decisions, such as what we eat for lunch or 7589_Ch01_001-016 29/08/17 12:06 PM Page 14 14 Journey Across the Life Span the amount of exercise we get, can be made every day. Although many Americans are moving toward healthy living, others still need encouragement to practice healthy behaviors. Each person must set realistic goals that will reinforce positive behaviors. The first step is to make an inventory of healthy and unhealthy behaviors and develop a health assessment plan (Boxes 1.6 and 1.7). ROLE OF THE NURSE IN HEALTH PROMOTION As changes occur in the health care system, the role of the practical nurse also needs to change to meet the demands of the new health care delivery system. Practical nurses will need to work not only in traditional hospital settings, but also in the community. B O 1.6 B O 1.7 X P erso nal Health Assessment P lan In any health assessment it is important to first become aware of your personal quality of life. Complete the following statements and determine your personal health action plan. 1. Based on my readings, my personal health issues of most concern are: 2. My top-priority health issue is: 3. I can address the preceding issues by taking the following actions: 4. My goal is to: X H e a l t h B eh avi or I n ven t or y Before beginning any lifestyle change, it is important to assess your behavior. List below the healthy and unhealthy things that you do. Healthy Behavior: Unhealthy Behavior: Emphasis will be on prevention and health promotion. All levels of nurses will be accountable to both the employer and the client. In the future, the practical nurse will have five roles and responsibilities: 1. Caregiver: Delivering health care services 2. Teacher: Educating the client, family, and community 3. Advocate: Helping clients choose between available options 4. Collaborator: Working as a member of a team, sharing and exchanging information 5. Role model: Practicing healthy lifestyle behaviors that will influence and reinforce clients’ actions SUMMARY 1. Early civilization was concerned with health and diseases. 4. Health is a balance of internal and external forces leading to optimal functioning. 2. Many improvements have contributed to today’s increased life expectancy. 5. Health promotion refers to health care directed toward increasing one’s optimal level of wellness. 3. Healthy People 2020 established two major goals for the nation: the first is aimed at increasing the quality and years of a healthy life, and the second is aimed at the elimination of health disparities. 6. A change in lifestyle or personal habits is often necessary to promote maximal health. 7589_Ch01_001-016 29/08/17 12:06 PM Page 15 Healthy Lifestyles 7. Health maintenance focuses on prevention and the need for early diagnosis and treatment. 8. An important goal on a national level is to expand health care opportunities and eliminate disparities. 9. Health restoration begins after the disease process is stabilized. The goal is to either restore function or help the person compensate for losses. 10. Leading a healthy lifestyle includes paying attention to nutrition, exercise, mental health, substance abuse avoidance, and disease prevention. 15 11. Emotions are best defined as a feeling state. Our emotions will produce both physiological and psychological changes. 12. Factors that influence a person’s health behavior include family, role models, social pressures, and self-concept. 13. Disease prevention is composed of three levels: primary, secondary, and tertiary. 14. The five roles for the practical nurse in health promotion are caregiver, teacher, advocate, collaborator, and role model. CRITICAL THINKING Exercise #1 Larry Woodhill, a 47-year-old bank manager, attends the wellness clinic offered by his organization. Larry weighs 230 pounds and is 5 feet, 8 inches tall. He has smoked two packs of cigarettes per week for the past 30 years. His recreational activities begin on Friday nights at the local bar, where Larry consumes five or six cans of beer. This activity is repeated on Saturday nights but not on Sundays. Through the wellness clinic, Larry embarks on an exercise program. 1. Without other major behavior changes, how do you evaluate the benefits of exercise for Larry? 2. Develop an approach to dietary counseling that may be beneficial for Larry. 3. What other healthy choices could Larry incorporate into his lifestyle? 4. Which of Larry’s behaviors are considered high risk? Exercise #2 A student begins classes after being out of school for several years. Prior to his first exam the student notes that he is becoming increasingly nervous and stressed. The night before his exam he stays up all night studying. On the morning of the exam he arrives feeling sick with stomach cramps and diarrhea. His muscles are tense, and he is jittery and sweaty. 1. What physiological responses is he experiencing? 2. Describe your own physiological responses to stress. 3. Describe what measures can be used to lower one’s stress response in this situation. 7589_Ch01_001-016 29/08/17 12:06 PM Page 16 16 Journey Across the Life Span MULTIPLE-CHOICE QUESTIONS 1. In early civilization, illness was often believed to be caused by: a. Bacteria and viruses b. Supernatural focus c. Internal imbalance d. External conflict 2. Knowledge of disease process occurred with the: a. Teachings of Hippocrates b. Use of herbal medicine c. Development of the U.S. Department of Health d. Advent of bacteriology 3. Which of the following statements best describes the Affordable Care Act? a. Medicare coverage will be available for all citizens. b. Expansion of Medicaid c. All health insurance companies will be owned and operated by the federal government. d. The major focus is providing inpatient care. 4. The health care worker is correct if she tells a client that Healthy People 2020 provides a: a. Focus on world health issues b. Framework from which Canadian health care developed c. Scientific base for disease prevention and health promotion for all people in the United States d. National health insurance for low-income Americans 5. The objective of the managed care system is to: a. Decrease the number of hospitalizations b. Assign risk and quality to each case c. Increase the revenue for physicians d. Decrease the number of days spent in the hospital 6. Health can be defined as: a. Harmony between illness and wellness b. Balance between internal and external forces c. A state of mental thought process d. A state of physical functioning 7. The objective of health promotion is to: a. Hold the professional nurse responsible for the client’s lifestyle practices b. Provide positive reinforcement to secure each healthy act c. Achieve an optimum level of wellness d. Decrease the person’s tolerance level for stressful events 8. Empowerment is: a. The intensity of feelings generated by the client b. A needs-based behavior c. Client-centered decision making d. Open interaction between the client and the environment 9. Which of the following is a positive benefit of exercise? a. Decreased muscle mass b. Improved cardiac output c. Decreased blood supply d. Decreased nerve function 10. Mental health is best described as: a. Being problem-free b. Always consistent c. Ritualistic and excessive d. Realistic and adaptive 11. Physiological responses to moderate anxiety include: a. Improved mood b. Relaxed posture c. Slowed breathing d. Increased heart rate 12. Common responses to stressful situations may include which of the following? (Choose all that apply.) a. Decreased heart rate b. Smooth muscle contractions c. Glandular secretions d. Increased breathing e. Drowsiness Visit www.DavisPlus.com for Student Resources.