overwhelmed by the many changes asked of him. How might Assad streamline his instructions about Mr. Williams’s diet?
understand his diet. homes (Zonfrillo et al., 2018).
Social Determinants of Health boxes and icons that introduce students to the many conditions that impact health. 212 UNIT 11 Factors Affecting Health Social Determinants of Health 8-1 Economic Stability ■ Employment ■ Food insecurity ■ Housing instability ■ Poverty Education Access and Quality ■ Early childhood education and development ■ Enrollment in higher education Carbon Monoxide Exposure Carbon monoxide (CO) is a colorless, tasteless, odor- less toxic gas. Exposure can cause headaches, weakness, nausea, and vomiting; prolonged exposure leads to sei- zures, dysrhythmias, unconsciousness, brain damage, and death. Each year in the United States, CO poisoning causes approximately 350 unintentional deaths (CDC, 2017a). ■ Most CO exposures occur at home. ■ Most CO exposures involve females, children under the age of 17 years, and adults aged 18 to 44 years. ■ High school graduation ■ Language and literacy Social and Community Context ■ Civic participation ■ Discrimination ■ Incarceration ■ Social cohesion Health Care Access and Quality ■ CO poisoning accounts for a majority of deaths at the scene of fires and is also a relatively common cause of death by suicide. ■ Many CO deaths occur during cold weather among older adults and the poor who seek nonconventional heat sources (e.g., gas ranges and ovens) to stay warm. Scalds and Burns The following are common causes of scalds and burns: ■ Scald injuries (e.g., from hot water, steam, or grease) are the most common cause of burns in children younger than age 3. Scalding burns (especially on both feet or both hands) and cigarette burns in children and vulnerable older adults should always prompt you to assess for abuse (see Procedure 6-1). ■ Access to health care ■ Access to primary care ■ Health literacy Neighborhood and Built Environment ■ Access to foods that support healthy eating patterns ■ Crime and violence ■ Environmental conditions ■ Quality of housing Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. n.d. Healthy People 2030, https://health.gov/healthypeople/objectives-and-data/social- determinants-health ■ Warming food or formula in the microwave may cause the food to become hotter than intended, lead- ing to burns in infants and young children. HOW DO PEOPLE EXPERIENCE WELLNESS, HEALTH, AND ILLNESS? In envisioning health and illness as a continuum, full-spectrum nurses promote wellness regardless of the circumstances a client faces now or in the future. This approach requires the holistic understanding that health is multidimensional. The following are some of the many dimensions of health that we experience along the is greater in the presence of such heating devices as kerosene heaters, wood-burning stoves, and home sauna heating elements. People may use these as heat ■ Sunburn can cause a first- or second-degree burn. ■ Contact burns may occur from contact with metal surfaces and vinyl seats when cars are parked in the sun. The risk of contact burns in all age-groups older misused opioids in the past year (Substance Abuse and Mental Health Services Administration [SAMHSA], 2022). ■ Treatment choice depends on the poison ingested. For most poisonings, the most effective intervention is professional administration of activated charcoal orally or via gastric tube. However, charcoal is not effective for ethanol, alkali, iron, boric acid, lithium, methanol, or cyanide. Depending on the situation, other options for medical treatment include gastric lavage, dialysis, administration of antidotes (i.e., Narcan), and forced diuresis.
Poisoning Poisoning death rates have more than quadrupled in the past 20 years. Although young children are frequent victims, the increase has been mainly among adults. In many cases, the person does not die but becomes ill or suffers other effects. Poisoning exposure accounts for more than 2 million emergency department visits per year in the United States (CDC, 2022). ■ Young children are poisoned most often by improper storage of household chemicals, medicines and vita- mins, and cosmetics (see Box 21-1). The use of lead in paint has been banned since 1978, but lead-based paint can still be found in older homes and toys produced in some foreign countries. Some soil (which young children often put in their mouths) contains high levels of lead. In the United States, poor, urban, and immigrant populations are at higher risk for lead exposure than other groups. ■ Older children and adolescents may attempt suicide by overdosing with medicines or be poisoned acci- dentally when experimenting with recreational or prescription drugs. ■ Adults experience poisoning as a result of illegal drug use or misuse or abuse of prescription drugs, especially narcotic medications, tranquilizers, and antidepressants.
Applying the Full-Spectrum Nursing Model
PATIENT SITUATION Mrs. Ong is a 75-year-old retired schoolteacher who suffered a stroke 8 months ago. After leaving the hospital, she has been living in a nursing home. Mrs. Ong has residual weakness on the right side—her dominant side—and has not mastered the use of tableware with her left hand. On admission to the nursing home 7 months ago, she weighed 150 pounds. Today she weighs only 125 pounds. Mrs. Ong refuses to go to the dining room for meals. The UAPs report that she eats a few bites of most foods but never eats more than half of anything. THINKING 1. Theoretical Knowledge: a. Based on Mrs. Ong’s sex, age, and activity level, make a rough estimate of the number of kcal/day she needs. b. What are two other more precise ways you could determine Mrs. Ong’s ideal body weight? 2. Critical Thinking (Considering Alternatives): What are some possible explanations for why Mrs. Ong is not eating all her food? a. Suppose you have decided to use the general ideal weight guide to determine Mrs. Ong’s ideal weight. What, specifically, would you need to do? You do not need to calculate; just list the action steps. b. Suppose you have decided to determine Mrs. Ong’s BMI. What equipment would you need? c. What is the formula for calculating BMI from the height and weight? 4. Nursing Process (Nursing Diagnosis/Analyzing Cues): Write a nursing diagnosis for Mrs. Ong. Use just the data provided in the situation. Assume her BMI is 20. CARING 5. Self-Knowledge: What would you be feeling if you were in Mrs. Ong’s situation? 6. Ethical Knowledge: What are one or two things you would do to help Mrs. Ong feel cared for and cared about? DOING 3. Practical Knowledge: 958 UNIT 4 Supporting Physiological Function
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Critical Thinking and Clinical Judgment
■ Household cleansers, including oven cleaner, drain cleaner, toilet bowl cleaner, and furniture polish ■ Medicines, including cough and cold preparations, vitamins, pain medications, antidepressants, anticonvulsants, and iron tablets, which may look like candies to children ■ Indoor houseplants, including poinsettia, Dieffenbachia, Philodendron, and many others ■ Cosmetics, hair relaxer, nail products, mouthwash ■ Kerosene, gasoline, lighter fluid, paint thinner, lamp oil, antifreeze, windshield washer fluid, lighter fluid, and other chemicals ■ Alcoholic beverages BOX 21-1 ■ Poisonous Agents Commonly Ingested by Children
Because these are critical-judgment questions, they usually do not have a single right answer. Discuss the questions with your peers—discussion can stimulate critical thinking. 1. Recall the employees (Isaac Schwartz and Sujing Lee) interviewed in the Meet Your Patient scenario. In addition, you now have two more patients, Wakenda Pierre and Luceno Jarin. Their information is in the following paragraphs: ■ Isaac Schwartz, a 65-year-old accountant, works long hours. He describes a sedentary lifestyle, no tobacco use, infrequent alcohol use, no medical problems, and a nutrition history of skipping meals and daily consumption of restaurant food. You measure his height as 69 in. and weight as 245 lb. ■ Sujing Lee, a 29-year-old project manager, regularly works 65 hours per week. Sujing is 30 weeks pregnant. She does not smoke or drink and has never been hospitalized or had surgery. She has gained a total of 25 lb after becoming pregnant. Her diet consists mainly of traditional Asian food. She eats three meals a day and always brings lunch from home. Lately, she has been feeling “tired all the time.” At the screening, she weighs 126 lb and is 63 in. tall. ■ Wakenda Pierre is a 38-year-old administrative assistant. She exercises at the gym 4 or 5 days per week, smokes an occasional cigarette, has 2 or 3 drinks every night before dinner, struggles with keeping her blood pressure under control, and eats fast food for breakfast and lunch every day. She is 72 in. tall and weighs 165 lb.
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Applying the Full-Spectrum Nursing Model and Critical-Thinking and Clinical Judgment exercises guide students in applying their critical-thinking and clinical-reasoning skills to real-world patient scenarios. ■ Luceno Jarin is a 65-year-old business executive. He tells you he was diagnosed with type 2 diabetes mellitus 5 years ago. He is struggling to follow his prescribed diet. He drinks alcohol sporadically and walks briskly 30 minutes every day of the week. He is 67 in. tall and weighs 205 lb. a. Determine each client’s BMI. Based on these results, what conclusions can you make about their weight status? b. What are the likely causes of each person’s weight status? c. What additional work-up would be recommended for each client? d. What indications would lead you to believe that each client has adopted a healthier lifestyle? 2. Three clients are admitted to the medical-surgical unit of your local hospital. On their admission, the primary nurse collected this information: ■ Wild plants and mushrooms ■ Pesticides, rodent poisons
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CLIENT 3
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