1. Chapter 13 Young to Middle Adult Denise Coffey MSN, RN
This time period presents many challenges, rewards, and crises. This group is faced with working, maybe raising families as well as caring for aging parents, facing potential problems with employment, dealing with changes in economy ( domestic and foreign), and dealing with their own developmental needs.
Young adulthood lasts from the late teens into the mid to late 30s.
Middle adulthood ranges from the 30s through the 60s.
During this stage, people become aware of changes in reproductive organs and physical abilities. They also deal with potential changes in their goals. They oftentimes reassess life situations.
Clients present challenges to nurses. Nurses need to recognize the needs of their clients even if the nurses themselves are experiencing some of the same challenges and events.

2. Young Adult Physical changes Cognitive changes
Growth completed by the age of 20
Cognitive changes
Critical thinking habits increase
At this age, health concerns can revolve around pregnant women and childbearing. This age usually does not experience severe health issues. Usually a personal lifestyle assessment will help the nurse to plan and implement a care plan adapted to their lifestyle and needs.
Cognitively critical thinking habits increase. Formal and informal educational experiences, general life experiences, and occupational experiences affect their problem solving and motor skills.
Young adults continually strive to evolve and adjust to changes in the home, workplace, and their personal lives. Insecurity with home, work, and life causes stress and rigidity.

3. Alternative family structures and parenting
Psychosocial Changes
Lifestyle
Career
Sexuality
Childbearing cycle
Types of families
Parenthood
Alternative family structures and parenting
Singlehood
Emotional health
Emotional health of young adults is related to their ability to address and resolve personal and social tasks.
Between 23 and 28, self-reflection and ability for intimacy is refined.
From 29 to 34 this group strives to achieve and master their world.
From 35 to 43 they examine life goals and relationships. A midlife crisis may occur.
These 9 general principles are involved in the psychosocial development of young adults.
In regards to lifestyles, they need to examine their familial history of cardiac, respiratory, renal, endocrine, and neoplastic diseases. Habits such as smoking, drinking, drug use, lack of exercise, poor diets, and stress are modifiable.
Career choices are important for success. Oftentimes families rely on both partners to work. At the same time, both partners need to share in household and child care duties.
Sexually, mature relationship and intimacy are established. Childbearing issues surrounding conception, pregnancy, and birth have an impact on both partners.
The family can be headed by a single parent, a traditional mother and father, or there may be an alternative family structure. All three of these circumstances contribute to psychological, economic, and social stability or instability.
Box 13-2 presents 10 hallmarks of emotional health issues this group faces.

4. Health Risks Risk factors Family history Personal hygiene habits
Violent death and injury
Substance abuse
Unplanned pregnancies
Sexually transmitted infections
Environmental or occupational forces
These 8 health risks affect lifestyle patterns and family health. Risk factors include smoking, alcohol and drug abuse. Smoking and second hand smoke contribute to lung disorders.
Family history of disease puts this group at risk for developing diseases in older life. Heredity can be a negative factor.
Personal hygiene habits can present health risks. Poor dental hygiene can lead to periodontal disease.
Violence is the greatest cause of mortality and morbidity. Causes for violence include poverty, family demise, child abuse and neglect, and exposure to violence. It will be important to perform a psychosocial assessment for factors which might lead to violence.
Substance abuse includes alcohol, caffeine, drugs, alcohol and drugs. Substance abuse may not be apparent unless a specific assessment if performed.
Sexually transmitted diseases (STIs) include syphilis, chlamydia, gonorrhea, herpes and AIDS. These can lead to chronic disorders, infertility or death.
Work related hazards or agents round out the 8 health risk factors.

5. Health Concerns Health promotion Infertility Exercise
Routine health screening
Psychosocial health
Pregnant woman and childbearing family
Table 13-1 presents occupational problems.
Other problems come in the form of diabetes and high cholesterol, Crohn’s disease, irritable bowel disease.
Male and female infertility create problems. 15% of infertile couples have no cause.
Exercise is important to prevent or decrease the development of chronic health such as hypertension, obesity and diabetes. It will be important to share with your clients that exercise improves cardiovascular functioning by decreasing blood pressure and heart rate, increasing strength and size of muscles and decreasing fatigue, insomnia and stress.
It is also very important to stress routine health screening. ASK students to name common routine health screenings that need to be completed. ANSWER: breast self exam, male self exam, PSA, mammograms.
Psychosocial health are related to stress from job or family. Pregnant Woman and childbearing create physiological changes as well as cognitive and psychosocial changes. Prenatal care is a must. See Table 13-2 for changes during pregnancy.

6. Acute Care
Treatment for accidents, substance abuse, exposure to environment, stress-related illnesses, respiratory infections, influenza, urinary tract infections, and conditions requiring minor surgery
Education is important
At this stage, it will be important to keep your clients informed about their health status and health care decisions.

7. Restorative and Continuing Care
Hypertension, coronary artery disease, accidents, rheumatoid arthritis, AIDS, and cancer
Nursing interventions relate to sense of identify, establishment of independence, reorganization of relationships
If chronic illnesses occur, you will need to remember that these threaten an adult’s independence and can result in the need to change personal, family and career goals.

8. Middle Adult Begins in the mid 30s and lasts through the late 60s
Physical changes
May impact self-concept and body image
Cognitive changes
Rare, unless illness or trauma occurs
Table 13-1 summarizes the many physical changes which occur. Most visibly, you will see gray hair, wrinkling, a thickening at the waist, decreases in hearing and site.
Women are faced with menopause. Men are faced with erectile dysfunction.

9. Psychosocial Changes Expected events Sandwich generation
Career transition
Family psychosocial events
Those expected events include children moving out, divorce, separation, death of family and friends.
Many adults become the sandwich generation, caring for aging parents, children and grandchildren. When making your nursing assessment it will be important to assess these psychosocial events and what types of support services may be necessary.
By choice or by changes in the workplace middle adults may leave their jobs. Anticipated changes can be dealt with. However, those unexpected departures from the job may produce profound stress on health, family and self concept.
Family psychosocial events include the fact that many people over the age of 35 are single. It could be a choice or not. This group may lack relationships and feel isolated. During this period of time, death, separation, divorce of a spouse or lifelong partner may occur.
Lastly, when children leave home, parents feel stressed out. They need an adjustment stage.

10. Positive health habits
Health Concern
Stress and
stress reduction
Levels of wellness
Obesity
Positive health habits
Anxiety
Depression
Health concerns revolve around stress, wellness, obesity and the adoption of healthy lifestyle habits.
This groups can experience a lot of stressors. Some related to stress related illnesses such as heart attacks, hypertension, migraines, ulcers, colitis, autoimmune disease backaches, arthritis and cancers. When planning care for these clients, you will need to assess factors and locate support services.
Levels of wellness may vary. Table 13-3 can guide you through your assessment and clue you what to look for.
Obesity is a major concern for middle aged adults. Obesity can lead to diabetes, coronary artery disease, osteoarthritis and obstructive sleep apnea.
With these facts in mind, it will be important to focus your health teaching on prevalent health issues. Box 13-3 presents you with positive health habits. Additionally, Box 13-4 presents various barriers to change this group may experience.
Anxiety can occur at any age. However, anxiety in this age group may be related to change, conflict and perceived lack of control with the environment. Anxiety can lead to psychosomatic illness and depression.

11. Acute and Restorative Care
Recovering from an injury or illness may take longer.
Chronic illnesses affect roles and responsibilities.
At this age, recovery may take longer due to a delayed health process. Especially if the client has a chronic illness such as diabetes, respiratory, circulatory or neurological condition.
Stress and depression can set in, especially if they are a “sandwich” family, caring for children and aging adults.
Assessments need to look closely at physical and psychosocial factors. Health teaching needs to be specifically targeted and referrals made to organization which can provide assistance.