Stress

Introduction

We all face different challenges and obstacles and sometimes the pressure is hard to handle. When we feel overwhelmed, under the gun, or unsure of how to meet the demands placed on us, we experience stress.

In small doses, stress can be a good thing. It can give you the push you need, motivating you to do your best. But when the going gets too tough and life’s demands exceed your ability to cope, stress becomes a threat to both your physical and emotional well-being. According to old concept To be alive is to be under stress.

Definition: According to Hans Selye, Stress is nonspecific response of the body to any demand made upon it, whether it is caused by the results of pleasant and unpleasant situation.

Stress is any physiological and psychological tension that threats a person’s total equilibrium. In medical terms, stress is the disruption of homeostasis through physical and psychological stimuli.

It is now accepted fact in the medical community that stress is one of the major causes of all illness. Stress can cause migraines, stroke, eczema, a weak immune system and many other diseases.

Classification of Stress

1.       Good stress

·         It motivates, focuses energy

·         It is short-term

·         It is perceived as within our coping abilities

·         It feels exciting

·         It improves performance

Examples of good stress

·         Meeting a challenge

·         Coming in first or wining

·         Getting a promotion

·         Marriage

·         The holidays

·         Buying a new home

·         Receiving a promotion or raise at work

·         Starting a new job

2.       Distress

It is the most commonly referred to type of stress, having negative implications. The word distress has various meanings

·         Distress is a kind of suffering

·         In medicine, distress is stress caused by adverse events.

It has following characteristics

·         It causes anxiety or concern

·         It can be short-or-long-term

·         It is perceived as outside of our coping abilities

·         It feels unpleasant

·         It decreases performance

·         It can lead to mental and physical problems

Examples of Distress

·         The death of a spouse

·         Divorce

·         Losing contact with loved ones

·         The death of a family member

·         Hospitalization (oneself or a family member)

·         Injury or illness (oneself or a family member)

·         Being abused or neglected

·         Separation from a spouse

·         Conflict in interpersonal relationships

·         Money problems

·         Unemployment

·         Sleep problems

·         Children’s problems at school

·         Legal problems

Different Types of Stress

1. Acute stress: Acute stress is the most common and most recognizable from of stress, the kind of sudden jolt in which a person knows exactly why he/she is stressed. Along with obvious dangers and threats, common causes of acute stress include noise, isolation, crowding and hunger. Normally, the body rests when these types of stressful events cease and life gets back to normal. Because the effects are short-term, acute stress usually doesn’t cause severe or permanent damage to the body.

2. Episodic acute stress: Some people endure acute stress frequently; their lives are chaotic; out of control, and they always seem to be facing multiple stressful situations. They’re always in a rush, always late, always taking on too many projects, handling too many demands. Unfortunately, people with episodic acute stress may find it so habitual that they resist changing their lifestyles until they suffer severe physical symptoms.

3. Chronic stress: Chronic stress is stress that wears you down day after day and year after year, with no visible escape. It grinds away at both mental and physical health, leading to breakdown and even death.

Common causes of chronic stress include:

·         Poverty and financial worries

·         Long-term unemployment

·         Dysfunctional family relationships

·         Caring for a chronically ill family member

·         Felling trapped in unhealthy relationships or career choices

·         Living in an area besieged by war or violence

·         Bullying or harassment

4. Traumatic stress: Severe stress reactions can result from a catastrophic event or intense experience such as a natural disaster, sexual assault, life-threatening accident, or participation in combat.

After the initial shock and emotional fallout, many trauma victims gradually begin to recover. But for some people, the psychological and physical symptoms triggered by the trauma don’t go away, the body doesn’t regain its equilibrium, and life doesn’t return to normal. This is a condition known as post-traumatic stress disorder. Common symptoms include flashbacks or nightmares about the trauma, avoidance of places and things associated with the trauma, hyper vigilance for signs of danger, chronic irritability and tension, and depression. PTSD is a serious disorder that requires professional intervention.  

Older Adulthood

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7 Health Challenges of Aging 2nd

Experts explain how to prepare for the health issues people face as they age.


Arthritis affects nearly half the elderly population and is a leading cause of disability. "Old injuries from playing weekend warrior or high school football, and years of wearing high-heeled shoes catch up with us," says Brangman. "And arthritis in the knees is the price we pay for walking upright on two legs." The keys to prevention: avoid overuse, do steady, regular exercise rather than in weekend spurts, and stop if you feel pain. "The adage, 'no pain, no gain,' is not true."

And managing your weight is just as essential for joint health as cardiovascular health. The Framingham osteoarthritis study showed that a weight loss of just 11 pounds could reduce the risk of developing osteoarthritis in the knees by 50%.

Osteoporosis and Falls
Osteoporosis and low bone mass affect almost 44 million adults age 50 and older, most of them women. According to the National Osteoporosis Association, osteoporosis is not part of normal aging. Healthy behaviors and treatment, when appropriate, can prevent or minimize the condition.

In a given year, more than one-third of adults age 65 and older experience a fall. Twenty percent to 30% of those who fall suffer injuries that decrease mobility and independence; falls are the leading cause of death from injury in this age group.


"Stop smoking, watch your alcohol intake, get plenty of calcium, and limit foods with high acidic content," says Brangman. "Avoid sodas. They encourage loss of calcium. Our bodies always maintain calcium, and when there's not enough coming in from our diet, it comes out from our bones. One reason women are especially at risk for osteoporosis is that if they've had children; it takes a whole lot of calcium to develop a baby, and that calcium is taken from the mother's bones if she's not getting enough in her diet." Adults in middle age need 1,000 to 1,200 milligrams of calcium daily.

Vitamin D, "the sunshine vitamin," is also important. Using sunscreens to protect against skin cancer is wise, but sunscreens block ultraviolet rays the body needs to make vitamin D. Furthermore, with age our bodies become less efficient at making vitamin D from sunlight, Brangman tells WebMD. "There is a move to get the FDA to increase the minimum requirement for vitamin D to at least 800 and maybe 1,000 units. Most multiple vitamins contain 400 units. Make sure you're getting enough from low-fat dairy products, or take a supplement."

Weight-bearing exercise also helps to keep bones healthy. "If you're not exercising, starting at any age is beneficial," says Brangman. "It's never too late, but the sooner the better."

Older Adulthood

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Physiological changes during older adulthood 3rd

8. Changes in Immune System: Age-related changes in the immune system increase vulnerability to inflections, tumors and immune disease. Factors that affect immune system function include hormonal changes, age, nutrition and psychological factors.

  a. As we grow older, our bodies are less able to produce antibodies which are important in fighting infections. As a result older adults are at greater risk for infections.
  b. The thymus gland produces hormones that are important for the development of white blood cells. The shrinking of the thymus gland begins after adolescence and the level of thymus hormones cannot be detected in the blood.
  c. As we age, the immune system also responds less vigorously to skin tests in which a foreign substance is injected below the skin surface, indicating a diminished response to antigens.

Summary of age-related changes in the immune system are:
• Decrease production of thyme hormones
• Decrease levels of antibody response
• Response to antigens diminishes

9. Changes in Musculoskeletal System
 Age-related changes in the musculoskeletal system
• Height decreases an average of 2 inches.
• Weight increase until about age 60 and then declines.
• Body fat mass can double, lean muscle mass is lost.
• Decline in bone density.
• Skin becomes thinner and dryer.
• Hair becomes gray.

10. Changes in Reproductive System
Age-related changes in the female reproductive system:
• Ovulation ceases and estrogen levels drop by 95%.
• Vaginal walls become thinner and lose elasticity.
• Most women experience a decrease in the production of vaginal lubrication.
Age-related changes in the male reproductive system
• In some men, testosterone levels drop by up to 35%.
• The size of the testes decreases.
• There is a decline in the rate of sperm production although the extent varies among individuals.
• Erectile dysfunction, in which an erection cannot be achieved, is experienced by 15% of men by the age of 65 and increases to 50% by age 80.

Older Adulthood

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Physiological changes during older adulthood 2nd

4. Changes in gastrointestinal system: The gastrointestinal system consists of the esophagus, the stomach, the small intestine, the large intestine or colon, the liver, gallbladder and the pancreas. Generally the physiological changes of an aging digestive system are minor.

Major gastrointestinal changes with aging 
  a. Increased prevalence of atrophic gastritis and achlorhydria.
  b. The liver is less efficient in metabolizing drugs and repairing damaged liver cells.
  c. Diverticulitis in the colon may cause pain.
  d. Reduced peristalsis of the colon can increase risk for constipation.

5. Changes in Urinary System: The urinary system includes the kidneys, ureters, urethra and bladder. It undergoes substantial changes in function as we grow older. In both men and women, urinary changes are often associated with changes in the reproductive system.



Urinary system changes with aging 
  a. Kidney mass decrease by 25-30 percent and the number of glomeruli decrease by 30 to 40 percent. These changes reduce the ability to filter and concentrate urine and to clear drugs.
  b. With aging, there is a reduced hormonal response and an impaired ability to conserve salt which may increase risk for dehydration.
  c. Bladder capacity decreases and there is an increase in residual urine and frequency. These changes increase the changes of urinary infections, incontinence and urinary obstruction.

6. Changes in Endocrine System: The endocrine system is a complex network of glandular tissues that secrete hormones directly into the blood which are used by target organs. The endocrine system controls a variety of important functions such as energy metabolism, reproduction and stress response.

Age-related changes in the endocrine system
  
  a. Insulin resistance may prevent efficient conversion of glucose into energy.
  b. A decrease in aldosterone and cortisol may affect immune and cardiovascular function.

7. Changes in Nervous System

  a. Older nerve cells may have fewer dendrites and some may become demyelinated which can slow the speed of message transmission. Most of these changes do not appear to affect ordinary activities of living.
  b. Decreased blood supply to the brain and loss of cells cause memory loss and confusion which may alter the personality of an older.
  c. The sense organs are functioning less than younger e.g. Hearing slowly declines, visual acuity also declines.
  d. The sense of taste and smell diminishes resulting in decreased appetite.
  e. Ability to respond to stimuli decreases which causes loss of sensation and perception.
  f. As people grow older, the rate at which they process information declines. Information processing has three phases

• Encoding: Getting information into the system. Encoding is particularly vulnerable to age. As we age it takes more time to encode information than when they were younger. This slower rate of encoding may be due to changes in our vision, hearing and other senses that reduce the efficiency of memory. The slower rate of encoding is most likely the reason for age-related declines in short-term memory.
• Storage: retaining information
• Retrieval: recalling information 

Two types of memory tasks are recall and recognition. Regardless of age, recognition is better than recall. recognition does not declines as we age, but recall does. Long-term memory may decline as we age depending on the extent to difficulty with encoding information. Very long-term memory which spans months or years is relatively stable until well after age 70.

Older Adulthood

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Physiological changes during older adulthood

Physiological changes during older adulthood

• A number of physiological changes occur as we  grow older.
• Most of the normal changes of aging have no impact on normal functioning,although they become apparent when the body is placed under stress (e.g.,acute illness,physical exertion).For example ,the heart rate of older adults is lower than that of younger adults.
• It is important to be able to recognize the changes of normal aging versus the effects of disease.Untreated disease can result in''excess disability'' and reduce the quality of life of individuals.
• Poor health in later life is not inevitable. Much of the illness and disability associated with aging is related to modifiable lifestyle factors that are present in middle  age.

Following are the changes in various systems of an older 

1.changes in the integumenty system
  a. The skin becomes thinner drier and wrinkles appear on the face and neck.
  b. The skin can be easily injured or bruised.
  c. The subcutaneous layer of fat is lost causing sagging of the skin and less tolerance to cold.
  d. There may appear lesion or spots over the skin.
  e. Perspiration may decrease due to diminished blood supply to the skin.

2. Changes in cardiovascular system: In healthy people, the changes that normally occur in the cardiovascular system with aging do not significantly limit the normal work capacity of the heart. Most of the changes that cause clinically significant declines in cardiovascular function are the results of disease.

Major cardiovascular changes with aging are:

  a. The maximum heart rate decreases and it takes longer for heart rate and blood pressure to return to normal resting levels after exertion.
  b. The aorta and other arteries become thicker which may bring a moderate increase in systolic blood pressure with aging. In some individuals, this may result in hypertension.
  c. The valves between the chambers of the heart thicken and become stiffer. As a result heart murmurs are fairly common among older adults.
  d. The pacemaker of the heart loses cells and develops fibrous tissue and fat deposits. These changes may cause a slightly shower heart rate and even heart block. Abnormal heart rhythms and extra heart beats become more common.

3. Changes in respiratory System: The respiratory system reflects changes that occur in many other body systems, including the cardiovascular, nervous and musculature system. Most of the normal respiratory changes with age are of little functional significance in healthy older adults. However, they do reduce reserve capacity and increase vulnerability to respiratory disease.

Major age-related changes in the respiratory system

  a. The lunges become stiffer, muscle strength and endurance diminish, and the chest wall becomes more rigid.
  b.  Total lung capacity remains constant but vital capacity decreases and residual volume increase.
  c. The alveolar surface area decreases by up to 20 percent. Alveolar tend to collapse sooner on expiration.
  d. There is an increase in mucus production and a decrease in the activity and number of cilia.
  e. The body becomes less efficient in monitoring and controlling breathing.

Older Adulthood

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Nursing Theory of Aging

Nursing Theory of Aging 

• Miller (2004) has developed the functional consequences theory.
• Older adults experiences functional consequences because of age related changes and additional risk factors.
• Without interventions, many functional consequences are negative; with them, however functional consequences can be positive.
• The role of regent logic nurse is to identify the factor that causes negative functional consequences and to initiate  interventions that will result in positive ones.
• Normal age related changes and factors may negatively interfere with patients activity and quality of life.
• The nurse must differentiate between normal age related changes that can be reversed and risk factors that can be modified.

Importance to Nurses 
1. Each theory provides framework and insight into the differences among elderly patients.
2. Nurses play a significant role in helping aging person experience health fulfillment and sense of well being.
3. Nurses attitude towards aging can have an enormous impact on patients.
4  It makes the nurse aware whether the changes are related to aging or disease condition.
5. It helps to provide specific care keeping in mind about the various changes in their biological and psychological aspect.
6. It helps to differentiate normal aging from the abnormal one.
7. It can be tested, changed or used to guide research or to provide base for evaluation.
8. It guides the nurses in helping the old people adapt to various changes.
9. It helps the older people on re-balancing the relationship.

Natural changes during older adulthood 

Ageing is a natural process. It should be regarded as a normal inevitable biological changes which are incident to old age is gerontology. Care of aged is called geriatrics.

Old people have limited regenerative capabilities and are more prone to disease, syndromes, and sickness than other age groups. There is often a common physical decline, and people become less active. Old age can reason, along with other things:

• Hair loss
• Changes of hair color to gray or white 
• Wrinkles and liver spots on the skin.
• Agility and slower reaction times 
• Reduced ability to clear thinking 
• Lessened hearing 
• Diminished eyesight 
• Difficulty recalling memories 
• Lessening or termination of sex, sometimes because of physical symptoms such as erectile dysfunction in men, but often simply a decline in libido.
• Greater weakness to bone disease such as osteoarthritis 

Some myths and facts related to aging are given below:

Myths:
1. Ageing is the time of tranquility and that ageing is synonymous with senility.
2 Old age is time of reduced activity.
3. Older person are thought to be resistant to change.
4. Ageing is a uniform process that progresses at the same rate and with the same results for all.

Facts:
1. Many older people retain their mental faculties well beyond the ninth decade of life.
2. Societal factors may limit opportunities for older adults to demonstrate their productivity but many older adults remain productive throughout life.
3. resistant to changes tends to be lifelong characteristics, not one developed with advancing age.
4. Ageing affects each individual differently and the outcomes of ageing may be different from one individual to another.


Nursing care of older adults is challenging and they should be cared for according to their level of understanding because all older adults are not the same. For example, some may be physically active, intelligent and productive members of the community whereas others may not be aware of these differences.  

Theories

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Psychological theories

1. Disengagement theory: One of the earliest theories 

• Developed by Elaine cumming and Willaim Henry (cumming and Henry 1961)
• This theory viewed aging as a process through which society and the individual gradually withdraw or disengage from each other.
• Nobody grows old merely by living a number of years. We grow old by deserting our ideas . Years may wrinkle the skin but to give up enthusiasm wrinkles the soul. - Samuel Ullman.

2. Activity theory : Proposed by Havighrust (1963)

• Suggest that aged people should continue an active middle-aged lifestyle and should remain as active as possible.
• It suggests that obstacles are to be resisted and that problems involving declining health, loss of roles and responsibilities, reduction in income and diminishing circle of friends are to be overcome.
• It suggests many ways for older people to maintain an active life.
• For most elderly people when physical activity is much reduced, intellectual activities should be emphasized.
• when old friends and relatives are dying or otherwise lost, the establishment of new friendship would be encouraged.

3. Continuity theory: Negatron, 1964

• In spite of aging process, personality and basic patterns of behavior are considered to be constant in the individual.
• Patterns and activity levels develop over a life time will largely determine whether an individual remain engaged and active or disengaged and inactive as they age.
• This theory encourages young people to consider their own future aging process.

4. Social Exchange theory :

• Postulates that social interaction between individuals and groups continues as long as everyone profits from the interaction.
• When there is no longer profit from the social exchange, imbalance occurs in the interaction and one individual is perceived as having more power than the over.
• The decrease in the social interaction of the aged is the result of exchange relationship that gradually erodes the power of the aged.

Environmental Theories :

• The elements in the environments have been considered by the researchers to have an effect on aging phenomena.
• Biologists have considered the effects of the environment on the cellular structure of the human organism.

1. Radiation Theory: Excessive exposure to the suns radiation puts the skin at risk during the somatic mutation process.

2. Stress Theory: According to Perlman (1954), Human aging is a disease syndrome arising from a struggle between environmental stress and biological resistance and relative adaptation to the effects of stress or agents. These stress or agents might include air, pollutants, chemical and psychological and sociological events.

Developmental Theory : 

• Erikson (1963) theorized that person's life consists of eight stages.
• Each stage represents a crucial turning point in life stretching from birth to death, with its own developmental conflicts to be resolved.
• According to him, the major developmental task of old age is either to achieve ego integrity or to suffer despair.

Theories

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Middle Adulthood (40-50 years of age)

Introduction 

• Middle aged starts at the age of 40 and ends at 50 years.
• This is the period of physiological changes that are gradual and inevitable; although physical growth has stopped he/she continue to mature emotionally.
• In this period he or she has obtained personal achievements and socioeconomic stability.
• He or she enjoys the role in assisting other young people or children. That is the time of helping aging parents progress through the later years of life.
• The middle aged adults use his leisure time in creative work and get satisfaction from his/her own work.
• This is the time when a person prepares for retirement. 

Physiological Development 

• Major physiological changes occur between 45-65 years of age.
• The changes in physical appearance and functions vary from person to person.
• The most visible changes are grey hair, loss of hair, wrinkling, body metabolism which begins to slow down due to lack of excess fat deposition especially around waist and abdomen.
• Presbyopia ( blurred vision at close range ) is common in middle adulthood. 
• The impact of physiological changes has an effect on the person's self concept and body image.

Cognitive Development 

• Middle aged adults are able to learn new skills and information.
• Some adults prepare themselves for new education, career and vocational training.
• The cognitive function changes when they are seriously ill or have trauma.

Psychological Development 

1. The psychological changes in the middle aged are due to children moving away from home, divorce and death of spouse.

• The changes may cause stress and affect the health of an individual .

Sexuality 

• During this period sex hormone begins to decline such as estrogen and progesterone in the female. Therefore most of the women experience menopause between the age of 45-60 years of age.
• There is decreased level of androgen which may cause climacteric changes in both male and females, middle aged adult experience changes in the erection and decreased repeated orgasm. Therefore some may experience emotional distress and for this reason, both male and female clients need more information about menopause and climacteric changes.

Physiological Needs and Developmental tasks 

Physiological needs of Middle Aged are :

1. Adaptation to changing sexuality.
2. Promotion of adaptive health maintenance measures.
3. Monitoring for and treatment of chronic illness.
4. Early detection of loss of perception.

Seven Development tasks have been Described by "Havighurst" 

1. Achieving adult civic social responsibility.
2. Establishing and maintaining as standard of living.
3. Helping teenage children become responsible and happy adults.
4. Developing leisure activities.
5. Relating to one's spouse as a person.
6. Accepting and adjusting to physiological changes of middle age.
7. Adjusting to aging parents.

Central tasks of middle adulthood 

1. Express love through more than sexual contacts.
2. Maintain healthy life patterns.
3. Develop a sense of unity with mate.
4. Help growing and grown children to be responsible adults.
5. Relinquish central role in lives of grown children.
6. Accept children's mates and friends.
7. Create a comfortable home.
8. Be proud of accomplishments of self and mate/spouse.
9. Reverse roles with aging parents.
10. Achieve mature, civic and social responsibility.
11. Adjust to physical changes of middle age.
12. Use leisure time creativity.

Major Health Problems of Middle adulthood

Common health problems in middle adulthood include:

1. Diabetes
2. Accidents
3. Heart diseases
4. Stroke
5. Hypertension
6. Cancer
7. Alcoholism
8. Degenerative joint disease, Gout
9. Gallbladder disease 
10. Coronary artery disease 
11. Varicose veins
12. Gl disorders: peptic ulcer disease 
13. Obesity 
14. Dental problems 
15. Visual changes 
16. Reproductive/menopausal problems
17. Anxiety/stress
18. Accidents/injuries.

Many of these diseases are preventable wholly or in part through behavior changes . Middle aged adults can influence their own health as well as their children's through healthier life styles.

Nursing consideration in middle adulthood 

1. Encouraging regular medical check up 
2. Teaching self breast examination to females and self testicular examination to males.
3. Encouraging to have pap smear test done for females.

INTRODUCTION

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INTRODUCTION TO NURSING CARE OF ADULT

INTRODUCTION TO NURSING CARE OF ADULT

Developmental Needs and tasks
young adult
Middle aged adult
Older adults
Major Health Problems of Adult `
young adult
Middle aged adults eg gall stone, ulcer heart conditions
Older adults eg CVA
Young Adults (21-39 years )

Introduction
Young adulthood starts at the age of 21 year and ends at 39 years.
Young adults are usually physically healthy, chronic illness are less in this age group.
Young adulthood is a period of productive life. The young adult may attend college or may have a job and choose a life partner and marry. Some may remain single, but most of them are involved in rearing children and caring for parents.
The young adult changes gradually in his/her attitudes due to natural due to natural process of maturation and socialization. During this period young adults set goals and choose a carrier.
He or she gradually enters middle age and may be aware of some changes in his/her reproductive life and other physical changes. During this transitional period, the person may reassess his/her goals in life and add new goals.
Physiological Development
Physiological development is complete and he or she may experience changes in body structure or shape.
The young adult are usually active and may not have serious illness.
They ignore minor physical symptoms and often postpone seeking medical help.
Chronic illness does not appear in this age group.
The physical characteristics of young adults gradually change into middle age.

Cognitive Development
Young Adults develop a habit of rational thinking.
They gain experience through different areas such as formal and informal education.
General day to life experience and occupational/job opportunities greatly increase the individual's conceptual and problem solving skills as well as motor skills.
They are often found to be satisfied with their job or occupation.
Psycho-social Development
Emotional health of a young adult depends upon how he resolves his/her personal problems, social tasks and frequency of exposure ti similar problems.
During this period he refines his life goals and relationship. He wants success in his chosen carrier.
He may have more social contacts eg. work place, cub etc.
The young adults gives more attention to his carrier or occupation and wants to improve his socioeconomic status through his chosen carrier. Successful employment not only ensures economic security but also leads to friendship, social activities, support and respects from coworkers. In this regard a nurse also helps the individual in achieving of his her goals.
Development needs and tasks of Young adults
The physical needs of young adult are :
1. Establishment of lifelong health maintenance measures.
2. Early detection of disease process.
3. Assistance with reproduction.
According to Diekelmann (1976) there are five developmental tasks:
1. The young adults achieve Independence from parental control.
2. They begin to control strong friendships and intimate relationship outside the family.
3. They establish personal sets of values.
4. They prepare for life work and develop the capacity for intimacy.
Major health problems of Young Adults
1. Accidents related to the following activities:
    Driving
    Occupational
     Recreational
2. Social Problems:
     Drug abuse
     Tobacco use
      Alcohol and substance abuse
      Suicidal attitude (poison, burn, hanging)
      AIDS, STD

INTRODUCTION

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