Heroic measures are defined as extraordinary, emergent life-saving measures used

to prolong life when death is imminent. While diabetes is a chronic condition a

nd the administration of insulin is life-saving this does not meet the criterion
as a heroic measure because death is not imminent. The dilemma for the nursing
staff is the discrepancy between the client's understanding of what constitutes
a heroic measure and the true definition. Through education and additional supp
ort, the client will hopefully come to understand that this is a controllable pr
ocess.

The client is really saying that he is overwhelmed. He needs education, support,

and possibly even some sleep.

In caring for this client, the nurse will take on the roles of caregiver, especi
ally during the acute care admission; and educator, both in the hospital and aft
er discharge. The nurse may also play act as client advocate, both in and out o
f the acute care setting, by looking for an assisted living facility that will m
eet the needs of the client and his wife and facilitating any changes the client
wants to make to his advanced directive after he adapts to his disease. A case
manager would hopefully be assigned to help coordinate this client's long-term c
are needs.

Jacob is at risk for alterations in health from obesity, cardiovascular disease,

cancer, substance abuse, and physical and psychosocial stressors.

Does the middle adult:

Accept the aging body?
Feel comfortable with and respect him-/herself?
Enjoy some new freedom to be independent?
Accept changes in family roles?
Enjoy success and satisfaction from work and/or family roles?
Interact well and share companionable activities with a partner?
Expand or renew previous interest?
Pursue charitable and altruistic activities?
Consider plans for retirement?
Have a meaningful philosophy of life?
Follow preventive healthcare practices?

The nurse can promote healthy behaviors in Jacob by:

Choose foods from all food groups, and eat a variety of foods.
Choose a diet low in fat (30% or less of total calories), saturated fat (less th
an 10% of calories), and cholesterol (less than 300mg daily). Adjust daily calor
ie intake to maintain healthy weight.
Choose a diet that each day includes at least 3 servings of vegetables, 2 servin
gs of fruits, and 6 servings of grains.
Use sugar, NaCl, and Na in moderation.
Increase Ca intake (in perimenopausal women) to 1200mg daily.
Consume high-fiber foods.
Make exercise a part of life, carrying out regular exercise that is moderately s
trenuous, is consistent, and avoids overexertion; exercise for 30min at least 4-
5/wk.
Include exercise as part of any weight reduction program.
Have an annual vision examination.
Have an annual dental checkup.
Have a physical examination anually, including assessment for cancer of the thyr
oid, testes, prostate, mouth, ovaries, skin, lymph nodes, and for cholesterol an
d blood glucose levels.
For female, have a mammogram q year from age 40 on.
For females, have a Pap test as recommended for the young adult.
Have an annual stool blood test; or a digital rectal examination (DRE) and a fle
xible sigmoidoscopy q 5yrs; or a colonoscopy and DRE q 10yrs or a double-contras
t barium enema and a DRE q 5-10yrs.
For males, have testicular and prostate examinations annually, including DRE, af
ter age 50.
Conduct breast self-examination or testicular self-examination q month. (The per
imenopausal woman should set a specific date each month for the exam, as menstru
al periods may be irregular or absent).