Community Health Nursing Final Exam Study Guide Essay
They typically have to stay in the hospital for a longer amount of time because they have a lot more co-morbidities that need to be treated. Being brought to the ED is extremely expensive. Critical interventions are very costly, and so are all the diagnostic tests that must be done. They usually don’t have insurance. High mental heath issues in the homeless population. High risk for infections, trauma, violence. Don’t age very well. Where do they seek health care services? (pg. 425, Effects of Homeless on Health) Health care is usually crisis oriented and sought in emergency departments.
Those who access health care have a hard time following prescribed regimens. Insulin-dependent diabetic man who lives on the street may sleep in a shelter. His ability to get adequate rest, exercise, take insulin on a schedule, eat regular meals, or follow a prescribed diet is virtually impossible. How does someone purchase an antibiotic without money? How is a child treated for scabies and lice when there are no bathing facilities? How does an older adult with peripheral vascular disease elevate his legs when he must be out of the shelter at 7am and on the streets all day?
Do they practice preventative health care? (pg. 425, Effects of Homelessness on Health) Health problems are often directly related to poor access to preventive health care. Homeless people devote a large portion of their time trying to survive. Health promotion activities are a luxury for them, not part of their daily lives. Healthy People 2010 has goals to increase awareness and use of preventive heath services, but it’s very hard for the homeless. *See Healthy People 2010 box on pg. 426* 2. What is mental health? (pg. 433)
Mental health: being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. (by Healthy People 2010) It is an integral part of personal well-being, of both family and interpersonal relationships, and of contributions to community or society. How can nurses help families cope with the many conditions characterized by alterations in their thinking, mood, or behavior, resulting in distress and/or impaired functioning? Comes at different levels depending on the diagnosis and how it impacts that person.
What can be done with that diagnosis? Are they being treated with medications or therapies to overcome some of these issues? These things will bring them to a state of having a higher quality of life. They are less likely to hold down jobs (i. e. schizophrenia, bipolar disorder, depression). Some of these cause a break with reality. Very individualized. Medication management; wrap around services. They can help link with resources. Assessments to take a look at evaluation piece. Are the therapies working for them and making them the best they can be?
3. Caregiver stress and prevention measures that can be done by nurses? (pg. 351, 377) Caregiver burden: the physical, psychological, emotional, social and financial problems that can be experienced by those who provide care for impaired others People become caregivers because they wanted to be with their loved one and they want to keep them out of facilities. They are very selfless and do everything for that person. Assess them. Provide them with links to resources. Talk to them about respit care and other services that are available.
Female spouses represent the largest group of family caregivers Stress, strain and burnout are words that are used to reflect the negative effects of the family caregiver burnout Issues involve the work itself, past and present relationships, effect on others and the caregivers lifestyle and well-being For many families the caregiving experience is a positive, rewarding and fulfilling one Nursing interventions can facilitate good health for older persons and there caregivers and contribute to meaningful family relationships during this period T= training in care techniques, safe medication use, recognition of abnormalities and available resources L= leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs C= care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid and health management 4. Youth violence, how does it effect communities? What preventative things can be done to reduce the violence among this age group? (pg.
435) A doctor suggested that community mental health providers work to do the following: Reestablish the village through the creation of coalitions and partnerships. Provide access to health care and mental health care to treat conditions associated with violent behavior. Improve bonding, attachment, and connectedness by supporting mothers and families. Improve self-esteem among youths by recognizing and building on strengths. Increase social skills by helping children learn to stop, think, and act. Reestablish the adult protective shield by educating and supporting parents. Minimize the effects of trauma through early intervention. 5. How do nurses care for very poor families? (pg.
423, Briefly Noted section) A client’s advice to nurses who care for the poor is as follows: Treat the poor like everyone else. Do not be condescending. Do not make it obvious that someone is poor. Do not prejudge; ask if someone wants to pay on their bill. Remember that people can’t always pay for their medicine. Suggest programs that might help, such as food banks, churches, and clothing centers. Poor people need a lot of support. Many poor people need help to learn how to promote their own health given a paucity of resources. 6. How does homelessness effect the individual and their overall health? (pg. 425-426) Homelessness is correlated with acute and chronic illness. Health problems include:
Hypothermia & heat-related illnesses Infestations & poor skin integrity Peripheral vascular disease- homeless people are on their feet for many hours and often sleep in positions that compromise their peripheral circulation. Hypertension- exacerbated by high rates of alcohol abuse and the high sodium content of foods served in fast-food restaurants, shelters, and other meal sites. Diabetes & nutritional deficits Respiratory infections & COPD Tuberculosis (TB) HIV/AIDS- prevalence of HIV in the homeless is estimated to be at least double that found in the general population. Use of intravenous drugs and the risk for sexual assault are other factors.
Homeless persons with AIDS develop more virulent forms of infectious diseases, have longer hospitalizations, and have less access to treatment. Trauma- major cause of death and disability. Major trauma includes: gunshot/stab wounds, head trauma, suicide attempts, and fractures. Minor trauma includes: bruises, abrasions, concussions, sprains, puncture wounds, eye injuries, and cellulitis. Mental illness Use and abuse of tobacco, alcohol, and illicit drugs Risk for exposure to viruses & bacteria that cause pneumonia/TB- caused by crowded living conditions. Psychological, social, spiritual well-being- loss of friends, personal possessions, and familiar surroundings. Homeless people live in chaos, confusions, and fear.
They experience a loss of dignity, low self-esteem, lack of social support, and generalized despair. Homelessness affects health across the life span: pregnancy, childhood, adolescence, or older adult. Each group has unique needs that the nurse must know. (pg. 426, Homelessness & At-Risk Populations) *Nurses must identify the precursors to homelessness, anticipate the effects on physical, emotional, and spiritual well-being, and resources that can assist the homeless* Homeless Pregnant Women: High risk for complex health problems. Their outcomes are significantly poorer than general population. Significant challenges include: -Higher rates of STDs-Higher addiction to drugs & alcohol -Poorer nutritional status-Less access to prenatal care
-Higher incidence of poor birth outcomes (low birthweight & low Apgar scores) Homeless Children: Similar to poor children but with more serious consequences. -Experience more symptoms of acute illness (fever, ear infection, diarrhea) -Behaviors: withdrawal, depression, aggression, regression, self-mutilation -Poor nutrition-Inconsistent healthcare -High levels of anxiety-Inability to practice good health behaviors -Higher rates of absenteeism-Academic failure -Delayed communication-More mental health problems Homeless Adolescents: Exhibit greater risk-taking behaviors. -Earlier onset of sexual activity-Poorer health status -Decreased access to healthcare-Runaway behavior -More likely to use alcohol/drugs-Physical/sexual abuse -Exchange sex for food, clothing, shelter
-Increased risk of contracting serious communicable diseases: AIDS, hepatitis B Homeless Older Adults: Most vulnerable due to longstanding poverty, fewer supportive relationships, and likely have become homeless as a result of catastrophic events. -Lower life expectancy -Permanent physical deformities: these are often secondary to poor or absent medical care -Untreated chronic conditions: TB, hypertension, arthritis, cardiovascular disease, injuries, malnutrition, poor oral health, and hypothermia. *Not a question on the study guide, but knowing Pelland she will have a question about this so here we go* Levels of Prevention and the Nurse in Community Health (pg. 438) Primary preventive services: -Affordable housing-Multisystem case management -Housing subsidies-Birth control services
-Effective job-training programs-Safe sex education -Employer incentives-Needle-exchange programs -Preventive heath care services-Parent education/counseling services Secondary preventive activities are aimed at reducing the prevalence or pathological nature of a condition. (Early diagnosis, prompt treatment, and imitation of disability) -Supportive and emergency housing-Soup kitchens/meal sites -Targeted case management-Comprehensive physical/mental heath services -House subsidies-Screening people for depression Tertiary prevention efforts attempt to restore and enhance functioning. -Support of affordable housing -Promotion of psychosocial rehab programs
-Involvement in advocacy groups for the mentally ill or homeless population -Homelessness: comprehensive case management, physical/mental health services, emergency-shelter housing, needle-exchange programs, and drug/alcohol treatment. *Role of the Nurse: Interventions for the poor, homeless, mentally ill, and other high-risk people, pg. 438-440* 7. Understand the differences between drug abuse, drug addiction, drug dependence, and substance abuse? Define them. (pg. 445-446) Drug abuse: use of a drug without a prescription or any use of an illegal drug. Drug addiction: a pattern of abuse characterized by an overwhelming preoccupation with the use (compulsive use) of a drug and securing its supply and a high tendency to relapse if the drug is removed.
Addicts may become both physically and psychologically dependent on a drug. There may be a risk of harm and the need to stop drug abuse. Drug dependence: a state of neuroadaptation, a physiologic change in the central nervous system (CNS) and aterations in other systems caused by the chronic, regular administration of a drug. People who are dependent on drugs must continue using them to prevent symptoms of withdrawal. When a person is given an opiate such as morphine on a regular basis for pain management, the morphine needs to be gradually tapered rather than abruptly stopped to prevent symptoms of withdrawal. It is both psychological and physical.
Psychological- feelings of satisfaction and desire to repeat the drug experience or to avoid the discomfort of not having the drug. Craving and compulsion are part of this. Physical- seen when there is an abstinence effect, and this effect results in physical changes that are uncomfortable. Substance abuse: use of any substance that threatens a person’s health or impairs social or economic functioning. The term substance broadens the scope to include alcohol, tobacco, legal drugs, & foods. 8. When working with alcohol addiction it is important that nurses understand the physiological effects. (pg. 446-447) Alcoholism: addition to the drug called alcohol. They are recognized as illnesses under a biopsychosocial model.
The disease concept identifies them as chronic and progressive diseases in which a person’s use of a drug or drugs continues despite problems it causes in any area of life- physical, emotional, social, economic, or spiritual. Chronic alcohol abuse has multiple metabolic and physiological effects on all organ systems. GI disturbances: inflammation of the GI tract, malabsorption, ulcers, liver problems, and cancers. Cardiovascular disturbances: cardiac dysrhythmias, cardiomyopathy, hypertension, atherosclerosis, and blood dyscrasias. CNS problems: depression, sleep disturbances, memory loss, organic brain syndrome, Wernicke-Korsakoff syndrome, alcohol withdrawal syndrome, and alcoholic dementia. Neuromuscular problems: myopathy, peripheral neuropathy.
Metabolic disturbances: hypokalemia, hypomagnesemia, ketoacidosis, pancreatitis, diabetes. Males: testicular atrophy, sterility, impotence, gynecomastia. Look at Evidence-Based Practice boxes on the bottom of pg. 447 9. Understand that tobacco is a drug. Know the impact of smoking on public health. (pg. 448) Stimulant: activate or excite the nervous system and make you feel more alert or energetic. They do not give the person more energy, they only make the body expend its own energy sooner and in greater quantities than it normally would. Smoking is the foremost preventable cause of death in the U. S. Cigarette smoking-related mortality in the U. S. – pg.
448, Table 24-1 Nicotine: the active ingredient in the tobacco plant, which is toxic. The body quickly develops tolerance to the nicotine. If a person smokes regularly, tolerance develops within hours. Pipes and cigars are less hazardous because the harsher smoke discourages deep inhalation. They increase the risk of cancer of the lips, mouth, and throat. Mainstream smoke: smoke inhaled and exhaled by the smoker Sidestream smoke: smoke that comes off a cigarette from the outside rather than being drawn through the cigarette (in the atmosphere) Higher concentration of toxic and carcinogenic compounds than mainstream smoke Nicotine is also used as chewing tobacco or snuff
Smokeless tobacco, a wad is put in the mouth and the nicotine is absorbed sublingually Higher doses of nicotine are delivered in the smokeless forms because the nicotine is not destroyed by heat Smokeless is less addictive because nicotine enters the bloodstream less effectively. What could a public nurse do in addressing teenage smoking? * 10. Know the effects of alcohol on the body, age and gender related factors (pg. 446-447). Refer to #8 for the effects of alcohol on the body. Blood alcohol concentration (BAC): determined by the concentration of alcohol in the drink, the rate of drinking, the rate of absorption, the rate of metabolism, and a person’s weight and sex. The amount of alcohol the liver can metabolize per hour is equal to about ? ounce of whiskey, 4 ounces of wine, or 12 ounces of beer.
Tolerance: develops with chronic consumption and a person can reach a high BAC with minimal CNS effects. Women are more affected by alcohol than men. Women have less alcohol dehydrogenase activity. Females suffer the long-term effects of alcohol intake at much lower doses in a shorter time span. 11. Understand drug use and the levels of health prevention that can be implemented to help patients with these issues. Predisposing/Contributing Factors for Substance Abuse: (pg. 450-451) 3 variables that influence the drug experience: a. 1. 1. Set- refers to the individual using the drug, as well as that person’s expectations, including unconscious expectations, about the drug being used.
A person’s health may alter a drug’s effects from one day to the next. a. 1. 2. Setting- the influence of the physical, social, and cultural environment within which the use occurs. Social conditions influence the use of drugs. Example ? fact pace of life, competition at school/workplace can lead to drug use in order to feel better, sleep better, have more energy, and just as a “treat. ” Drug use may numb the pain or escape from reality. a. 1. 3. Specific drug being used Primary Prevention & Role of the Nurse: (pg. 451) ***Focused on health promotion and disease prevention*** Nurses can be effective in teaching, promoting, and facilitating people in choosing healthy options rather than reliance on drugs.
Teach clients to be assertive in their relationships with others and how to make more beneficial decisions by looking at pros and cons of each option and related consequences. Help clients understand that medications may mask problems rather than solve them. Use stress reduction and relaxation techniques along with a balanced lifestyle rather than medications. Assist clients to balance their need for rest, nutrition, and exercise on a daily basis can reduce complaints. Help clients learn about drug-free community activities (pg. 451, How to Substance Abuse Prevention box) Help clients identify community resources and solve problems to meet basic needs rather than avoid them.
Increase resiliency in youth: help them develop an increased sense of responsibility for their own success, help them identify their talents, motivate them to dedicate their lives to helping society rather than believing that their only purpose in life is to be consumers, provide realistic appraisals and feedback, stress multicultural competence, encourage and value education, increase cooperative solutions to problems rather than competitive/aggressive solutions. There is a long section about Drug Education on pg. 451-452. Recommend reading/highlighting it. Provide community education to teach healthy lifestyles and focus on how to resist getting involved in substance abuse. Secondary Prevention & Role of the Nurse: (pg. 452-456)
Identify substance abuse and plan appropriate interventions requires individual assessments. When drug abuse, dependence, or addiction is identified, the nurse should assist clients to understand the connection between their drug-use patterns and the negative consequences on their health, families, and community. Institute early detection programs in schools, the workplace, and other areas in which people gather to determine the presence of substance abuse. Assessing for ATOD problems: Nurse should assess for self-medication practices and recreational drug use. After obtaining a medication history, follow-up questions can determine if a problem exists: If using a prescription drug is the client following the directions correctly?
Has the client increased dosage or frequency above the prescription level? Is the person using any prescribed psychoactive drugs? If so, for how long and what is the dosage? **Think of the “4 H’s” to remember what to ask when assessing drug-use patterns ? How taken (route), How much, How often, How long** Determine the reason the person uses the drug. Denial is the primary symptom of addiction: lying about use, minimizing use patterns, blaming or rationalizing, intellectualizing, changing the subject, using anger or humor, “going with the flow” Pg. 453, How To box for assessing socioeconomic problems resulting from substance abuse. Drug Testing:
Drug testing can be done by examining a person’s urine, blood, saliva, breath, or hair. Urine is the most common. It indicates only past use of certain drugs, not intoxication. Blood, breath, and saliva tests can indicate current use and amount. A serum drug screen can be useful when overdose is suspected. Hair testing is gaining attention because the results can provide a long history of drug-use patterns. Employee assistance programs (EAPs): beneficial services in many work settings. Many EAP clients have substance use problems since most adults with these problems are employed. These programs identify health problems among employees and offer counseling or referral to other health care providers as necessary.
High-risk groups: Adolescents, older adults, injection drug users, drug use during pregnancy, use of illicit drugs. Pg. 454-456, just read the more detailed description of these groups. Codependency and Family involvement: Codependency: a stress-induced preoccupation with the addicted person’s life, leading to extreme dependence and excessive concern for the addict. This happens to people close to the addict so that they can continue the relationship. Try to meet the addict’s needs at the expense of their own; they may underlie medical complaints and emotional stress Examples: Don’t talk, don’t feel, don’t trust, don’t lose control, don’t seek help from outside the family.
Many codependents assume the roles of an enabler. Enabling: the act of shielding or preventing the addict from experiencing the consequences of the addiction. The addict does not always understand the cost of the addiction and thus is “enabled” to continue to use. Anyone can be an enabler (Police officer, boss, co-worker, drug treatment counselor, health care professionals who do not address the negative health consequences). The nurse can help families recognize the problem of addiction and help them confront the addicted member in a caring manner. Family members should be given guidance about resources and services available to help them cope more effectively.
Treatment options, counseling assistance, financial assistance, support services, legal services. Tertiary Prevention & Role of the Nurse: (pg. 456-458) Nurse is in a key position to help the addict and the addict’s family. Nurse’s knowledge of community resources and how to mobilize them can significantly influence the quality of care clients receive. Develop programs to help people reduce or end substance abuse. Detoxification: the clearing of one or more drugs from the person’s body and managing the withdrawal symptoms. Depending on the particular drug and the degree of dependence, the time required may reange from a few days to several weeks.
Outpatient or home detox for persons requiring medical detox for alcohol withdrawal can be a cost-effective treatment. Nurses can monitor and evaluate the client’s heath status in the home environment to reduce the risk of medical complications related to alcohol withdrawal, and provide encouragement and support for the client to complete the detox. Addiction treatment: focuses on the addiction process. The goal is to help clients view addiction as a chronic disease and assist them to make lifestyle changes that stop the progression of the disease. Treatment facilities are multidisciplinary because intervention strategies require a wide range of approaches.
Interactions between addict, family, culture, and community and strategies include medical management, education, counseling, vocational rehab, stress management, and support services. ***Key is to match individual clients with the interventions most appropriate for them*** The goal of the educational part of the programs is to provide information about the disease and how drugs affect a person physically and psychologically. Clients are informed of various lifestyle changes that are recommended, and they earn about tools to assist them in making these changes. Long-term residential programs (halfway houses): help to ease the person recovering from addiction back to society.
Provide continued support and counseling in a structured environment. Support groups: AA groups began a strong movement of peer support to treat a chronic illness. Examples: Narcotics Anonymous (NA), Pills Anonymous, Overeaters Anonymous, Gamblers Anon. These help addicted people develop a daily program of recovery and reinforce the recovery process. The fellowship, support and encouragement provide a vital social network. Pg. 459, Box 24-1 and Box 24-2. Nurse’s Role and interventions for clients with alcoholism & drug addiction 12. Understand what constitutes the definition of a family. (pg. 313) The definition of family is critical to the practice of nursing.
Family has traditionally been defined using the legal concepts of relationships such as genetic ties, adoption, guardianship, or marriage. It has become much more broad since the 1980s. Family: refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. The members of the family are self-defined. The nurses working with families should ask people who they consider to be their family and then include those members in health care planning. Most persons view families and their experiences based on their own family or origin. It is important to be aware of and attempt to understand other family variations.
The family may range from traditional nuclear and extended family to “postmodern” family structures such as single-parent families, stepfamilies, same-gender families, and families consisting of friends. Family function: Family structure: 13. Know the definition of cue logic and framing. (pg. 321=Cue logic, pg. 322=framing) Box 18-8: Steps of the Outcome Present-State Testing Family Nursing Process Model (OPT) Cue logic: as nurses gather information about the family, they begin to place the information into meaningful datasets that help them see the whole family (as the client) Nurses organize information into logical groups or clusters to determine the most important keystone issue challenging the family health.
One of the most important pieces of information provided by the referral source is the focus, or the cluster of cues or symptoms, that leads them to believe that a problem might exist. The central issue identified by the referral source may not be the actual keystone issue but may be another problem that contributes to the keystone issue. Case study on page 321-322 that discusses the importance of identifying the keystone family issue and making an accurate family nursing diagnosis. Scenario 1 & 2 Box 18-9: Helpful Reflective Questions in Family Nursing Diagnosis Am I continuing to focus on the central issue? Am I sure that I am understanding the information correctly? Is everyone involved focused on the central issue?
Have I collected enough information to be drawing inferences or conclusions? Have I made any assumptions that might not be true or valid? Box 18-10: Reflective Critical Thinking Process for the Nurse 1. Is this plan being developed in collaboration with the family? 2. Will the proposed approaches enhance family strengths and increase independence of family members? 3. Is this action within the information and skill level of the family members or their own resources? 4. On a scale of 1 to 10 (10 is highest), how committed and motivated are family members to adhere to the plan? 5. Are there adequate resources available to carry out the plan? 6. How would family members respond to these questions? 7.
Will this action diminish or strengthen the coping ability of the family? Framing: it is very important to consider how you as the nurse frame the question while listening to the family client story. In reference to Scenario 1 & 2 of the cue logic section*** Scenario 2, the nurse asked a question that allowed critical thinking about several options concurrently: Gathered information from the referral source. Conducted an assessment of the impact of the new diagnosis on the whole family. Made a clinical judgment that had a more far-reaching effect on the health outcome of the family. Keystone family issue needs to be stated in a way that matches the nursing classification system used in the agency.
These include: North American Nursing Diagnosis Association system, the Omaha System, the Diagnostic and Statistical Manual of Mental Disorders, and the International Classification of Diseases. After the keystone family diagnosis has been identified and verified with the family, the next steps are as follows: Determine the present state Determine the outcome Test the evaluation criteria determining if the outcome has been achieved **These next steps are all sections in the book but not mentioned on the study guide so I didn’t do them, but maybe just look them over if you want pg. 323-324 ? ** How to Plan for the Assessment Process: (Box on pg. 322) Assessment of families requires an organized plan before you see the family. This planning includes the following: 1. Why are you seeing the family? 2. Who will be present during the interview? 3. Where will you see the family, and how will the space be arranged? 4. What are you going to be assessing? 5. How are you going to collect the data?
6. What are you going to do with the information you find? 14. How do families communicate? What communication frameworks used assess family communication patterns? (pg. 319) Interactional theory: Have an idea about other theories Structure-Function Theory: Systems Approach: Developmental Theory: 15. How do you assess family violence? How is the diagnosis made? (pg. 469, 476-478) Box 25-3 Assessing for Violence in a Community Context the cumulation*** what are you looking for.. physical and behavioral evidence Public health nurse works directly with CPS/APS. Contact them first. Nurses are in a key position to predict and deal with abusive tendencies. By understanding factor contributing to the development of abusive behaviors, nurses can identify abuse-prone families. Nurses need to understand that the factors that characterize people who become involved in family violence include upbringing, living conditions, and increased stress. Of these factors, the one most predictably present is previous exposure to some form of violence.
Several factors influence the onset and support the continuation of abusive patters. Factors to include in an assessment for indivudal or family violence, or for potential family violence include (IMPORTANT to see Figure 25-1 on pg. 477, they all interconnect in some way): Societal factors Inadequate and prejudicial legilation for women, children, and elderly persons Inferior education, training, and status of minorities Influence of public schools through use of abusive discipline patterns Societal acceptance of violence (media, religion) Patriarchal socioeconomic and sociopolitical structure Intrafamilial-system factors Autocratic and hierarchical family government Strict disciplinary beliefs
Rigid role assignments Role reversal Social isolation Resistance to change Role modeling of abusive parenting from on generation to another Victim member factors Learned or actual helplessness Acquired or congenital disability Inability to meet expectations of others Poor self-esteem Social isolation Object of scape-goating, symbiosis Perpetrator factors Low self-esteem Fear and distrust of others Poor self-control Isolated; inadequate social skills Immature motivation for marriage of childbearing Weak coping skills Other Abuse or neglect Arrested development of family members: dysfunctional family 16. What is a health risk appraisal and what does it do? (pg.
334) Health risk appraisal: refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. The general approach is to determine whether a risk factor is present and to what degree. On the basis of scientific evidence, each factor is weighed and a total score is derived. This appraisal method provides an individual score that can be examined as a whole within the family, thus appraising the health risks that are likely to be experience by other members of the family.
Family health risk appraisal: 17. Understand family transitions and what causes the risk? (pg. 336-337) Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Transitions often requires families to do the following: Change behaviors, schedules, and patterns of communication Make new decisions Reallocate family roles Learn new skills Identify and learn to use new resources Demands that transitions place on families have implications for the healt