8.2.3: Person, Gender, and Cultural Differences in Conformity
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Learning Objectives
- Summarize the social psychological literature concerning differences in conformity between men and women.
- Review research concerning the relationship between culture and conformity.
- Explain the concept of psychological reactance and describe how and when it might occur.
Although we have focused to this point on the situational determinants of conformity, such as the number of people in the majority and their unanimity and status, we have not yet considered the question of which people are likely to conform and which people are not. In this section we will consider how personality variables, gender, and culture influence conformity.
Person Differences
Even in cases in which the pressure to conform is strong and a large percentage of individuals do conform (such as in Solomon Asch’s line-judging research), not everyone does so. There are usually some people willing and able to go against the prevailing norm. In Asch’s study, for instance, despite the strong situational pressures, 24% of the participants never conformed on any of the trials.
People prefer to have an “optimal” balance between being similar to, and different from, others (Brewer, 2003). When people are made to feel too similar to others, they tend to express their individuality, but when they are made to feel too different from others, they attempt to increase their acceptance by others. Supporting this idea, research has found that people who have lower self-esteem are more likely to conform in comparison with those who have higher self-esteem. This makes sense because self-esteem rises when we know we are being accepted by others, and people with lower self-esteem have a greater need to belong. And people who are dependent on and who have a strong need for approval from others are also more conforming (Bornstein, 1992).
Age also matters, such that individuals who are either younger or older are more easily influenced than individuals who are in their 40s and 50s (Visser & Krosnick, 1998). People who highly identify with the group that is creating the conformity are also more likely to conform to group norms, in comparison to people who don’t really care very much (Jetten, Spears, & Manstead, 1997; Terry & Hogg, 1996).
However, although there are some differences among people in terms of their tendency to conform (it has even been suggested that some people have a “need for uniqueness” that leads them to be particularly likely to resist conformity; Snyder & Fromkin, 1977), research has generally found that the impact of person variables on conformity is smaller than the influence of situational variables, such as the number and unanimity of the majority.
Gender Differences
Several reviews and meta-analyses of the existing research on conformity and leadership in men and women have now been conducted, and so it is possible to draw some strong conclusions in this regard. In terms of conformity, the overall conclusion from these studies is that that there are only small differences between men and women in the amount of conformity they exhibit, and these differences are influenced as much by the social situation in which the conformity occurs as by gender differences themselves. For instance, in Milgram’s studies he found no differences in conformity between men and women.
On average, men and women have different levels of self-concern and other-concern. Men are, on average, more concerned about appearing to have high status and may be able to demonstrate this status by acting independently from the opinions of others. On the other hand, and again although there are substantial individual differences among them, women are, on average, more concerned with connecting to others and maintaining group harmony. Taken together, this means that, at least when they are being observed by others, men are likely to hold their ground, act independently, and refuse to conform, whereas women are more likely to conform to the opinions of others in order to prevent social disagreement. These differences are less apparent when the conformity occurs in private (Eagly, 1978, 1983).
The observed gender differences in conformity have social explanations—namely that women are socialized to be more caring about the desires of others—but there are also evolutionary explanations. Men may be more likely to resist conformity to demonstrate to women that they are good mates. Griskevicius, Goldstein, Mortensen, Cialdini, and Kenrick (2006) found that men, but not women, who had been primed with thoughts about romantic and sexual attraction were less likely to conform to the opinions of others on a subsequent task than were men who had not been primed to think about romantic attraction.
In addition to the public versus private nature of the situation, the topic being discussed also is important, such that both men and women are less likely to conform on topics that they know a lot about, in comparison with topics on which they feel less knowledgeable (Eagly & Chravala, 1986). When the topic is sports, women tend to conform to men, whereas the opposite is true when the topic is fashion. Thus it appears that the small observed differences between men and women in conformity are due, at least in part, to informational influence.
Because men have higher status in most societies, they are more likely to be perceived as effective leaders (Eagly, Makhijani, & Klonsky, 1992; Rojahn & Willemsen, 1994; Shackelford, Wood, & Worchel, 1996). And men are more likely to be leaders in most cultures. For instance, in the current U.S. Senate, 83% of the members are men. The percentages also favor men in the U.S. House of Representatives (84%) and the Supreme Court (66%). Similar differences are found in the legislatures of almost all countries. There are also more men than women in leadership roles, and particularly in high-level administrative positions, in many different types of businesses and other organizations. Women are not promoted to positions of leadership as fast as men are in real working groups, even when actual performance is taken into consideration (Geis, Boston, & Hoffman, 1985; Heilman, Block, & Martell, 1995).
Men are also more likely than women to emerge and act as leaders in small groups, even when other personality characteristics are accounted for (Bartol & Martin, 1986; Megargee, 1969; Porter, Geis, Cooper, & Newman, 1985). In one experiment, Nyquist and Spence (1986) had pairs of same- and mixed-sex students interact. In each pair there was one highly dominant and one low dominant individual, as assessed by previous personality measures. They found that in pairs in which there was one man and one woman, the dominant man became the leader 90% of the time, but the dominant woman became the leader only 35% of the time.
Keep in mind, however, that the fact that men are perceived as effective leaders, and are more likely to become leaders, does not necessarily mean that they are actually better, more effective leaders than women. Indeed, a meta-analysis studying the effectiveness of male and female leaders did not find that there were any gender differences overall (Eagly, Karau, & Makhijani, 1995) and even found that women excelled over men in some domains. Furthermore, the differences that were found tended to occur primarily when a group was first forming but dissipated over time as the group members got to know one another individually.
One difficulty for women as they attempt to lead is that traditional leadership behaviors, such as showing independence and exerting power over others, conflict with the expected social roles for women. The norms for what constitutes success in corporate life are usually defined in masculine terms, including assertiveness or aggressiveness, self-promotion, and perhaps even macho behavior. It is difficult for women to gain power because to do so they must conform to these masculine norms, and often this goes against their personal beliefs about appropriate behavior (Rudman & Glick, 1999). And when women do take on male models of expressing power, it may backfire on them because they end up being disliked because they are acting nonstereotypically for their gender. In an important U.S. Supreme Court case, a female account executive argued that she was denied promotion (although she was a top performer) because she acted too “masculine,” even though the same behaviors were required for the success of the male coworkers (Fiske, Bersoff, Borgida, Deaux, & Heilman, 1991).
One way that women can react to this “double-bind” in which they must take on masculine characteristics to succeed, but if they do they are not liked, is to adopt more feminine leadership styles, in which they use more interpersonally oriented behaviors such as agreeing with others, acting in a friendly manner, and encouraging subordinates to participate in the decision-making process (Eagly & Johnson, 1990; Eagly et al., 1992; Wood, 1987). In short, women are more likely to take on a transformational leadership style than are men—doing so allows them to be effective leaders while not acting in an excessively masculine way (Eagly & Carli, 2007; Eagly, Johannesen-Schmidt, & van Egen, 2003).
In sum, women may conform somewhat more than men, although these differences are small and limited to situations in which the responses are made publicly. In terms of leadership effectiveness, there is no evidence that men, overall, make better leaders than do women. However, men do better as leaders on tasks that are “masculine” in the sense that they require the ability to direct and control people. On the other hand, women do better on tasks that are more “feminine” in the sense that they involve creating harmonious relationships among the group members.
Cultural Differences
In addition to gender differences, there is also evidence that conformity is greater in some cultures than others. Your knowledge about the cultural differences between individualistic and collectivistic cultures might lead you to think that collectivists will be more conforming than individualists, and there is some support for this. Bond and Smith (1996) analyzed results of 133 studies that had used Asch’s line-judging task in 17 different countries. They then categorized each of the countries in terms of the degree to which it could be considered collectivist versus individualist in orientation. They found a significant relationship, such that conformity was greater in more collectivist than in individualist countries.
Kim and Markus (1999) analyzed advertisements from popular magazines in the United States and in Korea to see if they differentially emphasized conformity and uniqueness. As you can see in Figure 7.10, they found that while U.S. magazine ads tended to focus on uniqueness (“Choose your own view!” and “Individualize”) Korean ads tended to focus more on themes of conformity (“Seven out of 10 people use this product” and “Our company is working toward building a harmonious society”).
Kim and Markus (1999) found that U.S. magazine ads tended to focus on uniqueness whereas Korean ads tended to focus more on conformity.
In summary, although the effects of individual differences on conformity tend to be smaller than those of the social context, they do matter. And gender and cultural differences can also be important. Conformity, like most other social psychological processes, represents an interaction between the situation and the person.
Psychological Reactance
Conformity is usually quite adaptive overall, both for the individuals who conform and for the group as a whole. Conforming to the opinions of others can help us enhance and protect ourselves by providing us with important and accurate information and can help us better relate to others. Following the directives of effective leaders can help a group attain goals that would not be possible without them. And if only half of the people in your neighborhood thought it was appropriate to stop on red and go on green but the other half thought the opposite—and behaved accordingly—there would be problems indeed.
But social influence does not always produce conformity. If we feel that we have the choice to conform or not conform, we may well choose to do so in order to be accepted or to obtain valid knowledge. On the other hand, if we perceive that others are trying to force our conformity, the influence pressure may backfire, resulting in the opposite of what the influencer intends.
Consider an experiment conducted by Pennebaker and Sanders (1976), who attempted to get people to stop writing graffiti on the walls of campus restrooms. In some restrooms they posted a sign that read “Do not write on these walls under any circumstances!” whereas in other restrooms they placed a sign that simply said “Please don’t write on these walls.” Two weeks later, the researchers returned to the restrooms to see if the signs had made a difference. They found that there was much less graffiti in the second restroom than in the first one. It seems as if people who were given strong pressures to not engage in the behavior were more likely to react against those directives than were people who were given a weaker message.
When individuals feel that their freedom is being threatened by influence attempts and yet they also have the ability to resist that persuasion, they may experience psychological reactance , a strong motivational state that prevents conformity (Brehm, 1966; Miron & Brehm, 2006). Reactance is aroused when our ability to choose which behaviors to engage in is eliminated or threatened with elimination. The outcome of the experience of reactance is that people may not conform at all and may even move their opinions or behaviors away from the desires of the influencer.
Reactance represents a desire to restore freedom that is being threatened. A child who feels that his or her parents are forcing him to eat his asparagus may react quite vehemently with a strong refusal to touch the plate. And an adult who feels that she is being pressured by a car salesman might feel the same way and leave the showroom entirely, resulting in the opposite of the salesman’s intended outcome.
Of course, parents are sometimes aware of this potential, and even use “reverse psychology”—for example, telling a child that she cannot go outside when they really want her to, hoping that reactance will occur. In the Broadway musical The Fantasticks , neighboring fathers set up to make one’s daughter and the other’s son fall in love with each other by building a fence between their properties. The fence is seen by the children as an infringement on their freedom to see each other, and as predicted by the idea of reactance, they ultimately fall in love.
In addition to helping us understand the affective determinants of conformity and of failure to conform, reactance has been observed to have its ironic effects in a number of real-world contexts. For instance, Wolf and Montgomery (1977) found that when judges give jury members instructions indicating that they absolutely must not pay any attention to particular information that had been presented in a courtroom trial (because it had been ruled as inadmissible), the jurors were more likely to use that information in their judgments. And Bushman and Stack (1996) found that warning labels on violent films (for instance, “This film contains extreme violence—Viewer discretion advised”) created more reactance (and thus led participants to be more interested in viewing the film) than did similar labels that simply provided information (“This film contains extreme violence”). In another relevant study, Kray, Reb, Galinsky, and Thompson (2004) found that when women were told that they were poor negotiators and would be unable to succeed on a negotiation task, this information led them to work even harder and to be more successful at the task.
Finally, within clinical therapy, it has been argued that people sometimes are less likely to try to reduce the harmful behaviors that they engage in, such as smoking or drug abuse, when the people they care about try too hard to press them to do so (Shoham, Trost, & Rohrbaugh, 2004). One patient was recorded as having reported that his wife kept telling him that he should quit drinking, saying, “If you loved me enough, you’d give up the booze.” However, he also reported that when she gave up on him and said instead, “I don’t care what you do anymore,” he then enrolled in a treatment program (Shoham et al., 2004, p. 177).
Key Takeaways
- Although some person variables predict conformity, overall situational variables are more important.
- There are some small gender differences in conformity. In public situations, men are somewhat more likely to hold their ground, act independently, and refuse to conform, whereas women are more likely to conform to the opinions of others in order to prevent social disagreement. These differences are less apparent when the conformity occurs in private.
- Conformity to social norms is more likely in Eastern, collectivist cultures than in Western, independent cultures.
- Psychological reactance occurs when people feel that their ability to choose which behaviors to engage in is eliminated or threatened with elimination. The outcome of the experience of reactance is that people may not conform at all and may even move their opinions or behaviors away from the desires of the influencer.
Exercise and Critical Thinking
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Following this paragraph are some examples of social influence and conformity. In each case, the person who is conforming has changed his or her behavior because of the expressed opinions or behaviors of another person. In some cases the influence of the others is more obvious; in other cases less so. Using the principles discussed in Chapter 1 “Introducing Social Psychology”, first consider the likely role of the social situation versus the individual person. Did the person freely engage in the behavior, did the social situation force him to engage in the behavior, or was there some combination of both? Then consider the role of underlying human goals—concern for self and concern for others. Did the conformity occur primarily because the person wanted to feel good about himself or herself or because he or she cared for those around him or her? Then ask yourself about the role of cognition, affect, and behavior. Do you think the conformity was primarily behavioral, or did it involve a real change in the person’s thoughts and feelings?
a. Bill laughed at the movie, even though he didn’t think it was all that funny; he realized he was laughing just because all his friends were laughing.
b. Frank realized that he was starting to like jazz music, in part because his roommate liked it.
c. Jennifer went to the mall with her friends so that they could help her choose a gown for the upcoming prom.
d. Sally tried a cigarette at a party because all her friends urged her to.
e. Phil spent over $150 on a pair of sneakers, even though he couldn’t really afford them, because his best friend had a pair.
References
Bartol, K. M., & Martin, D. C. (1986). Women and men in task groups. In R. D. Ashmore & F. K. Del Boca (Eds.), The social psychology of female-male relations . New York, NY: Academic Press.
Bond, R., & Smith, P. B. (1996). Culture and conformity: A meta-analysis of studies using Asch’s (1952b, 1956) line judgment task. Psychological Bulletin, 119 (1), 111–137.
Bornstein, R. F. (1992). The dependent personality: Developmental, social, and clinical perspectives. Psychological Bulletin, 112 , 3–23.
Brehm, J. (1966). A theory of psychological reactance . New York, NY: Academic Press; Miron, A. M., & Brehm, J. W. (2006). Reaktanz theorie—40 Jahre spärer. Zeitschrift fur Sozialpsychologie, 37 , 9–18. doi: 10.1024/0044-35<IP_ADDRESS>.
Brewer, M. B. (2003). Optimal distinctiveness, social identity, and the self. In M. R. Leary & J. P. Tangney (Eds.), Handbook of self and identity (pp. 480–491). New York, NY: Guilford Press.
Bushman, B. J., & Stack, A. D. (1996). Forbidden fruit versus tainted fruit: Effects of warning labels on attraction to television violence. Journal of Experimental Psychology: Applied, 2 , 207–226.
Eagly, A. H. (1978). Sex differences in influenceability. Psychological Bulletin, 85 , 86–116.
Eagly, A. H. (1983). Gender and social influence: A social psychological analysis. American Psychologist, 38 , 971–981.
Eagly, A. H., & Carli, L. L. (2007). Through the labyrinth: The truth about how women become leaders . Boston, MA: Harvard Business School Press.
Eagly, A. H., & Chravala, C. (1986). Sex differences in conformity: Status and gender-role interpretations. Psychology of Women Quarterly, 10 , 203–220.
Eagly, A. H., & Johnson, B. T. (1990). Gender and leadership style: A meta-analysis. Psychological Bulletin, 108 , 233–256
Eagly, A. H., Johannesen-Schmidt, M. C., & van Engen, M. L. (2003). Transformational, transactional, and laissez-faire leadership styles: A meta-analysis comparing men and women. Psychological Bulletin, 129 , 569–591.
Eagly, A. H., Karau, S. J., & Makhijani, M. G. (1995). Gender and the effectiveness of leaders: A meta-analysis. Psychological Bulletin, 117 , 125–145.
Eagly, A. H., Makhijani, M. G., & Klonsky, B. G. (1992). Gender and evaluation of leaders: A meta-analysis. Psychological Bulletin, 111 , 3–22
Fiske, S. T., Bersoff, D. N., Borgida, E., Deaux, K., & Heilman, M. E. (1991). Social science research on trial. The use of sex stereotyping research in Price Waterhouse v. Hopkins . American Psychologist, 46 , 1049–1060.
Geis, F. L., Boston, M. B., and Hoffman, N. (1985). Sex of authority role models and achievement by men and women: Leadership performance and recognition, Journal of Personality and Social Psychology, 49 , 636–653.
Griskevicius, V., Goldstein, N. J., Mortensen, C. R., Cialdini, R. B., & Kenrick, D. T. (2006). Going along versus going alone: When fundamental motives facilitate strategic (non)conformity. Journal of Personality and Social Psychology, 91 , 281–294.
Heilman, M. E., Block, C. J., & Martell, R. (1995). Sex stereotypes: Do they influence perceptions of managers? Journal of Social Behavior and Personality, 10 , 237–252.
Jetten, J., Spears, R., & Manstead, A. S. R. (1997). Strength of identification and intergroup differentiation: The influence of group norms. European Journal of Social Psychology, 27 , 603–609.
Kim, H., & Markus, H. R. (1999). Deviance or uniqueness, harmony or conformity? A cultural analysis. Journal of Personality and Social Psychology, 77 , 785–800.
Kray, L. J., Reb, J., Galinsky, A. D., & Thompson, L. (2004). Stereotype reactance at the bargaining table: The effect of stereotype activation and power on claiming and creating value. Personality and Social Psychology Bulletin, 30 , 399–411.
Megargee, E. I. (1969). Influence of sex roles on the manifestation of leadership. Journal of Applied Psychology, 53 , 377–382.
Nyquist, L. V., & Spence, J. T. (1986). Effects of dispositional dominance and sex role expectations on leadership behaviors. Journal of Personality and Social Psychology, 50 , 87–93.
Pennebaker, J. W., & Sanders, D. Y. (1976). American graffiti: Effects of authority and reactance arousal. Personality and Social Psychology Bulletin, 2 , 264–267.
Porter, N., Geis, F. L., Cooper, E., & Newman, E. (1985). Androgyny and leadership in mixed-sex groups. Journal of Personality and Social Psychology, 49 , 808–823.
Rojahn, K., & Willemsen, T. M. (1994). The evaluation of effectiveness and likability of gender-role congruent and gender-role incongruent leaders. Sex Roles, 30 , 109–119.
Rudman, L. A., & Glick, P. (1999). Feminized management and backlash toward agentic women: The hidden costs to women of a kinder, gentler image of middle-managers. Journal of Personality and Social Psychology, 77 , 1004–1010.
Shackelford, S., Wood, W., & Worchel, S. (1996). Behavioral styles and the influence of women in mixed-sex groups. Social Psychology Quarterly, 59 , 284–293.
Shoham, V., Trost, S. E., & Rohrbaugh, M. J. (Eds.). (2004). From state to trait and back again: Reactance theory goes clinical . Mahwah, NJ: Lawrence Erlbaum.
Snyder, C. R., & Fromkin, H. L. (1977). Abnormality as a positive characteristic: The development and validation of a scale measuring need for uniqueness. Journal of Abnormal Psychology, 86 (5), 518–527.
Terry, D., & Hogg, M. (1996). Group norms and the attitude-behavior relationship: A role for group identification. Personality and Social Psychology Bulletin, 22 , 776–793.
Visser, P. S., & Krosnick, J. A. (1998). The development of attitude strength over the life cycle: Surge and decline. Journal of Personality and Social Psychology, 75 , 1389–1410.
Wolf, S., & Montgomery, D. A. (1977). Effects of inadmissible evidence and level of judicial admonishment to disregard on the judgments of mock jurors. Journal of Applied Social Psychology, 7 , 205–219.
Wood, W. (1987). A meta-analytic review of sex differences in group performance. Psychological Bulletin, 102 , 53–71.


10.4: The “Graying” Population and Life Expectancy
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Learning Objectives
- Explain trends in life expectancies, including factors that contribute to longer life
The “Graying” of America
The term “graying of America” refers to the fact that the American population is steadily becoming more dominated by older people. In other words, the median age of Americans is going up.
According to the U.S. Census Bureau’s 2017 National Population Projections, the year 2030 marks an important demographic turning point in U.S. history. By 2030, all baby boomers will be older than age 65. This will expand the size of the older population so that 1 in every 5 residents will be retirement age. And by 2035, it’s projected that there will be 76.7 million people under the age of 18 but 78 million people above the age of 65. [1]
The 2030s are projected to be a transformative decade for the U.S. population. The population is expected to grow at a slower pace, age considerably and become more racially and ethnically diverse. Net international migration is projected to overtake natural increase in 2030 as the primary driver of population growth in the United States, another demographic first for the United States.
Although births are projected to be nearly four times larger than the level of net international migration in coming decades, a rising number of deaths will increasingly offset how much births are able to contribute to population growth. Between 2020 and 2050, the number of deaths is projected to rise substantially as the population ages and a significant share of the population, the baby boomers, age into older adulthood. As a result, the population will naturally grow very slowly, leaving net international migration to overtake natural increase as the leading cause of population growth, even as projected levels of migration remain relatively constant. [2]
“Graying” Around the World
While the world’s oldest countries are mostly in Europe today, some Asian and Latin American countries are quickly catching up. The percentage of the population aged 65 and over in 2015 ranged from a high of 26.6 percent for Japan to a low of around 1 percent for Qatar and United Arab Emirates. Of the world’s 25 oldest countries, 22 are in Europe, with Germany and Italy leading the ranks of European countries for many years (He, Goodkind, and Kowal, 2015).
By 2050, Slovenia and Bulgaria are projected to be the oldest European countries. Japan, however, is currently the oldest nation in the world and is projected to retain this position through at least 2050. With the rapid aging taking place in Asia, the countries of South Korea, Hong Kong, and Taiwan are projected to join Japan at the top of the list of oldest countries and areas by 2050, when more than one-third of these Asian countries’ total populations are projected to be aged 65 and over. [3]
Life Expectancy
Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of birth, current age and other demographic factors including gender. The most commonly used measure of life expectancy is at birth (LEB). There are great variations in life expectancy in different parts of the world, mos tly due to differenc es in public health, medical care, and diet, but also affected by education, economic circumstances, violence, mental health, and sex.
Life Expectancy in the United States
According to the CDC (Centers for Disease Control and Prevention), life expectancy in the U.S. now stands at 78.7 years. Women continue to outlive men, with life expectancy being 76.3 years for males, and 81.1 years for females. Life expectancy varies according to race and ethnicity. It is highest for Hispanics, for both males and females, and lower for blacks than for whites or Hispanics.
Statistics from the U.S. Census Bureau reveal that the 85-and over age group is the fastest-growing age group in America. According to the Census Bureau and AgingStats.gov , the over-65 population grew from 3 million in 1900 to 40 million in 2010, an increase of more than 1200%. But during this same time, the over-85 population grew from just over 100,000 in 1900 to 5.5 million in 2010–an increase of 5400%!
When ca lculating life expectancy, we consider all of the elements of heredity, health history, current health habits, and current life experiences which contribute to a longer life or subtract from a person’s life expectancy. Recent studies concluded that cutting calorie intake by 15 percent over two years can slow aging and protect against diseases such as cancer, diabetes, and Alzheimer’s. [4]
Some life factors are beyond a person’s control, and some are controllable. The rising cost of health care is a source of financial vulnerability to older adults. Vaccines are especially important for older adults. As you get older you’re more likely to get diseases like the flu, pneumonia, and shingles, and to have complications that can lead to long-term illness, hospitalization, and even death.
Things that contribute to longer life expectancies include eating a healthy diet that is rich in plants and nuts. Staying physically active, not smoking, and consuming moderate amounts of alcohol, tea, or coffee are also reported to be beneficial to leading a long life. Other recommendations include being conscientious, prioritizing your happiness, avoiding stress and anxiety, and having a strong social support network. Establishing a consistent sleep schedule and maintaining between 7-8 hours of sleep per night is also beneficial. [5]
A major reason a person will statistically live longer once they reach an older age is simply that they have made it this far without anything killing them. Also, there appears to be several factors which may explain changes in life expectancy in the United States and around the world—h ealth conditions are better, m any diseases have been eliminated or better controlled through medicine, working conditions are better and b etter lifestyles choices are being made. Such factors significantly contribute to longer life expectancies.
Life Expectancy Tables
Sometimes referred to mortality tables, death charts or actuarial life tables, these life expectancy tables are strictly statistical, and do not take into consideration any personal health information or lifestyle information. Take a look at life expectancy tables on the Life Expectancy Calculators website .
Understanding Life Expectancy
Life expectancy is also used in describing the physi cal quality of life. Quality of life is the general well-being of individuals and societies, outlining negative and positive features of life. Quality of life considers lif e satisfaction, including everything from physical health, family, education, employment, wealth, safety, security, freedom, religious beliefs, and the environment.
Increased life expectancy brings concern over the health and independence of those living longer. Greater attention is now being given to the number of years a person can expect to live without disability, which is called active life expectancy . When this distinction is made, we see that although women live longer than men, they are more at risk of living with disability (Weitz, 2007).
What factors co ntribute to poor health in women? Marriage has been linked to longevity, but spending years in a stressful marriage can increase the risk of illness. This negative effect is experienced more by women than men and seems to accumulate through the years. The impact of a stressful marriage on health may not occur until a woman reaches 70 or older (Umberson, Williams, et. al., 2006). Sexism can also create chronic stress. The stress experienced by women as they work outside the home as well as care for family members can also ultimately have a negative impact on health (He et als, 2005).
The shorter life expectancy for men in general, is attributed to greater stress, poorer attention to health, more involvement in dangerous occupations, and higher rates of death due to accidents, homicide, and suicide. Social support can increase longevity. For men, life expectancy and health seems to improve with marriage. Spouses are less likely to engage in risky health practices and wives are more likely to monitor their husband’s diet and health regimes. But men who live in stressful marriages can also experience poorer health as a result.
Health and Sexuality
It has been suggested that an active sex life can inc rease longevity among the elderly. [6] Dr.  [7] Positive sexual health in older age is gradually becoming more of a common topic and less taboo. Population percentage increase among older Americans has resulted in placing more attention on the needs of this age group, including their ideas on sexual health, desires, and attitudes. This shift in attitudes and behaviors, combined with medical advances to prolong a sexually active life, has changed the landscape of aging sexuality.
There are a number of associated health benefits with practicing positive sexual health. Positive sexual health often acts as a de-stressor promoting increased relaxation. Researchers also report health benefits such as decreased pain sensitivity, improved cardiovascular health, lower levels of depression, increased self-esteem, and better relationship satisfaction. This could also imply that there are negative consequences of poor sexual health or lack of sexual activity, including depression, low self-esteem, increased frustration, and loneliness.
Key players in improving the quality of life among older adults are the adults themselves. By exercising, reducing stress, not smoking, limiting use of alcohol, consuming more fruits and vegetables, and eating less meat and dairy, older adults can expect to live longer and more active lives (He et. als, 2005). Regular exercise is also associated with a lower risk of developing neurodegenerative disorders, especially Alzheimer’s disease and Parkinson’s disease. Stress reduction both in late adulthood and earlier in life is also crucial. The reduction of societal stressors can prom ote active life expectancy. In the last 40 years, smoking rates have decreased, but obesity has increased, and physical activity has only modestly increased.
Glossary
- active life expectancy
- the number of years a person can expect to live without disability
- life expectancy
- a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age and other demographic factors including gender
- quality of life
- the general well-being of individuals and societies, including life satisfaction, physical health, family, education, employment, wealth, safety, security, freedom, religious beliefs, and the environment
- US Census Bureau. (2018, October 05). Population Projections. Retrieved from https://www.census.gov/programs-surveys/popproj.html<EMAIL_ADDRESS>- US Census Bureau. (2018, December 03). Older People Projected to Outnumber Children. Retrieved from https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html<EMAIL_ADDRESS>- He, Wan, Daniel Goodking, and Paul Kowal. An Aging World: 2015. United States Census Bureau. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2016/demo/p95-16-1.pdf<EMAIL_ADDRESS>- Lea nne M. Redman, Steven R. Smith, Jeffrey H. Burton, Corby K. Martin, Dora Il'yasova, Eric Ravussin (April 2018). Metabolic Slowing and Reduced Oxidative Damage with Sustained Caloric Restriction Support the Rate of Living and Oxidative Damage Theories of Aging.Cell Metabolism. Retrieved from https://www.cell.com/cell-metabolism/fulltext/S1550-4131(18)30130-X?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS155041311830130X%3Fshowall%3Dtrue<EMAIL_ADDRESS>- Petre, Alina (April 2019). 13 Habits Linked to a Long Life (Backed by Science. Healthline . Retrieved from https://www.healthline.com/nutrition...to-a-long-life<EMAIL_ADDRESS>- Castleman, Michael. The Prescription for a Longer Life? More Sex. Psychology Today. Retrieved from https://www.psychologytoday.com/us/b...-life-more-sex<EMAIL_ADDRESS>- Syme, Maggie. (2014). The evolving concept of older adult sexual behavior and its benefits. Generations . 38. 35-41<EMAIL_ADDRESS>Contributors and Attributions
- Modification, adaptation, and original content. Authored by : Sonja Ann Miller for Lumen Learning. Provided by : Lumen Learning. License : CC BY-SA: Attribution-ShareAlike
- Psyc 200 Lifespan Psychology. Authored by : Laura Overstreet. Located at : http://opencourselibrary.org/econ-201/ . License : CC BY: Attribution
- Life expectancy. Provided by : Wikipedia. Located at : https://en.Wikipedia.org/wiki/Life_expectancy . License : CC BY-SA: Attribution-ShareAlike
- Quality of Life. Provided by : Wikipedia. Located at : https://en.Wikipedia.org/wiki/Quality_of_life . License : CC BY-SA: Attribution-ShareAlike
- Sexuality in Older Age. Provided by : Wikipedia. Located at : https://en.Wikipedia.org/wiki/Sexuality_in_older_age#cite_note-:0-3 . License : CC BY-SA: Attribution-ShareAlike
- Life expectancy at birth by race. Authored by : Elizabeth Arias, Ph.D.. Provided by : Centers for Disease Control and Prevention. Project : NCHS Data Brief No. 244, April 2016 . License : All Rights Reserved
- The Necessity of Exercise: Physical Activity and Aging. Provided by : USC School of Gerontology. Located at : https://medium.com/@gerontologyonline/the-necessity-of-exercise-physical-activity-and-aging-infographic-1af6db1cafdd . License : All Rights Reserved
- Graph on age projections. Provided by : Partners 4 Prosperity. Located at : https://partners4prosperity.com//wp-content/uploads/2014/09/aging-85-and-over.gif . License : All Rights Reserved
- From Pyramid to Pillar: A Century of Change, Population of the U.S.. Provided by : U.S. Census Bureau. Located at : https://www.census.gov/library/visualizations/2018/comm/century-of-change.html . License : Public Domain: No Known Copyright


37.4: How Hormones Work - Intracellular Hormone Receptors
- Describe how hormones alter cellular activity by binding to intracellular receptors
Intracellular Hormone Receptors
Lipid-derived (soluble) hormones such as steroid hormones diffuse across the lipid bilayer membranes of the endocrine cell. Once outside the cell, they bind to transport proteins that keep them soluble in the bloodstream. At the target cell, the hormones are released from the carrier protein and diffuse across the lipid bilayer of the plasma membrane of the target cells. They then adhere to intracellular receptors residing in the cytoplasm or in the nucleus. The cell signaling pathways induced by the steroid hormones regulate specific genes within the cell’s DNA. The hormones and receptor complex act as transcription regulators by increasing or decreasing the synthesis of mRNA molecules from specific genes. This, in turn, determines the amount of corresponding protein that is synthesized from this RNA; this is known as altering gene expression. This protein can be used either to change the structure of the cell or to produce enzymes that catalyze chemical reactions. In this way, the steroid hormone regulates specific cell processes.
Other lipid-soluble hormones that are not steroid hormones, such as vitamin D and thyroxine, have receptors located in the nucleus. The hormones diffuse across both the plasma membrane and the nuclear envelope, then bind to receptors in the nucleus. The hormone-receptor complex stimulates transcription of specific genes in the same way that steroid hormones do. For example, the active vitamin D metabolite, calcitriol, mediates its biological effects by binding to the vitamin D receptor (VDR), which is principally located in the nuclei of target cells. The binding of calcitriol to the VDR allows the VDR to act as a transcription factor that modulates the gene expression of transport proteins that are involved in calcium absorption in the intestine. VDR activation in the intestine, bone, kidney, and parathyroid gland cells leads to the maintenance of calcium and phosphorus levels in the blood and to the maintenance of bone content.
Key Points
- Lipid -soluble hormones are able to diffuse directly across the membranes of both the endocrine cell where they are produced and that of the target cell, as the cell membranes are made of a lipid bilayer.
- These hormones can bind to receptors that are located either in the cytoplasm of the cell or within the nucleus of the cell.
- When these hormones bind to their receptors, this signals the cell to synthesize more or less mRNA from a gene or genes, which then results in more or less protein being created from those mRNA molecules.
- The increase or decrease in protein production can alter the cell structurally or alter how and when it catalyzes chemical reactions.
Key Terms
- gene expression : the transcription and translation of a gene into messenger RNA and, thus, into a protein
- transcription : the synthesis of RNA under the direction of DNA
- steroid : a class of organic compounds having a structure of 17 carbon atoms arranged in four rings; they are lipids, and occur naturally as sterols, bile acids, adrenal and sex hormones, and some vitamins


33.9: Practice Exercises
33.9 Practice Exercises
Day One
1.
Put each set into normal form and prime form.
Answer.
Day Two
2.
For each of the six sets in the example below, determine the normal form, prime form, Forte number, and interval vector.
Answer.
Day Three
3.
Transposition (Tn) of Sets. Transpose the following sets as specified.
- Transpose [3, 6, 7] at T2: [ , , ]
- Transpose [2, 4, 8, 9] at T7: [ , , , ]
- Transpose [1, 2, 4, 7, 8] at T9: [ , , , , ]
Answer.
4.
Inversion (TnI) of Sets. Invert the following sets. Write your answers in normal form.
- Invert [7, 10, 11] at T0I: [ , , ]
- Invert [0, 2, 4] at T4I: [ , , ]
- Invert [4, 6, 10, 11] at T9I: [ , , , ]
Answer.
5.
Specify the interval of inversion from the first set to the second set.
- [2, 4, 7] inverts to [3, 6, 8] at what TnI?
- [1, 2, 4, 7] inverts to [4, 7, 9, 10] at what TnI?
- [6, 7, 10, 1, 2] inverts to [3, 4, 7, 10, 11] at what TnI?
Answer.
Click
here to download the first homework assignment for this chapter.
Click
here to download the second homework assignment for this chapter.
Click
here to download the third homework assignment for this chapter.
PDF versions of the textbook, homework exercises, and practice exercises can be found at
musictheory.pugetsound.edu


7.13F: DNA Sequencing Based on Sanger Dideoxynucleotides
- Recall dideoxynucleotide sequencing
Sanger sequencing, also known as chain-termination sequencing, refers to a method of DNA sequencing developed by Frederick Sanger in 1977. This method is based on amplification of the DNA fragment to be sequenced by DNA polymerase and incorporation of modified nucleotides – specifically, dideoxynucleotides (ddNTPs).
The classical chain-termination method requires a single-stranded DNA template, a DNA primer, a DNA polymerase, normal deoxynucleotidetriphosphates (dNTPs), and modified nucleotides (dideoxyNTPs) that terminate DNA strand elongation. These chain-terminating nucleotides lack a 3′-OH group required for the formation of a phosphodiester bond between two nucleotides, causing DNA polymerase to cease extension of DNA when a ddNTP is incorporated. The ddNTPs may be radioactively or fluorescently labelled for detection in automated sequencing machines.The DNA sample is divided into four separate sequencing reactions, containing all four of the standard deoxynucleotides (dATP, dGTP, dCTP and dTTP) and the DNA polymerase. To each reaction is added only one of the four dideoxynucleotides (ddATP, ddGTP, ddCTP, or ddTTP). Following rounds of template DNA extension from the bound primer, the resulting DNA fragments are heat denatured and separated by size using gel electrophoresis. This is frequently performed using a denaturing polyacrylamide-urea gel with each of the four reactions run in one of four individual lanes (lanes A, T, G, C). The DNA bands may then be visualized by autoradiography or UV light and the DNA sequence can be directly read off the X-ray film or gel image.
Technical variations of chain-termination sequencing include tagging with nucleotides containing radioactive phosphorus for radiolabelling, or using a primer labeled at the 5′ end with a fluorescent dye. Dye-primer sequencing facilitates reading in an optical system for faster and more economical analysis and automation. The later development by Leroy Hood and coworkers of fluorescently labeled ddNTPs and primers set the stage for automated, high-throughput DNA sequencing. Chain-termination methods have greatly simplified DNA sequencing. More recently, dye-terminator sequencing has been developed. Dye-terminator sequencing utilizes labelling of the chain terminator ddNTPs, which permits sequencing in a single reaction, rather than four reactions as in the labelled-primer method. In dye-terminator sequencing, each of the four dideoxynucleotide chain terminators is labelled with fluorescent dyes, each of which emit light at different wavelengths.
Automated DNA-sequencing instruments (DNA sequencers) can sequence up to 384 DNA samples in a single batch (run) in up to 24 runs a day. DNA sequencers carry out capillary electrophoresis for size separation, detection and recording of dye fluorescence, and data output as fluorescent peak trace chromatograms. Automation has lead to the sequencing of entire genomes.
Key Points
- The lack of the second deoxy group on an dNTP making it ddNTP, stops the incorporation of further nucleotides, this termination creates DNA lengths stopped at every nucleotide, this is central to further identifying each nucleotide.
- Different labels can be used, ddNTPS, dNTPs and primers can all be labelled with radioactivity and fluorescently.
- Using fluorescent labels, dideoxy sequencing can be automated allowing high-throughput methods which have been utilized to sequence entire genomes.
Key Terms
- chromatogram : The visual output from a chromatograph. Usually a graphical display or histogram.
- dideoxynucleotide : Any nucleotide formed from a deoxynucleotide by loss of an a second hydroxy group from the deoxyribose group


32.1: Impressionism
Impressionism is associated with Claude Debussy and Maurice Ravel in France, Ottorino Respighi in Italy, Charles Tomlinson Griffes in America, and Frederick Delius in England. We will focus on just three techniques found in the music of Debussy and Ravel: (1) the use of modes, (2) the use of upper extensions above the 7th in chord construction in tertian harmonies (9ths, 11ths, and 13ths, which we saw in the chapter on jazz), and (3) parallelism, also known as “planing.”
-
Use of modes.
Composers such as Debussy and Ravel sometimes wrote in the church modes (Phrygian, Lydian, etc.—see
Scales
) as an alternative to the heavily chromatic music of Richard Wagner (listen to the influential
Prelude to Act I
of Wagner’s Tristan und Isolde).
- The first movement of Debussy’s String Quartet in G minor, Op. 10, begins in Phrygian mode. Notice that the seventh chord that occurs on the 5^ scale degree is half-diminished in Phrygian. (The penultimate chord in this example is not in Phrygian mode.)
- The second movement (“Danse profane”) of Debussy’s Danses begins in Lydian mode.
- The first movement of Ravel’s Piano Trio Ravel begins in the Dorian mode. Notice that the penultimate chord is outside of the mode.
- At the end of the first movement of Ravel’s Piano Trio, Ravel transforms the theme by placing it in the Lydian mode. In this example, the final two chords are outside of the Lydian mode.
-
Use of upper extensions in chords
. Debussy and Ravel used chords containing ninths, elevenths, and thirteenths, sometimes with chromatic alterations to those upper extensions.
- In bar 15 of Debussy’s “Clair de lune” from his Suite bergamasque, Debussy uses an EmE♭m9 chord with the 9th of the chord in the melody.
- Bar 8 of Debussy’s “La Puerta del Vino” from Book II of his Preludes, contains a DD♭7 in the left hand with the notes in the right hand alternating between the ♯9 and the ♭9.
- In bar 70 of the same piece, Debussy also includes the ♯11 in the right hand, in addition to the ♯9 and ♭9.
-
Use of parallelism
(also known as “planing”). In contrast to the
prohibition against parallel fifths and octaves in traditional voice leading
, both Debussy and Ravel would take a chord voicing and move all voices in parallel motion.
- In Pavane pour une infante défunte, Ravel writes dominant 9th chords in parallel motion in bar 27.
- At 5 bars after rehearsal number 5 in Prelude to the Afternoon of a Faun, Debussy writes chromatically ascending dominant seventh chords.
- At 4 bars after rehearsal number 2 in the same piece, Debussy moves seventh chords in parallel motion. Notice that the chords are not all of the same quality.


10.2: Pathogen Identification Last updated Save as PDF Page ID 8687 Boundless Boundless 10.2A: Occurrence of a Disease An occurrence of disease greater than would be expected at a particular time and place is called an outbreak. 10.2B: Disease Severity and Duration The severity and duration of diseases vary greatly and are important for epidemiological studies. 10.2C: Extent of Host Involvement Host-pathogen interactions are the interactions taking place between a pathogen (e.g. virus, bacteria) and their host (e.g. humans, plants). 10.2D: Identification of Microbes Based on Molecular Genetics Modern nucleic acid-based microbial detection methods make it possible to identify microbes that are associated with a disease.


19.15: Introduction to Employment Laws and Small Business
What you’ll learn to do: Summarize employment laws relevant to small businesses
Small business owners often treat human resources management the way they do emergency preparedness: they just don’t do it until it’s too late, and when it’s needed, they have to scramble. By not keeping good records, by not keeping current with employment laws on the state and federal level, they hurt themselves and their company’s bottom line.
Federal and state requirements change, and businesses that want to avoid fines and penalties need to stay on top of them. HR professionals can step in and help small businesses stay compliant with state and federal laws.
Contributors and Attributions
- Introduction to Employment Laws and Small Business. Authored by : Freedom Learning Group. Provided by : Lumen Learning. License : CC BY: Attribution


10.2: Safety Precautions
1. Do not:
a. be late for class. You will miss important instructions.
b. eat or drink in the laboratory
c. ingest any reagents or chemicals used in the laboratory
d. pour chemicals down the sink unless instructed otherwise
2. Dispose of laboratory materials as instructed. Take note of the location of:
a. Regular trash can
b. Biohazard bag
c. Sharps container for disposal of glass slides and small sharp objects
3. Take note of the location of the:
a. Fire extinguisher
b.  Location of security phone
e. Safety glasses cabinet
4. Report all spills, unsafe conditions, or accidents to the instructor.
5. Wash your hands before leaving the laboratory
6. Keep work area neat and organized. Clean up when done with the laboratory exercise.
7. Push in your chair before you leave


9.7: Applying the Nursing Process
Now that we have discussed the pathophysiology of our immune system and interventions to treat and prevent infection, let’s apply this information to using the nursing process when providing patient care.
Assessment
When assessing an individual who is feeling ill but has not yet been diagnosed with an infection, general symptoms associated with the prodromal period of disease may be present due to the activation of the immune system. These symptoms include a feeling of malaise (not feeling well), headache, fever, and lack of appetite. As an infection moves into the acute phase of disease, more specific symptoms and signs related to the specific type of infection will occur.
A fever is a common sign of inflammation and infection. A temperature of 38 degrees Celsius (100.4 degrees F) is generally considered a low-grade fever, and a temperature of 38.3 degrees Celsius (101 degrees F) is considered a fever. [1] As discussed earlier in this chapter, fever is part of the nonspecific innate immune response and can be beneficial in destroying pathogens. However, extremely elevated temperatures can cause cell and organ damage, and prolonged fever can cause dehydration.
Infection raises the metabolic rate, causing an increased heart rate. The respiratory rate may also increase as the body rids itself of carbon dioxide created during increased metabolism. However, be aware that an elevated heart rate above 90 and a respiratory rate above 20 are also criteria for systemic inflammatory response syndrome (SIRS) in patients with an existing infection.
As an infection develops, the lymph nodes that drain that area often become enlarged and tender. The swelling indicates that the lymphocytes and macrophages in the lymph node are fighting the infection. If a skin infection is developing, general signs of inflammation, such as redness, warmth, swelling, and tenderness, will occur at the site. As white blood cells migrate to the site, purulent drainage may occur.
Some viruses, bacteria, and toxins cause gastrointestinal inflammation, resulting in loss of appetite, nausea, vomiting, and diarrhea.
See Table 9.7a for a comparison of expected findings on physical assessment versus unexpected findings indicating a new infectious process that requires notification of the health care provider.
| Assessment | Expected Findings | Unexpected Findings to Report to Health Care Provider |
|---|---|---|
| Vital Signs | Within normal range | New temperature over 100.4 F or 38 C. |
| Neurological | Within baseline level of consciousness | New confusion and/or worsening level of consciousness. |
| Wound or Incision | Progressive healing of a wound with no signs of infection | New redness, warmth, tenderness, or purulent drainage from a wound. |
| Respiratory | No cough or production of sputum | New cough and/or productive cough of purulent sputum. Adventitious breath sounds (crackles, rhonchi, wheezing). New dyspnea. |
| Genitourinary | Urine clear, light yellow without odor | Malodorous, cloudy, bloody urine, with increased frequency, urgency, or pain with urination. |
| Gastrointestinal | Good appetite and food intake; feces formed and brown | Loss of appetite. Nausea and vomiting. Diarrhea; discolored or unusually malodorous feces. |
|
*CRITICAL CONDITIONS
requiring immediate notification of the provider and/or implementation of a sepsis protocol:
Two or more of the following criteria in a patient with an existing infection indicate SIRS:
|
Life Span Considerations
Infants do not have well-developed immune systems, placing this group at higher risk of infection. Breastfeeding helps protect infants from some infectious diseases by providing passive immunity until their immune system matures. New mothers should be encouraged to breastfeed their newborns. [2]
On the other end of the continuum, the immune system gradually decreases in effectiveness with age, making older adults also more vulnerable to infection. Early detection of infection can be challenging in older adults because they may not have a fever or increased white blood cell count (WBC), but instead develop subtle changes like new mental status changes. [3] The most common infections in older adults are urinary tract infections (UTI), bacterial pneumonia, influenza, and skin infections.
Diagnostic Tests
Several types of diagnostic tests may be ordered by a health care provider when a patient is suspected of having an infection, such as complete blood count with differential, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), serum lactate levels, and blood cultures (if sepsis is suspected). Other cultures may be obtained based on the site of the suspected infection.
CBC With Differential
When an infection is suspected, a complete blood count with differential is usually obtained.
A complete blood count (CBC) includes the red blood cell count (RBC), white blood cell count (WBC), platelets, hemoglobin, and hematocrit values. A differential provides additional information, including the relative percentages of each type of white blood cell. See Figure 9.22 [4] for an illustration of a complete blood count with differential.
When there is an infection or an inflammatory process somewhere in the body, the bone marrow produces more WBCs (also called leukocytes), releasing them into the blood where they move to the site of infection or inflammation. An increase in white blood cells is known as leukocytosis and is a sign of the inflammatory response. The normal range of WBC varies slightly from lab to lab but is generally 4,500-11,000 for adults, reported as 4.5-11.0 x 10 9 per liter (L). [5]
There are five types of white blood cells, each with different functions. The differential blood count gives the relative percentage of each type of white blood cell and also reveals abnormal white blood cells. The five types of white blood cells are as follows:
- Neutrophils
- Eosinophils
- Basophils
- Lymphocytes
- Monocytes
Neutrophils make up the largest number of circulating WBCs. They move into an area of damaged or infected tissue where they engulf and destroy bacteria or sometimes fungi. [6] An elevated neutrophil count is called neutrophilia, and decreased neutrophil count is called neutropenia. [7]
Eosinophils respond to infections caused by parasites, play a role in allergic reactions (hypersensitivities), and control the extent of immune responses and inflammation. Elevated levels of eosinophils are referred to as eosinophilia. [8]
Basophils make up the fewest number of circulating WBCs and are thought to be involved in allergic reactions. [9]
Lymphocytes include three types of cells, although the differential count does not distinguish among them:
- B lymphocytes (B cells) produce antibodies that target and destroy bacteria, viruses, and other “non-self” foreign antigens.
- T lymphocytes (T cells) mature in the thymus and consist of a few different types. Some T cells help the body distinguish between “self” and “non-self” antigens; some initiate and control the extent of an immune response, boosting it as needed and then slowing it as the condition resolves; and other types of T cells directly attack and neutralize virus-infected or cancerous cells.
Monocytes, similar to neutrophils, move to an area of infection and engulf and destroy bacteria. They are associated with chronic rather than acute infections. They are also involved in tissue repair and other functions involving the immune system. [11]
Care must be taken when interpreting the results of a differential. A health care provider will consider an individual’s signs and symptoms and medical history, as well as the degree to which each type of cell is increased or decreased. A number of factors can cause a transient rise or drop in the number of any type of cell. For example, bacterial infections usually produce an increase in neutrophils, but a severe infection, like sepsis, can use up the available neutrophils, causing a low number to be found in the blood. Eosinophils are often elevated in parasitic and allergic responses. Acute viral infections often cause an increased level of lymphocytes (referred to as lymphocytosis). [12]
Erythrocyte Sedimentation Rate (ESR)
An erythrocyte sedimentation rate (ESR) is a test that indirectly measures inflammation. This test measures how quickly erythrocytes or red blood cells (RBCs) settle at the bottom of a test tube that contains a blood sample. When a sample of blood is placed in a tube, the red blood cells normally settle out relatively slowly, leaving a small amount of clear plasma. The red cells settle at a faster rate when there is an increased level of proteins, such as C-reactive protein (CRP), that increases in the blood in response to inflammation. The ESR test is not diagnostic; it is a nonspecific test indicating the presence or absence of an inflammatory condition. [13]
C-Reactive Protein (CRP)
C-Reactive Protein (CRP) levels in the blood increase when there is a condition causing inflammation somewhere in the body. CRP is a nonspecific indicator of inflammation and one of the most sensitive acute phase reactants, meaning it is released into the blood within a few hours after the start of an infection or other cause of inflammation. The level of CRP can jump as much as a thousand-fold in response to a severe bacterial infection, and its rise in the blood can precede symptoms of fever or pain. [14]
Lactate
Serum lactate levels are measured when sepsis is suspected in a patient with an existing infection. Sepsis can quickly lead to septic shock and death due to multi-organ failure so early recognition is crucial.
Lactate is one of the substances produced by cells as the body turns food into energy (i.e., cellular metabolism), with the highest level of production occurring in the muscles. Normally, the level of lactate in blood is low. Lactate is produced in excess by muscle cells and other tissues when there is insufficient oxygen at the cellular level.
Lactic acid can accumulate in the body and blood when it is produced faster than the liver can break it down, which can lead to lactic acidosis. Excess lactate may be produced due to several medical conditions that cause decreased transport of oxygen to the tissues, such as sepsis, hypovolemic shock, heart attack, heart failure, or respiratory distress. [15]
Blood Culture
Blood cultures are ordered when sepsis is suspected. In many facilities, lab personnel draw the blood samples for blood cultures to avoid contamination of the sample. With some infections, pathogens are only found in the blood intermittently, so a series of three or more blood cultures, as well as blood draws from different veins, may be performed to increase the chance of finding the infection.
Blood cultures are incubated for several days before being reported as negative. Some types of bacteria and fungi grow more slowly than others and/or may take longer to detect if initially present in low numbers.
A positive result indicates bacteria have been found in the blood (bacteremia). Other types of pathogens, such as a fungus or a virus, may also be found in a blood culture. When a blood culture is positive, the specific microbe causing the infection is identified and susceptibility testing is performed to inform the health care provider which antibiotics or other medications are most likely to be effective for treatment.
It is important for nurses to remember that when new orders for both antibiotics and a blood culture are received, antibiotics should not be administered until after the blood culture is drawn. Administering antibiotics before the blood culture is drawn will impact the results and adversely affect the treatment plan.
Cultures and Other Diagnostic Tests
Several types of swabs and cultures may be ordered based on the site of a suspected infection, such as a nasal swab, nasopharyngeal swab, sputum culture, urine culture, and wound culture. If a lower respiratory tract infection is suspected, a chest X-ray may be ordered.
Read additional information about the following topics in Open RN Nursing Skills :
- Specimen Collection
- Collecting urine cultures in “ Facilitation of Elimination ”
- Collecting wound cultures in “ Wound Care ”
Therapeutic Drug Monitoring
When antibiotics are prescribed to treat an infection, some types of antibiotics require blood tests to ensure the dosage of the medication reaches and stays within therapeutic ranges in the blood. These tests are often referred to as peak and/or trough levels. The nurse must be aware of these orders because they impact the timing of administration of antibiotics.
Read about therapeutic drug monitoring in the “ Medication Safety ” section of the “Kinetics and Dynamics” chapter in Open RN Nursing Pharmacology .
Diagnoses
There are many NANDA-I nursing diagnoses applicable to infection. Nursing diagnoses associated with actual infections are customized based on the signs and symptoms of the specific infection (e.g., a patient with pneumonia may have an actual nursing diagnosis of Ineffective Airway Clearance ). Review a nursing care planning source for a list of current NANDA-I approved nursing diagnoses based on the type of infection occurring. [16]
Two common risk diagnoses are Risk for Infection for patients at risk for developing an infection and Risk for Shock for patients with an existing infection who are at risk for developing sepsis and septic shock. See Table 9.7b for the risk diagnoses of Risk for Infection and Risk for Shock .
Table 9.7b NANDA-I Diagnoses Associated with Infection
| NANDA-I Diagnosis | Definition | Other |
|---|---|---|
| Risk for Infection | Susceptible to invasion and multiplication of pathogenic organisms, which may compromise health |
Risk Factors
|
| Risk of Shock | Susceptible to inadequate blood flow to the body’s tissues that may lead to life-threatening cellular dysfunction, which may compromise health |
Associated Conditions
|
Examples
For example, a nurse caring for a patient with an open wound assesses the wound regularly because patients with nonintact skin are always at increased risk for developing infection. A sample PES statement would be the following: “ Risk for Infection as evidenced by alteration in skin integrity and insufficient knowledge to avoid exposure to pathogens.” The nurse plans to provide patient education regarding care of the wound to prevent bacterial contamination during dressing changes.
Whenever caring for a patient with an existing infection, nurses know it is important to closely monitor for signs of developing SIRS and sepsis. A sample PES statement for a patient with an existing infection is as follows: “ Risk for Shock as evidenced by the associated condition of infection.”
Note: Recall that in NANDA-I risk diagnoses, there are no etiological factors because a vulnerability reflects the potential for developing a problem. Read more about creating PES statements for risk diagnoses in the “ Nursing Process ” chapter.
Outcomes
An example of a broad goal for all patients is the following: “The patient will remain free from infection during their health care stay.” [17]
An example of a SMART expected outcome to prevent infection is: “The patient will demonstrate how to perform dressing changes using aseptic technique prior to discharge from the hospital.” [18]
Read more about creating SMART outcomes in the “ Nursing Process” chapter.
Planning Interventions
When planning interventions for a patient who is at risk for developing an infection, the nurse selects interventions such as those listed in the following box for “Infection Protection.”
- Monitor vital signs for signs of infection
- Monitor for early signs of localized and systemic infection for patients at risk
- Screen all visitors for communicable disease
- Encourage respiratory hygiene for patients, visitors, and staff members
- Maintain aseptic technique during nursing procedures
- Use sterile technique for invasive procedures or care of open wounds
- Use standard precautions with all patients to prevent the spread of infection
- Initiate transmission-based precautions for patients suspected of communicable infection, as appropriate
- Promote sufficient nutritional intake
- Encourage fluid intake, as appropriate
- Encourage rest
- Encourage frequent ambulation or turn immobilized patients frequently
- Ensure appropriate hygienic care, including proper hand hygiene, daily bathing, oral care, and perineal care performed by either the nurse or the patient, as appropriate
- Moisturize dry skin to keep it intact
- Use strategies to prevent healthcare-acquired respiratory infection, such as incentive spirometry, coughing and deep breathing, positional changes, and early ambulation as appropriate
- Use strategies to prevent wound infection such as changing saturated dressings to reduce the potential reservoir of bacteria
- Teach the patient and family members the importance of a nutritious diet, exercise, and adequate rest to promote healing and health at home
- Teach the patient and family about signs and symptoms of infection and when to report them to the health care provider
- Encourage the annual influenza vaccine and keeping other recommended vaccinations up-to-date
- If a patient smokes, encourage smoking cessation because smoking damages the mucociliary escalator and places the patient at increased risk for infection
- Report signs and symptoms of suspected infection or sepsis to the health care provider
- Suspect an infection if an older adult patient has new signs of lethargy or confusion
If a patient has an infection with a fever, the nursing diagnosis Hyperthermia may be applicable. See the following box for interventions for patients with fever/hyperthermia.
- Assess for associated symptoms such as diaphoresis, shaking chills (rigors)
- Monitor level of consciousness
- Adjust room temperature to the patient’s comfort without inducing chilling
- Administer antipyretics, as appropriate (e.g., acetaminophen, ibuprofen)
- Apply external cooling methods as needed (cold packs or cool sponge bath)
- Encourage fluid intake
- Monitor for signs of dehydration
Implementing Interventions
When caring for a patient with an active infection, transmission-based precautions may be required based on the specific type of pathogen. Antibiotics and/or other antimicrobials are administered as prescribed, and the patient and family are instructed how to take prescribed antibiotics with measures to prevent antibiotic resistance (i.e., complete prescribed length of therapy even if they feel better in a few days).
If cultures have been obtained, it is important to monitor and report new results to the provider to ensure the prescribed antibiotic therapy is appropriate based on susceptibility results.
It is important to continually monitor patients with an existing infection for signs of SIRS/sepsis:
- Carefully monitor vital signs. Immediately notify the provider for two or more of the following indicators that suggest SIRS: heart rate greater than 90 beats per minute, temperature greater than 38 degrees C or less than 36 degrees C, systolic blood pressure less than 90 mm Hg, respiratory rate greater than 20, or a white blood cell count greater than 12,000 or less than 4,000. [21] Anticipate new orders for a lactate level and blood cultures for early diagnosis of sepsis.
- Monitor for signs of new decreased mental status, especially in older adults, that can indicate decreased oxygenation or tissue perfusion associated with sepsis and septic shock.
- For patients presenting with early signs of shock, administer oxygen immediately to maintain oxygen saturation greater than 90%. Administer prescribed antibiotics within an hour after diagnosis for improved survival. Be aware that IV fluids and vasopressor medications may be required to treat shock. [22]
Read about different classes of antimicrobial agents in the “ Antimicrobials ” chapter in Open RN Nursing Pharmacology.
Evaluation
It is always important to evaluate the effectiveness of interventions used to prevent and treat infection. Evaluation helps the nurse determine whether the established outcomes have been met and if the planned interventions are still appropriate for the patient at the time of implementation. If outcomes are not met, interventions may need to be added or revised to help the patient meet their goals.
- Abad, C., Fearday, A., & Safdar, N. (2010). Adverse effects of isolation in hospitalised patients: A systematic review. The Journal of Hospital Infection, 76 (2), 97-102. https://doi.org/10.1016/j.jhin.2010.04.027 ↵
- Centers for Disease Control and Prevention. (2020, May 28). Breastfeeding, Frequently asked questions (FAQs). https://www.cdc.gov/breastfeeding/faq/index.htm ↵
- Centers for Disease Control and Prevention. (2020, May 28). Breastfeeding, Frequently asked questions (FAQs). https://www.cdc.gov/breastfeeding/faq/index.htm ↵
- “ Blausen_0425_Formed_Elements.png ” by BruceBlaus.com staff is licensed under CC BY 3.0 ↵
- Centers for Disease Control and Prevention. (2021, January 19). Candida auris . https://www.cdc.gov/fungal/candida-auris/index.html ↵
- Centers for Disease Control and Prevention. (2021, January 19). Candida auris . https://www.cdc.gov/fungal/candida-auris/index.html ↵
- LabTestsOnline.org. (2021, January 27). White blood cell count (WBC) . https://labtestsonline.org/tests/white-blood-cell-count-wbc ↵
- LabTestsOnline.org. (2021, January 27). White blood cell count (WBC) . https://labtestsonline.org/tests/white-blood-cell-count-wbc ↵
- LabTestsOnline.org. (2021, January 27). White blood cell count (WBC) . https://labtestsonline.org/tests/white-blood-cell-count-wbc ↵
- LabTestsOnline.org. (2021, January 27). White blood cell count (WBC) . https://labtestsonline.org/tests/white-blood-cell-count-wbc ↵
- LabTestsOnline.org. (2021, January 27). White blood cell count (WBC) . https://labtestsonline.org/tests/white-blood-cell-count-wbc ↵
- LabTestsOnline.org. (2021, January 27). White blood cell count (WBC) . https://labtestsonline.org/tests/white-blood-cell-count-wbc ↵
- LabTestsOnline.org. (2020, July 29). Erythrocyte sedimentation rate (ESR) . https://labtestsonline.org/tests/erythrocyte-sedimentation-rate-esr ↵
- LabTestsOnline.org. (2020, August 12). C-Reactive protein (CRP) . https://labtestsonline.org/tests/c-reactive-protein-crp ↵
- LabTestsOnline.org. (2020, August 12). Lactate. https://labtestsonline.org/tests/lactate ↵
- Herdman, T., & Kamitsuru, S. (2017). NANDA international nursing diagnoses: Definitions & classification 2018-2020 (11th ed.). Thieme Publishers. pp. 382, 405. ↵
- Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care . https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html ↵
- Johnson, M., Moorhead, S., Bulechek, G., Butcher, H., Maas, M., & Swanson, E. (2012). NOC and NIC linkages to NANDA-I and clinical conditions: Supporting critical reasoning and quality care. Elsevier. p. 268. ↵
- Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018). Nursing interventions classification (NIC). Elsevier. pp. 214, 226-227, 346. ↵
- Wilson, J., Bak, A., & Loveday, H. P. Applying human factors and ergonomics to the misuse of nonsterile clinical gloves in acute care. American Journal of Infection Control, 45 (7), 779-786. https://doi.org/10.1016/j.ajic.2017.02.019 . ↵
- Herdman, T., & Kamitsuru, S. (2017). NANDA international nursing diagnoses: Definitions & classification 2018-2020 (11th ed.). Thieme Publishers. pp. 382, 405. ↵
- This work is a derivative of StatPearls by Chakraborty & Burns and is licensed under CC BY 4.0 ↵


27.3: Recognizing Common Abdominal Disorders
By the end of this section, you will be able to:
- Examine the common causes for abdominal distention
- Recognize the common causes for abdominal bulges
- Remember the cause of enlarged abdominal organs
Patients may experience a multitude of symptoms when experiencing an abdominal disorder. Symptoms include increased gassiness, diarrhea , constipation, or pain. Abdominal disorders can be distinguished by general fullness or swelling called distention and or localized swelling referred to as bulges. Using a detailed patient interview to guide the physical exam, a nurse not only will be able to perform a complete abdominal assessment but also help identify causes of common abdominal disorders from distention to abdominal hernias and enlarged organs.
Common Causes of Abdominal Distention
It is important to assess for abdominal distention because it is a manifestation of numerous diseases. Assessing the abdomen when the patient is in the supine position is needed to see the abdomen in a relaxed state and the contour of the abdomen. Remembering to assess the abdomen in a look, listen, feel order. If the patient is sitting up during an abdominal exam, it is difficult to see if the abdomen is flat, concave, rounded, or distended. This positioning allows the nurse to assess for distention or bulges. The most common causes of abdominal distention are the “5 Fs” (Cleveland Clinic, 2021):
- Fat: Excess amounts of fat may be in the abdominal area due to obesity or a manifestation of certain diseases, such as Cushing syndrome. Excess visceral (abdominal) fat is associated with an increased risk for cardiovascular disease and insulin resistance.
- Flatus: Increased gas in the intestines can be caused by numerous conditions, such as aerophagia (swallowing air), food intolerance, carbonated beverages, irritable bowel syndrome, constipation, ulcerative colitis, and certain medications.
- Feces: Constipation can cause a buildup of feces in the intestines, in turn causing abdominal distention.
- Fluid: Ascites is a buildup of fluid in the peritoneal space (the layer of tissue that surrounds the abdomen) resulting from congestion within the liver, creating distention.
- Fetus: Abdominal distention during pregnancy occurs due to the growing uterus, which is housed in the lower abdomen. Different hormones during pregnancy allow the abdominal muscles to relax to allow for this expansion.
Getting older is a normal and healthy part of life. As one grows older, one of the benefits is that one may get wiser and develop life skills. Likewise, one must also make adjustments in their life to accommodate the changes related to the GI tract. When an individual ages, the following occur:
- Changes in diet and physical activity: As a person ages, they may become less active and lead a sedentary lifestyle, which contributes to constipation. Furthermore, an older person may need more fiber in the diet to account for the slowing of the intestines.
- Decreased muscle tone: Muscles lose tone over time and may cause stool to move more slowly through the intestines.
- Medications: As a person ages, they may need to take multiple medications. Often, a side effect of these medications is impaired bowel function leading to constipation.
- Slower digestion: When a person ages, the gut motility (how food moves through the gut) slows down. This can result in constipation.
- To account for these changes, the older adult should maintain a balanced diet full of fiber, stay well hydrated, engage in regular physical activity, and communicate with their provider about changes in their bowel patterns.
Common Causes of Abdominal Bulges
Common causes of abdominal bulges are hernias. Abdominal bulging may be differentiated from abdominal distention such that abdominal bulging may be localized to a specific area of the abdomen and not the entire abdomen. Abdominal bulges may be from hernias, tumors or masses, or enlargement of organs.
Hernias
Hernias are a common cause of abdominal bulges. A hernia occurs when an abdominal organ pushes through a weakness in the abdominal wall. There are different types of hernias; they are named for their location on the body (Figure 27.9), and include:
- epigastric hernia, involves the upper part of the stomach
- femoral hernia, similar to the inguinal hernia but lower in the groin; most commonly found in females
- incisional hernia, results from a surgical incision (healed or not fully healed)
- inguinal hernia (direct or indirect), the most common type of hernia that occurs in the groin or scrotum
- umbilical hernia, found at the belly button
Cause of Enlarged Abdominal Organs
The term visceromegaly refers to the abnormal enlargement of abdominal organs, such as the liver, stomach spleen, pancreas, or kidneys. This enlargement can be caused by a variety of diseases and conditions.
Enlarged Liver
The most common causes of hepatomegaly (enlarged liver) are:
- alcoholic liver disease. Excess consumption of alcohol can lead to liver inflammation and enlargement.
- cirrhosis: chronic liver damage, often from drug or alcohol use, that forms scar tissue in the liver, causing liver enlargement
- congestive heart failure. If the heart is unable to pump blood to the rest of the body, liver congestion may result, causing enlargement, in turn
- diseases: hematochromatosis, an excess of iron in the liver; Wilson’s disease, an excess of copper in the liver; both cause liver enlargement
- hepatitis: viral infection (types A, B, and C) that causes swelling and inflammation of the liver
- infections: parasitic or bacterial that cause the inflammation and organ enlargement
- liver cancer
- nonalcoholic fatty liver disease: caused by an accumulation of fat either from obesity or metabolic syndrome
Enlarged Spleen
An enlarged spleen is called splenomegaly . Splenomegaly can cause an increased risk of rupture and subsequent hemorrhage. Therefore, the nurse must educate the patient that there should be no contact sports and physical limitations are needed. Splenomegaly can be caused by multiple conditions, including:
- autoimmune diseases (e.g., lupus, rheumatoid arthritis)
- blood disorders: diseases that affect the blood cells (e.g., lymphoma, leukemia, anemias)
- infections (e.g., viral and bacterial infections, malaria)
- inflammatory disorders (e.g., sarcoidosis)
- liver disease
- metabolic disorders(e.g., Gaucher disease, Niemann–Pick disease)
- traumatic injury
Aortic Aneurysm
An aortic aneurysm is a localized enlargement of the abdomen at the level of the abdominal aorta . A person may not have symptoms, but the danger is that if the aortic aneurysm bursts, it can be life threatening and require emergency medical attention. Risk factors that may contribute to an abdominal aortic aneurysm are increased age, smoking, high blood pressure, and a family history of abdominal aortic aneurysm.
When a patient is experiencing an aortic aneurysm, conducting the physical exam is important to recognize the signs of this critical issue. This video demonstrates what signs to look for during the exam if an aortic aneurysm is present.
Enlarged Kidney
The enlargement of a kidney is called nephromegaly . Common causes of nephromegaly include:
- congenital (from birth) abnormalities: occur when the kidney is larger than normal from birth
- glomerulonephritis: inflammation of the kidney’s filtering system, which causes enlargement
- hydronephrosis: occurs when there is a backup of urine from the kidney that causes swelling; often caused by kidney stones, tumors, or structural abnormalities
- infections of the kidney: cause inflammation and swelling of the kidney
- polycystic kidney disease: genetic disorder in which multiple fluid-filled cysts grow on the kidney, causing enlargement
A healthcare provider may request a urinalysis and culture to test for infection, blood in the urine, or for different proteins and glucose.
Enlarged Gallbladder
An enlarged gallbladder can be caused by various conditions, including:
- biliary obstruction: tumors or structures in the bile ducts
- cholecystitis: inflamed gallbladder from infection
- gallstones: hardened deposits of the gallbladder that obstruct the bile flow of bile
- heart failure: often associated with liver enlargement, which leads to gallbladder distention
- pancreatitis: inflammation of the pancreas that leads to swelling of the surrounding areas, including the gall bladder
Stomach Cancer
Stomach cancer, or gastric cancer , occurs when abnormal cells grow rapidly in the lining of the stomach. The most common causes of stomach cancer are:
- age and sex: older adults and males are more prone to stomach cancer.
- chronic gastritis: inflammation of the stomach lining associated with Helicobacter pylori
- diet: diets high in salt, pickled foods, and smoked foods, and diets low in fruit and vegetables may increase risk of stomach cancer
- family history: familial history of stomach cancers
- H. pylori infections: long-term infection by this bacterium increases risk of stomach cancer
- previous stomach surgeries
- tobacco and alcohol use