Health promotion and maintenence

What framework should I use for every Health Promotion question?

AGE/STAGE → EXPECTED → RISK → PREVENT → SCREEN → TEACH

Ask:

• What age/life stage?

• What is normal here?

• What is NOT expected?

• What risk should be prevented?

• What screening fits?

• How should I teach this person?

What is Health Promotion mostly testing?

NORMAL vs ABNORMAL

and

PREVENTION vs TREATMENT

You are often being asked:

“Is this expected for this age/stage, or does it need follow-up?”

Primary vs secondary vs tertiary prevention?

PRIMARY = PREVENT IT

Before disease occurs.

Examples:

• Vaccines

• Smoking cessation

• Exercise

• Folic acid

• Sunscreen

• Condoms

• Injury prevention

SECONDARY = FIND IT EARLY

Screening.

Examples:

• Mammogram

• BP screening

• Cervical screening

• Colorectal screening

• Newborn screening

TERTIARY = LIMIT THE DAMAGE

Disease already exists.

Examples:

• Cardiac rehab

• Stroke rehab

• Diabetic foot-care program

• PT after injury

What should I assess BEFORE teaching?

• Readiness

• Pain

• Anxiety

• Cognitive ability

• Developmental level

• Language

• Literacy

• Hearing/vision

• Motivation

• Prior knowledge

• Physical ability

🚨 Severe pain, respiratory distress, vomiting, sedation, crisis?

STABILIZE FIRST. TEACH LATER.

What is the best way to know teaching worked?

TEACH-BACK

Better than:

“Do you understand?”

Ask:

“Show me how you'll use the inhaler.”

or

“Tell me what you'll do if your blood sugar is low.”

Demonstration/explanation = actual understanding.

What if the client does not speak the nurse's language?

Use a trained medical interpreter when needed.

Don't rely on:

• Young children

• Random staff

• Family for complex/sensitive interpretation when professional interpretation is appropriate

And:

Speak directly to the client, not just the interpreter.

What developmental task goes with each age group?

• Infant → Trust

• Toddler → Autonomy

• Preschool → Initiative

• School age → Industry

• Adolescent → Identity

• Young adult → Intimacy

• Middle adult → Generativity

• Older adult → Integrity

What should I associate with the infant stage?

TRUST + CAREGIVER

Nursing:

• Meet needs consistently

• Comfort/hold

• Maintain routines

• Encourage caregiver presence

Play:

• Sensorimotor/solitary

• Rattles

• Mobiles

• Peek-a-boo

What should I associate with toddlers?

AUTONOMY = “I DO IT.”

Expected:

• “No!”

• Independence

• Ritualism

• Temper tantrums

• Parallel play

• Exploration

Nursing:

• Give 2 acceptable choices

• Keep routines

• Set safe limits

Don't ask:

“Do you want your medicine?”

Say:

“Water or juice with your medicine?”

What should I associate with preschoolers?

INITIATIVE + MAGICAL THINKING + PRETEND PLAY

Expected:

• Imagination

• Curiosity

• Associative play

• Belief thoughts can cause events

Teaching:

• Simple

• Concrete

• Play/dolls/models

• Shortly before procedure

Never imply illness/procedure is punishment.

What should I associate with school-age children?

INDUSTRY = ACHIEVEMENT

They value:

• Tasks

• School

• Skills

• Rules

• Peer comparison

• Completing things

Nursing:

• Explain procedures

• Let them participate

• Give achievable tasks

Play:

COOPERATIVE

What should I associate with adolescence?

IDENTITY + PEERS + PRIVACY

Important:

• Body image

• Independence

• Sexuality

• Peer influence

• Risk-taking

• Future goals

Nursing:

• Speak directly to adolescent

• Provide privacy

• Explain confidentiality limits

• Assess mood, substances, sexual health, violence, safety

• Avoid judgment

Young, middle and older adult developmental focus?

Young adult
→ intimacy, relationships, independence, career

Middle adult
→ generativity, productivity, family, mentoring, contribution

Older adult
→ integrity, reflection, meaning, acceptance

What play type belongs to each stage?

• Infant → solitary/sensorimotor

• Toddler → PARALLEL

• Preschool → ASSOCIATIVE + pretend

• School age → COOPERATIVE

• Adolescent → peer/social activities

Memorize:

Parallel → Associative → Cooperative

What are the two major directions of child development?

HEAD → TOE

Cephalocaudal

CENTER → OUTWARD

Proximodistal

Also:

Gross motor control generally develops before refined fine-motor control.

What milestone sequence matters more than memorizing 100 exact dates?

MOTOR:

Head control → roll → sit → crawl → stand → walk → run

LANGUAGE:

Coo → babble → words → 2-word phrases → sentences

What are the high-yield infant growth facts?

Birth weight generally:

• Doubles around 4–6 months

• Triples around 1 year

Growth is rapid during infancy.

What major milestones should I recognize in early infancy?

~2 months

• Social response

• Looks at caregiver

• Early head control

• Sounds beyond crying

~4 months

• Social smile/laugh

• Better head control

• Reaching/tracking

~6 months

• ROLL + REACH + SIT WITH SUPPORT

• Mouths objects

• Recognizes familiar people

What major milestones should I recognize later in infancy?

~9 months

• Sits independently

• Babbling

• Responds to name

• Transfers objects

• Stranger anxiety

~12 months

• Pulls to stand/cruises

• May take steps

• Waves

• Simple words/special caregiver name

• Understands simple commands like “no”

Think:

STAND + WORDS + GESTURES

What are the big toddler milestone clusters?

~18 months

• Walks independently

• Scribbles

• Uses spoon imperfectly

• Increasing vocabulary

• Increasing independence

~2 years

• RUNS

• Kicks ball

• 2-WORD PHRASES

• Follows simple directions

• PARALLEL PLAY

Think:

RUN + TWO WORDS + PARALLEL

What developmental finding should NEVER be brushed off?

LOSS OF A PREVIOUSLY ACQUIRED SKILL

Also concerning:

• Major delay across domains

• Significant language delay

• No progression in gross motor skills

• Does not respond to sound

• Severe social delay

• Regression

Regression = FOLLOW UP.

What do fontanel findings tell me?

Posterior fontanel
→ closes earlier

Anterior fontanel
→ closes later, usually during second year

Sunken
→ think dehydration

Persistently bulging in calm infant
→ possible increased ICP/illness

When is a toddler ready for toilet training?

Readiness > exact age.

Look for:

• Stays dry for periods

• Recognizes urge

• Can sit/walk

• Can communicate needs

• Interested in toileting

• Follows simple directions

Never punish accidents.

What are toddlers at highest risk for?

Because mobility > judgment:

• Poisoning

• Falls

• Burns

• Drowning

• Choking

• Motor-vehicle injury

Teach:

• Lock meds/chemicals

• Supervise water

• Keep small objects away

• Protect stairs/windows

• Keep hot objects away

What are the high-yield nutrition rules?

INFANT

• Breast milk and/or iron-fortified formula primary early nutrition

• Introduce complementary foods when developmentally ready

• NO HONEY <1 year

• Cow's milk should not replace breast milk/formula as primary drink in first year

• Avoid choking hazards

TODDLER

• Appetite may decrease as growth slows

• Small nutritious meals/snacks

• Don't force food

• Avoid power struggles

What are the stable NCLEX vaccine principles?

• Vaccines = PRIMARY prevention

• Screen for contraindications

• Mild illness ≠ automatic reason to withhold

• Live vaccines require caution in pregnancy/severe immunosuppression

• Keep vaccines up to date

• Delayed series generally doesn't need restarting solely because time passed

High-yield live examples:

MMR + VARICELLA

Avoid during pregnancy.

What is screening?

SECONDARY PREVENTION

Looking for disease/risk before obvious symptoms.

Screening depends on:

• Age

• Reproductive anatomy/sex

• Family history

• Previous results

• Lifestyle

• Risk factors

Risk changes the plan.

How do I distinguish screening from diagnostic evaluation?

Asymptomatic
→ screening

Symptomatic
→ diagnostic evaluation

Example:

Routine mammogram in appropriate asymptomatic client
→ screening.

New breast mass
→ needs diagnostic evaluation, not just routine screening.

How should I approach high-risk health behavior questions?

Assess:

• Tobacco

• Alcohol

• Substances

• Unsafe sex

• Poor diet

• Sedentary lifestyle

• Unsafe driving

• Sun exposure

Do NOT shame.

Assess readiness to change + provide realistic risk reduction.

What are the big contraception principles?

No method is “best” for everyone.

Consider:

• Pregnancy goals

• Medical history

• Adherence

• STI protection

• Contraindications

• Client preference

CONDOMS

→ reduce STI transmission.

Hormonal contraception

→ does NOT protect against STIs.

When should estrogen-containing contraception make me concerned?

Think CLOT RISK.

Question in clients with:

• Major thromboembolic history

• Certain clotting disorders

• Migraine with aura

• Uncontrolled HTN

• Smoking at older reproductive age, especially 35+

• Certain estrogen-sensitive cancers

What is the main preconception teaching?

Promote:

• Chronic disease control

• Medication review

• No tobacco/alcohol/drugs

• Healthy nutrition

• Vaccination

• Family/genetic history when indicated

FOLIC ACID

reduces neural-tube-defect risk.

Important:

It matters BEFORE pregnancy is often recognized.

Presumptive vs probable vs positive signs?

PRESUMPTIVE

Client experiences:

• Amenorrhea

• Nausea

• Breast tenderness

• Fatigue

• Urinary frequency

• Quickening

PROBABLE

Objective but not definitive:

• Positive pregnancy test

• Uterine enlargement

• Cervical changes

• Braxton Hicks

POSITIVE

Fetus directly confirmed:

• Fetal heart activity

• Ultrasound visualization

• Fetal movement palpated by examiner

How do I estimate a due date from LMP?

SUBTRACT 3 MONTHS → ADD 7 DAYS → ADD 1 YEAR

Example:
May 10 → February 17 of next year.

Which pregnancy findings can be expected?

Often expected:

• Urinary frequency

• Breast tenderness

• Mild dependent edema

• Increased vaginal discharge

• Constipation

• Heartburn

• Mild SOB later

• Mild ↑ HR

• Pigmentation changes

• Braxton Hicks

Expected discomfort ≠ dangerous complication.

What pregnancy findings require evaluation?

🚨 Report:

• Vaginal bleeding

• Severe headache

• Visual changes

• RUQ/epigastric pain

• Sudden marked swelling

• Leaking fluid

• Preterm regular contractions

• Significantly decreased fetal movement

• Severe abdominal pain

• Fever

• Significant difficulty breathing

Pregnant client becomes dizzy/hypotensive while lying flat. What do I think?

VENA CAVA COMPRESSION

Cues:

• Dizzy

• Pale

• Nauseated

• Hypotensive while supine

Action:

TURN SIDE-LYING, commonly LEFT.

Improves venous return.

What is the key distinction between true and false labor?

TRUE LABOR

• Stronger

• More regular

• Closer together

• Continue despite rest/activity

• PROGRESSIVE CERVICAL CHANGE

FALSE LABOR

• Irregular

• Don't progressively intensify

• May improve with rest/activity changes

• No progressive cervical change

Cervical change = TRUE labor clue.

What are the 4 stages of labor?

1. True labor → complete dilation

2. Complete dilation → birth

3. Birth → placenta

4. Immediate postpartum recovery

What should a normal postpartum fundus feel like?

FIRM + MIDLINE

Boggy
→ think uterine atony/bleeding risk.

Displaced laterally/right
→ think FULL BLADDER

A full bladder can prevent good uterine contraction.

What is the normal lochia progression?

RUBRA → SEROSA → ALBA

• Rubra = red/bloody

• Serosa = pink/brown

• Alba = white/yellow

Concern:

• Heavy bleeding

• Large clots

• Return to heavy bright-red bleeding

What postpartum symptoms should NEVER be brushed off?

• Heavy bleeding

• Large clots

• Fever

• Foul lochia

• Severe headache

• Vision changes

• Chest pain

• Shortness of breath

• Unilateral leg pain/swelling

• Severe abdominal pain

• Severe worsening mental-health symptoms

How do I distinguish postpartum blues, depression and psychosis?

BLUES

• Early

• Mild

• Tearful

• Irritable

• Overwhelmed

• Temporary

DEPRESSION

• More persistent/severe

• Sadness

• Loss of interest

• Guilt/hopelessness

• Poor functioning

• Bonding difficulty

PSYCHOSIS 🚨

• Hallucinations

• Delusions

• Severe confusion

• Disorganized behavior

• Harm-related thoughts/commands

Psychosis = EMERGENCY.

Parent + infant safety first.

What newborn respiratory findings are NOT normal?

🚨

• Grunting

• Nasal flaring

• Retractions

• Central cyanosis

• Persistent tachypnea

• Apnea

Think:

RESPIRATORY DISTRESS → EVALUATE

Why are newborns at high risk for heat loss?

• Large surface area

• Limited insulation

• Immature thermoregulation

Prevent with:

• Drying

• Skin-to-skin

• Warm blankets

• Hat

• Warm environment

Cold stress increases metabolic demand.

What feeding/jaundice findings should concern me?

Watch feeding for:

• Poor latch

• Persistent sleepiness preventing feeds

• Dehydration

• Excessive weight loss

JAUNDICE

Some later jaundice can occur in normal transition.

🚨 Jaundice in FIRST 24 HOURS = concerning

Also:

• Rapid worsening

• Poor feeding

• Lethargy

• High bilirubin

What is the safe sleep pattern?

BACK + FIRM + EMPTY

• Back to sleep

• Firm surface

• No loose blankets

• No pillows/soft objects

• Avoid overheating

• Appropriate separate sleep surface

Don't put infant prone because “they sleep better.”

What can be normal aging, and what is NOT normal?

POSSIBLE NORMAL AGE-RELATED CHANGES

• Thinner/less elastic skin

• Reduced bone density

• Reduced muscle mass

• Reduced renal reserve

• Slower GI motility

• Presbyopia

• Presbycusis

• Slower reaction time

• Sleep changes

NOT NORMAL

• Acute confusion

• Severe functional memory loss

• Depression

• Repeated falls

• New incontinence

• Major unexplained weight loss

• Severe pain

• SOB

• Major functional decline

NEW CONFUSION ≠ NORMAL AGING.

What are ADLs vs IADLs, and why do they matter?

ADLs = BASIC SELF-CARE

• Bathing

• Dressing

• Toileting

• Feeding

• Transferring

• Continence

IADLs = INDEPENDENT LIVING

• Medications

• Shopping

• Cooking

• Transportation

• Finances

• Housekeeping

IADL decline may occur before ADL loss.

Before discharge ask:

• Can they physically do it?

• Do they understand?

• Can they get meds/equipment?

• Can they afford/access care?

• Transportation?

• Caregiver support?

• Home hazards?

A perfect plan is useless if the client cannot actually carry it out.

What should I mentally say before answering any Health Promotion question?

“This client is a ______, so I EXPECT ______. Their biggest age/life-stage RISK is ______. The appropriate PREVENTION/SCREENING/TEACHING is ______. The finding that is NOT EXPECTED and needs follow-up is ______.”

Then ask:

Is this NORMAL for the stage or ABNORMAL?

And:

Is this asking me to PREVENT, SCREEN, or LIMIT COMPLICATIONS?