Exam 1

Health Promotion

The process of enabling people (individuals, families, communities, and populations) to increase control over, and to improve their health

- the "goal" of being healthy

- behavior of a person who is motivated by a personal desire to increase well-being and health potential

Wellness

- Positive state of health of an individual, family, or community.

- It is multi-dimensional encompassing several dimensions, including physical, mental, spiritual, social, occupational, environmental, intellectual, and financial

- active state of being healthy

Disease Promotion

Behaviors motivated by a desire to avoid illness, detect illness early, and manage illnesses when they occur

Illness

- is an abnormal process in which any of the person's functioning is altered, in comparison to the previous condition of health

- a personal state in which a person's physical, emotional, intellectual, social, developmental, spiritual function is compromised or diminished

- can be chronic or acute

Health (WHO)

- as morbidity or how frequently a disease occurs and mortality or number of deaths resulting from disease.

Morbidity

-how frequently a disease occurs

Mortality

the number of deaths resulting from a disease

Disease (illness-wellness continuum)

- 0

- premature death

- multiple medications

- poor quality of life

- potential becomes limited

- body has limited function

Poor Health (illness-wellness continuum)

- 1-3

- symptoms

- drug therapy

- surgery

- losing normal function

Neutral (Illness-wellness continuum)

- 4-6

- no symptoms

- nutrition inconsistent

- exercises sporadic

- health not a high priority

Good health (illness-wellness continuum)

- 7-9

- regular exercise

- good nutrition

- wellness education

- minimal nerve interference

Optimal Health (illness-wellness continuum)

- 10

- 100% function

- continuous development

- active participation

- wellness lifestyle

Levels of Health promotion

1. Primary Prevention

2. Secondary Prevention

3. Tertiary Prevention

Primary Health Promotion

➔Directed toward promoting health and preventing the development of disease/injury.

➔“P” -> Prevent

➔Focus on people or groups

➔Examples:

◆immunization clinics

◆family planning,

◆accident prevention education

Secondary Health Promotion

➔Focus on screening for early detection of disease

➔“S” for Sceening

➔Identify illness, reverse or reduce its severity or provide a cure returning person to maximum health as quickly as possible

➔Examples:

◆Encouraging regular medical/dental/vision exams

◆Screenings like BP, Lipids, Skin, Breast Checks

➔Direct nursing interventions at this level include administering appropriate meds and caring for wounds

Tertiary Health Promotion

➔After disease/illness diagnosed and treated with goal of reducing disability and helping rehab patients to max functioning

➔Examples:

◆Teaching on disease state & preventing complications

◆Monitoring response to prescribed therapy

◆Linking services to enhance quality of life

Dimensions of Wellness and Health

•These factors influence a person's health-illness status as well as health beliefs and health practices

•Each dimension interrelates and impacts a person's behaviors toward both health and illness

•Nursing assessments of strengths and weaknesses in each dimension help develop plan of care fit for the individual in a holistic manner

- intellectual

- environmental

- spiritual

- sociocultural

- emotional

- physical

Environmental (dimension of health and wellness)

housing, sanitation, climate, pollution, safe food/water accessibility

Intellectual (dimension of health and wellness)

cognitive abilities, education, past experiences

Sociocultural (dimension of health and wellness)

economic level, lifestyle, family, and culture

Spiritual (dimension of health and wellness)

religious and/or spiritual

Physical (dimension of health and wellness)

genetic, age, development, race, biological sex, not mentioned in book but important to consider gender identity as well as sex assigned at birth

Emotional (dimension of health and wellness)

the mind, stress, emotions

Children & Adolescents age related health promotion activities

- Reducing obesity,

- improving healthy food options,

- preventing tobacco use,

- managing chronic conditions,

- social/emotional learning,

- dental health,

- promoting better sleep,

- immunizations,

- safety precautions (internet, seatbelt, helmet).

Characteristics of Resilient Teenagers: Home

- connected, caring parents or family members

- acceptance of responsibility

- chores

- care of siblings or other relatives

Characteristics of Resilient Teenagers: Education and Employment

- better than average school performance

- feelings of connection to school

- limited employment (>20 hr/wk)

- strong participation in extracurricular, school-related activities, including sports

Characteristics of Resilient Teenagers: Activities

- leadership among peers

- religious affiliation

Characteristics of Resilient Teenagers: Drugs

- pledge to abstain

- refusal skills

Characteristics of Resilient Teenagers: Sexuality

- pledge to abstain

- refusal skills

- consistently responsible sexual behavior

Characteristics of Resilient Teenagers: Suicidality

- no personal history of attempted suicide

- no family history of attempted or accomplished suicide

- access to a confidant

- successful coping skills

- substance free

Characteristics of Resilient Teenagers: Safety

- seat belt and helmet use

- conflict resolution skills

- substance free

- refusal to ride in cars with potentially intoxicated driver

Adults (age related health promotion activities)

- Smoking cessation,

accessing healthy food/physical activity,

-preventing excessive alcohol use,

- promoting lifestyle change & disease management,

- reproductive health,

- preventative screening services (mammogram, colonoscopy, skin cancer, testicular exam, gyn testing),

- dental health,

- mental and emotional wellbeing,

- better sleep

Older Adults (age related health promotion activities)

- Dementia screening,

- caregiver support,

- preventing falls,

- reducing pain,

- arthritis intervention,

- screening for chronic conditions,

- immunizations (flu, pneumonia),

- dental care,

- better sleep,

- emotional wellbeing

Multiple Sclerosis

- A chronic disease of the central nervous system marked by damage to the myelin sheath.

- Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech

cause of multiple sclerosis

unknown cause

Risk Factors for Multiple Sclerosis

◆Geographic location (being farther from equator)

◆Vitamin D

◆Smoking

◆Obesity

◆Genetic predisposition

◆Infection: measles, EBV, HSV 6

Factors that improve health outcomes of Multiple Sclerosis

➔ diet and lifestyle improvements including staying physically fit, eating a healthy diet, reducing stress, enhancing wellbeing

➔ Exercise has been associated with reduced rates of MS relapses and slowed disability progression

Disease Prevention

behavior motivated by a desired to avoid or detect disease or to maintain functioning within the constraints of an illness of disability.

Neonate

first 4 weeks of life

Infant

from 4 weeks old to 1 year old

Toddler

from 1 to 3 years of age

Preschool child

from 3 to 5 years of age

School age child

from 6 to 12 years of age

Adolescent

ranges from 13 to 17 years of age

Young Adult

from 18 to 25 years of age

Adult

defined as from 26 to 65 years of age

Older Adult

over 65 years of age

Developmental Stages and Prevention: Childhood

■Vaccines: Birth Through Age 18 Immunization Schedule | AAFP

■Lead, anemia (Iron deficiency anemia)

■Screentime, safety (outdoor, internet)

■Obesity

Developmental Stages and Prevention: Adolescence

■Vaccines: Birth Through Age 18 Immunization Schedule | AAFP

■Obesity, cholesterol, diabetes, hypertension

■Safety (outdoor, vehicle, gun, sex practices, internet)

Developmental Stages and Prevention: Adulthood

■Vaccines: Adult Immunization Schedule | AAFP

■Obesity, chronic diseases, oral health etc

Developmental Stages and Prevention: Older Adult

■Vaccines: Adult Immunization Schedule | AAFP

■Chronic diseases, safety, oral health

Modifiable Risk Factors

- can be changed or adjusted

- Diet

•Lifestyle

•Living circumstances

•Smoking

•Alcohol Intake

•Accessing healthcare/attending screening activities

Nonmodifiable Risk Factors

- non-modifiable things that cannot be changed

- Sex assigned at birth

•Genetics

•Race

•Age

Major Risk Factor Areas

•Age - each age group has specific health risk factors to be aware of

•Genetic factors - importance of personal & family hx

•Physiological factors - obesity, pregnancy

•Health habits

•Lifestyle

•Environment

Primary Prevention

➔intervening before health effects occur

◆ex.) vaccines, altering risky behaviors (poor eating, tobacco use)

Secondary Prevention

➔screening to identify diseases in earliest stages, before onset of signs and symptoms

◆ex.) mammogram, BP testing

Tertiary Prevention

➔managing disease post diagnosis to slow or stop progression

◆ex.) chemotherapy, rehab, screening for complications (falls, nutritional imbalances)

Types of Clinical Preventative Care

- immunization

- screening

- behavior/lifestyle counseling

- chemoprevention

Immunization (clinical preventative care)

●Childhood immunizations to prevent 15 different diseases & occur in the first few months-years of life

●Adolescent vaccines include HPV, meningococcal

●Adult immunizations include DPT boosters as well as flu, pneumonia, hepatitis A & B, shingles if appropriate

●Now covid-19 vaccines recommended across lifespan as well

●Goal is to prevent disease BEFORE it occurs.

Screening (clinical preventative care)

•Identification of asymptomatic diseases or risk factors, can be population specific (pregnancy, HIV, MSM, DM, older adults, transgender, cancer survivors)

•Wide and encompasses many clinical moments (simple as BP, complex as domestic violence)

•Testing starts in prenatal period - Down syndrome, maternal BP etc

•Continue throughout life including mammogram, colonoscopy, depression/anxiety, hearing, vision/dental visits, specific/tailored screenings dependent upon concern or condition

Behavioral/Lifestyle (clinical preventative care)

●How best to educate on lifestyle changes, find out what motivates patient, can be hard to achieve this preventative activity in clinical practice as time is limited

●We know this is most important preventative activity, though!

●Think about educating on smoking cessation, eating healthy diet, limiting alcohol, increasing physical activity, or safe sex practices

●Important to know & understand evidence that behavior change = risk reduction for condition and that counseling leads to behavior change

Chemoprevention (clinical preventative care)

•Using medications to prevent disease or prevent worsening disease states

•Used early in life to prevent disease ex.) folate during pregnancy to prevent NTD or ocular prophy abx to newborns

•Think statin treatment for hypercholesterolemia or BP medication, diabetes treatment to prevent target-organ damage

•Want to intervene before disease occurs or to prevent worsened health outcomes in the future

Chronic Disease

➔Sometimes referred to as Non Communicable Diseases (NCDs)

➔Include heart disease, CVAs, cancer, chronic respiratory disease, diabetes, obesity, and oral disease

➔Affect physical health as well as psychological states

➔Negatively impact level of autonomy and skills needed to perform daily tasks

➔Often are permanent

➔Associated with functional limitations in many different physical and mental dimensions

Treatments often targeted on disease modification, prevention of further health decline, and improvement of overall quality of life and health

Individual Prevention

•Modifiable vs non modifiable risk factors

•Risk compounding

•Focus on developmental stages and appropriate prevention recommendations

•Personal education, family values, financial situation, lifestyle

•Participating in health screening practices

Consider the health dimensions here

Local Prevention

•Extends beyond individual

•Local community actions to promote change in order to prevent or reduce illness and disease

•Strategies include community education, neighborhood awareness

•Zoning laws to create safe exercise spaces or reduce number of liquor stores

•Community involvement can promote individuals accessing healthier lifestyle choices

State Prevention

•Promote both local and federal prevention efforts

•Inspections or regulation enforcement efforts at foods establishments, swimming pools, waste disposal

•State-sponsored efforts support health screening programs e.g. anti-smoking, health education efforts

•Child lead poisoning prevention, heart disease and stroke prevention programming

National Prevention

•Includes regulatory programs, health initiatives, policies that establish programming to reduce both presence and exposure to harmful agents in environment

•Examples are Clean Water Act, National Tobacco Control Program, National Asthma Control

•Think about Environmental Protection Agencies, Health and Human Services, DEA, USDA, Dept of Housing and Urban Development

Awareness and Education

•Inform and educate decision makers, practitioners, providers, and individuals about health prevention

•Educate workers both in and out of health field

•Public health education initiatives

•Media's role in promoting prevention activities

•Programs to proactively educate targeted groups such as those at high risk for disease or injury

Physical Activity Recommendations: Kids (6-17 years old)

60 minutes or more of physical activity each day

Physical Activity Recommendations: Preschool- ages Children (3-5 years old)

physically active throughout the day with opportunities for active play

Physical Activity Recommendations: Adults

•150 minutes each week of moderate-intensity aerobic activity every week PLUS

•Muscle strengthening activities 2 days a week

•Easy as walking 30 minutes 5 days a week

Subjective data

what the patient "says"

Objective data

what you as the nurse "observe"/collect from your physical exam assessment

Physical Activity

•As a preventative tool to reduce chronic disease

•CDC (2020) lists as a key component to reduce risk of chronic conditions like type 2 diabetes, heart disease, cancer, depression and anxiety, and dementia

Healthy Eating

•Another preventative measure to reduce chronic disease risks

•Overweight and being obese linked to cardiovascular disease, type 2 diabetes, sleep issues (OSA), infertility, musculoskeletal problems, shortened life expectancy

•Range of weights that are linked to higher rates of disease

•Affected by behavior, environment, and genetics

Overweight vs Obese

- Over: excess body weight compared to standards

- Obese: abnormally high proportion of body fat

•BMI is an important factor in defining weight categories but is not always the best measure most notably in those with disabilities

•Underestimates the amount of fat vs amount of lean muscle mass

•Can use waist circumference: males >40 in, women >35 inches higher risk for obesity-related complications

•BMI 25-29.9 is overweight; BMI 30 + is obese in adults

•BMI >95th percentile is obese in children

•CDC (2022) lists obesity as an epidemic requiring multifaceted approach to addressing problem

Healthy Eating Recommendations

•Part of tackling obesity epidemic is addressing healthy eating

•Not just eating healthy foods but having a good relationship with foods, choosing foods that fit lifestyle and promote wellbeing for both person and environment

•CDC (2022) uses MyPlate which is personalized based on age, sex, height, weight, and physical activity level to give recommendations on how much of each food group to eat daily

•Not just a unilateral practice, must be combined with other elements of healthy lifestyle such as physical activity

Imbalanced Nutrition (nursing assessment)

•Assess patient's BMI & VS, consider waist circumference

•Assess current diet

•Evaluate physical, mental, and emotional status related to weight

•Assess complications with overweight/obese

•Evaluate knowledge base of nutritious diet

•Evaluate access to healthy foods and any possible limitations including transportation, cost, living environment, time

•Documenting weight objectively and including VS helps us better understand what risks a patient may have at developing a chronic disease or worsening health complications

•Looking at diet and knowledge around healthy eating can help us target interventions appropriate for patient

•Very important to assess for mental health issues r/t body image

•Also important to understand a patient's access to healthy foods so that appropriate services can implemented if needed

Activity Tolerance (nursing assessment)

- Assess physical activity level and mobility e.g. perform activity like walking or lifting light weights, AROM & PROM, work with PT/OT

- Taking resting pulse, BP, RR; Listen to heart sounds

- Perform activity then repeat VS s/p activity. Have patient rest and repeat VS in 3 minutes

- Provides baseline data for evaluation and intervention at nursing level

- Meaningful changes in VS can signal need for reduction in duration or intensity

- Warning signs (chest pain, vertigo, decreased VS suddenly) signal very poor tolerance and need for higher level intervention (i.e. notifying provider, calling EMS etc)

Obesity and Low Back Pain

•Low back pain (LBP) is a leading cause of disability worldwide

•80% of adults experience at least 1 episode during their lives

•Research focuses on modifiable risk factors for back pain

*** lower educational status, physically demanding work, emotional disorders, & being overweight or obese especially in females (weakly linked in males)

*** Obesity may have both biomechanical and inflammatory effects on body and spine

*** Higher fat mass correlated with higher pain intensity and disability in back

•Chou et. al. (2016) found mood disorders coupled with obesity linked to higher rates of subjective low back pain

•Hard to tease apart what comes first the mood disorder or obesity - likely multifactorial, just like our dimensions of health

Supportive Services for patients

●Pharmacological – advocate for patient to provider

●Educational – provide written information, digital/media links

●Community programming – free outdoor activities, walking, free or low cost gym

●Referrals – dietician, PT/OT, mental health, social work

Bacterial Pneumonia Caused by...

caused by Streptococcus pneumonia, Group A streptococci, Staphylococcus aureus, Mycoplasma catarrhalis, Mycoplasma pneumoniae

Expected Findings for Bacterial Pneuomonia

- high fever

- cough that can be unproductive or productive of white sputum

- Tachypnea

- Retractions and nasal flaring

- Chest pain

- Dullness with percussion

- Adventitious breath sounds (rhonchi, fine crackles)

- Pale color that can progress to cyanosis

- Irritability, restlessness, lethargy

- Abdominal pain, diarrhea, lack of appetite, and vomiting

Laboratory Tests for Bacterial Pneumonia

- radiographic examination to detect presence of infiltrates

- Gram stain and culture of sputum in older children

- nasopharyngeal specimens

- blood cultures

- occasionally lung aspiration and biopsy

- elevated anti-streptolysin titer if streptococcal infection present

Nursing Care for Bacterial Pneuomonia

- encourage rest

- administer IV antibiotics

- promote increased oral intake

- monitor I & O

- administer antipyretics for fever

- CPT and postural drainage can be helpful

- Administer IV fluids

- Administer oxygen

- monitor continuous oximetry

- the pneumococcal conjugate vaccine is encouraged for the prevention of pneumonia

Effects of Illness on Patient & Family Depends on....

•Nature (what type it is or how it was contracted)

•Severity (acute or chronic)

•Duration of events (how long did it happen)

•Attitudes towards the precipitating factor by the patient and others (how is it emotional affecting you)

•The associated financial cost (missing work)

•The required lifestyle changes (dieting, exercising, taking medication)

•The significant adjustments in usual roles (kid becomes caregiver)

health-illness continuum

- description of a person's health status as a range with anchors that include poor health or imminent death on one end of the continuum to high-level wellness on the other end

- Beginning at a high level of wellness, an individual can move through good health, normal health, poor health, extremely poor health, and eventually to death.

- Individuals move back and forth within this continuum day by day

Acute Illness

- Characterized by severe symptoms of relatively short duration.

- •Symptoms often appear abruptly and subside quickly, may or may not require intervention by healthcare professionals.

- •Many subside without medical intervention or with only OTC medications

- •Following illness, most individuals return to their normal level of wellness.

Illness Behaviors (stages)

Stage 1: Experiencing symptoms

Stage 2: Assuming the sick role

Stage 3: Assuming a dependent role

Stage 4: Achieving recovery and rehabilitation

SARS-CoV-2

- COVID

- community acquired

- viral

- transmission-person to person (droplets) or fomite (inanimate objects)

Chronic Illness

- •One that lasts for an extended period, usually 6 months or longer, and often for the duration of the individual’s life.

- •Usually have a slow onset and have periods of remission, when the symptoms disappear , and episodes of exacerbations when the symptoms reappear.

Situations of Family Crises

- chronic illness

- major injuries

- mental illness

- pediatric illness

Major injuries-

lose of a body part (mastectomy, amputation, disfigurement)

Mental illness

- a disorder that affects a person's thoughts, emotions, and behaviors

- bipolar, anxiety

Kubler-Ross Grief Cycle

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

Kubler-Ross Grief Cycle: Denial

- avoidance

- confusion

- excitement

- shock/fear

Kubler-Ross Grief Cycle: Anger

- frustration

- irritability

- anxiety

Kubler-Ross Grief Cycle: Bargaining

- struggle to find meaning

- to help others

- to tell your own story

Kubler-Ross Grief Cycle: Depression

- helplessness

- hostility

- avoidance

Kubler-Ross Grief Cycle: Acceptance

- exploring opportunities

- introducing new plans

- moving forward