EM

Health Promotion

NCLEX Exam Preparation Notes

Basic Care and Comfort

  • Basic care and comfort is often a weak area for students.
  • Focus on preventing pressure ulcers and other simple aspects of patient care.

Blueprint Overview

  • Focus on safety-related issues in all categories.

Health Promotion

  • Older Adults:
    • Health promotion teachings for older adults in home health include:
      • Immunizations
        • Annual flu vaccine
        • Shingles vaccine (for those 55 and older who had chickenpox)
        • Pneumococcal vaccine (for pneumonia prevention, especially important for those with respiratory issues)
          • Typically a one-time shot, but follow healthcare provider recommendations.
  • Immunizations (General):
    • Understanding general information is key.
    • Specific schedules are less important due to frequent updates, but understand health-promoting activities related to vaccines like Hepatitis B, Hib, and MMR.
    • Measles immunization recommendations are fluid due to outbreaks.
  • General Well-being:
    • Encourage aerobic exercise (3-4 times a week, 30-60 minutes).
    • Walking is a great exercise for most people.
  • Diet:
    • Consider the patient's age when discussing diet.
    • Infants:
      • Assess nutritional status by:
        • Weighing the baby.
        • Comparing current weight to birth weight and previous visits.
        • Evaluating dietary history using a three-day dietary recall.
          • Type of feeding (breastfed vs. bottle-fed).
          • Supplementation with foods based on age.
      • Dietary recall is commonly used to assess anyone's nutritional status.
    • Adults:
      • Assess nutrition through:
        • Dietary history.
        • Blood tests (cardiac panel for cholesterol, LDL, HDL, triglycerides).
          • LDL: low-density lipoprotein.
          • HDL: high-density lipoprotein.
        • Complete Blood Count (CBC) for anemia.
          • Iron deficiency is common in young children before solid food intake.
  • Teenagers:
    • Warning signs of eating disorders:
      • Hyperfixation on weight.
      • Anemia.
      • Electrolyte imbalances.
      • Low albumin levels.
      • Enamel breakdown.
      • Individuals may be underweight, average weight, or slightly overweight.
  • Health Promotion and Screenings Review:
    • ATI Community Health book (pages 9-10) provides an overview of health promotion, screenings, and basic teachings.

Communication Barriers

  • Communication barriers can affect any patient (babies to surgical patients).
  • Interpreters:
    • Always talk to the patient, not the interpreter.
    • Use certified medical interpreters approved by the facility.
    • Do not use family members (e.g., a 10-year-old) as interpreters.
    • Document interpreter use in nursing records, especially for patient teaching, informed consent, and medication administration.
    • Important for ensuring understanding and legal compliance.
      *There are at least two questions about interpreters of the NCLEX.

Targeted Screenings

  • Hearing Screening:
    • Usually first done at birth.
    • Screening indicates a need for further testing, not a diagnosis.
  • Gestational Diabetes Screening:
    • One-hour test indicates potential issues, followed by a three-hour glucose tolerance test for diagnosis.
  • Cancer Screenings:
    • Colorectal cancer:
      • Colonoscopy recommended starting at age 50 (may change).
      • Important for early detection and cure due to high prevalence.
    • Prostate cancer: easy to screen for.
  • Suicide Screening:
    • Use screening tools (questionnaires) in mental health settings and general check-ups.
    • Report any threats of harm to self or others (overrides confidentiality).
    • Assess previous attempts as a critical part of the history.

Prenatal Screenings

  • Fetal Monitoring:
    • Normal fetal heart rate range: 110-160 bpm.
    • Understand gravida, term, preterm, abortion, living children (GTPAL).
  • Ultrasounds:
    • Check baby's developmental appropriateness for age
    • The earlier the test, the more accurate it is.
    • Typically around 20 weeks they'll do one with the anatomy to make sure everything's correct with the heart function, the amniotic fluid volume etc.
  • Biophysical Profile (BPP):
    • Ultrasound measuring five categories.
    • A more in-depth test of fetal well-being after a non-stress test shows complications.
  • Amniocentesis:
    • Done between 15-20 weeks, but not routinely.
    • Looks for risk of Down syndrome (Trisomy 21), Trisomy 18, and neural tube defects.
    • Uses quad screen (four different things assessed).
  • Rh Factor and RhoGAM:
    • If the mother is Rh-negative and the baby is Rh-positive, antibodies can attack the baby's red blood cells.
    • RhoGAM is given to prevent this.

Labor and Delivery

  • Understand the differences between variable decelerations (cord compression), early decelerations (head compression), accelerations, and late decelerations (placental insufficiency).
  • Late decelerations are the worst.
  • Interventions for Fetal Heart Rate Issues:
    • Start with the least invasive interventions and move to more aggressive ones.
      • Repositioning
      • Preparing for C-section, etc.
  • Early Decelerations:
    • Mirror contractions.
    • Caused by head compression.
    • Normal response.
  • Late Decelerations:
    • Begin after the peak of contraction.
    • Indicate placental insufficiency.
  • Contraction Measurement:
    • Frequency: beginning of one contraction to the beginning of the next.
    • Duration: how long each contraction lasts.

Newborn Assessment

  • Respiratory Distress:
    • Look for signs like retractions, straining, and rapid breathing.
  • Apgar Score:
    • Ranges from 0-10.
    • Scores of 7-10 are generally good.
  • PKU Screening:
    • Blood draw 24 hours after birth.
    • Detects phenylketonuria, which can cause brain damage if untreated.

Pediatric Safety and Teaching

  • Focus on safety teaching for parents.
  • Common Complications:
    • Poisoning (especially for mobile children).
    • Car seat safety (rear-facing until 2 years or meeting height/weight requirements, car seat every time, and not in front with airbags).
  • Burns, anxiety, panic.

Pharmacology: MAOIs and Tyramine

  • Used for conditions like stroke and mental health issues.
  • Tyramine-restricted diets are necessary.
  • Foods containing tyramine:
    • Aged cheese
    • Smoked meats
    • Wine
    • Chocolate
    • Organ meats
    • Pepperoni
  • Important to identify appropriate diets for patients on MAOIs like Pitalzine.