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.