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Page 3 Health Promotion and Maintenance Study Guide for the NCLEX-PN® Exam

Health Promotion/Disease Prevention

Client Care

While much of healthcare is focused on treating conditions and diseases, there is high value in focusing on disease prevention and health promotion in client care.

Prepare the Client

To determine on what areas to focus for disease prevention and health promotion, the client should undergo a physical exam. To prepare the client for the physical exam, ensure that the client’s privacy is respected, the client is comfortable, and be sure to explain the procedure to the client.

Immunizations

A main mechanism for disease prevention is immunizations. Immunizations are available for many diseases to give clients immunity to these diseases without suffering from the disease itself.

Needs

When discussing immunizations with the client or the client’s family member, identify which immunizations are required and which are voluntary. For example, to enroll in a public school, certain immunizations may be required.

Precautions and Contraindications

Prior to an immunization, clients should be asked if they have a history of an unexpected response or allergic reaction to an immunization. If so, the immunization may be contraindicated. In other scenarios, precautions, such as premedication prior to the immunization, can prevent side effects.

Client Response

The client should be monitored immediately after receiving the immunization and in the days following to ensure that the client does not have an unexpected or allergic response to the immunization.

Client Assessment

Most basic care will begin with a client assessment. This helps determine what areas need attention and establish a baseline to track progress.

Health History

A health history should be obtained upon a first visit or admission to a hospital. This should include the client’s lifestyle, history of the present illness, additional medical conditions or comorbidities, surgical history, medication history, and the family/genetic history. This will help determine if the client is at risk for certain diseases.

Health Screening

When necessary, a health screening can be performed. These screenings are usually a diagnostic test or exam that will determine if additional follow-up is needed. Screenings usually do not result in a diagnosis but lead to investigation to determine the true cause or diagnosis.

Check Results— When a diagnostic screening test has been performed, it will be helpful to check the results of these tests to determine if follow-up is needed. In the outpatient setting, the nurse may be checking the results of a Pap smear or stool occult blood test.

Assist— The nurse may also be able to assist with physical screening exams. These may include scoliosis screenings, breast self-exams, testicular self-exams, and blood pressure checks. When necessary, the client should be instructed how to perform these exams themselves.

Client Self-Care

Clients should be taught and encouraged to perform self-care and retain their independence, especially during a hospitalization. However, there are certain considerations to make. For example, clients with certain conditions or disabilities may not be capable of all tasks and encouraging them can lead to frustration.

Client Ability

The nurse should consider the client’s ability and support for performing self-care tasks. These include but are not limited to feeding, dressing, bathing, hygiene, meal prep, telephone use, and shopping. The nurse should check and monitor progress with these tasks along with assessing the support system if the client needs assistance.

Effect on Care Plan

If there are self-care tasks that the client needs additional teaching, support, or reinforcement, the client’s care plan may need to be altered to include teaching about these tasks. In addition, if there are barriers to certain tasks, then the care plan may need to be altered.

Prevention/Promotion

In addition to inpatient care, nurses may be responsible for disease prevention and health promotion outside of the healthcare facility.

Community

There are many opportunities in the community for disease prevention, health promotion, and education. These activities may include participation in health screenings, health promotion programs, and community health education programs. Additionally, the nurse may be responsible for gathering and distributing resources to the community.

Personal

There are personal interventions that can be made as well. If the nurse determines that the client is at risk for certain diseases or behaviors, there are interventions that may be helpful. In many situations, education and resources can be provided and may lead to actions that change behavior and/or decrease risk.

Assess

As with most other interventions, health promotion and disease prevention begins with a client assessment. The nurse will likely begin with a review of available information, a conversation with the client, and potentially a focused physical exam.

Risk Factors— The nurse should determine what the client may be at risk for based on certain factors. The client’s age, gender, ethnicity, and lifestyle may put the client at higher risk for diseases and illnesses. While some of these factors cannot be changed, the nurse may be able to encourage lifestyle changes to decrease risk.

Health-Seeking Behavior— The nurse can also assess if the client is exhibiting health-seeking behavior. A client willing to be proactive is a great candidate for education on health promotion and disease prevention. For example, these clients may be interested in learning how to correctly perform breast and testicular self-exams.

Teach

When the nurse has assessed the client’s health risks, the nurse should teach the client about these risks. They may be based on family, population, or community characteristics. The nurse can assist the client in identifying what risks could be decreased with interventions.

Assist

The nurse can then assist the client with disease-preventing activities. If focusing on reducing risk of a disease, this may include actions like smoking cessation or exercising. If the client is at risk due to community risks, the nurse can assist with proactive measures to counteract these risks.

Monitor

Following these interventions, the nurse should monitor the client’s actions toward better health. These may include smoking cessation, exercise, diet, stress management, screening examinations, immunizations, and/or limiting risk-taking behaviors.

Client Choices

High-Risk Behaviors

While there are factors leading to diseases and illnesses over which clients have no control, there are client choices related to behavior that may place them at higher risk.

Identify

When caring for a client, the nurse should attempt to identify any high-risk behaviors that the client is engaging in or at risk for engaging in. Some high-risk behaviors to consider include substance abuse and high-risk sexual practices. The nurse can also assist the client in identifying what behaviors and activities may be high risk for disease and illnesses, such as smoking. Identifying these behaviors is the first step in prevention.

Provide Information and Teach

The nurse can provide information on these high-risk behaviors along with how to prevent the potential consequences of these behaviors. In the community, the nurse may assist in teaching the client about unprotected sexual relations or needle sharing to decrease the risk of communicable diseases. Community, employer-based, and hospital-based smoking cessation programs are also available to clients to help stop smoking and reduce their risk of disease and illness.

Lifestyle Choices

The nurse should make clients aware that their lifestyle choices can affect their health. Consider and discuss both the positive and negative impacts of these lifestyle choices with the client.

General

Clients are faced with general lifestyle choices in their everyday lives. Ideally, they would make choices that were positive and beneficial in relation to their overall health and avoid choices or behaviors that would have a negative impact. The nurse can assist the client in framing these lifestyle choices in attempts to optimize health.

Identify Risky Choices

The nurse can help the client identify risky choices that may impact health. Additionally, the nurse should respect other choices that may not be as common. For example, in different communities, homeschooling may be more common. Some clients may prefer rural or urban living, which may impact lifestyle choices.

Teach

In addition to teaching the client about risky choices, the nurse can teach the client about better choices or healthier alternatives. The client may simply be unaware of alternatives that exist to some of the choices in their everyday lives.

Monitor

When these interventions have been done, the nurse can monitor clients for their efforts at making better life choices. These activities include, but are not limited to, a consistent exercise regimen or smoking cessation. The high number of encounters by the nurse in healthcare settings make this a great opportunity for constant monitoring.

Family Planning and Sexuality

When the client has reached puberty, the nurse may be in a position to discuss family planning and sexuality. This tends to be a very personal matter, so the nurse should ensure the client is comfortable before approaching this topic. It may be important to do so, however, as the client may not be willing to discuss this with family members, and the nurse could provide needed education.

Know Methods of Contraception

There are multiple methods of contraception in which the client may be interested. These range from monitoring the basal temperature to oral contraception to implantable contraception. It is important to note that there are contraindications to some of these methods in some cases. For example, clients who smoke or have hypertension may have an increased risk of side effects from oral contraceptives.

Family Planning Support

The nurse can provide family planning support and education to the client. This begins with recognizing the client’s need or desire for contraception. The nurse should also explain the expected outcomes and failure rates of these methods.

Sexuality

When caring for the client, the nurse should respond to the client’s need to discuss sensitive sexuality issues with an open mind and practice active, effective listening. This conversation may help the nurse identify the client’s attitudes on or perception of sexuality and/or identify opportunities for additional education.