Page 3 - Health Promotion and Maintenance Study Guide for the NCLEX-RN Exam
Health Promotion and Disease Prevention
In the traditional medical model, health was defined as the absence of disease. Today, we recognize that many people enjoy a high quality of life (healthy life) despite one or more health challenges. The term health and wellness is a more encompassing term that is used to represent a state of physical, social, and emotional well-being and the pursuit of each. Nurses play a critical role in educating and empowering patients to take control of their own health. They can help patients find the health resources they need based on their specific health condition and/or disability. Be familiar with programs in each of the following areas of health promotion and wellness.
Healthy weight management should focus on incremental changes to move patients toward a desirable weight for their height and build. It is important to note that even a modest weight loss of 10 to 20 pounds can significantly positively impact those with chronic health conditions such as Type II Diabetes.
The reasons people continue to smoke despite the known negative health effects, which are numerous. Nicotine addiction, depression, anxiety, habit, and repeated exposure to smoking-associated stimuli in both social and workplace settings all play a role. Often those with low incomes, low education, and psychosocial problems find it difficult to quit. More than one strategy will typically be necessary to achieve successful smoking cessation.
Nutrition plays a large role in health and wellness. While good, sensible eating is universally recommended, remember that special groups will need more specific recommendations. Patients with hypertension should avoid excess sodium and sodium-containing foods such as canned or processed foods. Patients at risk for osteoporosis should be encouraged to increase their calcium intake. Those with diabetes will need restricted carbohydrates, and those with high cholesterol should avoid saturated fats like those in red/fatty meats and trans fats in deep fried and fast foods.
Exercise provides numerous health benefits for everyone at any age or activity level. Exercise can help improve cardiovascular and respiratory function, assist in weight control, stimulate metabolism, improve sleep, decrease the risk of osteoporosis/strengthen bones, and improve overall strength, balance, flexibility, and endurance. There is also good evidence to show that exercise can improve mental health and positively impact a number of disorders such as depression and anxiety. Exercise also decreases social isolation.
Be aware that many patients will incorporate other alternative therapies with their traditional western medical regimens. These may include massage, acupuncture, hypnosis, and others. Patients often take over-the-counter medications, vitamins, supplements, and homeopathic remedies such as herbs or essential oils. Some patients may see alternative medical providers such as a shaman or chiropractor.
The importance of performing a breast self-examination (BSE) should be taught to every female patient once they reach puberty. Women should do their BSE during day 5 to 7 of their menstrual cycle on a monthly basis. Menopausal patients should also continue to perform monthly BSEs.
Testicular cancer is one of the most curable solid tumors. It is most common in men ages 15 to 35 years. Male patients should be counseled on the importance of testicular self-examination and should perform one regularly, preferably after bathing when the scrotum is most relaxed. Any swelling, lumps, or other abnormalities need to be reported immediately to the patient’s medical provider.
Hormone Replacement Therapy (HRT)
Perimenopausal and menopausal women may be candidates for hormone replacement therapy (HRT) to help control the negative symptoms of their condition such as hot flashes, sweating, and vaginal dryness. While HRT has protective effects against the development of osteoporosis, it may increase the risk of the development of coronary artery disease (CAD), breast cancer, deep vein thrombosis (DVT), and stroke. Therefore, the risks and benefits of HRT need to be carefully weighed for each individual patient.
Immunizations play an important part of overall health and wellness throughout a patient’s lifetime. Generally, most immunizations are given to children aged 2 months to 12 months. The Hepatitis B vaccine is given to newborns shortly after birth with two additional doses given at 1–2 months and 6–18 months of age. Rotavirus is given in 2–3 doses at ages 2, 4, and 6 months. No Rotavirus vaccines are given after 8 months and 0 days of age. DTaP is a five-dose series given at 2 months, 4 months, 6 months, between 15 and 18 months, and between 4 and 6 years. Hib and Pneumococcal conjugate (PCV-13) are given at 2, 4, 6 (sometimes for Hib) and 12–15 months. The Hepatitis A vaccine is a two-dose series recommended at 12–18 months with a second dose administered 6 months later. The annual influenza (flu) vaccine may be given after 6 months of age. With the flu vaccine, two doses are required in the first year to achieve immunity. After the first year, the child may return to once yearly dosing. The MMR and Varicella vaccines are given between the ages of 12 and 15 months with second doses given at 4–6 years. HPV vaccination is now recommended as a two dose series for ages 9–14 and a three-dose series for those who start the series after age 15. College freshmen who plan on living in dormitories who are previously unvaccinated should receive the meningococcal vaccine. Adults over the age of 60 should all receive the vaccination to prevent shingles (herpes zoster) as well as pneumococcal pneumonia.
The importance of the connection between oral health and other physical disease should be stressed from an early age. Gum disease or periodontal disease has been linked to diabetes, heart disease, and other chronic, inflammatory conditions. Patients should be counseled on the importance of dental visits and cleanings every six months beginning at 2 years of age.
Nurses often interact more intimately with patients than any other member of the healthcare team. They may be the first to identify a patient’s mental health issues or those at risk for developing depression, anxiety, etc. Nurses can provide these patients with helpful suggestions on how to effectively manage stress and assist with arranging care for those who need intervention from a mental health specialist or counselor.
Heart Disease and Stroke Prevention
High blood pressure is frequently associated with heart problems and strokes. Nurses can identify blood pressure abnormalities and encourage patients to monitor their own blood pressure at home, especially those who have a family history of hypertension. Nurses can also help educate patients on worrisome symptoms and the normal parameters for both systolic and diastolic blood pressures.
Nurses should counsel all patients on the dangers of excessive ultraviolet (UV) exposure and the importance of regular skin cancer screenings. They can also provide helpful information on sunscreen, protective clothing, and times of day to avoid outdoor activities.
Knowledge of health screening requires a nurse to combine knowledge of pathophysiology with known risk factors for certain ethnic and/or age groups of patients. Below are descriptions of many routine health screening exams and, when applicable, populations in which the screenings should take place.
Blood Sugar Check
Two types of blood sugar levels can be checked: fasting and non-fasting. For a patient who is fasting (more than 8 hours), a level of greater than 125 mg/dL indicates the need for further testing. A non-fasting patient should have a level less than 199 mg/dL.
Blood Pressure Check
Normal blood pressure is defined as anything less than 120/80 mmHg. While there are several subcategories of hypertension (elevated, stage I, and stage II), severe hypertension is defined as a blood pressure greater than 140/90 mmHg. Known as the “silent killer,” hypertension, even when severe, may be completely asymptomatic. Incidence of hypertension is higher in the southeastern U.S. and in African-Americans. Other risk factors for hypertension include age over 60, inactive lifestyle, and hyperlipidemia.
Fasting Lipid Profile
Every adult should have a fasting lipid profile done at least once every 5 years. Following are the target results of such a screening.
- Total Cholesterol— < 200mg/dL
- Triglycerides— < 150ml/dL
- Low-density lipoprotein— < 100mg/dL (also known as LDL or “bad” cholesterol and is closely linked to the development of atherosclerosis)
- High-density lipoprotein— > 40mg/dL for men; > 50mg/dL for women (also known as HDL or “good” cholesterol and is cardioprotective)
Every adult over the age of 50 should have regular colorectal screening. These tests may include fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, double-contrast barium enema (DCBE), and/or digital rectal exam (DRE). In patients with a positive family history of colorectal cancer, screenings should begin at an earlier age and possibly be more frequent.
All men should be screened for prostate cancer starting at the age of 50. A blood test measuring a man’s level of prostate-specific antigen (PSA) along with digital rectal exam (DRE) are the tests that are used.
All women between the ages of 40 and 50 should have a baseline mammogram. Annual screenings are generally indicated in most women until the age of 55. They may be done bi-annually or continued annually. A positive family history of breast cancer may dictate earlier screening mammograms for some women.