Page 4 - Health Promotion and Maintenance Study Guide for the NCLEX-RN Exam

High Risk Behaviors

Detailed history-taking is essential as some patients may engage in certain high risk behaviors or lifestyles that increase their risk for the development of disease, illness, injury, or death. Many patients may not realize they’re at risk, so identification and education of these is an essential part of comprehensive healthcare.

Unprotected sexual activities (anal, vaginal, or oral) can increase the risk of sexually transmitted diseases (STDs) as well as HIV/AIDs in certain populations. It may also lead to unplanned pregnancy. Using contraception and/or barrier protection methods can take planning and identification of resources for patients who need them. Nurses are often well suited to give this direction and education.

Accident Avoidance

For many age groups, the number one cause of death is unintended injuries. Nurses can provide counseling on ways to reduce risk such as seatbelt use while in the care and the use of helmets or other protective equipment when biking, etc.

Lifestyle Choices

Lifestyle choices vary for each patient. They are a set of actions or characteristics that range from habits to thoughtful, intentional decisions. Examples include remaining single or child-free, living in a particular environment (rural versus urban), or engaging in and practicing alternative healthcare (homeopathic, etc.). Each of these can impact a patient’s health negatively or positively depending on his or her particular health circumstances.

Self-Care

Self-care activities are those actions and practices that patients engage in to promote or enhance their own health and well-being. They are not directed or overseen by medical professionals. However, for some patients who have developmental/physical disabilities or are elderly, there may be limited or curtailed abilities to perform self-care activities. Nurses need to identify patients in need and utilize professional, institutional, and personal (family/friends) resources to ensure a patient’s ability to live as independently as possible.

Physical Assessment Techniques

Health histories and history of present illness (HPI) are subjective descriptions of a patient’s symptoms and health circumstances. Physical assessment of the patient provides objective information about a patient’s physical condition. The combination of the two helps guide decision-making and planned intervention. There are four main physical assessment techniques: inspection, palpation, percussion, and auscultation.

Inspection

Inspection, or purposeful observation, can provide a wealth of information about a patient’s general health. Posture, body habitus, movements, and speech indicate information about a patient’s nutritional status, personal care habits (dental care, exercise, etc.), as well as provide as an alert for deviations from the expected developmental phase. Vital signs are also part of inspection. In some cases, personalization of assessment techniques may be required. For instance, a child will require a small/child-sized blood pressure cuff to obtain accurate information.

Palpation

Palpation is using both the fingertips and palms to apply light to deep pressure to certain internal structures to gather information regarding their function and state. Palpation is used to assess pulse rate, rhythm, and quality. It is also used to note a cardiac thrill (a palpable heart murmur) as well as tender, swollen, or displaced bones or internal organs such as the liver, spleen, etc. Palpation can indicate a patient’s hydration or fluid status by assessing skin turgor and signs of edema.

Percussion

Percussion techniques provide information regarding the levels of air and fluid within an organ or body cavity. To perform percussion, the middle finger of one hand presses over the structure while the index and middle finger of the other hand lightly taps on the pressed finger. The returned sound will be dull (soft) if there is fluid/exudate present and hollow (loud) if there is air. Percussion is most used to assess conditions of the chest cavity (i.e., lungs) and the abdomen.

Auscultation

Auscultation is the technique of using a stethoscope to listen to the movement of air and fluid inside of the body. The stethoscope has two sides that are useful for the assessment of different sounds: the bell (smaller, hollow cup) picks up very low frequency sounds (heart murmurs, some bowel sounds, arterial bruits, etc.), while the diaphragm (larger, flat) is better for high frequency sounds (breath sounds, normal heart sounds, blood pressure, etc.).

Teaching Patients Effectively

Nurses are invaluable sources of information and education. They need to understand the principles of teaching and learning to effectively communicate this information with patients.

Know About the Patient

Take the time to learn more about the patients and assess each patient’s ability and readiness to learn. Ask about and identify how a patient likes to learn or learns best and make accommodations for this to help ensure that the information is received, processed, and understood. It is helpful to have a consistent, organized approach to clearly deliver medical information.

Age and development— Consider the age and development of the patient. Tailor the message as appropriate. Examples would be using small, simple words for younger patients, and allowing older/adolescent patients learn more independently through the use of trusted Internet-based websites.

Living situation— A patient who is socially isolated due to physical limitations (decreased sight or hearing) or geographically isolated from family and friends will likely need special accommodations for the learning process to be effective.

Learning preference— Different people learn differently. Visual learners may prefer diagrams, handouts, or pamphlets. Auditory learners will prefer face-to-face discussions or group meetings. Tactile (kinesthetic) learners will want to touch, feel, and move a model or device to better “experience” what they are learning.

Know About Possible Barriers to Learning

A critical part of effective teaching is ensuring that the material received is understood. A nurse must identify any potential barriers to learning prior to teaching to ensure that the process is effective and produces the desired effect.

Physical condition— Consider a patient’s ability to hear and see during communication. Adjust tone and rate of speech or use materials with enlarged print or braille if indicated.

Financial concerns— Consider a patient’s financial ability to pay for a procedure, surgery, medication, or other treatment. Discussing strategies or resources to help ease these concerns will help build rapport and trust with patients.

Absence of support systems— Patients may feel isolated and alone if they lack the proper support systems. Be available to these patients and guide them to the proper resources to help them find the support they need.

Literacy skills and comprehension— Patients with low literacy skills and decreased ability to comprehend will need special accommodation. A balance of proper tone and delivery is necessary to avoid sounding condescending or belittling.

Cultural background— Cultural beliefs need to be considered when teaching patients. Be sensitive to and respectful of certain ethnic traditions and practices.

Language barriers— Language barriers need to be identified and professional, medically trained translators should be used whenever possible.

Attitude and motivation— An unmotivated patient is unlikely to put forth the effort required to learn. Identify the reasons behind a poor attitude and make efforts to remedy them whenever possible.

Acceptance of responsibility— Patients must recognize and accept personal responsibility over their health and circumstances and take initiative to make the necessary changes to get better.

Environment— Patients need the proper environment to receive information and learn effectively. Minimize distractions and ensure proper measures are taken to respect the patient’s privacy.

Teaching Strategies

A nurse can use many teaching techniques and strategies to ensure patients understand and can perform the actions identified throughout the medical information teaching.

Let the patient help establish and evaluate their own goals.— Encourage patients to take an active part in getting better. Helping them establish and evaluate their own goals makes them part of the treatment team and motivates them to adhere to a treatment regimen. In this way, patients take more ownership over their condition, healing, and wellness.

Have the patient demonstrate understanding.— Asking patients if they understand or have any questions allows an opportunity to identify gaps in learning. If they seem reluctant to ask questions, the nurse can also ask them to repeat back what they understood in their own words. For procedures or self-care that necessitate learning a new skill, ask them to perform the task to ensure they understand.

Evaluate and modify the plan.— Despite the nurse’s best efforts, effective patient education can sometimes be difficult. Be flexible and ready to try multiple strategies if the teaching efforts are not producing the intended results.

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