Health

Promotion and
Maintenance

Topics
▪ Aging Process
▪ Health Promotion and Disease Prevention
▪ Health Screening
▪ High Risk Behaviors
▪ Lifestyle Choices
▪ Self-Care
▪ Techniques of Physical Assessment
▪ Ante/Intra/Postpartum and Newborn Care → Maternity/L+D lectures
▪ Developmental Stages and Transitions → Growth + Development lecture
 Aging Process

Normal changes with age

● Decreased vision and hearing
● Decreased strength
○ Risk for falls
● Decalcification of bones
○ Risk for fractures
● Decreased liver + kidney function
○ Careful with drug doses!
● Decreased skin turgor/elasticity
 Health Promotion + Disease
Prevention

Levels of Prevention
● Primary
○ Intervening before an individual has a health issue
○ Examples:
■ Education
■ Immunizations
● Secondary
○ Early Identification of the disease
■ Screenings
■ Health Fairs
● Tertiary
○ Treats the disease and prevents further complications
■ Nutritional education for someone with CHF
NCLEX Question
An example of a healthcare environment that provides tertiary prevention care
and services is a(n):

A. Acute care facility

B. Primary care outpatient clinic
C. Outpatient surgical center
D. Physical rehabilitation center in the community

Answer: D
Choice D is correct. An example of a healthcare environment that provides tertiary
prevention care and services is a physical rehabilitation center in the community.

Choice A is incorrect. An acute care facility provides primary prevention care and services,
not tertiary prevention care and services.

Choice B is incorrect. A primary care outpatient clinic provides primary prevention care and
services, not tertiary prevention care and services.

Choice C is incorrect. An outpatient surgical center provides secondary prevention care and
services, not tertiary prevention care and services.
Risk Factors for Disease
● Modifiable
○ Smoking
○ Drinking
○ Dietary habits
● Nonmodifiable
○ Genetics
○ Age
○ Ethnicity
○ Gender

Providing education
● How will the client learn best?
○ Visual? Verbal? Demonstration?
○ Teach-back
● Barriers to educator
○ Language
○ Low health literacy
○ Reading comprehension
○ Stress
Health Screenings
Screenings
● STD screening
○ Recommended for anyone sexually active
○ Highest risk - sexually active women < 25 years old.
● Colorectal cancer screening
○ Recommended for those >50 years old
○ Earlier if family history
● Breast cancer screening
○ Recommended for women > 40 years old
○ Earlier if family history

Ethnicity related risk factors

● Sickle Cell Anemia ● Cancer
○ African Americans ○ Caucasians
○ Latin Americans ● Thalassemia
● Hypertension ○ Mediterranean
○ African Americans ● Tay Sachs Disease
○ Pacific Islanders ○ Ashkenazi Jewish
○ Native Americans
● Cystic Fibrosis
● Diabetes ○ European
○ African Americans
○ Native Americans
 High-risk Behaviors

Identify high risk behaviors

● Smoking
● Alcohol use
● Drug use
● Sun exposure
○ Tanning beds
● Unprotexted sex
● Lack of sleep
● Stress
● Sedentary lifestyle
● Dietary choices
 Lifestyle Choices

Family Planning
● Methods of contraception → Know the risks + contraindications!
○ Abstinence
○ Condoms
○ Oral contraceptives → History of clotting disorder
○ DIaphragm → History of toxic shock syndrome
○ Intrauterine devices
○ Injectable depomedroxyprogesterone acetate
Complementary/Alternative Medicine
● Your health history should include asking about any treatments!
● This includes:
○ Chiropractic care
○ Massage
○ Meditation
○ Homeopathic remedies
○ Biofeedback
○ Hypnosis
○ Transcutaneous Nerve Stimulation (TENS)
○ Acupuncture/pressure
○ Reiki
○ Herbs
 Self-Care

Assessment
Can the client care for themselves? Do they have what they need to do so?
● Equipment
● Support system
● Community resources
● Access to healthy food
● Safe drinking water
● Appropriate housing
○ Stairs? Can they get to the bathroom, kitchen, etc.?
○ Home safety assessment
● Caregivers
Activities of Daily Living (ADLs)
● Dressing
● Basic hygiene
● Eating
● Toileting
● Ambulating

Techniques of Physical
Assessment
Complete Assessment
● Gather baseline data
● Obtain a complete medical history
● General survey of the client
● Complete physical assessment
○ Head to toe!
○ Includes vital signs!

Medical History
● Any previous diagnoses
● Family history
● Females
○ Last menstrual period
○ Contraception method if applicable
General Survey
● Your “across the room” assessment
● What’s their general appearance?
○ Obvious distress
■ ABCs
■ Pain
■ Anxiety
○ Level of hygiene
○ Skin integrity

Methods of assessment
● Inspection
○ Visual exam
● Palpation
○ Any swelling? Pain or discomfort? Lumps?
● Percussion
○ Tapping to hear sounds - locate fluid, air, solid masses
■ Resonance - hollow - over air (lungs)
■ Flatness - loud boom - over solid things (muscle, bones)
■ Tympany - drum like - over fluid (abdomen)
● Auscultation
○ Listen
Auscultation
● Heart ● Lungs
○ Normal
○ Normal
■ S1, S2
■ Clear and equal bilaterally
○ Adventitious
○ Adventitious
■ S3, S4, murmurs
■ Crackles
● Bowel ● Rales
○ Normal ● Rhonchi
■ Active ■ Stridor
○ Abnormal ■ Wheezes
■ Absent ■ Diminished
■ Hypoactive
■ Hyperactive
Head
● Round and symmetrical
● Facial movements symmetrical
● No lumps or masses
● Fontanels
○ In babies should be soft and flat
○ Anterior
■ Closes between 6 and 18 mo
○ Posterior
■ Closes by 2 months
Ears
● Ears are symmetrical
● Tympanic membrane

Eyes
● Pupils equal, round, and reactive to light and accommodation (PERRLA)
● Cardinal movements → Assess for nystagmus
● Visual acuity with Snellen chart
 Snellen Chart
Can read at 20 feet what most people
can read at 200 feet. Poor vision

Can read at 20 feet what most people

can read at 20 feet. Normal vision

Nose
● Assess for any drainage, tenderness, masses
● Nares are clear
● Visualize with otoscope
Mouth
● Lips/mucous membranes moist and pink
● Uvula, tonsils, hard and soft palates
● Gag reflex

Neck
● Palpate thyroid gland and lymph nodes
● Neck and head movement
● Swelling/pain
Skin + Nails
● Color
○ Appropriate for ethnicity
○ Pale
○ Mottling
● Temperature
○ Warm
○ Cool
● Skin integrity
● Nails
○ Brittle
○ Clubbing

Chest: Cardiovascular Assessment

● Chest symmetrical
● Heart sounds
● Pulses
○ Normal +2
● Capillary refill
○ Normal <3 seconds
● Edema
Chest: Respiratory assessment
● Breath sounds
● Chest rise and fall
○ Should be even symmetrical
● Work of breathing
○ Retractions
○ Nasal flaring
○ Grunting
○ Head bobbing
○ Tripoding

Abdomen
● Size/shape
○ Flat
○ Scaphoid
○ Distended
● Tenderness to palpation
● Bowel sounds
● Pulsations??
○ Danger! Abdominal aortic aneurysm!!
Genitalia Rectum
● Assess skin and hair ● Rectal tone
○ Redness ● Tenderness
○ Tenderness
● Blood
○ Swelling
○ Any complaints? ● Ask about stools