Levels of Prevention

• Illness prevention reduces disease risk and promotes health through proactive measures.

Primary Prevention

• Focuses on promoting health and preventing disease or injury.
• Includes immunization clinics (Vaccinations), family-planning services, diet/exercise, and stopping smoking/reducing alcohol consumption.

Secondary Prevention

• Involves screening for early detection with prompt diagnosis and treatment.
• Includes screenings, Pap smears/mammograms/testicular exams, and family counseling.

Tertiary Prevention

• Begins after illness is diagnosed and treated, aiming to reduce disability and rehabilitate the patient.

• Includes medication, medical/physical/occupational therapy, surgical treatment, and rehabilitation.

• Health constitutes complete physical, mental, and social well-being, more than just the absence of disease.

Functions of Health Organizations

• Occupational Safety and Health Administration (OSHA) set legal standards in the U.S. to ensure safe and healthful working conditions, reducing work-related injuries and illnesses since 1970.
• The Centers for Disease Control and Prevention (CDC) is a national public health agency focused on disease prevention, health promotion, and public safety.
• State Boards of Nursing regulate nursing practice within each U.S. state, ensuring nurses are qualified, competent, and adhere to legal and ethical standards.
• State Nurse Practice Acts are laws established in each state regulating nursing practice, varying among states, and allowing graduates to take licensing exams.
• The Joint Commission is a nonprofit that enhances credibility, improves patient care, and ensures compliance with safety regulations.

Maslow's Basic Human Needs Hierarchy

• Psychological outline of human needs in a pyramid structure.

• Physiological: Basic survival needs like air, food, water, sleep, elimination.

• Safety and security: Physical and emotional needs like housing, community, climate, trust, and freedom from fear.

• Love and belonging: Understanding and acceptance in giving and receiving love from family, peers, friends, and the community.

• Self-Esteem: The need to feel good about oneself and have a sense of pride and accomplishment.

• Self-actualization: The need to reach full potential through developing unique capabilities and accepting self and others.

• Delegation is the transfer of responsibility for performing an activity to another person.

• CNA tasks include ambulation, repositioning, feeding, and taking vital signs.

• LPN tasks include administering medication, wound care, suctioning, eternal feeding, and reinforcing RN teaching.

Client Privacy and Professionalism

• HIPAA enforces confidentiality in healthcare, protecting all patient information on paper, computer, or spoken aloud.
• Violations of HIPAA include sharing patient information without consent, leaving records unsecured, and discussing patients in public areas.
• Professionalism violations include posting patient information on social media and making inappropriate jokes or comments about patients.

Nonverbal Communication

• Transmission of information without words, including facial expressions, eye contact, space, boundaries, and body movement
• Respond by maintaining eye contact, using open body language, and matching your tone to patients' emotions (acting calm and reassuring).

Diets

• Clear Liquid: Includes only clear fluids or foods that become liquid at body temperature (minimal digestion), such as clear broth, coffee, tea, and clear fruits.

• Diabetic: Focuses on blood sugar (glucose) control while ensuring balanced nutrition with high fiber and low cholesterol.

• DASH (Dietary Approaches to Stop Hypertension): Lowers blood pressure, reducing the risk of stroke, heart, and kidney disease, by emphasizing fruits, vegetables, low sodium, high potassium, and whole grains

• Cardiac: Promotes heart health, reduces the risk of heart disease, high blood pressure, and stroke, and manages conditions like high cholesterol through low cholesterol, whole grains, and limited sodium (1500-2300mg/day).

• Pureed: Made up of liquids and foods blenderized to liquid form, allowing all foods to be consumed in blended form.

• Mechanical Soft: Regular diet modified for texture for patients who have difficulty chewing/swallowing; includes soft, easy-to-chew foods.

• SA Node (Pacemaker): Fires impulses 60-100 bpm.

• Mass of tissue in the upper right atrium indicating transmission of electrical impulses, causing contraction of the heart.

• AV Nodes delay impulses to allow ventricular filling and can act as a backup at 40-60 bpm.

• Mass of tissue at the bottom of the right atrium; the impulse reaches the AV node, and enters the atrioventricular bundle, or bundle of His.

Advanced Directives

• Legal documents allowing patients to specify instructions for health care treatment if they cannot communicate postoperatively.
• These include a Living Will and Durable Power of Attorney for Health Care.

Power of Attorney for Health Care

• Is a legal document that allows an individual to appoint someone else to make medical decisions on their behalf.

Subjective and Objective Data

• Subjective data is perceived only by the affected person (e.g., nausea, chills, pain).

• Objective data is observable and measurable data (e.g., vomiting, temperature, skin moisture).

• An actual diagnosis is an undesirable human response to a health condition/life process that exists in a patient (e.g., edema, ulcer).

• A risk potential diagnosis is a clinical judgment about a patient's vulnerability to developing an undesirable human response (e.g., risk for falls, infection).

• Physician-initiated intervention is ordered or prescribed by a physician and carried out by a nurse based on the physician's clinical judgment.

• Ageism is a form of prejudice in which older adults are stereotyped and discriminated against, viewed as incapable, and not regarded with the same desires, needs, and concerns as younger adults.

• Sundowning syndrome is when an older adult habitually becomes confused, restless, and agitated after dark.

• Wandering may occur with hallucinations, delusions, or paranoia.

Focus of Care for Older Adults Includes:

• Healthy diets (low in fat, fruits, vegetables, and grains)
• Exercise as part of daily activities
• Moderate alcohol consumption
• No smoking
• Discussion with a primary provider about vitamins, minerals, and herbs.

Nurse's Functions

• Advocate: Protects human or legal rights based on the belief that patients have the right to make informed decisions.
• Advocate: speaks up for patients' rights, ensures informed consent, and voices concerns.
• Educator: Uses communication skills to assess, implement, and evaluate teaching plans for patients and families.
• Educator: includes Patient education and health promotion.
• Counselor: Uses therapeutic communication skills to provide information, make referrals, and facilitate problem-solving.
• Counselor: includes emotional support and coping strategies.
• Coordinator of care: Ensures patients receive the right care, at the right time, cost-effectively, and by the right person in the right setting through healthcare team collaboration and discharge planning.

Outcome Statements

• Psychomotor domain addresses the patient's achievement of new skills.
• Cognitive domain increases in patient knowledge or intellectual behaviors.
• Affective domain describes changes in patient values, beliefs, and attitudes.

Documentation

• A written or electronic legal record of pertinent patient interactions, including assessing, diagnosing, implementing, and evaluating.

• Effective documentation is complete, accurate, concise, factual, consistent with standards, organized, timely, legally prudent, and confidential.

• Brain Natriuretic Peptide (BNP) is a neurohormone that regulates BP and fluid volume; blood levels increase as ventricular walls expand, serving as a diagnostic tool for heart failure severity.

• Preload refers to the stretch of ventricular cardiac muscle fibers at the end of diastole (blood volume returning).

• Afterload is the resistance to blood ejection from the ventricle, a second determinant of stroke volume (pressure heart pumps against).

• Cardiac Output (CO) = Heart Rate (HR) x Stroke Volume (SV).

• Multiplying the stroke volume (volume of blood ejected per heartbeat) by the heart rate provides the amount of blood pumped per minute.

• CHF care includes monitoring weight and I&O for fluid volume management in patients with congestive heart failure.

• Positioning with head of bed elevation facilitates effective breathing and helps manage edema.

• Hypertensive urgency: Blood pressure is severely elevated but there is no evidence of progressive target organ damage.

• Hypertensive emergency: Blood pressure is severely elevated with evidence of actual or probable target organ damage.

• Uncontrolled hypertension is high blood pressure not brought within normal ranges despite treatment.

• Uncontrolled hypertension increases the risk of premature death, disabilities, cardiovascular disease, stroke, and chronic kidney disease.

• Primary hypertension is high blood pressure with no identifiable cause (affects 90-95% of patients).

• Secondary hypertension is high blood pressure from an identified cause (affects 5-10% of patients).

Hypertension Diet

• DASH (Dietary Approaches to Stop Hypertension) diet includes vegetables, fruits, whole grains, low sodium (<2g/day), and high potassium (3500-5000mg/day).

Type 1 Diabetes

• Body's immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas.
• Insulin deficiency results in little to no insulin to regulate blood sugar .
• Develops in young children
• Treatment requires insulin therapy through injections or an insulin pump and blood sugar monitoring.
• Onset is rapid and symptoms include excessive thirst, frequent urination, and blurred vision.
• Complications include heart and kidney disease, nerve damage, and amputation.

Type 2 Diabetes

• Characterized by insulin resistance, impaired insulin secretion, and eventual pancreatic beta cell dysfunction.
• Pancreas may produce normal or high levels of insulin, but the body becomes resistant.
• Typically develops in adulthood but can occur in children with obesity or during adolescence
• Treatment includes lifestyle and dietary changes, oral medication, and insulin injections if the condition worsens.
• Symptoms develop gradually and may include increased thirst, frequent urination, and blurred vision.
• Complications include cardiovascular disease, kidney disease, nerve damage, eye problems, and poor circulation.

Diagnosing Diabetes

• Diagnosed by a fasting plasma glucose test, HgbA1c (Glycated hemoglobin) to measure glucose control over the past 3 months, an oral glucose tolerance test, or a random blood glucose test.

• Normal fasting plasma glucose: 70-99 mg/dL, high: 126 mg/dL.

• Normal HgbA1c (Hemoglobin A1c): less than 5.7%, high: greater than/equal to 6.5%.

• Normal oral glucose tolerance: less than 140 mg/dL, high: greater than/equal to 200 mg/dL.

• Diabetic Ketoacidosis (DKA): A metabolic derangement from insulin deficiency where the body breaks down fat to ketones.

• DKA involves hyperglycemia, ketosis, and metabolic acidosis.

• FAST is used to identify signs of a cerebrovascular accident; F - Face drooping, A - Arm weakness, S - Speech difficulty, T - Time.

• TIA (Transient Ischemic Attack) is a neurologic deficit that resolves in 24 hours, with temporary ischemia to the brain.

• TIA may serve as warning sign of impending stroke (3-15% are proceeded by a TIA)

• tPA (tissue plasminogen activator): used to treat certain types of strokes particularly ischemic strokes.

• Thrombolytic therapy treats ischemic stroke by dissolving the blood clot.

• Atelectasis refers to the closure or collapse of alveoli.

• Frequent turning, early mobilization, lung expansion strategies, deep breathing, coughing, postural drainage, and suctioning prevent atelectasis.

• Dysphagia: Difficulty swallowing due to impaired function of the mouth, tongue, and pharynx

• Interventions: Assist the patient with meals, elevate the bed to a high Fowler's position diet:

• Hospital-acquired pneumonia (HAP) develops 48 hours or more after hospitalization.

• Preventative measures: elevation of the head of bed (30° to 45°), peptic ulcer disease prophylaxis, deep venous thrombosis (DVT) prophylaxis, and daily oral care.

Sick Day Rules

• S: Sugar-Check blood glucose every 2-4 hours

• 1: Insulin- keep taking insulin

• C: Carbs-drink/eat 15g carbs every 1-2 hours

• K: Ketones- test urine for ketones

• Instruct patients to take insulin or oral antidiabetic agents, report elevated glucose, take supplemental doses of regular insulin, and take liquids to avoid dehydration.

• Hyperglycemia occurs, check blood sugar, drink water, take insulin or medication, and perform light exercise.

• Hypoglycemia occurs, check blood sugar, eat 15 grams of fast-acting carbs; if unconscious, administer glucagon and call 911.

• Appropriate exercise for CVA: Affected extremities are exercised passively through a full ROM 4-5x daily to maintain joint mobility.

• HgBA1c (Glycated hemoglobin): measure of glucose control for the past 3 months

• Focus care on obvious needs, issues, and deficits for hemorrhagic stroke patients, plus monitoring for recurrent bleeding and implementing aneurysm precautions.

• Hypoglycemia occurs when blood sugar is 70mg/dL or less.

• Hypoglycemia is often caused by too much insulin, too little food, or excessive physical activity.

• Treatment involves consuming 15-20 g of a fast-acting carbohydrate, such as juice.

• Hyperglycemia is high blood glucose greater than/equal to 180mg/dL presenting hypotension, dehydration, tachycardia, and neurological signs.

• Signs of Type 2 diabetes include polyuria, polydipsia, polyphagia, fatigue, weakness, vision changes, tingling/numbness, dry skin, lesions, with slow wound-healing.

Modifiable Risk Factors

• Includes factors that can be changed or adapted (diet, physical activity, hypertension, high cholesterol).

Non-Modifiable Risk Factors

• Includes factors that cannot be changed (age, gender, ethnicity/race, genetics, and family history)
• Signal in urine indicates a deficiency of insulin and uncontrolled Type 1 diabetes.