NRBS3008 Foundations of Nursing Practice PDF Fall 2024

NRBS3008 Foundations of Nursing Practice Blue Print for Exam 2 Fall 2024 Week 6: Health Promotion, Wellness, And Disease Prevention (9 Questions) Lecture Recording will be posted in PANOPTO. o Wellness-Illness Continuum https://www.youtube.com/watch?v=lMgeNYktqEk&ab_channel=SusanBane...

NRBS3008 Foundations of Nursing Practice Blue Print for Exam 2 Fall 2024 Week 6: Health Promotion, Wellness, And Disease Prevention (9 Questions) Lecture Recording will be posted in PANOPTO. o Wellness-Illness Continuum https://www.youtube.com/watch?v=lMgeNYktqEk&ab_channel=SusanBane Health/wellness is viewed as a continuum. Various levels and degrees of wellness and illness. Wellness is a relative concept, may be very subjective; not an absolute. Wellness is not just the absence of disease Illness is a state of being relatively unhealthy in mind, body, or spirit. Health illness continuum: Visual model that describes levels of wellness or illness of a person, family, or community. ○ Ranges from optimal wellness condition to death ○ Optimal wellness = maximum energy ○ Death = total depletion of energy= o Definitions of Health, & Cultural Aspects of Health WHO definition of health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. ○ WHO’s prerequisites for health Allender (2018), Definition of Health: A holistic state of wellbeing which includes soundness of mind, body & spirit (p.11). Cultural Aspects: In some cultures: ○ Health is seen as the freedom from & absence of evil. ○ Illness is seen as a punishment for being bad or doing evil. ○ Religion, folklores, superstition influential factors Other Definitions of Health: 1  ○ The general condition of the body or mind with reference to soundness and vigor: good health; poor health. ○ Soundness of body or mind; freedom from disease... dictionary.reference.com ○ The condition of being well or free from disease. Overall condition of someone's body or mind (merriam-webster.com/dictionary). o State of Homeostasis State of Homeostasis = The ability or tendency of a person, family, or community to maintain internal equilibrium (or stability) by adjusting to the external environment. o 8 Considerations for General well-being 1. Physical Physical activity, diet, sleep, nutrition 2. Emotional Coping effectively with life, creating satisfying relationships 3. Spiritual Expanding our sense of purpose and meaning in life 4. Social Developing a sense of connection, belonging, and a support system 5. Environmental Occupying pleasant, stimulating environments that support well-being Ex: Living in a bad neighborhood can increase stress levels, do you have access to green spaces, access to organic food, etc. 6. Financial Satisfaction with current and future financial situations Ability to afford healthy foods, have health insurance 7. Occupational Personal satisfaction and enrichment derived from one’s work 8. Intellectual Recognizing creative abilities and expanding knowledge and skills o Difference between state of well-being and freedom from disease State of Well Being = Satisfactory condition of existence; characterized by health, happiness, and prosperity; welfare. Homeostasis is being maintained. 2 You can be free of diseases (having physical health and/or other types of health) without having all types of health (i.e. financial, occupational, social) that together affect your overall well- being. o Maslow’s Hierarchy of Human Needs *Image from Dr. K’s slide was so hard to read, so I found these clearer images online. Same info. - Jules (xx) Quizlet Q: The nurse assists a postoperative client with ambulation. The nurse recognizes that assisting the client when performing this skill meets which of MAslow’s basic human needs? A: Safety; security o Health Promotion, Disease Prevention and Levels of prevention. o Health Promotion: is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions. o Disease Prevention: Proactively initiating preventive measures aimed at reducing the burden of disease and associated risk factors. 3 Levels of prevention (primary, secondary, & tertiary) WHO’s concept of disease prevention: ○ Risk factor reduction ○ Arrested progress ○ Reduced consequences ○ Activities that avoid illness o Levels of Prevention: PRIMARY = intervening before negative health effects occur. 3  ○ Health Protection + Health Promotion + Illness & Injury Prevention ○ Prevent disease or injury before it ever occurs. ○ Prevent human exposures to hazards that cause disease or injury. ○ Alter unhealthy or unsafe behaviors that can lead to disease or injury, ○ Increase resistance to disease or injury should exposure occur. ○ Examples: Immunizations, seatbelt laws, education, nutrition, exercise, smoking cessation programs SECONDARY = detection and treatment of preclinical changes to reduce the impact of disease or injury and limit disability. ○ Goal: to reduce the progression / severity of the illness, reduce disability, prevent further disability ○ Health Wellness Screening + Early Diagnosing + Early Treatment ○ Early detection and treatment of existing health problems ○ Intervention after health problems develops ○ Resolving health problems and preventing complications ○ Exampes: mammography, Pap Smear, Colonoscopy, endoscopy TERTIARY = reversing, minimizing, or delaying the effects of a disease or disability. ○ Prevention of complication + Treatment of consequence + Prevention of recurrence ○ Tertiary prevention is any and all action aimed at returning the client to the highest level of function and preventing further deterioration in health. ○ Examples: Pharmaceutical interventions, assistive devices, rehabilitation services, palliative care, hospice, smoking cessation programs o Overview of Healthy People Initiatives, Public Health Policies, & health Education o Healthy People Initiatives: National health promotion and disease prevention objectives developed every ten years to improve the health of all Americans. Launched in 1979. Original focus was reducing preventable death and injury. Healthy People 2030 is in its fifth edition. 4  o Public Health Policies: Influence the health of a nation through health promotion and disease prevention programs. Are influenced by three primary variables: institutions, interests, and ideas. o Health Education: Learning experiences designed to improve the health of an individual or community through increased knowledge or by influencing attitudes. Strategies for health education include: Notifying individuals or groups of their risk factors for certain health conditions Benefits of healthy behaviors Behaviors that need to be changed The tools needed to make such changes. o Factors influencing personal health, Risk Factors, Culture, Factors Influencing Personal Health: ○ Genetics ○ Socioeconomic Status ○ Age ○ Sex ○ Ethnicity / culture ○ Family health history ○ Lifestyle ○ Others, such as Social Determinants of Health: Genetics Behavior Environmental and physical influences Medical care Social factors Risk Factors 5  ○ Modifiable Risk Factors = behaviors and exposures that can raise or lower a person’s risk and measures that can be taken to reduce that risk (lifestyle, weight, behaviors) ○ Nonmodifiable Risk Factors = conditions that increase the risk of developing a disease. I.e. genetics, ethnicity/race, age, family health history Culture ○ Defined as a shared group of ideas and behaviors by people or a society. o Application of Jean Watson’s Theory of Caring, Pender’s Health Promotion Model and Orem’s Self-Care Theory as Nursing Theoretical Frameworks for Health Promotion, Wellness, & Disease Prevention. Jean Watson’s Theory of Caring / Philosophy and Science of Caring ○ Caring can be demonstrated and practiced ○ Caring consists of carative factors ○ Caring promotes growth ○ A caring environment accepts persons as they are and looks to what they may become ○ A caring environment offers development of potential ○ Caring promotes health, and is better than curing (Promoting health is more desirable than seeking to cure) ○ Caring is central to nursing Jean Watson’s 10 Carative Factors: ○ 1. Forming humanistic-altruistic value system (unselfish concerns for humanity) ○ 2. Instilling faith-hope ○ 3. Cultivating sensitivity to self and others ○ 4. Developing helping-trust relationship ○ 5. Promoting expression of feelings ○ 6. Using problem-solving for decision making ○ 7. Promoting teaching-learning ○ 8. Promoting supportive environment ○ 9. Assisting with gratification of human needs 6  ○ 10. Allowing for existential-phenomenological forces. ( A factor that helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attending to the hierarchical ordering of needs.) Basically the nurse assists the person to find the strength or courage to confront life or death. Pender’s Health Promotion Model ○ Focuses on these 3 primary areas: i. Individual characteristics and experience ii. Behavior-specific cognitions and affect iii. Behavioral outcomes ○ Introduction: iv. The health promotion model (HPM) was designed to be a “complementary counterpart to models of health protection.” v. Model seeks to explain proactive behavior vi. Stresses cognitive processes that regulate one’s behavior, such as perception of health status, benefits of & barriers to healthy lifestyle (cultural implications) vii. Defines health as/ a positive dynamic state not merely the absence of disease". viii. Health promotion is directed at increasing a client’s level of well being. ix. Describes the multi dimensional nature of persons as they interact within their environment to pursue health ○ Assumptions: x. Individuals seek to actively regulate their own behavior. xi. Individuals will interact with the environment, progressively transforming the environment and being transformed over time (Eg: Global Warming & going green = reduce pollution. conserve resources. conserve energy. reduce consumption and waste). xii. Health professionals are part of the interpersonal environment, which exerts influence on persons throughout their life span. xiii. Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change 7  ○ Health Promotion and Disease Prevention should be the primary focus in health care xiv. When health promotion and disease prevention fail to prevent problems, then care in illness becomes the next priority xv. Community health care setting is the best avenue in promoting health & preventing illnesses. xvi. Using Pender’s Health Promotion Model, community programs may be focused on activities that can improve the well-being of the people. (i.e. by legislative officials, and healthcare providers.) xvii. Health promotion and disease prevention can be easily carried out in the community, compared to programs aimed at curing existing diseases. Orem’s Self-Care Theory ○ Defined Nursing as: “The act of assisting others in the provision and management of self-care.” The theory focuses on each individual’s ability to perform self-care. ○ Self-Care is defined as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.” ○ Self-care Deficit = delineates when nursing is needed. ○ Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective self- care. ATI Wellness and Self Care: Health Promotion and Disease Prevention Q. The WHOs Definition of health promotion focuses on the concept of A. Improving control over health Q. A nurse giving a series of workshops of health and wellness to an older group of adults at a community center.. Which demonstrates the attendees understood? A. “ I have my health when i am physically, mentally and socially well B. “Health means wholeness, so every aspect of me combines to make a healthy whole self” C. “ Health Means i do the things that keep me at my best, like exercising and eating right” Q. A nurse is giving a presentation… health promotion and disease prevention… which activities? A. Wearing sunscreen outdoors B. Receiving a influenza immunization C. Protecting ears from loud noises 8 Week 7: Nutritional Care o Six Classes of Nutrients, Importance of each, Factors Affecting Food Habits, Risk factors for poor nutrition, Components of Nutritional Assessment Proteins - Provide amino acids needed to repair muscle - Beans, soy, nuts, meat, egg and fish - Activity levels, age and gender can determine how much protein is needed per day - Individuals with poor protein intake such as those experiencing chemo or radiation treatment - Proteins make up 10-35% of total calorie intake Carbohydrates - Broken down into sugars and can be composed of simple carbs: fructose, sucrose or lactose. Or complex carbs such as starch and fiber - Carbs make up 45 to 65% of daily caloric intake - Primary fuel source - Found in vegetables, fruits, milk, nuts, grains, legumes and seeds Fats - Essential to provide energy and absorb vitamins - Limited quantities - Plays a major role in determining cholesterol levels - Trans and Saturated fats should be avoided or limited ; raise LDL and lower HDL - Can lead to CVD, HTN and hyperlipidemia - Found in full fat dairy products such as cheese, butter and milk - Less than 10% of calories per day from saturated fats & keep trans as low as possible - Monounsaturated fats or unsaturated fats are preferred - Found in Nuts, olives, olive oil, seeds and avocados Vitamins - Micronutrients that promote and ward off disease while supporting function of the body 9  - Aids in promoting healthy vision, bones and skin - Not produced in the body so must be derived from the diet - Water soluble vitamins vs Fat soluble vitamins - Water: B complexes and vit C - Found in whole grains, pork, seeds, yogurt, milk, almonds, fish, nuts, leafy green vegetables - Fat: Vit A, D, E and K (DAKE) - Fish oil, beef liver, sweet potatoes, almonds, sunflower seeds, spinach, liver, butter, kale, parsley Minerals - Micronutrients that help the body develop and function normally - Zinc: Boosts immune system and promotes healing - Calcium: Helps with strengthening bones and teeth muscle function and blood pressure regulation - Milk, broccoli, leafy greens - Phosphorus: healthy bones - Eggs, fish, poultry - Magnesium: Muscle contraction, immune system, nerve transmission - Legumes, green veggies, seafood - Sodium - Fluid balance, nerve transmission, muscle contraction - Salt, soy sauce, meat - Chloride - Fluid balance and stomach acid - Salt, meats, soy sauce - Potassium - Fluid balance, muscle function and nerve transmission - Bananas, fruits, legumes and whole grains - Sulfur - Protein molecules - Iron - Mineral that the body needs for growth and development 10  - Used to make - hemoglobin, a protein in RBCs that carries O2 from the lungs to all parts of the body - myoglobin - a protein that provides O2 to muscles - Some hormones - Vegetarians need more iron than omnivores bc the body doesn’t store iron from plants as well as it does iron from meats/animal products - Foods rich in iron - Lean meat / seafood / poultry - Iron fortified breakfast cereals and breads - White beans / lentils / kidney beans / peas - Spinach - Nuts / dried fruits / raisins - Magnesium - Protein synthesis - Muscle and nerve function - Blood glucose control - BP regulation - Required for energy production, oxidative phosphorylation, glycolysis - Contributes to the structural development of bone and is required for the synthesis of DNA / RNA - Plays a role in active transport of calcium and potassium across cell membranes - Foods rich in magnesium - Green leafy vegetables - Legumes / nuts / seeds - Whole grains - Foods containing dietary fiber - Chia seeds / pumpkin seeds - Copper - Cofactor for several enzymes involved in energy production, iron metabolism, neuropeptide activation, connective tissue synthesis, and neurotransmitter synthesis - Also involved in may physiologic processes such as angiogenesis (formation of new blood vessels), regulation of gene expression, brain development, pigmentation, immune system functioning - Foods rich in copper 11  - Shellfish - Seeds and nuts - Organ meats - Wheat bran cereals - Chocolate - Beef / liver - Iodine - Trace element that is naturally present in some foods, added to some types of salt, and is available as a dietary supplement - Essential component of the thyroid hormones T4 and T3 - Thyroid hormones regulate many important biochem reactions including protein synthesis and enzymatic activity and critical determinants of metabolic activity - Required for proper skeletal and CNS development in fetuses and infants - Foods rich in iodine - Seaweed - Fish / seafood - Eggs - Breast milk / infant formulas - Dairy products - Fluoride - Trace mineral naturally found in small amounts in a variety of foods - Most recognized for its role in preventing and reversing dental caries and building strong teeth and bones - Most fluoride is absorbed in the gut and stored in bones and teeth - Food sources of fluoride - Brewed black tea and coffee - Fluoridated water - Canned shellfish - Oatmeal - Raisins - Potatoes - Selenium - Nutritionally essential - Plays a critical role in reproduction, thyroid hormone metabolism, DNA synthesis, protection from oxidative damage and infection - Inorganic / organic 12  - Foods rich in selenium - Brazil nuts - Seafoods - Organ meats - Muscle meats - Cereals / grains - Dairy products 5 Components for Nutritional Assessment 1. Dietary Data a. 24-hour recall method b. Food diaries/calorie counts c. Food frequency record d. Diet history 2. Medical and socioeconomic data 3. Anthropometric data (BMI: height and weight) 4. Clinical data 5. Biochemical data o Short Term vs Long Term Nutritional Support (NG vs GT feedings) NG Tube = SHORT TERM (200 lbs or are uncooperative. o Passive Range of Motion (ROM) vs Active ROM Exercises Expected Outcomes When Performing ROM Exercises ○ ROM is the complete extent of movement of a joint ○ The patient maintains or improves joint mobility. ○ Muscle strength is improved or maintained. ○ Muscle atrophy and contractures are prevented. - Passive Range- exercises performed by nurses with little or no patient participation - Moving each joint through its complete range of motion. Used to help completely immobilized clients retain as much joint range of motion as possible. - Muscle strength neither maintained nor increased bc no muscle contraction. - Active Range- exercises done independently by the patient. Supervision of nurse or PT to ensure they’re doing it correctly. - Moving each joint through its complete range of motion. Maintain and increase muscle strength and help keep joint problems and contractures from developing. **Both ROMs use flexion of joints - Flexion (bend; reduce the angle btw the bones) - Extension (straighten the limb) - Abduction (Move away from baseline) - adduction (Bring closer to the baseline) - Pronation (Turning to face backward/ Moving palm of the hand to face downward) 39  - Supination (Turning to face forward) - Circumduction (Circular Motion/ Moving in a circular Fashion - Rotation (Side to Side/ Moving Lengthwise) - Inversion (Turn Inward) - Eversion (Turn Outward) o Use of Compression Stockings & Pneumonic Compression Devices (Slide # 34-36) Graduated Compression Stockings Physician order required for use Used for patients at risk for deep-vein thrombosis and pulmonary embolism to prevent phlebitis Increases the velocity of blood flow in the superficial and deep veins and improves venous valve function in the legs, promoting venous return to the heart Applied in the morning before the patient is out of bed and while the patient is supine If the patient is sitting or has been up and about the patient should lie down with legs and feet elevated for at least 15 minutes before applying stockings Must be changed every 8 hours and hand washed to maintain their elasticity Pneumatic Compression Devices (PCDs) Consist of fabric sleeves containing air bladders that apply brief pressure to the legs. ○ You should be able to fit 2 fingers in the sleeve to ensure correct fit Intermittent compression pushes blood from the smaller blood vessels into the deeper vessels and into the femoral veins. This action enhances blood flow and venous return and promotes fibrinolysis, deterring venous thrombosis. The sleeves are attached by tubing to an air pump. May be used in combination with antiembolism stockings and anticoagulant therapy to prevent thrombosis formation 40 ATI Engage Fundamentals: Mobility Q. A nurse is caring for a client who requires maximum assistance to transfer from the bed to a chair. Which of the following pieces of equipment should the nurse use? A. Mechanical Lift Q. A nurse is preparing to transfer a client from a bed to a wheelchair. Which of the following actions demonstrated proper use of body mechanics? A. Looking at the client face to face when transferring the client Q. A nurse is providing teaching for a client who injured their ankle, Which of the following information should the nurse include A. Tendons connect muscle to bone Q. A nurse is providing teaching for a client who has kyphosis, Which of the following information should the nurse include? A. Kyphosis is rounded upper back with the pelvis tilted forward Q. A nurse is caring for a client who has pneumonia. In which of the following positions should the nurse place the client to promote postural drainage? A. Prone Q. A nurse is performing a focused assessment on an older client's mobility. Which of the following findings should indicate to the nurse that the client is experiencing age-related change to their musculoskeletal system? A. Increased curvature of the thoracic spine Q. A nurse is caring for a client who requires assistance with ADLs. Which of the following referrals should the nurse recommend for this client? A. Occupational therapist Q. A nurse is caring for a client who is at risk for developing atelectasis. Which of the following actions should the nurse take A. Remind the client to use the incentive spirometer Q. A nurse is planning to care for a post op client. IN which of the following positions should the nurse place the client to prevent atelectasis A. Fowlers Q. A nurse is discussing proper body mechanics with a group of AP. 41  A. A stable center of gravity increases stability and balance B. A wide base lowers the center of gravity C. Proper body alignment involves tightening the abdomen Q. A nurse is assessing a client's mobility and notes one of the clients feet drag behind them when ambulating. Which of the following conditions should the nurse suspect? A. Foot Drop Q. A nurse is caring for a client who requires total assistance with mobility. When using the MAT tool, which of the following pieces of equipment should the nurse use to transfer the client? A. Mechanical Lift Q. A nurse is completing the MAT for a client and determines that the client is at Level 1. The nurse should identify that the client is unable to perform which task ? A. Sit on the edge of the bed for 1 minute Q. A nurse is teaching a client who has an unsteady gait about how to use a walker, Which of the following instructions should the nurse include A. The top of the walker should be at the level of your wrists Q. A nurse is caring for a client who has a stroke and reports difficulty with perception. The nurse should assess which of the following? A. Diminished awareness of body position and balance 42