N4530 Community Health Nursing PDF

N4530 Community Health Nursing Class Guide Module 1.2 Health Promotion and Risk Reduction Read Nies & McEwen, Ch. 4 Outcomes: Use theories of health promotion to plan education for patients and populations Demonstrates an understanding of risks based on modifiable and non-modifiable factors. P...

N4530 Community Health Nursing Class Guide Module 1.2 Health Promotion and Risk Reduction Read Nies & McEwen, Ch. 4 Outcomes: Use theories of health promotion to plan education for patients and populations Demonstrates an understanding of risks based on modifiable and non-modifiable factors. Provides education and screening recommendations based on the relationship of risk to health and health promotion and protection activities. Communicates risk to patients and populations Class Guide: Review HP2030 overarching goals for improving health outcomes. Note the HP objectives related to Health Literacy https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030 Watch the video (2:20) at the top of the page, 5 Things to Know About Health Literacy. 1. Summarize personal health literacy and compare to organizational health literacy: Personal Health Literacy→ The individuals ability to access and understand health care information and the how to make health decisions that are informed. This relies on the abilities to read, comprehend medical instructions, and to be able to communicate effectively with health care providers and to be able to maneuver the health care system. Organizational Health Literacy→ The healthcare organizations ability to enable individuals to locate, synthesize and use healthcare information and offered services. This includes the design of materials to communicate policies and services that are offered to the public/populations diverse needs. Need to make sure the services offered are accessible and can be used. Read and study the section on the Determinants of Health p. 54-55 Pender’s Health Promotion Model explores biopsychosocial factors that influence individuals when engaging in healthy behaviors. The Health Belief Model is often used for guiding health education and health promotion activities. 2. The following are key concepts of the HBM: (see Table 4.1) Key Concepts and Definitions of the Health Belief Model Concept Definition Perceived susceptibility One's belief regarding the chance of getting a given condition Perceived severity One's belief regarding the seriousness of a given condition Perceived benefits One's belief in the ability of an advised action to reduce the health risk or seriousness of a given condition Perceived barriers One's belief regarding the tangible and psychological costs of an advised action Cues to action Strategies or conditions in one's environment that activate readiness to take action Self-efficacy One's confidence in one's ability to take action to reduce health risks 3. The Transtheoretical Model is based on the assumption that behavior change takes place over time, going through stages of change. Change is difficult, even for the most motivated of individuals. People resist change for many reasons. Change may: Be unpleasant (exercising) Require giving up pleasure (eating desserts or watching TV) Be painful (insulin injections) Be stressful (eating new foods) Jeopardize social relationships (gatherings with friends and family that involve food) 4. Review the Stages of Change (Table 4.2). What is the Decisional Balance construct and how can you apply this to patient education? The Transtheoretical Model Constructs Description Stages of Change Precontemplation The individual has no intention to take action toward behavior change in the next 6 months. May be in this phase because of a lack of information about the consequences of the behavior or failure on previous attempts at change. Contemplation The individual has some intention to take action toward behavior change in the next 6 months. Weighing pros and cons to change. Preparation The individual intends to take action within the next month and has taken  steps toward behavior change. Has a plan of action. Action The individual has changed overt behavior for less than 6 months. Has changed behavior sufficiently to reduce risk of disease. Maintenance The individual has changed overt behavior for more than 6 months. Strives to prevent relapse. This phase may last months to years. Decisional Balance Pros The benefits of behavior change Cons The costs of behavior change What is the Decisional Balance construct and how can you apply this to patient education? It is the weighing of pros vs. cons of a behavior that is changing. During patient education, it can be used to assist patients to identify the benefits vs costs to motivate them toward healthier behavior. 5. The probability that a specific event will occur in a given time frame is? Risk 3 criteria for establishing a risk factor: The frequency of the disease varies by category or amount of the factor. Lung cancer is more likely to develop in cigarette smokers than in nonsmokers and in those who smoke heavily than in those who smoke little. The risk factor must precede the onset of the disease. Cigarette smokers have lung cancer after they have been smoking for a while. If smokers had lung cancer before starting to smoke, this fact would cast doubt on smoking as a risk factor for lung cancer. The association of concern must not be due to any source of error. In any research study (especially one involving human behavior), there are many sources of error, such as study design, data collection methods, and data analysis. Other criteria that have been noted in the literature include the strength of the association, consistency with repetition, specificity, and plausibility (Friis and Sellers, 2004). 6. Type of risk are over which the person has control? Modifiable Risk Type of risk where the person has little to no control? Non-Modifiable Risk What is an example of each type? Modifiable Risk: Stopping smoking to lower the risk of heart disease. Non-Modifiable: A genetic predisposition to breast cancer. 7. Complete the AHA/ACC risk assessment tool found on their website (note: for most of you, you will need to change your age to use the risk calculator - use 50 y/o and use normal values if you don’t know your lab numbers). Print results and submit with the ALG.  8. Review the Surgeon General's “My Family Health Portrait” on the CDC site, and enter your information. Print your results and submit them with the ALG (this can be used to help complete the genogram assignment with the Family Project) 9. Risk reduction is a proactive process that allows a person to address actual or potential threats to their health. 10. Risk communication is the process of informing the public about health risks or threats. This is affected by what 3 things regarding the public’s understanding of risks? Risk communication is affected by the way individuals and communities perceive, process, and act on their understanding of risk. Give an example of this during the early phase of the Covid pandemic. The masses understanding of the virus was impacted by the unclear, conflicting information and messaging about mask use. 11. In the US, what is the leading cause of preventable death? In the United States, smoking is the leading cause of preventable death, accounting for approximately one out of every five deaths, or 438,000 deaths, per year. And is what type of factor in cancers of the esophagus, bladder, stomach, oral, pharynx, larynx, cervix, and lungs? Smoking is a causal factor in cancers of the esophagus, bladder, stomach, oral cavity, pharynx, larynx, cervix, and lungs, with more than 90% of lung cancers in men and 80% of lung cancers among women attributable to smoking. Over 16 million Americans are currently living with a disease caused by smoking. Smoking harms nearly every organ in the body Smoking also has an economic impact, costing $170 billion annually in healthcare and lost productivity. 12. Smoking is most common among adults who are less educated and live in which socioeconomic class? Smoking is most common among adults who are less educated and adults who live below the poverty level. Smoking rates are higher in the Midwest and lowest in the western US. What percent of smokers say they would like to quit? More than 70% of current smokers report that they would like to quit smoking (CDC, n.d.a,b). 13. What age range do most people start smoking? 18-25 Though the rate of smoking has declined among Americans since the 1990s, more high school juniors and seniors smoke than do adults. Half of high school-aged smokers have tried to quit at least once. Those who start using tobacco in their teens have a harder time giving up smoking later in life. Most smokers pick up the habit at age 18, with very few initiating smoking after the age of 25. 14. Hour many hours of sleep should you get at night? Age Sleep Needs Newborns (1–2 months) 10.5–18 h Infants (3–11 months) 9–12 h during night and 30-min to 2-h naps, 1–4 h  a day Toddlers (1–3 years) 12–14 h Preschoolers (3–5 years) 11–13 h School-aged children (5–12 years) 10–11 h Teens (11–17 years) 8.5–9.25 h Adults 7–9 h Older adults 7–9 h 15. Be sure to read and study the rest of the chapter but for the class guide we are going to explore some other resources to take a deeper look at labs used for preventative screenings. Use this chapter, the American Heart Association https://www.heart.org/ and your lab reference book. You may use other sources as long as they are referenced and are evidence-based. 16. Use information from the AHA and lab reference book to answer the following: a. What tests are included in a lipid panel? What does each test measure? What are the normal ranges for screening? Total Cholesterol→ Overall cholesterol levels in the blood. Normal Range is less than 200 mg/dL LDL Cholesterol→ Overall amount of LDL in blood. Normal Range is 100-129 mg/dL HDL Cholesterol→ Overall amount of HDL in blood. Normal Range men 40 mg/dL or higher. Women 50 mg/dL or higher. Triglycerides→ Overall amount of Triglycerides in the blood. Normal Range is less than 150 mg/dL. b. What are population-based screening recommendations for lipid levels? Adults→ Fasting lipid profile Adults w/CAD Risk Factors→ Annual Test Adolescents→ Ages 9-11. Then again between ages 17-21. Elderly→ Diagnostic testing based on life expectancy and risk factors. 17. What lifestyle changes can improve lipid levels, and why are they effective? Modifiable Diet Reduce saturated/Trans fats intake can reduce Low Density Lipids. Increase soluble fiber intake. Ex, oats, vegetables and fruits. Can aid in ↓ cholesterol absorption. Increase consumption of fish or flaxseed to increase omega-3 fatty acids to ↑ High Density Lipids and reduce triglycerides.  Excercise Routine regular aerobic exercise. Ex, walking, cycling, running can aid in increasing High Density Lipids and to reduce Low Density Lipids. Managing Weight Reducing excess weight can lower total cholesterol, Low Density Lipids and triglycerides and improve High Density Lipids. Smoking Cessation Stopping smoking can aid in improving High Density Lipids and to lower cardiovascular risk overall. 18. Use your pathophysiology textbook to explain how coronary artery disease develops - in detail and how it progresses. Include factors contributing to each part of this “web of causation.” Include genetic, lifestyle, and community factors contributing to a person's risk for CAD. Coronary Artery Disease develops when the arteries that are used to supply blood to the heart start to become narrowed/blocked as a result of the buildup of plaque (atherosclerosis). Atherosclerosis will start with damage to the inner lining of the arteries. This damage can be the result of high blood pressure, increased cholesterol, diabetes and or smoking. Endothelial Damage→ will result in inflammation and the accumulation of Low Density Lipids in the walls of the arteries. Formation of Fatty Streaks→ Low Density Lipids become oxidized, then attract macrophages that will ingest cholesterol that then will result in foam cells that turn into fatty streaks. Plaque Forming→ Sustain fatty streak development will result in the creation of fibrous plaque. This plaque will narrow the arteries. Rupture of Plaque→ Unstable plaques can rupture and cause a blood clot to form. This can become a blockage to the blood that flows to the heart. This can result in a heart attack. Genetic Social Determinants of Health→ A family history of heart disease can influence the likely hood of CAD. Community Social Determinants of Health→ The socioeconomic status, the ability to access healthcare, and the access to healthy food and an exercise routine can impact the affect of CAD risk. Lifestyle Social Determinants of Health→ Lack of exercise combined with poor diet, smoking and increased alcohol use can lead to the accumulation of plaque in the arteries. 19. What does a high-sensitivity C-reactive protein test measure? This test will measure the level of hs-CRP. This specific protein is produced by the liver as a result to inflammation. The increased levels of hs-CRP are an indicator of chronic inflammation. This chronic inflammation has been linked to the increase in cardiovascular events.  Why is this sometimes used as part of a cardiac screening? This diagnostic test is used in heart screenings due to increased/high CRP levels are a possible indicator/sign of inflammation in the arteries, this is a main indicator in the progress and development of CAD and atherosclerosis. 20. What is the role of inflammation in the development of CAD? Inflammation has a main function in the progress and development of CAD by adding to the dysfunction of endothelial, formation of plaque, and plaque instability. What can be done to lower chronic inflammation levels?  Regular/Routine exercise  Anti-Inflammatory Diet  Management of Stress  Statins (Medication)  Smoking Cessation 21. Use the American Heart Association site to answer the following: a. What are the normal ranges for blood pressure? Less than 120/80 mm Hg. b. List the ranges for stages of HTN and referral criteria. Elevated Systolic 120-129 mm Hg. Diastolic 80-89 mmHg. HTN Stage 1 Systolic 130-139. Diastolic 80-89 mm Hg. HTN Stage 2 Systolic 140 mm Hg or higher. Diastolic 90 mm Hg or higher. HTN Crisis Systolic 180 mm Hg. Diastolic 120 mm Hg. c. What are population-based screening recommendations? Adults should have routine blood pressure checks beginning at 18. Patients that are obese, family history or smoke, screenings should be earlier and more frequent. d. What can be done to lower blood pressure? DASH Diet Decrease sodium intake Decrease alcohol consumption Routine Exercise Stress Management Smoking Cessation 22. Use the American Diabetes Association site https://diabetes.org/ to answer the following: a. What is a normal blood glucose range? Fasting blood glucose 80-130 mg/dL. Postprandial 180 mg/dL. b. What is hemoglobin A1c and what does it measure? Include a chart that gives the A1c relationship to average blood glucose levels. Hemoglobin A1c is the test that measures and gives an average of the blood glucose during a 3 month span. Measure the percentage of glucose that is connected to hemoglobin.  A1c (%) Estimated Avg Blood Glucose (mg/dL) 5.7 117 6.0 126 7.0 154 8.0 183 9.0 212 10.0 240 c. What are the criteria for pre-diabetes, and what are the diagnostic criteria for diabetes? Pre Diabetes Fasting blood glucose 100-125 mg/dL A1c 5.7%to 6.4% Oral Glucose Tolerance Test 140-199 mg/dL after 2 hours of consumption. Diabetes Fasting blood glucose 125 mg/dL or higher A1c 6.5% or higher Oral Glucose Tolerance Test 200 mg/dL or higher after 2 hours of consumption. d. What lifestyle changes help prevent or manage DM? Balanced Diet Routine Exercise Management of body weight Medication Adherence Regular Assessment/Monitoring of blood glucose levels 23. What test in the lipid panel might be elevated if the blood glucose is high? Triglycerides may be high if blood glucose is elevated. Why? High blood glucose can be an indicator that insulin resistance or diabetes. When blood glucose is not used for energy, the liver will process/synthesize the extra into fatty acids. Then these fatty acids are moved into the blood as triglycerides and stored there. Causing triglycerides to be high along with elevated blood glucose. Use the American Cancer Society site https://www.cancer.org/ or other evidence-based site to answer the following: 24. What are the current recommendations for screening mammograms? Women between the ages of 45-54 Annually Women between the ages of 40-44 Option to start annually if choose to Women between aged 55 and older every two years 25. What are current screening recommendations for colorectal cancer? Recommended for adults that are 45 years of age or older. Screening will need to be continued until the age of 75, while making considerations to continue until age 85 based on patient history. Not recommended after age 85. What are screening options? Stool based test Visual exam 26. Why is screening for colon cancer so important? The screening for colon cancer is important because, early detection of colon cancer is highly treatable. Early screening can find precancerous polyps before they progress into cancer. Early stage cancer detection can significantly decrease mortality rates. Colorectal cancer will often progress with no symptoms. The regular screening can be crucial in detection of the disease in patients that do not show signs/symptoms. 27. Find a comprehensive list of recommended screenings, from a reliable source, based on age and sex. You do not need to list them here but what are ways to communicate these to patients and the public? Websites, posters, brochures. Patient education during routine healthcare visits. Outreach in the community. Electronic Health Records can be used to send reminders for either patients or providers. Apps/Social Media and other digital platforms can be used to distribute screening information. 28. From reliable sites such as the Harvard School of Public Health Nutrition Source https://nutritionsource.hsph.harvard.edu/ , AHA, ADA, your textbook, etc. – plan teaching for healthy diets, including recommended sources of protein, types of healthy fats, fats to avoid, the importance of fiber, and the difference in simple and complex carbohydrates. Recommended Sources of Protein ◦ Plant based proteins→ beans, tofu, lentils and chickpeas ◦ Animal based proteins→ Chicken, fish, eggs and fish ◦ Dairy→ Low/Non Fat milk, yogurt and or cheese. Healthy Fats ◦ Monounsaturated Fats→ Olive oil, nuts and avocado ◦ Polyunsaturated Fats→ Salmon, walnuts, flaxseeds and foods that are loaded with omega-3s Avoid These Fats ◦ Saturated Fats→ Red meat, Dairy that is full fat and butter  ◦ Trans Fats→ Processed foods, baked goods, fried foods and margarine Fiber ◦ Soluble Fiber→ Legumes, apples, carrots and oats ◦ Insoluble Fiber→ Grains, nuts, vegetables and seeds Simple Carbohydrates: Cause rapid spikes in blood sugar. These are found in sugar, soda and other sweets. Complex Carbohydrates: Are digested at a slower rate. These types are found in grains, legumes, fruits and vegetables. 29. Plan specific diet teaching for lowering LDL, increasing HDL, lowering BP, and managing blood glucose. To Lower Low Density Lipids Increase Fiber Consumption. Consume unsaturated fats instead of saturated fats. Reduce consumption of fried and processed foods. Increase consumption of fortified foods that contain stanols. To Increase High Density Lipids Start an exercise routine. Increase consumption of foods that are rich in monousaturated fats. Almonds, olive oil and avocado’s are great examples. To Lower Blood Pressure Start the DASH Diet. Decrease sodium intake to 1500-2200 mg a day. Decrease alcohol intake and increase foods rich in potassium to aid in blood pressure regulation. To Manage Blood Glucose Increase consumption of foods that have a low glycemic index. Whole grains, non starchy vegetables and legumes. Schedule consistent meal times to sustain blood sugar levels. Add lean proteins and fats that are healthy to slow carbohydrate absorption. 30. What are the recommendations for exercise for most adults? Adults need to engage in moderate intensity aerobic exercise for 150 minutes per week. Ex, bike riding, brisk walking. Or 75 minutes of vigorous exercise. Ex, running. Muscle strengthening weight training should be added for more benefits. 31. Read Clinical Example 4.1 What are her modifiable and non-modifiable risk factors? Modifiable: ◦ Diet ◦ Physical Activity ◦ Stress Management ◦ Smoking Cessation Non-Modifiable ◦ Age ◦ Family Health History What are her positive health behaviors? ◦ Following diet guidelines to manage weight. diet consisting mostly of vegetables, grains, and fruit. ◦ BMI within normal range ◦ Routine Exercise ◦ Smoking Cessation ◦ Rarely drinks alcohol Where are areas she could improve? ◦ Increase physical activity ◦ Consistent heart healthy diet ◦ Effective stress management Use the theories in health promotion to make a plan including education for Jamie R. (note this is discussed later in the chapter – keep reading!) Patient Education Teach Jaime the benefits/gains of improved cardiovascular health with exercise and reducing risk factors. Aid Jaime in setting SMART goals for diet and exercise. Promote the idea of include her family/friends in her goal of better health. This can offer motivation and accountability. Use the Health Belief Model to inform Jaime of the threat of cardiovascular disease by pointing out her risks and highlight the benefits of changing her behavior. Cooperate and find resolutions to barriers to change.