Health Promotion Guidelines Across Lifespan

Notes

Intra-uterine
Oxygen
  • To meet the fetal demands for oxygen, the pregnant mother gradually increases her normal blood flow by about one-third, peaking at about 8 months.
  • Respiratory rate and cardiac output increase significantly during this period.
  • Feta circulation travels from the placenta through umbilical arteries, which caries deoxygenated blood away from the fetus.
Nutrition and Fluids
  • The fetus obtains nourishment from the placental circulation and by swallowing amniotic fluid.
  • Nutritional needs are met when the mother eats a well-balanced diet containing sufficient calories and nutrients to meet both her needs and those of the fetus.
  • Adequate folic acid, one of the B vitamins, is important in order to prevent neural tube defects
  • Folic rich foods are green leafy vegetables, oranges, dried beans and suggest she take a vitamin supplement that contain folic acid.
Rest and Activity
  • The fetus sleeps most of the time and develops a pattern of sleep and wakefulness that usually persist after birth.
  • Fetal activity can be felt by the mother at about the fifth lunar month of pregnancy
Elimination
  • Fetal feces are formed in the intestines from swallowed amniotic fluid throughout the pregnancy, but are normally not excreted until after birth.
  • Urine normally is excreted into the amniotic fluid when the kidneys mature (16 to 20 weeks).
Temperature Maintenance
  • Amniotic fluid usually provides a safe and comfortable temperature for the fetus.
  • Significant changes in the maternal temperature can alter the temperature of the amniotic fluid and the fetus.
  • Significant alter in temperature increases due to illness, hot whirlpool baths, or saunas may result in birth defects.
  • In the last weeks of gestation, the fetus develops subcutaneous fatty tissue stores that will help maintain body temperature at birth.
Safety
  • The body systems form during the embryonic period. As a result, the embryo is particularly vulnerable to damage from teratogen, which is anything that adversely affects normal cellular development in the embryo or fetus.
  • It is important for the nurse to inquire about possible pregnancy when giving medications that are known teratogens and also ask when the woman is scheduled for tests that involve radiography (x-ray).
  • Smoking, alcohol, and drugs can affect the environment for the fetus. Smoking has been associated with preterm labor, spontaneous abortion, low-birth weight infants, and sudden infant death syndrome and learning disorders.
  • Fetal alcohol syndrome (FAS), a result of impaired mitochondrial development, leads to microcephaly, mental retardation, learning disorders, and other central nervous system defects.
Infants
Health Examinations
  • Screening of newborns for hearing loss; follow-up at 3 months and early intervention by 6 months if appropriate
  • At 2 weeks and at 2,4,6, and 12 months
Protective Measures
  • Immunizations: diptheria,tetanus, acellular pertussis (DTaP), inactivated poliovirus vaccine (IVP), pneumococcal, measles-mumps-rubella (MMR), Haemophilus influenzae type B (HIB), hepatitis B (HepB), varicella and influenza vaccines as recommended
  • Fluoride supplements if there is adequate water fluoridation (less than 0.7 part per million)
  • Screening for tuberculosis
  • Screening for phenylketonuria (PKU) and other metabolic conditions
  • Prompt attention for illnesses
  • Appropriate skin hygiene and clothing
Infant Safety
  • Importance of supervision
  • Car seat, crib, playpen, bath, and home environment safety ,measures
  • Feeding measures (e.g., avoid propping bottle)
  • Provide toys with no small parts or sharp edges
  • Eliminate toxins in the environment (e.g., chemicals, radon, lead, mercury)
  • Use smoke and carbon monoxide (CO) detectors in home
Nutrition
  • Breast-feeding to age 12 months
  • Breast-feeding and bottle feeding techniques
  • Formula preparation
  • Feeding schedule
  • Introduction of solid foods
  • Need for iron supplements at 4 to 6 months
Elimination
  • Characteristics and frequency of stool and urine elimination
  • Diarrhea and its effects
Rest/ Sleep
  • Establish routine for sleep and rest patterns
Sensory Stimulation
  • Touch: holding, cuddling, rocking
  • Vision: colorful, moving toys
  • Hearing: soothing voice tones, music, singing
  • Play: toys appropriate for development
Toddlers
Health Examinations
  • At 15 and 18 months and then as recommended by the primary care provider
  • Dental visit starting at age of 3 or earlier
Protective Measures
  • Immunizations: continuing DTaP, IPV series, pneumococcal, MMR, Haemophilus influenzae type B, hepatitis, hepatitis A, and influenza vaccines as recommended
  • Screenings for tuberculosis and lead poisoning
  • Fluoride supplements if there is inadequate water fluoridation (less than 0.7 part per million)
Toddler Safety
  • Importance of constant supervision and teaching child to obey commands
  • Home environment safety measures (e.g., lock medicine cabinet)
  • Outdoor safety measures (e.g., close supervision near water)
  • Appropriate toys
  • Eliminate toxins in environment (e.g., pesticides, herbicides, mercury, lead, arsenic in playground materials)
  • Use smoke and carbon monoxide (CO) detectors in home
Nutrition
  • Importance of nutritious meals and snacks
  • Teaching simple mealtime manners
  • Dental care
Elimination
  • Toilet training techniques
Rest/Sleep
  • Dealing with sleep disturbances
Play
  • Providing adequate space and variety of activities
  • Toys that allow “acting on” behaviors and provide motor and sensory stimulation
Preschoolers
Health Examinations
  • Every 1 to 2 years
Protective Measures
  • Immunizations: continuing DTaP, IPV series, MMR, hepatitis, pneumococcal, influenza, and other immunizations as recommended
  • Screenings for tuberculosis
  • Vision and hearing screening
  • Regular dental screenings and fluoride treatment
Preschooler Safety
  • Educating child about simple safety rules (e.g., crossing the street)
  • Teaching child to play safely (e.g., bicycle and playground safety)
  • Educating to prevent poisoning; exposure to toxic materials
Nutrition
  • Importance of nutritious meals and snacks
Elimination
  • Teaching proper hygiene (e.g., washing hands after using bathroom)
Rest/ Sleep
  • Dealing with sleep disturbances (e.g., night terrors, sleepwalking)
Play
  • Providing times for group play activities
  • Teaching child simple games that require cooperation and interaction
  • Providing toys and dress-ups for role-playing
School-Age Children
Health Examinations
  • Annual physical examination or as recommended
Protective Measures
  • Immunizations as recommended (e.g., MMR, meningococcal, tetanus-diphtheria, adult preparation [Td])
  • Screening for tuberculosis
  • Periodic vision, speech, and hearing screenings
  • Regular dental screenings and fluoride treatment
  • Providing accurate information about sexual issues (e.g., reproduction, AIDS)
School-Age Child Safety
  • Using proper equipment when participating in sports and other physical activities (e.g., helmets, pads)
  • Encouraging child to take responsibility for own safety (e.g., participating in bicycle and water safety courses)
Nutrition
  • Importance of child not skipping meals and eating balance diet
  • Experiences with food that may lead to obesity
Elimination
  • Utilizing positive approaches for elimination problems (e.g., enuresis)
Play and Social Interactions
  • Providing opportunities for a variety of organized group activities
  • Accepting realistic expectations of child’s abilities
  • Acting as role models in acceptance of other persons who may be different
  • Providing a home environment that limits TV viewing and video games and encourages completion of homework and healthy exercise
Adolescents
Health Examinations
  • As recommended by the primary care provider
Protective Measures
  • Immunizations as recommended, such as adult tetanus –diphtheria vaccine, MMR, pneumococcal, and hepatitis B vaccine
  • Screening for tuberculosis
  • Periodic vision and hearing screenings
  • Regular dental assessments
  • Obtaining and providing accurate information about sexual issues
Adolescent Safety
  • Adolescent’s taking responsibility for using motor vehicles safely (e.g., completing a driver’s education course, wearing seat belt and helmet)
  • Making certain that proper precautions are taken during all athletic activities (e.g., medical supervision, proper equipment)
  • Parent’s keeping lines of communication open and being alert to signs of substance abuse and emotional disturbances in the adolescent
Nutrition and Exercise
  • Importance of healthy snacks and appropriate patterns of food intake and exercise
  • Factors that may lead to nutritional problems (e.g., obesity , anorexia nervosa, bulimia)
  • Balancing sedentary activities with regular exercise
Social Interactions
  • Encouraging and facilitating adolescent success in school
  • Encouraging adolescent to establish relationships that promote discussion of feelings, concerns, and fears.
  • Parents’ encouraging adolescent peer group activities that promote appropriate moral and spiritual values
  • Parents’ acting as role models for appropriate social interactions
  • Parents’ providing a comfortable home environment for appropriate adolescent peer group activities
  • Parents’ expecting adolescents to participate in and contribute to family activities
Young Adults
Health Test and Screenings
  • Routine physical examination (every 1 to 3 years for females; every 5 years for males)
  • Immunizations as recommended, such as tetanus-diphtheria boosters every 0 years, meningococcal vaccine if not given in early adolescence, and hepatitis B vaccine
  • Regular dental assessments (every 6 months)
  • Periodic vision and hearing screenings
  • Professional breast examination every 1 to 3 years
  • Papanicolaou smear annually within 3 years of onset of sexual activity
  • Testicular examination every year
  • Screening for cardiovascular disease (e.g., cholesterol test every 5 years if results are normal; blood pressure to detect hypertension; baseline electrocardiogram at age 35)
  • Tuberculosis skin test every 2 years
  • Smoking: history and counseling if needed
Safety
  • Motor vehicle safety reinforcement (e.g., using designated drivers when drinking, maintaining brakes and tires) and making sure the vehicle is insured from a company such as Money Expert.
  • Sun protection measures
  • Workplace safety measures
  • Water safety reinforcement (e.g., no diving in shallow water)
Nutrition and Exercise
  • Importance of adequate iron intake in diet
  • Nutritional and exercise factors that may lead to cardiovascular disease (e.g., obesity, cholesterol, and fat intake, lack of vigorous exercise)
Social Interactions
  • Encouraging personal relationship that promote discussion of feelings, concerns, and fears
  • Setting short-and long- term goals for work and career choices
Middle-Aged Adults
Health Test and Screening
  • Physical examination (every 3 to 5 years until age 40, then annually)
  • Immunizations as recommended, such as a tetanus booster every 10 years, and current recommendations for influenza vaccine.
  • Regular dental assessments (e.g., every 6 months)
  • Tonometry for signs of glaucoma and other eye diseases every 2 to 3 years or annually if indicated
  • Breast examination annually by primary care provider
  • Testicular examination annually by primary care provider
  • Screenings for cardiovascular disease (e.g., blood pressure measurement; electrocardiogram and cholesterol test as directed by the primary care provider)
  • Screenings for colorectal, breast, cervical, uterine, and prostate cancer
  • Screening for tuberculosis every 2 years
  • Smoking: history and counseling, if needed
Safety
  • Motor vehicle safety reinforcement, especially when driving at night
  • Workplace safety measures
  • Home safety measures: keeping hallways and stairways lighted and uncluttered, using smoke detector, using nonskid mats and handrails in the bathrooms
Nutrition and Exercise
  • Importance of adequate protein, calcium, and vitamin D in diet
  • Nutritional and exercise factors that may lead to cardiovascular disease (e.g., obesity, cholesterol and fat intake, lack of vigorous exercise)
  • An exercise program that emphasizes skill and coordination
Social Interactions
  • The possibility of a middle crisis: encourage discussion of feelings, concerns, and fears
  • Providing time to expand and review previous interests
  • Retirement planning (financial and possible diversional activities), with partner if appropriate
Elders
Health Test and Screening
  • Total cholesterol and high density lipid protein measurement every 3 to 5 years until age 75
  • Aspirin, 81 mg daily, if in high- risk group
  • Diabetes mellitus screen every 3 years, if in high-risk group
  • Smoking cessation
  • Screening mammogram every 1 to 2 years (women)
  • Clinical breast exam annually (women)
  • Pap smear annually if there is a history of abnormal smears or previous hysterectomy of malignancy (United States Preventive Services Task Force, 2003)
    • Older women who have regular, normal Pap smear or hysterectomy for nonmalignant causes do NOT need Pap smear beyond the age of 65
  • Annual digital rectal exam
  • Annual prostate-specific antigen (PSA)
  • Annual fecal occult blood test (FOBT)
  • Sigmoidoscopy every 5 years; colonoscopy every 10 years
  • Visual acuity screen annually
  • Hearing screen annually
  • Depression screen periodically
  • Family violence screen periodically
  • Height and weight measurements annually
  • Sexually transmitted disease testing, if high- risk group
  • Annual flu vaccine if over 65 or in high-risk group
  • Pneumococcal vaccine at 65 and every 10 years thereafter
  • Td vaccine every 10 years
Safety
  • Home safety measures to prevent falls, fire, burns, scalds, and electrocution
  • Working smoke detectors and carbon monoxide detectors in the home
  • Motor vehicle safety reinforcement, especially when driving at night
  • Elder driver skills evaluation (some states require for license renewal)
  • Precautions to prevent pedestrian accidents
Nutrition and Exercise
  • Importance of a well-balanced diet with fewer calories to accommodate lower metabolic rate and decreased physical activity
  • Importance of sufficient amounts of vitamin D and calcium to prevent osteoporosis
  • Nutritional and exercise factors that may lead to cardiovascular disease (e.g., obesity, cholesterol and fat intake, lack of exercise)
  • Importance of 30 minutes of moderate physical activity daily; 20 minutes of vigorous physical activity 3 times per week
Elimination
  • Importance of adequate roughage in the diet, adequate exercise, and at least six 8-once glasses of fluid daily to prevent constipation
Social Interaction
  • Encouraging intellectual and recreational pursuits
  • Encouraging personal relationships that promote discussion of feelings, concerns, and fears
  • Assessment of risk factors for maltreatment
  • Availability of social community centers and programs for seniors

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