NSG 200 Health Promotion

Causes of Dry Mouth

A dry mouth can be aggravated by poor fluid intake, heavy smoking, alcohol use, high salt intake, anxiety, and many medications. Medications that can cause dryness of the mouth include diuretics; laxatives, if used excessively; and tranquilizers, such as diazepam (Valium). Some chemotherapeutic agents used to treat cancer also cause oral dryness and lesions. A common side effect of the anticonvulsant drug phenytoin (Dilantin) is gingival hyperplasia. Optimal oral hygiene (e.g., brushing with a soft toothbrush, flossing) is necessary for patients taking these medications.

Oral Care - Pregnancy

A pregnant woman's progesterone level rises, and other hormones change after conception. The effect in the woman's mouth can be gingivitis, increased or decreased saliva, or granulomas on the gums. The stomach contents, coming through the mouth with morning sickness, also bring up gastric acids. This can hasten tooth decay The incidence of periodontal disease (gum disease) increases during pregnancy because the rise in female hormones affects gingival tissue and increases its reaction to bacterial plaque. Many pregnant women experience more bleeding from the gingival sulcus during brushing and increased redness and swelling of the gingiva (gum).

NREM

About 80% of sleep during a night is NREM sleep. NREM sleep is divided into four stages, each associated with distinct brain and body activity. Stage N1 is the stage of light sleep and lasts only a few minutes. During this stage, the eyes move very slowly, and the muscle activity slows. The sleeper can be easily awakened, and if roused, often remembers fragmented visual images. Stage N2 is the stage of light sleep during which body processes continue to slow down. Eye movements stop, and brain waves become slower. Bursts of rapid brain waves sometimes occur. Stage N2 constitutes 50% of total sleep, Stages N3 and N4 are together called deep sleep. In stage N3, extremely slow brain waves appear, punctuated with smaller, faster waves. In stage N4, delta waves predominate. In either stage of deep sleep, the sleeper is difficult to arouse. The eyes do not move, and muscle activity ceases. People awakened during deep sleep often feel disoriented. Some children wet their beds, have night terrors, or sleepwalk during deep sleep

Cardiovascular

Adequate moderate-intensity exercise (40%-60% of maximum capacity such as walking a mile in 15-20 minutes) increases the heart rate, the strength of heart muscle contraction, and the blood supply to the heart and muscles through increased cardiac output. In two studies with male participants, levels of "good" (high-density lipoprotein [HDL]) cholesterol were increased through regular endurance (walking/jogging) exercise. Exercise also promotes heart health by mediating the harmful effects of stress. The types of exercise that provide cardiac benefit vary. They include aerobic exercise such as walking and cycling. Recent research supports the benefits of yoga practice in cardiovascular health. Statistically significant effects include lowered systolic and diastolic blood pressure, improved oxygen uptake, improved heart rate variability, improved circulation, and self-reported stress reduction

Health Promotion - Pregnancy

Age of the mother Commitment to and availability of prenatal care Presence of a supportive significant other, spouse, friend, or family member Events surrounding the fertilization process (pregnancy by choice, rape, incest) Presence of other physical impairments (e.g., gestational diabetes) or mental conditions (e.g., schizophrenia) Previous pregnancy experiences and outcomes Mother's choice of childbirth setting (hospital, home delivery) Cultural or ethnic factors; for example, attitudes toward and access to flu shots during pregnancy

Recommended Health Promotion Activities - School Age

Annual physical examination or as recommended Immunizations as recommended, e.g., human papilloma virus [HPV] can be given as early as 9 years old (CDC, 2015b), MMR, meningococcal, tetanus-diphtheria [Tdap], and annual influenza vaccines (CDC, 2015g) Screening for blood cholesterol level between 9 and 11 years to reduce risks of obesity (AAP, 2015a) Periodic vision, speech, and hearing screenings Education about nutrition and obesity prevention, rest and exercise, safety promotion, and injury control Prediabetes screening, if in high-risk group (American Diabetes Association, 2015) Regular dental screenings and fluoride treatments

Lips

Are they a normal color and without breaks in the surface?

Tonsils (if present)

Are they a similar color and not swollen? Do they have an exudate?

Gums

Are they of even color without being swollen?

Elimination

As adequate exercise promotes efficient blood flow and increases peristalsis, the body excretes wastes more effectively. In that way, adequate exercise helps prevent stasis (stagnation) of urine in the bladder and constipation in the colon.

Immune

As respiratory and musculoskeletal effort increase with exercise and as gravity is enlisted with postural changes, lymph fluid is more efficiently pumped from tissues into lymph capillaries and vessels throughout the body. Circulation through lymph nodes, where destruction of pathogens and removal of foreign antigens can occur, also improves.

Advocacy

Assess all patients' health literacy abilities to encourage full participation in their healthcare. Educate vulnerable populations about their legal rights and ways to give input to their healthcare providers. Be informed about the current national and global health and wellness issues.

Goals of Healthy People 2020

Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death Achieve health equity, eliminate disparities, and improve the health of all groups Create social and physical environments that promote good health for all Promote quality of life, healthy development, and healthy behaviors across all life stages.

Oral Care - Preschoolers

Because deciduous teeth guide the entrance of permanent teeth, dental care is essential to keep these deciduous teeth in good repair and to establish good dental habits early. Abnormally placed or lost deciduous teeth can cause misalignment of permanent teeth. Fluoride remains important at this stage to prevent dental caries. Preschoolers need to be taught to brush their teeth after eating and to limit their intake of refined sugars. Parental supervision may be needed to ensure the completion of these self-care activities. Regular dental checkups are required during these years when permanent teeth appear.

Assessment

Become adept in the four primary techniques used in physical examinations: inspection, palpation, percussion, and auscultation. Review documentation of patient interviews to produce a complete nursing health history. Keep updated with the current literature about evidence-based assessments.

Bone density

Bone density and strength are maintained through weight bearing. The stress of weight-bearing and high-impact movement maintains a balance between osteoblasts (bone-building cells) and osteoclasts (bone-resorption and breakdown cells). Weight-bearing activity is particularly important for individuals at risk for osteoporosis. Examples of weight-bearing activity are walking, dancing, and weight lifting. Non-weight-bearing exercises offer great benefit for individuals with a variety of health considerations. Examples of non-weight-bearing exercise are swimming and bicycling.

Patient Teaching - Oral Care

Brush teeth thoroughly after meals and at bedtime. Fluoride toothpaste is often recommended because of its antibacterial protection. If the teeth cannot be brushed after meals, vigorously rinse the mouth with water. Floss teeth daily. Ensure an adequate intake of nutrients, particularly calcium, phosphorus, fluoride, and vitamins A, C, and D. Avoid sweet foods and drinks between meals. Take them in moderation at meals. Eat coarse, fibrous foods (cleansing foods), such as fresh fruits and raw vegetables. Have topical fluoride applications as prescribed by a dentist. This treatment is useful for adults and teens in cases of dry mouth, gum disease, frequent cavities, braces, crowns, and bridges (WebMD, 2016). Have a checkup by a dentist every 6 months.

Patients at risk

Certain patients are prone to oral problems because of lack of knowledge or the inability to maintain oral hygiene. Among these are patients who are seriously ill, confused, comatose, depressed, illiterate, or dehydrated. Patients with nasogastric tubes and patients receiving oxygen are likely to develop dry oral mucous membranes, especially if they breathe through their mouths. Patients who have had oral or jaw surgery must maintain meticulous oral hygiene to prevent the development of infections.

Herbal Remedy - safety alert

Chamomile can set off allergic responses in people who are allergic to ragweed, marigolds, daisies, and chrysanthemums. Kava can seriously damage liver cells, even with short-term use. Lavender can have side effects of constipation and headache. Lemon balm can result in nausea and abdominal pain. Passionflower can cause drowsiness, dizziness, and confusion. Valerian can trigger headaches and drowsiness.

Oral Care - Infant to Toddlers

Dental caries occur frequently during the toddler period, often as a result of the excessive intake of sweets or a prolonged use of bottle feeding during naps and at bedtime. The nurse should give parents the following instructions to promote and maintain dental health: Beginning at about 18 months of age, brush the child's teeth with a soft toothbrush. Use only a toothbrush moistened with water at first and introduce toothpaste later. Use toothpaste that contains fluoride. Give a fluoride supplement daily or as recommended by the primary care provider or dentist, unless the drinking water is fluoridated. Schedule an initial dental visit for the child at age 6 months, to discuss fluoride varnish applications through age 5 years. This is to prevent the most common chronic disease affecting young children, dental cavities (AAP, 2015a). Seek professional dental attention for any problems like discoloring of the teeth, chipping, or signs of infection such as redness and swelling.

Teeth

Do they show evidence of food collecting on them? Are particles caught between them?

Assessment Questions for Kids (asking parents) - Oral Care

Do you share spoons, forks and other utensils with your baby? Do you put your young child to bed with a bottle of milk, formula, juice, or other product that contains sugar? Does your local water supply contain fluoride? Do you use bottled water for cooking or drinking? Is your child exposed to cigarette smoke? Do you know whom to contact in case your child knocks out or breaks a tooth? Does your child suck her fingers or thumb?

Breath

Does the patient's breath have any unusual or foul odor?

Patient Teaching - Dry Mouth

Drink water frequently. Avoid mouthwash rinses that contains alcohol. Limit fluids with caffeine and alcohol. Sip water or sugar-free fluids, or let ice chips melt in your mouth for moisture. Drink water during meals to help with chewing and swallowing. Eat soft, moist, room-temperature food. Avoid salty or dry foods. Enjoy sugar-free hard candies or chew sugar-free gum. Be aware that they might contain xylitol, which can cause diarrhea or abdominal cramps. Try over-the-counter saliva substitutes. Consciously breathe through your nose, not your mouth. Sleep next to a room humidifier. Moisturize lips with an ointment.

Xerostomia

Dryness of the mouth caused by reduction of saliva

Factors Affecting sleep

Emotional stress Individual is preoccupied with personal problems (e.g., school- or job-related pressures, financial difficulties, family or marriage problems). Anxiety increases norepinephrine blood levels, resulting in less deep sleep and REM sleep and more stage changes and awakenings. Stimulants and alcohol Caffeine-containing beverages stimulate central nervous system. Alcohol may hasten onset of sleep, but it disrupts REM sleep. Diet Weight gain is associated with reduced total sleep time, interrupted sleep, and earlier awakening. Weight loss is associated with increase in total sleep time and fewer interruptions of sleep. Dietary L-tryptophan found in cheese and milk may induce sleep. Smoking Nicotine is a stimulant. Smokers often have more difficulty falling asleep than nonsmokers. They are usually easily aroused and often describe themselves as light sleepers. Smokers can try not smoking after the evening meal. Motivation for alertness and boredom Motivation can increase alertness when a tired individual wants to stay awake. Motivation alone is insufficient to overcome normal circadian rhythm or sleepiness due to insufficient sleep. When insufficient sleep combines with boredom, sleep is likely to occur. Medications Hypnotics can interfere with deep sleep and suppress REM sleep. Beta-blockers can cause insomnia and nightmares. Narcotics such as meperidine hydrochloride (Demerol) and morphine suppress REM sleep and cause frequent awakenings and drowsiness. Tranquilizers interfere with REM sleep. Although antidepressants suppress REM sleep, this effect is therapeutic, resulting in immediate but transient improvement in mood. Patients taking hypnotic medications and antidepressants may experience REM rebound (increased REM sleep) when medications are discontinued. Environment Sounds, lighting, and comfort of bedding can contribute to or hinder onset and maintenance of sleep. Pain, illness, and injury Medical conditions can disturb regular sleep.

Metabolism/Endocrine

Exercise elevates the metabolic rate, thus increasing the production of body heat, waste products, and calorie use. During strenuous exercise, the metabolic rate can increase to as much as 20 times the normal rate. This elevation lasts after exercise is completed. Exercise increases the use of triglycerides and fatty acids, resulting in a reduced level of serum triglycerides and cholesterol. Weight loss and exercise stabilize blood sugar and make cells more responsive to insulin. The Diabetes Prevention Program, a large 3-year study, showed that even a modest 5% decrease in body weight (about 10 pounds in most participants) achieved through exercise and dietary modification reduced the risk of diabetes by a striking 58%. In those over 60 years of age, the reduction was 71%

GI

Exercise improves the appetite and increases gastrointestinal tract tone, facilitating peristalsis. Activities such as rowing, swimming, walking, and sit-ups work the abdominal muscles and can help relieve constipation (Fontaine, 2014). Abdominal compressive exercise, such as with twisting and forward bending yoga postures, has been shown to improve symptoms of irritable bowel syndrome

Recommended Health Promotion Activities - Adolescent

Health examination as recommended by the primary care provider Immunizations as recommended, such as adult Tdap vaccine, MMR, pneumococcal, HPV (recommended for 11- and 12-year-olds; CDC, 2015b), annual influenza vaccines (CDC, 2015g), and HepB vaccine HIV screening between ages 16 and 18 years old (AAP, 2015a) Periodic vision and hearing screenings Regular dental assessments Assessing for depression annually for ages 11-21 (AAP, 2015a) Use of CRAFFT (Car, Relax, Forget, Friends, Trouble) screening questionnaire for drug and alcohol use (AAP, 2015a) Education about hormonal changes, peer group influences, self-concept and body image, sexuality, safety promotion, and accident prevention Prediabetes screening, if in high-risk group (American Diabetes Association, 2015)

Recommended Health Promotion Activities - Toddler

Health examinations at 15 and 18 months and then as recommended by the pediatrician Dental visits starting at tooth formation, with fluoride varnish application from age 6 months through 5 years Immunizations: continuing DTaP, IPV, pneumococcal, MMR, varicella, HIB, HepA, HepB, annual influenza vaccines (CDC, 2015g), and meningococcal vaccines as recommended Risk assessment at age 15 months and 30 months to detect iron deficiency Fluoride supplements if there is inadequate water fluoridation (less than 0.6 parts per million) Education about nutrition, rest and exercise, safety promotion, and injury control

Recommended Health Promotion Activities - Preschool

Health examinations every 1-2 years Immunizations: continuing DTaP, IPV, MMR, HepA and HepB, pneumococcal, varicella, annual influenza vaccines (CDC, 2015g), and other immunizations as recommended Vision and hearing screening Dental visits regularly with fluoride varnish application through age 5 years Education about nutrition, rest and exercise, safety promotion, and injury control

Benefits of physical fitness

Improving mood and overall mental health Reducing the risk for cardiovascular disease Strengthening bone and muscle Reducing the risk of some illnesses, such as type 2 diabetes, and some cancers Improving stability and reducing risk of falling in older adults.

Family

Include family members in the patient education process, especially when making discharge plans. Be aware of the impact that recent family crises, such as divorce or death, can have on the recovery of patients. Include a family health history in the assessment of patients, using a genogram if indicated.

Factors that indicate the need for additional resources/teaching

Increase in physical limitations Presence of one or more chronic illnesses Change in cognitive status Difficulty gaining access to healthcare services due to transportation problems Inadequacy of support systems Need for environmental modifications for safety and maintaining independence Attitude of hopelessness and depression, which decreases the motivation to use resources or learn new information.

external locus of control

Individuals who believe their health is controlled by forces outside their control (e.g., chance, fate, others) are said to have an external locus of control. For example, a research study of adults over age 80 examined individuals who attributed their current health status to uncontrollable "old age."

Exercise - Lifespan considerations

Infants (birth to 1 year) Outside two to three times a day, as tolerated Toddlers (1-3 years) 60-90 minutes of outdoor play daily Preschoolers (3-6 years) 60-90 minutes of outdoor play daily Children (6-17 years) 60 minutes of physical activity daily, most of it aerobic activity Some vigorous intensity, some muscle and bone strengthening 3 days a week Adults (18-64 years) 150 minutes of moderate-intensity aerobic activity each week OR 75 minutes of vigorous-intensity activities OR a mix of equivalent intensities 2 days a week, muscle-strengthening Older adults (65 years and older) 150 minutes of moderate-intensity aerobic activity each week OR 75 minutes of vigorous-intensity activities OR a mix of equivalent intensities 2 days a week, muscle-strengthening Pregnant or postpartum women 150 minutes of moderate-intensity aerobic activity each week Vigorous activity if already engaged Discuss with healthcare provider

Throat

Is it a healthy color, similar to the tongue? Does it have a coating over it? Is the surface smooth or bumpy and swollen?

Mucosa

Is it moist, without surface breaks, and of appropriate color?

Tongue

Is it pink, smooth, and muscular?

Nursing Interventions - Sleep

Make evidence-based suggestions to help the patient get more hours of restful sleep. Ask the patient: Is your difficulty falling asleep, or maintaining sleep during the night? Or both problems? Suggest that the patient keep a sleep diary to see the patterns of her sleep habits. Emphasize that the most important change to make in a bedtime routine is to set a routine mandatory time to go to bed and set a routine mandatory time to get out of bed. The patient needs to train his mind and body to expect to sleep on this schedule. Assure the patient that the rigidity of the new schedule and food intake changes will become more comfortable over time and will give the best opportunity for restful sleep.

Psychoneurologic

Mental disorders such as depression or chronic stress may affect an individual's desire to move. A patient with depression, for example, may lack enthusiasm for taking part in any activity and may even lack energy for usual hygiene practices. Chronic stress can deplete the body's energy reserves to the point that the resulting fatigue discourages the desire to exercise, even though muscular exertion (especially with movement modalities such as yoga and t'ai chi) could help release stored stress

Health Promotion - Nursing Interventions

Model healthy exercise attitudes and behaviors. Nurses should know how their physical activity patterns measure up against the recommendations for movement and strength training. Even if they are not tracking their own data, nurses should be familiar with ways that patients can record their efforts, such as exercise diaries and step pedometers. Facilitate patient involvement in setting specific, reasonable physical activity goals. Set target deadlines for evaluation of efforts, such as "by the next check-up visit." Teach patients self-care strategies to enhance fitness and to be ready to deal with the possible aches and pains of increasing exercise. Have visual aids handy to show how to perform stretching exercises before more rigorous activities. Assist individuals, families, and communities to increase their physical activities. This might mean advocating places to do indoor exercises, such as a gym, or outside exercises, such as hiking trails. Educate patients to be effective consumers of products to assist with exercise, such as yoga mats, dumbbells, and exercise machines. Reinforce patients' personal and family health-promoting exercises. Advocate in the community for changes that promote physical fitness in a healthy environment.

Two types of sleep

NREM (non-REM) sleep and REM sleep. During a healthy adult's sleep, NREM and REM sleep alternate every 90-110 minutes for complete sleep cycle. The healthy adult sleeper usually experiences four to six cycles of sleep during 7-8 hours

Sleep - Newborns

Newborns sleep on an irregular schedule with periods of 1-3 hours spent awake. Unlike older children and adults, newborns enter REM sleep (called active sleep during the newborn period) immediately. Rapid eye movements are observable through closed lids, and body movements and irregular respirations may be observed. NREM sleep (also called quiet sleep during the newborn period) is characterized by regular respirations, closed eyes, and the absence of body and eye movements. Newborns spend nearly 50% of their time in each of these states, and the sleep cycle is about 50 minutes

Oral Care - Older Adults

Nurses have an important role in promoting optimal geriatric oral healthcare. Good oral health can have a positive effect on the older adults' ability to eat nutritious meals and other good health habits. They are often at risk for dental cavities and periodontal disease because they cannot maintain their oral hygiene practices and/or may not be able to visit the dentist routinely. Lack of fluoridated water and preventive dentistry during their developmental years can contribute to tooth and gum problems in older adults (Edelman et al., 2013). As a result, about 25% of adults 60 years old and older no longer have any natural teeth. About 23% of 65- to 74-year-olds have severe gum disease (CDC, 2013c). Loss of teeth occurs mainly because of periodontal disease rather than dental caries. Oral care may be difficult for certain older adults to perform due to problems with dexterity or dementia. Nurses can help by problem-solving with caregivers ways to remove residual food debris, including rinsing the mouth after meals. Even using plain water can reduce bacteria by 30%. Use of an electric toothbrush might be useful (Periodontitis, 2013). Xerostomia (severe dryness of the mouth) is common in older adults. Drinking at least 7 glasses of water per day can trigger the production of more saliva

Radiation

Patients who are receiving or have received radiation treatments to the head and neck may have permanent damage to salivary glands. Their very dry mouth can be treated with a thick liquid called artificial saliva. Some patients prefer to sip liquids to moisten their mouth. Radiation can also damage teeth and jaw structure.

Recommended Health Promotion Activities - Middle Age Adult

Physical examination (every 3-5 years until age 40, then annually) Immunizations as recommended, such as a tetanus booster every 10 years and annual influenza vaccines (CDC, 2015g). Regular dental assessments (e.g., every 6 months) Tonometry for signs of glaucoma and other eye diseases every 2-3 years or annually if indicated Breast examination for women annually by primary care provider. For ages 40-44, choice of getting mammogram; for ages 45-54, annual mammogram; age 55 and older, choice of mammogram annually or every 2 years (American Cancer Society, 2015). Screen women for cervical dysplasia with a Pap test until age 65 every 3 years or Pap and HPV test every 5 years (American Cancer Society, 2015) Testicular examination for men annually by primary care provider. Prostate-specific antigen (PSA) testing starting at age 50, or age 45 for African Americans with positive history (American Cancer Society, 2015) Screenings for cardiovascular disease (e.g., blood pressure measurement, electrocardiogram and cholesterol test as directed by primary care provider) Diabetes mellitus screen every 3 years, if in high-risk group (American Diabetes Association, 2015) Starting at age 50, screenings for colorectal cancer: choice of flexible sigmoidoscopy every 5 years, colonoscopy every 10 years, double-contrast barium enema every 5 years, or CT colonography (virtual colonoscopy) every 5 years (American Cancer Society, 2015) Smoking: history and counseling, if needed. Starting at age 55, low-dose CT chest scan with contrast annually if 30 pack-year smoking history, current smoker, or quit smoking within the last 15 years (American Cancer Society, 2015) Education about adequate sleep, weight control, medication compliance, and accident prevention

Risk Factors

Practices with potentially negative effects on health are often referred to as risk factors. For example, overeating, getting insufficient exercise, and being overweight are closely related to the incidence of heart disease, arteriosclerosis, diabetes, and hypertension. Excessive use of tobacco is implicated in lung cancer, emphysema, and cardiovascular diseases.

Reproduction

Prepare the patient and significant others for the profound physical and psychologic changes of pregnancy. Emphasize the value of keeping routine visits for prenatal care for the health of the mother and the baby. Individualize care for the pregnant adolescent and the pregnant woman over 35 years old.

Oral Care - Adolescents and Adults

Proper diet and tooth and mouth care should be evaluated and reinforced for adolescents and adults. Specific measures to prevent tooth decay and periodontal disease are listed in the Patient Teaching feature. Smokers should be made aware of the latest research on their smoking habit and the risk of losing teeth. Researchers looking at data from over 20,000 study participants found that those who smoked at least 15 cigarettes per day were much more likely to lose their teeth. Male smokers were more than 3 times as likely, and female smokers more than 2 times as likely to lose their teeth as nonsmokers. After 10-20 years of smoking cessation, the risk decreased to the level of nonsmokers

Recommended Health Promotion Activities - Older Adult

Regular dental assessments (e.g., every 6 months) Tonometry for signs of glaucoma and other eye diseases every 2-3 years or annually if indicated Total cholesterol and high-density lipoprotein measurement every 3-5 years until age 75 Aspirin, 81 mg, daily, if in high-risk group Diabetes mellitus screen every 3 years, if in high-risk group (American Diabetes Association, 2015) Smoking: history and counseling, if needed. Until age 74, low-dose CT chest scan with contrast annually if 30 pack-year smoking history, current smoker, or quit smoking within the past 15 years (American Cancer Society, 2015) Breast examination for women annually by primary care provider. Mammogram annually or every 2 years (American Cancer Society, 2015) Pap smear for women, only if previous abnormal smears, serious cervical precancer, or hysterectomy for malignancy (American Cancer Society, 2015) Annual digital rectal exam Testicular examination for men annually by primary care provider. PSA testing by choice, with repeat frequency depending on PSA level (American Cancer Society, 2015) Annual guaiac-based fecal occult blood test (gFOBT), fecal immunochemcial test (FIT), or stool DNA test (sDNA) every 3 years (American Cancer Society, 2015) Screenings for colorectal cancer: choice of flexible sigmoidoscopy every 5 years, colonoscopy every 10 years, double-contrast barium enema every 5 years, or CT colonography (virtual colonoscopy) every 5 years (American Cancer Society, 2015) Visual acuity and hearing screen annually Depression screen and family violence screen periodically Height and weight measurements annually Sexually transmitted disease testing, if in high-risk group Annual flu vaccine if over 65 or in high-risk group (CDC, 2015g). Two pneumococcal vaccines, PCV13 and PPSV23, at age 65 (CDC, 2015a) Single dose of shingles vaccine starting at 60 years Tetanus booster every 10 years Education about restful sleep, adequate nutrition, maximization of strengths, medication compliance, and accident prevention

Recommended Health Promotion Activities - Young Adult

Routine physical examination (every 1-3 years for women; every 5 years for men) Immunizations as recommended, such as tetanus-diphtheria boosters every 10 years, meningococcal vaccine if not given in early adolescence, annual influenza vaccines (CDC, 2015g), and hepatitis B vaccine HPV vaccine for women up to 26 years old who have not yet received or completed the vaccine series (CDC, 2015b) Regular dental assessments (every 6 months) Risk-based assessment of vision at age 18 (AAP, 2015a) Professional breast examination every 1-3 years for women Screening for cervical dysplasia for women starting at 21 years old (AAP, 2015a) Pap test pattern: every 3 years for women age 21-29; every 3 years or Pap and HPV test every 5 years for women age 30-65 (American Cancer Society, 2015) Testicular examination every year for men 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) Diabetes mellitus screen every 3 years, if in high-risk group (American Diabetes Association, 2015) Smoking: history and counseling, if needed Education about career efforts and personal balance, stress management, sexuality, safety promotion, and accident prevention

Recommended Health Promotion Activities - Newborn to Infant

Screening of newborns for congenital heart disease and for hearing loss (American Academy of Pediatrics [AAP], 2015b) Health examinations at 2 weeks and at 2, 4, 6, 9, and 12 months Immunizations: diphtheria, tetanus, acellular pertussis (DTaP), inactivated poliovirus vaccine (IPV), pneumococcal (PVC), Haemophilus influenzae type b (HIB), hepatitis B (HepB), hepatitis A (HepA), rotavirus, and influenza vaccines (over 6 months of age) as recommended. Varicella and measles-mumps-rubella (MMR) are not given before 12 months of age. Fluoride supplements for infants over 6 months of age if there is inadequate water fluoridation (less than 0.3 parts per million) Screening for metabolic conditions including phenylketonuria (PKU) Denver Developmental Screening Test (DDST-II) or other developmental screening Education about infant-parent attachment and bonding, playful activities to stimulate development, safety promotion, and injury control

internal locus of control

Social learning theory makes an effort to capture this likelihood through its explanation of locus of control. Individuals who believe that they can affect their own health and well-being are said to have an internal locus of control. These individuals are more likely to take control over their own health, follow therapeutic regimens, and engage in health promotion and prevention activities, including exercise and dietary modifications.

Mobility

Teach patients the proper way to use crutches, canes, and walkers to avoid the complication of falling. Perform range-of-motion exercises on patients who are immobile. Adapt physical fitness exercises to the limitations posed by musculoskeletal disorders, such as doing stretches while sitting in a chair.

Health

The combination of physical, mental/emotional, and social well-being. Health has traditionally been defined as the presence or absence of disease. Nightingale (1859/1969) defined health as a state of being well and using every power the individual possesses to the fullest extent. The World Health Organization (WHO, 1948) takes a more holistic view of health. Its constitution defines health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.

Functions of sleep

The effects of sleep on the body are not completely understood. Sleep exerts physiologic effects on both the nervous system and other body structures. Sleep in some way restores normal levels of activity and normal balance among parts of the nervous system. Sleep is also necessary for protein synthesis, which allows repair processes to occur. The role of sleep in psychologic well-being is best noticed by the deterioration in mental functioning related to sleep loss. Individuals with inadequate amounts of sleep tend to become emotionally irritable, have poor concentration, and experience difficulty making decisions.

REM

The first REM sleep usually occurs about 70-90 minutes after sleep begins. Most dreams take place during REM sleep. A healthy adult sleeper typically spends more than 2 hours each night dreaming. During REM sleep, the body and brain are highly active. Distinctive eye movements occur; breathing becomes more rapid, irregular, and shallow; and voluntary muscle tone is dramatically decreased. The heart rate increases, blood pressure rises, and men develop penile erections. Researchers think that the regions of the brain used in learning, thinking, and organizing information are stimulated during REM sleep

Target heart rate

The goal is to work up to and sustain a target heart rate during exercise; the target rate is based on the individual's age. To determine target heart rate, first calculate the individual's maximum heart rate by subtracting her current age in years from 220. Then, obtain the target heart rate by taking 60%-85% of the maximum. Because heart rates vary among individuals, the talk test is one of several tests being used to replace this measure.

Muscoskeletal

The size, shape, tone, and strength of muscles (including the heart muscle) are maintained with mild exercise and increased with strenuous exercise. With strenuous exercise, muscles hypertrophy (enlarge), and the efficiency of muscular contraction increases. Hypertrophy is commonly seen in the arm muscles of a tennis player, the leg muscles of a skater, and the arm and hand muscles of a carpenter.

circadian rhythm

The term circadian is from the Latin circa dies, meaning "about a day." Although sleep and waking cycles are the best known of the circadian rhythms, body temperature, heart activity, blood pressure, oxygen consumption, metabolism, and many other physiologic functions also follow a circadian pattern

Talk Test

This test is easier to implement and keeps most individuals at 60% of maximum heart rate or higher. The test is simple: When exercising, an individual should experience labored breathing, yet still be able to carry on a conversation.

Infection

Use good infection prevention measures to reduce the risk of spread of infection, especially healthcare-associated infections. Promptly recognize the early signs of an infected wound and immediately respond. Teach patients and caregivers good hygiene habits and compliance with taking antimicrobial medications.

respiratory

Ventilation (air circulating into and out of the lungs) and oxygen intake increase during exercise, thereby improving gas exchange. More toxins are eliminated with deeper breathing, and problem solving and emotional stability are enhanced by increased oxygen to the brain. Adequate exercise also prevents pooling of secretions in the bronchi and bronchioles, decreasing breathing effort and risk of infection. Attention to exercising muscles of respiration (by deep breathing) throughout activity as well as during rest enhances oxygenation (improving stamina) and circulation of lymph (improving immune function). A strong body of evidence supports the use of lower-extremity exercise forms (e.g., walking, treadmill, stationary bike, stair climbing) for treating individuals with COPD. Increasing research reports cite the benefits of yogic breathing and postures for individuals with asthma

Assessment Questions for Adults - Oral Care

What are your usual mouth care and/or denture care practices? What oral hygiene products do you routinely use (e.g., mouthwash, type of toothpaste, dental floss, denture cleaner)? When was your last dental examination, and how often do you see your dentist? Do you have any problems managing your mouth care? Have you had or do you have any problems such as bleeding, swollen or reddened gums, ulcerations, lumps, or tooth pain?

Trauma

When caring for a trauma victim, prioritize assessment of health by using the ABCDEs. (A 5 airway, B 5 breathing, C 5 circulation, D 5 disability and neurologic assessment, E 5 exposure and environmental control) To help prevent the trauma of abuse, identify patients' high-risk situations and review their strengths and coping skills.

Exercise

a type of physical activity that is planned, structured, repetitive, and purposive. It refers to bodily movement performed to improve or maintain one or more components of physical fitness.

Injury

act or event that causes damage, harm, or loss to a body's functioning.

Disease

an alteration in body functions that reduces the capacities or shortens the normal lifespan. Some diseases mainly affect the individual's physical condition; others affect the individual's mental status. Disease results from many causes, such as infection, inflammation, biochemical imbalances, stress, environmental factors, or genetic factors. Its presence is usually signaled by identifiable signs and symptoms.

activity-exercise pattern

an individual's routine of exercise, activity, leisure, and recreation. It includes: (a) activities of daily living (ADLs) that require energy expenditure, such as hygiene, dressing, cooking, shopping, eating, working, and home maintenance, and (b) the type, quality, and quantity of exercise, including sports.

Functional Strength

another goal of exercise, and it is defined as the body's ability to perform work.

Physical activity

any bodily movement produced by skeletal muscle contraction that increases energy expenditure above a basal level.

Health beliefs

are concepts about health that individuals believe are true. They may or may not be founded in fact. Some beliefs are influenced by culture, such as the belief that health and wellness are closely associated with the amount and quality of blood in the body. For example, in the American South, some individuals use the phrase "high blood" to mean they have too much blood in the body, causing headaches and dizziness. Another example is the racial/ethnic disparity in flu vaccination rates for older adults.

Isotonic exercises

are dynamic exercises, the muscle shortens to produce muscle contraction and active movement. Most physical conditioning exercises—running, walking, swimming, cycling, and other such activities—are isotonic, as are ADLs and active range-of-motion (ROM) exercises (those initiated by the patient). Examples of isotonic bed exercises are pushing or pulling against a stationary object, using a trapeze to lift the body off the bed, lifting the buttocks off the bed by pushing with the hands against the mattress, and pushing the body to a sitting position. Isotonic exercises increase muscle tone, mass, and strength and maintain joint flexibility and circulation. During isotonic exercise, both heart rate and cardiac output quicken to increase blood flow to all parts of the body.

Isokinetic exercises

are resistive exercises, involve muscle contraction or tension against resistance; thus they can be either isotonic or isometric. During isokinetic exercises, the individual moves (isotonic) or tenses (isometric) against resistance. Special machines or devices provide the resistance to the movement. These exercises are used in physical conditioning and are often done to build up certain muscle groups. For example, the pectorals (chest muscles) may be increased in size and strength by weight lifting

Isometric exercies

are static or setting exercises, muscles contract without moving the joint (muscle length does not change). These exercises involve exerting pressure against a solid object and are useful for strengthening abdominal, gluteal, and quadriceps muscles used in ambulation; for maintaining strength in immobilized muscles in casts or traction; and for endurance training. These are often called "quad sets." Isometric exercises produce a mild increase in heart rate and cardiac output but no appreciable increase in blood flow to other parts of the body.

Sleep

basic human need; it is a universal biological process common to all individuals. Humans spend about one third of their lives asleep. We require sleep for many reasons: to cope with daily stresses, to prevent fatigue, to conserve energy, to restore the mind and body, and to enjoy life more fully. Sleep enhances daytime functioning. It is vital not only for optimal psychologic functioning but also for physiologic functioning.

biological rhythms

daily cycles in many of our physiologic functions and activities: sleep, body temperature, alertness, neurotransmitter levels, and so on. They are controlled within the body and are synchronized with environmental factors such as light and darkness

Self-Concept

how an individual feels about the self (self-esteem) and perceives the physical self (body image) and his needs, roles, and abilities. Self-concept affects how individuals view and handle situations. Such attitudes can affect health practices, responses to stress and illness, and treatment seeking. An example is the anorexic woman who deprives herself of needed nutrients because she believes she is too fat, even though she is well below an acceptable weight level. Self-perceptions are also associated with an individual's definition of health. For example, a 75-year-old man who can no longer move large objects may need to redefine his concept of health in view of his current abilities.

Remission

improvement or absence of signs of disease

High Risk Variables

inadequate nutrition lack of money and/or insurance for dental care excessive intake of refined sugars family history of periodontal disease Some older individuals may also be at risk, for example, those who choose salty and enamel-eroding sugary foods because of a decline in their number of taste buds. Decreased saliva production in older adults, which produces a dry mouth and thinning of the oral mucosa, is another factor.

The intellectual component of wellness

includes the ability to learn and use information effectively for personal, family, and career development. Intellectual wellness involves striving for continued growth and learning to deal effectively with new challenges.

Sick-role behavior

includes using the healthcare system for help and may involve dependent behaviors, such as avoiding usual responsibilities. An example would be a patient staying in bed for an extended rest and not doing housework, going to a job, or attending school. How patients behave when they are ill is highly individualized. It is affected by many variables such as age, sex, occupation, socioeconomic status, religion, ethnic origin, psychologic stability, personality, education, and modes of coping.

The environmental component of wellness

involves the ability to promote health measures that improve the standard of living and quality of life in the community and includes influences such as food, water, and air.

Illness behavior

involves ways that individuals describe, monitor, and interpret their symptoms, and take remedial actions. An example would be a patient eating a family recipe for chicken soup when flu symptoms start.

Illness

is a highly personal state in which the individual's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished. It is not synonymous with disease, and it may or may not be related to disease. One individual can have a disease, such as a growth in the stomach, and not feel ill. Another individual can feel ill—that is, feel uncomfortable—and yet have no discernible disease.

Wellness

is a state of well-being. Basic aspects of wellness include self-responsibility; an ultimate goal; a dynamic, growing process; and daily decision making in the areas of nutrition, stress management, physical fitness, preventive healthcare, and emotional health. Most important, wellness focuses attention on the whole being of the individual

Benefits of regular exercise

is essential for maintaining optimum mental and physical health. It can have effects on cognitive function and on the musculoskeletal, cardiovascular, respiratory, gastrointestinal, metabolic/endocrine, elimination, immune, and psychoneurologic systems

The occupational component of wellness

is the ability to achieve a balance between work and leisure time. Individuals' beliefs about education, employment, and home influence their personal satisfaction and relationships with others.

The physical component of wellness

is the ability to carry out daily tasks, achieve fitness (e.g., pulmonary, cardiovascular, gastrointestinal), maintain adequate nutrition and proper body fat levels, avoid abusing drugs and alcohol or using tobacco products, and generally practice positive lifestyle habits.

Acute Illness

is typically characterized by severe symptoms of relatively short duration. The symptoms often appear abruptly and subside quickly and, depending upon the cause, may or may not require intervention by healthcare professionals. Some acute illnesses are serious (e.g., appendicitis may require surgery). But many acute illnesses, such as colds, subside without medical intervention or with only over-the-counter medications. Following an acute illness, most individuals return to their normal level of wellness.

Chronic Illness

one that lasts for an extended period, usually 6 months or longer, and often for the duration of the individual's life. Chronic illnesses usually have a slow onset and often have periods of remission, when the symptoms disappear, and exacerbation, when the symptoms reappear.

Exacerbation

period in chronic illness when the symptoms of the disease reappear

Complementary health approaches

practices and products of nonmainstream origin (alternative therapies) acupuncture. Alexander technique. aromatherapy. herbal medicine. homeopathy. naturopathy. reiki. yoga.

Life-style choices

refer to an individual's general way of life, including living conditions and individual patterns of behavior, which are influenced by sociocultural factors and personal characteristics. In brief, lifestyle is often considered the behavior and activities over which individuals have control.

Well-being

s a component of health. The Centers for Disease Control and Prevention (CDC, 2013b) defines well-being as "the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning, judging life positively and feeling good."

Primary Prevention

services focus on health promotion and illness prevention. legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking) immunization against infectious diseases.

Secondary Prevention

services include the diagnosis and treatment of disease. Examples include: regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer) daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes.

Tertiary Prevention

services seek to restore health following an illness or accident and include rehabilitation and palliative services. Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Examples include: cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) support groups that allow members to share strategies for living well vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.

The social component of wellness

the ability of individuals to interact successfully with other people and within their environment, to develop and maintain intimacy with significant others, and to develop respect and tolerance for those with different opinions and beliefs.

physical fitness

the ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time pursuits and respond to emergencies. Physical fitness includes a number of components consisting of cardiorespiratory endurance (aerobic power), skeletal muscle endurance, skeletal muscle strength, skeletal muscle power, flexibility, balance, speed of movement, reaction time, and body composition

The emotional component of wellness

the ability to manage stress and to express emotions appropriately. Emotional wellness involves individuals' ability to recognize, accept, and express their feelings and to accept their limitations.

Aerobic exercise

the amount of oxygen taken into the body is greater than that used to perform the activity. Aerobic exercises use large muscle groups that move repetitively. Aerobic exercises improve cardiovascular conditioning and physical fitness and bring more oxygen into the body than is used to perform the activity.

The spiritual component of wellness

the belief in some force (nature, science, religion, or a higher power) that serves to unite human beings and provide meaning and purpose to life. It includes individuals' own morals, values, and ethics.

anaerobic exercise

the muscles cannot draw out enough oxygen from the bloodstream, and anaerobic pathways are used to provide additional energy for a short time. This type of exercise, such as weight lifting and sprinting, is used in endurance training for athletes.

Integrative Health

the process of incorporating complementary health approaches into mainstream Western healthcare.

Activity Tolerance

the type and amount of exercise or daily living activities an individual is able to perform without experiencing adverse effects.

Acute illness

typically characterized by severe symptoms of relatively short duration. The symptoms often appear abruptly and subside quickly and, depending upon the cause, may or may not require intervention by healthcare professionals. Some acute illnesses are serious (e.g., appendicitis may require surgery). But many acute illnesses, such as colds, subside without medical intervention or with only over-the-counter medications. Following an acute illness, most individuals return to their normal level of wellness.

Alternative medicine

which substitutes nonmainstream approaches in place of conventional medicine, is uncommon. An example of alternative medicine is treating cancer with a special diet rather than with chemotherapy, radiation, or surgery.