Fundamentals Chapter 6: Health and Wellness

Maslow's hierarchy of needs

*Selfactualization* *Self-esteem* *Love and belonging needs* *Safety and security* (Physical safety & Psychological safety) *Psychological* (Oxygen, Fluids, Nutrition, Body, temperature, Elimination, Shelter, Sex)

Five stages of health behavior change

-Precontemplation -Contemplation -Preparation -Action -Maintenance stage

Tertiary prevention

-aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -examples: prevention of pressure ulcers as complication of a spinal cord injury; promoting independence for the client who has traumatic brain injury

Secondary prevention

-focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status -examples: communicable disease screening and case finding; early detection and treatment of diabetes; exercise programs for older adult clients who are frail

5. A male patient has been laid off from his construction job and has many unpaid bills. He is going through a divorce from his marriage of 15 years and has been seeing his pastor to help him through this difficult time. He does not have a primary health care provider because he has never really been sick and his parents never took him to a physician when he was a child. Which external variables influence the patient's health practices? (Select all that apply.) 1. Difficulty paying his bills 2. Seeing his pastor as a means of support 3. Age of patient (46 years) 4. Stress from the divorce and the loss of a job 5. Family practice of not routinely seeing a health care provider

1. Difficulty paying his bills 5. Family practice of not routinely seeing a health care provider

7. When taking care of patients, a nurse routinely asks if they take any vitamins or herbal medications, encourages family members to bring in music that the patient likes to help the patient relax, and frequently prays with her patients if that is important to them. The nurse is practicing which model? 1. Holistic 2. Health belief 3. Transtheoretical 4. Health promotion

1. Holistic

6. A nurse is conducting a home visit with an older-adult couple. While in the home the nurse weighs each individual and reviews the 3-day food diary with them. She also checks their blood pressure and encourages them to increase their fluids and activity levels to help with their voiced concern about constipation. The nurse is addressing which level of need according to Maslow? 1. Physiological 2. Safety and security 3. Love and belonging 4. Self-actualization

1. Physiological

1. A nurse is presenting a program to workers in a factory covering safety topics, including the wearing of hearing protectors when workers are in the factory. Which level of prevention is the nurse practicing? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Quaternary prevention

1. Primary prevention

Ms. Thom, age 46, works as an RN in the intensive care unit at a large busy medical center. Over the last three years she has gained 30 lbs and quit attending the fitness classes at the local recreation center. Her co-workers keep trying to get her to come back to fitness class, but she says that she is too tired after work and just wants to go home. She has smoked for 15 years, but says that she is trying to cut back on the number of cigarettes each day because she watched her mother die from emphysema. She has picked up some literature from Employee Health on smoking cessation. She was recently diagnosed with hypertension. 1. Using the health belief model, identify the modifying factors impacting Ms. Thom's likelihood of taking a preventive health action.

1. The modifying factors influence the individual's perception of seriousness of the illness. Modifying factors include demographic and sociopsychological variables, perceived threat of the illness, and cues to action. For Ms. Thom, modifying factors include the demographic and sociopsychological variables of age and peer group influence, as her co-workers try to get her to exercise again. Ms. Thom's perceived threat of illness comes from the recent diagnosis of hypertension. Ms. Thom has two cues to action: her mother dying from emphysema and the media materials on smoking cessation she picked up from Employee Health.

9. Which statement made by a nurse shows that the nurse is engaging in an activity to help cope with secondary traumatic stress and burnout? 1. "I don't need time for lunch since I am not very hungry." 2. "I am enjoying my quilting group that meets each week at my church." 3. "I am going to drop my gym membership because I don't have time to go." 4. "I don't know any of the other nurses who met today to discuss hospital-wide problems with nurse satisfaction."

2. "I am enjoying my quilting group that meets each week at my church."

11. After a class on Pender's health promotion model, students make the following statements. Which statement does the faculty member need to clarify? 1. "The desired outcome of the model is health-promoting behavior." 2. "Perceived self-efficacy is not related to the model." 3. "The individual has unique characteristics and experiences that affect his or her actions." 4. "Patients need to commit to a plan of action before they adopt a health-promoting behavior."

2. "Perceived self-efficacy is not related to the model."

13. As part of a faith community nursing program in her church, a nurse is developing a health promotion program on breast selfexamination for the women's group. Which statement made by one of the participants is related to the individual's perception of susceptibility to an illness? 1. "I have a door hanging tag in my bathroom to remind me to do my breast self-examination monthly." 2. "Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer." 3. "Since I am only 25 years of age, the risk of breast cancer for me is very low." 4. "I participate every year in our local walk/run to raise money for breast cancer research."

2. "Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer."

4. A patient comes to the local health clinic and states: "I've noticed how many people are out walking in my neighborhood. Is walking good for you?" What is the best response to help the patient through the stages of change for exercise? 1. "Walking is OK. I really think running is better." 2. "Yes, walking is great exercise. Do you think you could go for a 5-minute walk next week?" 3. "Yes, I want you to begin walking. Walk for 30 minutes every day and start to eat more fruits and vegetables." 4. "They probably aren't walking fast enough or far enough. You need to spend at least 45 minutes if you are going to do any good."

2. "Yes, walking is great exercise. Do you think you could go for a 5-minute walk next week?"

10. Which of the following are symptoms of secondary traumatic stress and burnout that commonly affect nurses? (Select all that apply.) 1. Regular participation in a book club 2. Lack of interest in exercise 3. Difficulty falling asleep 4. Lack of desire to go to work 5. Anxiety while working

2. Lack of interest in exercise 3. Difficulty falling asleep 4. Lack of desire to go to work 5. Anxiety while working

14. The nurse assesses the following risk factors for coronary artery disease (CAD) in a female patient. Which factors are classified as genetic and physiological? (Select all that apply.) 1. Sedentary lifestyle 2. Mother died from CAD at age 48 3. History of hypertension 4. Eats diet high in sodium 5. Elevated cholesterol level

2. Mother died from CAD at age 48 3. History of hypertension 5. Elevated cholesterol level

Ms. Thom, age 46, works as an RN in the intensive care unit at a large busy medical center. Over the last three years she has gained 30 lbs and quit attending the fitness classes at the local recreation center. Her co-workers keep trying to get her to come back to fitness class, but she says that she is too tired after work and just wants to go home. She has smoked for 15 years, but says that she is trying to cut back on the number of cigarettes each day because she watched her mother die from emphysema. She has picked up some literature from Employee Health on smoking cessation. She was recently diagnosed with hypertension. 2. Which primary intervention activities are important for Ms. Thom?

2. The primary prevention/intervention activities that are important for Ms. Thom are healthy diet and exercise, influenza vaccine, stress management, and health education on smoking cessation.

8. Using the Transtheoretical Model of Change, order the steps that a patient goes through to make a lifestyle change related to physical activity. 1. The individual recognizes that he is out of shape when his daughter asks him to walk with her after school. 2. Eight months after beginning walking, the individual participates with his wife in a local 5K race. 3. The individual becomes angry when the physician tells him that he needs to increase his activity to lose 30 lbs. 4. The individual walks 2 to 3 miles, 5 nights a week, with his wife. 5. The individual visits the local running store to purchase walking shoes and obtain advice on a walking plan.

3, 1, 5, 4, 2. 3. The individual becomes angry when the physician tells him that he needs to increase his activity to lose 30 lbs. 1. The individual recognizes that he is out of shape when his daughter asks him to walk with her after school. 5. The individual visits the local running store to purchase walking shoes and obtain advice on a walking plan. 4. The individual walks 2 to 3 miles, 5 nights a week, with his wife. 2. Eight months after beginning walking, the individual participates with his wife in a local 5K race.

3. Based on the transtheoretical model of change, what is the most appropriate response to a patient who states: "Me, stop smoking? I've been smoking since I was 16!" 1. "That's fine. Some people who smoke live a long life." 2. "OK. I want you to decrease the number of cigarettes you smoke by one each day, and I'll see you in 1 month." 3. "I understand. Can you think of the greatest reason why stopping smoking would be challenging for you?" 4. "I'd like you to attend a smoking cessation class this week and use nicotine replacement patches as directed."

3. "I understand. Can you think of the greatest reason why stopping smoking would be challenging for you?"

15. Which activity shows a nurse engaged in primary prevention? 1. A home health care nurse visits a patient's home to change a wound dressing. 2. A nurse is assessing risk factors of a patient in the emergency department admitted with chest pain. 3. A school health nurse provides a program to the first-year students on healthy eating. 4. A nurse schedules a patient who had a myocardial infarction for cardiac rehabilitation sessions weekly.

3. A school health nurse provides a program to the first-year students on healthy eating.

Ms. Thom, age 46, works as an RN in the intensive care unit at a large busy medical center. Over the last three years she has gained 30 lbs and quit attending the fitness classes at the local recreation center. Her co-workers keep trying to get her to come back to fitness class, but she says that she is too tired after work and just wants to go home. She has smoked for 15 years, but says that she is trying to cut back on the number of cigarettes each day because she watched her mother die from emphysema. She has picked up some literature from Employee Health on smoking cessation. She was recently diagnosed with hypertension. 3. Using the transtheoretical model of change, in which stage is Ms. Thom most likely related to her smoking? Explain your answer.

3. Ms. Thom is in the preparation stage. At this time she is making small changes in preparation for a change in the next month. She has started to cut down on the number of cigarettes she smokes each day. She has also picked up materials on smoking cessation. In this stage Ms. Thom believes that the advantages of changing her behavior and stopping smoking outweigh the disadvantages. She will need assistance to plan for the change.

12. A patient registered at the local fitness center and purchased a pair of exercise shoes. The patient is in what stage of behavioral change? 1. Precontemplation 2. Contemplation 3. Preparation 4. Action

3. Preparation

2. A patient had surgery for a total knee replacement a week ago and is currently participating in daily physical rehabilitation sessions at the surgeon's office. In what level of prevention is the patient participating? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Quaternary prevention

3. Tertiary prevention

Health

A state of complete physical, mental, and social well-being

Models of health offer a perspective by which to understand the relationships between the concepts of health, wellness, and illness. Nurses are in a unique position to assist patients in achieving and maintaining optimal levels of health because nurses (Select all that apply.) a. Understand the challenges of today's health care system. b. Identify actual and potential risk factors. c. Have coined the term "illness behavior." d. Can minimize the effects of illness and assist to the return of optimal health

A, B, D a. Understand the challenges of today's health care system. b. Identify actual and potential risk factors. d. Can minimize the effects of illness and assist to the return of optimal health

Action

Actively engaged in strategies to change behavior; lasts up to 6 months

Health belief model

Addresses the relationship between a person's beliefs and behaviors

Holistic health model

Attempts to create conditions that promote a patient's optimal level of health.

Just as health and health behavior are affected by internal and external variables, so are illness and illness behavior. Which external variables can affect illness and behavior? (Select all that apply.) a. Perception of the seriousness of the illness b. Patient's coping skills c. Cultural background d. Social support e. Socioeconomic status

C, D, E c. Cultural background d. Social support e. Socioeconomic status

preparation

Making small changes in preparation for a change in the next month

Precontemplation

Not intending to make changes within the next 6 months

secondary traumatic stress and burnout

Symptoms include decline in health, emotional exhaustion, irritability, restlessness, impaired ability to focus and engage with patients, feelings of hopelessness, inability to take pleasure from activities, and anxiety.

Illness behavior

Ways in which people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system.

Wellness

Wellness education teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self-responsibility.

Illness

a state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired.

A 62-year-old male patient has had chronic obstructive pulmonary disease (COPD) for many years but has been unable to quit smoking. When approached by the nurse, he states that he would be "better off dead." He states that he has always supported his family, and now the doc-tor says he can no longer work because of his condition and oxygen dependency. His wife will now have to go to work, and he is sure that she will not make enough money to pay the bills. In preparing the patient for discharge, the nurse should a. Develop a plan of care for the family. b. Contact psychiatric services. c. Assure the patient that things will work out. d. Focus the plan of care on maximizing pa-tient function.

a. Develop a plan of care for the family.

The nurse is preparing a smoking cessation class and is amazed at how many people still smoke even with the information on lung cancer so readily available. She believes that her class will convert many smokers to nonsmokers once they get all the latest information. The nurse is a be-liever in which of the following health care models? a. Health Belief Model b. Health Promotion Model c. Basic Human Needs Model d. Holistic Health Model

a. Health Belief Model

The nurse is working in a drug rehabilitation clinic and is in the process of admitting a patient who says that she wants to be "detoxified." It is important for the nurse to a. Identify the patient's stage of change. b. Realize that the patient is ready to change. c. Instruct the patient that she will have to change her lifestyle. d. Instruct the patient that relapses are not tolerated.

a. Identify the patient's stage of change.

Many variables influence a patient's health beliefs and practices. Internal and external variables influence how a person thinks and acts. An example of an internal variable would be a. Perception of functioning. b. Family practices. c. Socioeconomic factors. d. Cultural background.

a. Perception of functioning.

The nurse is working in a clinic that is designed to provide health education and immunizations. As such, this clinic is designed to provide a. Primary prevention. b. Secondary prevention. c. Tertiary prevention. d. Diagnosis and prompt intervention.

a. Primary prevention.

Chronic illness

an on-going illness, slow or gradual in onset; it has no known cure; it can be controlled and complications prevented with proper treatment

Risk factor

anything that increases the likelihood of injury, disease, or other health problems

The patient has been overweight for most of her life. She has tried dieting in the past and has lost weight, only to regain it when she stopped dieting. She is visiting the weight loss clinic/health club because she has decided to do it. She states that she will join right after the holidays, in 3 months. The nurse recognizes that the patient is in which stage of the change process? a. Precontemplation b. Contemplation c. Preparation d. Action

b. Contemplation

According to the World Health Organization, what is the best definition for "health"? a. Simply the absence of disease b. Involving the total person and environment c. Strictly personal in nature d. Status of pathological state

b. Involving the total person and environment

The patient is admitted to the emergency department of the local hospital from home with reports of chest discomfort and shortness of breath. She is placed on oxygen, has labs and blood gases drawn, and is given an electrocardiogram and breathing treatments. What level of preventive care is this patient receiving? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

b. Secondary prevention

Risk factors can be placed in the following interrelated categories: genetic and physiological factors, age, physical environment, and lifestyle. The presence of any of these risk factors means that a. A person with the risk factor will get the disease. b. The chances of getting the disease are increased. c. The disease is guaranteed not to develop if the risk factor is controlled. d. Risk modification will have no effect on disease prevention.

b. The chances of getting the disease are increased.

The nurse is caring for a patient who has been trying to quit smoking. She has been smoke free for 2 weeks but had two cigarettes last night and at least two this morning. What should the nurse anticipate? a. The patient does not want to and never will quit smoking. b. The patient will return to the contemplation or precontemplation phase. c. The patient will need to adopt a new life-style for change to be effective. d. The patient must pick up her attempt right where she left off.

b. The patient will return to the contemplation or precontemplation phase.

The patient had a colostomy placed 1 week ago. When approached by the nurse, the patient and his wife refuse to talk about it and refuse to be taught about how to care for it. The nurse realizes that the patient and his wife are in which stage of adjustment? a. Shock b. Withdrawal c. Acceptance d. Rehabilitation

b. Withdrawal

The nurse is admitting a patient with uncontrolled diabetes mellitus. It is the fourth time the patient is being admitted in the last 6 months for high blood sugars. During the admission pro-cess, the nurse asks the patient about her employment status and displays a nonjudgmental atti-tude. Why does the nurse do this? a. Noncompliant patients thrive on the dis-approval of authority figures. b. External variables have little effect on compliance. c. A person's compliance is affected by economic status. d. Employment status is an internal variable that impacts compliance.

c. A person's compliance is affected by economic status.

The health care model that utilizes Maslow's hierarchy as its base is the _____ Model. a. Health Belief b. Health Promotion c. Basic Human Needs d. Holistic Health

c. Basic Human Needs

To increase quality and years of healthy life, Healthy People 2020 focuses on four areas. One of those areas is a. Allowing people to continue current be-haviors to reduce the stress of change. b. Focusing only on individual health changes that will lead to better communi-ties. c. Creating social and physical environments that promote good health. d. Focusing on illness treatment to provide fast recuperation.

c. Creating social and physical environments that promote good health.

An argument for passing "universal health care" legislation is that it would help fulfill the Healthy People 2020 goal of a. Increasing quality of life in America. b. Prolonging healthy life in America. c. Eliminating health disparities in America. d. Promoting healthy behaviors.

c. Eliminating health disparities in America.

A patient is admitted to a rehabilitation facility following a stroke. The patient has right-sided paralysis and is unable to speak. The patient will be receiving physical therapy and speech ther-apy. What are these examples of? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

c. Tertiary prevention

Contemplation

considering a change within the next 6 months

The patient is describing moderate incisional pain that was not relieved by the last dose of hydromorphone (Dilaudid) given 90 minutes earlier. The patient is not due for another dose of medication for another 2 1/2 hours. The nurse repositions the patient, asks what type of music she likes, and puts on the music channel on the television, setting it to play that type of music. The nurse is attempting to utilize which health care model? a. Health Belief Model b. Health Promotion Model c. Basic Human Needs Model d. Holistic Health Model

d. Holistic Health Model

The patient has quit smoking and has been smoke free for the past 2 years. Of the following stages, which best fits her current stage of change? a. Contemplation b. Preparation c. Action d. Maintenance

d. Maintenance

The nurse is working on a committee to evaluate the need for increasing the levels of fluoride in the drinking water of the community. In doing so, the nurse is fostering the concept of a. Illness prevention. b. Active health promotion. c. Wellness education. d. Passive health promotion.

d. Passive health promotion.

External factors impacting health practices include:

family beliefs and economic impact.

Health promotion

help patients maintain or enhance their present levels of health.

Active strategies of health promotion

individuals are motivated to adopt specific health programs

Passive strategies of health promotion

individuals gain from the activities of others without acting themselves

Health behaviors

practices that have an impact on physical well-being

Illness prevention

protects patients from actual or potential threats to health & motivates people to avoid a decline in health or functional levels.

Acute illness

rapidly occurring illness that runs its course, allowing a person to return to one's previous level of functioning

maintenance stage

sustained change over time; begins 6 months after action has started and continues indefinitely

Primary prevention

true prevention; it precedes disease or dysfunction and is applied to patients considered physically and emotionally healthy.

Key points to remember

• Health and wellness are not merely the absence of disease and illness. • A person's state of health, wellness, or illness depends on individual values, personality, and lifestyle. • Multiple models of health in which persons are active participants explain relationships among health beliefs, health behaviors, health promotion, and individual well-being. • Health beliefs, practices, and illness behaviors are influenced by internal and external variables, and you need to consider them when planning care. • Health promotion activities help maintain or enhance health, whereas wellness education teaches patients how to care for themselves. • Illness prevention activities protect against health threats and thus maintain an optimal level of health. • Nursing incorporates health promotion activities, wellness education, and illness prevention activities rather than simply treating illness. • The three levels of preventive care are primary, secondary, and tertiary. • Risk factors threaten health, influence health practices, and are important considerations in illness prevention activities. • Improvement in health usually involves a change in health behaviors. • The transtheoretical model of change describes a series of changes through which patients progress for successful behavior change rather than simply assuming that all patients are in an action stage. • Illness has many effects on a patient and family, including changes in behavior and emotions, family roles and dynamics, body image, and self-concept. • Using personal and professional strategies that focus on caring for self can help to decrease or prevent compassion fatigue.