Health Promotion & Maintenance

This podcast is for  nursing students who are trying to improve their understanding of the Health Promotion & Maintenance portion of NCLEX NextGen. It covers the most tested upon material and how you should study specific key topics. 

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Transcript

Hey guys and welcome to N-Deep with NCLEX NextGen Podcast

I am Dr. Spencer. I am a doctorally Prepared Family Nurse Practitioner, Nursing Tutor, and founder of NurseFirstNp an online nursing tutoring service designed to empower nursing students with the confidence and competence to pass nursing school and NCLEX. I am dedicated to teaching nursing students how to think like a nurse so they can understand nursing content not just memorize it. 
 If your looking for a nursing tutor who doesn’t just teach you what to know but also teaches you how to think like a nurse to pass nursing test in the comfort of your home, or while doing whatever it is that keeps you on the go. You are in the right place. Make sure you subscribe and leave a review. Also, feel free to leave me a message on my website NurseFirstNP.org of any content you would like me to discuss on a future podcast… I am here to serve you guys. 

Hey guys its Dr. Spencer from NurseFirstNP.  You are listening to N-Deep with NCLEX NextGen weekly videos to guide you on what to and how to study to pass NCLEX NextGen on your first attempt. 

In this weeks video, I am going to be talking about… Health Promotion and Maintenance throughout the lifespan…This section use to always confuse me in nursing school because I could never remember all of the developmental milestones. Like when toddlers/preschoolers should be able to draw a circle or walk up the stairs. I still have to go back and look at it in my book even while practicing as a FNP now. Because you never know, kids are born with special abilities now a days. They come out with teeth and everything.

So with this section you guys can expect to see approximately 9 percent of the questions on NCLEX- NextGen to be on Health Promotion and Maintenance.  This section particularly focuses on knowledge of expected growth and developmental principles, prevention and/or early detection of health problems, and strategies to achieve optimal health. 

We will first discuss the developmental stages and how one transitions into those developmental stages throughout the lifespan. We will also talk about health promotion/disease prevention, health screening, high-risk behaviors as it relates to life-style choices, self-care teaching, and techniques of physical assessment as it relates to each developmental stage. 

 Okay so lets jump right into it… 

 When thinking about health promotion and maintenance as one ages through life. You first have to think about the maternal factors that may impact how one first transitions into life. The prenatal period is a very critical time for the mother and the newborn. 

 Prenatal

 When studying health promotion and maintenance during the prenatal period, you must keep in mind factors that can cause the baby to be delivered full-term, premature, or overdue. 

 You guys know the prenatal time is a very crucial time because it can determine the infants growth and developmental rate. 

 Nutrition-

 So think about the vitamins and foods you should tell the pregnant patient to take/eat? 

Think of what medications you would tell the pregnant women not to take (Think Teratogenic)?

 Vaccinations

Think about the different vaccinations the mother should have received to ensure she has a healthy baby. 

 Think about all the vaccines mothers should receive during the prenatal period.

 Think RHO.

 Complications

You also need to think about maternal health factors that increases her risk of complication during delivery or the post-partum period such as pre-eclampsia, diabetes mellitus and hypertension.  

What complications may she experience from a vaginal delivery versus a caesarean section. 

 Fetal movements & heart rate

At what gestational age do you tell the expecting mother she will start feeling fetal movements? What are they called?

 Through what maneuver can the nurse detect fetal movements and what gestational age? 

 What’s the normal fetal heart rate based on ages of gestation?  

 At what gestational age can you hear the heart beat and how do you hear it? 

 What are some normal pregnancy events you should educate your patient about such as quickening, and Braxton Hicks contraction as well as when should she expect to have them according to her gestational age. 

Danger signs

What danger signs would you tell your pregnant patient to monitor for during pregnancy?

 Think Danger signs such as vaginal bleeding, sudden swelling of extremities, and abdominal pain. 

 Your also need to be mindful that expecting mothers of different cultures behave differently during the prenatal and delivery period. 

 What cultures am I referring to?

 Weight 

In addition to educating the mother on the proper foods, and medications to take, you should educate your expecting mother of how much weight she should gain. 

 Thinking about the mother’s weight before pregnancy. If the mother is a teenager, is the amount of weight the mother should gain is the same as an adult female.  So how much weight should the pregnant teen gain vs the adult. Do you recommend such based off her BMI?

 Autoimmune disease

What if the mother has a family hx of sickle cell or another genetic condition. How could you test the baby for any of this? Is it via ultrasound or via amniocentesis. At what time during pregnancy would you test for certain conditions?

 Lastly, you should teach her how to breastfeed before the delivery of the baby.

Okay now you have educated your expecting mother on health promotion measures she should take during the prenatal period. What education can you provide her for during the intrapartum period? 

 Intrapartum Care-

 Its time to deliver the baby. 

What are the signs of the onset of labor. 

What are the three main factors that may cause labor to begin. 

What kind of care must be performed during the labor stages.  

What are the stages, and what stage  is the explusion of the placenta. 

What if the mother starts to have late decelerations. What would you tell her to do? What do you do? What causes changes in decelerations. 

 Okay so now the baby and the mother has successfully gone through labor and delivery. 

 Post-Partum

 What do you assess the mother for after delivering the baby…

Think about the signs and symptoms of hemorrhaging and infection… ( Think low blood pressure, high heart rate, increase in temperature)

So when thinking about Newborns think about what you should expect to see when the baby first comes out. How does the baby’s head look? What’s a normal shaped head?  

 What color should the newborn be? Remember ABCs guys. Like APGAR score.. 

Think about what the baby would look like if it comes out to soon (premature) or too late….

Think about to what reflexes should the baby have and when should they go away. 

 Think when they should pass meconium?

What do if the baby is jaundiced.

 So with all that being said, think about what maternal factors may influence how the baby develop or looks. 

 For example, what would the baby look like if the mother smoked or dranked alcohol during pregnancy. What will the baby be at risk for?

Think about what warning signs you will tell your new-mother to monitor for when she takes the newborn home. Think ABCs such as vomiting, unable to keep food down, and not breathing easily. 

 Maternal expectations- Make sure you address maternal concerns such as the blues/maternal mood swings, when she should start menstruating, is it delayed if she is breastfeeding, how to treat mastitis? 

 Newborns

-       What type of milk should newborns drink and how does the breastfeeding schedule differ from the formula feeding schedule. How does the stool differ.

 Infants-

 Okay so now the baby is safely delivered, and the mother is bringing the baby to the doctors office for a health check for a 3 month health check. 

As it relates to  physical assessment think about reflexes, and normal/abnormal growth rates including head circumference. ( how much should the baby weigh at 6 months vs 12 months as compared to date of delivery) 

 Think about what reflexes you should see in an infant (from birth to 12 months) and when should said reflexes  go away..

 What physical findings are expected? Think about swollen genitals/breasts, milia on face. 

 Big one think about when the posterior and anterior fontanelles should close. 

 What if the parents of the infant comes in to the clinic and ask you when can they expect their child to start growing teeth? What would you tell them?? How would you tell them to clean their teeth and what would you instruct them to give the child for teething pain.

 Think about immunization schedule, and think about developmental milestones. And contraindications to administering vaccinations. 

 So, knowing that the infant isn’t born with the ability to roll over..

You know infants are at increased risk of suffocation…

So how would you instruct parents to lay their child for sleeping…

Would you recommend they sleep with their favorite stuff animal in the crib??

Would you recommend the infant sleeps in the bed with the parents. 

How much do they sleep as compared to the toddlers?

 Think about what type of milk you would recommend to the parents based off being a newborn vs being a toddler. 

Think about when would you tell the parents to introduced solid food to the infant and what method should they do such?  

 Think about the most common cause of death during this period.

When studying how one transitions from birth to infant to toddler so forth and so on… Think about how each age range may react to changes in development in relation to Erikson Stages of Psychosocial development.

 Think Erikson’s trust vs mistrust

 What are signs the infant is experiencing trust or mistrust of the parents. What are some signs as they get older.

 Toddler

 As the infant transitions into toddler stage, Think about how do they learn and explore their environment. Think about Erikson psychosocial theory autonomy vs shame and doubt and Piaget Sensorimotor stage. 

Think Feud psychosexual development oral stage where their mouth is a major source of gratification and exploration. 

Since they love putting things in their mouth, they are at increased for what?

Choking and poisoning. 

 Also during this time period is the anal stage where the toddler starts exhibiting control of the anal sphincter.

 You’re also thinking about parental education to help them identify when their toddler is ready to to start toilet training. 

 Also, your thinking about how do they eat and how should you instruct the parents to prepare the food. 

 How should they be placed in a car seat?

 When do they transition to a Booster seat.

 How do they sleep as compared to the newborn and infant? 

 Think Naps guys. 

Preschool

 You know as the child continues to grow their thought process change. 

 So now your toddler is in preschool. 

Do they still engage in solitary play? Are they able to be fair with other kids and share their friends’ feelings.  Again, thinking about Piaget Cognitive development and Erikson psychosocial development. 

 You also know that the beginning of this time period the child may have 

Conflict with the same parent of the same sex and feelings of intimate sexual possessiveness for the opposite-sex parent according to Feud Theory. 

What may you see or hear the child say? 

 So what if the child missed some vaccinations as a toddler or infant, how do you catch the child up on vaccines.

 School age (5 to 12 yrs)

Think about what health promotion screenings should take place during this time.  

As the child goes through pre-puberty how does the play change. 

What risk factors are they at risk for during the school age period. 

Do they still need to sit in a booster seat while in the car. 

 When do you start assessing for vision and hearing problems? 

 Puberty ( 13 to 18 years)

 When thinking about health promotion and maintenance as it relates to puberty you want to think about the physical changes that an adolescent may experience. 

You also want to think about how they may feel about the physical changes they are going through, especially if their development isn’t as fast as their peers. 

Think Tanner guys…

 When should they start puberty and what does that look like. When does puberty stop? What condition can cause a early puberty or late puberty. Think about things like Turner’s syndrome, or eating disorders 

How do they perceive themselves and where do they get their identify from? Is it their peers or their parents. 

 What mental health disorders are they are at increased risk for?

Think anorexia nervosa, bulimia, depression. 

 What health screenings do you start testing during puberty?

Think adolescent females and anemia and adolescent obesity and blood pressure screenings. 

 Just a key note guys… When differentiating from eating disorders and health disorders, when you have test question stating the teenager has been losing weight…Make sure you

Think about what key findings in the test question that would narrow your test answer to Type 1 DM instead of anorexia nervosa. Think unintentional weight loss despite an increase in eating.

 How do adolescents sleep?

What is the leading cause of death during this time period?

 So now your adolescent patient has became an adult

 Adulthood- (ages after puberty and before senior citizens)

 So you know growth slows down as one ages. So when studying adulthood and health and promotion maintenance think about the modifiable risk factors you want to teach your patients to help prevent chronic conditions in the older adult hood. 

 Especially since cardiac output begins to decrease during this time period .

What health promotion education would you teach them to  prevent heart disease?

Think eating healthy and exercise. 

 What labs would increase a person’s risk for heart disease?

When do you perform lipid panel screenings.  What if your patient has a LDL cholesterol higher than 200.. What does that mean?

Thinking about heart disease think blood pressure, cholesterol and A1c (contributing factors).

What BMI might increase a person’s risk for heart disease?

What lifestyle behaviors may increase a person’s risk for heart disease. 

Think smoking.

 Also during this time period you know one experiences a decrease in visual acuity especially near vision (presbyopia), Hearing acuity diminishes, especially In high pitched sounds (presbycusis), and Hormonal production decreases resulting in menopause, or andropause. 

 You want to begin many cancer screenings during this time period such as breast cancer, cervical cancer, prostate exam, testicular cancer, colorectal cancer, skin cancer screenings.

 In reference to Menopause, and midlife crisis. 

How might this age group respond to these life changes. 

Are there any treatment for menopause? 

Menopause- and hormone replacement therapy should you recommend it?

Keeping in mind Menopause causes loss of estrogen which increases the risk for osteoporosis and heart disease.

 As one gets older its hard to fight off viruses 

 What vaccines are recommended during this time period. Whats the schedule. For instance, if your patient has received the PCV13 (pneumonia vaccine) when can they get the PPSV 23? What if they received the PPSV 23 before the age of 50 can they get the PCV13?

 Think about shingles guys, what’s the vaccine when should patient’s receive it  and how is shingles  spread? 

 Think about what emotional/mental state this age range may be in

Think Generativity versus stagnation

In order for them to stimulate feelings of Generativity they need to engage in tasks to guide next generation, accept middle-age changes, adjust to the needs of aging parents, and reevaluate goals and accomplishments versus. If they do not they end up focusing on themselves, becoming overly concerned with one own physical and emotional health needs. 

 Think about what your patient may say that may make you think they are in one stage versus another.

For example, what if they say “none of my kids every think about me and my needs” 

 Now we are going to talk about the older adults

 Older Adults- (age over 65)

 Older than age 65- 

As you know as one ages

The immune response declines steadily after younger adulthood as the thymus loses size and function. Which is responsible for the increase in infections such as pneumonia, septicemia, immune disorders and cancer. 

 You know this age range needs to stay vaccinated. 

Think about what specific patient factors that would require earlier vaccination. Such as in diabetes and the pneumonia vaccine.

 What happens to the cardiovascular system during this time period?

 Blood vessels become less elastic and often rigid and tortous, venous return becomes less efficient which Increases the risk for orthostatic hypotension

 What else is this patient at increased risk for? Hypertension

 Which means they are at increased risk for what? CVA, MI

Think about what happens during the age range to the respiratory system. 

 Pulmonary elasticity and ciliary action decrease, so that clearing of the lungs become less efficient. Respiratory rate may increase with diminished depth. 

 This increases this population risk for what? Respiratory infections.

 Which means they are at increased risk after surgery for what? Pneumonia, Atelectasis.

 So what nursing interventions can you teach this age range to prevent such?

 Think about lifestyle factors that increase their risk for respiratory issues after surgery. 

Think about smoking, having a low BMI (<19), or dementia ( Think about why Dementia increases their risk for respiratory complications).

 You guys can expect  to be tested on a good bit of the older population because this specific population is living longer with health comorbidities. 

Thinking about nutrition. Does this age range need an increase in calories or protein.

 Nutrition is very important in this age because lack of nutrition can cause skin issues. 

Think about the skin…Since the skin has a decrease in skin turgor, and subcutaneous fat.

 Which predisposes them to what? skin ulcers.

 What else tends to decline with age?

 Thinking about the senses. You know that this population has a decrease in vision, hearing, and smell/taste. So what precautions would you teach this patient to prevent injury?

 What are signs and symptoms this patient may be experiencing hearing deficits or vison deficits? 

How would you communicate with this patient?

 So how would you tell them to care for there glasses, dentures, and hearing aids.

How do you know if their hearing aids are working?

Think about when your patient is in the hospital you want to make sure you tell them measures to prevent dentures from being thrown in the trash.

Like never place dentures in a napkin on tray.

Due to a decrease in senses, they are at increased risk for falls.

So you should automatically think about teaching them how to prevent falls especially at home. 

How would you tell them to walk with a cane or a walker.

 Think about where this age range may be mentally and emotionally. 

Psychosocial-

According to Erikson, they fall into the 

Ego integrity vs despair

Ego integrity is faciliatated when an older adult has successfully accomplished tasks earlier in life. A person who regrets the past and sees current problems as insurmountable, however, may end up in despair (feeling like they have unresolved problems and missed opportunities).

 Depending on where they are emotionally and mentally may impact their ability to safely manage their chronic illnesses. 

Thinking about self -care what other mental states may hinder their ability to take care of themselves.

 Think dementia, depression, and delirium which may make them a victim of polypharmacy and elder abuse. 

 Think about the signs of polypharmacy and elder abuse.

A big one guys- polypharmacy can increase your patient risk for falls.

How does dementia, depression, and delirium differ in their presentation. 

Think about which of these causes issues with short term memory vs long term memory. 

 Also, delirium is also associated with what disorder in the elderly? UTI

 These are the type of questions you guys need to be asking yourselves as your studying for NCLEX Next-Gen. Asking yourselves these types of questions ensures you actually understand the information, so you can better apply it when taking NCLEX Next-Gen.

 As mentioned before guys this podcast is geared towards teaching you how to think like a nurse in order to pass NCLEX NextGen on the first attempt. Similar to you guys, I knew I knew the information but the way the test questions asked the question, I would always doubt myself. So this podcast is to help you get familiar with the type of questions you should be asking yourself as you study for NCLEX. 

Thank you guys so much for listening this podcast, I pray that this serve as a guide to help you become more confident and competent in taking NCLEX. Please guys reach out to me on Instagram- nursing tutor or on my website Nursefirstnp.org. If you need any additional clarification on topics presented in this podcast- questions can range from how to learn the medications better, or if you just need tips on how to study for NCLEX whether its your first time or third time.  or if you would like this podcast transcript or the one-own-one cheatsheet showing you not only how to study this section but what to study in this section, visit my website nursefirstnp.org. Remember, I am here to serve you guys.   Good luck and best wishes..

 Remember, guys you don’t need to know everything to pass NCLEX NextGen just the most important things. So study with Strategy!! See you next week.