Health Promotion

Larry Santiago, MSN, RN

Health Care Delivery and Nursing Practice

• Nursing is defined as the “diagnosis and treatment of human responses to health and illness”.

Health Care Delivery and Nursing Practice 2

• Health is defined as a “state of complete physical, mental, and social well-being”.

Health Care Delivery and Nursing Practice 3

• Wellness “includes a conscious and deliberate approach to an advanced state of physical, psychological, and spiritual health”.

Maslow’s Hierarchy of Needs

Roles of the Nurse

Practitioner Role

Leadership Role

Roles of the Nurse 2

• Research Role

Health Education

• Goal of patient education is to encourage people to adhere to therapeutic regimens

Health Education 2

• Teaching techniques and methods enhance learning

Health Education 3

• Learning readiness

• Learning environment

Health Education 4

• People with disabilities

• Gerontologic considerations

Health Promotion

• Health Promotion encourages people to achieve as high a level of wellness as possible

Health Promotion 2

• Health Promotion principles include: self-responsibility, nutrition,stress

management

and exercise

Chronic Illness

Larry Santiago, MSN, RN

Chronic Conditions

• Medical conditions or health problems with associated symptoms or disabilities that require long-term management

Chronic Conditions 2

• Occur in every age

group

• Major and minor activity limitations

• Expensive

Phases of Chronic Illness

• 1) Pretrajectory phase – person is at risk for developing a chronic condition because of genetic factors or lifestyle

behaviors that increase

susceptibility to chronic

illness

Phases of Chronic Illness 2

• 2) Trajectory phase – characterized by the onset of symptoms or disability associated with a chronic condition

Phases of Chronic Illness 3

• 3) Stable phase – indicates that symptoms and disability are being managed adequately

Phases of Chronic Illness 4

• 4) Unstable phase – characterized by exacerbation of illness symptoms, development of complications, or reactivation of an illness in remission

Phases of Chronic Illness 5

• 5) Acute phase – characterized by sudden onset of severe or unrelieved symptoms that require hospitalization

Phases of Chronic Illness 6

• Crisis phase – characterized by a critical or life-threatening situation that requires emergency treatment or care

Phases of Chronic Illness 7

• Comeback phase – recovery after an acute period

• Downward phase – marks the worsening of a condition

• Dying phase – characterized by the gradual or rapid decline despite efforts to halt the disorder

Nursing Management

1. Identify trajectory phase• - assess the patient to determine the

specific phase

Nursing Management 2

2. Establish goals – should be a collaborative effort with the patient, family, and nurse working together

Nursing Management 3

• 3) Establish a plan to achieve desired outcomes

• 4) Identify factors that facilitate or hinder attainment of goals

Nursing Management 4

• 5) Implementing Interventions

• 6) Evaluating the

Effectiveness of

Interventions

End-of-Life Care

Larry Santiago, MSN, RN

Death and Dying

• Technology has prolonged life

Death and Dying 2

• Sociocultural Context

End of Life Care

• Palliative Care

End of Life Care 2

• Hospice Care

Advance Directives

• Written documents that allow the individual of sound mind to document preferences regarding end-of-life care

• Most common types:

- Living will

- Durable power of attorney for health care

Health Care of the Older Adult

Larry Santiago, MSN, RN

Health Care of the Older Adult

• Gerontology is the study of the aging process

Health Care of the Older Adult 2

• Demographics of Aging

Health Care of the Older Adult 3

• Health Care Costs of Aging

Health Care of the Older Adult 4

• Ageism is prejudice or discrimination against older adults

Age Related Changes

• Physical

Age Related Changes 2

• Psychosocial

Age Related Changes 3

• Cognitive

Age Related Changes 4

• Environmental

Age Related Changes 5

• Pharmacologic

Living Arrangements

–Own home

–Family home

–Continuing Care Retirement Communities

–Long term care

Geriatric Syndromes

• Impaired Mobility

• Urinary Incontinence

• Immunodeficiency

• Depression

• Delirium

• Dementia

Perspectives in Transcultural Nursing

Larry Santiago, MSN,RN

Culture

• Culture involves learned and transmitted knowledge about values, beliefs, rules of behavior, and lifestyle practices that guide groups in their thinking and actions

Culture 2

• Subcultures and minorities

Transcultural Nursing• Focus on cultural care values, beliefs, and practices of individuals from a particular culture (Giger & Davidhizar, 1999)

Transcultural Nursing 2

• Acculturation - process by which members of a cultural group adapt or learn how to take on the behaviors of another group

Transcultural Nursing 3

• Cultural blindness – inability of a person to recognize his/her own values, beliefs, and practices and those of others because of strong ethnocentric tendencies

Transcultural Nursing 5

• Cultural imposition – tendency to impose one’s cultural beliefs, values, and patterns of behavior on a person/persons from a different culture

Transcultural Nursing 6

• Cultural taboos – those activities governed by rules of behavior that are avoided, forbidden, or prohibited by a particular cultural group

Culturally Competent Nursing Care

• Cross-Cultural Communication

Culturally Competent Nursing Care

• Culturally Mediated Characteristics

• - Space and Distance

Culturally Competent Nursing Care 2

• Eye Contact

Culturally Competent Nursing Care 3

• Time

Culturally Competent Nursing Care 4

• Touch

Culturally Competent Nursing Care 5

• Communication

Culturally Competent Nursing Care

• Diet

Acid-Base Disturbances

Larry Santiago, MSN, RN

Acid-Base Disturbances

• Identification of the specific acid-base imbalance is important in identifying the underlying cause of the disorder and in determining appropriate treatment

Kidneys

• Regulate the bicarbonate level in the ECF

• In respiratory acidosis and most metabolic acidosis, kidneys excrete hydrogen and conserve bicarbonate to help restore balance

• In respiratory and metabolic alkalosis, kidneys retain hydrogren and

excrete bicarb

Lungs

• Adjusts ventilation in response to the amount of CO2 in the blood

• In metabolic acidosis, respirations increase, causing greater elimination of CO2

• In metabolic alkalosis,

respiratory rate decreases,

causing CO2 to be retained

Metabolic Acidosis

• Clinical disturbance characterized by low pH, and low bicarbonate (HCO3) concentration

» Low pH Low HCO3»

Causes of Metabolic Acidosis

• Results from direct loss of bicarbonate

- Diarrhea

- Diuretics

- Early renal insufficiency

- TPN without bicarbonate

Clinical Manifestations of Metabolic Acidosis

• Headache

• Confusion

• Drowsiness

• Increased respiratory rate and depth

• Nausea and vomiting

• Increased BP

• Cold, clammy skin

Metabolic Alkalosis

• Clinical disturbance characterized by a high pH and a high bicarbonate

» high pH high HCO3

Causes of Metabolic Alkalosis

• Vomiting or gastric suction

• Pyloric stenosis

• Hypokalemia

• Hyperaldosteronism

• Cushing’s syndrome

• Causes decreased Calcium

Clinical Manifestations of Metabolic Alkalosis

• Related to hypocalcemia

- Tingling of the fingers and toes

- Dizziness

- Hypertonic muscles

- Depressed respirations

- Atrial tachycardia

Respiratory Acidosis

• Clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mmHg

• Always due to the inadequate excretion of CO2 with inadequate ventilation, resulting in elevated CO2 levels

low pH high PaCO2

Causes of Respiratory Acidosis

• Pulmonary edema

• Aspiration of a foreign object

• Atelectasis

• Pneumothorax

• Sedative overdose

• Sleep apnea

• Severe pneumonia

Clinical Manifestations of Respiratory Acidosis

• Increased pulse and respiratory rate

• Increased BP

• Mental cloudiness

• Feeling of fullness in the head

• Cerebrovascular vasodilation

Respiratory Alkalosis

• Arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg

high pH low PaCO2

Causes of Respiratory Alkalosis

• Always due to hyperventilation

• Excessive “blowing off” of CO2

- Extreme anxiety

- Hypoxemia

- Gram negative bacteremia

- Inappropriate ventilator settings

Clinical Manifestations of Respiratory Alkalosis

• Lightheadedness

• Inability to concentrate

• Tinnitus

• Loss of consciousness

• Tachycardia

• Ventricular/atrial

dysrhythmias

Normal values

• pH 7.35-7.45

• PaCO2 35-45

• HCO3 22-26