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Health Promotion & Maintenance (HPM) Overview

Covers lifespan: preconception → newborn → pediatrics → adults → geriatrics.

Nurse’s role: proactive teaching, risk reduction, assessing needs, prevention, and early recognition of red-flag assessment findings.

Prevents risk factors from ever emerging.

Examples: community exercise programs, safe walking areas, school nutrition standards.

Prevents disease or injury before it occurs.

Examples: immunizations, seat belt teaching, smoking counseling, surgery pre-teaching.

Detects disease early in asymptomatic clients.

Screenings: colonoscopy, pap tests, mammograms, blood pressure checks.

Disease already exists — goal is to reduce complications and maximize functioning.

Examples: cardiac rehab, diabetes foot care teaching, chronic medication management.

Normal sequence: Inspection → Palpation → Percussion → Listening
Abdomen exception: Inspection → Listening → Percussion → Palpation
Why? Touching first can artificially change bowel sounds.

Stridor

High-pitched, harsh, inspiratory sound → airway emergency.

Immediate actions: call rapid response, prepare advanced airway, oxygen, suction.

Tracheal deviation + absent breath sounds on one side

Strongly suggests tension pneumothorax.

Prepare for needle decompression or chest tube.

High-pitched “tinkling” sounds → sudden silence

Possible obstruction or ileus → perforation risk.

Actions: notify provider, strict I/O, make NPO, prepare NG tube, assess for rebound tenderness.

Colorectal screening: Begins at age 45 for average risk.

Pap tests:

Age 21–29: every 3 years.

Age 30–65: Pap every 3 years OR Pap + HPV every 5 years.

Older adult: integrity vs. despair → use reminiscence, life review, validation.

Toddlers/young children: concrete, literal → simple language, medical play.

Teens: abstract thinkers → risk discussions, long-term consequences.

Tdap every pregnancy, regardless of prior doses.

Timing: 27–36 weeks → maximizes antibody transfer to baby.

No live vaccines during pregnancy (MMR, varicella).

Administer postpartum; avoid pregnancy for 28 days after MMR.

Fundal massage

Oxytocin

Rapid fluids

Call for help

Prepare for additional interventions (e.g., uterotonics)

Signs: jittery, tremors, irritability, lethargy, poor feeding.

Check glucose immediately; feed or give IV glucose per protocol.

Mild slowing is normal. Dementia is NOT normal aging.

Use Beers Criteria to identify unsafe medications.

High risk meds: sedatives, benzodiazepines, anticholinergics.

Fix environment first: lighting, footwear, remove rugs, grab bars.

A: A1C

B: Blood pressure

C: Colon cancer

D: DEXA (bone density)

O: Open-ended questions

A: Affirmations

R: Reflective listening

S: Summaries

Assess

Advise

Agree

Assist

Arrange

Clients with positive BRCA results are not obligated to inform family members.

Respect autonomy and confidentiality.

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