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
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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
•
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Results from direct loss of bicarbonate
Diarrhea
Diuretics
Early renal insufficiency
TPN without bicarbonate
Clinical Manifestations of Metabolic
Acidosis
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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
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Vomiting or gastric suction
Pyloric stenosis
Hypokalemia
Hyperaldosteronism
Cushing’s syndrome
Causes decreased Calcium
Clinical Manifestations of Metabolic
Alkalosis
•
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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
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Pulmonary edema
Aspiration of a foreign object
Atelectasis
Pneumothorax
Sedative overdose
Sleep apnea
Severe pneumonia
Clinical Manifestations of
Respiratory Acidosis
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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
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Always due to hyperventilation
Excessive “blowing off” of CO2
Extreme anxiety
Hypoxemia
Gram negative bacteremia
Inappropriate ventilator settings
Clinical Manifestations of
Respiratory Alkalosis
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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