NURS 7735 ADVANCED HEALTH ASSESSMENT, HEALTH MAINTENANCE AND PROMOTION

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NURS 7735 ADVANCED HEALTH ASSESSMENT, HEALTH
MAINTENANCE AND PROMOTION

• HEALTH PROMOTION
• HEALTH SCREENING

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DEFINITIONS

• HEALTH PROMOTION
• PRIMARY PREVENTION
• SECONDARY PREVENTION
• TERTIARY PREVENTION
• INCIDENCE

• PREVALANCE
• MORBIDITY
• MORTALITY
• RISK FACTOR
• RISK ASSESSMENT
• SCREENING
• CHEMO-PROPHYLAXSIS

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HEALTH PROMOTION

• ANY COMBINATION OF EDUCATIONAL, ORGANIZATIONAL,
  ECONOMIC AND ENVIRONMENTAL SUPPORT FOR BEHAVIORS
  AND CONDITIONS OF LIVING CONDUCIVE TO HEALTH

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DISEASE PREVENTION

• PRIMARY PREVENTION PROTECTION OF ENTIRELY
  ASYMPTOMATIC INDIVIDUALS
• IMMUNIZATION OF CHILDREN

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DISEASE PREVENTION

• SECONDARY PREVENTION
• IDENTIFY AND TREAT ASYMPTOMATIC INDIVIDUALS WHO
  HAVE RISK FACTORS OR PRECLINICAL DISEASE
• CERVICAL PAP SMEAR

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DISEASE PREVENTION

• TERTIARY PREVENTION
• PREVENTATIVE MEASURES IN SYMPTOMATIC INDIVIDUALS
• INSULIN THERAPY IN DIABETICS

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INCIDENCE

• PROPORTION OF THE POPULATION THAT ACQUIRES THE
  MARKER IN A GIVEN PERIOD OF TIME
• UP TO 25 OF WOMEN SUFFER MAJOR DEPRESSION AT
  SOME TIME IN THEIR LIVES

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PREVALANCE

• PROPORTION OF THE POPULATION THAT HAS THE DISEASE
  AT ANY GIVEN TIME
• 1 OF THE POPULATION HAS BIPOLAR DISORDER

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MORBIDITY

• ILLNESS
• THERE WERE 12 MILLION CASES OF RUBELLA DURING THE
  LAST US PANDEMIC IN 1964

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MORTALITY

• DEATH
• THERE WERE 30,353 DEATHS BY SUICIDE REPORTED IN
  1997

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RISK FACTOR

• PERSONAL CHARACTERISTICS, PHYSIOLOGIC PARAMETERS,
  SYMPTOMS, OR PRECLINICAL DISEASE STATES THAT
  INCREASE THE LIKELIHOOD THAT AN INDIVIDUAL HAS OR
  WILL DEVELOP A PARTICULAR DISEASE

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RISK ASSESSMENT

• COLLECTION OF INFORMATION ABOUT RISK FACTORS
  DURING THE HISTORY, PHYSICAL, AND LABORATORY
  EXAMINATION

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SCREENING

• TOOLS OR APPROACHES WHICH UNCOVER RISK FACTORS

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CHEMOPROPHYLAXIS

• USE OF DRUGS, NUTRITIONAL/ MINERAL SUPPLEMENTS,
  OR OTHER NATURAL SUBSTANCES BY ASYMPTOMATIC
  PERSONS TO PREVENT FUTURE DISEASE

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HEALTHY PEOPLE 2010

• BACKGROUND
• NATIONAL HEALTH POLICY, ORIGINALLY PUBLISHED AS
  HEALTHY PEOPLE 2000 IN 1990
• A RESPONSE TO GROWING EVIDENCE (SINCE 1970s) THAT
  HEALTH PROMOTION WORKED AND TO THE POPULAR
  WELLNESS MOVEMENT

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HEALTHY PEOPLE 2010

• PHILOSOPHICAL STATEMENT
• ARTICULATION OF NATIONAL HEALTH GOALS
• SUGGESTIONS OF INTERVENTIONS
• ALLOWANCE FOR INNOVATIVE NATIONAL, REGIONAL AND
  LOCAL PARTICIPATION

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DOMAINS OF HEALTH PROMOTION

• CONTROLLING COMMUNICABLE DISEASE
• PROTECTION OF THE ENVIRONMENT

• MODIFICATION OF PERSONAL BEHAVIORS
• PREVENTION OR REDUCTION OF SEVERITY OF CHRONIC,
  NON-COMMUNICABLE DISEASE

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WORK TO BE DONE

• GOOD NUTRITION
• SAFE SEX
• PHYSICAL ACTIVITY
• MODERATE ETOH
• TOBACCO CESSATION

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FAILURES TO INSTITUTE HEALTH PROMOTION PROGRAMS

• NOT GLAMOROUS
• PROFESSIONAL PREPARATION LAPSES
• SKEPTICISM ABOUT EFFICACY
• NOT REIMBURSABLE
• LACK OF AGREEMENT CONCERNING A CARE PACKAGE
• LOST OPPORTUNITIES

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METHODS OF HEALTH PROMOTION

• SCREENING TESTS
• IMMUNIZATIONS
• CHEMOPROPHYLAXIS
• COUNSELING

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AINT IT IRONIC?52 YEAR OLD MAN PRESENTS IN
CLINIC FOR C/O DYSPEPSIA. THE COMPLAINT IS
ADDRESSED. PT IS NEVER ASKED ABOUT OR COUNSELED
ABOUT HIS TOBACCO USE, YET HIS RISK FOR CV
MORBIDITY AND MORTALITY WOULD BE HIS GREATEST
PROBLEM AT THIS POINT. YOU WOULD THINK THAT OF
THE 20 MINUTES YOU WOULD SPEND WITH THE PATIENT,
10 WOULD BE SPENT ASSESSING AND TREATING HIS C/C
AND 10 WOULD BE SPENT ON HEALTH PROMOTION. DOES
THIS HAPPEN?? IS IT FEASIBLE?? WOULD IT WORK??
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SETTING PRIORITIESGUIDING PRINCIPLES

• HOW SERIOUS IS THE TARGET CONDITION?

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SETTING PRIORITIESGUIDING PRINCIPLES

• HOW COMMON IS THE RISK FACTOR?

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SETTING PRIORITIESGUIDING PRINCIPLES

• WHAT IS THE MAGNITUDE OF RISK ASOCIATED WITH THE
  RISK FACTOR?

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SETTING PRIORITIESGUIDING PRINCIPLES

• HOW ACCURATELY CAN THE RISK FACTOR BE DETECTED?

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SETTING PRIORITIESGUIDING PRINCIPLES

• IS THERE EVIDENCE THAT POTENTIAL INTERVENTIONS
  IMPROVE HEALTH OUTCOMES?

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SETTING PRIORITIESGUIDING PRINCIPLES

• HOW DOES ALL OF THIS INFORMATION COMPARE WITH
  OTHER HEALTH PRIORITIES?

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IDEAL RISK ASSESSMENT

• ACCURATE
• VALID
• CHEAP
• RELIABLE
• EASY TO USE
• HIGH PATIENT ACCEPTANCE
• FITS PRIORITIES

• LEADS TO EFFECTIVE INTERVENTIONS
• UNCOVERS SERIOUS CONDITION
• INDIVIDUALIZED TO TARGET POPULATIONS

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BACK TO THE SIX PRINCIPLES GUIDING RISK ASSESSMENT
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HOW SERIOUS IS THE TARGET CONDITION?

• BURDEN OF SUFFERING IS A FUNCTION OF FREQUENCY
  AND SEVERITY

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HOW COMMON IS THE RISK FACTOR?

• PAY SPECIAL ATTENTION TO SPECIAL GROUPS

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WHAT IS THE MAGNITUDE OF RISK ASSOCIATED WITH THE
RISK FACTOR?

• RELATIVE RISK
• VS
• ABSOLUTE RISK

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HOW ACCURATELY CAN THE RISK FACTOR BE DETECTED?

• SENSITIVITY
• SPECIFICITY
• FALSE POSITIVES
• FALSE NEGATIVES

• RELIABILITY
• POSITIVE PREDICTIVE VALUE

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IS THERE EVIDENCE THAT POTENTIAL INTERVENTIONS
IMPROVE HEALTH OUTCOMES?

• IS THERE A NEED TO SCREEN FOR CONDITIONS FOR
  WHICH THERE ARE NO EFFECTIVE TREATMENTS?

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HOW DOES ALL OF THIS INFORMATION COMPARE WITH
OTHER HEALTH PRIORITIES?

• PRIORITIES TAKE PRECEDENCE