HEALTH PROMOTION HEALTH SCREENING

Health Promotion
Definitions
Health promotion behavior is behavior in which the client views health as a goal and engages in behaviors designed to achieve or maintain that goal. Health care includes prevention, early detection, treatment and rehabilitation for clients with potential for or existing illness or disability. Healthy lifestyle can increase or maintain client's level of wellness and functional ability.

4. Health screening (for risk factors or illness) can prevent or minimize illness and disability.
5. Disease prevention behaviors are behaviors designed to decrease the likelihood/risk of illness

 Primary prevention 1.health promotion and disease prevention 2.applied to clients considered physically and emotionally healthy 3.example: exercise programs, healthy diet

 Secondary prevention 1.early detection of illness 2.focuses on individuals who are experiencing health problems and illnesses and who are at risk for complications 3.activities are directed at diagnosis and prompt treatment 4.example: breast self examination, cholesterol screening

Tertiary prevention

1. prevention of further deterioration in disease or disability 2. occurs when a defect or disability is permanent and irreversible 3. activities are directed at rehabilitation 4. example: alcoholics anonymous

Health Promotion Programs and Health Screening

A. Blood pressure screening 1. Screening should be done annually beginning at age 21 for both males and females 2. Screening for children and adolescents is also recommended but optimal interval has yet to be determined

3. Ausculatory method with a properly calibrated and fitting cuff should be used 4. Person should be seated quietly in a chair for at least five minutes with feet on the floor and arms supported at heart level 5. At least two measurements should be done, two minutes apart 6. Pre-hyerptensive individuals (SBP 120-139 and DBP 80-89) should be counseled on lifestyle modifications such as weight reduction, exercise, diet, and smoking cessation 7. SBP > 140 and / or DBP > 90 should be referred to a health care provider for antihypertensive drug therapy

B. Breast self-examinations 1.Should be started by age twenty 2.Done at the same time of the month preferably seven days after onset of the menstrual cycle; if no menstrual cycles, do at the same time each month 3.Technique should be reviewed by a health care provider to ensure effectiveness 4.Limited effectiveness, but when done regularly helps a woman understand how her breasts normally feel

5. Most changes are benign, but unusual or spontaneous changes should be checked by a health care provider without delay - these include: a. lump or thickening (breast or underarm) b. red or hot skin c. orange peel skin d. dimpling or puckering e. itch or rash, especially in nipple area f. retracted nipple g. change in direction of nipple h. bloody or spontaneous discharge i. unusual pain j. a sore on the breast that does not heal

C. Risky behaviors - assist in assessment of behaviors that impact the health of individuals in the following developmental stages 1.Adolescents (age 13-19) a.eating disorders i. anorexia nervosa - restrictive eating ii. bulimia nervosa - binge eating followed by purging

b.injury prevention i. wearing of seat belts ii. wearing of helmets iii. sports injuries iv. homicide and suicide c. substance abuse i. tobacco ii. underage drinking iii. illicit drug use

d.sexual behavior i. sexually transmitted disease - use of condoms ii. unintended pregnancy e.stress i. changing roles marriage beginning a new family starting a new job ii. depression

3. a. b. c. i. ii. iii.
d. e. i. ii. iii. iv.

middle adult (age 35-65) obesity lack of exercise substance abuse tobacco alcoholism illicit drug use
lack of preventative health care stress job family / divorce depression acceptance of aging

4. older adult (age 65 and older) a. obesity b. lack of exercise c. substance abuse i. tobacco ii. alcoholism iii.illicit drug use d. injury prevention i. falls ii. seatbelts iii.suicide iv. multiple medications

D. Scoliosis screening 1.Recommendations vary but generally accepted to perform screening at onset of adolescence 2.Significantly more prevalent in girls than boys 3.Early intervention important because untreated scoliosis can lead to disfigurement, impaired mobility, and cardiopulmonary complications

4. Technique: clothing should be removed from upper body a. while standing, check adolescent for asymmetry of shoulders, scapula, hips, or waist b. assess for misalignment of spinous processes lateral curvature and convexity of thoracic spine indicate scoliosis c. with feet together and legs straight, have adolescent bend forward until back is parallel to floor; check for prominence of ribs on one side only and hip and leg asymmetry - chest wall on side of convexity is prominent and scapula on side of convexity is elevated 5. Abnormalities are to be followed up by a health care provider and referral to orthopedist may be necessary for severe curvatures

E. Testicular self-examinations 1.Monthly self-examination should begin in adolescence, since this is the highest risk group 2.Best time to perform exam is during or after a bath or shower when the scrotum is relaxed

3. Limited research to determine if regular examinations reduce death rate but they are strongly encouraged for men with risk factors such as a. family history of testicular cancer b. cryptorchidism c. previous germ cell tumor in one testicle 4. Findings that should be reported to a health care provider include a. hard lumps or nodules 1. change in size, shape, or consistency of the testes 2. Cholesterol - once every five years if normal age 45 and older 3. In women: mammography

 Timing of Mammograms The National Cancer Insitutute (NCI) and the American Cancer Society differ in their recommendations for scheduling of mammorgrams. The NCI recommends (2002): Women in their 40s should be screened every one to two years with mammography. Women aged 50 and older should be screened every one to two years. Women who are at higher than average risk of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and the frequency of screening.

 The ACS guidelines for the detection of breast cancer in asymptomatic women (2002): Women 40 years of age and older should have a mammogram every year. Women 40 and older should have a physical examination of the breast every year, performed by a health care professional, such as a physician, physician assistant, nurse or nurse practitioner. This examination should take place near and preferable before, the annual mammogram. Women 20-39 should have a physical examination of the breast every three years, performed by health care professional such as a physician, physician assistant, nurse or nurse practitioner.

BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.
In women: the first papanicolau smear at the onset of sexual activity and/or over age 18, annually In men: prostate-specific antigen - annually 50 years of age or at age 40 for those at risk

For colon cancer

digital rectal exam every year after the age of 40 guaiac test for occult blood every year after the age of 50 proctoscopy every three to five years after the age of 50 after two negative annual exams colonoscopy

Tuberculosis skin tests: intradermal injection of antigen Diabetes: fasting plasma glucose, ideally eight to 12 hours fast Vision: after age 39, medical eye exam every three to five years Hearing: candidates for screening include:
family history of childhood hearing impairment perinatal infection (rubella, herpes, cytomegalovirus) low birth weight infants chronic ear infection

 Compliance
Definition: adherence to primary or secondary prevention recommendations Factors influencing compliance
personal meaning and perceptions: knowledge, values, beliefs, outcome expectations social factors: environmental context, social relationships, social support, societal norms, economic resources deficiencies in the health care system: access, costs, wait time, monolingual services

 Noncompliance
An individual's informed decision not to adhere to a therapeutic recommendation Individual unable or unwilling to alter habitual behaviors or adopt new behaviors necessary to a prescribed therapeutic regimen

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