Health

Promotion
and Risk
Managemen
t
Dr. Karen Lipford NGR5053
TOPICS
• Guidelines for Health Assessment of
Patients (Age)
• Terminology
• Levels of Prevention
• Immunization Guidelines
• Referrals
• Lab Screening
• Leading causes of death (CDC)
• Healthy People 2030
• Health Promotion Activities
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Guidelines for Health Assessment Per Age
Adolescents (ages 11-19)​ When to Start​ How Often​
Complete physical exam (see note pages below) Age 11-14 yoa annually

Syphilis screening (M&F) When sexually active Prn or with PAP smear, etc.

Males (Breast/testicular Exam) adolescence monthly

Age 9-14 YOA Series 2 months apart

HPV (Gardasil 9)
Age 15-26 YOA Series of three at 0, 2, and 6 months)

HIV Aged 13-64 years​ At least once; assess knowledge of prevention, contraception, protective
barriers, etc. ​

Tetanus-diptheria (Td); substitute 1 dose of Tdap (Adacel) for Td As early as 7 YOA Every 10 years

Meningococcal (Menactra, Menveo) All adolescents 11-18 YOA Controversial: revaccinate one time only for high risk (dorm living) after
5 years from last

Influenza annually

Pneumococcal (pneumococcal conjugate vaccine {PCV 15 or 19-64 YOA with certain underlying conditions PCV 15 followed by PPSV23 ≥1 year later (minimum 8 weeks for
PCV20}, pneumococcal polysaccharide vaccine {PPSV23} (smoking, alcoholism, chronic liver, heart, or lung immunocompromise, CSF leak, or cochlear implant) OR PCV20
disease)

PPD Screening See note pages below Annual TB Education

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Sources of Information: Bright Futures and Healthy People: Complete physical exam to include: hgt/wgt (check
for eating disorders), skin exam, oral cavity (gingivitis, dental caries, etc.), hearing, abuse/neglect/depression and
blood pressure (<120/80 mm/Hg)
PPD screening for those who have the following: spent time with someone with TB, are immigrants from a
country in which TB is common, live with people who live/work in high-risk settings, are healthcare workers, are
infants, children, adolescents exposed to adults at high risk).

Well child visits schedule per American Academy of Pediatrics: first week visit 3-5 days old, 1 month, 2 months, 4
months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years (24 months), 2.5 years (30 months), 3
years old (36 months) and yearly thereafter. Check vital signs (no BP), hgt, wgt, head circumference, track on
growth chart. Hearing and vision gross assessment on exam, parent history, spot screen can be done starting at 6
months. All newborns screening for hearing at birth. Head circumference until 2 years. No BP unless at risk.

Do not administer live vaccines to: acutely ill individuals, pregnant women (avoid pregnancy for 4 weeks
postimmunization), HIV/AIDS patients with low T cells and high viral loads, actively immunosuppressed with
medication, and active with any kind of cancer with or without treatment (radiation/chemotherapy).

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Guidelines for Health Assessment According to Age
Young adults (20-39 YOA) When to start? How often?

Females (PAP smear with gonorrhea and chlamydia screens) PAPS: 21 YOA, ACS recommends 25 YOA, chlamydia Every 3 years
testing for all sexually active women ≤ 25 YOA

Females (cytology) conventional or liquid based 21-29 YOA Every 3 years

HPV cotest (cytology + HPV test administered together) Not to be used for women < 30 YOA Every 5 years

Females (breast self exam) Starting at 21 YOA Optional

Clinical breast exam by clinician Adolescence/now Every 3 years, annually starting at 40 YOA

BP Now With every healthcare visit or every 2 years (normal

<120/80 mmHg)

Total cholesterol and high-density lipoproteins (HDL) or full 17-21 YOA Once during this time; more often if patient has obesity
fasting panel or diabetes

Skin self exams Now Regularly

Dental cleaning and check up Now Every 6-12 months

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 Guidelines for Health Assessment
per Age
Middle Aged Adults (40-59
When to Start​ How Often​
YOA)
Females (mammography) American Cancer Society (ACS): annually for aged 45-54 years, every 2 ACS: continue as long as the woman is in good health and
years after 55 YOA expected to live ≥ 10 years

(mammography cont) United States Preventative Services Task Force (USPSTF): every 2 years USPSTF: for aged 75 and older no specific recommendations to
for aged 50-74 YOA discontinue

(mammography cont) American College of Obstetricians and Gynecologists (ACOG): annually ACOG: no recommendations to discontinue
for aged 50-74 YOA

Age 50: average risk and are expected to live at least 10 more years. Future screening if no prostate cancer is found:
Age 45: high risk: African Americans and men who have a first degree A. PSA ≤ 2.5 ng/ml: may only need to be retested every 2
Males: Prostate screening (digital rectal exam and relative (father or brother) diagnosed with prostate cancer at an early years.
prostate-specific antigen (PSA).This is controversial age (younger than age 65) B. PSA ≥ 2.5 ng/ml: yearly retesting.
discuss with patient at the different ages listed to the
right.
Age 40: Even higher risk (those with more than one first degree For all ages: digital rectal exam can be used in addition to PSA
relative who has prostate cancer at an early age. testing.

A. Stool based (annual fecal immunochemical test: annual

high sensitivity, guaiac-based fecal occult blood test; or
Colorectal cancer (second leading cause of cancer Age 45-75 YOA (average-risk in good health with life expectance > 10 multitarget stool DNA test every 3 years OR
deaths) years. B. Structural colonoscopy every 10 years; CT colonography
every 5 years, or flexible sigmoidoscopy every 5 years.
C. All positive results on non-colonoscopy screening should be
followed up with colonoscopy.

Herpes zoster (Shingrix) Age 50 YOA A. Series of two, second dose 2-6 months later

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Guidelines for Health Assessment per Age
(elderly adults aged 60 and older)
Pap Smear: with GC and chlamydia screens. PAP:
age 21 YOA, ACS recommends 25 years. Every 3
years; discontinue at age 65 with consistently
normal cytology tests for a long period of time.
 Sensitivity True positives; the
degree to which those
who have a disease
screen/test positive

Specificity True negatives; the

degree to which those
who do not have a
disease screen/test
Terminology negative

to Remember Incidence of a disease The frequency with

which a disease or
disorder appears in a
particular population or
area at a given time

Prevalence of a disease The proportion of a

population that is
affected by a disease or
disorder at a particular
time.
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• Sensitivity refers to its ability to correctly identify individuals who have the disease or
condition. It is the proportion of true positive results among individuals who have a disease
or condition. So a test with high sensitivity is more likely to give a true positive results and
correctly detect the disease or condition when present. On the other hand, a test with low
sensitivity is more likely to produce a high number of false negatives and may miss
identifying the disease or condition in individuals when present.
• Specificity of a screening test refers to the ability of the test to correctly identify people
who do not have the disease or condition that you are testing for. A highly specific test
means that there are few false positive results. IN other words, the specificity of a test is its
ability to designate an individual who does not have a disease as negative. A test with high
specificity is more likely to give a true negative results and correctly identify that the
disease or illness is not present. A test with low specificity is more likely to produce a high
number of false positives that may incorrectly identify disease or illness in individuals when
it is not present.
• Incidence of disease is a measure of how many new cases of a disease occur in a population
over a specific time period. It can be calculated as a rate or a proportion. Incidence can
help estimate the risk or probability of developing a disease. Incidence differs from
prevalence, which includes both new and existing cases.
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 Primordial Prevention Begins in childhood and
focuses on lifestyle
choice to prevent
development of risk
factors. Can even begin
preconception

Primary Prevention (think Involves modifying risk

promote) factors to prevent the
Terminology development of a
disease.

to Remember Secondary Prevention Focuses on screening,

(think screening) early identification, and
treatment of existing
problems.

Tertiary Prevention (think Includes rehabilitation

rehab) and restoration of health.

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(prevention of risk factors before they appear): Primordial prevention: examples would be healthy diet, regular
exercise, avoiding tobacco, etc. Advocacy for social change to make physical activity easier (example). This can
have an impact on whole populations through public health policy.
(Targets risk factors to prevent the onset of disease):

Primary prevention: lifestyle and behavioral changes, wearing seat belts, immunizations and vaccinations, safety
initiatives, etc. Primary care advice as part of routine consultations.
Secondary prevention: any screening, PAP smears, PSA, cholesterol, etc. Primary care focus is risk reduction for
those at risk of chronic disease, falls, injury (already have a problem and could get worse).
Tertiary prevention: cardiac rehab after an MI, PT following a mitral valve closure, etc.

Mental Health Care Prevention Measures:

Primary: helping people to cope with stress and decreasing stressors: teaching parenting skills, providing
support services for unemployed, providing food, shelter, and other services to homeless, providing education
about eh harmful effects of drugs and alcohol to school children.
Secondary: Identifying problems early and beginning tx: f/u for patients at risk for recurrence, staffing rape
crisis centers, providing suicide hotlines, and providing referrals as needed.
Tertiary: preventing complications and promoting rehab through teaching patients socially acceptable behaviors.
Examples: teaching the patient to manage daily living skills, monitoring effectiveness of outpatient services, and
referring patients to support services.
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Immunization Guidelines: Additional Information
Antigens Substances capable of inducing a specific immune response

Antibodies Molecules synthesized in reaction to an antigen

Mumps vaccination 2 doses should be given to all healthcare workers (no prior evidence of immunity
necessary) regardless of when they were born.
Active immunity conferred by antibody formation stimulated with a specific antigen such as typhoid fever
immunizations and toxoids. Another way is natural acquire immunity is which is acquired
by exposure to the actual disease with a resulting infection.

Passive immunity conferred by the introduction of antibody proteins such as gamma globulin injections or
maternal immunity transferred to the fetus
Hepatitis A vaccine should be considered for military personnel, travelers to endemic areas, and those who
have same sex with men, among others.

Hepatitis B vaccine should be given to all healthcare workers and high-risk patients including sexually active
adults.
Varicella (Varivax) Two doses at least 4 weeks apart if 13 YOA and older and if 12 months to 12 years at
least 3 months apart. First dose in children is usually 12 to 15 months and second dose
usually at 4-6 years.
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• Further Information on immunizations:
• All persons 6 months and older should receive annual influenza vaccination (per CDC).
Children 6 months to 8 YOA require 2 doses of influenza vaccine 4 weeks apart during
their first season of vaccinations.
• Live attenuated influenza vaccine (LAIV) should not be used in persons younger then 2
YOA or older than 49 YOA.
• Persons with egg allergy should always receive the vaccination from a healthcare provider
familiar with potential reaction and should be observed for at least 30 minutes post
injection for signs of reaction.
• Immunocompromised individuals should not receive live attenuated vaccinations.
• Use live vaccine or inactivated for healthy nonpregnant adults younger than 50 YOA with
no high-risk medical conditions. All others should receive the inactivated vaccine only.
• MMR (Mumps, Measles, Rubella). Live vaccine
• Not for pregnant women, cancer patients, , immunocompromised, HIV/AIDS with T4 cell
counts less than 200, people on high dose steroids, or who have received a blood
transfusion within the last two weeks.
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Immunization Schedule (slide
courtesy of Dr. Jessica Bahorski)

02/15/2025 Sample Footer Text 14

When should you refer?
• Referral is often an incorrect
answer on Board Certification
Exams. On boards, you must
prove that you know what to do.
For example, if you are
reviewing a client’s lab work for
antipsychotic monitoring, do you
know when you should refer to
their PCP? The next few slides
will go over some common lab
work.
02/15/2025 15
Labs
Diabetes Screening American Diabetes Association: Serum fasting (8 hours NPO) glucose ≥126 mg/dL, on
more than one occasion OR random plasma glucose ≥ 200 mg/dL with signs of
hyperglycemia (polyuria, polydipsia, and weight loss) OR, plasma glucose ≥ 200
mg/dL measured 2 hours after a glucose load of 1.75 grams/kg (maximum dose 75
grams) in an oral glucose tolerance test OR glycated hemoglobin A1C ≥ 6.5%; Normal:
< 5.7%; Prediabetes: 5.7%-6.4%

Cholesterol Screening Total cholesterol desirable=<200 mg/dL, VLDLs (triglycerides): Normal=<150 mg/dL,
LDLs: (optimal = <100 mg/dL and for diabetes <70 mg/dL. HDLs: Low=<40 mg/dL;
high=≥60 mg/dL

Renal Function Blood urea nitrogen (BUN): Normal (10-20 mg/dL); may be elevated with
dehydration. Serum creatinine (sCr): Normal (0.5-1.5 mg/dL); most sensitive
indicator of renal function is GFR or glomerular filtration rate.

Liver Function Aspartate aminotransferase (AST) test: AST (enzyme found in liver; high levels can be
a sign of liver damage or disease). Alanine transaminase (ALT) test enzyme mostly
found in liver; high levels can be a sign of liver damage). AST and ALT may be
elevated in hepatitis, alcohol use disorder, cirrhosis, mononucleosis, use of statins, or
other reasons. GGT (Gamma glutamyl transpeptidase) isoenzyme of alkaline
phosphatase and assists in amino acids and peptides crossing cell membrane.
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• Liver function tests cont: ALT levels WNL (5-35 U/l). Found in liver, body fluids, heart,
kidneys, and skeletal muscles. Catalyst necessary for amino acid production. High levels
will be seen in liver disease or damage, mononucleosis, biliary tract obstruction, recent
CVA, muscle injury, muscular dystrophy, acute pancreatitis, MI, renal failure, burns, etc.
Values can be increased by acetaminophen, allopurinol, aspirin, carbamazepine, some
antibiotics, oral contraceptives, propranolol, heparin, etc.
• AST: normal (5-40 U/l) important in amino acids, , large amounts in liver and myocardial
cells.. High levels noted in shock, MI, acute liver damage, acute pancreatitis,
mononucleosis, biliary tract obstruction, CHF, cardiac arrhythmias, pericarditis, cirrhosis,
pulmonary infarct, DTs, hemolytic anemia, etc. Exercise can increase levels. Drugs such
as anticoagulants, antihypertensives, cholinergic agents, some antibiotics, oral
contraceptives, etc.
• GGT: normal (10-38 IU/l); noted in hepatobiliary tissue, renal tubular and pancreatic
epithelium, other sources can be prostate, brain, and heart. Used to evaluate and
monitor a client with known or suspected alcohol abuse, because levels rise even after
small amounts of ingestion. Early increased found in liver disease. MI after 4-10 days,
CHF, diabetes mellitus with hypertension, seizure disorder, etc.
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Thyroid Levels TSH (2-10 mU/l), T4
Free (0.8-2.8 ng/dl)
Hyperthyroidism Hypothyroidism
• Grave’s Disease, females, onset • Causes: Primary disease of
between 20-40 YOA are most thyroid gland, pituitary deficiency
common. Can be other causes. of TSH, hypothalamic deficiency
• Labs:TSH assay is the most of TRH, Iodine deficiency,
Hashimoto’s thyroiditis,
sensitive test and is low in most
Idiopathic causes, and damage to
cases. Serum T3 and T4 thyroid
gland.
resin uptake and free thyroxine
index are usually increased. Can • Labs: TSH elevated, T4 low or low
have normal T4 but elevated T3 normal, T3 is usually decreased
as well. but is not a reliable test.

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• Function of thyroid gland is to take iodine from the circulating blood, combine with amino
acid tyrosine and convert to T3 and T4. T3 and T4 stored in thyroid gland until released
under the influence of TSH (pituitary gland). Only a small amount of T3 and T4 is bound in
protein. The free amount is what is the true determinant of thyroid status.

• Hyperthyroidism: s/s nervous, anxious, fatigue, diaphoresis, fine tremors, weight loss,
increased appetite, hyperreflexia of DTRs, smooth, warm, moist skin, exophthalmos, heat
intolerance, increased incidence of a. fib. Specialist referral as needed especially if
comorbidities.

• Hypothyroidism: s/s: weakness, muscle fatigue, arthralgia, cramps, cold intolerance,

constipation, dry skin, weight gain, brittle nails, hair loss, edema of hands/face, slowed DTRs,
etc. Synthroid is the usual treatment 50-100 mcg/day, increasing by 25 mcg every 1-2 weeks
or until symptoms stabilize; if >60 YOA often need less dosage.
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Labs (electrolytes)
Electrolytes Should be a part of routine screening for acute and critical illnesses or where there is
a known disorder associated with fluid, electrolyte, or acid-base balance. For
example, many causes of delirium can be due to electrolyte imbalance. Eating
disorders will frequently have electrolyte imbalances. Should know values for
sodium, potassium, magnesium, chloride, calcium, and phosphate.
Sodium (action impact Regulates fluid volume, works with potassium and calcium to maintain
on water in the body) neuromuscular irritability for conduction of nerve impulses. Also have seen lab
WNL (135-14 mEq/l) values of (135-148) as normal.

Potassium (action on Major intracellular electrolyte and regulates intracellular fluid osmolality and provides
nerves, muscles, heart) the balance for intracellular electrical neutrality. Maintains resting membrane
WNL (3.5-4.5 mEq/dl) potential. Regulated by kidneys, aldosterone levels, insulin secretion, and changes in
pH. Also have seen lab values of (3.5-5.1) as normal.
Chloride (osmotic Major extracellular electrolyte and regulates extracellular fluid osmolality and
pressure, acid-base maintains in conjunction with Na electroneutrality. Na is actively transported, and Cl
balance). WNL (98-106 passively follows. So Na levels have an impact on Cl levels.
mmol/dl)

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• Na: increased levels (hypernatremia) in hypovolemia, dehydration, sweating excessively, diabetes insipidus, excessive salt
ingestion, gastroenteritis, drugs such as adrenocorticosteroids, methyldopa, hydralazine, or cough medicine can increase.
Too much Na can cause: convulsions, pulmonary edema, thirst, fever, dry mucous membranes, restlessness, etc..
• Decreased levels (hyponatremia) of NA: Addison’s Dz, renal disorder, GI fluid loss from vomiting, diarrhea, NG suction,
ileus, diuretics. Drugs such as lithium, vasopressin, or diuretics can lower. Too little Na can cause: lethargy, headache,
confusion, apprehension, seizures, ascites, weight gain, etc.

• K: hyperkalemia noted in acidosis, insulin deficiency, Addison’s dz, acute renal failure, hypoaldosteronism, infection,
dehydration. Chronic marijuana use can elevate. Will have muscle weakness, paralysis, tingling of lips and fingers, diarrhea,
ECG changes on T waves and Q-T interval depending up on the potassium levels. Will eventually lead to cardiac arrest.
• Hypokalemia noted in alkalosis, excessive insulin, Cushing’s syndrome, GI loss, laxative abuse, burns, trauma, anorexia
nervosa, etc. Will have impaired carbohydrate metabolism, polyuria, polydipsia, smooth muscle atony, cardiac
dysrhythmias, paralysis and respiratory arrest, etc.

• Cl: hyperchloremia noted in acidosis, hyperkalemia, hypernatremia, Dehydration, renal failure, Cushing’s syndrome,
hyperventilation, anemia.
• Hypochloremia noted in alkalosis, hypokalemia, hyponatremia, GI loss, diuresis, overhydration, Addison’s Dz, burns.

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Labs (electrolytes cont)
Calcium (action on Most Ca is located in the bone, needed for bone structure, blood clotting, hormone
nerves, heart, and secretion, transmission of nerve impulses and contraction of muscles.
blood clotting) WNL
(8.8-10.5 mg/dl)
Phosphate (Calcium Involved in energy metabolism, DNA/RNA synthesis, nerve signals, bone formation,
inverse relationship) pH regulation, building blocks of cell membranes, etc. Some labs will list normal as
WNL (3-4.5 mEq/dl) (2.5-4.5 mEq/dl).

Magnesium (action on Major intracellular cation but most is stored in bone and muscle. Regulated by the
heart by countering kidneys. The cause of neuromuscular excitability. Involved in enzymatic reactions.
calcium, regulates
neurotransmitters)
WNL (1.3-2.1 mEq/l)

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• Calcium balance is mediated by parathyroid hormone, Vitamin D and calcitonin.
• Hypocalcemia: symptoms will be convulsions, tetany, continuous severe muscle spasm, ECG changes (prolonged QT interval), hyperreflexia,
paresthesias around mouth and fingers, etc. Low levels can be caused by alkalosis, renal failure, pancreatitis, inadequate dietary intake,
hypoparathyroidism, drugs such as barbiturates, anticonvulsants, adrenocorticosteroids, etc.
• Hypercalcemia: symptoms will be fatigue, weakness, lethargy, anorexia, shorted QT interval, bradycardia, heart blocked, etc. High levels can
be caused by acidosis, hyperparathyroidism, Vit D intoxication, Addison’s Dz, cancers of the bone, leukemia, myeloma, hyperthyroidism,
drugs such as thiazide diuretics, hormones, Vit D and calcium.

• Hypophosphatemia: symptoms will be muscle pain and bone pain, muscle weakness, confusion, numbness and weak reflexes, seizures.
Low levels caused by inadequate intake of phosphate, hyperparathyroidism, sepsis, respiratory alkalosis, insulin therapy, anorexia, etc.
• Hyperphosphatemia: symptoms will be muscle crams, numbness around the mouth, tetany, bone and joint pain, rash, ectopic calcifications
in soft tissue, etc. High levels can be caused by advanced kidney disease, hypoparathyroidism, acidosis, damage to cells, etc.

• Hypomagnesemia: Symptoms will be depression, confusion, ataxia, tetany, convulsions, increased reflexes, etc. Low levels can be caused
by hypokalemia, DKA, malnutrition, alcoholism, acute pancreatitis, etc.
• Hypermagnesemia: symptoms will be N&V, muscle weakness, bradycardia, respiratory depression, decreased skeletal muscle contraction
and nerve function, etc. High levels caused by Addison’s disease, renal failure, DKA, dehydration, hypo and hyperthyroidism.

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Leading causes of death per CDC
• Leading causes (top 10) of death • Leading causes of death in
in adults: 1. heart disease 2. adolescents (ages 10-24). 1.
cancer 3. COVID 19 4. accidents or unintentional
unintentional injuries 5. Stroke 6. injuries 2. homicide 3. suicide 4.
chronic lower respiratory other 5. cancer 6. heart disease
disease (asthma/COPD) 7. • MVA leading causes of death by
Alzheimer’s Dz 8. Diabetes 9. accidents in teenagers
Chronic liver dz and cirrhosis 10.
nephritis (nephrotic syndrome
and nephrosis)

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• Notice that suicide is not even in the top 10 for adults. Back in 2017 it
was #10
• Leading cause of cancer deaths is lung for men and women. Second
leading cause for men is prostate. Second leading cause for men and
women combined (cancer) is colorectal.

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Physiologic
development
and Tanner
Staging

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• The Tanner stages are used to describe the specific changes that
children and teens may experience during puberty. Sometimes
known as the sexual maturity ratings. Stage 1 is pre-pubertal stage
and stage 5 being the fully mature adult stage.

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Healthy People 2030
• To allow people to live longer • 5 sections of HP 2030
and healthier lives • A. Health Conditions
• Reduce health disparities • B. Health Behaviors
• Create environments that • C. Populations
promote health
• D. Settings and Systems
• Improve quality of life across all
age groups • E. Social Determinants of Health
• 62 topic areas with 355 total
objectives divided across 5
sections
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• Mental Health and Mental health disorders are included within the
Health Conditions Section and aims to utilize preventive measures,
screening, assessment tools, and mental health services to improve
mental health care, particularly access and pursuit of treatment.

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Healthy People 2030 Mental
Healthcare Goals
• Increase # of adults seeking • Increase the # of adolescents with
mental health care services/tx major depressive episodes who seek
tx (focus on disparities by location,
• Increase # of children with mental
insurance status, sex, race, ethnicity,
illness seeking mental healthcare age income, and country of birth)
services/tx
• Increase the # of adults with major
• Reduce suicide rate (focus on depressive episodes who seek tx
disparities by age and sex) (focus on disparities by location,
• Reduce suicide attempts by age, and education).
adolescents (focus on disparities • Other goals include expanding txs
in obesity, sex, school grade, race, for children and adults and
and ethnicity) increasing depression screening.
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Health
Promotion
Activities
Specific to
Mental Health • Stress management and relaxation techniques
(Mometrix) • Exercise
• Medication education
• Pursuing healthy hobbies
• Establishing a support network that encourages a healthy
lifestyle
• Prioritizing adequate and quality sleep
• Redirecting negative thinking
• Recognizing s/s of relapse
• Healthy eating
• Knowing when to seek professional health
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Health Promotion specific to the
Community
• Programs for children to help • Anti-bullying campaigns
with coping skills or problem • LGBT community support to
solving prevent abuse and prejudice
• 12 step programs for substance • Senior citizens’ programs
use (peer support) (services and social activities)
• Early childhood intervention • Primordial, primary, secondary,
programs (parenting skills) and tertiary prevention
• Sheltered workshops to learn strategies
skills for people with mental • Boys and Girls clubs in safe
impairment environments
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 Anticipatory Guidance Method of educating
patient/family about a
dx, prognosis, and future
care.

Usual anticipatory Practice of giving a

Terminology Guidance generic set of guidelines

to a certain population.

to Remember
Targeted anticipatory Healthcare provider
Guidance speaks to an individual
about their concerns or
questions.

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• Anticipatory Guidance: Helps with the formulation of realistic
expectations. A catalyst for questions and concerns. Ways to do so is:
ask if they have questions, business card or contact information if
they have questions later, written guidelines, directing them to
reputable support groups or assign them to a social worker, asking if
they want a chaplain.

• Usual anticipatory guidance: For example giving parents of a toddler

information about expected developmental milestones, etc.

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Additional Health Promotion
Measures
• Smoking (per HHS) • 5-P approach for obtaining sexual
• Exercise histories: A. Partners (gender and #).
B. Pregnancy prevention (birth
• Emergency Contraception control). C. Protection (methods
• Prevention of STDs (per CDC) used). D. Practices (type of sexual
practices: oral, anal, vaginal and use
of condoms). E. Past hx of STDs

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• According to the US Department of Health and Human Services (HHS) the guidelines for helping smokers to quit includes the following: Ask
about smoking every visit. Advise all smokers to quit and how it is beneficial. Assess readiness to quit and provide resources. If not willing
to quit, attempt to motivate with information. Assist with a plan that sets a date (within 2 weeks) to remove cigarettes. Enlist aide of
family/friends. Give meds if needed to help and other resources as needed. Follow up monitoring.

• Exercise: daily exercise is needed for adults at least 30 minutes daily or 150 minutes/week.
• 4-5 years old: supervised activities but remember lack of coordination/judgment can result in injury.
• 6-12 yoa: noncompetitive sports are best. If team sports: supervised. Gymnastics may begin but watch for eating disorders.
• 12-18 yoa: exercise 3xwkly for 30 minutes.

• Emergency contraception: inhibits ovulation and prevents pregnancy rather than aborting a pregnancy. Contraindicated in those with a
history of thromboembolia or severe migraine headaches with neurological symptoms. This is because it contains hormones in differing
amounts (ethinyl estradiol, norgestrel or levonorgestrel). Give less than 72 hours since unprotected sexual intercourse, negative pelvic
exam, and negative pregnancy test. Depending on type of brand/concentration or hormones can involve taking anywhere from 1-20 pills
and then a second dose of 1-20 pills 12 hours later. f/u pregnancy test should be done if no menstruation within 3 weeks. There is a failure
rate of 1.5%. Side effects: nausea, breast tenderness, irregular bleeding.

• Per CDC 5 strategies to prevent and control STDs: 1. education about safe sex practices to those at risk, 2.. identify symptomatic and
asymptomatic people who are infected who may not seek tx. 3. Diagnose and tx those infected. 4. Prevent infection of sex partners, and 5.
provide pre-exposure vaccination for those at risk.

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CDC
recommendations to
prevent STDs (as
noted in Mometrix)
• Education about abstinence and reduction of # of sex partners
• Pre-exposure vaccination
• Male latex condoms or polyurethane for all sexual encounters
with only water based lubricants used with latex
• Female condoms may be used if male condom can’t be used
properly
• Condoms and diaphragms should not be used with
spermicides containing nonoxynol-9
• Non barrier contraceptives do not protect from STDs and
must not be relied upon to prevent dz.
• Women should not about emergency contraception with
medication or insertion of copper intrauterine device.

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• Pre-exposure vaccination: all those evaluated for STDs should receive
a Hep B vaccine. Men having sex with men and illicit drug users
should receive Hep A vaccine.

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References (besides those listed on content slides)

• Mometrix Test Preparation Book ISBN: 978-1-61072-303-9

• ANA Enterprise Test Preparation Book ISBN: 978-1-935213-79-6
• Springer Publishing PMHNP Test Prep Book: ISBN: 978-0-8261-7942-
5
• Barkley Review book (you cannot purchase unless you attend their
review).

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