🌿 New Lesson 18
Health Promotion & Maintenance
Screenings, immunizations, prenatal care, growth & development, aging process, disease prevention.
Screenings
Key Health Screenings by Age
| Screening | Who / When | Frequency |
|---|---|---|
| Blood Pressure | All adults ≥18 | Every 1–2 years (annually if elevated) |
| Cholesterol (Lipid Panel) | Men ≥35, Women ≥45 | Younger if risk factors | Every 5 years |
| Colorectal Cancer | Adults ≥45 | Colonoscopy every 10 years or stool test annually |
| Mammogram | Women 40–74 (ACS recommends starting at 40) | Every 1–2 years |
| Pap Smear / Cervical | Women 21–65 | Every 3 years (or 5 with HPV co-test) |
| Diabetes (A1C/FPG) | Adults ≥35 or with risk factors | Every 3 years (annually if prediabetic) |
| Bone Density (DEXA) | Women ≥65 | Younger with risk factors | Repeat per provider guidance |
| Newborn Metabolic Screen | All newborns | Within first 24–48 hours of birth |
Immunizations
Immunization Schedule Highlights
| Vaccine | Schedule | Key Points |
|---|---|---|
| Hepatitis B | Birth, 1–2 mo, 6–18 mo | First vaccine given at birth |
| DTaP | 2, 4, 6 mo; 15–18 mo; 4–6 yr | Diphtheria, Tetanus, Pertussis |
| MMR | 12–15 mo; 4–6 yr | Live vaccine — contraindicated in pregnancy/immunosuppressed |
| Varicella | 12–15 mo; 4–6 yr | Live vaccine — same precautions as MMR |
| Influenza | Annually ≥6 months | Inactivated or live-attenuated nasal (healthy non-pregnant ≥2 yr) |
| Pneumococcal (PCV) | 2, 4, 6 mo; 12–15 mo + Adults ≥65 | Also for immunocompromised adults |
| HPV | 11–12 yr (can start 9 yr) | 2 or 3-dose series depending on age at start |
| Tdap Booster | Pregnancy 27–36 weeks; Adults every 10 yr | Protects newborn from pertussis |
🚫
Live vaccines contraindicated in: Pregnancy, immunocompromised patients, patients receiving high-dose steroids. Examples: MMR, Varicella, LAIV (nasal flu).
Growth & Development
Growth & Development Milestones
| Age | Motor | Language | Social |
|---|---|---|---|
| 2 months | Lifts head prone | Cooing | Social smile |
| 4 months | Rolls front-to-back | Laughs, squeals | Responds to faces |
| 6 months | Sits with support | Babbles consonants | Stranger anxiety begins |
| 9 months | Crawls, pulls to stand | "Mama/Dada" non-specific | Separation anxiety peak |
| 12 months | Walks with one hand held | 1–3 words specifically | Waves bye-bye |
| 18 months | Walks independently, runs | 10–20 words | Parallel play |
| 2 years | Kicks a ball, jumps | 2-word phrases | Parallel play continues |
| 3 years | Tricycle, stairs alternating | 3-word sentences | Associative play begins |
| 4–5 years | Hops, skips | Full sentences, questions | Cooperative play, rules |
🚩
Red flags: Any regression (loss of achieved skills) at any age = ALWAYS report. No social smile by 3 months, no words by 16 months = refer.
Prenatal & Aging
Prenatal Care Timeline
| Trimester | Key Assessments & Teaching |
|---|---|
| First (1–12 wks) | Confirm pregnancy, blood type/Rh, STI screening, CBC, urinalysis, blood pressure baseline, folic acid teaching, nausea management |
| Second (13–26 wks) | AFP/quad screen (15–20 wks), anatomy ultrasound (18–20 wks), glucose tolerance screen (24–28 wks), fundal height assessment |
| Third (27–40 wks) | GBS culture (35–37 wks), fetal movement counts, NST/BPP if indicated, Tdap vaccine (27–36 wks), birth plan discussion |
Age-Related Changes (Older Adults)
| System | Normal Aging Change | Nursing Implication |
|---|---|---|
| Renal | Decreased GFR | Drug accumulation — start low, go slow |
| Cardiac | Decreased cardiac reserve | Less tolerance for fluid overload or blood loss |
| Pulmonary | Decreased cough reflex, lung elasticity | Higher aspiration/pneumonia risk |
| Neurological | Slower processing, decreased pain sensation | Atypical illness presentations |
| Musculoskeletal | Decreased bone density, muscle mass | Fall risk, fracture risk |
📖 Study Notes
🌿
Disease prevention levels:
Primary = prevent disease before it occurs (vaccines, education).
Secondary = early detection (screenings, mammograms).
Tertiary = limit disability from existing disease (rehab, management).
Primary = prevent disease before it occurs (vaccines, education).
Secondary = early detection (screenings, mammograms).
Tertiary = limit disability from existing disease (rehab, management).
💡
Live vaccine mnemonic: VIM — Varicella, Influenza (nasal), MMR. These three are live and contraindicated in pregnancy and immunosuppressed patients.
⭐
Folic acid is critical: 400–800 mcg daily BEFORE conception and in the first trimester to prevent neural tube defects. Teach all women of childbearing age.