NR503 NGN FINAL EXAM STUDY GUIDE 2023-2024
GRADED A
Week 5 (Ch. 2)
1.Discriminate populations at risk for development of chronic health
conditions while associating the role of the Advanced Practice Nurse in
levels of promotion.
Common risk factors: unhealthy diet, physical inactivity, and tobacco use
Childhood risk: There is now extensive evidence from many countries that
conditions before birth and in early childhood influence health in adult life. For
example, low birth weight is now known to be associated with increased rates of
high blood pressure, heart disease, stroke and diabetes.
Risk accumulation: Ageing is an important marker of the accumulation of
modifiable risks for chronic disease: the impact of risk factors increases over the
life course.
Underlying determinants: The underlying determinants of chronic diseases are a
reflection of the major forces driving social, economic and cultural change –
globalization, urbanization, population ageing, and the general policy environment.
Poverty: Chronic diseases and poverty are interconnected in a vicious circle. At the
same time, poverty and worsening of already existing poverty are caused by
chronic diseases. The poor are more vulnerable for several reasons, including
,greater exposure to risks and decreased access to health services. Psychosocial
stress also plays a role.
Preventative health actions are often categorized in three levels:
• Primary prevention - aims to prevent disease or injury
before it ever occurs.
▪ This is done by preventing exposures to hazards that cause disease
or injury, altering unhealthy or unsafe behaviors that can lead to
disease or injury, and increasing resistance to
disease or injury should exposure occur.
▪ Nurses play the part of educators that offer information and
counseling to communities and populations that encourage
positive health behaviors ▪ Examples include:
• legislation and enforcement to ban or control the use of
hazardous products (e.g. asbestos) or to mandate safe and
healthy practices (e.g. use of seatbelts and bike helmets)
• education about healthy and safe habits (e.g. eating well,
exercising regularly, not smoking)
• immunization against infectious diseases.
• Secondary prevention - aims to reduce the impact of a
disease or injury that has already occurred
▪ This is done by detecting and treating disease or injury as soon as
possible to halt or slow its progress, encouraging personal
strategies to prevent reinjury or recurrence, and implementing
programs to return people to their original health and function to
prevent long-term problems.
▪ Nurses work with these patients to reduce and manage
controllable risks, modifying the individuals’ lifestyle choices
and using early detection methods to catch diseases in their
beginning stages when treatment may be more effective.
▪ Examples include:
• regular exams and screening tests to detect disease in its
earliest stages (e.g. mammograms to detect breast cancer)
• daily, low-dose aspirins and/or diet and exercise programs
to prevent further heart attacks or strokes
, • suitably modified work so injured or ill workers can return
safely to their jobs.
• Tertiary prevention - aims to soften the impact of an
ongoing illness or injury that has lasting effects
▪ This is done by helping people manage long-term, often-complex
health problems and injuries (e.g. chronic diseases, permanent
impairments) in order to improve as much as possible their ability
to function, their quality of life and their life expectancy.
▪ Nurses are tasked with helping individuals execute a care plan
and make any additional behavior modifications necessary to
improve conditions ▪ Examples include:
• cardiac or stroke rehabilitation programs, chronic disease
management programs (e.g. for diabetes, arthritis,
depression, etc.)
• support groups that allow members to share strategies for
living well
• vocational rehabilitation programs to retrain workers for
new jobs when they have recovered as much as possible.
Members of minorities are overrepresented on the low tiers of the socioeconomic
ladder. Poor economic achievement is also a common characteristic among
populations at risk, such as the homeless, migrant workers, and refugees. However,
the APN should be able to distinguish between cultural and socioeconomic class
issues and not interpret behavior as having a cultural origin when the fact is based
on socioeconomic class. A good resource for APNs is the Cross-Cultural Health
Care Program (CCHCP), which has a plethora of materials to improve cultural
competency among healthcare providers, including a training program for
healthcare providers. In order to provide appropriate healthcare interventions,
culture and all its variants must be addressed.
(p28)APRNs may be able to access health information needed by working together
with other sectors outside of health, such as housing, labor, education, and
community-based or faith-based organizations that offer services to immigrant
communities. This involves the collection, documentation, and use of data that can
be used to monitor health inequalities in exposures, opportunities, and outcomes.
, Examples of social determinants that are related to health inequalities include
poverty, educational level, racism, income, and poor housing. These inequalities
can lead to poor quality of life, poor self-rated health, multiple morbidities, limited
access to resources, premature death, and unnecessary risks and vulnerabilities.
(p25) APRNs can best determine the effectiveness of an intervention and longterm
impact by focusing on an accurate assessment and interpretation of data that are
generated or collected using individual, population, and community health
indicators.
(p27)APRNs can work in partnership with community members to identify what
community members see as relevant and important, build social capital, use
outcome data to advocate for changes in policy, and then continue to work in
partnership to identify strategies to intervene, monitor,and improve those outcomes
(p40-41)APRNs have numerous resources they can access to improve quality and
timely access to quality healthcare and decrease health disparities. The National
Partnership for Action (NPA) to End Health Disparities
( minorityhealth.hhs.gov/npa) was started by the Office of Minority Health to
mobilize individuals and groups to work to improve quality and eliminate health
disparities. The National Priorities includes key private and public stakeholders
who have agreed to work on major health priorities of patients and families,
palliative and end-of-life care, care coordination, patient safety, and population
health. The Quality Alliance Steering Committee is another partnership of
healthcare leaders who work to improve healthcare quality and costs. Various
strategies to bridge the gaps in healthcare quality are available at the national level
and may be applied or considered at the state, regional, or local level in
collaboration with stakeholders as a means of decreasing health disparities.
(p43) APRNs are better prepared to develop effective interventions to eliminate
or reduce health disparities. Such strategies may include advocating better health
insurance coverage
for poor and immigrant populations; ensuring that sufficient
