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Difficulty: Very hardHealth Promotion and Disease Prevention

A nurse in a community health clinic is developing a health promotion plan for a 65-year-old female client with a history of type 2 diabetes mellitus. During the assessment, the client states, "My mother had a severe stroke at my age, so I am very worried. I have also been occasionally losing my balance when walking, but I know feeling unsteady is just a normal part of getting older." Which of the following nursing actions represents the highest priority secondary prevention intervention for this client?

  1. A
    Scheduling a routine dual-energy x-ray absorptiometry (DEXA) scan and a screening mammogram.
  2. B
    Validating that mild unsteadiness is an expected age-related change and recommending the installation of home safety devices.
  3. Conducting a stroke risk screening, including a focused neurological exam and auscultation of the carotid arteries.Answer
  4. D
    Providing comprehensive education on implementing a low-sodium diet and establishing a daily aerobic exercise routine.

Answer

Conducting a stroke risk screening, including a focused neurological exam and auscultation of the carotid arteries.
Secondary prevention focuses on the screening and early detection of disease to halt its progression. The client is presenting with new-onset balance issues, which she incorrectly attributes to normal aging. Given her history of diabetes and family history of stroke, these symptoms could indicate a transient ischemic attack (TIA) or an impending stroke. Conducting a targeted stroke risk screening and neurological exam is the highest priority secondary prevention measure because it addresses a potentially life-threatening acute physiological change.

Step-by-Step Solution

1
Analyze the client's reported symptoms, medical history, and statements.
The client has a history of diabetes, a family history of stroke, and reports new-onset balance loss which she incorrectly attributes to getting older.
Identifying all risk factors and isolating acute symptoms is necessary for safe care planning.
2
Differentiate between normal physiological aging and clinical pathology.
Occasional loss of balance is not a normal part of aging; it is a significant neurological warning sign that requires investigation.
Dismissing pathological symptoms as normal aging can lead to severe adverse outcomes and missed diagnoses.
3
Classify potential nursing interventions by their correct prevention level.
Stroke screening and mammograms are secondary prevention (early detection). Diet/exercise education is primary prevention. Safety devices are primary/tertiary prevention.
The question specifically requests an intervention that qualifies as secondary prevention.
4
Prioritize the identified secondary prevention interventions based on clinical urgency.
Screening the client for a potential acute stroke or transient ischemic attack (TIA) takes absolute precedence over scheduling routine bone density or cancer screenings.
Acute physiological needs and immediate safety risks must always be addressed before routine health maintenance.

Key Concept

Levels of Disease Prevention and Clinical Prioritization
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Topics

Health Promotion and Disease Prevention

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