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Medical-Surgical Nursing

9.5 Prevention of Chronic Disease

Medical-Surgical Nursing9.5 Prevention of Chronic Disease

Learning Objectives

By the end of this section, you will be able to:

  • Describe modifiable and healthy lifestyle practices to prevent chronic disease
  • Discuss the recommended preventive health screenings in diagnosing chronic disease
  • Summarize secondary and tertiary prevention strategies in the management of chronic disease

Though some chronic diseases occur regardless of lifestyle choices, many are entirely preventable, or at least may be limited in severity, with the implementation of healthy lifestyle changes. Even if lifestyle changes cannot entirely prevent a disease, they may slow its progression and promote the highest quality of life possible while living with a chronic health condition. These lifestyle modifications are categorized into three levels of prevention: primary, secondary, and tertiary (Figure 9.7).

A triangle representing the levels of prevention with tertiary prevention at the top, secondary prevention in the middle, and primary prevention at the bottom.
Figure 9.7 Chronic disease prevention occurs in three levels: primary, secondary, and tertiary. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Primary Prevention

Strategies that aim to prevent disease from occurring in healthy individuals can be identified as primary prevention. These interventions are implemented as health promotion strategies in the hope that the person will never develop chronic illness. Examples of primary prevention strategies include

  • diet and exercise programs
  • distribution of condoms and cervical diaphragms to prevent pregnancy or sexually transmitted diseases
  • immunizations
  • needle-exchange programs
  • pre-exposure prophylaxis for HIV
  • smoking cessation programs

Exercise

It is common knowledge that exercise is beneficial for overall health, but what is less well known is that consistent exercise has been linked to a lower risk of developing chronic health conditions such as type 2 diabetes, heart disease, dementia, certain cancers, and depression (CDC, 2023b). The CDC recommends that adults perform moderate-intensity aerobic exercise for at least 150 minutes per week, plus isometric muscle-strengthening exercises at least two days per week. Examples of moderate-intensity exercises include walking, running, biking, dancing, and gardening.

Lifestyle Choices

In addition to exercising consistently, other lifestyle choices have been linked to a decreased risk of chronic disease development. Smoking tobacco and vaping are risk factors for many chronic illnesses, so smoking cessation is one of the most important lifestyle modifications for preventing disease. Additionally, overconsumption of alcohol has been shown to increase the risk of chronic disease development, so it is recommended that adults consume alcohol in moderation: defined as two or fewer drinks in a day for a man and no more than one drink per day for a woman. Other important lifestyle choices for preventing the development of chronic disease include getting adequate sleep each night, limiting stress, and maintaining social connectedness with others.

Healthy Eating

Diet is another factor that can be used as a primary prevention strategy for chronic disease. The typical American diet is high in processed food, fats, and sugar, increasing the risk of CVD, diabetes, and many other chronic conditions. Consuming a healthy diet significantly decrease the risk of chronic disease development (Kimokoti & Millen, 2016). Current recommendations include a diet that is high in the following foods: fruits, low-fat dairy products, nuts and seeds, omega-3 fatty acids, vegetables, and whole grains.

Additionally, current dietary recommendations suggest limiting intake of refined grains, sugary and salty foods, and processed snack items.

Secondary Prevention

Approaches aimed at the early detection of disease are called secondary prevention strategies. The hope is that by detecting the condition early, the damage from the disorder will be limited and interventions can be implemented right away. Examples of secondary prevention strategies include regular physical examinations and screenings for specific medical conditions.

Chronic Disease Screenings

For each chronic disease, there are specific screening guidelines and recommendations based on age, gender, genetics, and other demographic factors. Some of these screening recommendations are listed in Table 9.3.

Condition Screening Recommendations
Breast cancer
  • Annual mammograms should begin at age 40 years.
  • After age 55 years, mammograms can be performed every other year.
  • Guidelines may change slightly for individuals at increased risk for cancer due to family history or certain genetic mutations (e.g., in the BRCA1 gene) (American Cancer Society, 2022).
Cervical cancer
  • A human papillomavirus test is recommended every 5 years for females aged 25–65 years.
  • A Pap smear is recommended every 3 years (American Cancer Society, 2021).
Colorectal cancer
  • Beginning at age 45 years, individuals at average risk should receive a colonoscopy every 10 years; earlier or more frequent screenings are recommended for those at higher risk due to family history or genetic factors.
  • Regular screenings should be continued through to at least age 75 years (if the individual is expected to live at least 10 more years) (American Cancer Society, 2023).
Diabetes
  • Screening for type 2 diabetes should be performed annually in overweight and obese individuals OR in individuals aged 40–70 years (American Academy of Family Physicians, n.d.).
Hyperlipidemia
  • A lipid panel should be completed every 4–6 years for healthy adults.
  • More frequent (typically annual) lipid panels should be completed for individuals at high risk due to factors such as genetics, family history, and poor diet (CDC, 2024).
Hypertension
  • The US Preventive Services Task Force (USPTSF) recommends screening all adults who are older than 18 years and who do not have diagnosed high blood pressure.
  • Adults older than 40 years and those at increased risk for high blood pressure should be screened annually (US Department of Health and Human Services, 2021).
Table 9.3 Screening Recommendations for Chronic Conditions

Family Genetics

Many chronic conditions are associated with a family history. Individuals with a strong family history of certain chronic conditions may be advised to obtain genetic tests or counseling to see if they also possess genetic mutations that would increase their risk of developing the disorder. Individuals with such risk factors should be screened for the disorder earlier and more frequently than those without the additional risk factors.

Tertiary Prevention

Care approaches implemented after an individual has been diagnosed with a chronic disease are called tertiary prevention strategies. These strategies aim to limit the negative effects of the condition and allow the person to have the highest quality of life possible despite their chronic illness. Tertiary prevention strategies include physical and occupational therapy, rehabilitation services, and symptom control (e.g., medications, follow-up appointments).

Interdisciplinary Plan of Care

Interdisciplinary Team for Patients with Chronic Illness

  • Primary care provider (PCP): the main point of contact for the patient’s health care needs and helps coordinate care
  • Specialists (e.g., cardiologist, endocrinologist): provide specialized management of chronic conditions, including diagnosis and overseeing treatment
  • Nurses: provide direct patient care, coordinate care with other providers, and educate patients and families about the management of chronic disease
  • Pharmacists: ensure safe and effective medication management, including medication reconciliation, reviewing medication regimens for potential adverse effects, and providing patient education on medication use and adherence
  • Physical therapists: help patients improve mobility, strength, and function through exercises
  • Occupational therapists: help patients in regaining independence with ADLs
  • Nutritionists and registered dietitians: provide nutritional assessment, counseling, and education to help patients manage chronic conditions through diet and lifestyle modifications
  • Social workers: assist patients and families navigate the health care system, access resources, address psychosocial needs, and coordinate care across multiple providers and settings
  • Home health aides (or nurses): provide assistance with ADLs, personal care, and light household tasks for patients who require support at home due to chronic illness or disability
  • Case managers: coordinate care across various health care settings, ensuring continuity of care, assisting with discharge planning, and advocating for the patient’s needs and preferences
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