Health Promotion and Maintenance
Levels of prevention
Primary prevention stops disease before it occurs - immunizations, seat belts, nutrition education, smoking cessation counseling. Secondary prevention detects disease early - mammography, Pap smear, blood pressure screening, colonoscopy, TB skin testing. Tertiary prevention limits disability and restores function - cardiac rehab, physical therapy after stroke, support groups. Exam items often swap secondary and tertiary; ask whether the person already has the disease.
Growth and development
Know major milestones by age band and the theorist behind them. Erikson: infancy trust versus mistrust, toddler autonomy versus shame and doubt, preschooler initiative versus guilt, school-age industry versus inferiority, adolescent identity versus role confusion. Piaget: sensorimotor (0–2), preoperational (2–7, egocentric, magical thinking), concrete operational (7–11), formal operational (11+). Match teaching to the stage: a preschooler needs play and short explanations, a school-age child wants simple logic and reasons, an adolescent needs privacy and control.
Screening, immunization, and teaching
Screening intervals and immunization schedules are high yield. A common trap is a parent who believes a vaccine causes the disease or wants to delay it - respond with accurate information, not argument. Health literacy skills: teach-back, plain language, and limiting teaching to the few facts the patient must act on. Ask about family and cultural practices without judgment.
Aging and anticipatory guidance
Older adults: fall prevention, medication reconciliation, sensory changes, driving safety, advance care planning. Anticipatory guidance means teaching what comes next - expect regression in a hospitalized toddler, expect body-image concerns in an adolescent.
Worked example
A 52-year-old with no symptoms asks why she needs a colonoscopy. That is secondary prevention - screening an asymptomatic person for early disease - whereas her influenza vaccine is primary prevention. Naming the level correctly is usually the entire question.