Population test 2

Healthy people 2020

15 examples of social determinants of health: (1) availability of resources to meet daily needs; (2) access to educational, economic, and job opportunities; (3) access to health services; (4) quality of education and job training; (5) availability of community-based resources in support of community living and opportunities for recreation; (6) transportation options; (7) public safety; (8) social support; (9) social norms and attitudes; (10) exposure to crime, violence, and social disorder; (11) socioeconomic conditions; (12) residential segregation; (13) language/literacy; (14) access to mass media and emerging technologies; (15) culture 15 social determinate of health availability of resources to meet needs access to health services access to education

Defining the Magnitude of a Problem

Endemic Usual persistent disease at low to med level Sporadic Irregular pattern with occasional cases at irregular intervals Epidemic Disease in excess of expected level for a time period Sometimes referred to as outbreak reason we do surveillance, is do we have a problem on our hand endemic- what is the baseline topical area and malaria, it is endemic, certain level we commonly see sporadic- is a irregular level, a case here and there epidemic- this is an increase level about the endemic level if we have an outbreak of measles then we are above the level of normal

WHY

Estimate the magnitude of a problem (disease or event). Determine geographic distribution of an illness or symptoms. Portray the natural history of a disease. Detect epidemics; define a problem. Generate hypotheses; stimulate research. Evaluate control measures. Monitor changes in infectious agents. Detect changes in health practices. Facilitate planning. talk about the major reason the other reason is to determine how big of a problem is the whole issue with vaping, see the very commonly reported health problem when we have or when we have issue look in the region of a population such as zykia virus can define an epidemic can start developing hypothesis about diseases how are we going to treat it and what is the health care systems level

childhood obesity

At epidemic levels Negative psychosocial and social ipact Increases risk for: Cardiovascular disease Metabolic disease Musculoskeletal disease Respiratory disease Renal disease Rising Comorbidity: Type 2 diabetes Screening recommended for BMI 85th to 95th percentile

Three.....

Certain conditions—especially beginning in early childhood—affect both health and education. Socioeconomic status or home environment can create stress, and cause illness.

infant mortality rate

What it reflects: Medical care quality and access Socioeconomic conditions Public health practices use this on a global level to look at the health of the country spend ton of money on health care and still have bad outcomes ranked at 27th in health care, we have gotten worse overtime 50 years ago we were 12 how people are able to access health care risk reduction and health promotion

risk factors for family

Genetics Age Biological characteristics Personal health habits Lifestyle Environment what is the family genetics look like certain conditions are hereditary what particular health risk they may be at risk for what the priorities are what is their life style and personal health habits do they smoke or drink are children being exposed to secondhand risk family, as a context- focus on individual but how does the individual family function, put individual first and family second client- all parts of the family are equal, how the whole family is effecting, family 1st and individual second system- whole of the family is greater than its parts, how is one diagnosis effecting the relationship between the families what changes have occurred system- who does the family react with the society, can it conform or fit in with the population

START Color-Coded Triage Tag

Green = walking wounded Yellow = systemic but not yet life-threatening complications Red = life-threatening conditions that can be stabilized and have a high probability of survival Black = deceased or injuries so extensive that nothing can be done to save them Hazmat tag = contaminated red, most emergent need to be treated time line- with in 60 minutes some sort of compromise to respirations, major contusion to body, need immediate intervention

Family nursing in the community

Family Nursing: consists of nurses and families working together to ensure the success of the family and its members in adapting to responses to health and illness Nurses are responsible for the following: Helping families promote their health Meeting family health needs Coping with health problems within the context of the existing family structure and community resources Collaborating with families to develop useful interventions family nursing is working in partnership with nursing those are the goals with family nursing look at family health, the family as a unit just like an invidiuals health it is dynamic and changing well being of family can be genetic the mental health of the family. The social relationships, the community do they work well together their culture will impact the health of the family the spiritual factors of the family no family is perfect, we all have strength and weakness, what are the family strength and where do they need additional support

Theoretical Frameworks for Family Nursing

Family systems theory Family development and life-cycle theory Bioecological systems theory there are some theoretical frame works, these are social science

The Health of a Child Has Long-Term Implications

Health habits adopted by children and youth profoundly influence their potential to lead healthy, productive lives. The physical and emotional health of a child plays a pivotal role in the overall development and well-being of the entire family. Children who are healthy, well-nourished, well cared for at home, and safe and secure in their world achieve a higher potential. can lead healthy productive life as adults they thrive and need emotional support, they need the feeling of belonging they need to feel relaxed and that their family is always there for them

Major Health Issues and Chronic Disease Management of Adults (Cont.)

Health status indicators Chronic disease Cardiovascular disease Hypertension Stroke Diabetes Mental Illness Cancer Weight control

social determinants of health

Factors apart from medical care that influence health in important ways and can be shaped by social policies- e.g., education, child care, housing, income, conditions in neighborhoods. The WHO notes that individuals are unlikely to be able to directly control many of the determinants of health. social determinate of health factors apart from medical care that influence someone care they are usually by someones social policy childcare, is it available or affordable are they living in sanitary conditions is housing affordable, what does the housing look like are there playgrounds or side walks social and cultural impacts of health

Family Health

Family Health: a dynamic changing relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of the family system Families are neither all good nor all bad. All families have both strengths and difficulties. All families have seeds of resilience. Individuals health effects family functioning and in turn family function effects invidiuals health. The assessment of the family health involves simultaneous assessment of the family and individual

Social and Family Policy Challenges

Family Medical Leave (1993) Social Security and Temporary Assistance to Needy Families Challenges Social policies Teen pregnancy prevention policies School immunization laws Medicare and Medicaid (1965) Affordable Care Act (2010) family medical leave, if someone adopts or has a child, can utilize the family medical league some employers offer 6 weeks, some offer 12 how does it impact the family there is some TANIF- every state has a different leave how does this impact our family and our families health teen pregnancy prevention policy different information they share some states may provide more information about contraceptives if they are not able to attend school have different beliefs, might be based on culture medicare and medicaid- there are a lot of families that fall not the gap. they may not be able to afford medical care Family Medical Leave (1993)- family member can take a defined amount of leave for the family events without fear of losing his or her job

social determinants of health

looking at the U.S as a whole 18 percent of children are living in poverty children living in poverty by race are coming from these marginalized group african american, latino hispanic

Areas of Operation in Disaster Response

there is also during a disease have to think about where the disaster is located where they are going to be transported to local hospital people who send out EMT's  1. initial triage and rescue area 2. treatment and transportation/evacuation area 3. incident command and standing area primary- participating in developing a disaster management plan for the community secondary- assessing victims after the disaster tertiary- participating in home visits to uncover dangers that may cause additional injury to victim

START adult triage

walks us through are they breathing on their own, what is the respiratory rate, less than 30 assess the mental status are they able to obey commands 

disease surveillance

we do surveillance at local level and state level, because we want to detect disease and detect early we look at the vulnerable groups and how we want to effect them what are the vectors involved, is it airborne surveillance gives us these priorities about where we need to devert health resource and personal we want to keep families healthy

Family Systems Theory Approach

"Dysfunction" that affects one member will probably affect others and the family as a whole. those that need psychosocial development and are considered nonhealthy families The family's wellness is highly dependent on the role of the family in every aspect of health care. dysfunctional families are unmotivated, noncompliant and resistant families are neither all good or all bad, all families have strength and difficulties The level of wellness of the whole family can be raised by reducing lifestyle and environmental risks by emphasizing health promotion, self-care, health education, and family counseling. family system, see the family as a system a change in one persons health can change the patient in another way look at how their health can impact if one person makes positive life style changes then can bring the whole family up

Bullying

Cyber bullying significant problem Girls more likely to be cyber bullied Victims report thinking about self harm and suicide seeing bullying and childhood bullying can see cyberbullying facebook, instagram, snapchat and getting pulled by their classmates and peers need to talk to parents about bullying women tend to be more cyberbullies then men

Disaster Definitions

A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources. Mass casualty involves 100+ individuals Multiple casualty involves 2 to 99 individuals Casualties can be classified as a direct victim, indirect victim, displaced person, or refugee they can be man main or natural disasters can cause death or injury have different levels, mass causitalites multiple causalities and causalities that are direct victims, they are injured, community members at large a natural disaster or community members may have to go to another country diaster is a pretty broad definition

yellow

A young man is brought to emergency department as one of the first of many victims of a motor vehicle accident that caused multiple casualties. The man is awake and alert. He has a fracture of his right tibia and several small lacerations on his face. How should this man be triaged? Priority 1: Red Priority 2: Yellow Priority 3: Green Priority 4: Black

Childhood Health Issues

Accidental injury leading cause of death in children ages 1 to 14. Childhood obesity it can lead to numerous health problems. Childhood immunization benchmark of child health. Environmental concerns toxic exposure to chemicals: air water Child maltreatment Children with special health care needs need multiple health care services. there are some major leading childhood one of the leading cause of death is accidental injury obesity among children, immunizations- children are way behind and can cause problems child maltreatment and children with special health needs

Health Disparities Among Special Groups of Adults

Adults of color Incarcerated adults LQTBQA Adults with physical and mental disabilities Frail older adults POC (people of color)- tend to not receive not the same care as others whether this is due to inadequate providers people of color have later development of breast cancer because they are not getting the testing they need LGBT- substance use, STD, sex trafficking a lot of these people may not be accepted by their family may be hard to find a provider to offer the care they need can lead to substance use, depression, anxiety frail older adults- may need help with transportation, social security or medicare going to effect their ability to access care Incarcerated women experience health disparities due to low budgeting, there is a small supply of feminine hygiene products, and not enough prenatal care if a women is pregnant in jail. people are isolated mental and physical activity- need to make sure their are accomidity do they need to offer interpreter

Role of the Nurse in Response

Assessment Implementation of the disaster plan Referrals Identification of at-risk communities Ongoing assessment and surveillance Ensuring accurate communication and information do community assessment throughout the response phase need to continue to assess what the needs of the community are what is the communities disaster plan and what is the community disaster who is at risk and supporting the community efforts

Learning objectives

At the end of the session, students will be able to: Describe why surveillance and outbreak management is important Differentiate between different surveillance systems Define terminology that describes the magnitude of a problem being monitored Describe the steps to conducting an outbreak investigation

today

By the end of the session, participant will be able to: Identify and describe the stages of disaster management Identify key teaching points for families relating to emergency preparedness Triage patients using START triage system Discriminate between community psychosocial response stages the stages of disaster management - talk about the triage system, the responses in the community see when disaster occurs

recovery stage

Begins when the danger from the disaster has passed. All local, state, and federal agencies are present in the area. Help victims rebuild their lives Restore public services Cleanup of damage and repair begins Evaluation and revision of the disaster plans Understand the financial impact recovery stage the danger has passed, the event has occurred, the hurricane has gone and now we are into recover we have local resources and local resources help people rebuild lives moving out debree and damage this is the time to start evaluating disaster plans what was the financial impact how are we able to get some additional help

Clear Connection Between Health & Education

Better educated individuals are less likely to self-report a past diagnosis of an acute or chronic disease, less likely to die from the most common acute and chronic diseases, and are less likely to report anxiety or depression. poverty is going to impact health educational opportunities and how that impacts your health can see a decrease in risk 4 years of education will decrease your risk diabetes or poor health status and the number days of you were sick 4 year degrees that make you more prone to higher income having a college degree can afford you a better pay and can pay for a gym membership having a college degree can impact health outcomes

Family caregiving

Caregiver burden TLC T = training in care techniques, safe medication use, recognition of abnormalities, and available resources L = leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs C = care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, and health management

HOW: data sources

Cases reported by clinicians, health care agencies, and laboratories to state health departments Death certificates Administrative data (i.e., billing) Sentinel surveillance system data sources can come from a lot of different sources can get cases of certain disease that are reported of certain providers our health department have to report cases report to CDC can detect epidemics detect mortality datâ that is collected from death certificates if we are worried about zyka then we need to identify that there is more cases can see lots of cases and they may need to monitor this

Major Health Issues and Chronic Disease Management of Adults

Chronic Illness: Cure is not expected adults are a larger lump, they bring larger adults into this group

patterns of occurrence

Common source outbreak refers to a group exposed to a common noxious influence Point source all persons exposed become ill at the same time, during one incubation period (type of common source). Mixed outbreak when a victim of a common source epidemic has person-to-person contact with others and spreads the disease can see different patterns that are occurant can have a common source outbreak a group has been exposed to anthrax they occur at the same time period mixed outbreak- this is when someone from a common source, such as anthrax is on your clothes from one location and you bring it to another location

Family Systems Theory Approach (Cont.)

Commonalities in risk factors and diseases shared by family members can lead to case finding within family. Individual is assessed within larger context of family. Family is vital support system to individual member. - Friedman (1994)

Community Teaching: Emergency Preparedness

Communication plan—emergency phone numbers; place to meet Be prepared to shut off all utilities in home; water may be precious; electricity and gas can pose safety threat Package of vital records available when evacuating a home: medical records, insurance policies, cash/travelers checks Emergency kit: extra medications, extra batteries for medical devices Plans for homebound pets: leave food and water—not allowed in shelters Encourage families to learn first aid and CPR this can be more of a community level other things people can have is the vital records, emergency kit, what are we going to do with pets first CPR

responses to disaster

Community Heroic phase-overwhelming need for people to do what they can to help others survive the disaster, first responders, health and medical personal, work hours on end with no thought of their own needs. Honeymoon phase-survivors rejoice that their lives and love ones lives will be spared. They will share experiences and stories. Disillusionment phase- occurs after time has elapsed and people began to notice that additional heath and reinforcement may not be immediate forthcomings. a sense of dispair results and exhaustion starts to take a toll on volunteers, rescuers and medical personal. Nurses need to consider psychological impact and emotional, cognitive and spiritual burn out Reconstruction phase-the longest phase, homes, schools and churches need to rebuild and establish. The goal is to return to state of normalcy there are different responses to disaster neighbors help neighbors everyone pitches in to help everyone redistillation the reality test, how impacted is the community resconstion phase- set up structure for the family who lost their homes

accident and injury prevention

Community car seat checks Safety incorporated into required school health education Reduce Gun Violence Promoting safe playgrounds and recreational areas need to make sure we buckle up all ages in age appropriate car seats, depending on age and size and everyone needs to have a seatbelt

steps to conduct an investigation

Confirm outbreak Verify diagnosis or define case Establish # of cases Evaluate data collected to person place and time Develop hypothesis Institute control measures and communicate findings doing the assessment how would you do the assessment in the outbreak saw spike in cases in certain part of pittsburgh, would need to find case and what the case is, would need to have nurses seek out how many cases their are, seek information about who the person is, where is the location, what were they doing, what is the environment location ex. they all shopped at the one grocery store, what do they have in common hypothesis- they all went to the grocery store and they all ate the lettus may need to start quarantine people as our control, or we take the lettus off the shelf, may need to alert the media need to communicate findings

Future of Disaster Management

Continue to plan and train in all-hazards environment, regardless of specialty practice. The nature of disasters will retain the element of unpredictability. diaster management is continuous we continue with climate change there is a need to continue and prerfect and use best evidence

Nursing Approaches to Family Health Risk Reduction (Cont.)

Contracting with families Process Beginning Working Termination Advantages and disadvantages Empowering families Directed toward the building of nurse-family partnerships Emphasizes health risk reduction and health promotion

nurse competencies

Core competencies include: Analytic assessment skills Communication Community dimensions of practice Basic public health science skills Leadership and systems thinking just like in some many others always using our assessment skills, communicating risk, educating community about disease and how to reduce risk we talk about the essential functions talk about look at incident and function of disease look at how nurses can be leaders who is at more risk for vulnerable

Priority 4: Black Tag

Deceased Victims Victim unlikely to survive due to severity of injuries, level of available care or both Palliative care and pain relief should be provided are deceased, or such a serious injury that getting them to injury will not help them provide comfort care

Priority 2: Yellow Tag

Delayed Care Victims transport can be delayed Includes serious and potentially life-threatening injuries, but status not expected to deteriorate significantly over the next several hours Reevaluate every 30 to 60 minutes yellow is delayed care can be waited a little longer to be treated ex. someone who broke arm or limb

Types of survalence system

Passive system Case reports to local health dept. by healthcare providers Lab results reported to local health dept. These are summarized by local dept and sent to state or national (CDC) Active system RN actively searches for cases Nurse names disease and gathers the evidence Sentinel system Trending for commonly occurring diseases or key indicators. Sample HCP or agencies asked to report on problem there is passive certain report of cases reported lab results active- good idea of how many people have a certain disease nurses go out and find who is effect by this certain disease

injuries and accidents

Developmental Considerations Infants: small bodies/mobility, small bodies can fit through places and become entrapped, small airways can be easily occluded Suffocation leading cause of death, can cause them more prone to drowns, burns and suffocation. Toddlers/Preschoolers non fatal falls -large number of falls and being stuck by an object, increase motor skills make supervision difficult School age: bicycle injuries, more at risk for bicycle and motor vehicle injuries. boys are more likely to get injured than girls, highest rate of injury is 10-14 helmets are number one way to prevent injury Adolescents: MVA and violence, risk taking becomes more conscious especially by boys. high risk of motor vehicle accidents and fatal poisoning such as from drugs and alcohol homocide is 3rd leading cause of death in adolescents suicide is leading cause of death from 15-24 years old mature minor doctor that give children 15 and older consent to medical care MVA/Sports MVA—leading cause of death in children and teens Children in car seat until or inches In back: 12 and under Drowning, poisoning and burns most of other deaths Sports injuries increasing preventing injuries and accidents infants are more prone to fall and hit something their airways are smaller accidental injury toddlers and preschools may get into things, they are curious most common type of injury is bicycle injuries most common death of adolescence is motor vehicle accidents and violence need to be up to date on car seats should inform patients about how long patients can sit in carseat safety belt use drowning, people not securing pools, people not using right flotation devices secure chemical toxic look at sports injuries the different sports and activities Children ages 8 until 17 are required to wear a seat belt in all seats. Children ages 4 until 8 must ride in a child safety seat or booster seat unless they are over 4 feet 9 inches or weigh more than 40 lbs. Children under age 4 must be restrained in a childpassenger restraint system.

health disparities

Differences in health that adversely affect groups of people who are already at a disadvantage economically /socially - e.g., African Americans, Latinos, low‐income, disabled, and/or LGBT people - because of historical discrimination or marginalization when we see differences in health outcomes they are related to social determinants of health need to considerate their ability to determine health lives those who can be economically or socially it can be based on race or ethnicity low income family can be at a disadvantage LGBTQ community all these groups are marginalized with health disparities

objectives

Discuss major health problems of infants, children and adolescents. Discuss risk factors for adults, including those that are different for men and women. Describe risk factors for older adults. Discuss risk factors for persons in the community who have special health needs. Explain nursing measures designed to reduce risks for adults in the community.

Women's health concerns

Eating disorders Reproductive health-conteceptive counseling, increase in folic acid Gestational diabetes- diabetes that occurs while pregnant Menopause- the levels of hormones change in the women's body Breast cancer- most diagnosed cancer in females secondary prevention such as early screening makes a difference in death rates Osteoporosis- loss of bone mass can make them more at risk for falls, more prominent in women due to menopause balemia and anorexia- have a focus on that with women contraceptive use- healthy pregnancy, prenatal care the use of hormone replacement therapy can increase risk of breast cancer because of estrogen increase women at risk for breast cancer because of the screening anorexia- fear of gaining weight coupled with disturbances of perceived body image bulimia- reoccurant episodes of binging, purging, strict diets, fasting and use of laxatives or diuretics, and excessive exercising

Family Functions

Economic function Reproductive function Socialization function Affective function Health care function when thinking about the family and the systems approach the economic function how does this impact the family health it can effect their ability to buy healthier foods serves reproductive function their children can be apart of a family socialization- this is part of the community affective- the mental health aspect, the love and support, the place you belong and are loved health care function- the parents are going to guide how to take care of yourself, be active how to utilize heath care

Why? Three possible ways...

Education creates opportunities for better health. More likely to have jobs with higher earnings Live in communities with more resources like greater schools and access to nutritious food, health services, and transportation; and Acquire knowledge and skills to support healthier behaviors.

Major Health Issues and Chronic Disease Management of Adults (Cont.)

Health status indicators Chronic disease Cardiovascular disease- 81.1 americans have CVD, heart disease is the leading cause of death in the U.S Hypertension- 1 in 3 do not know they have hypertension and it is asymptomatic, can lead to stroke, CVD, kidney disease and other complications Stroke-highest increase in hispanic men who have strokes , need to advocate for smoking cessation because the risk of stroke is 2x as high in those who smoke compared to those who don't Diabetes- 29.1 million AMERICANS have diabetes, this can cause an increase in blindness, kidney disease, stroke and loss of extremities Mental Illness- people with mental illness continued to be label as negative despite many of the change in views in the population, need to use effective behaviors and therapies and medication, worry about social media outlets and negative view Cancer- second leading cause of death in the u.s, early screening and prevention promote healthy lifestyles, expansion of services and help decrease the effects Weight control tend to focus on as adults tend to look at heart disease, hypertension, stroke rates of diabetes these are major chronic disease we observe in adults

Role of the Nurse in Disaster Preparedness

Help initiate or update the agency's disaster plan Provide educational programs and materials regarding disasters specific to the area. Organize disaster drills. Provide an updated record of vulnerable populations within the community. Review individual strategies. can help agency's develop and and prepare plans if you have been assigned for a particular community or township, can do it at the agency level or community level thinking about the vulnerable population can do this one on one and prepare in an emergency

WHY'D

Helps public health departments: Identify trends and unusual disease patterns. Set priorities for using scarce resources. Develop and evaluate programs for commonly occurring and universally occurring diseases or events. can identify disease patterns surveillance data to evaluate data what are the cases of TB

preparedness

Plans must include: Authority Communication Logistical coordination of: Supplies and equipment Human resources Evacuation and rescue Plans must be dynamic and change as needed. Plans must be tested in different disaster scenario drills. Personal & professional preparedness, have to be prepared at multiple different levels who is going to be incharge what is the order of operations how are we going to get equipment and supplies what plans and resources do we have for evaccuation do we have boats, helicopters, ambulances have to be very flexible, things can occur very rapidly, due to weather helicopters may not be able to come in, can practice drills and opportunities to practice personal and professional- how are we preparing our medical providers to prepare for disaster

Two.......

Poor health puts educational attainment at risk. Educational setbacks starting at a young age, due to chronic absences, difficulty in school.

Family Interviewing: What are you assessing?

Manners Therapeutic conversations Genogram and Ecomap Therapeutic questions Commending family or individual strengths Issues in family interviewing Many locations, family informant, family health portrait, involvement of children in the in home phase that interviewing will help you get more information with the family sit down with the family, get to know them using reflective language- them talking and this is what you here them saying looking people in the eyes, nodding that you are actively listening, asking open ended question reflective piece this is what i hear you saying be sure to not just focus on the problems, look at the strengths find resources to tap into whatever they are dealing with interact with the children when you are around the family, ask the children questions

Obesity prevention

Media- increased use increases sedentary lifestyle Let's Move Campaign Healthy schools Access to affordable, healthy foods Food deserts Raising physical activity levels CDC recommends 60 minutes every day Empowering families to make healthy choices 0-6 most important years to develop healthy eating habits for lifetime Child feeding practices primary factor a lot of obesity prevention comes from the media the Lets move- addressing the obesity Obama- brough health into the schools increase the activity levels for an hour a day impact of the family, the health of children, the family needs to be apart of the family go outside and play and reduce childhood obesity childhood is where you develop your life style

Prevention (Mitigation & Protection)

Identify potential disaster risks. Create risk maps Educate citizens regarding what actions to take to prepare for disasters. Individual, family, and community level Develop a plan for meeting the potential disasters identified. Example: Create resource maps Preventing the effects, not necessarily the disaster what disasters might we be at risk for, what natural disaster could occur mass shooting in malls, and places rivers, things could flood educate people on the actions they can take to prevent the level always have a plan, have emergency exits evaluation routes can reduce the effects of the disaster

Priority One: Red Tag

Immediate/Emergent Care Needed Victim can be helped by immediate intervention and transport Requires medical attention within 60 minutes for survival Includes compromise to airway, breathing,

Nursing Approaches to Family Health Risk Reduction: Home Visit

Initiation phase- 1st contact between the nurse and the family Pre-visit phase-need to review the referral, understand why they might have refused the visit, look at the family record In-home phase-gives the nurse a chance to asses the home, the lawn, the yard, the neighborhood and the family interaction. Determine clients expectation Termination phase- when the purpose of the visit has been accomplished, the nurse review the family, the goal is to plan further home visits Post-visit phase-documenting the visit and services provided when we are going to do a visit with a family, there are different phases to go through initiation phase- reach out to family, introduce yourself revisit phase talking to health care providers, and scheduling with the family that it is ideal to do the visit in someones home -this because if you are at someones home you can see the reality of the patient and their environment in-home- want to gain trust, get to know the family members, introduce yourself, get to know them. What is the biggest problem what are their barriers to health termination phase- plan for some type of evaluation follow up with you in a month or two weeks if you follow up, make sure you follow up with their visit post visit- update anyone who referred that family, update findings with physician, and evaluate the plan you came up with

Pattern of occurrence

Intermittent or continuous People exposed over a period of days or weeks Propagated Does not have a common source Spreads gradually from person to person over more than one incubation period, intermittent- people being exposed not all at the same time but here and there propagated- it is not a common source it is more sporadic would not worry too much about the patterns of occurrence, will not need to know the pattern it is

environmental concerns

Lead Poisoning Serum lead level >10ug/dl Most common exposure: lead based paint, lead contaminated soil and dust Mercury Ingestion of contaminated fish Plasticizers BPAs Environmental Tobacco Smoke Increased ear infections, asthma, missed school days, preterm birth lead poising- if serum level over 110 this can be in older homes, they do ask about lead exposure the most common is lead based paint mercury through contaminated fish use more BPA free definitey encouraging families for BPA free items smoking- it is on hands, make sure we decrease the cost can increase asthma and cause an increase in missing school low income likely effected by asthma because of the pollutants in the air, and the subsidized housing rolling in grass can increase exposure to pesticides rolling on carpet can increase exposure to chemicals in rugs

Governmental Responsibilities

Local government (first responders) Responsible for the safety and welfare of its citizens. State government (Office of Emergency Management) Involved when a disaster overwhelms the local community's resources. Federal government (Department of Homeland Security and CDC) A single department focusing on protecting the American people and their homeland most disasters are going to start at the local level medical professionals addressing the health and welfare of the citizens a lot of people who have hurricanes, the governor will alert a state of emergency and fema can come in

Men health concerns

Men's health concerns Cancers unique to men Prostate cancer- african americans rates are twice as high as anyone else Testicular cancer- most common solid tumor Erectile dysfunction- up to 52% of men ages 40-70 experience this but are embarrassed to talk to their provider about it men health look at cancer and how they are unique to men prostate cancer and testicular cancer do not see this as high as a rate erectile dysfunction- another health concern to address

Priority 3: Green Tag

Minor/Non Urgent Care Victim with relatively minor injuries Status unlikely to deteriorate over time May be able to assist in own care Need treatment but can wait for hours "Walking Wounded" Examples: Sprains, rashes, minor pain Re-evaluate every 1-2 hours walking wounded, some sort of laceration, no difficulting breathing or profession issues no emergent

reportable diseases

National: NNDSS National Notifiable Disease Surveillance System State: Requirements and list differ by state Allow us to see trends Morbidity and mortality weekly report Summary of Notifiable disease national notifiale disease surveillance system can tell you what diseases such as anthrax needs to be reported at a national level have to report lead poisoning, plague, diseases these exist at national and local level

Priority 3: Orange Tag

Non emergent psychiatric condition the stress response is a major thing, someone who has had some sort of extreme response to the disaster focus on mental heath 

Demographic Characteristics

Older women twice as likely as older men to live alone Want to AGE IN PLACE. High percentage of income is spent on health care Sizable proportion living in POVERTY PRIMARY SOURCE OF INCOME: Social Security/Medicare

Defining the Magnitude cont'd

Pandemic Epidemic over several countries Holoendemic Highly prevalent problem commonly acquired early in life Prevalence decreases as person ages pandemic- expanding countries or continent this is the settee the normal levels than what we expect to see holoedemic- this talks about younger people are more prone to contracting malaria compare to those who do are older this is not seen as much

immunization intervals

Passive immunity Mom to baby Lasts 2 months Can mount immune response to vaccine at 2 months Immunizations started at 2 months except for Hepatitis B which begins at birth Primary response After first injection Antibodies produced slowly + in small concentrations Secondary Response Subsequent injections, body recognizes antigen and antibodies produces faster and in higher concentrations Once series is started—do NOT need to restart if series interrupted first, can think about passive immunity can get diseases through the mom this can last after she has had the baby our body provides immunity for baby because their bodies are still developing this is why we start vaccines at 2 months have to get the series in order to get the full effect of the immunity need the secondary response with the rest of the immunity once you start a serious you do not need to restart, you just have to finish the series

poverty

Poverty is a primary cause of vulnerability Poverty is a relative state. The federal definition of poverty is used to develop eligibility criteria for programs such as Medicaid and welfare assistance. In 2016 the federal poverty guideline for a family of four was $24,300 for all states except Hawaii and Alaska. However, many people who earn just a little more than the federal poverty guideline are unable to pay for their living expenses but are ineligible for assistance programs. poverty- relative state cannot give a strict definition determine eligibility depends on federal poverty 24,300 dollars is the eligibility for a family of 4 they reassess every year based on the people in the family

Health Effects of ACE

Prevalent Diseases Ischemic heart disease, cancer, chronic lung disease, skeletal fractures, liver disease Risk Factors for Common Diseases Smoking, alcohol abuse, promiscuity, obesity, illicit drug use, injection drug use, multiple somatic symptoms, poor self-rated health, high perceived risk of HIV/AIDS Mental Health Depressive disorders, anxiety, hallucinations, panic reactions, sleep disturbances, memory disturbances, poor anger control Sexual and Reproductive Health Early age of first intercourse, sexual dissatisfaction, teen pregnancy, unintended pregnancy, teen paternity, fetal death General Health and Social Problems High perceived stress, impaired job performance, marriage to an alcoholic, risk of perpetrating or being a victim of domestic violence, premature mortality heart disease, skeletal factors depression anxiety, panic attacks, high stress alcohol ism

Disaster Management Stages

Prevention Preparedness and planning stage Primary Prevention- involves either preventing the hazard from occurring or preventing exposures that would lead to injuries or disease. Response stage Secondary Prevention- Secondary prevention involves early diagnosis and appropriate management of injury or disease after the exposure has occurred. Recovery stage Tertiary Prevention-involves preventing further complications in the form of more severe injury, disability, or death. ... This rapid onset of disaster-related injuries markedly limits the effectiveness of secondary and tertiary prevention (e.g. response and recovery interventions) 3 different stages start with prevention how are we going to response when disaster occurs triage early, tertiary- having management after the fact, providing rehabilitation mitigation is an emergency management term for reducing risk to people and property from natural hazards before they occur

The changing family

Purposes of the family To meet the needs of society To meet the needs of individual family members DEFINING FAMILY How do YOU define Family? we look at the nuclear family, the way families look today are very much changing the main goals of family are to meet the needs of society need to give to the community look at the physical, mental and emotional also important part of family they participate in different social environments they are purchasing things from businesses in a lot of ways when we are promoting health family we can interact and support community economically

Response stage

Response stage begins immediately after the disaster incident occurs. May include: Shelter in place Evacuation Search and rescue Staging area Disaster triage diaster has now occurred the now we have to respond to the event tornado we do not want people out on the roads, centralized location to find family members. volunteers and responded to disaster triage

Health Issue: SIDS/ SUIDS

SIDS: Sudden Infant Death Syndrome Sudden death of infant under 1 year of age Unexplained after thorough investigation SUIDS: Sudden Unexplained Infant Death Sudden and unexplained death Includes explained( suffocation, trauma. Infection) and unexplained (SIDS) preventing SID or sudden death syndrome tends to be a united front as to what is safe sleep environment for kids cannot expain the cause, attribute it to sudden death syndrome

disease triage

START triage system "Simple Triage And Rapid Treatment" Used in multi-casualty or mass casualty incident Triage of injured person should occur in less than 1 minute based on: Respirations Perfusion Mental status Person is tagged with a colored triage tag Victims moved to the treatment area START- can use this for mass casualties triage based on respiratory, profusion and mental status give people different color, red, blue, black

Nutrition Education For Families

Should breastfeed exclusively for 1st 6 months Parent provides healthy meal; child decides how much to eat Limit 100% fruit juices; beverages should be water and milk It can take 10-15 tastes of new food for toddler to learn to like it Family meals important Avoid using food as punishment/reward No TV when eating Schedule regular mealtimes and snacks Parents should model healthy behaviors some specific not introducing foods too early this can contribute to obesity do not force children to eat as much on their plate do not push juice on kid can drink milk or water need to be providing formula or breast milk being patient with toddlers and trying new foods it is important to sit down together for a family meal families talk and embrace the relationships and share about their day family meals is a great way to foster family do not use food as a punishment or reward need a schedule, have regular meal times and quick go to snacks

Factors Affecting Child and Adolescent Health

Significant factors in overall well-being: Parents' or caregivers' income, education, and stability Security and safety of the home Nutritional and environmental issues Health care access and use Specific issues: Poverty Racial and ethnic disparities Health care use when we think about family impacting children caregivers, their education background, there stability can impact the well being the environment offers nutritious food there is clean air to breath or clean water to drink the family might skip certain doctors appointment because copay too high racial and ethnic disparities can impact their health providers- nurse can be biased against certain groups and poorer outcomes

Role of the Nurse in Disaster Recovery

Teach proper hygiene and make sure immunization records are current. Make referrals to mental health professionals. Be alert for environmental hazards. Ongoing needs assessment Case finding and referral the nurse is continuing to refer people to resources what is the post traumatic stress what environmental efforts has occurred

WHO preforms survalience

The Constitution of the United States provides for "police powers" necessary to preserve health safety. These powers include public health surveillance. State and local "police powers" also provide for surveillance activities. Health departments usually have legal authority to investigate unusual clusters of illness as well. legally, the constitution level provides us the ability to do convey our population provide at the national and state and local level if we saw some sort of epidemic or outbreak, we have state or authority to find out who the corporate is and what the issue is have some sort of authority

Disaster management

The set of DBA activities dedicated to securing data availability following a physical disaster or a database integrity failure. gotten some of the fema training

connection to health behavior

Those with more education, less likely to: smoke to drink a lot to be overweight or obese, or to use illegal drugs. link with health behaviors less likely to smoke, less like to drink a lot and less likely to use illegal drugs tend to see healthier behaviors have more income, can afford to go to the gym and get a membership better mental health, do not lean on use of illegal drugs people who are enrolled in college at the national level about 60-70 percent they are enrolled into a 4 year college if we break it down by family income, if they have 75,000 dollars or more, pretty constant about people enrolling in college income can impact their ability to get a college degree if we look at family income by race, can see that highest people living 100 percent below the poverty line, is black or african american hispanic and white are a little bit closer the difference between race and poverty

Preparedness/Planning Stage: Individual and Family Preparedness

Training in first aid Assembling a disaster emergency kit Establishing a predetermined meeting place away from home Making a family communication plan can do education on and have resources need to have some sort of first aid training extra medication needed by kids preparing a predetermined meeting place where is the essential meeting place where we can find each other people had to find members on social media when there is a disaster when major tornado's went through- need to assess if patients/ members are okay

Adolescent health issues

Unprotected sexual activity Sexting Teen childbearing and parenting Violence Tobacco, alcohol, and drugs there are a few specific issues there are issues around motor vehicle accidents and violence people start to have unprotected sex they might be sexting need to focus on contraceptives they might try drugs, weed/ alcohol

Are All Differences "Unfair"?

Young adults have better health than those over 80 years of age. African Americans are diagnosed with asthma at a 28-percent higher rate than whites. Skateboarders have more wrist fractures than non-skate-boarders. While rates of stomach cancer have decreased dramatically over the decades among all race and ethnic groups, Latinos still have higher risks than Whites. younger adults tend to be healthier the fact of life if you age you are more at risk for chronic health care conditions what social policy might be determining the difference can look at cancer rates and marginalized group tend to have higher rates of stomach cancer than whites

Eco maps

are there churches that we can get counseling from thinking about all the different services to help them through crisis can talk to the family about it or talk to oneself  help identify potential risk, genetic that you need to consider part of family health 

four approaches to nursing

can look at the family as a unit can look up in text book can think of family as concept the family may impact the childs health can think about the family as a unit each part sums to a whole can think about family as a system how will this impact the family and the stress of the children can think about family that functions in society schools in a good economy as a home health nurse may look at family as a contect can look at how their health can impact their children example if taking care of individual, may look at how the family can impact the individual such as if the mom had cancer

Adverse Childhood Events (ACE)

children who experience some adverse childhood event it will effect them throughout their life they have been in abuse they are malnourished can disrupt their development can lead to some sort of impairment, mental health might affect their cognitive ability unhealthy risky behaviors later in life if you experience abuse, you may not trust people, might pull away from friends and family can see how they can build the levels on top of each other can develop some sort of disability can lead to early mortality need to know how important it is to promote the health of children can jump in early and build up the reliance effect children later on in life

social determinants of health

economic stability are their businesses debt, this effects their ability to be healthy their ability to pay for medications living in debt will have a lot of stress talk about housing, what transportation is available if there bus stops or no bus stops violence in the community, is it safe or do people feel unsafe to leave their homes people coming together socially are there ways for children to come together is it walkable, are there side walks, how easy is it to get to bus stops the literacy levels, utilize health information, do they speak english health risk across the life span, the health/ belief and values, is it affordable or accessible what kind of training do people have access too is the community isolated, are they coming together are their support groups places people can come together are their kind of community, the way the community is coming together stress can impact peoples health is there stress in the larger community what is available, are their pediatricians, are their dentist who is providing care in those areas the lack of diversity how does that impact the care quantity over quality are the providers able to take time and is it culturally competent scientific evidence that this has negative outcomes morbidity, mortality, lower life expectancy because people have more chronic conditions, see higher health care cost, more depression and more stress can lead to disability major impacts, something we want to drive home

childhood immunization

immunization facts Increasing Immunizations remains a significant focus Only 34% girls recive full three doses of HPV vaccine 53% children receive hepatitis A series barriers to immunizations Cost Vaccine shortages Parental Refusal VFC Vaccines for Children federal program for free vaccines child hood immunizations and later into the adult hood have such a wonderful benefit for society as a whole still see a lot of children who are not receiving vaccines only 34% of girls get the full dose of HPV dose -this can happen because they change doctor or they forget 53% of children get hepatitis A serious immunizations have been successful at preventing children from getting diseases, the challenges is making sure that children receive immunizations on time parents get confused my media misinformation of vaccines causing autism the goal of immunizations is protect individual important to urge parents to obtain vaccines for children

social determiants of health

neighborhood environment economic stability health and health care education social and community context when we think about social determinants of health the neighborhood, how does this impact the health think about the kind of care that is being provided social and commity context are their relationships are people educated the economic stability of the family

stages

o Primary prevention - develop disaster plan, train rescue workers, educate the public about disaster plan and personal preparedness ♣ Prevention stage of disaster management • Identify potential disaster risks - create risk maps • Educate citizens regarding what actions to take to prepare for disasters - individual, family, community level • Develop a plan for meeting the potential disasters identified - create resource maps ♣ Preparedness and planning stage • Training and first aid - CPR • Assembling a disaster emergency kit • Establishing a predetermined meeting place away from home • Making a family communication plan • Plans must include o Authority - leader o Communication o Logistical coordination of ♣ Supplies and equipment ♣ Human resources ♣ Evacuation and rescue • Plans must be dynamic and change as needed • Plans must be tested in different disaster scenarios o Nurses role in disaster preparedness ♣ Help initiate or update the agency's disaster plan ♣ Provide educational programs and materials regarding disasters specific to the area ♣ Organize disaster drills ♣ Provide an updated record of vulnerable populations within the community ♣ Review individual strategies o Secondary prevention ♣ Triage ♣ Treatment of injuries ♣ Treatment of other conditions, including mental health ♣ Shelter supervision ♣ **finding cases early to minimize injury ♣ Response stage - begins immediately after the disaster incident occurs • Ex. Setting up the mobile • May include o Shelter in place o Evacuation o Search and rescue o Staging area o Disaster triage (see below) o Tertiary prevention ♣ Follow up care for injuries ♣ Follow up care for psychological problems ♣ Recovery assistance ♣ Prevention of future disasters and their consequences ♣ Recovery stage • Begins when the danger from the disaster has passed - after the disaster has occurred • All local, state, and federal agencies are present in the area o Help victims rebuild their lives o Restore public services o Cleanup of damage and repair begins o Evaluation and revision of the disaster plans o Understand the financial impact • Role of the nurse in disaster recovery o Teach proper hygiene and make sure immunization records are current o Make referrals to mental health professionals o Be alert for environmental hazards o Asses dangers of live or dead animals o Want to teach ♣ Boil water for drinking ♣ What they need to do to take care of themselves ♣ Up to date immunizations ♣ Referrals for mental health issues ♣ Look for rabid or decaying animals and remove

SIDS

risk factors Prone and side-lying sleep position Sleeping on a soft surface Maternal smoking during pregnancy Overheating Late or no prenatal care Young maternal age Preterm or low birth weight Male gender Lack of immunizations prevention Supine position only No smoking during pregnancy Firm sleep surface: no pillows, soft bedding, stuffed animals, sleeping on a chair No sleeping with adults or in waterbed Offer pacifier at naptime and bedtime with kind of introductions the SID has not been as much as an issue make sure that baby is on back and not side or stomach if women are over heated then we do not need the baby to be dressing like its super cold need to make sure that there is not maternal smoking leaving the baby unattending or soft surfaces can cause problems these are potential death factors

family health

someones experience of family can change throughout their life time move into adult hood and may have children may be single family with a child may get remarried, the idea of family can change throughout

Health risk across the life span

the family development and life-cycle can think about family health depending on the stages they are in in the family ex. the newly married couple or same sex couple a single parent with two small children, single parent, stress, need assistance with child care do they have good nutritional looks at family in life style and the risk we can identify BioEcological- what is in their community and how does that effect their health national level policies regulations and how this effects our families health

what goes into your health

the majority or large portion is the socioeconomic factors, the social support the income impacts health 30% goes into health behavior a lot are socioeconomic factors 20% is the actual health care, what is the quality of care

Education: It Matters to Health More Than Ever Before

the video talks about different ways education promotes health gives us opportunities to have a better health have good food system, might be playgrounds and parks how it can support those knowledge about unhealthy behaviors it can be a 2 day relationship think bout kids being impacted kids may feel that they live in a school system that is unsafe or the community they are apart of they are sick, there is a two way relationship condition children develop can effect this health and education