55, Chapter 71, (C228) ATI-Community Health <Chapter 1-7>
Bioterrorism Incidents
-Inhalational Anthrax: cause headache, fever, muscle ache, chest discomfort, shock. treat with IV cipro, antibiotics don't stop disease progression -Botulism: dif swallowing, weakness, nausea, vomiting ab cramps, dif breathing. treat with airway management, antitoxin, elim of toxin, supportive care -smallpox: high fever, fatigue, severe headache, rash that appears on face first, pus filled lesions, vomiting. no cure. supportive care and prevention with vaccine -ebola: fever, hemorrhage, vomiting, diarrhea, cough, jaundice, shock. no cure. airway management, dialysis, supportive care, prevention
Veterans
25 mil in US. 2 mil women, 9 mil >65. -veterans health include hospitals, outpatient clinics, home health services, hospice and palliative care, nursing omes, residential rehab, readjustment counseling -vet health issues: mental health, substance use and addiction, suicide, infectious disease, exposure to herbs, chemicals, and radiation, traumatic brain injury, spinal cord injury, traumatic amputations, cold injury, military sexual trauma, hearing loss, vision impair
A 16-year-old male patient comes to the free clinic and is subsequently diagnosed with primary syphilis. What health problem most likely prompted the patient to seek care? A) The emergence of a chancre on his penis B) Painful urination C) Signs of a systemic infection D) Unilateral testicular swelling
A
A medical nurse is careful to adhere to infection control protocols, including handwashing. Which statement about handwashing supports the nurse's practice? A) Frequent handwashing reduces transmission of pathogens from one patient to another. B) Wearing gloves is known to be an adequate substitute for handwashing. C) Bar soap is preferable to liquid soap. D) Waterless products should be avoided in situations where running water is unavailable.
A
A nurse who provides care in a busy ED is in contact with hundreds of patients each year. The nurse has a responsibility to receive what vaccine? A) Hepatitis B vaccine B) Human papillomavirus (HPV) vaccine C) Clostridium difficile vaccine D) Staphylococcus aureus vaccine
A
A nursing home patient has been diagnosed with Clostridium difficile. What type of precautions should the nurse implement to prevent the spread of this infectious disease to other residents? A) Contact B) Droplet C) Airborne D) Positive pressure isolation
A
A patient on Airborne Precautions asks the nurse to leave his door open. What is the nurse's best reply? A) "I have to keep your door shut at all times. I'll open the curtains so that you don't feel so closed in." B) "I'll keep the door open for you, but please try to avoid moving around the room too much." C) "I can open your door if you wear this mask." D) "I can open your door, but I'll have to come back and close it in a few minutes."
A
An adult patient in the ICU has a central venous catheter in place. Over the past 24 hours, the patient has developed signs and symptoms that are suggestive of a central line associated bloodstream infection (CLABSI). What aspect of the patient's care may have increased susceptibility to CLABSI? A) The patient's central line was placed in the femoral vein. B) The patient had blood cultures drawn from the central line. C) The patient was treated for vancomycin-resistant enterococcus (VRE) during a previous admission. D) The patient has received antibiotics and IV fluids through the same line.
A
An infectious outbreak of unknown origin has occurred in a long-term care facility. The nurse who oversees care at the facility should report the outbreak to what organization? A) Centers for Disease Control and Prevention (CDC) B) American Medical Association (AMA) C) Environmental Protection Agency (EPA) D) American Nurses Association (ANA)
A
During a health education session, a participant asks the nurse how a vaccine can protect from future exposures to diseases against which she is vaccinated. What would be the nurse's best response? A) The vaccine causes an antibody response in the body. B) The vaccine responds to an infection in the body after it occurs. C) The vaccine is similar to an antibiotic that is used to treat an infection. D) The vaccine actively attacks the microorganism.
A
Family members are caring for a patient with HIV in the patient's home. What should the nurse encourage family members to do to reduce the risk of infection transmission? A) Use caution when shaving the patient. B) Use separate dishes for the patient and family members. C) Use separate bed linens for the patient. D) Disinfect the patient's bedclothes regularly.
A
The nurse places a patient in isolation. Isolation techniques have the potential to break the chain of infection by interfering with what component of the chain of infection? A) Mode of transmission B) Agent C) Susceptible host D) Portal of entry
A
The nurse who provides care at a wilderness camp is teaching staff members about measures that reduce campers' and workers' risks of developing Giardia infections. The nurse should emphasize which of the following practices? A) Making sure not to drink water that has not been purified B) Avoiding the consumption of wild berries C) Removing ticks safely and promptly D) Using mosquito repellant consistently
A
The nurse who is leading a wellness workshop has been asked about actions to reduce the risk of bladder cancer. What health promotion action most directly addresses a major risk factor for bladder cancer? A) Smoking cessation B) Reduction of alcohol intake C) Maintenance of a diet high in vitamins and nutrients D) Vitamin D supplementation
A (People who smoke develop bladder cancer twice as often as those who do not smoke. High alcohol intake and low vitamin intake are not noted to contribute to bladder cancer.)
Community Health Program Planning, Development, Management
-Preplan: brainstorm ideas, gain entry into community and trust, obtain awareness, coordinate collaborations -Assessment: collect data about community and members, complete a needs assessment, strengths and weaknesses, evaluate health data -Diagnosis: identify and prioritize health needs of community -Planning: develop interventions to meet identified outcomes -Implementation: carry out the plan -Evaluation: examine success of intervention (strengths and weaknesses, achievement, recommendations, share findings)
Environmental Health Nursing Interventions
-Primary: educate on reducing hazards, adovate for safe water and air, support programs for waste reduction -Secondary: survey for health conditions related to enviro, obtain enviro health history, monitor for chem exposure, screen kids 6 months - 5 years for blood lead levels. assess homes, schools, work sites, community -Tertiary: refer home owners to lead abatement resources, educate asthmatic clients about enviro triggers, become active in consumer and health orgs, support cleanup of toxic waste sites
Epidemiological Triangle
-relationships among an agent, host and environment. interaction determines development and cessation of communicable diseases, forming a web which increases or decreases the risk for disease HOST: age, gender, genetics, ethnicity, immune status, physiological state, occupation AGENT: chemical (drugs, toxins), physical (noise, temperature), infectious agents (viruses, bacteria) ENVIRONMENT: geography, water/ food supply, presence of reservoirs, access to health care, high risk working conditions, poverty
Application of ethical principles to community health
-respect for autonomy: individuals select actions that fulfill their goals -nonmaleficience: no harm is done when applying care -beneficience: maximize possible benefits and minimize possible harms, assess risks and benefits when planning interventions -distributive justice: fair distribution of benefits and burden in society based on needs and contributions of its members
Secondary Data
-use of existing data to assess problem (census, healt records, prior health surveys) -ability to trend health issues over times -data may not rep current situation, can be time consuming
The nurse is assessing a patient admitted with renal stones. During the admission assessment, what parameters would be priorities for the nurse to address? Select all that apply. A) Dietary history B) Family history of renal stones C) Medication history D) Surgical history E) Vaccination history
A,B,C (Dietary and medication histories and family history of renal stones are obtained to identify factors predisposing the patient to stone formation. When caring for a patient with renal stones it would not normally be a priority to assess the vaccination history or surgical history, since these factors are not usually related to the etiology of kidney stones.)
A 2-year-old is brought to the clinic by her mother who tells the nurse her daughter has diarrhea and the child is complaining of pain in her stomach. The mother says that the little girl had not eaten anything unusual, consuming homemade chicken strips and carrot sticks the evening prior. Which bacterial infection would the nurse suspect this little girl of contracting? A) Escherichia coli B) Salmonella C) Shigella D) Giardia lamblia
B
A male patient with gonorrhea asks the nurse how he can reduce his risk of contracting another sexually transmitted infection. The patient is not in a monogamous relationship. The nurse should instruct the patient to do which of the following? A) Ask all potential sexual partners if they have a sexually transmitted disease. B) Wear a condom every time he has intercourse. C) Consider intercourse to be risk-free if his partner has no visible discharge, lesions, or rashes. D) Aim to limit the number of sexual partners to fewer than five over his lifetime.
B
A nurse is caring for a child who was admitted to the pediatric unit with infectious diarrhea. The nurse should be alert to what assessment finding as an indicator of dehydration? A) Labile BP B) Weak pulse C) Fever D) Diaphoresis
B
A patient has a concentration of S. aureus located on his skin. The patient is not showing signs of increased temperature, redness, or pain at the site. The nurse is aware that this is a sign of a microorganism at which of the following stages? A) Infection B) Colonization C) Disease D) Bacteremia
B
A patient is admitted from the ED diagnosed with Neisseria meningitides. What type of isolation precautions should the nurse institute? A) Contact precautions B) Droplet precautions C) Airborne precautions D) Observation precautions
B
A patient is alarmed that she has tested positive for MRSA following culture testing during her admission to the hospital. What should the nurse teach the patient about this diagnostic finding? A) "There are promising treatments for MRSA, so this is no cause for serious concern." B) "This doesn't mean that you have an infection; it shows that the bacteria live on one of your skin surfaces." C) "The vast majority of patients in the hospital test positive for MRSA, but the infection doesn't normally cause serious symptoms." D) "This finding is only preliminary, and your doctor will likely order further testing."
B
A public health nurse is teaching a mother about vaccinations prior to obtaining informed consent for her child's vaccination. What should the nurse cite as the most common adverse effect of vaccinations? A) Temporary sensitivity to the sun B) Allergic reactions to the antigen or carrier solution C) Nausea and vomiting D) Joint pain near the injection site
B
A student nurse completing a preceptorship is reviewing the use of standard precautions. Which of the following practices is most consistent with standard precautions? A) Wearing a mask and gown when starting an IV line B) Washing hands immediately after removing gloves C) Recapping all needles promptly after use to prevent needlestick injuries D) Double-gloving when working with a patient who has a blood-borne illness
B
An older adult patient tells the nurse that she had chicken pox as a child and is eager to be vaccinated against shingles. What should the nurse teach the patient about this vaccine? A) Vaccination against shingles is contraindicated in patients over the age of 80. B) Vaccination can reduce her risk of shingles by approximately 50%. C) Vaccination against shingles involves a series of three injections over the course of 6 months. D) Vaccination against shingles is only effective if preceded by a childhood varicella vaccination.
B
What is the best rationale for health care providers receiving the influenza vaccination on a yearly basis? A) To decreased nurses' susceptibility to health care-associated infections B) To decrease risk of transmission to vulnerable patients C) To eventually eradicate the influenza virus in the United States D) To prevent the emergence of drug-resistant strains of the influenza virus
B
The nurse educator is discussing emerging diseases with a group of nurses. The educator should cite what causes of emerging diseases? Select all that apply. A) Progressive weakening of human immune systems B) Use of extended-spectrum antibiotics C) Population movements D) Increased global travel E) Globalization of food supplies
B,C,D,E
Health Belief Model
predict or explain health behaviors -assumes that preventive health behaviors are taken primarily for the purpose of avoiding disease -emphasizes change at individual level -describes likelihood of taking an action to avoid disease based on: susceptibility, seriousness, threat of disease -modifying factors, cues to actions, perceived benefits minus perceived barriers to taking action
Ethical Considerations
prevent harm, promote good, respect individual and community rights, autonomy and diversity, promote confidentiality, competency, trustworthiness, advovacy -protect, promote, preserve and maintain good and prevent harm -balance indivdual rights vs. community groups -address challenges of autonomy and provide ethical care. right to info disclosure, privacy and informed consent, info confidentiality and participate in treatmnet decisions
Primary prevention
prevention of initial occurence of disease or injury. nutrition education, family planning and sex ed, smoking cessation education, communicable disease education, health and hygiene issues, safety education, prenatal classes, providing immunizations, advocating for access to health care, healthy environments
Occupational Health Nurse Role
primary prevention: teach good nutrition, provide immunization information, use protective equipment -secondary prevention: identify workplace hazards, early detection, prompt treatment, counsel and referral, prevent further limits -tertiary: restore health through rehab and strategies and limited duty programs
Bioterrorism Levels of Prevention
primary: prep with bioterrorism drill, vaccine, antibiotics, design plan, identify chain of command, nursing roles, protocol -secondary: recognize, activate response, implement infect control, screen population, assist with education on managmenet, monitor mortality and morbidity -tertiary:rehab survivors, monitor meds, evaluate effectiveness
Strategies for Improving Mental Health
primary: support, educate about mental health issues, teach stress reduction, parenting classes, coping abilities second: screen to detect disorder, crisis intervention tertiary: med monitoring, mental health intervention, referrals, maintain level of function to prevent relapse, assist in planning a regular lifestyle
Levels of Prevention in School Nursing
primary; assess knowledge regarding health issues (hand hygiene, healthy food choices, injury prevention, substance dependency), immunization status of children -secondary: assess children who become ill or injured at school, assess during emergencies, perform screening for early deterction of disease (vision and hearing, height and weight, oral health, scoliosis, infestations, general physical exams) assess children to detect child abuses or neglect, assess for evidence of mental illness, suicide and violence -tertiary: assess children with disabilities, assess children w long term health needs at school (provide care for disorders) e
Community Health Diagnoses
probs identified by community assessments -incorporate info from community assessment, general nursing knowledge and epidemiological concepts
Cultural Imposition
process of forcing ones cultural beliefs on others
Occupational Health Nurse
promote health and prevent occupational injury and illness -improve workplace, expenditure decreased by less sick time use, fewer worker compensation claims, decreased use of group health coverage -cost effective and high quality care: partner with hygenists, safety specialists, occupational medicine, HR< union reps and health insurance -assess risk for work related injury, plan and delivery health and safety services in the workplace, facilitate health promotion activities that lead to a more productive workforce -Obtain occupational health history: current and past jobs, exposure, underlying illness, previous injuries, healthy or unhealthy habits -work site walk though: observation of process and materials, job requirements, actual and potential hazards, employees -control strategies to reduce exposure based on work related injury or illness (engineering, altering work practices, PPE, workplace monitoring, health screening, employee assistance, job task) -protection from violence and work related injuries from falls, environmental hazards, burns -occupational health and legislations (OSHA, NACOSH, workers comp)
Case Management
promoting services and client family involvement, decreasing cost, providing education, advocating for services collaboration, communication skills -assess: clarify problem by evaluating physical, psychosocial, functional and financial needs -diagnose: determine cause and factors: -planning: prioritize probs, possible outcome,s advantages, role of participants, impact on client -implementation: contact service providers, referrals, coordinate services -evaluation: montiro client and agencies comparing projected outcomes, needs, satisfaction
Foundations of Community Health Nursing
provide the basis for care of the community and family. principles guide nurses in providing high quality care.
National Health Care Goals
reduce toxic air, waterborne disease, domestic water use, blood lead levels in kids, pesticide exposure, indoor allergens, homes with lead based paint, exposure to chem and pollutants, number of new schools near highways, global burden of disease d/t enviro concerns increase: alternate mode of transportation, days that beaches are open and safe for swimming, recycling of waste, testing for lead based paint in 1978 housing, monitor for disease or conditions caused by enviro hazards, homes with radon mitigation, schools with practices to promote health/ safety
Referrrals
restoring, maintaining or promoting health. linking client with community and self care measures -health care services: physicians, acute care, primary care, health departments, ling term, home care, rehab, PT< OT, specialty services, pharmacy -support: psych, church, support groups, life care planner, med equipment provider, meal delivery, transportation -engage in a relationship, establish referral, resources, accept decision to use a resource, facilitate referral, evaluate outcome -BARRIERS: lack of motivation, inadequate info or understanding, accessibility, priorities, finances, culture. attitudes of healt hcare personnel, cost, physical accessibility, time limitiations, limited expertise
Consultations
someone with knowledge who provides expert advice -initiate consult, seek expertise, request opinions, incorporate recommendations, serve as expert
Surveys
specific questions in written format. data collected on client population and problems, random sampling, available as written or online format, contact with participants not required -limit: low response rate, expensive, time consuming, superficial data, reading/ writing needed
Epidemiology
study of health related trends in population for the purpose of disease prevention, health maintenance and health promotion -relies on statistics to determine rate of spread of disease, people affected, effectiveness of prevention and health promotion, goals met -spread, transmission and incidence of disease and injury -nurses are in a position of identifying cases, recognizing disease paterns, eliminate barriers, provide education targeted at disease or risk factors -study of relationships among an agent, host and environment --> agent is the cause of disease, host is the living being, environment is the setting of host
Prevention and Control of Communicable Disease
systematic collection and analysis of data regarding infectious disease -nationally notifiable disease: anthrax, botulism, cholera, diphtheria, giardiasis, gonorrhea, hep a-c, hiv, flu, legionnaires, lyme, malaria, meningitis, mumps, pertussis, polio,rabies, rubella, salmonella, SARs, shigella, smallpox, syphilis, tetanus, TB, typhoid fever, vanco GOALS: reduce infection transmitted through food, HIV, aids, deaths from HIV, vaccine preventable disease, antibiotic courses for ear infections -increase in consumers with food safety, surviving >3 yrs with aids, TB testing for HIV, HIV education, condom use, immunization and flu shots, shingles immunizations
Ethnocentrism
tendency of people to view the world from the perspective of their own cultural background and viewpoint
Principalism
the dominant approach to ethical decision making. principles of respect for autonomy, nonmaleficience, beneficience & distributive justice
Morality
the principle of right & wrong based on social and generational experiences
Environmental Risks
toxins (lead, pesticieds, mercury, solvents, asbestos, radon) -air pollution -water pollution
Ch 7: Continuity of Care
transition from inpatient to outpatient. use technology to maintain care. partnerships essential in improving health. among individuals, families, community agencies, citizen groups -partnering entities: individual, family, community agency, civic organization, citizen group, educational setting, political office, employment bureau -successful parternship: shared power and goals, integrity, flexibility, negotiation
Homelessness
unemployed, low wage, migrant workers, female heads of house, families with children, people with mental illness, veterans, substance use and addictive disorders, unaccompanied youth, runaways, intimate partner violence abuse, HIV/AIDs, older adults with no place to go -health issues: upper resp disorders, TB, skin disorders, substance use disorders, HIV/ AIDS, trauma, mental illness, dental caries, hypothermia, malnutrition
Learning styles
visual: learn through seeing, not taking, video viewing, presentations -auditoy: listening, verbal lectures, discussion, reading outloud, interpret meaning while listening -tactile-kinesthetic learners: learn through doing, trial and error, hands on approaches, return demonstrations
Using and Interpreter
when a nurse or client cant understand the others language. -knowledge of health terms. family members as interpreters not advisable -consider client preferences. shouldnt be from same community as client -teaching materials in clients language
Faith Community Nurse
works with clients who share common faith traditions. practices that are important to health and healing. -caring and spirituality, CIRCLE model of nursing (caring, intuition, respect for religion beliefs, caution, listening, emotional support Missionary nurse: promote health and disease prevention by meeting spiritual, physical and emotional needs of people across the globe. -Parish nurse; promote health and wellness of faith communities (church members) & individuals. work closely with pastoral care staff, professional health care members to provide holistic approach
Communicable Disease
worldwide communicable disease is responsible for the deaths of millions each year. -leading causes: acute respiratory infections, AIDS, diarrheal disease, TB, measles, malaria POP at risk: young children, older adults, immunosuppressed clients, high risk lifestyle, international travelers, health care workers e -CDC reccomends immunizations
Medicare and Medicaid
Medicare: 65 and older, social security, disability for 2 yrs, ALS, kidney failure, kidney transplant or dialysis. includes hospital care, home care, limited skilled nursing. medical care, diagnostics, physiotherapy. private insurance. prescription drug coverage Medicarid: low socioeconomic status and children (federal and state gov funds). based on household size, income (priority to pregnant women, children, disability). inpatient & outpatient services, radiology, labs, home care, vaccines, family planning ,early and periodic screening, diagnosis, treatment <21
Strategies to Reduce Societal Violence
PRIMARY: conflict resolution, anger management, parenting classes, ed about comunity services, ensure safe environment for elderly, assist in removing factors that contribute to stress by referring to caretaker of older adult clients, elderly safe guard funds, DPOA SECONDARY: screen at risk individuals, assess bruises, screen all pregnant, refer victims to ED, assess suicide contemplation, suprport offender, address stressor TERTIARY: establish long term follow up, make resources in community available, refer to mental health, grief counsel, support groups
Strategies for Rural and Migrant Health Care
PRIMARY: education about pesticide exposure, accident prevention, prenatal care, dental and immunization prevention -SECONDARY: screen for pesticide exposure, skin cancer, chronic disease, communicable disease TERTIARY: treat for pesticide exposure, mobilize primary care and emergency service
Strategies to Reduce Substance Use Disorders
PRIMARY: increase public awareness, encourage development of life skills SECONDARY: identify at risk individuals to reduce sources of stress, screen for substance use TERTIARY: assist with developing a plan to avoid high risk situations, refer to community groups (AA), monitor phar, emotional support
Epidemiological Process
Phases: determine nature, extent and significance of the problem --> using data, formulate a theory --> gather information from a variety of sources to narrow possibilities --> make the plan --> put the plan into action --> eval the plan --> report and follow up
Levels of Communicable Disease Prevention
Primary: prevent disease spread, education on immunization, travel to other countries, hand hygiene and precautions Secondary: increase screening and case finding, refer cases for diagnostic findings, provide post exposure prophylaxis, quarantine clients Tertiary: decrease complications and disabilities of disease, monitor treatment, identify community resources
Strategies for and Barriers to Implementing Community Health Programs
Strategies: thorough assessment, interpret data, collaborate, commuicate, sufficient resources, logical planning, skilled leadership -Barriers: inadequate assessment, miconstrued data, no involvement in community partners, impaired communication, inadequate resource, lack of planning, poor leadership
CH 5: Care of Special Populations
Vulnerable populations: subject to violence, substance use disorders, mental health issues, homelessness, rural and migrant health -factors: poverty, dif acccess healthcare, young or advanced age, chronic stress, environmental factors GOALS: increase number of people with PCP, with health insurance, reduce those with delay in health and prescribed meds
Culture Assessment
effect of culture on communication, space and physical contact, time, social organization, enviro control factors -assess: ethnic background, religious preferences, family structure, language, communication needs, education, cultural values, food patterns, health practices -3 steps of data collection: ethnic background, religious pref, family structure, food patterns, health practice. ask qs that access clients perception of health needs. identify how culture may impact nursing
Hospice Nurse
enhance quality of life through palliative care, supporting client and family through dying process, providing bereavement support to family after death -home, hospice center, hospital, long term care -not aimed toward cure. relief of pain and suffering -care for entire family -interprofesional approach, control symptoms, directed by provider, managed by nurse, volunteer for nonmedical care, postmortem bereavement, help family transition from recovery to acceptance of death
Principles of Community Health Nursing
ethical considerations, advocacy, epidemiology, calculations, edimiological triangle, epidemiologcal process, community based health education
Deontology
ethical theory based on the idea that actions are based on moral rules or duties regardless of the consequences
Disasters
event causing human suffering and demands more resources than available to community. man made, naturally occurring, combingation -Disaster PREVENTION: surveillance, airport security, public health immunization and quarantine, flood barriers, demographic, identify and assess at risk populations -Disaster PREP: national state and local lev. coordinate community efforts, prep for disaster, action plan, disasiter kit, meeting place, communication protocol, drills -Disaster RESPONSE: federal emergency management, CDC, homeland security, red cross, public helath. assess disaster, number affected, fresh water and food, sanitation -Disaster RECOVERY: when danger no longer exists. until economic and civil life is restored, sanitation control, PTSD common.reactions: heroic, honeymoon, disillusionment, reconstruction
Community Oriented Nursing
focus on at risk individuals, families, groups and community nursing: health care to determine health needs of a community and intervene at the individual, family and group level to improve the collective health of the community
Public Health Nursing Practice
focus same as community health nursing -nursing to promote preserve and maintain the health of population through disease and disability prevention and health protection of community as a whole -core functions: systematic assessment of the health of population, develop policies to support the health of populations, ensure that essential health services are avialbale to all
Community Based Nursing
focus: individuals and families. -nursing is illness care: manage acute and chronic conditions in setting where individuals, families and groups live work and attend (schools, camps, prisons)
Community Health Nursing Practice
focus: synthesis of nursing and public health theory -nursing to promote, preserve and maintain the health of populations by the delivery of health services to individuals, families and groups in order to impact community health
Analysis of Community Assessment Data
gathering collected data into composite database, assessing completeness of data, identifying and generating missing data, synthesizing data and identifying themes, identifying community needs and problems, identifying community strengths and resources
Coordinated School Health programs
health education, physical education, health services, nutrition services, counseling, psych and social services, promote health for staff, facilitate family and community involvement
Defense Mechanisms
herd immunity: protection due to immunity of community members making exposure unlikely -Natural immunity: natural mechanisms of the body to resist specific antigens -acquired: develops through exposure --> active: product antibodies in response to infection. passive: transfer antibodies to host from mom to baby, Ig, plasma protein or antitoxins
Nightingales theory of environment
highlights relationship between individuals environment and health -depicts health as a continuum -emphasizes preventive care
A clinic nurse is caring for a male patient diagnosed with gonorrhea who has been prescribed ceftriaxone and doxycycline. The patient asks why he is receiving two antibiotics. What is the nurse's best response? A) "There are many drug-resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment." B) "The combination of these two antibiotics reduces the later risk of reinfection." C) "Many people infected with gonorrhea are infected with chlamydia as well." D) "This combination of medications will eradicate the infection twice as fast than a single antibiotic."
C
A long-term care facility is the site of an outbreak of infectious diarrhea. The nurse educator has emphasized the importance of hand hygiene to staff members. The use of alcohol-based cleansers may be ineffective if the causative microorganism is identified as what? A) Shigella B) Escherichia coli C) Clostridium difficile D) Norovirus
C
A mother brings her 12 month-old son into the clinic for his measles-mumps-rubella (MMR) vaccination. What would the clinic nurse advise the mother about the MMR vaccine? A) Photophobia and hives might occur. B) There are no documented reactions to an MMR. C) Fever and hypersensitivity reaction might occur. D) Hypothermia might occur.
C
A nurse is preparing to administer a patient's scheduled dose of subcutaneous heparin. To reduce the risk of needlestick injury, the nurse should perform what action? A) Recap the needle before leaving the bedside. B) Recap the needle immediately before leaving the room. C) Avoid recapping the needle before disposing of it. D) Wear gloves when administering the injection.
C
A patient's diagnostic testing revealed that he is colonized with vancomycin-resistant enterococcus (VRE). What change in the patient's health status could precipitate an infection? A) Use of a narrow-spectrum antibiotic B) Treatment of a concurrent infection using vancomycin C) Development of a skin break D) Persistent contact of the bacteria with skin surfaces
C
A public health nurse promoting the annual influenza vaccination is focusing health promotion efforts on the populations most vulnerable to death from influenza. The nurse should focus on which of the following groups? A) Preschool-aged children B) Adults with diabetes and/or renal failure C) Older adults with compromised health status D) Infants under the age of 12 months
C
An immunosuppressed patient is receiving chemotherapy treatment at home. What infection-control measure should the nurse recommend to the family? A) Family members should avoid receiving vaccinations until the patient has recovered from his or her illness. B) Wipe down hard surfaces with a dilute bleach solution once per day. C) Maintain cleanliness in the home, but recognize that the home does not need to be sterile. D) Avoid physical contact with the patient unless absolutely necessary.
C
The infectious control nurse is presenting a program on West Nile virus for a local community group. To reduce the incidence of this disease, the nurse should recommend what action? A) Covering open wounds at all times B) Vigilant handwashing in home and work settings C) Consistent use of mosquito repellants D) Annual vaccination
C
The nurse is caring for a patient who is colonized with methicillin-resistant Staphylococcus aureus (MRSA). What infection control measure has the greatest potential to reduce transmission of MRSA and other nosocomial pathogens in a health care setting? A) Using antibacterial soap when bathing patients with MRSA B) Conducting culture surveys on a regularly scheduled basis C) Performing hand hygiene before and after contact with every patient D) Using aseptic housekeeping practices for environmental cleaning
C
The nurse is providing care for an older adult patient who has developed signs and symptoms of Calicivirus (Norovirus). What assessment should the nurse prioritize when planning this patient's care? A) Respiratory status B) Pain C) Fluid intake and output D) Deep tendon reflexes and neurological status
C
When a disease infects a host a portal of entry is needed for an organism to gain access. What has been identified as the portal of entry for tuberculosis? A) Integumentary system B) Urinary system C) Respiratory system D) Gastrointestinal system
C
A patient has been admitted to the postsurgical unit following the creation of an ileal conduit. What should the nurse measure to determine the size of the appliance needed? A) The circumference of the stoma B) The narrowest part of the stoma C) The widest part of the stoma D) Half the width of the stoma
C ( The correct appliance size is determined by measuring the widest part of the stoma with a ruler. The permanent appliance should be no more than 1.6 mm (1/8 inch) larger than the diameter of the stoma and the same shape as the stoma to prevent contact of the skin with drainage.)
An older adult patient has been diagnosed with Legionella infection. When planning this patient's care, the nurse should prioritize which of the following nursing actions? A) Monitoring for evidence of skin breakdown B) Emotional support and promotion of coping C) Assessment for signs of internal hemorrhage D) Vigilant monitoring of respiratory status
D
The nurse is caring for a patient with secondary syphilis. What intervention should the nurse institute when caring for this patient? A) Ensure that the patient is housed in a private room. B) Administer hydrocortisone ointment to the lesions as ordered. C) Administer combination therapy with antiretrovirals as ordered. D) Wear gloves if contact with lesions is possible.
D
The nurse receives a phone call from a clinic patient who experienced fever and slight dyspnea several hours after receiving the pneumococcus vaccine. What is the nurse's most appropriate action? A) Instruct the patient to call 911. B) Inform the patient that this is an expected response to vaccination. C) Encourage the patient to take NSAIDs until symptoms are relieved. D) Ensure that the adverse reaction is reported.
D
A female patient's most recent urinalysis results are suggestive of bacteriuria. When assessing this patient, the nurse's data analysis should be informed by what principle? A) Most UTIs in female patients are caused by viruses and do not cause obvious symptoms. B) A diagnosis of bacteriuria requires three consecutive positive results. C) Urine contains varying levels of healthy bacterial flora. D) Urine samples are frequently contaminated by bacteria normally present in the urethral area.
D ( Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 105 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.)
A patient is postoperative day 3 following the creation of an ileal conduit for the treatment of invasive bladder cancer. The patient is quickly learning to self-manage the urinary diversion, but expresses concern about the presence of mucus in the urine. What is the nurse's most appropriate response? A) Report this finding promptly to the primary care provider. B) Obtain a sterile urine sample and send it for culture. C) Obtain a urine sample and check it for pH. D) Reassure the patient that this is an expected phenomenon.
D (Because mucous membrane is used in forming the conduit, the patient may excrete a large amount of mucus mixed with urine. This causes anxiety in many patients. To help relieve this anxiety, the nurse reassures the patient that this is a normal occurrence after an ileal conduit procedure. Urine testing for culture or pH is not required.)
An older adult has experienced a new onset of urinary incontinence and family members identify this problem as being unprecedented. When assessing the patient for factors that may have contributed to incontinence, the nurse should prioritize what assessment? A) Reviewing the patient's 24-hour food recall for changes in diet B) Assessing for recent contact with individuals who have UTIs C) Assessing for changes in the patient's level of psychosocial stress D) Reviewing the patient's medication administration record for recent changes
D (Many medications affect urinary continence in addition to causing other unwanted or unexpected effects. Stress and dietary changes could potentially affect the patient's continence, but medications are more frequently causative of incontinence. UTIs can cause incontinence, but these infections do not result from contact with infected individuals.)
A nurse's colleague has applied an incontinence pad to an older adult patient who has experienced occasional episodes of functional incontinence. What principle should guide the nurse's management of urinary incontinence in older adults? A) Diuretics should be promptly discontinued when an older adult experiences incontinence. B) Restricting fluid intake is recommended for older adults experiencing incontinence. C) Urinary catheterization is a first-line treatment for incontinence in older adults with incontinence. D) Urinary incontinence is not considered a normal consequence of aging.
D (Nursing management is based on the premise that incontinence is not inevitable with illness or aging and that it is often reversible and treatable. Diuretics cannot always be safely discontinued. Fluid restriction and catheterization are not considered to be safe, first-line interventions for the treatment of incontinence.)
A patient being treated in the hospital has been experiencing occasional urinary retention. What nursing action should the nurse take to encourage a patient who is having difficulty voiding? A) Use a slipper bedpan. B) Apply a cold compress to the perineum. C) Have the patient lie in a supine position. D) Provide privacy for the patient.
D (Nursing measures to encourage normal voiding patterns include providing privacy, ensuring an environment and body position conducive to voiding, and assisting the patient with the use of the bathroom or bedside commode, rather than a bedpan, to provide a more natural setting for voiding. Most people find supine positioning not conducive to voiding.)
A gerontologic nurse is assessing a patient who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply. A) Food cravings B) Upper abdominal pain C) Insatiable thirst D) Uncharacteristic fatigue E) New onset of confusion
D (The most common subjective presenting symptom of UTI in older adults is generalized fatigue. The most common objective finding is a change in cognitive functioning. Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none is directly suggestive of a UTI.)
Factors Affecting Susceptibility to Illness and Injury
Host factor: worker characteritics (experience, age, pregnancy) -agent factors: biological agents, chemical agents, mechanical agents, physical agents, psych agents -Environmental factors: physical factors, social factors, psych factors
Assessment of Environmental Health
I PREPARE to determine exposure -I: investigate potential exposures -P: present work (exposure, PPE, location of material safety data sheets, home exposure, trends) -R: Residence -E: Enviro concerns (water, air, soil, waste) -P: Past work (exposure, farm, military, volunteer) -A: Activities (hobbies, gardening, fishing, hunting, burning) -R: Referrals and resources -E: Educate (risk reduction ,prevention)
Rural and Migrant Health
Rural Residents: higher infant and maternal morbidity rates & diabetes, obesity, less likely to be phys active, higher suicide. increased injuries, increased occupational risks, less likely to seek prev care -barriers: distance, lack of transportation, unpredictable weather, inability to pay for care, shortage of rural hospitals -migrant worker health probs: dental disease, TB, chronic conditions, stress, anxiety, leukemia, anemia, cancers, lack of prenatal care, higher infant mortality
Health Care Orgs and Financing
-WORLD health org: provides infor about international disease, standards for vaccines and antibiotics. focus on health care workforce and education, environment, sanitation, infectious disease, maternal and child health -FEDERAL health agencies: US department of HHS, funded through taxes, includes admin for children and families, admin for community living, medicaid and medicare -agency for healthcare research and quality -CDC to prevent and control disease -agency for toxic substances and disease -FDA -Health resources and service admin -indian health services -national institute of health (biomedical research) -substance abuse and mental health services -veterans health admin to finance military persons -STATE HEALTH: manages WIC programs, children health insurance program, public health policies, assists local health dep, state board of nursing to oversee nurse practice act, licensure, states school of nursing -LOCAL HEALTH: health of citizens, identify community needs, report disease to state, local tax funding. office of emergency management responsible for emergency response plan -PRIVATE health: health insurance, employer benefits, managed care (HMOs, preferred provider orgs, medical savings)
Community Assessment: Individual, Family, Aggregates
-approach to emphasize community as a client, foundation for program planning -nurse helps to develop and implement strategies. assesses needs of community by interacting with community partners, witnessing interaction between community programs and response of clients to services, identifying future services based on visible needs of community members Community assessment includes: people (demographic, biologic factors, social factors, cultural factors -place or environment: physical factors, enviro factors -social systems: health, economic, education, religious, welfate, political, recreational, legal, communication, transportation, resources and services
Cultural competence: areas for self assessment
-aware of culture and view of others, cultural sensitive assessment, knowledge to develop culturally appropriate nursing interventions, goal in learning about diverse population
Learning Theories in Community Health
-behavioral: reinforcement methods to change learners behaviors -cognitive: use sensory input and repetition to change learners patterns of thoughts and behaviors -critical theory: use ongoing discussion and inquiry to increase learners depth of knowledge and change thinking and behaviors -developmental theory: use techniques specific to learners developmental stages to determine readiness to learn and impart knowledge -humanistic theory: assist learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest -social learning: links info to beliefs and values to change or shift the learners expectations
Aggregates of the Community
-children and adolescent: health concerns, screening/ prevention, national health goals, community education -women: reproductive health, heart disease, diabetes, malignant neoplasm. screening for height and weight, blood pressure, cholesterol, dental health, pap, mammograms, sigmoidoscopy, vaccinations, immunizations, diabetes, HIB, skin cancer. reduction in osteoporosis, cancer, sexual violence. increase in planned pregnancies, prenatal care, breastfeeding, early warning signs of stroke -men: heart disease, malignant neoplasm, unintentional injury, lung disease, liver disease. screening for height and weight, BP, dental health, digital rectal exam, sigmoidoscopy, immunizations, diabetes, HIV, skin cancer, cholesterol. reduce cancer deaths, HIV and aids, fatal injuries. fincrease in muscle strengthening activities, identifying warning signs of stroke -older adults: heart disease, cancer, stroke, COPD, pneumonia, flu, substance use. screeen blood pressure, height and weight, dental health, sigmoidoscopy, mammogram, pap smear, vision, hearing, substance use, immunization, functional assessments, meds, osteoporsosi, diabetes, skin cancer
Windshield Survey
-descriptive approach assessing several community components by driving through a community -descriptive overview of community: people, place, natural environment, boundaries, location of health services, man made environment, housing, social systems -need a driver, may be time consuming, only based on visual
Roles for Nurse in Environmental Health
-facilitate public participation, perform individual and population risk assessments, implement risk communication, conduct epidemiological investigations, participate in policy development
Chapter 2: Factors Influencing Community Health
-family,culture, social and environmental factors, access to health care, financing -culture is the beliefs, values, attitudes and behviors shared by a group of people and transmitted -enviro health refers to influence of environment conditions of development of disease -access to care impacted by availability of services in a community, individual, family and community
Develop Community Health Education Plan
-identify population specific learning need -consider specific concerns and effect of health needs on population -select aspects of learning theories to use in educational program based on identified learning needs -identify barriers to learning and learning styles -design educational program: short and long term learning objectives, select apprpriate educational method based on learning objectives and assessment of participants learning style , content appropriate to objective, eval method -implement program -evaluate
Epidemiological calculation
-incidence: number new cases in population at a time/ population total x 1000 -prevalnce: number of existin cases in the population ata time / population total x 1000 -crude mortality rate: number of deaths / population total x 1000 -infant mortality rate: number of infants deaths before 1 year of age / number live births in same year x1000 -attack rate: number of people exposed to an agent who develop disease / total number of people exposed
Tracheostomy Care
-leave old ties in place until new ones are secured -use clean technique to clean inner cannula if placed over a month ago -place thumb over suction port to suction -insert catheter 5 cm into trach tube
Health Promotion and disease prevention
-primary, secondary and tertiary -national health goals based on scientific data and trends -healthy people initiated in 1979 and every 10 years publishes national health objectives -coordinated by US department of health -national goals guide the nurse in developing health promotion strategies to improve individual and community health -community health nurse actively helps people change lives to move toward optimal health -preventive services: health education and counseling, immunizations, other actions -preventive services in multiple community settings -plan and implement screening for at risk
A 42-year-old woman comes to the clinic complaining of occasional urinary incontinence when she sneezes. The clinic nurse should recognize what type of incontinence? A) Stress incontinence B) Reflex incontinence C) Overflow incontinence D) Functional incontinence
A ( Stress incontinence is the involuntary loss of urine through an intact urethra as a result of sudden increase in intra-abdominal pressure. Reflex incontinence is loss of urine due to hyperreflexia or involuntary urethral relaxation in the absence of normal sensations usually associated with voiding. Overflow incontinence is an involuntary urine loss associated with overdistension of the bladder. Functional incontinence refers to those instances in which the function of the lower urinary tract is intact, but other factors (outside the urinary system) make it difficult or impossible for the patient to reach the toilet in time for voiding.)
A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patient's urine output hourly and notifies the physician when the hourly output is less than what? A) 30 mL B) 50 mL C) 100 mL D) 125 mL
A (A urine output below 30 mL/hr may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis.)
The nurse has tested the pH of urine from a patient's newly created ileal conduit and obtained a result of 6.8. What is the nurse's best response to this assessment finding? A) Obtain an order to increase the patient's dose of ascorbic acid. B) Administer IV sodium bicarbonate as ordered. C) Encourage the patient to drink at least 500 mL of water and retest in 3 hours. D) Irrigate the ileal conduit with a dilute citric acid solution as ordered.
A (Because severe alkaline encrustation can accumulate rapidly around the stoma, the urine pH is kept below 6.5 by administration of ascorbic acid by mouth. An increased pH may suggest a need to increase ascorbic acid dosing. This is not treated by administering bicarbonate or citric acid, nor by increasing fluid intake.)
The nurse is working with a patient who has been experiencing episodes of urinary retention. What assessment finding would suggest that the patient is experiencing retention? A) The patient's suprapubic region is dull on percussion. B) The patient is uncharacteristically drowsy. C) The patient claims to void large amounts of urine 2 to 3 times daily. D) The patient takes a beta adrenergic blocker for the treatment of hypertension.
A (Dullness on percussion of the suprapubic region is suggestive of urinary retention. Patients retaining urine are typically restless, not drowsy. A patient experiencing retention usually voids frequent, small amounts of urine and the use of beta-blockers is unrelated to urinary retention.)
A patient with kidney stones is scheduled for extracorporeal shock wave lithotripsy (ESWL). What should the nurse include in the patient's post-procedure care? A) Strain the patient's urine following the procedure. B) Administer a bolus of 500 mL normal saline following the procedure. C) Monitor the patient for fluid overload following the procedure. D) Insert a urinary catheter for 24 to 48 hours after the procedure.
A (Following ESWL, the nurse should strain the patient's urine for gravel or sand. There is no need to administer an IV bolus after the procedure and there is not a heightened risk of fluid overload. Catheter insertion is not normally indicated following ESWL.)
A patient is undergoing diagnostic testing for a suspected urinary obstruction. The nurse should know that incomplete emptying of the bladder due to bladder outlet obstruction can cause what? A) Hydronephrosis B) Nephritic syndrome C) Pylonephritis D) Nephrotoxicity
A (If voiding dysfunction goes undetected and untreated, the upper urinary system may become compromised. Chronic incomplete bladder emptying from poor detrusor pressure results in recurrent bladder infection. Incomplete bladder emptying due to bladder outlet obstruction, causing high-pressure detrusor contractions, can result in hydronephrosis from the high detrusor pressure that radiates up the ureters to the renal pelvis. This problem does not normally cause nephritic syndrome or pyelonephritis. Nephrotoxicity results from chemical causes.)
The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patient's health education, what nutritional guidelines should the nurse provide? A) Restrict protein intake as ordered. B) Increase intake of potassium-rich foods. C) Follow a low-calcium diet. D) Encourage intake of food containing oxalates.
A (Protein is restricted to 60 g/d, while sodium is restricted to 3 to 4 g/d. Low-calcium diets are generally not recommended except for true absorptive hypercalciuria. The patient should avoid intake of oxalate-containing foods and there is no need to increase potassium intake.)
The nurse and urologist have both been unsuccessful in catheterizing a patient with a prostatic obstruction and a full bladder. What approach does the nurse anticipate the physician using to drain the patient's bladder? A) Insertion of a suprapubic catheter B) Scheduling the patient immediately for a prostatectomy C) Application of warm compresses to the perineum to assist with relaxation D) Medication administration to relax the bladder muscles and reattempting catheterization in 6 hours
A (When the patient cannot void, catheterization is used to prevent overdistention of the bladder. In the case of prostatic obstruction, attempts at catheterization by the urologist may not be successful, requiring insertion of a suprapubic catheter. A prostatectomy may be necessary, but would not be undertaken for the sole purpose of relieving a urethral obstruction. Delaying by applying compresses or administering medications could result in harm.)
A female patient has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the patient, the nurse should address what topic? A) The risk of developing a vaginal yeast infection as a consequent of antibiotic therapy B) The need to expect a heavy menstrual period following the course of antibiotics C) The risk of developing antibiotic resistance after the course of antibiotics D) The need to undergo a series of three urine cultures after the antibiotics have been completed
A (Yeast vaginitis occurs in as many as 25% of patients treated with antimicrobial agents that affect vaginal flora. Yeast vaginitis can cause more symptoms and be more difficult and costly to treat than the original UTI. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics.)
A nurse is participating in a vaccination clinic at the local public health clinic. The nurse is describing the public health benefits of vaccinations to participants. Vaccine programs addressing which of the following diseases have been deemed successful? Select all that apply. A) Polio B) Diphtheria C) Hepatitis D) Tuberculosis E) Pertussis
A,B,E
Transmission of Communicable Disease
AIRBORNE: measles, chickenpox, TB, pertussis, influenza FOODBORNE: salmonella, hep A, trichinosis, E coli staph, c dif WATERBORNE: (fecal contram of water) cholera, typhoid fever, bacillary dysentery, giardia VECTOR: lyme disease, rocky mountain spotted fever, malaria --> lyme appears as a erythematous ring with a white center, mild fever, fatigue, muscle aches DIRECT CONTACT: STI, mono, pinworm, impetigo, lice, scabies
The nurse has implemented a bladder retraining program for an older adult patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient typically has approximately 50 mL of urine remaining in her bladder after voiding. What would be the nurse's best response to this finding? A) Perform a straight catheterization on this patient. B) Avoid further interventions at this time, as this is an acceptable finding. C) Place an indwelling urinary catheter. D) Press on the patient's bladder in an attempt to encourage complete emptying.
B ( In adults older than 60 years of age, 50 to 100 mL of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. Consequently, further interventions are not likely warranted.)
A nurse on a busy medical unit provides care for many patients who require indwelling urinary catheters at some point during their hospital care. The nurse should recognize a heightened risk of injury associated with indwelling catheter use in which patient? A) A patient whose diagnosis of chronic kidney disease requires a fluid restriction B) A patient who has Alzheimer's disease and who is acutely agitated C) A patient who is on bed rest following a recent episode of venous thromboembolism D) A patient who has decreased mobility following a transmetatarsal amputation
B ( Patients who are confused and agitated risk trauma through the removal of an indwelling catheter which has the balloon still inflated. Recent VTE, amputation, and fluid restriction do not directly create a risk for injury or trauma associated with indwelling catheter use.)
The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day? A) 1,250 mL B) 2,000 mL C) 2,750 mL D) 3,500 mL
B ( Unless contraindicated by renal failure or hydronephrosis, patients with renal stones should drink at least eight 8-ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute. A urine output exceeding 2 L a day is advisable.)
A patient with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the patient's plan of care? A) Impaired physical mobility related to presence of an indwelling urinary catheter B) Risk for infection related to presence of an indwelling urinary catheter C) Toileting self-care deficit related to urinary catheterization D) Disturbed body image related to urinary catheterization
B (Catheters create a high risk for UTIs. Because of this acute physiologic threat, the patient's risk for infection is usually prioritized over functional and psychosocial diagnoses.)
The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs should the nurse cite? A) Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic. B) The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group. C) Men of all ages are less prone to UTIs, but typically experience more severe symptoms. D) The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs.
B (The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging. The prevalence of infection in men older than 50 years of age approaches that of women in the same age group. Men are not more likely to be asymptomatic and are not known to be reluctant to report UTIs.)
A nurse is caring for a female patient whose urinary retention has not responded to conservative treatment. When educating this patient about self-catheterization, the nurse should encourage what practice? A) Assuming a supine position for self-catheterization B) Using clean technique at home to catheterize C) Inserting the catheter 1 to 2 inches into the urethra D) Self-catheterizing every 2 hours at home
B (The patient may use a "clean" (nonsterile) technique at home, where the risk of cross-contamination is reduced. The average daytime clean intermittent catheterization schedule is every 4 to 6 hours and just before bedtime. The female patient assumes a Fowler's position and uses a mirror to help locate the urinary meatus. The nurse teaches her to catheterize herself by inserting a catheter 7.5 cm (3 inches) into the urethra, in a downward and backward direction.)
A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patient's discharge education, what is the most plausible nursing diagnosis that the nurse should address? A) Impaired mobility related to limitations posed by the ileal conduit B) Deficient knowledge related to care of the ileal conduit C) Risk for deficient fluid volume related to urinary diversion D) Risk for autonomic dysreflexia related to disruption of the sacral plexus
B (The patient will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.)
A patient has been successfully treated for kidney stones and is preparing for discharge. The nurse recognizes the risk of recurrence and has planned the patient's discharge education accordingly. What preventative measure should the nurse encourage the patient to adopt? A) Increasing intake of protein from plant sources B) Increasing fluid intake C) Adopting a high-calcium diet D) Eating several small meals each day
B (Increased fluid intake is encouraged to prevent the recurrence of kidney stones. Protein intake from all sources should be limited. Most patients do not require a low-calcium diet, but increased calcium intake would be contraindicated for all patients. Eating small, frequent meals does not influence the risk for recurrence.)
The clinic nurse is preparing a plan of care for a patient with a history of stress incontinence. What role will the nurse have in implementing a behavioral therapy approach? A) Provide medication teaching related to pseudoephedrine sulfate. B) Teach the patient to perform pelvic floor muscle exercises. C) Prepare the patient for an anterior vaginal repair procedure. D) Provide information on periurethral bulking.
B (Pelvic floor muscle exercises (sometimes called Kegel exercises) represent the cornerstone of behavioral intervention for addressing symptoms of stress, urge, and mixed incontinence. None of the other listed interventions has a behavioral approach.)
Resection of a patient's bladder tumor has been incomplete and the patient is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the patient, the nurse should emphasize the need to do which of the following? A) Remain NPO for 12 hours prior to the treatment. B) Hold the solution in the bladder for 2 hours before voiding. C) Drink the intravesical solution quickly and on an empty stomach. D) Avoid acidic foods and beverages until the full cycle of treatment is complete.
B (The patient is allowed to eat and drink before the instillation procedure. Once the bladder is full, the patient must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during treatment.)
A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? A) Administer prophylactic antibiotics as ordered. B) Limit the use of indwelling urinary catheters. C) Encourage frequent mobility and repositioning. D) Toilet residents who are immobile on a scheduled basis.
B (When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adult's risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally administered. Mobility does not have a direct effect on UTI risk.)
The nurse is caring for a patient who has undergone creation of a urinary diversion. Forty-eight hours postoperatively, the nurse's assessment reveals that the stoma is a dark purplish color. What is the nurse's most appropriate response? A) Document the presence of a healthy stoma. B) Assess the patient for further signs and symptoms of infection. C) Inform the primary care provider that the vascular supply may be compromised. D) Liaise with the wound-ostomy-continence (WOC) nurse because the ostomy appliance around the stoma may be too loose.
C (A healthy stoma is pink or red. A change from this normal color to a dark purplish color suggests that the vascular supply may be compromised. A loose ostomy appliance and infections do not cause a dark purplish stoma.)
A patient who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the patient? A) Remind the patient that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. B) Remind the patient that occasional febrile episodes are expected following ESWL. C) Tell the patient to report to the ED for further assessment. D) Tell the patient to monitor his temperature for the next 24 hours and then contact his urologist's office.
C (Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.)
A patient has had her indwelling urinary catheter removed after having it in place for 10 days during recovery from an acute illness. Two hours after removal of the catheter, the patient informs the nurse that she is experiencing urinary urgency resulting in several small-volume voids. What is the nurse's best response? A) Inform the patient that urgency and occasional incontinence are expected for the first few weeks post-removal. B) Obtain an order for a loop diuretic in order to enhance urine output and bladder function. C) Inform the patient that this is not unexpected in the short term and scan the patient's bladder following each void. D) Obtain an order to reinsert the patient's urinary catheter and attempt removal in 24 to 48 hours.
C (Immediately after the indwelling catheter is removed, the patient is placed on a timed voiding schedule, usually every 2 to 3 hours. At the given time interval, the patient is instructed to void. The bladder is then scanned using a portable ultrasonic bladder scanner; if the bladder has not emptied completely, straight catheterization may be performed. An indwelling catheter would not be reinserted to resolve the problem and diuretics would not be beneficial. Ongoing incontinence is not an expected finding after catheter removal.)
A nurse is working with a female patient who has developed stress urinary incontinence. Pelvic floor muscle exercises have been prescribed by the primary care provider. How can the nurse best promote successful treatment? A) Clearly explain the potential benefits of pelvic floor muscle exercises. B) Ensure the patient knows that surgery will be required if the exercises are unsuccessful. C) Arrange for biofeedback when the patient is learning to perform the exercises. D) Contact the patient weekly to ensure that she is performing the exercises consistently.
C (Research shows that written or verbal instruction alone is usually inadequate to teach an individual how to identify and strengthen the pelvic floor for sufficient bladder and bowel control. Biofeedback-assisted pelvic muscle exercise (PME) uses either electromyography or manometry to help the individual identify the pelvic muscles as he or she attempts to learn which muscle group is involved when performing PME. This objective assessment is likely superior to weekly contact with the patient. Surgery is not necessarily indicated if behavioral techniques are unsuccessful.)
A female patient has been experiencing recurrent urinary tract infections. What health education should the nurse provide to this patient? A) Bathe daily and keep the perineal region clean. B) Avoid voiding immediately after sexual intercourse. C) Drink liberal amounts of fluids. D) Void at least every 6 to 8 hours.
C (The patient is encouraged to drink liberal amounts of fluids (water is the best choice) to increase urine production and flow, which flushes the bacteria from the urinary tract. Frequent voiding (every 2 to 3 hours) is encouraged to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection. The patient should be encouraged to shower rather than bathe.)
The nurse is caring for a patient who underwent percutaneous lithotripsy earlier in the day. What instruction should the nurse give the patient? A) Limit oral fluid intake for 1 to 2 days. B) Report the presence of fine, sand like particles through the nephrostomy tube. C) Notify the physician about cloudy or foul-smelling urine. D) Report any pink-tinged urine within 24 hours after the procedure.
C (The patient should report the presence of foul-smelling or cloudy urine since this is suggestive of a UTI. Unless contraindicated, the patient should be instructed to drink large quantities of fluid each day to flush the kidneys. Sand like debris is normal due to residual stone products. Hematuria is common after lithotripsy.)
A patient with a recent history of nephrolithiasis has presented to the ED. After determining that the patient's cardiopulmonary status is stable, what aspect of care should the nurse prioritize? A) IV fluid administration B) Insertion of an indwelling urinary catheter C) Pain management D) Assisting with aspiration of the stone
C (The patient with kidney stones is often in excruciating pain, and this is a high priority for nursing interventions. In the short term, this would supersede the patient's need for IV fluids or for catheterization. Kidney stones cannot be aspirated.)
The nurse is caring for a patient with an indwelling urinary catheter. The nurse is aware that what nursing action helps prevent infection in a patient with an indwelling catheter? A) Vigorously clean the meatus area daily. B) Apply powder to the perineal area twice daily. C) Empty the drainage bag at least every 8 hours. D) Irrigate the catheter every 8 hours with normal saline.
C (To reduce the risk of bacterial proliferation, the nurse should empty the collection bag at least every 8 hours through the drainage spout, and more frequently if there is a large volume of urine. Vigorous cleaning of the meatus while the catheter is in place is discouraged, because the cleaning action can move the catheter, increasing the risk of infection. The spout (or drainage port) of any urinary drainage bag can become contaminated when opened to drain the bag. Irrigation of the catheter opens the closed system, increasing the likelihood of infection.)
Bioterrorism
Category A:highest priority agents, posing risk to national security due to high mortality: smallpox, botulism, anthrax, tularemia, hemmorhagic viral fever, plaque B: second highest priority, high morbidity, low morality: typhus & cholera C: pathogens for mass dissemination, easy to produce, potential for high mortality: hantavirus -nurse: plan and prep for respose, identify agent, report activity, control and contain
A patient has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis. When planning the patient's admission assessment, the nurse should be aware of the signs and symptoms that are characteristic of this diagnosis? Select all that apply. A) Diarrhea B) High fever C) Hematuria D) Urinary frequency E) Acute pain
C,D,E (Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain, radiating down the thigh and to the genitalia. Often, the patient has a desire to void, but little urine is passed, and it usually contains blood because of the abrasive action of the stone. This group of symptoms is called ureteral colic. Diarrhea is not associated with this presentation and a fever is usually absent due to the noninfectious nature of the health problem.)
Chapter 4: Practice Settings and Aggregates
Community health nurses practice in diverse setting: home health, hospice nurses, occupational health nurses, parish nurses, school nurses, case managers -aggregates receive services: infancy to death, families, groups within the community
A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention? A) Rashes on the palms of the hands and soles of the feet B) Cauliflower-like warts on the penis C) Painful, red papules on the shaft of the penis D) Foul-smelling discharge from the penis
D
A patient has presented at the ED with copious diarrhea and accompanying signs of dehydration. During the patient's health history, the nurse learns that the patient recently ate oysters from the Gulf of Mexico. The nurse should recognize the need to have the patient's stool cultured for microorganisms associated with what disease? A) Ebola B) West Nile virus C) Legionnaire's disease D) Cholera
D
A patient on the medical unit is found to have pulmonary tuberculosis (TB). What is the most appropriate precaution for the staff to take to prevent transmission of this disease? A) Standard precautions only B) Droplet precautions C) Standard and contact precautions D) Standard and airborne precautions
D
A patient has a flaccid bladder secondary to a spinal cord injury. The nurse recognizes this patient's high risk for urinary retention and should implement what intervention in the patient's plan of care? A) Relaxation techniques B) Sodium restriction C) Lower abdominal massage D) Double voiding
D (To enhance emptying of a flaccid bladder, the patient may be taught to "double void." After each voiding, the patient is instructed to remain on the toilet, relax for 1 to 2 minutes, and then attempt to void again in an effort to further empty the bladder. Relaxation does not affect the neurologic etiology of a flaccid bladder. Sodium restriction and massage are similarly ineffective.)
An adult patient has been hospitalized with pyelonephritis. The nurse's review of the patient's intake and output records reveals that the patient has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? A) Supplement the patient's fluid intake with a high-calorie diet. B) Emphasize the need to limit intake to 2 L of fluid daily. C) Obtain an order for a high-sodium diet to prevent dilutional hyponatremia. D) Encourage the patient to continue this pattern of fluid intake.
D (Unless contraindicated, 3 to 4 L of fluids per day is encouraged to dilute the urine, decrease burning on urination, and prevent dehydration. No need to supplement this fluid intake with additional calories or sodium.)
Conveying Cultural Sensitivity
address clients by last name, introduce name and position, be honest about culture knowledge, use language that is sensitive, find out what clients know about their health problems, incorporate their pref into care, NO assumptions, encourage questions, respect values, beliefs and practice, show respect
Access to Health Care
advocate for improved access -evaluate adequacy of health services within community, identify barriers encountered including: inadequate health insurance, inability to pay for services, language and culture barriers, lack of health care providers, geographic isolation, social isolation, lack of communication tools, lack of personal or public transportation, inconvenient hours, attitudes of health care personnel toward clients of low socioeconomic status
Mental Health
affective disorders (bipolar, major depression), anxiey (OCD, panic, phobias, PTSD), schizophrenia, dementia, conduct disorders, eating disorders -factors contributing: coping ability, life e vents, social events, chronic health probs, stigma with seeking service
Avian Influenza
aka bird flu. may need to stay at home for up to two weeks to prevent the spread of disease. -antivirals can minimize symptoms -flu vaccination does not protect -need 2 injection of h5n1 28 days apart when an outbreak occurs
Ch 1: Overview of Community Health Nursing
broad field that allows nurses to practice in a wide variety of settings. -promote the health and welfare of clients across the lifespan and from diverse populations -nurses in the community should understand the foundations of community health, principles, health promotion and disease prevention
School Nurse
case manager, community outreach, consultant, counselor, direct caregiver, health educator, researcher
Advocacy
client advocate is the role of the community health nurse. nurse plays the role of informer, supporter, mediator for the client. -clients who are autonomous beings who have the right to make decisions affecting their own health and welfare -clients have the right to expect a nurse client relationship based on trust, collaboration, and shared respect, related to health and considerate of their thoughts and feelings. clients are responsible for their own health -nurses responsibility to advocate for resources or services that meet the clients health care needs -advocating for clients requires assertiveness, placing priority on the clients values and willingness to progress through the chain of command for resolution
Ch 3: Community Health Program Planning
collaborative leadership role -nurse should plan, organize, implement and evaluate intervention programs that address specific health needs of the community -program planning should reflect priorities of community assessment -established based on perception of health needs, percent of population affected by problem, relevance of problem to the public, estimated impact of intervention
CH 6: Communicable Disease, Disaster, and Bioterrorism
communicable disease is an international health concern -nurses have unique skills to plan for and respond to natural and man made disasters
Families
community oriented nursing practice. enagage in assessment, planning ,developement and evaluation. -home visits allow for observation of barriers to health -family crisis: when a family is not able to cope with an event. resources inadequate for demands of the situation -healthy family: good communication, affirmation and support among members, sense of trust, members play and share together, members interact with eachother, shared sense of responsibility, traditions and rituals, seek help for problems -risk appraisal: biologic, enviro risk, behavioral risk
Essentials of Community Nursing
community: group of people and institutions that share geographic, civic or social parameters -communities vary in their characteristics and health needs -health is determined by the degree to which the community's collective health needs are identified and met -health indicators often used to describe the helath status of community and serve as targets for improvement -community health nurses practice in the community. have a facility from which they work but their practice is not limited to institutional settings -community is the client -community partnership occurs when community members, agencies and businesses actively participate in the process of health promotion and disease prevention -development of community partnerships is critical to the accomplishment of health promotion and disease prevention strategies -assess to determine needs and intervene to protect & promote health, preventing disease within a specific population
Milio's Framework for Prevention
complements health belief model. emphasizes change at the community level. identifies relationship between health deficits and availability of health promoting resources -theorizes that behavior changes within a large number of people can ultimately lead to social change
Family and Cultural Care
congruency between culture and health care is essential to the wellbeing of the clent. -comunity health nurses need to consider variations in culture, uniqueness needs to be considered, familiar with cultures in community -acculturation: merging/ adopting traits of a different culture. change in daily living in language, education, work, recreation, social experience, and health care system -culture awareness: self awareness of ones own cultural background, biases and differences --> these nurses are more likely to explore cultural variations in clients, understand how personal beliefs impact care, recognize meaning of health differs within cultures -do not stereotype -nurses need to be responsive to needs of client from dif cultures
Referrals, Discharge Planning & case management
coordinating individualized health care without disruption. manage services: follow up and referral
Informant Interviews
direct discussion with community members to obtain ideas and opinions -minimal cost, participants serve as future supporters, offer insight, reading/ writing of participants not required, personal interaction elicit more response -built in bias, meeting time and place limitation
Focus Groups
directed talk with a rep sample -participants may be supporters, insight into community support, reading not required -limit: irrelevant issue discussion, challenging to get participants, requires strong facilitator, dif to ensure sample is truly representative of overall community, time consuming
Secondary Prevention
early detection and treatment of disease with the goal of limiting severity and adverse effects -community assessments, disease surveillance, screening (cancer, diabetes, hypertension, hypercholesterolemia, TB, lead exposure, genetic disorders), control of outbreaks of communicable disease
Practice Settings: Home Health
home health nurse: nursing home, traditional home, assisted living -work as part of team, holistic care. nurses, pt, OT, home health aids, social workers and dieticians part of the care -provide skilled assessment, wound care, lab draws, med education, parenteral nutrition, IV fluids & meds, central line care, urinary catheter insertion and maintenance, coordination of other participants in health -evaluate living environment for safety - older adults= increase fall risk -ask about food in home, help with household activities, living alone, support system, set up and dispense of medications, access to health care -encourage clients to be independent and involved
Violence
homicide, assault, rape (higher in cities 8pm-2am weekend summer), suicide (higher among men >65), abuse, sexual violence, emotional violence, neglect, economic maltreatment -factors for abuse: history of being abused, low self esteem, fear and distrust, poor self control, inadequate social skills, minimal social support, immature motivation, weak coping skills -factors for violence: work stress, unemployment, media, crowded living, poverty, powerlessness, social isolation, lack of community resources
Environmental health history
housing residence, age, location, school, day care, work. ocupations of household measures, tobacco smoke presence? -remodeling activities -hobbies in home -exposure to chem -pets in home, healthy? -lead exposure -drinking water source -sewage and waste -pesticides -where children play
Technology and Community nursing
increases life expectatncy, impacts communities and health outcomes -informatics: combines nursing with information and communication in health records, databases, billing, electronic meeting, chat rooms -telehealth: quality health care through technology, skilled nursing transferring info to providers, home care increased using this, balance with hands on care -transmit: vitals, glucose, ECG results, voice convos, heart sounds, lung sounds and bowel sounds, images of wounds, and surgical incision
Three methods of direct data for community assessment
informant interview, participant observation, windshield survey
Tertiary Prevention
maximize recovery after injury or illness -rehab, nutrition counseling, exercise rehab, case maangement, physical and OT, support groups, exercise for hypertensive clients
Osteoarthritis Education
need to get 8-10 hours of sleep nightly and 1-2 hours during the day. -weight loss can reduce severity of disease -hot shower or bath may help with pain -exercise daily. on high pain days limits reps
Substance Use Disorders
negatively affect family, public safety and economy. dependence: pattern of pathological, compulsive disorders involving physiological and psych dependence -denial= defensive, lying, minimizing use, blaming, intellectualizing -health probs involved: low birth weight, congenital abnormalities, accidents, homicides, suicides, chronic disease, violence ALCOHOL: most commonly used substance, depressant. tolerance. withdrawal= irritable, tremors, nausea, vomit, headache, sweating, anxiety, sleep disturb, tachycardia, hypertension (determine when last drink was) TOBACCO: nicotine is stimulant= alertness & energy, tolernace Stimulants-caffeine, amphetamines, meth, cocaine Depressants: barbiturates, benzos, chloral hydrate, GHB Opiates: morphine, heroin, codeine, fentanyl Hallucinogens: LSD, PCP, ecstasy Inhalants: huffede
Partnerships with Legislative Bodies
nurses must stay informed on current policy and laws that influence health of community. advocate for policies that protect public health. -change agent: advocate for needs at local state and federal level -lobbyist: influence legislator -coalition: facilitate goal achievement by collaborating two groups -public office: serve society and advocate for change by influencing policy development
Community Health education
nurses provide education to promote maintain adn restore health -account for barriers: age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, lack of motivation
Participant Observation
observation of formal or informal community activities -indicates community priorities, environmental profile, identification of power structures -limits: bias, time consuming, cant ask questions
Discharge Planning
ongoing assessment to anticipate future needs. communication between client, nurse, provider, family. enhance the wellbeing of the client by establishing optinos for meeting health care needs. -begins at admission
Community Forum
open public meeting -opportunity for community input w. minimal cost -weakness: dif finding place and time, potential to drift from issue, challenge to get adequate participation, less vocal person may not speak
