Public Health Exam 2
A home visit to patients with dementia include assessment of what types of things?
Assessment of caregiver for burnout Patient's ability to perform ADLs & IADLs
What type of care facilitates are available to the older adult? What needs would these different facilitates be able to address?
Assisted living or assisted living facilities (residences) provide supervision or assistance with ADLs, coordination of services by outside health care providers, and monitoring of resident activities to help to ensure their health, safety, and well-being. Assistance may include the administration or supervision of medication or personal care services provided by trained staff. It is less costly than care in a nursing home. Nursing homes/long-term care/skilled nursing facilities include those services that provide care for people at different stages of dependence for extended periods of time. New choices are now available and provide housing for larger numbers of older adults than do nursing homes. The average nursing home cost is over $90,000 for a private room, and Medicare only covers limited stays in long-term care. For 100 days following a hospital stay, Medicare covers a nursing or rehabilitation center. Medicare does not, however, pay for custodial care (care that includes help with ADLs but not skilled nursing care). Medicaid will pay for nursing home care for those with limited assets.
What are the overall goals for Healthy People 2020?
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages.
A community- wide effort in the reduction of teen parenthood would require a primary focus on what part of teen pregnancy?
Birth control/Preventing it
Describe characteristics surrounding low-birth-weight babies
Birth weight is one of the most important predictors of infant mortality. Low birth weight babies are those weighing less than 2500 g (or less than 5.5lbs) at birth (p. 734). There is a correlation between low birth weight babies and preterm births. Complications of preterm birth Low maternal weight gain is associated with LBW infants who have higher incidences of growth problems, developmental delays, CNS disorders, and mental retardation (p. 741) Risk factors associated with low birth weight and infant mortality can be grouped into three categories Lifestyle: smoking, secondhand smoke exposure, inadequate nutrition, alcohol consumption, substance abuse, late prenatal care, environmental toxins, poverty, domestic violence, and unmarried status Underweight women (BMI less than 18.5) have twice as many LBW babies as women whose weight is within normal range. Sociodemographic: maternal age below 15 and above 35, low educational level, poverty, domestic violence, and unmarried status Medical and gestational history: primiparity, multiple gestation, short inter-pregnancy intervals, premature rupture of the membranes, uterine abnormality, febrile illness during pregnancy, spontaneous abortion, genetic factors, gestation-induced hypertension, less than ideal weight gain during pregnancy and diabetes
Describe characteristics of a competent community.
Competent community is a population that is aware of resources and alternatives, can make reasoned decisions about issues facing the group, andcan cope adaptively with problems. It parallels the concept of positive mental health. Collaborate, agree, work together to achieve goals
A community nurse is explaining elder abuse to a senior group, how should this be explained?
Elder abuse is defined as intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder. Types of abuse: Physical Abuse, Verbal or threats, Emotional or Psychological Abuse, Sexual Abuse, Neglect or Abandonment, Financial Exploitation.
What are some interventions for a nurse dealing with childhood obesity?
Family based therapy Modifying eating behaviors Promote physical activity Educate on healthy food options/choices
Multidrug resistant tuberculosis and increase incidences occurs for what reasons?
Funding cuts for surveillance, treatment, and research and premature sense that TB was defeated. noncompliance with therapy for the full, recommended period.
Know definitions in the book for incidence and prevalence.
Incidence: Refers to all new cases of a disease or health condition appearing during a given time (p. 258). Prevalence: Refers to all of the people with a particular health condition existing in a given population at a given point in time (p. 257).
Communicable disease needs to be notified to what agency first?
Local Health Department- Surveillance is key to security from biological threats. Health care service providers and laboratories are required to submit reportable information to the local health department. Local health jurisdictions can voluntarily send this information to the CDC National Notifiable Diseases Surveillance System (NNDSS).
Identify top causes of cancer among adults currently
Lung bronchial cancer
Understand the differences between palliative and hospice care.
Palliative care consists of comfort and symptom management and does not provide a cure Hospice is an option that takes a multidisciplinary approach to end-of-life care and needs. Hospice is more a concept of care than a specific place, although some hospice organizations provide individuals with a place to die with dignity if they have no home or choose not to die at home. Hospice is an option for people with a "projected" life expectancy of 6 months or less and often involves palliative care (pain and symptom relief) as opposed to ongoing curative measures.
Health screening for women should include what type of diagnostic testing?
Pap test to look for changes in cells of the cervix every 3 years - especially if they have an STD
A nurse identifies what drug is the most common abused in adults currently.
Prescription drugs
Explain the primary prevention needs of the older adult
Primary prevention improves overall health and well-being and prevents or delays chronic diseases. Primary prevention activities such as oral health maintenance, health education, follow-through of sound personal health practices (e.g., flossing, denture care, seat belt use, exercise), and maintenance of an appropriate immunization schedule ensure that older adults are doing all that they can to maintain their health.
Primary, Secondary, and Tertiary levels of prevention are related to families in crisis. Understand what these levels are and can they always be applied to all situations and reasoning behind i
Primary- Primary prevention reflects a fundamental human concern for well-being and includes planned activities undertaken by the nurse to prevent an unwanted event from occurring, to protect current health and healthy functioning, and to promote improved states of health for all members of a community. Opportunities for families to improve relationships with their partner or spouse and children may begin with learning social problem-solving skills. Ex promoting self-esteem, parenting classes, financial advising Secondary- Secondary prevention seeks to reduce the intensity and duration of a crisis and to promote adaptive behavior. By creating a positive relationship with family members and seeing them in their homes, the community health nurse can often uncover and intervene in a crisis or stop abusive situations. Ex. Help client prepare for future safety Tertiary- Tertiary prevention focuses on the rehabilitation of the family from the violence and crisis they have sustained. The family may never again have the same connections because partners may separate—by choice, motivated by fear or hatred; by court order, if the perpetrator is incarcerated; or by death. If the family chooses to stay together, long-term intervention for all family members is needed to establish a climate more conducive to family normalcy. Many of the services discussed as part of the secondary level of prevention are continued into the tertiary prevention phase to promote healing and to restore and promote family growth.
Explain what symptoms would lead a nurse to believe a child is a victim of sexual abuse?
Psychological symptoms of fear, anxiety or nervousness, guilt, denial, confusion, withdrawal, isolation and grief, age-inappropriate behavior such as bedwetting, drastic behavior changes and frightened of parents or caretakers Physical symptoms such as trauma to the genital area, pain during urination or defecation, difficulty walking or sitting, psychosomatic symptoms, STD's and genital discharge Other indicators include torn, stained or bloody undergarments, indirectly disclosing information, unexplained injuries/disease, or young pregnancy with a significant age disparity
Describe the process for the interview for someone who has a communicable disease.
Review the info and clarify that the disease is suspect or lack confirmation. Review the case definition. Identify the specific questionnaire for the report. Review the disease information—reservoir (source), incubation period, infectious period, symptoms, and treatment.
The community health nurse determines status of a community, what factors are identified in this process?
Status is the most common measure of the health of a community. It typically comprises morbidity and mortality data identifying the physical, emotional, and social determinants of health (SDH). Physical and social indices include vital statistics, leading causes of death and illness, suicide rates, and rates of drug and alcohol addiction. Social determinants can be identified by crime rates and functional ability level or by high school dropout rates or average income levels.
What are the steps in the nurse building a coalition?
Steps to coalition building include defining goals and objectives, conducting a community assessment, identifying key players or leaders, and identifying potential coalition members.
A community health nurse during visits can advocate for the client, what are some of the terms considered when discussing positive points?
Strengthening is used to list the positive aspects, instead of focusing on the negative; structure-process assists in reflecting on the positive physical aspects
What immunizations are strongly encouraged for students going to college?
T-Dap Meningococcal HPV Hepatitis B Polio MMR Varicella
A community health nurses uses an assessment tool to identify whether the adult can perform daily activities like shopping or finances. What is an appropriate scale to use?
The Lawton IADL instrument. IADL tasks include shopping, meal preparation, housekeeping, laundry, managing finances, taking medications, and using transportation. The Barthel Index is used to assess ADLs.
Identify the concept of community.
The concept of community as client refers to a group or population of people as the focus of nursing service community refers to a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging. It can be a society of people holding common rights and privileges (e.g., citizens of a town), sharing common interests (e.g., a community of farmers), or living under the same laws and regulations (e.g., a prison community). The function of any community includes its members' collective sense of belonging and their shared identity, values, norms, communication, and common interests and concerns
Explain the epidemiologic triad model. What would the community nurse address?
The epidemiological triad model consists of the agent, the host, and the environmental factors which contribute to an illness, injury, or wellness state. It is also known as the "Host, Agent, and Environment Model." A community nurse would address each part of the triad and may provide an intervention to any of the three parts in order to prevent the spread of illness (or to improve the health in a population).
What type of study uses descriptive epidemiology?
The goal of descriptive studies is to identify the patterns of occurrence of any health-related condition. They can be retrospective (identify cases and controls, then go back to review existing data) or prospective (identify groups and exposure factors, and then follow them forward in time). Prevalence, case control or any type of count studies are examples of descriptive epidemiological studies
Preparing classes for family health, how would the instructor describe a family?
The most basic unit- members are self defined by the family How do you define family? How would you define your own family? Who do you include as family members? What are your first memories of family? A group of individuals whose behaviors, actions, health conditions and interrelationships impact the health of the group and the individuals
Identify the fastest growing population globally
The population of those over 80 years of age
Describe the portal of entry.
The portal of entry is the means by which a disease or microorganism enters the previously uninfected host body. Examples of different portals of entry include: the skin, mucous membranes, the respiratory tract, and the GI tract.
How would the nurse instruct a parents to decrease dental caries?
The public health nurse would encourage parents to decrease dental caries by adopting the following measures: Get regular dental health check ups Emphasize proper dental hygiene, along with making referrals for dental treatment when needed. Dental health procedures have generally been found to be effective and safe for pregnant women, especially during the second trimester (p. 741) Sugar free gums that contain xylitol and chlorhexidine may be helpful in reducing the maternal-child transmission of caries causing bacteria (741)
Explain Munchausen syndrome.
This is a mental illness in which a person repeatedly acts as if they have a physical, emotional or cognitive disorder when they themselves have caused the symptoms. It is a factitious disorder imposed on self that is associated with severe emotional difficulties. People who have this disorder act this way because of an inner need to be perceived as ill or injured.
How does the United Nations define family? For the U.S. census- how is family defined?
UN - As the basic unit of society; Those members of the household who are related, to a specified degree, through blood, adoption or marriage US - Two or more individuals who depend on one another for emotional, physical and economical support
A nurse speaking about violence should incorporate knowledge of statistics for adolescents to include....?
Unintentional injuries were the leading cause of death in the 10- to 19-year-old age group. Homocide is another leading cause of death For children and adolescents, aged 6 to 19, unintentional strangulation deaths from the "choking game" are often misreported (Mechling, Ahern, & McGuiness, 2013). This behavior involves self-strangulation or strangulation by a friend through the use of hands or a noose, causing a brief euphoric high because of cerebral hypoxia.
Explain some positive results from the implementation of the WIC program
WIC IC isn't an entitlement program but rather Congress sets funding and eligibility requirements yearly. WIC provides the following benefits or positive results from its implementation: Provides women & children with nutritional status Helps achieve the initial goals of decreasing rates of preterm and low birth weight babies Helps increase the length of pregnancy Helps reduce the incidence of infant and child iron deficiency anemia Provides info to parents about eating healthfully and promoting healthy rates of growth which help them to become more aware of the need to reduce consumption of saturated fats, salt, sugar and overprocessed foods (p. 766).
What is "mandated reporting"
When any mandated reporter has reasonable cause to suspect or believes that a vulnerable individual has been abused, neglected, exploited, or abandoned, or is in a condition caused by one of these or is in need of protective services he/she must report this to the relevant authority.
Identify true statements about life expectancy in the United States.
White females life expectancy was 4 years greater than black females
Identify true statements about heart disease for adults.
Women are at a greater risk then men (more women are dying then men)
What is the guiding principle that enhances family practice?
Working with the family collectively; start at the family's presents level of functioning; adapt nursing interventions to the family's stage of development; recognize the validity of family structural variations; emphasize family strengths
The role of the community health nurse in promoting health of families is.......?
assess the family in a strength based model instead of defining whether they are functional or dysfunctional
What is the mode of transmission for Hepatitis B?
bloodborne, semen, or other body fluid
An assessment of a family should consider several links, describe them?
family demographics, physical environment, psychological/spiritual environment, family structure and roles, family functions, family values and beliefs, family communication patterns, family decision-making patterns, family problem-solving patterns, family coping patterns, family health behaviors, and family social and cultural patterns.
What are some known vectors in transmitting disease?
lectularius, mosquitos, rats, roaches, insects, fleas
During nutritional screening the nurse needs to know what BMI determines obesity, healthy and low weights.
most children will fall under healthy weight 45-65 percentile Healthy weight is BMI = 5th to under 85th percentile Underweight BMI = less than 5th percentile Risk of overweight = 85th to under 95th percentile
During family health visits certain precautions should be taken as the community health nurse, what are they?
observant about the neighborhood, travel safety, home environmental conditions, number of household members, client demeanor, and body language, as well as other nonverbal cues Wait at the door for the client you are scheduled to visit arrives at the door. Do not enter until it is confirmed that the family lives there and have invited you in. personal safety must be a consideration If family members are arguing or under the influence of drugs or alcohol, the situation may deteriorate rapidly and become unsafe; at this point, it is best to terminate the visit. Safe travel - Use of a personal or agency car, public transportation, or walking to visit families each has its own set of precautions for personal safety (running, accountable, etc.)
What is the key component of host?
"The host is a susceptible human or animal who harbors and nourishes a disease-causing agent" (p. 239). A host's susceptibility and response to an agent can be influenced by physical, psychological, and lifestyle factors. Inherent resistance is when a host can resist pathogens.
Give examples of how a community health nurse would empower a family to become more independent- be able to pick it out.
- Find the family's strengths - teach planning ahead for healthcare needs - Strengthening: communication technique where positive activities/strengths are highlighted and reinforced by the nurse in order to promote continuation of desired behaviors. - establish roles and responsibilities for members of the family to promote empowerment.
What are some priority safety interventions for school-age children?
-motor vehicle safety -seat belt -providing STI services Fire and burns
Why would a community health nurse encourage programs for mothers to exclusively breast feed their babies for the first 6 months of life? What are some statistics to support this type of program?
A community health nurse would encourage programs for mothers to exclusively breast feed their babies for the first 6 months of life to improve the baby's odds at staying alive. World Health Organization in 2015 state that 800,000 million infants worldwide would be saved if there were more infants exclusively breast-fed for the first six months of life. Currently, breast feeding practice worldwide is at 35% (p. 733). Only 49.4% of U.S. infants were breast-fed for the recommended 6-month period, and 18.8% were breast-fed exclusively for this 6-month period. These proportions do not reach the Healthy People 2020 targets of 81.9% for "ever breast-feeding' and 60.9% for "breast-feeding for the first 6 months" (p. 735) Other benefits of breast feeding include the following: Protection against respiratory infections & diarrhea, Long term increased cognitive development through adolescence, Improvement in blood pressure & total cholesterol A systematic review found that breast feeding had a positive effect on cognition ad was associated with improved results on intelligence tests. Several systematic reviews have found that the longer a mother breast feeds her infant, the greater the protection against later obesity for the child Milk is always at the right temp and no prep is required No formula or bottles to buy Breast milk contains immunoglobulins, enzymes and leukocytes that protect against pathogens; and it decreases incidence of allergy by eliminating exposure to potential antigens The chance for respiratory infection is reduced by 72% for infants that are breast-fed for more than 4 months Breast feeding burns extra calories for mom; helps reduce postpartum bleeding and delays ovulation and menstruation; it also lowers the risk of later ovarian and breast cancers. (p. 258)
