COMMUNITY ATI EVERYTHING:
Modes of Transportation: Waterborne
(fecal contamination of water) ■ Cholera ■ Typhoid fever ■ Bacillary dysentery ■ Giardia lamblia
Modes of Transportation: Airborne
(inhaled by a susceptible host) ■ Measles ■ Chickenpox ■ Tuberculosis (pulmonary or laryngeal) ■ Pertussis ■ Influenza
Modes of Transportation: Vector-borne
(via a carrier such as a mosquito or tick) ■ Lyme disease ■ Rocky Mountain spotted fever ■ Malaria
work site walk though or survey should focus on
- Observation of work processes and materials ■ Job requirements ■ Actual and potential hazards ■ Employee work practices (hygiene, waste disposal, housekeeping) ■ Incidence/prevalence of work-related illness/injuries ■ Control strategies to eliminate exposures
Mg
1.8-3
BUN
10-20
Sodium
136-145
Hgb
14-18 (males) 12-16 (females)
Platelets
150000-450000
A client will have a positive intradermal TB test within
2 to 10 weeks of exposure to the infection; TB has slow onset
potassium
3.5-5
Albumin
3.8-5
manifestations of alcohol withdrawal appears within
4 to 12 hr
Glycosylated hemoglobin (HbA1c) expected reference range is _________
4% to 6%, but an acceptable target for clients who have diabetes may be 6.5% to 8%, with a target goal of less than 7%.
HCT
42-52% (males) 37-47% (females)
The recommendation for saturated fat intake is no more than _____% of total daily caloric intake.
7%
fasting glucose
70-110
Ca++
9-10.5
GFR
90-120
LDL
<100
HDL
>40 (males) >50 (females)
In the "I PREPARE" mnemonic, A=
Activities
Modes of Transportation
Airborne, Foodborne, Waterborne, vector-born, direct contact
Program Planning: Diagnosis
Analyze data to determine health needs, prioritize health needs of the community
beneficence (Situation)
Assessing risks and benefits when planning interventions
Humanistic theory -
Assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest
resource barriers to referral process
Attitudes of health care personnel › Costs of services › Physical accessibility of resources › Time limitations › Limited expertise working with culturally diverse populations
Metoprolol tartrate (lopressor)
Beta-blockers can cause bradycardia and hypotension. Hold the medication if the apical pulse rate is less than 60/min, and notify the provider. ☐ Avoid giving to clients who have asthma. Cardioselective beta blockers (affect only beta1 receptors) are preferred to minimize effects on the respiratory system. ☐ Use with caution in clients who have heart failure. ☐ Encourage the client to sit and lie down slowly. ☐ Remind the client to notify the provider immediately if shortness of breath, edema, weight gain, or cough occur
Family health appraisals include
Biological risk assessment (genograms, genetic diseases), Environmental risks (including support systems) behavioral risks ( health values, and health perceptions)
Distributive Justice (situation)
Determining eligibility for health care services based on income and fiscal resources
Program Planning: Planning
Develop interventions, Establish goals and objectives for the selected solution, select strategies/interventions to meet the objectives
Nonmaleficence (situation)
Developing plans of care that include a system for monitoring and evaluating outcomes
Four levels of disaster management
Disaster Prevention Disaster Preparedness Disaster Response Disaster Recovery
______are often first-line medications to treat hypertension
Diuretics
Streptomycin sulfate (Streptomycin)
Due to its high level of toxicity, this medication should be used only in clients who have multidrug-resistant TB (MDR-TB)It can cause ototoxicity, so monitor hearing function and tolerance often. Report significant changes in urine output and renal function studies.
COMMUNITY ATI
EVERYTHING *FOUND ON QUIZLET*
things that decrease a risk for stroke
Early treatment of hypertension, maintenance of blood glucose within expected range, and refraining from smoking Maintaining a healthy weight and getting regular exercise
In the "I PREPARE" mnemonic, E=
Environmental Concerns OR Educate
Program Planning: Evaluation
Evaluate strengths/ weaknesses of program, determine achievement of desired outcomes, examine adequacy, efficiency, and cost effectiveness
Distributive Justice (definition)
Fair distribution of the benefits and burden in society is based on the needs and contributions of its members
hep A (HAV)
Fecal-oral route › Ingestion of contaminated food or water › Close personal contact with an infected individual (use PPE with incontinent patients)
Modes of Transportation: Foodborne
Food infection (bacterial, viral, parasitic infection of food) ☐ Salmonellosis ☐ Hepatitis A ☐ Trichinosis ☐ Escherichia coli (E. coli) ■ Food intoxication (toxins produced through bacterial growth, chemical contamination, or disease-producing substances) ☐ Staphylococcus aureus ☐ Clostridium botulinum
Community oriented nursing activities
Health care: Determining health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community
Triage Emergent category (class I) -
Highest priority is given to clients who have life-threatening injuries but also have a high possibility of survival once they are stabilized
disorders that increase a client's risk for stroke
Hypertension, diabetes mellitus, smoking, and other related disorders can increase a client's risk for a stroke.
First step in developing community health education plan
Identify population specific learning needs
community based nursing activities
Illness care: Management of acute and chronic conditions in settings where individuals, families, and groups live, work, and "attend" (schools, camps, prisons)
Medicare
Individuals must be older than 65 years and receiving Social Security, have been receiving disability benefits for 2 years, have amyotrophic lateral sclerosis and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to qualify for Medicare
Respect for autonomy (definition)
Individuals select those actions that fulfill their goals
potential indicators of hepatitis
Influenzalike symptoms ■ Fatigue ■ Decreased appetite with nausea ■ Abdominal pain ■ Joint pain ■ Fever ■ Vomiting ■ Dark-colored urine ■ Clay-colored stool ■ Jaundice
NPH insulin (Humulin N), detemir insulin (Levemir)
Intermediate-acting insulin ☐ Administered for glycemic control between meals and at night. ☐ Not administered before meals to control postprandial rise in blood glucose. ☐ Contains protamine (a protein), which causes a delay in the insulin absorption or onset and extends the duration of action of the insulin. ☐ Administer NPH insulin subcutaneous only and as the only insulin to mix with short-acting insulin. ☐ Administer detemir insulin subcutaneous only and is never mixed with othe
In the "I PREPARE" mnemonic, I=
Investigate potential exposures
Client barriers to referral process
Lack of motivation › Inadequate information about community resources › Inadequate understanding of the need for referral › Accessibility needs › Priorities › Finances › Cultural factors
general nursing care for hepatitis
Limit the client's activity in order to promote hepatic healing. ◯ Provide a high-carbohydrate, high-calorie, low- to moderate-fat, and low- to moderate-protein diet, and small, frequent meals to promote nutrition and healing. ◯ To promote hepatic rest and the regeneration of tissue, administer only necessary medications. ◯ Educate the client and family regarding measures to prevent the transmission of the disease with others at home (avoid sexual intercourse until hepatitis antibody testing is negative, avoid alcohol, avoid over-the-counter medications or herbal medications, use proper hand hygiene)
Social learning theory -
Links information to beliefs and values to change or shift the learners' expectations
Glargine insulin (Lantus)
Long-acting insulin ☐ Administered once daily, anytime during the day but always at the same time each day. ☐ Glargine insulin forms microprecipitates that dissolves slowly over 24 hr and maintains a steady blood sugar level with no peaks or troughs. ☐ Administer glargine insulin subcutaneous only and never administer IV.
State Departments of health
Manages WIC program; reports notifiable communicable disease within the state *to the CDC*
Beneficence (Definition)
Maximize possible benefits and minimize possible harms.
Nonmaleficence (definition)
No harm is done when applying standards of care
Crude Mortality rate
Number of deaths ÷ population total x 1,000 = _____ per 1,000
Prevalence calc
Number of existing cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000
Infant mortality rate
Number of infant deaths before 1 year of age in a year ÷ numbers of live births in the same year x 1,000 =_____ per 1,000
Incidence calc
Number of new cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000
Attack rate
Number of people exposed to a specific agent who develop the disease ÷ total number of people exposed
In the "I PREPARE" mnemonic, P=
Present work OR Past work
Lispro insulin (Humalog), aspart insulin (Novolog), glulisine insulin (Apidra)
Rapid-acting insulin ☐ Administer before meals to control postprandial rise in blood glucose. ☐ Onset is rapid, 10 to 30 min depending on which insulin is administered. ☐ Administer in conjunction with intermediate- or long-acting insulin to provide glycemic control between meals and at night.
Respect for autonomy (situation)
Respecting a client's right to self‑determination (making a decision not to pursue chemotherapy)
Local Health Department
Responsible for identifying and intervening to meet health needs of the local community. ◯ Work closely with local officials, businesses, and stakeholders. ◯ Report notifiable communicable diseases to *state* departments of health. ◯ Nurses at the community level typically function in the nursing roles of caregiver, advocate, teacher, coordinator, and consultant. ◯ Funded through local taxes with support from federal and state funds
Triage Urgent category (class II) -
Second-highest priority is given to clients who have major injuries that are not yet life-threatening and usually can wait 45 to 60 min for treatment
characteristics of successful partnerships
Shared power › Shared goals › Integrity › Flexibility › Negotiation
Regular insulin (Humulin R, Novolin R)
Short-acting insulin ☐ Administer 30 to 60 min before meals to control postprandial hyperglycemia.
______ is the most important preventable cause of death in the United States, according to the Centers for Disease Control and Prevention
Smoking
PPE for radiological incidents
Staff should wear water-resistant gowns, double-glove, and fully cover their bodies with caps, booties, masks, and goggles
Secondary Prevention -
Strategies that lead to early detection and treatment of disease with the goal of limiting severity and adverse effects (pick this if you see "screenings" or safety checks)
Tertiary Prevention -
Strategies that maximize recovery after an injury or illness
Primary Prevention -
Strategies that prevent the initial occurrence of disease or injury (pick this if you see "education" or "immunizations")
Triage Expectant category (class IV) -
The lowest priority is given to clients who are not expected to live and will be allowed to die naturally. Comfort measures may be provided, but restorative care will not
Triage Nonurgent category (class III) -
The next highest priority is given to clients who have minor injuries that are not life-threatening and do not need immediate attention
Secondary data collection
Use of existing data (death statistics; birth statistics; census data; mortality, morbidity data; health records; minutes from meetings; prior health surveys) to assess problem › Database of prior concerns/needs of population › Ability to trend health issues over time › Possibility that data may not represent current situation › Can be time-consuming
Critical theory -
Use of ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors
Behavioral theory -
Use of reinforcement methods to change learners' behaviors
Cognitive theory -
Use of sensory input and repetition to change learners' patterns of thought, thereby changing behaviors
Developmental theory -
Use of techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge
Nursing care for stroke
VS q1-2 hr; cardiac monitor, monitor LOC, elevate head of bed, institute seizure precautions
Underlying principles that affect vulnerable populations
Violence ● Substance use disorders ● Homelessness ● Mental health issues ● Poverty ● Chronic stress ● Poor self-esteem ● Access to health care services
Client education regarding response to chest pain:
X Stop activity and rest. X Place nitroglycerin tablet under tongue to dissolve (quick absorption). X If pain is unrelieved in 5 min, the client should call 911 or be driven to an emergency department. X The client can take up to two more doses of nitroglycerin at 5-min intervals.
American Diabetes Association (ADA) recommends screening a client who has
a BMI greater than 24 and age greater than 45 years, or if a child is overweight and has additional risk factors
Program planning: Assesment
a complete needs assessment and identify community strengths and weaknesses; assess the availability of community resources
TB diagnosis should be considered for any client who has
a persistent cough lasting longer than 3 weeks, chest pain, weakness, weight loss, anorexia, hemoptysis, dyspnea, fever, night sweats, or chills.
Epidemiological factors social environment
access to health care, high-risk working conditions, poverty
Barriers to learning in community education programs
age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, and lack of motivation
(Epidemiological) Susceptible Host factors
age, gender, genetics, ethnicity, immunological status, physiological state, occupation
The nurse should include bacteria as an ______ when discussing the epidemiological triangle
agent
The nurse should include toxins as an ____ when discussing the epidemiological triangle
agent
The agent is the
animate or inanimate object that causes the disease
Informant interviews
are direct conversations with individual community members for the purpose of obtaining ideas and opinions
Surveys
are specific questions asked in a written format and do not involve direct conversations with individual community members
community oriented nursing focus of care
at-risk individuals, families, groups; community
Facilitating small group discussions is an appropriate learning strategy for clients who are _____ learners
auditory
The prompt use of _________ at the onset of symptoms can prevent the serious complication of delirium tremens.
benzodiazepines
The nurse manager should include viruses as a ______ when discussing work-related illness and injury
biological agent
Transitions are times of risk for families. Transitions include
birth or adoption of a child, death of a family member, child moving out of the home, marriage of a child, major illness, divorce, and loss of the main family income
Streptokinase (Streptase) and alteplase (Activase) are used to
break up blood clots. ■ Thrombolytic agents have similar side effects and contraindications as anticoagulants. ■ For best results, give within 6 hr of infarction
Healthy nutrition should include lowering LDL_____________ , which can prevent diabetes and hyperlipidemia.
by decreasing intake of saturated fats
Cat C bio agents
can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. ■ Examples include hantavirus
Program Planning: Implementation
carry out the plan
School nurse can involve
case management, community outreach, consultant, counselor, direct caregiver, health educator, researcher
As a ____________, the nurse coordinates comprehensive services for students with complex health needs
case manager
Transitions require families to
change behaviors, make new decisions, reallocate family roles, learn new skills, and learn to use new resources
Epidemiological agents
chemical (drugs, toxins) physical (noise, tempurature) Infectious agents (Viruses, bacteria)
Poor hygiene is manifestation of
child neglect
An underweight child is a manifestation of
child neglect.
Community members exposed to anthrax will need access to
ciprofloxacin. Thismedication is used for the prophylactic treatment of anthrax
The community is the _____ in community health nursing
client
The nurse's first action when beginning a cultural assessment is to
collect self-identifying data about the client, including specific information about how the client's cultural beliefs influence family structure, food patterns, religious preferences, and health practices
As a __________, a nurse provides information to families, administrators, teachers, and parent-teacher groups to encourage decisions that promote the health of the students
consultant
School nurse as a researcher
contributes to the base of knowledge for school health and educational needs
School nurse as a case manager
coordinates comprehensive services for children who have complex health needs
As a ________, a nurse develops a trusting relationship with students and provides support on issues affecting their lives.
counselor
Medicaid
coverage for individuals of low socioeconomic status and children, through the combined efforts of federal and state governments. Eligibility is based on household size and income, with priority given to children, pregnant women, and those who have a disability
Chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan)
decrease the intensity of withdrawl symptoms, decrease risk of seizures
Increased blood pressure, tachycardia, and diaphoresis are indicators of
delirium tremens or alcohol withdrawal delirium
Risk factors for suicide include
depression or other mental disorders, substance use, and intimate partner issues.
National health goals are
derived from scientific data and trends collected during the prior decade. These goals are based on those issues that are considered major risks to the health and wellness of the United States' population
Healthy nutrition should include omega-3 fatty acids for secondary prevention of
diabetes and heart disease
Healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of ______________
diabetes and hyperlipidemia
As a ___________, a nurse provides illness or injury care to children at school
direct caregiver
Focus groups
directed talks with a representative sample of a community, and do not involve direct conversations with individual community members
Outlining specific roles of community agencies is a component of
disaster preparedness.
Identifying community vulnerabilities is a component of
disaster prevention.
Providing stress counseling is a component of
disaster recovery
Prioritizing care of individuals is a component of
disaster response.
complementary therapies for acute respiratory disorders
echinacea, large doses of vitamin C, and zinc preparations (lozenges and nasal sprays) may be useful in promoting improved immune response, as well as hand hygiene, and limiting exposure in vulnerable populations
Agencies transmitting or storing electronic health data must take measures to
ensure confidentiality and security of client information
The nurse should include resource availability as an _______ _______when discussing the epidemiological triangle
environmental factor
Homeless population characteristics (not all inclusive)
families with children (fastest growing segment) People who have mental illness (large segment) Older adults with no place to go and no support system
Epidemiological factors physical environment
geography, water/food supply, presence of reservoirs/vectors
In Community-based nursing VS Community-oriented nursing, community oriented nursing involves
health care of individuals, families, and groups (like a "class lesson") to improve the collective health of the community
Interpreters should have knowledge of
health-related terminology
Cat A bio agents
highest priority agents smallpox (variola), botulism toxin, anthrax, tularemia, hemorrhagic viral fevers (Ebola!), and plague
The nurse manager should include age as a _____ when discussing work-related illness and injury
host factor
The nurse should include altered immunity as a ___ ____ when discussing the epidemiological triangle
host factor
The nurse should include ethnicity as a _____ _______when discussing the epidemiological triangle
host factor
Loop diuretics, such as furosemide (Lasix), decrease sodium reabsorption and increase potassium excretion. Monitor the client closely for
hypokalemia
community based nursing focus of care
individuals; families
Informatics is the combination of nursing science with
information and communication technologies in the delivery of nursing care
the ethical principle of fidelity
involves keeping commitments and following through with promises
Double bagging hazardous materials
is not cost effective and is unnecessary unless the outside of a bag becomes contaminated.
Participant observation
is observing formal or informal community activities and does not involve direct conversations with individual community members
the ethical principle of respect for autonomy
is supporting the rights of individuals to determine and pursue personal health care goals
the ethical principle of veracity,
is the concept of telling the truth
four-medication TB regimen
isoniazid (Nydrazid), rifampin (Rifadin), pyrazinamide, and ethambutol hydrochloride (Myambutol)
The host is the
living being that is affected by the agent.
In Community-based nursing VS Community-oriented nursing, community-based nursing involves
management of acute and chronic conditions of individuals and individual families in a community setting
Healthy nutrition should include decreasing the consumption of _______________, which can prevent diabetes and hyperlipidemia.
meats and processed foods
Rates of suicide are highest in
men and individuals over the age of 65.
Cat B bio agents
moderately easy to disseminate and have high morbidity rates and low mortality rates. ■ Examples include typhus and cholera
Indications of carbon monoxide poisoning include
nausea, vomiting, headache, weakness, and unconsciousness
The home health nurse must evaluate the living environment for safety, paying close attention to
nonsecure rugs, electrical outlets, and extension cords; the use of oxygen; safety devices in the bathroom; and other potential environmental hazards
The use of family members as interpreters is
not advisable because clients may need privacy in discussing sensitive matters
Visual learners learn through "seeing" and methods such as
note taking, video viewing, and presentations. These learners "think in pictures."
Diabetic risk factors
obesity, hypertension, inactivity, hyperlipidemia, cigarette smoking, genetic history, elevated C-reactive protein (CRP), ethnic group, and women who have delivered infants weighing more than 9 lb
Program Planning: Preplaning
obtain community awareness, support, involvement * should not move forward without community support
Acculturation is the process
of merging with or adopting the traits of a different culture. Adapting to a new culture requires changes in daily living practices. These changes relate to language, education, work, recreation, social experiences, and the health care system
Who is most at risk for pneumonia?
people of all ages, but the young, older adult clients, and clients who are immunocompromised are more susceptible. Immobility is a contributing factor in the development of pneumonia.Older adult clients are more susceptible to infections and have decreased pulmonary reserves due to normal lung changes, including decreased lung elasticity and thickening alveoli.
A healing spiral fracture is a manifestation of
physical abuse.
Burns on the palms of the hands are a manifestation of
physical abuse.
The nurse manager should include lighting as a ______ when discussing work-related illness and injury
physical agent
The nurse manager should include noise as a ______ when discussing work-related illness and injury
physical agent
Thiazide diuretics, such as hydrochlorothiazide (Microzide), inhibit water and sodium reabsorption, and increase _______excretion
potassium
Discussing stress reduction techniques with employees at an industrial site is a __________prevention strategy.
primary
Implementing age-appropriate injury prevention programs for each grade level is a________prevention activity
primary
Placing posters with images of appropriate hand hygiene near restrooms is a ______prevention strategy
primary
Providing support programs for new parents is a ________prevention strategy.
primary
The nurse is using ________ prevention when providing influenza immunizations to employees at a local preschool
primary
The nurse manager should include stress as an outcome of __________when discussing work-related illness and injury
psychological agents
Tolerance to nicotine does develop
quickly.
Factors influenced by an individual's culture (note: not a comprehensive list)
religious preferences, family structure, food patterns, health practices and interactions
In the "I PREPARE" mnemonic, R=
residence (age of home, heating, recent remodeling, chemical storage, water) OR referrals and resources
Routinely checking students for pediculosis throughout the school year is a _________ prevention strategy
secondary
Screening a client whose spouse recently died for suicide risk is a _________prevention strategy
secondary
The nurse is using _____ prevention when performing a home safety check at a client's home
secondary
The nurse is using _______ prevention when implementing a program to notify individuals exposed to a communicable disease
secondary
Cultural awareness includes
self-awareness of one's own cultural background, biases, and differences
The environment is the
setting or surrounding that sustains the host
Genital irritation is a manifestation of .
sexual abuse
Nicotine is a central nervous system
stimulant, not depressant.
Hypertension occurs when
systolic blood pressure is at or above 140 mm Hg or diastolic blood pressure is at or above 90 mm Hg. Normal adult blood pressure is less than 120 mm Hg systolic and 80 mm Hg diastolic.
Providing equipment to practice hands-on skills is an appropriate learning strategy for clients who are ________ learners
tactile-kinesthetic
Teaching a client who has schizophrenia about medication interactions is a ________prevention strategy
tertiary
The nurse is using_______ prevention when teaching healthy nutrition to clients who have hypertension
tertiary
Working with the dietitian to determine carbohydrate counts for students with diabetes is a ________ prevention activity
tertiary
Centers for Medicare and Medicaid Services (CMS) - Also administers
the Health Insurance Portability and Accountability Act (HIPAA), disability insurance, Aid to Families with Dependent Children (AFDC), and Supplemental Security Income (SSI).
Community assessment is a comprehensive approach that emphasizes
the community as a client.
The case manager must be proactive for the client, balancing the impact of the illness against
the cost of care. Increased knowledge of disease processes promotes early intervention and facilitates transition from acute to community-based care
HbA1c is the best indicator of the average blood glucose level for
the past 120 days. It assists in evaluating treatment effectiveness and compliance.
An epidemic is when
the rate of disease exceeds the usual level of the condition in a defined population
subjective data for stroke
transient symptoms, such as visual disturbances, dizziness, slurred speech, and a weak extremity
Tactile-kinesthetic learners learn through "doing" and methods such as
trial and error, hands-on approaches, and return demonstration. These learners gain "meaning through exploration."
Auditory learners learn through "listening" and methods such as
verbal lectures, discussion, and reading aloud. These learners "interpret meaning while listening."
Showing informational videos is an appropriate learning strategy for clients who are ___ learners
visual
Supplying outlines for note-taking is an appropriate learning strategy for clients who are ______ learners
visual
In a biohazard incident (with few exceptions,) ________ is the universal antidote.
water For biological hazardous materials, wash skin with copious amounts of water and antibacterial soap.
The nurse should determine the work practices of employees when conducting a
work site survey
hep C (HCV)
› Blood › Drug abuse › Sexual contact
hep B (HBV)
› Blood › Unprotected sex with infected individual › Infants born to infected mothers › Contact with infected blood › Injection drug users
hep D (HDV)
› Coinfection with HBV › Injection drug users › Unprotected sex with infected individual
hep E (HEV)
› Fecal-oral route › Ingestion of contaminated food or water
Metformin HCI (Glucophage)
› Take with food to decrease adverse GI effects. › Instruct the client to take vitamin B12 and folic acid supplements. › Contact the provider if manifestations of lactic acidosis develop (myalgia, sluggishness, somnolence, and hyperventilation). › May take during pregnancy for gestational diabetes. › Never crush or chew the medication
work-related illness/injury control strategies often include
■ Engineering ■ Altering work practices ■ Providing personal protective equipment and education to prevent future injuries ■ Workplace monitoring ■ Health screening ■ Employee-assistance programs ■ Job-task analysis ■ Design, risk management, and emergency preparedness
Factors influencing an individual's potential for violence
■ History of being abused or exposure to violence ■ Low self-esteem ■ Fear and distrust of others ■ Poor self-control ■ Inadequate social skills ■ Minimal social support/isolation ■ Immature motivation for marriage or childbearing ■ Weak coping skills
Objective data for MI
■ Pallor, and cool, clammy skin ■ Tachycardia and/or heart palpitations ■ Diaphoresis ■ Vomiting ■ Decreased level of consciousness
Risk Factors Essential hypertension
■ Positive family history ■ Excessive sodium intake ■ Physical inactivity ■ Obesity ■ High alcohol consumption ■ African American ■ Smoking ■ Hyperlipidemia ■ Stress
National Health Goals for Older Adults
■ Reductions in ☐ Adults who have musculoskeletal concerns ☐ Older adults who have mental health concerns ☐ Hospitalizations due to heart failure ☐ Substance use in the older adult ☐ Sensory concerns such as hearing loss and cataracts ☐ Hip fractures among older adults ☐ Fall-related deaths ■ Increases in ☐ Screenings for colorectal cancer ☐ Participation in organized health promotion activities ☐ Public reporting of elder maltreatment ☐ Older adults who maintain an active lifestyle
National Health Goals for Families
■ Reductions in ☐ Barriers to access ☐ Allergic content within the home ☐ Families that are unable to have a child or maintain a pregnancy ☐ Passive smoke exposure ☐ Household hunger ■ Increases in ☐ Health education provided by an agency (Head Start, school system, college, places of employment, health departments) ☐ Home testing for radon ☐ Health insurance coverage ☐ Individuals who have a usual primary care provider
National Health Goals for Men
■ Reductions in ☐ Death from cancer specific to men, such as prostate ☐ Incidence of HIV and AIDS ☐ Fatal and nonfatal injuries ■ Increases in ☐ Participation in aerobic and muscle-strengthening activities ☐ Ability to identify warning signs of a heart attack and stroke
National health goals for Women
■ Reductions in ☐ Diseases involving bone, such as osteoporosis ☐ Death from cancer such as breast, ovarian, and cervical ☐ Sexual violence ■ Increases in ☐ Number of planned pregnancies versus unplanned ☐ Those who receive early and adequate prenatal care ☐ The number of mothers who breastfeed ☐ Ability to identify warning signs of a heart attack and stroke
Portals of entry
■ Respiratory passages ■ Gastrointestinal tract ■ Skin ■ Mucous membranes ■ Genitourinary tract ■ Eyes ■ Blood vessels
Portals of exit
■ Respiratory secretions ■ Feces ■ Blood ■ Semen ■ Vaginal secretions ■ Saliva ■ Skin lesion exudates
Nursing Care for TB
■ Wear an N95 or HEPA respirator when caring for clients who are hospitalized with TB. ■ Place the client in a negative airflow room, and implement airborne precautions. ■ Use barrier protection when the risk of hand or clothing contamination exists. ■ Have the client wear an N95 or HEPA respirator if transportation to another department is necessary. The client should be transported using the shortest and least busy route. ■ Teach the client to cough and expectorate sputum into tissues that are disposed of by the client into provided sacks. ■ Encourage fluid intake and a well-balanced diet for adequate caloric intake. ■ Encourage foods that are rich in protein, iron, and vitamin C.
Subjective data for MI
◯ Anxiety, feeling of impending doom ◯ Chest pain (substernal or precordial) ■ Pain can radiate down the shoulder or arm, or may present in the form of jaw pain. ■ Pain may be described as a crushing or aching pressure. ◯ Nausea ◯ Dizziness
When caring for clients who experience violence:
◯ Build trust and confidence with a client. ◯ Focus on the client rather than the situation. ◯ Assess for immediate danger. ◯ Provide emergency care as needed. ◯ Develop a plan for safety. ◯ Make needed referrals for community services and legal options. ◯ If abuse has occurred, complete mandatory reporting, following agency guidelines.
Stroke risk factors
◯ Cerebral aneurysm ◯ Arteriovenous malformation (AV) ◯ Diabetes mellitus ◯ Obesity ◯ Hypertension ◯ Atherosclerosis ◯ Hyperlipidemia ◯ Hypercoagulability ◯ Atrial fibrillation ◯ Use of oral contraceptives ◯ Smoking ◯ Cocaine use
Health Problems of Migrant Workers
◯ Dental disease ◯ Tuberculosis ◯ Chronic conditions ◯ Stress, anxiety, and other mental health concerns ◯ Leukemia ◯ Iron deficiency anemia ◯ Stomach, uterine, and cervical cancers ◯ Lack of prenatal care ◯ Higher infant mortality rates
Barriers to Health Care in Rural Areas
◯ Distance from services ◯ Lack of personal/public transportation ◯ Unpredictable weather and/or travel conditions ◯ Inability to pay for care/underinsured/uninsured ◯ Shortage of rural hospitals/health care provider
Steps in the referral process:
◯ Engaging in a working relationship with the client. ◯ Establishing criteria for the referral. ◯ Exploring resources. ◯ Accepting the client's decision to use a given resource. ◯ Making the referral. ◯ Facilitating the referral. ◯ Evaluating the outcome
risk factors for acute respiratory disorders
◯ Extremely young and advanced age ◯ Recent exposure to viral, bacterial, or influenza infections ◯ Lack of current immunization status (pneumonia, influenza) ◯ Exposure to plant pollen, molds, animal dander, foods, medications, and environmental contaminants Tobacco smoke ◯ Substance use (alcohol, cocaine) ◯ Chronic lung disease (asthma, emphysema) ◯ Immunocompromised status ◯ Presence of a foreign body ◯ Conditions that increase the risk of aspiration (dysphagia) ◯ Impaired ability to mobilize secretions (decreased level of consciousness, immobility, recent abdominal or thoracic surgery) ◯ Inactivity and immobility ◯ Mechanical ventilation (ventilator-acquired pneumonia)
Risk factors for TB
◯ Frequent and close contact with an untreated individual ◯ Lower socioeconomic status and homelessness ◯ Immunocompromised status (HIV, chemotherapy, kidney disease, diabetes, Crohn's disease) ◯ Poorly ventilated, crowded environments (prisons, long-term care facilities) ◯ Advanced age ◯ Recent travel outside of the United States to areas where TB is endemic ◯ Substance use ◯ Health care occupation that involves performance of high-risk activities (respiratory treatments, suctioning, coughing procedures)
Steps in analysis of community assessment data include:
◯ Gathering collected data into a 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.
Health Status of Rural Residents
◯ Higher infant and maternal morbidity rates ◯ Higher rates of diabetes mellitus ◯ More likely to be obese ◯ Less likely to meet physical activity recommendations ◯ Higher rates of suicide ◯ Increased trauma/injuries from lightning, farm machinery, drowning, and boating, snowmobile, all-terrain vehicle, and motorcycle crashes ◯ Increased occupational-associated risks (agriculture, fishing, mining, and construction are the most dangerous industries) ◯ Less likely to seek preventive care
Barriers to health care include:
◯ Inadequate health care insurance ◯ Inability to pay for health care services ◯ Language barriers ◯ Cultural barriers ◯ Lack of health care providers in a community ◯ Geographic isolation ◯ Social isolation ◯ Lack of communication tools (e.g., telephones) ◯ Lack of personal or public transportation to health care facilities ◯ Inconvenient hours ◯ Attitudes of health care personnel toward clients of low socioeconomic status or those with different cultural/ethnic backgrounds ◯ Eligibility requirements for state/federal assistance programs
Alcohol, tobacco, and other substance use and addictive disorders can cause multiple health problems, including:
◯ Low birth weight ◯ Congenital abnormalities ◯ Accidents ◯ Homicides ◯ Suicides ◯ Chronic diseases ◯ Violence
Risk factors for MI/Angina
◯ Male gender or postmenopausal women ◯ Hypertension ◯ Tobacco use ◯ Hyperlipidemia ◯ Metabolic disorders (diabetes mellitus, hyperthyroidism) ◯ Methamphetamine or cocaine use ◯ Stress (occupational, physical exercise, sexual activity)
Veterans Health Issues
◯ Mental health conditions (posttraumatic stress disorder, traumatic stress reactions, anger, depression) ◯ Substance use and addiction disorders ◯ Suicide ◯ Infectious diseases ◯ Exposures to herbicides, chemicals, and radiation ◯ Traumatic brain injuries ◯ Spinal cord injuries ◯ Traumatic amputations ◯ Cold injury ◯ Military sexual trauma ◯ Hearing impairments ◯ Visual impairments
Culturally aware nurses are:
◯ More likely to explore cultural variations among clients. ◯ Better able to understand how personal beliefs impact client care. ◯ Able to recognize the meaning of health differs with each culture.
Issues in Migrant Health
◯ Poor and unsanitary working and housing conditions ◯ Exposure to environmental pesticides ◯ Less access to dental, mental health, and pharmacy services ◯ Inability to afford care ◯ Availability of services (distance, transportation, hours of service, health record tracking) ◯ Language barriers and cultural aspects of health care
Case management nursing includes the following:
◯ Promoting interprofessional services and increased client/family involvement. ◯ Decreasing cost by improving client outcomes. ◯ Providing education to optimize health participation. ◯ Advocating for services and client rights.
National health goals:
◯ Reduction in per capita domestic water usage ◯ Reduction in blood lead levels in children ◯ Reduction in indoor allergens ◯ Reduction in the number of new schools near highways ◯ Increase in schools with policies/practices to promote health and safety
Recognizing Actual or Potential Child Abuse/Neglect
◯ Unexplained injury ◯ Unusual fear of the nurse and others ◯ Injuries/wounds not mentioned in history ◯ Fractures, including older healed fractures ◯ Presence of injuries/wounds/fractures in various stages of healing ◯ Subdural hematomas ◯ Trauma to genitalia ◯ Malnourishment or dehydration ◯ General poor hygiene or inappropriate dress for weather conditions ◯ Considered to be a "bad child"
Community Assessment: Social and Community Factors Influencing Violence
◯ Work stress ◯ Unemployment ◯ Media exposure to violence ◯ Crowded living conditions ◯ Poverty ◯ Feelings of powerlessness ◯ Social isolation ◯ Lack of community resources (playgrounds, parks, theaters)
occupational health history elicits information on
☐ Current and past jobs ☐ Current and past exposure to specific agents and any relationship of current symptoms to work activities ☐ Any precipitating factors, such as underlying illness, previous injuries, and healthy or unhealthy habits
Economic Maltreatment
☐ Failure to provide the needs of a victim when adequate funds are available ☐ Unpaid bills when another person is managing the finances ☐ Theft of or misuse of money or property
Manifestations of withdrawal include the following:
☐ Irritability ☐ Tremors ☐ Nausea ☐ Vomiting ☐ Headaches ☐ Diaphoresis ☐ Anxiety ☐ Sleep disturbances ☐ Tachycardia ☐ Elevated blood pressure
Leading causes of death in adolescents
☐ Motor vehicle/other unintentional injuries ☐ Homicide ☐ Suicide
Rifampin (Rifadin)
☐ Observe for hepatotoxicity. ☐ Inform the client that urine and other secretions will be orange. ☐ Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately. ☐ Inform the client this medication may interfere with the efficacy of oral contraceptives.
Pyrazinamide
☐ Observe for hepatotoxicity. ☐ Instruct the client to drink a glass of water with each dose and increase fluids during the day. ☐ Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately. ☐ Advise the client to avoid using alcohol while taking pyrazinamide.
Ethambutol (Myambutol)
☐ Obtain baseline visual acuity tests. ☐ Determine color discrimination ability. ☐ This medication should not be given to children younger than 13 years of age. ☐ Instruct the client to report changes in vision immediately.
leading causes of death in children
☐ Perinatal conditions/congenital anomalies ☐ Sudden Infant Death Syndrome (SIDS) ☐ Motor vehicle/other unintentional injuries
Neglect includes the failure to provide:
☐ Physical care, such as food, shelter, and hygiene ☐ Emotional care and/or stimulation necessary to achieve developmental milestones, such as speaking and interacting with a child ☐ Education for a child ☐ Needed health or dental care
National Health Goals for Children
☐ Reductions in X Dental caries X Obesity X Exposure to secondhand smoke ☐ Increases in X Newborn blood spot screenings and follow-up testing X Access to a medical home X Schools that require health education X Childhood immunizations X Use of child safety restraints X Physical activity
National Health Goals For adolescents
☐ Reductions in X Violent crimes X Initiation of tobacco use X Obesity X Inappropriate weight gain ☐ Increases in X Schools with a breakfast program X Participation in extracurricular activities X Wellness checkups within prior 12 months X Physical activity
The body processes alcohol dependent on several factors, including:
☐ The size and weight of the drinker ☐ Gender (affects metabolism) ☐ Carbonation (increases absorption) ☐ Time elapsed during alcohol consumption ☐ Food in the stomach ☐ The drinker's emotional state
Isoniazid (Nydrazid)
☐ This medication should be taken on an empty stomach. ☐ Monitor for hepatotoxicity and neurotoxicity, such as tingling of the hands and feet. ☐ Vitamin B6 (pyridoxine) is used to prevent neurotoxicity from isoniazide ☐ Advise the client not to drink alcohol while taking isoniazid because it may increase the risk for hepatotoxicity.
Nitroglycerin (Nitrostat) considerations
☐ Used to treat angina and help control blood pressure. ☐ Used cautiously with other antihypertensive medications. ☐ Vasodilators can cause orthostatic hypotension .Remind the client that a headache is a common side effect of this medication. ☐ Encourage the client to sit and lie down slowly.
