Community Nursing - Test 2
Which female would be at greatest risk for developing bulimia nervosa?
A 15-year-old cheerleader who wants to be a professional ballerina
Which person meets the legal definition of a veteran?
A 50-year-old female who retired from the Navy Legally, a veteran is an individual who has served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable. Any individual who completed service for any branch of armed forces is a veteran as long as they were not dishonorably discharged. Personnel serving in the National Guard are considered to be part-time employees and not active duty, full-time personnel.
managemnet of PTSD
CBT, SSRIs
Which factors result in rural residents having less access to health care than urban dwellers?
employment opportunities may be low paying and seasonal there are greater distances to travel and limited choice of health care providers health care providers prefer to work in higher-paying urban settings rural residents are less likely to have health insurance
What are some examples of subculture
ethnicity religion occupation healthrelated characteristics age sex geographic location
A nurse suspects that a client is depressed. Which symptoms are most likely being exhibited by the client?
fatigue irritability difficulty concentrating
what is time orientation
focus may be on the past, with traditions and ancetors playing an important role in the client's life - asians, native americans, east indians, and africans present focus, with little attention paid to the past or the future - concerned with the current situation focus may be on the future, with progress and change highly valued - U.S. is future focues
what is the naturalistic perspective
found most frequently among native americans, asians, and others who believe that human life is only one aspect of nature and a part of the general order of the cosmos believe that the forces of nature must be kept in natural balance or harmony to maintain health and well-being
active duty
full-time duty in the active military, including members of the reserve compnents on full-time training duty does not include full-time natioanl guard duty
native americans culture bound syndrome
ghost - terror, hallucinations, and sense of danger
what is leininger's theory of culture care diversity and universaity
gives precedence to understanding the cultural dimensions of human care and caring concerned with describing, explaining, and projecting nursing similarities and differences focused primarily on human care and caring in human cultures used world view, social structure, language, ethnohistory, environmental context, and the generic or fold and professional systems to provide a comprehensive and holistic view of influences in cultural care and well-being
define cultural competence
having an awareness and acceptance of cultures and the ability to interact effectively with people of diverse cultures
what is the ying-yang theory
health is believe to exist when all aspects of the person are in perfect balance
describe reported methamphetamine users
high school and college students college athletes while, blue-collar workrs men and women in their 20s and 30s who are jobless rural and urban divided equally among both men and women highest among 20 to 29 year olds (often has young child, putting them at risk for abuse)
culture bound syndromes - greek
hysteria - bizarre complints and behaviro because the uterus leaves the pelvis and goies to another part of the body
health promotion for PWD
i. Clients with disabilities may exhibit behavioral problems that discourage health care providers from caring for them, or they may resist others' attempts to care for them because of their discomfort or unfamiliarity with the health care setting or equipment. ii. Primary care assessment for this population should include immunizations and preventive screenings, such as breast, colon, and testicular cancer in males iii. Health promotion questions that assess diet, exercise, alcohol, drug use, smoking, and sexual health should be routine in primary care visits for diabled individuals
What is person-nature orientation
person-nature relationship perceived by: destiny, in which people are subjugated to nature in a fatalistic, inevitable manner harmony, in which people and nature exist together as a single entity mastery, in which people are intended to overcome natural forces and to put them to use for the benefit of humankind
A nurse is caring for an individual with intellectual and developmental disabilities (IDD). Which findings would be most concerning to the nurse?
poor skin turgor no bowel movement for the past 3 days symptoms of choking after taking a sip of water recent seizure
What are the rural health disparities
poverty increased age population decreasing access to health care lack of heath insurance lack of health education occupational health risks
transition from military to civilian life
pre-separation seminars, transition assistance programs, and job fairs
suicide prevention measures
programs and better screening/assessment
Veterans Health Administration
provides healthcare services to anyone who served in the military must serve for 24 consectutive months, honorable discharged
Ticket to Work and Work Incentives Improvement Act (TWIIA)
reduced the disincentives to work for PWD by increasing access to vocational services and provided new methods for retaining health insuracne after they returned to work addresses employment and benefit issues for people with disabilities
values
refers to a desirable or undesirable state of affairs values are a universal fewature of all cultures
What is the upstream perspective for the rural community
rely upon community involvement to create rural change attacking community-based problems at their roots - bringing awareness to local issues - pesticide use and effect on respiratory health emphasizing the "doing" aspects of health - accident prevention, local industries participating in risk reduction for workers maximizing the use of informal networks - education to ensure community members fully understand changes and initiatives
air force
responsible for conductin expeditionary and amphibious operations with the US navy as well as the army and air force
coast guard
responsible for marine safety standards for vessels and ports
What are the secondary prevention roles of the community nurse in relation to substance abuse
screening and finding resources and solutions specific to the particular community important to be aware of EBP for certain programs and to modify or discard those programs that have not proved successful over time
What is the CAGE tool?
screening tool that are brief and simple and allow health providers to talk about substance abuse by incorporating relevant questions into the interview and history of any client. A positive response does not constitute a diagnosis of alcohol or drug dependence, but it should raise suspicion and further investigation
active duty
service member is stationed either domestically or overseas - 6-24 months
intellectural disabilities
significant limitations in both intellctural functioning and adaptive behaviro
What are the 12 standards of the standards of practice for culturally competent nursing care
social justice critical reflection knowledge of cultures culturally competent practice cultural competence in health care systems and organizations multicultural workforce education and training in culturally competent care cross-cultural communication corss-cultural leadership policy development EBP and research
A nurse plans to implement interventions at the community level to address substance use disorders. Which interventions would the nurse likely implement?
support law enforcement measures to limit access to and distribution of addictive substances provide educational programs at schools and penal institutions create radio public service communications concerning the risks of substance abuse and the availability of treatment
cultural stereotyping
tendency to view individuals of common cultural backgrounds similarly and according to a preconceived notion of how they "ought" to behave
Which mental illness is most frequently diagnosed among adults in the United States?
Depression
what are the roles of a community mental health nurse
case manager content expert advocate grant writer educator coordinator collaborator
Which best describes the challenges when providing care to someone from a minority group?
communication, both words and gestures, may be unfamiliar few members of the minority group are nurses themselves the nurse may have to confront personal values and beliefs
What are other preventative measures at the government and private levels
community-based programs, training of health professionals, faith-based initiatives, volunteer consumer groups, organized sports programs, and employer programs
how is disability a social construct
complex phenomenon, reflecting the interaction between features of a person's body and features of the society in which the person lives conceptualized as the inability to perform important life functionig, it becomes as a product of interaction between health status and the demand of one's physcial and soical environment
define harm reduction
consists of individual and collective approaches to the treatment of substance use that are not primarily aimed at complete abstinence from all substances incremental change is sought, which involves elimination of the more harmful effects of substance use thought behavior and policy modifications. is a process rather than a static approach or and end in itself
What are the fatal four
constipation and bowel obstruction aspiration/GERD dehydration seizures
what are the barriers to health for migrant farm workers
cost & shortages of services cultural barriers - unlikely to seek care that doesn't require emergency treatment or surgery, lack of care provided within a cultural context Knowledge barriers - unaware of clinical & social services available at reduced or no cost to low-income families, comprehending eligibility crieteria language barriers - indigenous populations may not speak english or spanish fear created by lack of documentation/immigration status
national agenda for disability model
a. "Disability is noted by the National Agenda Agenda for the Prevention of Disabilities (NAPD) to be any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them; this will in turn influence quality of life."
persons with disabilities
a person whose physical or mental impairment substantially limits his or her major life activities
define cultural imposition
a person's tendency to impose his or her beliefs, values, and patterns of behavior on individuals from another culture
define ethnocentrism
a person's tendency to view his or her own way of life as the most desirable, acceptable, or best and to act in a superior manner toward another culture.
A nurse carefully explained that the medication had to be taken three times a day, with each meal. The patient came to the clinic with symptoms of medication overdose. How should the nurse respond?
"Can you tell me when in the day you and your family eat?" It is not helpful to confront the patient or accuse someone of noncompliance. A review of the prescription may have been helpful, but because the patient had an overdose, one might assume the medication is being taken more than three times a day. The nurse has engaged in cultural imposition—that is, assuming the patient's beliefs, values, and patterns of behavior are identical to hers. Not everyone eats exactly three times a day. The family may eat more or less than three times a day.
A nurse is interviewing a client to determine if she is eligible for VA benefits. Which question would assist the nurse in determining the requirement of service?
"Did you serve active duty for 24 consecutive months?" Veterans—and sometimes their survivors and dependents—are eligible for VA benefits when they fulfill two requirements related to service and separation. (1) Service: they must have served in active duty for 24 consecutive months or for a full period of call (Reserves and Guard). There are some exceptions to the length of service minimum, the most important being when a person is discharged for disability incurred or aggravated in the line of duty. (2) Separation: they must have been separated under any condition other than dishonorable.
A veteran tells the nurse that he hates the VA health insurance program and wishes that he would be allowed to see the local doctor instead of traveling to the VA clinic. Which statement would be most appropriate to be made by the nurse?
"The VA does not provide health insurance, rather this is a benefit that you receive for compensation for your service to our country." Many veterans do not realize that their care at their VA hospitals and clinics is not a type of health insurance. Instead, it is a benefit that they receive in compensation for their duty and service to the country. The difference between health insurance and VA health benefits is twofold. First, veterans do not have to "pay into" their VA benefits the way one would pay premiums for a health insurance plan. Second, the "coverage" received in the form of VA benefits is not transferable to other non-VA providers, except through formal contracts deemed appropriate by the VA and its providers.
What are the primary prevention methods at the federal level?
"War on Drugs" significant amount of fiscal resources has been allocated to law enforcement, interdiction, crop eradication, and harsh, punitive laws to prosecute drug users and manufacturers
A baby was dehydrated because of diarrhea. The mother explained that she had finally gone to a folk healer who told her to give the baby herbal tea, which did seem to be helping a bit, but the baby still seemed ill. Which statement would be the most appropriate reply by the nurse?
"Your healer is correct; fluids are crucial for your baby. Let me give you some special fluids for you to give the baby." Rejecting the folk healer's advice may cause the mother not to trust Western medicine. If possible, the nurse should build on what the mother is doing. It is usually helpful to include any behaviors that may be helpful or neutral in effect. In this case, the mother is encouraging fluid, which is crucial, and tea is boiled, so the water is clearly safe. Just adding salt and sugar is risky because of the need for careful measurement. Nothing in the example suggests the nurse recognizes what kind of tea is being given. It is easier to give the mother fluids with the appropriate electrolytes while supporting at least some aspect of the healer's advice. It must be remembered that most indigenous healing practices are innocuous.
culturological assessment
"a systematic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values, and practices to determine specific needs and interventions within the cultural context of the people being evaluated
ADVOCATE
1. A-advocate - don't assume the client has a physical or cognitive deficit until you have validated it 2. D -deficits - determine sensory, visual, and hearing deficits 3. V-vocation - encourage vocation or"avocation," including recreational therapy that encourages social interaction 4. O-outcomes - adopt the client's perspective as to what works best with no bias 5. C-communicate - listen and learn from client, family, and caregiver 6. A-assess - determine what deficits the client deems a challenge or an issue 7. T-transition-provide resources, information, and support when there is a change in a level of care, care providers, school, or role responsibility within the family unit 8. E-empower - encourage learning, memory, coping skills, independence, reinforce ability and success in ADLs, mobility, employment
Prevalence in the U.S. of disabilities
12-20% of U.S. population 18.7% are aged 5 years and older having a long-term condition or disability 12.6% is severe
what percent of youth aged 12 to 20 drink alcohol or have reported binge drinking in the past 30 days?
20%
A veteran has been diagnosed with an immersion foot injury. Which finding should the nurse anticipate when completing an assessment on the client?
A foot that has occasional numbness
Hispanics - culture bound syndrome
empacho - food into a ball causing pain fatigue - asthmalike symptoms Mal ojo (evil eye) - fitful sleep, crying, and diarrhea in children caused by a stranger's attention; sudden onset susto - anxiety, trembling, and phobias from sudden fright
Which do expert rural nurses report as benefits of their work?
Ability to develop close relationships and give holistic care being able to practice in the community where one lives constant challenges continual growth as an expert generalist intensity of purpose
A nurse eagerly explained to a long-term disabled male client the most recent relevant research related to his care. The client, rather than express appreciation, said, "I prefer to have my care given this way." The nurse explained that research suggested an alternative approach was more clinically effective, but the client said, "I am more comfortable during the day if my care is given this way." Which action should be taken by the nurse?
Accept that the client knows what works best A person who lives with a disability commonly becomes an expert at knowing what works best for his or her body. The nurse must ask the client what works best for him or her and what goals the client is pursuing. Research is based on probabilities of effectiveness with large groups, but individuals may have a different unique reaction to any intervention.
Which describes the most important need of every school-aged child with a disability?
An individualized education plan (IEP) A child should have all of the above items, an advocate in the school nurse, a teacher who understands, an assessment including comparison with developmental milestones, as all of these are components of an IEP with goals, cooperatively developed with the parents, to help the child succeed in school. The IEP describes the goals, as well as any special support needed to help achieve them. The IEP is the most comprehensive answer.
A woman who spoke English was an immigrant from the Middle East, attending the clinic for the first time with two female friends. When a male nurse attempted to get a health history, the woman refused to respond to his questions. Which action should be taken by the nurse?
Ask a female nurse to talk with the client
A nurse is working in a community setting caring for persons with mental health problems and their families. Which accurately describes how the nurse would fulfill the nursing role of coordinator?
Assisting the mental health client in navigating community agencies The nurse as coordinator helps the consumer "navigate" the segmented web of agencies and other service providers. Being an advocate and encouraging the community to overcome the stigma of mental illness are both activities the nurse would fulfill through the role of activist. Establishing supportive interpersonal relationships is fulfilled through the role of practitioner.
define upstream interventions
Attack community based problems at their roots, emphasize the "doing" aspects of health, and maximize the use of informal networks
A nurse was trying to decrease the amount of respiratory illness in the community. Which approach should be used by the nurse?
Attend each farm-workers' meeting and listen to how they perceive and discuss their problems Using informal networks in the community is essential. The involvement of informal networks and local leaders in planning health interventions is crucial. To be able to do that, the nurse must first listen to how the community perceives its problems.
A nurse is caring for a client from a different culture. Which action would be the most helpful for the nurse to take?
Be aware of cultural similarities and differences between the nurse and the client
Which is the drug of choice for treating persons with alcohol withdrawal?
Benzodiazepines
what takes place in the personal distance space (1.5-4 feet)
perceived as an extension of the self, similar to a bubble voice is moderate body odors are inapparent visual distortation does not occur much of the physical assessment will occur at this distance
Community-based mental health history
Community Mental Health Center (CMHC) program was developed in the 1960's Comprehensive services for people with mental illness Community Mental Health Centers Act signed by Kennedy in 1963 Resulted in deinstitutionalization of inpatients and the closing of mental institutions
Which age group has the highest prevalence of binge drinking and heavy drinking?
young adults aged 18 to 25 years
What might influence a young person to drink alcohol
young people rarely drink alone low social disapproval from peers
severe mental illness
Diagnosis applied to any adult who currently or at any time during the past year had a diagnosable mental, behavioral, or emotional disorder with moderate, severe, or extreme functional behavior in specific lifestyle areas.
A nurse is assessing a female veteran for military sexual trauma (MST). Which would be the most appropriate question for the nurse to ask?
Did anyone ever use force or threat of force to have sexual contact with you against your will?
A veteran reports to the nurse that she believes that she may be suffering from PTSD. Which would the nurse anticipate the client experiencing during the past month?
Difficulty sleeping negative feelings about oneself avoiding communication with others from her troop To be diagnosed with PTSD, an individual must have experienced a "stressor criterion," which means that the person has been exposed to an event that is considered traumatic (Friedman, 2016). In addition, an adult must experience all of these symptoms for at least a month: at least one reexperiencing symptom (e.g., flashbacks, bad dreams, frightening thoughts); at least one avoidance symptom (e.g., staying away from places, events, or objects that are reminders of the experience; avoiding thoughts or feelings related to the event); at least two arousal and reactivity symptoms (e.g., being easily startled, feeling tense or on edge, difficulty sleeping, angry outbursts); at least two cognition and mood symptoms (e.g., trouble remembering key features of the event, negative thoughts about oneself or the world, distorted feelings of guilt or blame, loss of interest in enjoyable activities) (NIMH, 2017).
Which insight is being stressed by advocacy groups regarding persons with disabilities today?
Disability results when physical and social barriers in the environment prevent a person from taking equal part in community life.
Which are strategies the nurse should practice to provide effective care for persons with disabilities?
Don't assume the client has a physical or cognitive deficit until you have validated it allocate additional time for care Adopt the client's perspective as to what works best without bias The acronym developed that spells ADVOCATE can help remind and guide the nurse of essential principles that are integral to the care of PWD. A—Advocate, D—Deficits, V—Vocation, O—Outcomes, C—Communicate, A—Assess, T—Transition, E—Empower. Effective strategies include not making assumptions about deficits before they have been validated; allocating additional time for care as necessary; adopting the client's perspective as to what works best without bias. Ineffective strategies include apologizing for errors, offering expert opinions or advise, and grabbing the arm of a person who is blind.
rehabnilitation act of 1973
○ Promoted disabled individuals' efforts to form community based, nonresidential programs and find resources within their geographic area
A veteran is receiving treatment for posttraumatic stress disorder (PTSD). As part of the therapy, the veteran identifies negative thoughts and emotions while focusing on specific sounds and movements. Which trauma-focused therapy is the client receiving?
Eye movement desensitization and reprocessing There are variations of trauma-focused therapies. These include (1) prolonged exposure therapy (where the individual is repeatedly questioned by the therapist about the trauma to encourage control of the thoughts and feelings to reduce fear of the memories); (2) cognitive processing therapy, which involves talking with the therapist about the negative thoughts and beliefs and development of strategies to manage the recollection of the trauma in a way that is less upsetting; and (3) eye movement desensitization and reprocessing, which involves identification of the negative thoughts, emotions, and feelings while focusing on specific sounds or movements, helping the brain work through the traumatic memories. Friedman noted that the most successful interventions include cognitive-behavioral therapy and medication (e.g., selective serotonin reuptake inhibitors such as sertraline [Zoloft] and paroxetine [Paxil]).
Which are the causes of mental illness?
Genetic inheritance combined with neurochemical and metabolic changes living through a severe disaster, whether manmade or natural physiological abnormalities in the brain structure PTSD social isolation, rejection, and/or stress
A veteran has been diagnosed with a mild traumatic brain injury (mTBI). Which symptoms would most likely be reported to the nurse?
Headaches Dizziness Memory problems
A nurse felt very good about an Asian man who had responded positively to the instructions given to him. Later, the nurse heard him tell his wife that there was no way he could implement the suggestions. Which best describes the problem that the client is experiencing?
His culture may value harmonious relationships over expressing disagreement. Asian clients may provide the nurse with the answers they think the nurse wants to hear. This behavior is consistent with their cultural value for harmonious relationships with others. The other responses do not recognize this cultural variation among this population that the nurse should recognize.
A person with obsessive-compulsive disorder (OCD) knows the ritual is senseless but is unable to stop. Which best explains why he does not quit doing the ritual?
If the compulsion is resisted, anxiety increases. The person with OCD feels compelled to engage in some ritual to avoid a persistent frightening thought, idea, image, or event. Obsessions are recurrent thoughts, emotions, or impulses that cannot be dismissed. Compulsions are the rituals or behaviors that are repeatedly performed to prevent, neutralize, or dispel the dreaded obsession. When the individual tries to resist the compulsion, anxiety increases.
A college student visits the student health center and tells the nurse that his roommate is talking about killing himself, has given some of his possessions away, and he believes the roommate has a gun. Which action should be taken by the nurse?
Immediately locate the roommate, talk to him, and, if the story is confirmed, stay with him until emergency services arrive.
Ethical issues for PWD
Institutionalization (past) Discrimination Healthcare Needs Eugenics Educational Attainment Housing Service Animals Employment Opportunities Respect/Autonomy/Consent
what is the long-acting narcotic antagonist traditional used as an adjunct in the treatment of opiate dependence
Naltrexone
Americans with Disabilities Act of 1990
Major anti-discrimination law for disabled; requires access (ramps, braille, etc.); unfunded mandate
Present day community mental health reform focuses on:
Making community health a national priority Establish early access Public education Quality standards in mental health care delivery systems
Which is the most commonly used illegal mood-altering substance?
Marijuana
affordable care act
Medical history — including mental health history —no longer results in enrollment denials or higher premiums. Individual and small-group plans are required to cover ten essential health benefits with no annual or lifetime limits. Mental health and addiction treatment are among the essential health benefits.
define detoxification
a short-term treatment intervention designed to manage acute withdrawal from the substance involves medical management to reduce the adverse side effects of the substance and help stabilize the client may be inpateint or outpatient, depending on the substance and severity of dependence
Which are basic components of 12-step programs to help treat addictive behaviors such as alcoholism?
a willingness to change attempts to make amends for wrong done to others recognition of personal strengths and weaknesses
Which best describes the change that was made to mental health care through the implementation of the ACA?
Parity now exists for mental health services. The Affordable Care Act (ACA) built on the 2008 Mental Health Parity and Addiction Equity Act (Substance Abuse and Mental Health Services Administration [SAHMSA], 2017) to extend federal parity protections to 62 million Americans with mental illnesses (USDHHS, Office of the Assistant Secretary for Planning and Evaluation, 2013). This parity law aimed to ensure that when coverage for mental health and substance use conditions is provided, it is generally comparable to coverage for medical and surgical care. The ACA built on the parity law by requiring coverage of mental health and substance use disorder benefits for millions of Americans who currently lack these benefits. Mental and behavioral health services are recognized as essential health benefits. Consequently, the ACA stipulated that all plans must cover behavioral health treatment, such as psychotherapy and counseling; mental and behavioral health inpatient services; and substance abuse treatment (HealthCare.gov, 2017). Similarly, preexisting mental and behavioral health conditions are covered, and spending limits aren't allowed. Parity protections now exist for mental health services.
Which statement about Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) is correct?
Persons with disabilities who receive SSI may receive a state supplement. SSI is funded through general tax revenues, whereas SSDI is funded through disability trust fund monies (Social Security taxes paid by workers, employers, and self-employed workers). To qualify for SSDI, the person with disabilities must be "insured" through Federal Insurance Contributions Act (FICA) earnings of self, parents, and/or spouse, and to qualify for SSI, the person with disabilities must have limited income and resources. SSDI recipients receive Medicare health benefits, and SSI recipients receive Medicaid health benefits. Some states may elect to pay a state supplement to some persons with disabilities in SSI programs, whereas in SSDI programs persons with disabilities are never provided with state supplements.
A nurse is caring for a veteran who has suffered a polytraumatic injury. Which would be the primary consideration for the nurse when working with this client?
Physical and cognitive abilities to complete ADLs independently may be lacking. The term polytrauma refers to two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities. Polytrauma is often the result of a blast-related event, and frequently includes TBI. For example, a soldier who has lost a limb, suffered a TBI, and lost his eyesight from a rocket-propelled grenade attack is said to have a polytraumatic injury. Care for veterans with these injuries is especially complicated because of the presence of several overlapping physical and cognitive impairments affecting their ability to perform ADLs. The primary consideration would relate to the client's impairments in completing ADLs.
Individuals with Disabilities Education Act (IDEA)
Provides a free appropriate public education for students with disabilities
A nurse reviewed the treatment the surgeon recommended for a woman's breast lump. When the nurse asked the woman if she could be admitted to the hospital for immediate surgery, the husband thanked the nurse for her time and said they would get back in touch after they speak with other family members. Which action would be most appropriate for the nurse to take?+
Recognize that the husband and other family members may need to have input into this decision We typically focus on the individual as the central figure in decisions about the self. However, in other cultures female clients may seek assistance from other members of the family and allow male relatives to make decisions about important health-related matters. The husband has indicated by his response that collateral relationships are valued, thus decisions about the client may be interrelated with the influence of illness on the entire family or group. The other responses do not address the value of collateral relationships that the nurse must recognize and address.
define substance use disorder
Substance use disorders are patterns of maladaptive use of psychoactive substances that lead to significant levels of impaired functioning or personal distress.
As a concerned citizen and professional, a nurse encourages the local senators and representatives to support expansion of health clinics for the poverty stricken. Which location is in most desperate need?
Rural areas where migrant and seasonal farmworkers (MSFW) labor In general, MSFW may have the poorest health of any aggregate in the United States and the least access to affordable health care. Thus, a location that serves this population would be most important.
A client reports hearing loss and tinnitus following military duty in the Gulf War. Which term would best describe this client's injury?
Service-connected disability A service-connected disability is a disease or injury that was incurred as a result of or during the veteran's active duty, or one that was aggravated by military service. Posttraumatic stress disorder is a mental illness that develops in some individuals who have experienced a shocking, frightening, or dangerous event. A traumatic brain injury is a disruption of brain function caused by an external mechanical force, including blunt force trauma, penetration by a foreign object, acceleration or deceleration movements, and pressure waves from explosive blasts. The term polytrauma refers to two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities. Polytrauma is often the result of a blast-related event and frequently includes TBI.
A young woman rolled her wheelchair up the ramp into the clinic to the desk where the intake nurse greeted her. Which should be the nurse's first response?
Sit so the nurse is at wheelchair level with the young woman Nurses who demonstrate understanding of the issues confronting people with disabilities should approach them at wheelchair level, listening to understand. Moving to wheelchair level should be the first action that the nurse takes before beginning a conversation with the client.
A patient with severe panic attacks refuses to come to the mental health clinic to get help even after being assured there is no charge for the initial assessment. Which provides the best explanation for this behavior?
Such persons have anticipatory anxiety, so they try to avoid situations that may lead to a panic attack, such as leaving their house. As the avoidance behavior intensifies, the client begins to withdraw further to avoid being in places or situations from which escape may be difficult. Individuals with agoraphobia frequently progress to the point where they cannot leave their homes without experiencing anxiety.
Which statement best defines Leininger's term "culture universal"?
The commonalities of values, norms, and life patterns that are held in all cultures Culture universal is used by Leininger to refer to the commonalities of values, norms of behavior, and life patterns that are similarly held among cultures about human behavior and lifestyles and form the basis for formulating theories for developing cross-cultural laws of human behavior.
Which best describes the proportion of the U.S. population that is made up of persons with a long-lasting condition or disability?
The proportion is almost 20% and increasing.
Which statements about veteran suicide are accurate
The suicide rate of veterans is higher than that of the general population the majority of veterans who die from suicide are age 50 or older the age group that has the highest suicide rate among female veterans is age 18-29 years old
Which statement regarding developmental disabilities is accurate?
Those with developmental disabilities exhibit limitations before 18 years of age. Developmental disabilities encompass those conditions that are manifested by limitation before the legal age of adulthood, which is 18. This includes issues that limit or present challenges to the performance of activities of daily living (ADLs). Developmental disabilities encompass those lifelong conditions that are chronic in nature and may incorporate either or both intellectual and physical disabilities. Developmental disabilities can be diagnosed at any point in time during childhood. A handicap is not a characteristic of a person, but rather a description of the relationship between the person and the environment; a handicap results when a person with an impairment cannot fulfill a normal life role in society on a macro level of analysis.
A veteran has been diagnosed with chronic multisymptom illness. Which would most likely be part of the client's health history?
Unexplained cognitive dysfunction Approximately 250,000 veterans of the 1991 Gulf War (about 25% to 32%) returned home with multiple varied, unexplained symptoms, including fatigue, dizziness, headaches, cognitive dysfunction, musculoskeletal pain, respiratory problems, rashes, and diarrhea. Popular media of the time referred to the disorder as Gulf War Syndrome or Gulf War Illness, although today the VHA refers to this cluster of symptoms as chronic multisymptom illness (CMI).
A veteran is receiving veteran's health care benefits. Which department directly coordinates these benefits?
Veterans Health Administration (VHA) The Department of Veterans Affairs has three subdivisions: the VHA, the Veterans Benefits Administration (VBA), and the National Cemetery Administration. The VHA provides all types of health care in every setting, including inpatient, outpatient, and long-term care. The VBA is an administrative arm responsible for unemployment and pension payments, home loans, vocational training, and educational benefits. The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a program in which the costs of some health care services for eligible civilian beneficiaries are covered by the VA.
army
a permanent organization of the military land forces of a nation or state
veteran
a person who has served in the militar
veteran status
a person who served in the active militray, naval, or air service and who was discharged or released under conditions other than dishonorable
stigma
disgrace associated with a particular circumstance, quality or person
dominant value orientation
a basic value orientation that is shared by the majority of its members as a result of early common experiences
What is the clinical institute withdrawal assessment
a continual assessment protocol commonly utilized in the medical setting that helps patients transition through alcohol withdrawal with less risk of delirium tremens and other medical problems
activity limitaion
a difficulty encounterd by an individual in executing a task or action
handicap
a disadvantage resulting from an impairment or a disability that prevents fulfillment of an expected role
culture-bound syndrome
a disease or illness that cannot be understood apart from some specific social context
traumatic brain injury
a disruption of brain function caused by external mechanical force, including blunt force trauma, penetration by foreign object, acceleration or deceleration movements, and pressure waves from exploding blast
what is used to promote cessation of alcohol abuse
disulfiram (Antabuse) when combined with ETOH, produces the classice disulfiram ethanol reaction (flushing, tachycardia, nausea, headache, chest tightness, and chest pain)
mental health
absence of mental disorders including emotionial, psychological and social well-being
Which are the most important factors in reducing disparities in health outcomes between different cultural groups?
access to a health care provider health care insurance
what are the common health issues of migrant and seasonal farmworkers
acute and chronic respiratory conditions (long-term exposure to grain dust, occupational asthma) chemical exposure (pesticides, herbicides) accidents and injuries (agricultural machinery, tractor related accidents)
what are the basic tenets of 12-step programs
admission of defeat and surrender to a higher power inventory of past shortcomings and strengths spiritual practices willingness to change making amends extension of this process into daily life
Association for Retarded Children (ARC)
advocated strongly for children with intellectual disabilities worlds largest community-based organization of and for people with intellectual and developmental disabilities
What are the foundations for the biomedical theory of illness
all events in life have a cause and effect the human body functions more or less mechanically all life can be reduced or divided into smaller parts all of reality can be observed and measured
define culture
an all pervasive and universal phenomenon
culture bound syndrome - whites
anorexia nervosa, bulima
define substance abuse
any unnecessary or improper use of chemical substances for non-medical purposes
define mutual help groups
associations that are voluntarily formed, are not professionally dominated, and operate through face to face supportive interaction focusing on a mutual goal usually organized by recovering substance abusers or those recovering from compulsive behavior problems the first was alcoholics anonymous
Steroid use is common with which groups?
athletes and other individuals willing to risk potential and irreversible health consequences to build muscle
independent living
begain in the 1960s-1970s with the deinstitutionalization movement groups improved institutional care and established communiyt-based independent living centers for PWD
What is the progression of use for methamphetamine
begin with intranasal or oral use and progress to intravenous use, and occasionally smoking
what is activity orientation
being, in which a spontaneous expression of impulses and desires is largely nondevelopmental in nature growing, in which the person is self-contained and has inner control, including the ability to self-actualize doing, in which the person actively strives to achieve and accomplish something that is regarded highly the person with a doing orientation often directs the doing toward achievement of an externally applied standard,, such as a code of behavior from a religious or ethical perspective examples of applied standards include: the 10 commandments, pillars of islam, hippocratic oath, and nightingale pledge
what is used as an effective tool for alcohol withdrawal because they decrease the likelihood of seizures and delirium
benzodiazepines
factors that influence mental health
biological factors - genetics, brain structure & fuctioning social factors - tragic events political factors - access to health care for mental illness gender race sexual orientation
culture bound syndrome - african americans
blackout - collapse, dizzy low blood - weakness, treated with diet high blood - too rich blood from eating too much red meat or rich foods thin blood - more susceptible to illness diseases of hex, witchcraft, or conjuring
What is the opioid agonist-antagonist that has been used in the treatment of opiate-dependent clinets and those with concurrent cocaine dependence
buprenorphine
measurement of disability
deafness or difficulty hearing blindness or difficulty seeing difficulty concentrating, remembering, or making decisions due to physical, mental, or emotional issues among those 5 years and older difficulty walking, clinbing stairs, dressing, or bathing among those 5 years of age or older difficulty doing errands independently
health problems associated with environmental exposures
dealing with exposure to things like chemicals, cold injureis, radiation, and air pollutants
What are the causes of decrease access to care in rural communities?
decrease in population economic base shift - lack of funding
addressing homelessness
decrease incarcerations
What is the DSM-5 criteria for substance use disorder?
defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria met by an individual the presence of 2 or more of 11 criteria now indicate substance use disorder: hazardous use; social/interpersonal problems related to use; neglected major roles to use; legal problems; withdrawal (but not for inhalant or hallucinogen disorders); tolerance; used larger amounts/longer; repeated attempts to quit/control use; much time spend using; physical/psychological problems related to use; and activities give up to use
case management
development of patient care plans to coordinate and provide care for complicated cases in a cost-effective manner.
service connected disability
disability that is obtained during active duty that qualifies for compensation
strategies for public health nurse caring for people with disabilities
i. Procuring the knowledge related to health conditions that may result from or lead to the disability ii. Be aware of the resources available and legal implications that affect the PWD iii. Literature supports that nurses and physicians who have not had experience caring for individuals with disabilities lack confidence and exhibit attitudes that are not conducive to caring for this vulnerable population iv. Work with interprofessional care team to form alliances with the client and family to reduce or eliminate barriers v. The Association of Rehabilitation Nurses 1. Proposed a competency model for nursing that can be a guide for public health nursing care of clients with disabilities in the current dynamic health care environment
What is human nature orientation
innate human nature may be good, evil, or a combination of good and evil some believe that life is a struggle to overcome a basically evil nature; they consider human nature to be unalterable or able to be perfected only through great discipline and effort The dominant U.S. cultural group chooses to believe the best about a person until that person proves toerhwise
what takes place at the public distance
interaction with others is impersonal speaker's voice must be projected subtle facial expressions are imperceptible
What are the characteristics of a rural community health nursing practice
isolation scarce resources wide range of practice skills services may include: maternal and child health, elder health, mental health, and occupational health
developmental disability
issues that limit or present challenges to performance
culture bound syndrome - chinese or southeast asians
koro - intense anxiety that the penis is retracting into the body
What are the health disparities among agricultural workers
lack of access to affordable health care increase risk of exposure to occupational and environmental hazards
describe aspects of the experience of disability
largest minority group in US temporary and permanent meaning of a disability can change depending on the time frame and the duration
What are the four basic characteristics of culture
learned from birth through the processes of language acquisition and socialization shared by members of the same cultural group adapted to specific conditions related to environmental and technical factors and to the availability of natural resources it is dynamic
Why are migrant and seasonal farmworkers vulnerable
low-income migratory status lack of access to preventive services
mental illness
major disturbance in an individual's thinking, feelings, or behavior that reflects a problem in mental function and causes distress or disability in social, work, or family activites
what age group and sex is more likely to become victims of unintentional injuries
males aged 15-24
caring for patients with amputations
management of physical and emotiona issues
define addiction
manifested by compulsive use patterns and the onset of withdrawal symptoms when substance use is abruptly stopped A behavioral pattern characterized by using a psychoactive substance despite physical, psychological, or social harm.
what is the most commonly used illicit drug?
marijuana
military sex trauma
may be physical assault of sexual nature, battery of sexual nature, sexual harassment that occured during active dutey
what is the treatment of choice in withdrawal from heroin and other opiates
methadone dispensed over an 8-day period in a tapering dose
what is the most widely produced controlled substance in the United States
methamphetamine
management of TBI
multidisciplinary team to manage symptoms and treatment
navy
naval warfare service branch
How many people are considered disabled world wide
over 1 billion people - 15% of the population
what are the 4 phases in the disabling process
pathology, impairment, functional limitation, disabilityd
define informal care systems
people who have assumed the role of caregiver on the basis of their individual qualities, life situations, or social roles Lay-cargivers are individuals who are not licensed health professionals, but often care for patients after a hospital stay.
define transcultural nursing
the philosophical and theoretical similarities between nursing and anthropology
cultural negotiation
the process in which messages, instructions, and belief systems are manipulated, linked, or processed between the professional and the lay models of health problems and preferred treatment
norms
the rules by which human behaviro is governed and result from the cultural values held by the group
co-occuring
the use of substances as well as having mental illness
what is magicoreligious
the world is seen as an arena in which supernatural forces dominate fate of the world depends on supernatural forces for good or evil
what is the goal to managing mental disorders
to decrease symptoms, improve occupational & soical function, create and strengthen coping skills, and encourage behaviors that imporve quality of life
How is the nurse-client relationship effected by cross-cultural communication
to ensure a mutually respectful and trusting relationship, the nurse shoudl introduce himself or herself and indicate how the client should refere to the nurse ask the patient to do the same
define abstinence
to refrain from something cornerstone of recovery difficult to maintain on a long-term basis important area of continuing research including replaspe prevention
polytrauma
tow or more injuries sustained in the same incident affecting multiple body parts and organ systems resulting in various impairements and functional disabilities
immersion foot
type of tissue damage caused by prolonged exposure to cold and wet conditions. leads to swelling, pain, and sensory disturbances in the feet
disability
umbrella term describing impairments, activity limitations and participation restrictions
What are the most common causes of rural injuries/deaths?
unintentional injuries, inlcuding MVA less likely to use seat belts less liekly to use preventive screening nonfatal firearm injuries in the home suicide attempts nontransport accidents including falls, firearm accidents, drowning, fire-related deaths, and accidental poisoning
subculture
used for fairly large aggregates of people who hsare characteristics that are not common to all members of the culture and that enable them to be a distinguishable subgroup
what takes place at the social distance
used for impersonal business transactions perceptual information is much less detailed much of the inerview will occur at this distance
What is social orientation
variations in cultural values orientation are also realted to the relationships that exists with others lineal relationships: exist by virtue of heredity and kinship ties. floows and ordered succession and have continuity through time collateral relationships: the focus is prmarily on group goals and family orientation is important. - Asian clients describe family honor and the importance of working together toward an achievement of the group versus a personal goal individual relationships: personal autonomy and independence. individual goals dominate, and group goals become secondary - Example - The U.S.
mental health issues/substance abuse
veteran peer support groups, access to timely and high quality mental health treatment
what takes place in the intimate zone (0-1.5 feet)
visual distortion occurs best for assessing breath and other body oders
japanese culture bound syndrome
wagamama - apathetic childish behavior with emotional outburst
A client has recently been diagnosed with a substance use disorder. Which criteria would be used to diagnose a client with this disorder?
withdrawal symptoms tolerance of the substance social problems related to use of the substance repeated attempts to control use of the substance without success neglect of major roles in order to use the substance
what are some increase risk for the agricultural worker
working in highly variable environmental conditions (temp extremes, a wide variety of work tasks, and unpredictable circumstances geographically isolated heterogeneous farm-related activities that are season dependent Higher rates of smoking, hypertension, obesity, poverty
What are the primary prevention methods for substance abuse at the community level?
working with other providers to perform a needs assessment identifies high-risk situations and potential problems that threaten the integrity of the community and its inhabitants
what is contemporary conceptualization of people with disabilities
● Modern Media ○ Portrayed as having a full range of personality types and unique abilities ○ If portrayed as fully functioning, integral members of society, often viewed by the public as unusual or unexpected ● Global Perspective ○ Nigerian ■ Children with disability have been perceived as cursed by God for gross disobedience, having ancestral violations of societal norms, or being witches and wizards ○ Chinese Culture ■ Those with disabilities have the lowest status ■ Traditional Chineses culture focuses on the cause of disability ● Believed to be a link between disability and previous wrongdoing ■ Believed to bring shame and guilt to the family
