Professor Cox-FINAL (USF)

13-types of grief

"Normal"/ Uncomplicated: uncomplicated grief anger, resentment, withdrawal, hopelessness, guilt somatic complaints (HA, CP, palps, Nausea, sleep changes, fatigue) Changes to some acceptance over time (by ~ 6mos). Dysfunctional /Complicated Grief: Difficult progression thru expected grief/loss stages Prolonged, more severe sxs, may cause/worsen depression or pre-existing MH d/o. SI, intense guilt, low self-esteem may result Somatic sxs persist for > 12 mos. Anticipatory Grief: 'letting go' before loss; grieve before actual loss Disenfranchised Grief: Loss that cannot be publicly shared or is not socially acceptable (ie. suicide in some cultures or religions).

4-SSRI Withdrawal Sxs

insomnia, anxiety, dystonia, tremors, N/V, headache, ***paresthesia

infestations

•Lice: •At-risk/Transmission: person - person; Global issue; esp. in close quarters, school aged kids, bedding, sharing clothing, helmets; some stigma associated may delay tx; Adult female louse lays eggs (nits) on base of neck and hair (visible to eye). •S & Sxs: pruritus, sores, risk -2ndary bacterial infections •Prevention: 1- minimize head / hair contact; Education about it not being r/t 'being unclean or dirty or poor'. 2- scalp checks esp. nape of neck & behind ears; can see white nits à adult lice. Need to apply shampoo tx and use comb to remove thoroughly; may need to shave head. Clean all towels/ bedding in hot water/dryer. Vacuum rugs. Clean furniture. Send out school alerts. 3- repeat txs; secondary infections. •Scabies: •At-risk/Transmission: dense, crowded /shared living environments, towels, clothing, bedding, sexually-active/ multiple partners; daycare, schools; Adult scabies mite burrows under skin to lay eggs; feces, saliva cause irritation. Dogs/cats •S & Sxs: intense itching (worse at night), rash - burrow tracks or lines/ tunnels (check: skin folds, palms, foot soles, finger/toe webbing, arm pits, around fingernails, under breast / nipples, genital area, buttocks), blisters, open sores from scratching; complications- infections, impetigo (staphylococcus aureus). •Prevention: 1- minimize personal / intimate contact with unfamiliar people; 2- visual skin assessment or derm scrapings; Tx with topical 5% Permethrin Cream at night; wash off in AM. Ivermectin (PO) for immunocompromised or severe cases. Supportive Rx- Benadryl. Clean all towels/ bedding in hot water/dryer. Vacuum rugs. Clean furniture. Send out school alerts. 3- repeat txs; secondary infections.

TB Screening

•PPD (screening) (Secondary Prev) nScreen high-risk populations n+ PPD skin reaction nClinical Review of Symptoms nFollow with CXR à Sputum Cultures n+AFB stained sputum smears X3 à used in some cases esp. cannot mount response to ppD nIsolation during testing... Specific Tx.'s for + cultures. •DOT- (Directly Observed Therapy) •to ensure client adherence to med. regimens & reduce risk of resistance. •BCG (vaccine) questionable efficacy •mostly in Europe, questionable efficacy, can create false negatives & positives on PPD •Treatment: •INH, Rifampin, Purazinamide

2-behavior modification

-Positive reinforcement with Praise/ rewards -neg reinforcement ignore undesirable behaviors -role model

6-common nursing diagnosis for BPD

- Risk for self-harm r/t poor judgment and impulsivity AEB by putting self into high risk situations (provide ex's)... - Less than adequate hydration/nutrition r/t excessive activity AEB by not eating or drinking for ___ time periods (provide ex's)...à - Sleep pattern disturbance r/t hyperactivity AEB by no sleep w/ constant activity for 48 hrs à -Impaired verbal communication r/t flight of ideas AEB by speech w/ rapidly switching thoughts. à

13-Milieu Mngt for dementia

- low level of auditory & visual stimulation Provide well-lit bedroom w/ window to help time orientation, minimize contrasts & shadows. Sundowner's Prevention: Radio low level ON & dim lighting. Per NCLEX Texts. NCLEX online review has conflicting info. on this recently; Some questions say turn OFF the TV & radio to avoid being overstimulating... * Key is to balance a safe environment with enough visual cues, lighting & ability for pt to orient more easily to the surroundings AND provide consistency & structure without being too over-stimulating or too under-stimulating. Safety - Lower bed, mattress; remove scatter rugs; keep bed rails raised (physical environment) Memory aids-clocks, calendars, photos, memorabilia, intro self w/ each contact Provide eyeglasses, assistive hearing devices prn Cover or remove mirrors to decrease fear & agitation

3-Motivational Interviewing (MI)

-Behavior change ---> client -most powerful=pts own words which would be elicited by OE questions -use OARS

6-Mood Stabilizers

-Lithium (Lithium carbonate) -Anticonvulsants: Tegretol (Carbamazepine) Depakote (Valproic Acid, VPA) Neurontin (Gabapentin) Topamax (Topiramate) Lamictal (Lamotrigine) Dilantin (Phenytoin) ALL require blood drug level monitoring labs: Li+-monitor BUN, Cr, and TSH Anticonvulsants: liver (AST/ALT)

4-Secondary Prevention Screening Tools

-Mood DO Questionnaire (MDQ) -PHQ-9: MDD management BDI- BAcked Depression Industry, lower score = better Geriatric Depression Scale (GDS)

4-common nursing diagnosis

-Risk for self-directed harm r/t divorce from partner, aeb acts of self-mutilation (safety - highest priority) -Hopelessness r/t loss of job, aeb feelings of despair (lesser than Suicidality but can be risk factor) -Sleep pattern disturbance r/t death of daughter, aeb inability to remain asleep for > 2 hrs. *HESi- "Sleeping through the night" is one of 1st symptom improvements with antidepressant tx. -Self-Esteem Disturbance r/t impaired cognition, aeb negative self-talk -Social Isolation r/t poor social skills, aeb inability to converse for > 2 minutes

1-mandated reporting

-Tarasoff Act (HI, DTO) - Duty to warn potential victim -Abuse/Neglect: Elder, Child, Dependent Adult Abuse -Infectious (ID) / Communicable Diseases (CD)

13-Cardinal symptoms observed in DAT 'A' words

-amnesia -agnosia (inability to recognize objects) -aphasia (loss of language) -apraxia (loss of purposeful movemt) -agraphia (loss of writing ability) -alexia (inability to understand written word, language) -anomia (difficulty remembering words) -mnemonic disturbances (cannot recall new events, LTM decline) -distr. in executive functioning

6-Stimulant common SE/ med education

-decreased appetite/wt loss -insomnia -HA's -anxiety -GI discomfort -increased risk for CV problems and sudden death med education: (first ask PATIENTS OPINION ON EFFECTIVENESS OF MEDS, not parents, teachers, coaches) -extended release may have less SE -dosing in AM and after meals reduces appetite and sleeping problems -monitor BMI, weight gain in children

6-Li+ education

-drink 8-10 glasses of water a day -avoid alc -take with food/milk -keep caffeine the same -do NOT make sudden changes to dietary salt intake

4-Risk Factor for suicide

-family hx -prior attempts -psychiatric hx -concurrent chronic medical problems -lack of access to MH Tx -divorced/widowed/single -acute stressors i.e. recent loss -HC Provider visit!!! -jokes about suicide, give away belongings*** -increased energy/ or (+), may have a plan

13-dementia typcially clears when these underlying issues are treated...

-hypothyroidism -pseudodementia -dehydration -malnutrition -meds/polypharm infections: -pernicious anemia (vit B12 deficiency) -niacin deficiency "Pellagra"--> vitamin B3 deficiency causes confusion, rash, photosensitivity, aggression, ataxic gait -vitamin deficiencies i.e. folic acid, B6, B12, high levels of homocysteine linked to CVD (high levels = cognitive decline in DAT) -syphilis: VRDL tests get bc mimics dementa

1-clients restrained only when:

-its an emergency -for a limited-time only -for self protection

13-dementia community assessment

-no change in LOC -memory/thinking/comprehension problems -majority of dementias = irreversible

3-Brief MI

-targets those who have not sought help -steps = screening, assessment/educate/feedback, behavior change and setting realistic goals with pt

13-stages of alzheimer's

1) mild-forgetfulness 2) moderate-confusion 3) moderate to severe-unable to identify familiar objects or people 4) late- end stage

1-criteria for a 5150

1-self harm DTS/SI 2-others harm DTO/HI (Tarasoff Act/mandatory reporting) 3-graves DO inability to care for self/basic needs not met

1-What are the gold standards of collaborative healthcare?

1. Medical therapies 2. Behavioral Therapies 3. Patient self-mngt care Nursing role across all levels= sxs mngt

3-Cambell's Model of Self-Awareness

1. Psychological (know your own emotions, motivations, self-concept, personality) 2. physical (knowing of physiology, body sensation/image) 3. Environmental (socio-cultural environment) 4. Philosophical (life having meaning)

Disruptive Mood Dysregulation Disorder (DMDD)

CHILDHOOD DO: chronically irritable with frequent, severe temper outbursts grossly out of proportion to situation sxs: persistent irritability, anf=gry mood, outburst observable by peers, teachers, parents

6- Manic episode

1. abnormally elevated mood and/or 2. very irritable (requires 4+ sxs below): -grandiosity -decreased need for sleep -increased energy -flight of ideas -distractibility -increased goal-directed activity -impulsivity -pressured speech

3-With therapeutic communication, do NOT use broad opening statements in...

1. an emergency 2. with dementia/other cognitive DOs

1-all MH patients entitled to:

1. humane tx 2. vote 3. due process of law 4. informed consent 5. confidentiality 6. written plan of care 7. communication to thise outside of care facility 8. LEAST RESTRICTIVE CARE

3-Stages of Change

1. pre-contemplative (highlight CONS) 2. Contemplative (highlight PROS) 3. Preparation Stage (take action/maintenance) 4. relapse stage (reassess)

13-medications and geriatric issues

1/3 all meds consumed by older adults polypharm!! grapefruit can raise drug levels = toxicity! start low, go slow caution with dementias d/t increased sensitivity to meds, decreased metabolisms, GI issues

4-TCA's

1st gen (Tofranil/Elavil/Anafranil) MOA: Decrease SNS stimulation (increases 5HT, blocks Ach) Indications: depression, anxiety, insomnia, migraines (elavil) common SE: anticholinergic SE, sedations (risk of falls in elderly), EKG changes pt. teaching: DRYING-need adequate fluids, get up slowly LETHAL IN OD!!!

4-MAOIs

1st gen- (Parnate, Nardil, Marplan) PANAMA MOA: increases 5HT, NE, DA pt teaching: AVOID TYRAMINE PRODUCTS AND NEVER USE W/ TCAs OR SSRIs---> leads to a hypertensive crisis, need 14-day washout period after stopping MAOI and starting other meds tyramine: aged chhese, fermented meats, liver, saurkraut, yeast, overripe fruits/veggies, avocado wine beer MAOI Selegiline (Emsam)-transdermal patch which may not be as risky

4-SSRI's

2nd gen-1st line option Prozac (Fluoxetine), Zoloft (Sertraline), Paxil (Paroxetine), Celexa (Citalopram), Lexapro(Escitalopram), Luvox(Fluvoxamine), Trintellix(Vortioxetine) MOA: increase 5HT indications: Depression, Anxiety, Other common SE: N, D, sexual SE (30%), insomnia, GI disturbances

4-Depression in Women

2x>men, 10% PPD, married = higher rates of depression, more common in 25-44y/o no psychotropic meds approved for pregnancy, risk for teratogenic effects

13- Confusion Assessment Method

4 cardinal features of delirium presence: 1. acute onset and fluctuating course 2. inattention 3. disorganized thinking 4. altered LOC 5. cognitive differences = illusions/hallucinations 6. physical needs and moos and behavior are assessed

4-Major Depression DSM-V Criteria

5+ total sxs... (must include #1 and/or #2)... most of the day nearly everyday for @least 2 weeks: 1. Depressed Mood (dysphoria) and/or 2. Anhedonia (loss of interest in everyday activities) -appetite/weight gain or loss -insomnia/hypersomnia -fatigue -psychomotor agitation or retardation -impaired concentration -excessive guilt -recurrent thoughts of SI

1. Maslow's Hierarchy of Needs

5. Self Actualization 4.Self-Esteem 3.Love & Belonging 2.Safety/Security 1. Physiological

6-Stevens Johnson Syndrome

with anticonvulsants: life-threatening, peeling rash. Affects mucous membranes nursing mngt: hold med and call HCP immediately, prepare for acute care

4-Dysthymia

>Depressed mood, 'most of the day, more days than not' for 2+ years, 2+ sxs: -under/over eating -sleep difficulties -fatigue -low self-esteem -hard time concentrating -hopelessness -impaired functioning

4-MDD Specifiers

>With Mixed Features: presence of MDD with at least 3 manic sxs, this may increase likelihood of BPD in future. >With Anxious Distress: may increase SI Specifiers may impact types of treatments

13-MSE findings with delirium

A- Alertness - LOC fluctuates. lO- Orientation B- Behavior- Impulsivity Attention, focus & concentration C- Cognition- Thought Process - Disorganized, cannot abstract, problem-solve or reason. Memory- Deficits in 3 areas (ability to register, retain & recall objects) Speech- language disturbance Thought Content - Perceptual Deficits- VH, Decreased ability to distinguish & integrate sensory info. & differentiate from hallucinations, illusions, dreams & imagery.

15-medicare (seniors) fully funded at federal level age 65 and over A B and C?

A-hospital inpatient care bills B- medical insurance/outpatient/primary coverage C-choice (gap coverage) D-Rx drugs

3-Cultural Diversity: ABCDE of what to do if there are problems with cultural diversity

A: Ask if you do not understand (pt is an expert of their experience) B: Be aware on non-verbal messages C: Change volume, pitch, approach , modify teaching, translation services D: Decrease distractions E: Examples) children/people with developmental delays = minimize distractions

Reportable diseases to the CDC include:

AIDS/HIV, TB, COVID-19, VRSA, MRSA, ebola, zika, measles, malaria, pertussis, polio, SARS, smallpox, tetanus, diptheria, gonorrhea, smallpox

4- The nurse should be aware that the person who is at highest risk for suicide is likely to be: a. a married person age 40, with 5 children b. a person who made a previous suicide attempt c. a student at exam time d. a person who is an alcoholic

Answer: D Rationale: (According to NCLEX) "b/c a previous attempt is only one factor while alcoholism has many influencing factors".

6- manic episode MSE findings

Appearance: Unusual, odd or 'over-the-top' Self-care deficit (lack of sleep, distractibility etc) Behavior Constant motor activity, restless, may not sit still Increased Energy Cognition: Affect: up, overly optimistic Thought Content: may be grandiose, delusions = common Thinking Process: Flight of ideas, easily distracted, poor focus Speech: rapid, pressured, loud Insight & Judgment: Poor, Impulsive Ex's - poor tx/med. adherence is common, impulsivity can lead to poor judgment & decision-making Functional impairments

2-Healthy People 2020 Goals

Access to Health Services Adolescent Health (ex- SSRI's) Dementias- Alzheimer's Disease Disability & Health (Depression = #1 cause of disability) Early & Middle Childhood Educational & Community-Based Programs Environmental Health, Food Safety Global Health Health Communication & Health HC-Associated Infections Health-Related QOL & Well-Being HIV; IZ's & Infectious Diseases

6- phobias (types) and mngt

Agoraphobia (without Panic): ◦Fear of public places w/o easy escape (> 6mos); may avoid situation. Social Anxiety Disorder: (formerly social phobia) ◦Fear of performance, social situations, scrutiny/being judged. Specifier: 'Performance Only' subtype Specific Phobia: ◦Fear of specific object or situation. Mngt: systematic desensitization therapy

13- types of cortical dementia

Alzheimer's Dz (DAT) Pick's Dz spherical protein 'pick's' bodies Aphasia; Progresses à death 2-10yrs Binswanger's Dz Small vessel Vascular dz White matter atrophy Creutzfeldt-Jakob Dz (BSE) Infectious protein. UK-1993: 150 deaths, 180,00 cattle death; 3 US cases (2003-2006); Central CA dairy cow confirmed 2012. Vascular Dementia Cortical OR SUB-cortical

assessment for parkinson's ABCDDDEEE and OPPSS

Anosmia- loss of smell Bladder problems, spasticity (frequency, sleep disruption) Constipation, Gastric retention (ANS sxs) Depression (20-40%+ all types), Anxiety, Mask-like facies (r/t akinesia) Diaphoresis (inappropriate) Dysphagia, Hypophonia- quiet, speech problems, swallowing, drooling problems- aspiration risks Erectile Dysfunction Excessive Daytime Sleepiness Executive Dysfunction (planning, organizing tasks)à Dementia; personality changes Orthostasis (ANS sx) Pain - 40% of pts; musculoskeletal; neuropathic in some (many endure unnecessary orthopedic procedures not attributed to PD) Psychosis, hallucinations Skin changes (Seborrhea)-r/t neuroendocrine dysfunction Sleep disturbances - Insomnia (dream enactment behavior or REM sleep behavior disorder=RBD)

lyme disease stages

Assess for Bacterial Infection ~ 3-30 days after tick bite (50-70% of pts) •Stage 1: •Red "Bulls Eye" rash at site of bite •As rash spreads out, center clears; •Fever, HA, stiff neck, malaise •Lymph node enlargement •Migratory joint & muscle pain •Infrequently causes severe, chronic disability •Responds best to antibiotics if treated in this stage. •Stage 2- 3: •Increased sxs - Neurological, HA's •Lesions, •Cardiac abnormalities / can cause death. •Arthritic attacks; chronic problems Sxs may occur months to yrs after lesions (Chronic illness)

1-review of bioethical principles

Autonomy - promotion of independence (*most commonly violated by health care providers; ie. Rt to refuse meds). Social justice - fairness, impartiality (ie. ICU nurse devotes equal attention to pt who attempted suicide as to pt w/brain trauma). Fidelity - faithfulness, promises, do no wrong. (ie. maintain skills thru education). Beneficence - promotion of good v. harm for client (individual, community). (ie. spend extra time to help calm a very anxious pt). Non-maleficence - avoiding intentional harm Veracity - intent to tell the truth (ie. honest about symptoms, med & side effect education). Respect - uses therapeutic & assertive communication to role model appropriate behavior & language; a professional standard & important element for safe & healthy boundaries.

1-DSM-V

Axis I=clinical DO, PDs, Developmental DOs, General medical conditions Axis II=psychosocial/environmental problems Axis III-global assessment of functioning (GAF 0-100) EX) Axis I Bipolar Affective Disorder, Alcohol Dependence, R/O (rule out) Substance-induced Mood d/o; Antisocial Personality Disorder (or None or "Deferred"); Type II DM, COPD, HTN (or None acute) Axis II Recent death of spouse, housing, financial, social support Axis III GAF = 20 (current); GAF = 55 (highest in past year); GAF = 30 (recent hospitalization)

6-Bipolar Affective DO

BP I: manic episode + MDD or mixed episode (1 week of manis and MDD at same time) BP II: hypomania + MDE cyclothymic DO: hypomania + non-MDD depression (dysthymia) for 2+ yrs

13-Barriers r/t older adult's finances and HC financing

Barriers: access to care, costs of disabilities, transportation HC financing: Medicare-partial coverage of costs, MH NOT always covered AARP: nurses advocacy!

13-DAT etiology

Biological factors- (Structural changes) Cerebral atrophy (loss of nerve cells) Neuritic Beta-Amyloid ("Senile" Plaques) Neurofibrillary Tangles (NFT's) ×"Alzheimer-Type changes" May also destroy neurons that secrete: AcetylCholine (Ach) & 5HT Key NT in memory & learning. http://alz.org/brain/08.asp (Brain changes) Genetic - Some chromosomal risks: ×Trisomy 21- Down's, 1, 14, 19, 21. Female gender. Environmental factors- Nutritional deficits (Vit B12) Toxins/pollution, Lifestyle- head traumas, CVD-CVA-strokes Thyroid deficiency

3-countertransference(CT) versus transference (T)

CT: feelings nurse ---> pt -make sure the focus is on the patient and not you T: feelings patient ---> nurse -exists in every interaction and impacts communication

4-Depression in Men

CVD associations, more common if separated/divorced, AA males 92% do not seek tx, 3x more likely to commit suicide

6-Lithium

Class: Mood Stabilizer, a simple salt Metabolism: renal!!! Therapeutic range: 0.6-1.2 mmol/L Lithium causes dehydration and inhibits ADH (cannot concentrate urine, loss of body water, = thirst) common SE: N/V***, cognitive blunting, fine hand tremor, metallic taste Toxicity: N, V, tremor, ataxic gait, nystagmus, dysarthria, renal impairment, seizures, coma, death.

13-geriatric issues: agitation causes and management

Causes: polypharm, akathisia, delirium, mood/PD/psychotic DO, cogn. impairment Mngt: safety= highest priority -non-pharm approaches may be more effective in reducing aggression in dementia -antipsychotics = main tx for addressing agitation and delirium -haloperidol + benzo = he efficacy and low SE

cognitive disorders: summary implementation

Counseling & communication techniques Health teaching & health promotion Referral to community supports Pharmacological interventions Interventions' Focus: Safety/ Environment (Mileau) Agitation/wandering Reality orientation Socialization / Groups Pet Therapy (AAT) Coping mechanisms Encourage independence & choices Medications Reminisce Tx / Prepare for dying / End of life

Modes of transmission

Direct: Vertical transmission- passing infection from parent à offspring (via sperm, placenta, milk, vaginal fluids contact) Horizontal transmission- person à person (infected host to another via touch, resp. droplets, body fluids etc). Common vehicle - infected host à susceptible host (via food, water, milk, blood, serum, saliva, or plasma). Ex's. Hep A (food, water); Hep B (Blood), TB (droplets) Airborne - droplet / respiratory (TB, Pertussis, influenza, swine flu, SARs - can be indirect too). Vector-borne- arthropods, ticks mosquitoes etc. Indirect: Common vehicle Inanimate Objects (Fomites)- water, telephone, tissues, door handles Animals- vary, biting, fecal contamination, meat products. Fecal-Oral route- Hep A, E-coli Airborne nVector-born

13- contributors to confusion

Drugs & alcohol (Incr'd Med SE susceptibility; Misuse of friends meds; etoh) Eyes & Ears (sensory deficits; risk of falls) Medical d/o (Uncontrolled Diabetes & Hypothyroidism; Vit B12 deficiency etc) Emotional/ Psychological d/o (Mood disorders, Memory issues; Contrib. to paranoia) Neurologic d/o (multi-farct dementias / cerebrovascular dz --> vascular dementias) Tumors, Traumas, Toxic Effects (MRI's, CT scans helpful tools to view mild head traumas & pathol. Reasons for changes in memory & behavior) Infections (UTI's, URI's - common confusion causes in elderly; U/A & CXR screen) Arteriosclerosis (cerebrovasc dzà Heart failure--> insuffic't blood /O2 to brain)

13- Delirium causes: DELIRIUMS

Drugs (digoxin, theophylline, cimetidine, anticholinergics, others) Emotional (agitated, depression, mania) Low PO2 (MI, CVA, anemia, PE, PNA) Infections (esp. UTI) Retention (urine or feces) Ictal (or postictal/seizure states) Undernutrition (dehydration, electrolyte d/o's) Metabolic (thyroid d/o, Addison's d/o, Vit B12 deficiency) Subdural Hematoma (bleeds)

ebola

Ebola Hemorrhagic Fever (EHF) nEpi: 1st discovered Ebola River (D.R. Congo) 1976 •2014-16, West African Outbreak (Guinea, Liberia, Sierra Leone); Containment work at outbreak à improved plan for interfacility transport etc. 2017 DR of Congo outbreak. 8 cases, 4 deaths. As of 2016: total cases: > 28,600 cases (suspected, probable & confirmed); total deaths: 11,310; U.S. (4 cases confirmed; 1 death). WHO data. •At-risk/Transmission: HC providers, family, those who come into contact with infected blood, body fluids, sexual contact; bed linens, objects, medical equipment or infected wildlife (eg. bushmeat or infected bats). •S & Sxs: fever, severe HA, muscle & GI pain, fatigue, N, V, D, unexplaining bleeding or bruising. Usually 2-21 days after exposure. •Prevention: Identify ELISA (antigen-capsture enzyme-linked immunosorbent assay testing; IgM & IgG antibodies; Vius Isolation Precautions; Follow stringent CDC protocols •Tx: Supportive Care (IV fluids, lytes, O2 & BP, antibiotics for other infections) •No current vaccine but in research. •Recovery - antibodies last 10yrs, in semen, body fluids; viral load decreases over time. Unknown if can recover fully or not. Some LT complications (Jt, vision).

transmission

Endemic- disease (dz. always present in a geographical area of population. Epidemic- dz. NOT always present; flares up on occasion. Pertussis - CA 2014 Even 1 case is 'epidemic' if dz. is considered previously eliminated from that area (1 case POLIO in US b/c it has been wiped out & eliminated completely from entire US). Pandemic- existence of dz. in large portions of population. nworldwide & affecting large populations; •HIV/AIDS both epidemic & pandemic; SARS was emerging dz & ex of pandemic; Swine flu. Control- reduction of incidence or prevalence of given disease to locally acceptable level as a result of deliberate efforts; multi-system approach Elimination- remove dz. from a geographic area Eradication- reduce incidence of dz. worldwide to zero, r/t deliberate efforts, with no need for further control measures; 100% permanent irreversible termination of a disease. •Smallpox - zero cases worldwide

Rubeola (measles)

Epi- •Highly contagious (90% not immune will get ill); currently on the rise since 2014. •No continuous transmission for 12 mos+ in US until 2014 outbreak. •1960's: 3-4 million (U.S.); 2000: Eliminated w/MMR vaccination campaign. •Lowest was 2000 (0 cases); 2004 (37 cases ); 2014 (668 cases) •Worldwide- ~20 million annual cases; 146,000 deaths, brain swelling, illness. At-risk: Non-vaccinated & travelers à current epidemic (mainly from Philippines & Vietnam; controlled April 2015). Adults in high risk settings: college students, HC personnel & international travelers; Need 2 doses separated by min.28 days. •Populations at risk...newborns to < 2 yrs, elderly, immune-compromised. Transmission: respiratory mucosa, droplets S & Sxs - rhinorhea, sore throat, cough, red watery eyes (conjunctivitis), red rash (after 3-5 days); high fever >104F, encephalitis (1/1000) brain swelling, damage, death; •Rubella (German Measles is milder disease). Prevention: •Vaccine- very effective: 1 dose ~ 93% effective if exposed; 2 doses ~ 97%. •2 doses in children = lifelong immunity (No Booster); Adults- 1 Booster

13-Spiritual Assessment

FICA * F (faith or beliefs) - What spiritual beliefs are most important to you? * I (implications or influence) - How is your faith affecting the way you cope now? * C (community) - Is there a group of like-minded believers with which you regularly meet? * A (address) - How would you like your health care team to support you spiritually?

family considerations

Family Burden: Education & Support - all stages Respite care to reduce burnout Educate: Disease course & progression Realistic & effective interactions Estab. routines for all caregivers Consistency of caregivers is key Community resources: Support groups, NAMI Day-care centers AAT In-home care Residential Care Facility (RCF) Skilled Nursing Facility (SNF) Board & Care (B & C) Hospice Advanced Directives, Healthcare Proxies, Living Wills when client still healthy!

4-Depression Etiology

Genetics: genes + family hx Biological: low levels of 5HT/NE DA reward circuit connected to prefrontal cortex---> decision making/will to live Inflammation ???

13-dementia MSE findings

Global Cognitive Impairment Abstraction, Judgment, insight, complex tasks- language, recognition Personality Change Memory Impairment Inability to recall previously learned info. Decline in Intellectual fn Inability to learn new information despite normal attention. Altered Judgment (when alert) Altered Affect Spatial Disorientation Decreased awareness of surroundings Possible disorientation to place & time ×Fall risks

TB

HIV at risk 1/3 world infected droplet transmission sxs: dry cough, fever, hemoptysis, fatigue, weight loss incubation 4-12 weeks from exposure

13-common nursing diagnosis for dementia

High Risk for Violence- self or other directed (priority) Risk for mobility, injury risk-falls (priority) Risk for injury Self-care deficit; imbalanced nutrition Altered Thought Process (common) or Impaired verbal communication Impaired memory Confusion Impaired environmental interpretation syndrome Readiness for enhanced sleep Caregiver role strain (!) Self-esteem- situational low

vaccine preventable diseases

Hepatitis B Hep A (not routine but vaccine exists; Mandatory for HC workers, high risk popul) Diphtheria Pertussis Measles, Mumps, Rubella (MMR) Polio Haemophilus influenzae Type B meningitis Varicella (chickenpox) Streptococcus Pneumoniae

2-Learning Theories

Humanistic: self-expression and belief/emotions Cognitive: individual thoughts/beliefs Behavioral: "rewards" "punishments" +/- reinforce Social-Learning: environment impacts learning, seeing and doing

Lyme disease

Infectious agent is transmitted by a carrier (Vector) •Lyme disease Deer tick (Blacklegged) bite Bacteria Borrelia Burgdorferi 20,000 cases/yr nationally (90% in NE/Midwest); On rise CA nCA title 17 mandated reporting even 'suspected' cases. •Rocky Mountain Spotted Fever (RMSF) Dog tick bite Vasculitis - severe rash, HA, fever nPrevention, Control - nVaccine recommended for high-risk areas: •1 vaccine approved for adults •76% effective after 3 doses •Vaccine - not a substitute for prevention nPt Ed: •Wear long sleeves, pants, socks •Use repellant on animals •Self checks after outdoor activities •Secondary prevention- Doxycycline X 2-3wks

influenza

Influenza - Acute viral respiratory infection. Vaccine-preventable disease nPrevention: hand-washing & IZ's. nTx: (acute illness) supportive care & timely anti-virals. nTransmission: Peaks Nov. - Feb. (US Jan-March); AAPeds recommends vaccines before late Oct. nRisk Group Recommendations: nAll > 6 mo, 1x year (seasonal vaccine); esp. high risk (asthma) nPregnant women (vaccine only; safe in all stages); Maternal antibodies protect newborn. nMandatory for all HC workers nChildren & adol's (& household contacts) w/ increased vulnerability (medical or social). nRe-vaccination w/ most current vaccine every fall. nFlu vaccine - Injection 'flu shot' for any person & at-risk pt's. nInactivated killed virus; ~ 2 wks à immunity. (CANNOT get flu from flu shot- see Canvas). nVaccination - best prevention; reduces # outpatient visits for flu by 50-75% annually. nContains 3-4 seasonal influenza viruses, grown in eggs; chosen annually by CDC to protect vs. common influenza viruses that research indicates will be most common/ risky during upcoming season. •(*) Children with egg allergy CAN receive vaccination withOUT additional precautions from those taken during routine vaccination (eg. having IM Benadryl on hand.) nNasal spray - 'Flu mist; Some years only; healthy persons, 2-49 yrs, not pregnant. n2016 - 17: NOT recommended; only 3% effective in 2012-2015. nLive virus; NOT all persons safe to take this; shedding active virus à immune compromised. nAllergy: low anaphylaxis risk; egg allergy-OK to get flu shot. n n(*) "Rate of anaphylaxis following influenza vaccine is similar to other vaccines (approx. 1 case per 1,000,000 doses). nAlthough most inactivated influenza vaccines contain eggs, there is little to no risk for allergic reaction associated with the vaccines among persons with egg allergy. * Egg allergy of any severity is not a contraindication to the influenza vaccine (Medscape.com; October 2016)"

3-Basic Communication

Intra: within individuals themselves Inter: occurs>2 people in small group public: large groups transpersonal: spiritual needs

13-therapeutic communication

Introduce self to client w/ each new contact Calm, Reassuring tone, Provide Empathy Establish eye contact, use short, simple sentences, visual reminders Avoid confrontation Do not argue, challenge, dispute or question hallucinations or delusions Reinforce reality ("You are in a safe place. We are here to help.") Reinforce orientation to time, place, & person. Enc. Reminiscence r/t past, happy times; talk about familiar things. Break instructions & activities into short time-frames. Limit choices when dressing or eating. (Ex: "Do you want___ or ___?") Minimize need for decision-making & abstract thinking to avoid frustration Minimize stimulating distractions in environment Encourage family visitation as appropriate.

13-JCAHO

Joint Commission on Accreditation of Healthcare Organizations-pts need spiritual assessmets and staff need education r/t: 1-dying pts 2-w/ emotional or behavior problems 3- in SUDs tx and recovery

Meds parkinson's

L-Dopa: sinemet (leva/carba/parcopa) COMT inhibitors: tasmar, COMTAN DA-Agonists: Mirapex, Bromocriptine, Permax, Requip MAO-B inhibitors: Selegiline (Eldepryl, Zelapar), Rasagiline (Azilect) Others: Anticholinergic (Artane, Cogentin) Amantadine (Symmetrel) Anti-viral, increases DA release & prevents DA re-uptake DBS (Deep Brain Stimulation) Surgical insertion- electrodes stimulate DA producing areas brain

1-Riese hearing

MEDS ONLY -can force patient to take meds without their permission -must offer PO first, give pt. opportunity to make the 'right' choice

4- Mood DO includes:

Main: Major Depression (dysthymia), Bipolar DO ('manic depression', cyclothymia) Others: PPD, SAD, Premenstral Dysphoric Disorder, etc.

TB Mantoux test

Mantoux test of purified protein derivative nPlace PPD: Give 0.1ml ID (wheal) nDocument: Date & Placement Location (L, R forearm) nRead skin response in 48-72hrs nMeasure Induration (hardness, NOT redness) in(mm) >5mm induration is Positive if: nHIV+, +CXR, close contact/exposure w/ infectious TB >10mm induration is Positive if: nDM, IDU, Etoh etc, foreign-born w/ high TB rates, medically underserved/low-income, residents in LTC facilities, jails etc. children < 4yrs old >15mm induration is Positive if: nall others > age 4 yrs w/ NO risk factors (can mount an immune response) Nursing: Document arm, date, size in millimeters!

Medicaid

Medical cost coverage for: - Low-income parents, children, seniors, people w/ disabilities. - Largest source of funding for medical / health-related services w/ limited income. - Problems: being poor/very poor, does not necessarily qualify one. - Est. ~60% poor Americans = not covered.

4-Depression in Elderly

NOT a normal part of aging. most at-risk group of suicide>25% of all suicides caucasian males 75 or older = 6x more likely to commit suicide than any other group pseudo-dementia: confusion and memory deficits r/t depression NOT dementia ... use GDScale

immunity:

Natural Immunity- Species innate immunity vs. a disease. Acquired Immunity- Exposure to specific infectious agent, toxin, or vaccine, or having a disease. Active Immunity or Immunization (IZ) - Admin. of antigen (vaccine or infectious agent) -Competent immune system needed to mount immune response (antibodies) -Immunity is indicated by the presence of host's antibodies (blood titer) Passive Immunity- Immediate immunization but Temporary. - Lasts only as long as substances remain in blood stream. • - Transfer of a specific antibody from immunized person à non-immunized person. •Ex. mom's antibody à baby (offers temporary resistance) •OR Immune Globulin or Anti-serum antibody-preparations •Ex. Rabies, Tetanus, Hep A immune globulins as a stop-gap measure if exposed. •Transfusion of plasma proteins, Immuno-globulins, or Anti-toxins, or transfer of immunity mother à neonate, across placenta. Herd Immunity- Immunity of a group or community. •- Based on resistance of a high proportion of individual members of the group. •- Implies those not immunized will be safe, IF at least 80% of population has Active Immunity. •(ie. is vaccinated and/or had direct contact with infectious agent à presence of antibodies).

Common medication adverse effects

Nausea, Vomiting Dizziness, postural hypotension Lower extremity edema Drowsiness & somnolence, sleep attacks Compulsive Behaviors; impulse disorders (eating, gambling, shopping, hypersexuality/inappropriate) Confusion, hallucinations, illusions, paranoia, sleep disturbances Life threatening, less common:... Pulmonary & retroperitoneal fibrosis; pleural effusion & pleural thickening, Raynaud's phenomena, valvular disease (more common with ergots).

3-What does OARS stand for?

Open ended questions Affirmations Reflections Summaries Empathy!!!

2-RN Led Groups

Open groups are those in which new members can join at any time. Closed groups are those in which all members begin the group at the same time. -health ed/med ed groups: med reconciliation -psycho-ed groups: increase self-control and relapse -duals diagnosis-SUDs sxs recovery model-structured with opportunities to maintain/enhance functioning

nursing role HIV/AIDS

PHN Role: HIV test counseling: •Everyone 13-65yrs (at least 1x) •Q3 or 6mos -Sexually active Males who have Sex with Men (MSM) •OR r/t risk factors nAssess risks & Counsel to receive test results nDiscuss risk behaviors & how to avoid risks. nDevelop a risk reduction plan WITH client (HARM REDUCTION plan) nEstab. f/u appt's as needed & post-test counseling nPost-test counseling: nNegative result: Counsel on risk-reduction activities; Real world canà increased risky bxs •Ensure understanding that results may not be accurate (6-12 wks for HIV antibody) •Negative Test: nIf LOW risk à 1x test for pts w/ NO risk factors nIf HIGH riskà annual or more frequent testing (as per previous slide) nPositive result: Counsel how to reduce risks & notify past/ future partners •à Linkage to HIV care (ART meds) • COMMUNITY Care of pt w/ HIV/AIDs: nCollaborate w/ Community service partners, assess needs for home care etc. nId. Resources (social, financial etc) support services nInterpret school & work policies nAssist employers by educating managers abt how to deal w/ ill or infected workers to reduce risk for breaching confidentiality or wrongful actions such as termination.

13-types of sub-cortical dementia

Parkinson's Dz (PD) Huntington's Chorea Genetic mutation - 50% inheritable; 'Chorea' (quick, jerky purposeless) AIMs, Depression Psychosis, Dementia. ~15-20 yrs: onset death. CoQ10 may slow ?? Dementia of Lewy Bodies (DLB) 2nd most common Late-onset dementia. ~15-20% of Neurodegenerative Dementias. Lewy bodies--> inside neurons -->3 DLB sxs: 1. Spontaneous Parkinson's or EPS signs 2. Persist or recurrent VH 3. Fluctuating cognition AIDS Dementia Complex (ARC)

nursing considerations with parkinson's

Parkinson-specific Meds- "Off" periods = when meds wear off & PD sxs return (before next L-dopa dose). Dyskinesia (AIMs caused by LT use of med L-Dopa & chronic PD itself) is replaced by PD RIGIDITY. * Nursing Advocacy: May require non-traditional, alternative & extra med times! https://www.youtube.com/watch?v=1ZDhHcBSnd4&feature=youtu.be (4:04 mins, MJ Fox Org-Dyskinesia video) Specialist Referrals (Movement Disorders Clinics). Multi-disciplinary care needed. PT, OT, Assistive Devices, Home Care, Speech Therapy, ENT/Swallow & Sleep studies, Psychiatry, Derm., Urology, occ. Neurosurgery. Manage Neuro-cognitive symptoms Depression correlates w/ functional ability (ADL's, cognitive fn, caregiver QOL). SSRI's, SNRI's psychoses (treat by reducing PD meds as much as possible; ok Seroquel, Clozaril) Caregiver strain, burnout: Offer Respite Care (!!) Support Groups Palliative care Hospice care, home care

viral hep c

Patho: single-stranded RNA virus with many different genomes Epi: Most common US chronic blood-borne infection (3% of world pop; 185 million worldwide) •Leading cause of chronic liver dz/cirrhosis & hepatocellualar carcinoma (HCC), ESLD & transplants. Transmission: via blood, virus can live ~72 hrs possibly up to one week in dried blood; at room temp on surfaces, "silent stalker". Primary Prevention: No vaccination (yet) Education & Behavioral focus. Secondary & Tertiary Prevention: •Std txs: Pegyulated-Interfeuron (peg-IFN; SQ tx) & Ribavirin (RBV; PO tx) (6-9 mos; many SE; pegylated makes IFN last longer in the body; SQ injections) •New txs: Direct-Acting Antiviral (DAA) agents (Boceprevir-BOC & Telaprevir -TEL) specifically target proteins resp. for viral replication (used alone or w/Std txs); effective across genotypes, PO & shorter tx durations; May clear virus, possibly 'cure' pts; $ expensive drugs. High risk groups: HC workers, emergency personnel, infants to infected moms, Intranasal/IDU's- sharing works/needles; organ or blood product recipients prior to 1992; 1980's- rapid spread Acute HCV disease: mild, usually non-specific symptoms •Incubation period: 2-6 months, fatigue, anorexia, wt loss, malaise; 15% spontaneous resolution but most become chronic Chronic HCV disease: 10th leading cause of death.

13-clues to dementia

Personal hygiene clues: Appearance loses meaning Dress clues: Antarctic expedition appearance; Madonna Versace fusion; or unkempt! Gait & motor clues: Disregard safety, unsteady, restless, directionless Facial clues: Anxiety, bewilderment, agitation

anxiety DO: summary of pharmacological interventions

Pharmacological: ST: "Anxiolytics" (cut anxiety) Benzodiazepines- PRN or regular ST use only! LT: SSRI's, TCA's, Other Anti-depressants, Beta-blockers, Antihistamines SSRI's (& SNRI's, SSRNI's)- 1st-line tx; also tx co-morbid depressive disorders; Effective but may take 3-4mos for full therapeutic effect. SE's, Risks: Discontinuation/Withdrawal Syndrome, ++5HT (Serotonin Syndrome) TCA's: Anafranil (OCD), Elavil; Anticholinergic SE's, risk in OD. Anxiolytics: Benzodiazepines (ie. Ativan, Klonopin, Valium; Xanax) Quick-acting but risk of addiction, dependence; OD risks via resp depression (esp. w/ other sedating drugs); Withdrawal risks à seizures, death (Alcohol & Benzo's main drug classes that can kill you on Withdrawal). Intended for Short-term (ST) or PRN use only. Other Non-Benzo: Buspar / Buspirone (TID-QID dosing), NOT PRN, safer, LESS habit-forming than Benzo's but some withdrawal sxs-HA's. Only effective ~50% of pts. Beta-Blockers: Propanolol (Inderal -Social Anxiety d/o), low BP as SE. Antihistamines: Diphenhydramine (Benadryl), Hydroxyzine (Atarax, Vistaril); used for sedative properties, SE- sedation, dry mouth (anti-cholinergic like SE). Sedatives: 'sleep-inducing' Sonata, Lunesta, Chloral Hydrate, Remeron, Trazodone Low-dose Antipsychotics: Seroquel (risks!) SE- sedation, wt gain / metabolic risks!

primary, secondary, and tertiary preventions for diseases

Primary Prevention Education for general populations (& at-risk groups) Complete scheduled immunizations Decrease high-risk sexual/substance use behaviors Secondary Prevention nContact investigation & case finding nScreening & early intervention, prevention education •STD/STI screening annually Tertiary Intervention Isolation, disease treatment, precautions nPrevent spread of disease Nursing Roles: Provision of Preventive Care for Communicable Diseases: At all levels of prevention, the nurse functions in the following roles: Counselor Educator Advocate Case manager Primary care provider

dementia interventions

Primary Prevention- Policy development: helmets; falls prev'n, safe nurse-pt staffing ratios; schools/sports. Education: head injury risks, TBI's; Wellness- Exercise, Nutrition, Diet, DM & CV-risk reduction, Neuro-Cognitive training/resilience; Depression Tx, Social engagement. Research: Estrogen therapy, new meds, funding-brain research. Secondary & Tertiary Prevention- Screening, Exercise, Lifestyle changes Assisted living; Hospice Meds ×Cholinesterase Inhibitors: ÎImprove self-care & slow cognitive decline in mild-mod. stages. ÎImprove Memory, daily fn. ×Symptom Management (Palliative Care / Comfort Care) Anti-anxiety & Anti-depressants (Mood) Antipsychotics- often used; may speed up death ? New EBP studies FDA black-box warnings; Cost/risk-benefit analysis

Food and water borne diseases

Primary Prevention: •Food-borne diseases Salmonellosis Escherichia coli 0157:H7 •Water-borne diseases Hepatitis A Typhoid fever Bacillary dysentery Cholera •Zoonoses (Zoonotic dz's) Dz's transmitted from vertebrae animals to humans. Rabies

prevention and control

Primary prevention •Preventing the start or spread of disease (dz.) before it occurs. Efforts to reduce risk of exposure to a risk factor or health determinant in individual or population. Ex. Immunizations (IZ's) Secondary prevention •Screening & early intervention to prevent dz. as soon as it starts in population. Efforts focus on sub-clinical or early clinical stage of a dz.; early detection & prompt effective interventions. Ex's - Screening programs - Pap smears, HIV testing, mammography to detect early cancer diagnosis Tertiary prevention •Reducing complications of existing dz. thru. tx. & rehab. in a community. Efforts focused on active clinical stage of dz. for recovery during disability or death stage to reduce long-term impairments & problems, reduce suffering, optimize fn, limit dysfunction, extend survival. Ex's- speech tx.., PT, OT & Medical tx.'s post CVA or Management of Diabetes. Role of Nurse- all levels; Multisystem approach to control

13-community health home care nursing safety checks

Remove scatter rugs Install door locks that cannot be easily opened Store cleaning supplies / toxins/ poisons in locked cupboards Lock water heater thermostat & maintain water at safe temp. Provide good lighting, stairs, thresholds Install handrails on stairs, bathrooms (grab bars) Mark stairs, steps, thresholds w/ colored tape Place mattresses on floor / beds in low position Remove clutter, keep clear, wide pathways for walking Secure electrical cords to baseboards

varciella-zoster virus VZV-chicken pox

Reportable disease to DPH Epi: >10,600 hospitalizations & 100-150 deaths/yr At-risk: HC professionals, teachers, college students, immune compromised, travel those working/living with children or in close quarters (jail, SNF/NH's) Transmission: person to person, touch S & Sxs: blister-like rash, itching, fatigue, fever (avoid aspirin) Prevention: Immunizations per CDC schedule 2 doses = 90% effective children, adol's & adults; first dose 12-15mos old, 2nd 4-6yrs (or >13 w/o IZ get 2 doses 28 days apart) Varivax (or combo with MMR/V - ProQuad)- live, attenuated virus (should last 10-20 yrs) Complications: Reyes syndrome - r/t ASA use (life-threatening) Herpes Zoster - severe pain, can be LT, only 30.6% Americans > age 60 get zoster vaccine (2015). "Shingles" Prevention: (new CDC & ACIP 2018 guidelines) (50 yrs +) 2 RZV "Shingrix" doses 2-6mos apart (recombinant zoster vaccine)

Diptheria

Reportable disease to DPH •Epi: Before 1920 vaccination > 200,000 cases & 15,520 deaths; < 5 cases in past decade with IZ program •At-risk: •Transmission: person to person via resp droplets or open sores or object from someone infected (ie. toy); bacteria produce a toxin that kills tissue; esp winter & spring months •S & Sxs: bacteria infect lining of resp tractà sore throat, weakness, fever, swollen glands... 2-3 days dead tissue forms thick gray pseudomembrane that coats throat, nose, tonsils -difficulty breathing & swallowing. Toxin into bloodstreamà CV, renal, nerve impairment •Prevention: IZ & handwashing (DT or DTap - younger children < 7 yrs) •DT, Td combo with pertussis IZ; Tdap & Td -older kids & adults.

other pharmacological therapies

SSRI's- Lexapro (Escitalopram)- decrease depression - DLB. Mood stabilizers- Depakote (VPA) for mood swings, agitation - Picks Dz. Low dose Antipsychotics- Seroquel (Quetiapine) for AH, VH, delusions- Vascular Dementias FDA black box warning: ×NMS, Sudden Death (all dementias & anti-psychotics). ×Use with caution. Monitor. Estrogen therapy- ?protective (not useful for existing DAT). Herbal Ginkgo Biloba - memory improvement ?, ×Increased risk of bleeding esp. in those taking antiplatelet meds. ×may increase risk of seizures in some pts.

6-panic attack sxs

SXS - Abrupt Onset, Peaks within 10 mins, 4+ sxs: 1) palpitations, pounding heart, or accelerated HR 2) sweating 3) trembling or shaking 4) sensations of SOB or smothering 5) feeling of choking 6) chest pain or discomfort 7) nausea or abdominal distress 8) feeling dizzy, unsteady, lightheaded, or faint (*Offer Paper bag if hyperventilating - may pass out!) 9) derealization (feelings of unreality) or depersonalization (being detached from oneself) 10) fear of losing control or going crazy 11) fear of dying 12) paresthesias (numbness or tingling sensations) 13) chills or hot flushes

3-SBIRT?

Screening (interview/self-report, CAGE), Brief Intervention(discuss personal risk, assess readiness to change, empathy and reflection), Referral to Tx (more intensive care may be needed)

3-Therapeutic Tools: Self

Self-reflection and analysis= self-awareness self-care-supports life balance and =safe nursing care

4-serotonin syndrome

St. John's wort can increase risk, sxs: Mild Increased HR, shivering, diaphoresis, dilated pupils , hyperreflexia, myoclonus (intermittent tremor, twitching), HA, nausea, diarrhea, confusion, hypervigilance Moderate: High BP, Hyperthermia (<104F), agitation, altered MS Severe: Severe HTN, Temp >106F --> seizures, metabolic acidosis, rhabdomyolysis, renal failure, DIC, coma, death nursing mngt: take vs>HOLD>D/C meds offer benzo sedation, acute care

corona

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) NOT Vaccine-preventable (yet) Epi: To date (4/2020) - 2.5million cases worldwide; 175K deaths; US #1 has highest cases > 800K. John's Hopkins Coronavirus Resource Center (live tracker): https://coronavirus.jhu.edu/map.html PH Pandemic - worsened by delayed response, lack of preparation, access to PPE, testing, EBP Tx. Infectivity - uncertain; 2-14 days. How long person is infectious is still unknown. Variable viral shedding (wide range). Environmental risk- variable, unknown for certain, may reside on dried plastic for up to 6 days; NO evidence of animal contact/pet transmission yet. Incubation pd- 1-14 days. Most 4-5d. Immunity- uncertain; antibodies are induced in those who have become infected; possibly protective but not certain, nor for how long if having the antibodies is protective. Virology (from Uptodate, CDC, WHO, April 2020) a Betacoronavirus in same subgenus as severe acute respiratory syndrome (SARS) virus (r/t bat coronaviruses, but in a different group of organisms). COVID-19 structure of receptor-binding gene region is very similar to SARS coronavirus, & Covid-19 appears to use the same receptor (angiotensin-converting enzyme 2 / ACE2), for cell entry. MERS (Middle East Respiratory Syndrome) distantly related betacoronavirus.

4-SADPERSONS

Sex Age Depression Previous attempt Ethanol abuse Rational thinking loss Social supports lacking Organized plan No spouse Sickness

4-Gold standard Tx for Anxiety and Mood DO

Symptom Management = Psychotherapy + Med's + Self-Care secondary: depression assessment, screening, sxs management, then MEDS tertiary: meds, ECT

pharmacological interventions

Symptom Management: agitation, aggression or psychosis; (NO Cure) Cholinesterase Inhibitors: (or Aceytlcholinesterase Inhibitor / AChEI) -Drugs that inhibit (prevent) Aceytlcholinesterase (Enzyme) from breaking down ACh in cerebral neurons ---> increased Ach availability & duration of action à improvements in DAT. -* Indicated for mild - moderate DAT; Start low, Go slow. Taper off. -Usually BID dosing (except Aricept-QD). -Monitor ability to swallow tabs (Oral /SL forms are available). -Do not improve mood (may need anti-depressant) Donepezil (Aricept) - also for severe DAT Tacrine (Cognex) not used as much d/t liver toxicity. Galantamine (Razadyne)Maintain adequate fluid intake, monitor HR, screen CVD; CAUTION w/ asthma/COPD d/t broncho-constriction w/ increased Ach; NSAIDs can increase GI upset/bleeding; Should NOT be used with anticholinergic drugs dt counteracting effects of these meds. TCA's, antihistamines & Typical Antipsychotics - can reduce effects of Aricept etc. Common SE: N/V/D/Bradycardia; loss of appetite; HA, pain Memantine (Namenda): for Moderate - Severe DAT NMDA Antagonists/ reduces Glutamate; blocks CA+ entry to nerve cells to slow cell death. May be used with Aricept etc. Common SE: HA, dizziness, constipation, confusion Rivastigmine (Exelon)

Viral Hep B

Transmission: via blood, body fluids same as HIV but can live longer; Universal Precautions important. Acute infection: self-limited, develop antibody & successfully eliminate virus from body; have life-long immunity. •Symptoms: jaundice, lethargy, nausea, joint pain, fever Chronic infection: ~2-6% of adults infected, remain life-long carriers & can transmit disease. Signs: may develop carcinoma or Chronic Active Hepatitis anorexia, fatigue, abdominal pain, jaundice, hepatomegaly. Vaccination:3 IM's- first dose, then @ 1 & 6 months

1-harm assessment

check for +/- SI or HI, if yes: 1. Plan 2. Intent 3. Means Safety=biggest priority, keep client or others safe from harm

disease of travelers and nursing role

Travel outside U.S. take precautions vs diseases may be exposed to; Zoonosis: infection transmitted from vertebrate animal to a human under natural conditions •Eg. Rabies (hydrophobia) Parasitic diseases: •More prevalent in tropical climates & countries w/ inadequate prevention & control methods •Intestinal parasitic infections •Parasitic opportunistic infections •Control & prevention of parasitic infections •Eg. Giardia, Treat with Flagyl (Metronidazole) Nursing Role: when taking clt history need to consider recent travel, possible exposures: •Malaria •Food-borne & water-borne diseases •Diarrheal diseases

avian/other influenza

Types: •Avian (H5N1) 1st human to human case found in Indonesia; 25 known subtypes. nIndirect transmission via chickens; Humans usually need direct contact with infected poultry to be infected. nVaccine development •Canine, Equine •Swine (H1N1) - Risk: Generally Low- most Avian flu viruses do not usually infect humans (species specific) - spread from ill person to healthy person rare but possible in some forms. Prevention / Treatment: - Handwashing, cough prevention; avoid environments; - Tamiflu (Oseltamivir), Relenza (Zanamivir), Amantadine: anti-virals; prevention or use within 48hrs of onset to reduce symptom severity. Vitamin D. Vaccines: n2009 Pandemic- Pandemrix; Fluzone, Influvac, Fluvax, Optaflu Symptoms (vary): nFlu-like à hemorrhagic, respiratory failure & death. nH1N1 pandemics. Respiratory- person to person. Ex: 1918 -"Spanish Flu" (H1N1) infected 500 million people worldwide; 3-5% world population died (more than in WW1 & WW2 combined & more in 24 weeks than HIV killed in 24 years!); Called Spanish flu b/c dur WW1 most nations censored this info except neutral Spain. nMostly younger people died. (d/t Cytokine Release Syndrome <CRS> or Cytokine Storm or infusion-related reaction, systemic inflammatory response syndrome = large # WBC's release inflammatory cytokines) nU.S. 28% popul was infected; > 675K died) n20% of infected diedà unusual hemorrhages, bacterial pneumonia

vaccine vs. immunization

Vaccination: giving antibodies, live or attenuated (weaker) infectious agents, in small amts to produce a host immune response. Immunization: (implies immunity) takes time to produce full immunity & often several vaccination.

4-high suicide precautions:

age: aging white males, adolescent 2nd gender: males more successful ethnicity: hispanic females, NA's & Alaskan natives identity: LGTBQ+, veterans social: chaotic env., access to lethal means, legal problems/incarceration/barriers to access MH Tx -occupation: men>fishing and hunting, mining, construction women>artists

2- at risk popuations

age: elderly (osteoporosis, cancer, dementia), teens (SI/STDs, accidens) ethnicities: AA (HTN/CVD)/NAs SUDs), hispanics (DM), filipino (gout), caucasian(young males violence) close living conditions-jails, SNF (violence, communicable dz) mentally ill- metabolic syndrome (HLD), SUDs, SI

6. Generalized anxiety disorder

an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal most days @least 6 months: -feeling wound-up/tense -easily fatigued -concentration problems -irritability -somatic complaints -difficult sleep

nosocomial infection

an infection acquired during hospitalization nAt-risk- •Hospital contact - pts, HC workers, visitors, anyone w/ contact •Immune- compromised (on immune suppressive meds) Prevention-Universal Precautions: •approach considers everyone as potentially infectious •procedures to prevent exposure to bld-borne or body fluid dz's nRemoval of Devices nEnvironmental Cleaning nHand washing & following policies & procedures nSurveillance & Education

vector-borne disease

an infectious disease acquired from organisms that transmit a pathogen from one host to another

4-Other Antidepressants

atypical AD: mixed SNRI/SSNRIs Trazodone (Desyrel) very sedating, PRN for sleep, risk for PRIAPISM Effexor (Venlafaxine) '50-50' drug MDD, 5HT effect at lower doses, NE effect at higher doses Wellbutrin/Zyban (Bupropion Hcl)-stimulant, only NE-DA reuptake inhibitor, smoking cessation, ADD/ADHD, SAD, contraindication in seizures and bulimia! Cymbalta(Duloxetine): for fibromyalgia and neuropathic pain Remeron(Mirtazapine): very sedating, weight gain Ketamine(Esketamine): short-term!!, SUD risks, providers go thru special training

2-crisis intervention

brief tx (1 day to 4-6 weeks) where you try and solve an immediate crisis, prevent further de-compensation

13-confusion/behavioral issues (causes and mngt)

causes: delirium, dementias, parkinson's mngt: safety and check 3 P's -pee (dysuria, increased frequency) get UA -Poop (constipations) -pain (any cause)

13- common DAT defense mechanisms

confabulation- protects ego by lying to fill in blanks of missing memory denial-refusal to believe changes are occuring perseveration-avoids answering questions by repeating phrases or behavior, unconscious attempt to maintain self-esteem

1-conservatorship

court-appointed person to make decisions for pt when they are not able to

13-common nursing diagnosis for delirium and outcomes

diagnosis: Risk for injury r/t___ aeb____... Deficient fluid volume Acute confusion Disturbed (Disruptions in...) thinking/cognition/thought process, memory, or perception Insomnia, Sleep deprivation Impaired verbal communication Fear Self-care deficit plans: pt will remain safe and free from injury while in hospital, pt. will return to premorbid level of functioning, pt will be oriented to time, place, and person

9-infant mental health: 3 patterns of child temperament

easy: adaptable, mild-moderate in intensity slow-to-warm-up: upsets easily by change, adapts with time difficult: low adaptability, negative mood, may have long-term impact

13-spirituality and end of life care

essential of palliative care-honoring preferences, values, and culture of client and family

primary interventions for parkinson's

exercise!!! tai chi (balance, new brain pathways) meditation (increase gray matter) family guidance

1-CHN role

focus on population health (individuals, families, or groups in community) and those at-risk for problems and diseases

2-Group Development

forming: members want to be accepted storming: different ideas compete, group can get stuck here norming: group comes to mutual plans and goals performing: group does active work adjourning: closure

small pox

global eradication raised red pustular lesions on faces, mucous membranes, palms, feet fever, malaise, n/v/d, fatigue, HA, back pain, scarring can be fatal

1-community-oriented care

holistic care to improve QOL health promotion and disease prevention, avoid admissions to acute care

6-Cyclothymia

hypomanic + dysthymia, 2 years or longer Tx: mood stabilizers and therapy to increase coping skills

4-Suicide Protective Factors

internal: *resilience, faith, flexibility, life satisfaction external: responsible for children/pets, + therapeutic relationships, social supports, sense of belonging

1-Psychiatric advanced directives (PAD)

legal doc that is written by pt when 'competent' and has their tx preferences

6-Hypomanic Episode

less than full-blown mania, some impairment in functioning 3 sxs: -grandiosity -decreased need for sleep -increased energy -flight of ideas -distractibility -increased goal-directed activity -impulsivity -pressured speech

1-Dual Diagnosis Management

manage simultaneously, and highest medical priorities first

biological agents: anthrax

mandated reporting to DPH, CDC, FBI causes black lesions, low fatality if tx early inhaled spores most deadly signs = fever, malaise, cough, chest pain, fever, shock

1-Tarasoff Act

mandated reporting, duty to warn/protect potential victim

2-Millieu Management

mngt of environment to assist patient in skill building, ADLs and safety

Hantavirus Pulmonary Syndrome

nReportable disease to DPH •Epi: Southwest US1993; US; Yosemite, CA- Aug. 2012: 10 cases, 3 fatal. •At-risk: anyone, rural, warm climates w/infected Rodents - 96% cases West of Mississippi River, US Whites 78% cases; South & Central America •Transmission: Rodents - cotton rat, deer mouse, rice rat, white-footed mouse; Persons who come into contact with infected rodent - house infestations; Argentina -rare cases person to person transmission; no known in US. •Fresh rodent urine, droppings, nestting materials are stirred up, tiny droplets à aersolized (airborne transmission); bites, touch of droppings, saliva, food contaminated by infected rodent droppings. •S & Sxs: fever, muscle aches, fatigueà pulmonary sxs, can be fatal even in healthy persons. •Prevention: No tx or IZ. ICU/ O2 intubations. •Avoid / eliminate infestations/ food sources; Avoid actions that raise dust such as sweeping, vacuuming, cleaning, opening sheds, garages etc esp in spring (rural settings); hiking, camping. Usually after continued contact. •

pneumonia PNA

nReportable disease to DPH •Epi: millions worldwide, 1 mill kids < 5yrs die/yr; 1 mill US seek care annually, 50,000 die US /yr (mostly adults) •At-risk: >age 65, < age 5yrs, chronic conditions (smokersm asthma, DM, CVD) •Transmission: nCommunity-Acquired, Hospital-Acquired, Ventilator-Acquired: different viral, bacterial & fungal setting-specific causes. •S & Sxs: cough, fever, SOB / Dyspnea à sepsis •Prevention: Handwashing, limit illness, cough into sleeve, limit contact w/cigarette smoke; manage/prevent DM, Asthma, COPD, Resp conditions. •IZ's & Tx of most common causes of PNA. nHaemophilus influenzae type b (Hib) nInfluenza (flu) nMeasles nPertussis (whooping cough) nPneumococcal nVaricella (chickenpox)

corona continued

nSxs- Mild (no / mild pneumonia) 81%; Severe dz-(dyspnea, hypoxia, >50% lung involvement on CXR) 14%; Critical dz- (respiratory failure, shock, multi-organ dysfunction) 5%. Case rate fatality 2.3%; no deaths in non-critical cases. •Fever (99% - although some studies say the sickest may NOT present with fever), Fatigue (70%), DRY cough (59%), Anorexia (40%), Myalgias (35%), SOB/Dyspnea (31%), Sputum production (27%), HA, Chills/shaking, Sore throat, GI sxs (nausea, diarrhea), Rash, Anosmia (new onset loss of smell or taste), Blood Clots (legs esp.), Strokes (esp. in young, healthy persons). Signs: Cyanosis- blue lips/face, SOB, New onset confusion, chest pain. nPrevention: hand-washing/sanitizer >60% alcohol, respiratory hygiene, avoid facial touching, environmental disinfection, PPE, shelter in place, social distancing 6-10 feet; Isolation for COVID+ persons (quarantine to isolation rooms); UV light, Moist heat, Hydrogen peroxide vapor to decontaminate may be effective (more studies needed). nSelf-care during isolation (keep schedules, social connections, exercise, sleep) nTx: (acute mild illness) supportive care; (acute or progressive severe illness) ICU (hypoxia, PNA, resp failure, shock) nTesting, prevention ("flattening the curve") nTransmission: Primary source is probably Bats (r/t RNA sequencing). Unknown if transmitted directly from batsà human or via some intermediate host: Now direct person à person; mainly respiratory droplets (Direct transmission - droplets via cough, sneeze, talk; infected person touches surface, then another person comes into contact with infected surface or person & touches eyes, nose, mouth, mucous membranes). Can spread via blood & stool; May spread from asymptomatic person. nRisk Group Recommendations: nPersons with underlying medical conditions: CVD, DM, HTN, Chronic lung dz, Cancer, Chronic Kidney dz, Obesity à increased likelihood to develop severe or critical dz. •Persons w/ increased vulnerability (medical or social). nAge - older age > risk of death. (8-15% fatal in those aged 70-79 & 80+) •Residing in a SNF or Nursing Home. Cruise ships. nUS ICU admission rates: > 45 years old (67%) (2/12/20- 3/16/20) nDeaths: Gender - Males in China & Italy > females; AA in US > other ethnicities / Racial Disparities. nPersonal & public contacts with Covid-19+ person nResiding/working in Close spaces with Covid-19+ n"Essential" workers- First responders, Health, Sanitation, Grocery, Food services.

viral hepatitis A

nTransmission: via fecal-oral mostly (sometimes water, food, sex) •Virus levels peak 1-2wks before symptoms appear, so contagious before feel / appear ill. nVaccine- preventable since 1995 •Worldwide; Source of infection not found in 25% cases. • nAt risk: travelers, children ages 5-14 yrs, day-care participants & geographic areas w/high rates like Western US, NA's, Alaskan Natives; areas of poor hygiene/sanitation; IDU's, MSM, persons w/ clotting disorders or chronic liver diseases. n nPrevention: •Immunization (IZ) •Good sanitation/hygiene •Prophylactic Immuno-Globulin (IG) recommended when exposure to close contacts. n(living w/ infected individual or food, water). IG must be given w/in 2 wks of exposure

13-depression: most common psychiatric DO of elderly part of aging? and Tx?

not a normal part of aging. psycho-stimulants are the tx of choice instead of ssris, BC: -they improve mood, concentration and energy quickly -few SE -no tolerance and adjunct analgesia -no concern about LT risks or habit forming issues

Parkinson's disease vs. drug-induced pseudo parkinson's syndrome

parkinson's disease= degenerative, progressive drug-induced = reversible, caused by meds antipsychotics/neuroleptics ×(ex's-Thorazine, Haldol, & Atypicals like Risperdal, Seroquel, Zyprexa, Clozaril) Antiemetics ×(ex's- Compazine, Reglan/Metoclopramide etc) Anti-hypertensive ×(ex- Reserpine in ~ 30% of pts) Caused by blockade of D2 (DA) striatal receptors à motor symptoms mimic PD (such as muscle rigidity, stiffness, etc... usually reversible when med d/c'd).

top 6 worldwide diseases:

pneumonia, diarrhea, TB, malaria, measles, HIV/AIDS

1-Role of a PHN (public health nurse)

promote health, prevent illness, focus on populaitons

1-community-based care

setting-specific (persons & families IN community) illness care-mngt of acute/chronic conditions IN community

4-SSRIs high risks:

suicide 1st few weeks b/c elevated energy, improved thinking IMPULSIVITY!!! serotonin syndrome: rare, potentially life-threatening d/t excess 5HT activity discontinuation syndrome: bothersome, withdrawal

TRAP

tremor (unilateral at rest) rigidity (lead-pipe) muscle stiffness, aches, pain akathisia postural disturbances

6-ADD/ADHD (types, meds, therapies)

types: inattentive, hyperactive-impulsive, combined meds: stimulants therapies: incentive-based, computer-gaming approaches

13-preventable dementia

vascular: aging, chronic infection (syphilis), chronic HTN/stroke alcoholism: wernicke-korsakoff thiamine B1 deficiency CTE/TBI: amnesia, MCI/mTBI (mild traumatic brain injury)

6- panic DO DSM-V

}A). Recurrent Panic Attacks }B). 1+ symptoms for >1 month: ◦* (a) persistent concern about future attacks. ◦* (b) worry about attack or consequences. (e.g. losing control, having a heart attack, "going crazy") ◦* (c) a significant change in behavior r/t attacks. }-Attacks are NOT r/t substance effects or general medical condition (e.g., hyperthyroidism). }-Attacks are NOT better accounted for by another mental d/o. }-Attacks cause marked distress &/or impairment in functioning. ◦Panic Disorder & Agoraphobia: separate DSM-V codes.

6- PTSD causes:

}A. Traumatic event exposure: (1 sx required) ◦direct, witnessed, learned of close contact exposure, indirect - usually via professional duties }B. Traumatic event is Persistently Re-Experienced: (1 sx required) ◦intrusive thoughts, nightmares, flashbacks, illusions, hallucinations, intense emotional distress and/or physical reactivity after exposure to reminders }C. Persistence Avoidance: (1 sxs required) ◦Trauma-related thoughts, feelings or reminders (people, situations, etc) }D. Persistent Negative Alterations in mood & cognition: (2 sxs required) ◦Inability to recall key features of trauma; persistent negative mood & affect, anhedonia ◦restricted affect (inability to feel positive / loving feelings); feeling guilt/self-blame, isolation, or sense of foreshortened future. }E. Alterations in arousal & reactivity: (2 sxs required) ◦sleep disturbance, difficulty concentrating ◦irritable or aggression, anger outbursts, reckless/risky or destructive behavior; ◦hypervigilance, exaggerated startle response.

6-stimulant meds

}Adderall & Adderall XR (Dextroamphetamine, Amphetamine) }Ritalin, Ritalin LA (Methylphenidate) ◦structurally similar to speed, drug effects similar to cocaine) }Concerta (Methylphenidate) }Dexedrine (Dextroamphetamine) }Others: ◦Focalin and Focalin XR (Dexmethylphenidate) ◦Metadate CD and Metadate ER (Methylphenidate) ◦Methylin (Methylphenidate) ◦Vyvanse (Lisdexamfetamine Dimesylate) ◦Desoxyn (Methamphetamine hydrochloride/HCL) ◦Note: Not all are FDA-approved for adults. }***Cylert- (Pemoline)- no longer widely available in US ◦(high risk of hepatic toxicity/liver failure)

6-anxiety causality:

}Biological (NT's) Reduced frontal lobe activity: Low 5HT ---> affects NE & E by both increasing AND decreasing NE levels (complex, r/t location pre or post synaptic blockade) NE--->E (Adrenaline / stress hormone, fight/flight response à incr'd SNS activity, arousal, stress affects immune Fn / Inflamm. resp, Decr'd 5HT, NE). Decreased GABA (inhibitory NT-decreases CNS activity) Increased Circulating Cortisol à erroneous stress response Meds: SSRIs/TCAs?Noradrenergic blockers****

6- OCD and Tx

}Obsessions: ◦recurrent thoughts, images or impulses ◦experienced as intrusive & inappropriate. ◦cause marked distress/ anxiety. }Compulsions: ◦repetitive behaviors or mental acts with goal to neutralize (reduce) anxiety or distress. ◦(act as defense mechanisms) ◦ }Nursing Tip: * Do NOT take away Compulsions (unless dangerous) until person has healthier sx-management / coping tools in place. Tx: SSRI: Luvox (Fluvoxamine) TCA medication: Anafranil (Clomipramine); IV options

6-non stimulant meds (when stimualnts are ineffective or cause intolerable SE)

}Strattera (Atomoxetine)- 1st FDA-approved as SSRI anti-depressant (moderate efficacy) now approved to tx ADHD for children, adolescents, & adults. }Intuniv, Tenex (Guanfacine)- 2nd FDA-approved for children & teens (ages 6 -17); QD dosing, anti-HTN }Other Antidepressants: TCA's: Pamelor (Nortriptyline) Mixed: Wellbutrin (Buproprion) & Effexor (Venlafaxine) Other meds: Catapres (Clonidine) * (*HESi -many uses; HTN, ADHD, etoh & opiate w/d & detox)

2-Levels of Prevention

•Primary Prevention: "True Prevention" -Focus: Population not experiencing problems -BEFORE problem begins -Efforts: Decreasing Incidence • Secondary Prevention: Screening & Early Intervention - "At-risk" -Focus: Individual/groups experiencing early problems -Early Detection & Screening (while outcome is still favorable); -Efforts: Decreasing Prevalence •Tertiary Prevention: Prevention of complications -Focus: Individual/with chronic problems -Efforts: Tx & Rehabilitation of current problems to facilitate an optimal level of functioning -Efforts: Decreasing disability & severity

6-Hildegard peplau (founder of psychiatric nursing) 4 stages of anxiety:

◦1. Mild ◦2. Moderate ◦3. Severe ◦4. Panic

WHO 10 golden rules for safe food prep

•1. Choose foods processed for safety •2. Cook food thoroughly •3. Eat Cooked foods immediately •4. Store cooked foods carefully •5. Reheat cooked foods thoroughly •6. Avoid contact between raw foods & cooked foods •7. Wash hands repeatedly •8. Keep all kitchen surfaces meticulously clean •9. Protect foods from insects, rodents, & other animals •10. Use safe water •http://www.who.int/foodsafety/publications/consumer/manual_keys.pdf

bed bugs

•Bed Bugs: •At-risk/Transmission: bug bites; urban areas, hotels/motels, infest the environment (not the person) ex. furniture, mattresses, suitcases, live in wall cracks etc; can live off any mammal's blood without feeding for up to 6 months; Usually come out at night. Do not spread disease; Global issue; esp. in close quarters, school aged kids, bedding, sharing clothing, helmets; some stigma associated may delay tx; Adult female louse lays eggs (nits) on base of neck and hair (visible to eye). •S & Sxs: pruritus esp. at night, insomnia; signs in the environment like blood spots on bed sheets, dead bug exoskeletons, an odor of almonds or raspberries; Bite sores, usually linear 'breakfast, lunch & dinner" pattern; can be raised; risk -2ndary bacterial infections. •Prevention: 1- minimize contact w/ unwashed /2nd hand clothing, bedding, furniture, careful with backpacks and luggage - do not leave on floors (place in plastic bins, off floors and in dry ice if possible; wash items in hot water & dryer). 2- Educate high risk groups- homeless, shelters etc. Exterminator inspections & insecticides; Skin checks. 3- repeat environmental treatments and manage secondary skin infections.

Pertussis (whooping cough)

•Epi: •2003-2005 US epidemic; Cyclical Q 3yrs; recently on rise; Herd immunity waning •At-risk: Increased Mortality: Newborns to < 2 yrs, elderly, immune-compromised •Transmission: respiratory droplets person to person •S & Sxs: Early- similar to cold - low fever, very runny nose, mild cough (may be confused with other resp. problems such as bronchitis or asthma; apneic episodes •Later stages- multiple coughing episodses with a distinctive 'Whoop" sound (worse at night) may cause vomiting or rib/cartilage fractures, severe fatigue. •Prevention: •Booster IZ's now recommended; Antibiotics- Azithromycin, comfort care

rabies

•Epi: 100% preventable; 55,000 people in Africa, Asia die/yr •At-risk: Children, Africa, Asian regions; Mostly from Dogs/ bites. •Those in contact w/ woodchucks/groundhogs (86% of CDC reported cases), raccoons, skunks, bats, foxes, dogs. Unvaccinated or wild animals exposure / bites. Animals bitten will need to be euthanized. •Transmission: via bite of infected (rabid) animalà infects CNS, death. •S & Sxs: HA, fever, weaknessà insomnia, anxiety, confusion, slight / partial paralysis, agitation, excitation, hallucinations, hypersalivation, difficulty swallowing, fear of water (hydrophobia)à death in 2-3days of sx onset. •Prevention: •1. Pets vaccinations (policies require this in SF), spayed/neutered. •2. Call animal control for stray animals. •3. Avoid areas with your pets around wild animals. •4. If bitten, wash wounds immediately. •5. See ED/ PCP for any animal bites; Can start vaccination PEP (post-exposure prophylaxis) tx with f/u shots on days 3, 7 & 14.

STIs

•Epi: 15 million new STI cases/yr US (>20% of Americans infected) •At-risk: adol's/young adults < 25 yrs, women, minorities, poor, urban, SUDs •Assessment: acquired thru behaviors that can be avoided /changed •Nursing Role: Prevention, Educ, Screening •Prevention: vaccine admin, early detection, health teaching - safer sex nMotivational Approaches - to enhance safer bx's nHarm Reduction - access to condoms, role modeling /peer teaching (adolescents) •Transmission: chronic infections can be transmitted to others; nScreening for Asymptomatic Dz phases / infections nBacterial: usu. treatable w/ Antibiotic; Antibiotic-resistant forms of STI's emerging! (e.g., Syphilis - chancre, Gonorrhea & Chlamydia - discharge in males) nViral: NO cure; prevention / screening n(Screening ex's: Pap smears, Pelvic/Genital exams; Vaccine for HPV recommended) nNew (!) at home screening kit for HPV esp useful w/ low income women (less access) •(HSV= Herpes simplex virus 2; HPV=Human Papilloma Virus, aka genital herpes)

typhoid fever

•Epi: 5,700 US cases/yr; 21.5 million/yr-World (Salmonella Typhi bacteria) •At-risk: International Travel (75% US cases); Developing areas where handwashing / sewage systems are less. •Bacteria lives only in humans; Infected carry dz in Bld & GI tract (stool). •Transmission: via food, drinks handled by host shedding dz or contaminated by sewage to food, drink or washing water. •S & Sxs: high sustained fever (103-104F), weakness, HA, loss appetite, GI pain, occ. flat rose-colored rash or spots. + Stool, blood samples for bacteria. •20% w/o tx will incur ongoing fever for wks-mos & may die of complications. •Prevention: •1Avoid risky foods, drinks. Use boiled or bottled water for eating, bathing. No ice. •2. Avoid raw or undercooked foods, fruits, veggies. Wash, cook well. Wash hands and surfaces. •3. Tx with antibiotics (less resistance w/ Fluoroquinolone; Cipro;

zika virus (mosquito)

•Epi: > 4,000 people acquired while traveling abroad & have been id'd in 49 / 50 U.S. states (not AK); 1st discovered 1947 in Uganda; Prior to 2007 only 14 cases noted. May 2015- Brazil outbreak- caused Olympic athlete absences; April 2016- 460 cases in US. •NO vaccine (2-3 yrs from development) •Transmission: infected mosquito-bite during pregnancy, virus infects fetus; Sex, blood transfusions - several days to 1 wk after exposure. •SXS: mild fever, rash, jt pain, conjunctivitis, muscle pain, HA (several days- week) mild-moderate; deaths are rare; infection protects vs future susceptibiility. •TX: Sx-Mngt- flu syndrome: rest, fluids, Do not take ASA or NSAIDS for fever (take Tylenol/Acetaminophen) •Pregnancy infection à Micro-encephaly (newborns brain damage, developmental delays, Intellectual Disability, Movt, Balance, feeding problems, hearing & vision loss); Guillain-Barre Syndrome (likely) •Screening: CDC recommends Urine testing; rRT-PCR testing of urine specimens collected w/in 14 days of illness onset & serum along w/ urine specimens obtained < 7 days after illness onset (2016) •Prevention: Eliminate stagnant water; Control mosquitoes in & outside of home; Use screens, air conditioning, netting over strollers, cribs & beds. Stay in air conditioned areas. •EPA-approved DEET products (OR picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol, 2-undecanone; Except <3 yrs); Permethrin on clothing or buy pre-treated items; Safer Sex; Condoms.

plague

•Epi: Current outbreak- Madagascar; •At-risk: Western US rural & semi-rural areas; LA, CA 1924 last urban outbreak. •Transmission: Rodents (many types) & their fleas; carnivores who eat infected rodents; urban, dense rodent infested areas. Flea bites infected rodentà bites human (fleas on pets, in homes). Handling tissues or body fluids of infected animal or person. Pneumonic plague- aersolized thru cough /resp droplets; Cats very susceptible to plagueà humans. •S & Sxs: Very serious, life-threatening illness. Spreads rapidly. •Bubonic plague- sudden fever, HA, chills, painful lymph nodes (buboes) from flea bites- require Antibiotics to prevent multiplying bacterial spread & death. •Septicemic- fever, chills, weakness, abdominal pain, shock, bleeding, skin turns black, cell, limb death. •Pneumonic plagues Prevention: Seek immediate attention; Prompt Txwith correct antibiotics required to prevent death; Screen for exposures- living/ travel to endemic areas; Assess Skin for Buboes; Bld Cultures; Lymph node aspiration; Prevent Sepsis; Tx with IV antibiotics (Gentamicin & Fluoroquinolones) 10-14 days

west nile

•Epi: NO vaccine or antiviral treatments WNV-(2016) 1,428 human cases reported to CDC; Malaria - now increasing; Super Malaria bugs •Transmission: mosquitoesà birds found in humans, birds & mosquitoes •SXS: Flu-like Symptoms (1/5 infected people) fever, HA, body aches, joint pain, N/ V/ D, rash. •< 1% serious Neuro-invasive sxs (10% die) meningitis or encephalitis - high fever, HA, stiff neck, disorientation, coma, tremors, sz's, paralysis (> 60 yrs highest risk group) •NO sxs in most people (70-80%) •WNV Treatment: Symptom-management of flu syndrome with rest, fluids, Do not take ASA or NSAIDS for fever (take OTC-Tylenol/Acetaminophen). •Malaria Treatment: None 100%; Atovaquone/Proguanil (Malarone) or Doxycycline (not in pregnant/nursing, infants or kids < 8yrs); Chloroquine (some resistance). •Both have Neuro-invasive potential: Screening CSF to detect WNV-specific IgM antibodies (detectable 3-8 days after illness onset; persist 30-90 days). Confirmation with viral cultures for RNA on serum, CSF, or tissue. ICU- supportive nrsg care; IV fluids, pain meds; Interferon, Ribavirin, steroids, IV Immunoglobulins (IGIV). •Prevention: Eliminate stagnant water-sources to reduce mosquito replication; Personal deterrents / protection efforts.

Bacillary dysentery

•Epi: severe form of shigellosis (traveller's diarrhea) •At-risk/Transmission: fecal-oral in endemic areas in the world; • Shigella bacteria invade intestinal mucosa, multiply & destroy cells in intestines, colon. •International travel, fecal contaminated water or food supplies. Disaster areas. Refugees-Displaced populations, famine-affected areas. •S & Sxs: •Bloody diarrhea (stool sample dx; specimen cultures) •Prevention: •1. International travel- food & water precautions, hand-washing, basic hygiene. •2. Oral Rehydration- Manage diarrhea; Supportive care; proper waste disposal. •3. Antibiotic Tx (variety; Cipro, or Bactrim-TMP-SMX); •Rare relapses if adherent to full antibx regimen. •4. No vaccine available.

cholera

•Epi: very common in US in 1800's; now rare d/t safe, clean water. Occ. sewage runoff risks. •At-risk/Transmission: international travel, fecal contaminated water or food supplies. Eating raw or undercooked, naturally contaminated shellfish. Same grps as Dysentery. •S & Sxs: •Cholera-profuse, watery diarrhea, 'rice-water stools', vomiting, muscle cramps, lowBP, tachycardia, circulatory collapse, shock, death. Sometimes mild. 20-25% untx'd severe cases are fatal (d/t e-lyte imbalances). •Prevention: •1. International travel- food & water precautions, hand-washing, basic hygiene. •2. Vaxchora vaccine for adults traveling to active cholera regions to prevent severe diarrhea. •3. Rehydration- Manage diarrhea; Supportive care; proper waste disposal. Antibiotic Tx (variety; IV) •Zinc 10-20mg/day (esp. kids 3-14yrsà less diarrhea) 4. When recover - do not become carriers but can re-acquire disease

WIC: Primary prevention

•Federally-funded health & supplemental nutrition program for low income women (pregnant, breastfeeding or w/young children up to age 5):

3-MI-"FRAMES"

•Feedback of Personal Risk •Responsibility of the Patient (Autonomy) •Advice to Change (in motivational way; affirmations etc) •Menu of Ways to Change Behavior •(what works for you?) •Empathic style (Reflective Listening) •Self-efficacy (offer optimism & hope) •Develop Discrepancies (Explore Pros & Cons) •Present current behavior/state (vs. desired goals) •Assess readiness for change

who's at risk for CD's

•Poverty - poor sanitation, overcrowding, poor HC access •Immigration from developing country - esp. w/o stringent IZ programs à Countries with less infrastructure or resources - esp. post-disaster. •Travel to foreign country - more susceptible with less native immunity to dz.'s prevalent in those areas or where diseases also kill natives in those regions. •Sexual behaviors •Immunocompromised individuals •Dense populations - LTC, Prisons, Dorms etc. •Cultural & political issues impact risks: nGov't. recognition & response influence risks . •Ex. HIV response nPublic Policies - also impact drugs, availability, cost & disease. à ... Increasing drug resistance to antibiotics. à ... Ease of travel, Bioterrorism.

6- trauma and stress-related disorders:

◦Acute Stress Disorder (ASD) SXS 3 days - 1 month (start with/in 1 month of stressor); can become PTSD; SAME SXS as PTSD. ◦Post-traumatic Stress Disorder (PTSD) SXS > 1 month + ; Occurs across life-span Risks: Younger > Older ; Female > Male (esp. widowed, separated, divorced) Most common traumas: Males: Combat exposure & witnessing violence; Females: Rape & sexual abuse. TX: Individual Factors become part of client-centered therapy; Specialists. Trauma-Specific Referrals: 1:1, Family therapy & Support Groups (ex. combat vets, sexual assault) Encourage Expression of Feelings: Journaling! CAMs, music, art etc. Not about details of trauma itself but how one feels. Teach: Stop, Look & Listen (Mindfulness-based Cognitive Therapy tool) (NCS data) PTSD videos: http://0-usfca.kanopystreaming.com.ignacio.usfca.edu/node/117467 Adjustment Disorders: DSM-V 'Stress Response Syndrome' that occurs after exposure to a distressing (traumatic or non-traumatic) event. (ie. loss of relationship etc). Subtypes: depressed, anxious, etc. Anxiety or Depressive symptoms directly after a specific triggering event, loss, trauma. ◦Tx - same as anxiety or depression but therapy will address specific triggering event. Formerly categorized under DSM-IV Mood Disorders.