(C228) ATI-Community Health <Chapter 5>*

Who are the front-line professionals who are able to assist those with substance use and addiction disorders?

Community health nurses!

What is the greatest health risk (cancer, cardiovascular disease, reps disease) when it comes to smoking cigarettes?

Deep inhalation of smoke

Is denial a primary sign of dependence? What may it include?

Denial is a primary sign of dependence and may include: -defensiveness -lying about use -minimizing use -blaming or rationalizing use -intellectualizing

What are some health problems of migrant workers?

Dental disease, TB, chronic conditions, stress, anxiety, mental health concerns, leukemia, IDA, stomach cancer, uterine cancer, cervical cancer, lack of prenatal care, higher infant mortality rates

How long does recovery from substance abuse and addictive disorders occurs? Does it involve relapses?

It occurs over years and usually involves relapses

What is nicotine?

It's a stimulant that temporarily creates a feeling of alertness and energy

What is tolerance to alcohol?

Its an increased requirement for alcohol to achieve the desired effect

What can alcohol, tobacco, and other substance abuse and addictive disorders cause?

Low birth weight, congenital abnormalities, accidents, homicides, suicides, chronic diseases, violence

What are some ways to alleviate existing homelessness?

Making referrals for financial assistance, food supplements, and health services

What do substance use disorders involve?

Maladaptive use of substances resulting in threats to an individual's health or social and economic functioning

Are males or females more likely to be assaulted?

Males

What are some veterans health issues?

Mental health conditions (PTSD, traumatic stress reactions, anger, depression), substance abuse and addition disorders, suicide, infectious diseases, exposures to chemicals (herbicides, chemicals, and radiation), traumatic brain injuries, spinal cord injuries, traumatic amputations, cold injury, military sexual trauma, hearing impairments, visual impirments

What is the Veterans Heath Administration responsible for?

Purchasing coverage and delivering health care to veterans and dependents

What risks does secondhand smoke pose to nonsmokers?

Respiratory disease, lung cancer

What are some secondary prevention strategies for rural and migrant health care?

Screen for pesticide exposure, skin cancer, chronic preventable disease, and communicable diseases

What is an example of physical violence toward an infant or child?

Shaken baby syndrome which is caused by violent shaking of young infants

Are youths at significantly higher or lower risk to be assaulted?

Significantly higher risk

What are several factors that affect the way the body processes alcohol?

Size and weight of drinker Gender (affects metabolism) Carbonation (increase absorption) Time elapsed during alcohol consumption Food in the stomach Drinker's emotional state

Who are most homicides committed by?

Someone known to the victim and occur during an argument

What are some examples of possible stakeholders for partnerships?

State and local veteran groups Offices of rural health Local aging services Community service organizations State and local health departments Faith-based organizations Various media outlets Employment services

What is an example of physical violence toward a domestic partner?

Striking or strangling the partner

What is important for recovery from substance abuse and addictive disorders?

Strong support system, including 12-step programs and self-help groups for family members

What is homicide often related to?

Substance use

Does tolerance to nicotine develop quickly or slowly?

quickly

What are some homeless population characteristics?

-Adults who are unemployed, earn low wages, or are migrant workers -Female heads of household -Families w/children (fastest growing segment) -People who have a mental illness (large segment) -Veterans -People who have substance use and addictive disorders -Unaccompanied youth -Adolescent runaways -Intimate partner abuse victims -People who have HIV or AIDS -Older adults w/no where to go and no support systems

What are some examples of specific mental health disorders?

-Affective disorders (bipolar disorder, major depression) -Anxiety disorders (OCD, panic, phobias, PTSD) -Schizophrenia -Dementia -Conduct disorders -Eating disorders

What are some tertiary prevention strategies for substance use disorders?

-Assist the client to develop a plan to avoid high-risk situations and to enhance coping and lifestyle changes -Refer the client to community groups like AA and NA -Monitor pharm mgmt. -Provide emotional support to recovering abusers and their families, including positive reinforcement

What are some things to do when caring for clients who experience violence?

-Build trust and confidence with a client. -Focus on the client rather than the situation. -Assess for immediate danger. -Provide emergency care as needed. -Develop a plan for safety. -Make needed referrals for community services and legal options. -If abuse has occurred, complete mandatory reporting, following agency guidelines.

What are some strategies for veteran health care?

-Coordinate referrals to available veteran resources -Advocate for continued strengthening of the VHA HC system -Assist clients to transition from active duty status to veteran -Ensure continuity of care b/w hospital and outpatient settings -Develop partnerships with local agencies to strengthen resources and achieve mutual goals

What are some risk factors for suicide?

-Depression or other mental disorders -Substance use -Intimate partner issues

What are some barriers to HC in rural areas?

-Distance from services -Lack of personal/public transportation -Unpredictable weather and/or travel conditions -Inability to pay for care/underinsured/uninsured -Shortage of rural hospitals/HCP

What are some primary prevention strategies for improving mental health?

-Educate populations regarding mental health issues. -Teach stress-reduction techniques -Provide parenting classes -Provide bereavement support -Promote protective factors (coping abilities) and risk factor reduction

What are some primary prevention strategies for rural and migrant health care?

-Educate regarding measures to reduce exposure to pesticides. -Teach regarding accident prevention measures -Provide prenatal care -Mobilize preventive services (dental, immunizations)

What are some tertiary prevention strategies to reduce societal violence?

-Establish parameters for long-term follow-up and supervision. -Make resources in the community available to the client (telephone numbers of crisis lines and shelters). -If court systems are involved, work with parents while the child is out of the home (in foster care) -Free to mental health professionals for long-term assistance -Provide grief counseling to families of suicide or homicide victims -Develop support groups for caregivers and victims of violence

What is economic maltreatment?

-Failure to provide the needs of a victim when adequate funds are available -Unpaid bills when another person is managing the finances -Theft of or misuse of money or property

When is incidence higher for rape (location, time, time of the week, and season)?

-Higher in cities -between 8 pm and 2 am -on the weekends -summer months

What are some of the health status characteristics of rural residents?

-Higher infant and maternal morbidity rates, higher rates of DM, more likely to be obese, less likely to meet physical activity recommendations, higher rates of suicide -Increased trauma/injuries from things like lightening, farm machinery, drowning, and boating, snowmobile, all-terrain vehicle, and motorcycle crashes -Increased occupational-associated risks -Less likely to seek preventative care

What factors influence an individual's potential for violence?

-Hx of being abused or exposure to violence -Low self-esteem -Fear and distrust of others -Poor self-control -Inadequate social skills -Minimal social support/isolation -Immature motivation for marriage or childbearing -Weak coping skills

What are some tertiary prevention strategies for improving mental health?

-Perform medication monitoring -Provide mental health interventions -Make referrals to various groups of professionals, including support groups -Maintain the client's level of function to prevent relapse or frequent rehospitalization -Identify behavioral, environmental, and biological triggers that may lead to relapse -Assist the client in planning a regular lifestyle and minimizing sources of stress -Educate the client and family regarding med side effects, potential interactions

What does neglect fail to provide?

-Physical care such as food, shelter, and hygiene -Emotional care and/or stimulation necessary to achieve developmental milestones, itch as speaking and interacting with a child -Education for a child -Needed health or dental care

What are some issues in migrant health?

-Poor and unsanitary working and housing conditions -Exposure to environmental pesticides -Less access to HC services -Inability to afford care -Availability of services (distance, transportation, etc.) -Language barriers and culture aspects of heath care

What are some secondary prevention strategies for improving mental health?

-Screen to detect mental health disorders -Work directly with at-risk individuals, families, and groups through the formation of a. therapeutic relationship -Conduct crisis intervention

Who are rates of suicide higher in: -Men or women? -Individuals over or younger than 65?

-higher in men -higher in people older than 65

How much alcohol does the body burn per hour?

0.5 oz of alcohol per hour

What is dependence?

A pattern of pathological, compulsive use of substances and involves physiological and psychological dependence

What does repeated use of nicotine to avoid the subsequent "down" that will follow this period of stimulation leads to what?

A vicious cycle of use and physical dependence (withdrawal effects if not consumed)

What happens to excess alcohol that isn't metabolized?

It circulates in the blood and affects the CNS and the brain

What makes alcohol a depressant?

It dulls the senses to outside stimulation and sedated the inhibitory centers in the brain

What are some secondary prevention strategies to reduce societal violence?

-Identify and screen those at risk for abuse and individuals who are potential abusers. -Assess and evaluate any unexplained bruises or injuries of any individual. -Screen all pregnant women for potential abuse. This may be the one time in some women's lives that they may access the HC system on a regular basis -Refer sexual assault or rape victims to a local emergency department for assessment by a sexual assault abuse team. Caution the client not to bathe following the assault because it will destroy physical evidence. -Assess and counsel anyone contemplating suicide or homicide and refer the individual to the appropriate services. -Support and educate the offender, even though a report must be made. -Assess and help offenders address and deal with the stressors that may be causing or contributing to the abuse, such as mental illness or substance abuse. -Alert all involved about available resources within the community. -Advocate for legislation designed to assist older adult independence and caregivers and to increase funding for programs that supply services to low-income, at-risk individuals.

What are some secondary prevention strategies for substance use disorders?

-Identify at-risk individuals and assist them to reduce sources of stress, including possible referral to social services to eliminate financial difficulties or other sources of stress -Screen people for maladaptive substance abuse

What are some primary prevention strategies for substance use disorders?

-Increase public awareness, particularly among young people, regarding the hazards and addictive qualities of substance abuse (e.g., public education campaigns, school education programs) -Encourage development of life skills

What are three national health goals to address for vulnerable populations?

-Increasing the number of people who have a routine PCP -Increasing the number of people with health insurance -Reducing the number of people who are unable or have a delay in accessing health care services and prescribed medications

What are some factors contributing to mental health of aggregates?

-Individual coping abilities -Stressful life events (exposure to violence) -Social events (recent divorce, separation, unemployment, bereavement) -Chronic health problems -Stigma associated w/seeking mental health services

What are some primary prevention strategies to reduce societal violence?

-Teach alternative methods of conflict resolution, anger mgmt., and coping strategies in community settings. -Organize parenting classes to provide anticipatory guidance of expected age-appropriate behaviors, appropriate parental responses, and forms of discipline. -Educate clients about community services that are available to provide protection from violence. -Promote public understanding about the aging process and about safeguards to ensure a safe and secure environment for older adults within the community. -Assist in removing or reducing factors that contribute to stress by referring caretakers of older adult clients to respite services, assisting an unemployed parent in finding employment, or increasing social support networks for social isolated families. -Encourage older adults and their families to safeguard their funds and property by getting more info about financial representative trust, durable POA, a representative payee, and joint tenancy. -Teach individuals that no one has a right to touch or hurt another person, and make sure they know how to report cases of abuse.

What are some tertiary prevention strategies for rural and migrant health care?

-Treat for symptoms of pesticide exposure -Mobilize primary care and emergency services

Ways to recognize actual or potential child abuse/neglect?

-Unexplained injury -Unusual fear of the nurse and others -Injuries/wounds not mentioned in history -Fractures, including older healed fractures -Presence of injuries/wounds/fractures in various stages of healing -Subdural hematomas -Trauma to genitalia -Malnourishment or dehydration -General poor hygiene or inappropriate dress for weather conditions -Considered to be a "bad child"

Ways to recognize potential or actual older adult abuse?

-Unexplained or repeated physical injuries -Physical neglect and unmet basic needs -Rejection of assistance by caregiver -Financial mismanagement -Withdrawal and passivity -Depression

What are some physical assessment findings to include when doing an individual assessment?

-VS which varies depending on substance being used -Appearance- can appear disheveled with an unsteady gait -Eyes- pupils can appear dilated or pinpoint, red, poor eye contact -Skin- can be diaphoresis, cool, and/or clammy; needle track marks or spider angiomas may be visible -Nose- can be runny, congested, red and/or cauliflower-shaped -Tremors- fine or coarse tremors

What are some examples of issues that vulnerable populations might have to deal with?

-Violence -Substance use disorders -Mental health issues/illnesses -Homelessness -Rural and migrant health -Poverty -Difficulty accessing health care -Poor self-esteem -Young or advanced age -Chronic stress -Environmental factors

How many veterans are in the US? How many are women? How many are over 65?

25 million, 2 mil are women, and 9 mil are over 65

Following prolonged use, how long does it take for manifestation of alcohol withdrawal appear?

4-12 hours

What do cigars, pipes, and smokeless tobacco increase the risk of?

Cancers of the lips, mouth, and throat

What often precedes homicide within families?

Abuse

When using inhalants, what would death result from?

Acute cardiac Dysrhythmias or asphyxiation

What are some ways to prevent recurrence of poverty, homelessness, and health problems?

Advocate and provide efforts toward political activity to provide needed services for people who have mental illness and are homeless. Make referrals for employee assistance and educational programs to allow clients who are homeless to eliminate the factors contributing to their homelessness.

What is the most commonly used substance in the US?

Alcohol

Is rape often reported or unreported?

Unreported

What are some health issues of homeless populations?

Upper reps disorders, TB, skin disorders and infestations, substance use disorders, HIV/AIDS, trauma, mental illness, dental caries, hypothermia and heat related illnesses, malnutrition

A nurse at an urban community health agency is developing an education program from city leaders about homelessness. Which of the following should the nurse include as the fastest-growing segment of the homeless population? A. Families with children B. Adolescent runaways C. Intimate partner abuse victims D. Older adults

Answer: A A. Correct- this is the fastest growing segment of the homeless population B. Incorrect- not the fastest growing segment C. Incorrect- not the fastest growing segment D. Incorrect- not the fastest growing segment

A nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following findings is a manifestation of withdrawal? A. Decreased BP B. Diaphoresis C. Pin-point pupils D. Bradycardia

Answer: B A. Incorrect- it should be increased BP B. Correct- this is a manifestation of alcohol withdrawal C. Incorrect- it should be dilated pupils D. Incorrect- it should be tachycardia

A community health nurse is developing strategies to prevent or improve mental health issues in the local area. In which of the following situations is the nurse implementing a tertiary prevention strategy? A. Providing support programs for new parents B. Screening a client whose spouse recently died for suicide risk C. Teaching a client who has schizophrenia about medication interactions D. Discussing stress reduction techniques with employees at an industrial site

Answer: C A. Incorrect- this is primary prevention B. Incorrect- this is secondary prevention C. Correct- this is tertiary prevention D. Incorrect- this is primary prevention

A community health nurse is developing an education program on substance use disorders for a group of adolescents. Which of the following should the nurse include when discussing nicotine and smoking? A. Smoking is the 5th most preventable cause of death in the US. B. Nicotine is a CNS depressant. C. Withdrawal effects from smoking are minimal. D. Tolerance to nicotine develops quickly.

Answer: D A. Incorrect- its the first-most, not 5th most B. Incorrect- its a stimulant, not depressant C. Incorrect- they are substantial and increase physical dependence D. Correct- it develops quickly

A nurse at a community clinic is conducting a well-child visit with a preschool-age child. The nurse should identify which of the following as a manifestation of child neglect? (Select all that apply.) A. Underweight B. Healing spiral fracture of the arm C. Genital irritation D. Burns on the palms of the hands E. Poor hygiene

Answers: A and E A. Correct- this is a manifestation of child neglect. B. Incorrect- this is a manifestation of physical abuse C. Incorrect- this is a manifestation of sexual abuse D. Incorrect- this is a manifestation of physical abuse E. Correct- this is a manifestation of child neglect

What do hallucinogens (psychedelics) produce?

Anxiety, paranoia, impaired judgement, and hallucinations

What are some ways to prevent individuals and families from becoming homeless?

Assist them with eliminating factors that may contribute to homelessness

The direct effect of alcohol is determined by what?

Blood alcohol level

What is an example of physical violence toward an older adult?

Elder abuse such as pushing an older adult parent and causing her to fall

What is LSD, PCP, MDMA (ecstasy)?

Hallucinogens

What are the 5 types of violence within communities?

Homicide Assault Rape Suicide Abuse

What do some inpatient and outpatient services include in the Veterans Health Admin?

Hospitals, outpatient clinics, home health services, hospice and palliative care services, nursing homes, residential rehab TX program, readjustment counseling centers

What are the cardinal signs of dependence?

Include manifestations of tolerance and withdrawal

What is emotional violence?

Includes behavior that minimizes an individual's feelings of self-worth or humiliates, threatens, or intimidates a family member

What are indicators of delirium tremens or alcohol withdrawal delirium?

Increased BP, tachycardia, and diaphoresis

Are homicide rates increasing or decreasing among adolescents?

Increasing

What is the majority of violence against women?

Intimate partner violence

What are some of the S/S of alcohol withdrawal?

Irritability, tremors, N/V, headaches, diaphoresis, anxiety, sleep disturbances, tachycardia, elevated BP

What are some examples of opiates?

Morphine, heroin, codeine, and fentanyl

What are the 5 types of abuse?

Physical violence Sexual violence Emotional violence Neglect Economic maltreatment

What is important to determine in order to accurately assess for signs of withdrawal and delirium tremens?

The last drink the client has taken

What can prevent the serious complication of delirium tremens?

The prompt use of Benzos at the onset of symptoms

What is the nation's largest integrated HC system?

Veterans Health Administration

What are inhalants?

Volatile substances that are inhaled

When does sexual violence occur?

When sexual contact takes place without consent, whether the victim is able or unable to give that consent

Do men or women report attempting suicide more?

Women report attempting suicide more often than men

What are some of the social and community factors influencing violence?

Work stress, unemployment, media exposure to violence, crowded living conditions, poverty, feelings of powerlessness, social isolation, lack of community resources (playgrounds, parks, theaters)

What are barbiturates, benzos, chloral hydrate, and GHB?

depressants

What is the most important preventable cause of death in the US?

smoking

What are caffeine, amphetamines, methamphetamines, and cocaine?

stimulants