Community Health Nursing EXAM 3

Herd immunity

Refers to the immunity of a group

Genital warts

Viral Cauliflower life growths Caused by HPV Linked to cervical cancer

Detoxification

Alcohol, benzodiazepines, and barbiturates can produce life-threatening withdrawal symptoms, wean gradually.

Support groups for ATOD

Alcoholics Anonymous Al-Anon and Alateen Narcotics anonymous Pills anonymous for person with polydrug addictions Over eaters anonymous Gamblers anonymous

Human capital

All of the strengths, knowledge, and skills that enable someone to live a productive life (generally patient in a vulnerable state are lacking somewhere in there.)

I = Investigate Potential exposures: do you feel sick, do you have any symptoms P = Present work: what are you expose to? Do you wear PPE, are work clothes worn home R = Residence: when was it built, recent remodeling, drinking water E = Environmental concerns: where is your home, landfill P = Past work: have you been in the military, worked on a farm? A = activities: hobbies, garden, pesticides R = Referrals and resources EPA OSHA E = Educate: create a plan, follow up

1) It is essential that nurses know about environmental health 2) Nurses should not use products or practices that harm health or the environment 3) Nurses have a right to work in a safe and healthy place and nurses and other health care professionals have the right to know in a timely manner about any possible harmful products, chemicals, pollutants, and hazards to which they may be exposed 4) Multidisciplinary collaboration is a factor that sustains a healthy environment 5) the choice of materials, products, technology and practices in the environment that affect nurses is based on best practices 6) & 7) Nurses should respect the diversity of the people whom they serve and also they and their clients work and live 8) nurses, other health care workers, families, patients, and communities have the right to know timely information about potentially harmful products 9) & 10) Nurses should participate in both research and advocacy related to promoting a safe and healthy environment

HIV affects 38 million persons worldwide

2/3 of those live in sub-Saharan Africa About 12 million people in the U.S.

HIV new cases

27% heterosexuals

A community citizen reports to the public health nurse that the city water in one neighborhood has had an unusual taste for the past few months. Which of the following actions should the nurse take first?

A. Check the most recent consumer confidence report CORRECT B. Consult the centers for disease control and prevention C. Notify the environmental protection agency D. Place a call to the poison control center

A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues. Which of the following acts would the nurse most likely discuss with the student?

A. Chemical safety information, site security, and fuel regulatory act B. Comprehensive environmental response, compensation and liability act C. Food quality protection act D. Occupational Safety and Health Act CORRECT

Urban children are more likely to see eye a pediatrician when they are ill.

Rural adults and children are more likely to have a general practitioner (not a pediatrician) as a regular caregiver.

Infectiousness

A measure of a potential ability of an infected host to transmit an infection

Environmental health disparities

A person of color is more likely to live near a hazardous waste site or incinerator. Have children who are lead poisoned. Have children with asthma (strong association with environmental exposures).

Surveillance activities can be related to the core functions of public health assessment, policy development, and assurance.

A quality surveillance system requires collaboration among agencies and individuals.

Nicotine acts as both

A stimulant and a depressant

Assault

A violent physical or verbal attack

In which of the following situations would the nurse most likely use active surveillance?

A. A newspaper wants to know the incidence of asthma in the community B. A real-time ongoing communication channel is established to monitor a particular symptom C. Several children become ill with GI upset at one local school CORRECT D. The nurse is asked to report the incidence of a specific no reportable common problem in the community

Which of the following is the most accurate description of a migrant farmworker?

A. A person who does farm work as the primary means of employment, although other work may be done when the seasonal work ends B. A person who immigrated to the United States to "follow the crops" in performing seasonal farm work C. A person who moves from place to place to earn money performing seasonal agricultural work CORRECT D. A person who specializes in the development of rural land for the purpose of farming

In addition to those barriers faced by many resident in rural areas, what additional barrier to health care is a Hispanic migrant farmworker likely to encounter?

A. Absence of culturally competent care CORRECT B. Availability of specialists C. Distance of health care facilities from the place of residence D. High cost of health care

A migrant farmworker presents to the clinic reporting an acute onset of severe abdominal pain, nausea, vomiting, diarrhea, and headache with difficulty concentrating. Which of the following conditions would cause such symptoms?

A. Appendicitis B. Bacterial gastroenteritis C. Pesticide poisoning CORRECT D. Viral illness

Which of the following best describes countries that bear the greatest burden of disasters?

A. Arid regions that are prone to drought B. Developing countries with limited resources CORRECT C. Industrialization countries with much to lose D. Water-boundary regions that are prone to floods and hurricanes

A nurse practitioner has established a mobile clinic to vaccinate noninstitutionalized adults against influence. Which of the following phases of the nursing process is being implemented?

A. Assessment B. Planning C. Intervention CORRECT D. Evaluation

Harm reduction is a new approach to ATOD problems; it deals with substance abuse primarily as a health problem rather than a criminal problem.

All persons have ideas, opinions, and attitudes about drugs that influence their actions.

In partnering with vulnerable clients, which of the following techniques will create a more successful interaction with the individual client (select all that apply)?

A. Demonstrate trustworthiness and dependability (correct) B. Direct the care of the client so that they feel that the nurse is in control C. Develop programs and policies for populations of vulnerable persons (correct) D. Foster a cycle of dependency sot he nurse feels needed E. Create a partnership with the client through careful assessment (correct)

A nurse is attempting to minimize damage following a bioterrorism attack in the community. Which of the following would be the most crucial aspect for the nurse to consider?

A. Detecting an increase in people with similar signs and symptoms CORRECT B. Identifying typical chemical or biological agents C. Identifying factors that put people at risk D. Recognizing areas of vulnerability within an area

A community is experiencing the honeymoon phase following a disaster. Which of the following is most likely to occur in the community?

A. First responders work tirelessly to save others B. Survivors share their stories CORRECT C. Medical personnel experience exhaustion D. Community organizations rebuild the community

The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately?

A. Herpes zoster B. Hepatitis B C. Hepatitis C D. Tuberculosis

Mr. Schmidt is treating a 52 year old male for a possible eye infection. While the patient is at the clinic, Mr. Schmidt also requests a dental evaluation and educates T he patient about diet and exercise, smoking and alcohol cessation counseling, and the importance of follow-up for influenza immunization at a future clinic. What type of nursing approach is being used?

A. Holistic B. Comprehensive services (correct) C. Wrap-around services (includes things other than health health related services D. Family-centered services

Which of the following statements by a parent indicates a need for increased learning regarding appropriate (nonabusive) discipline of a child?

A. I have stopped using a switch on my child, and I am learning to count to 10 before reacting B. I never spank or hit; I yell at them to stop being stupid, and if they don't, I tell them no one is every going to love them if they act like that CORRECT C. I use timeouts when my child acts out or is naughty. Sometimes my child doesn't cope well with this, but I am persistent D. When my child misbehaves, I distract him and focus his attention on other things. If he throws a tantrum, I have been known to just pick him up and leave from wherever we are

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "Why," he asks, "should my tax dollars be used to pay for their children to be immunized?" Which of the following would be the best response by the nurse?

A. Immunizations are requires by law, and if their parents can't afford it, you and I will have to pay for it B. It's just the right thing to do C. Only by making sure most kids are immunized can we stop epidemics that might hurt all of us. CORRECT D. We're a religious God-fearing community, and we take care of each other

What is the main purpose of implementing a substance abuse program at a construction worksite?

A. Lowers workers compensation rates for the company. B. Provides a topic of health education C. Provides a mechanism of terminating problem employees D. Harm reduction as a focus on health promotion CORRECT

Which of the following is an accurate concern about the use of marijuana?

A. Marijuana has painful withdrawal symptoms B. Marijuana may damage the respiratory tract CORRECT C. Marijuana can often reduce pain but physicians refuse to prescribe it D. Marijuana quickly leads to psychological and physiological dependence

A nurse offers homeless clients yearly tuberculosis screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used?

A. Primary prevention B. Secondary prevention CORRECT C. Tertiary prevention D. Secondary and tertiary prevention

What primary prevention strategies are useful for the school nurse to use to prevent violence in the school and community?

A. Provide education about different forms of violence and ways to get help and intervene CORRECT B. Organize a violence screening day C. Provide referrals to appropriate community organizations D. Creat support groups for bullied kids

Jorge approaches Ms. Giles and informs her that he has been taking prescription opioids. He is fearful of dependence and wants advice on how to stop the medication.

A. Reassure Jorge that there is no chance of developing dependence. B. Inform Jorge that he must stop taking the medications immediately or risk termination C. Instruct Jorge that he should gradually taper off the dose to avoid withdrawal symptoms CORRECT D. Encourage Jorge to stop the medication and replace it with another narcotic

Most of the care (both home and outpatient) that is provided for HIV is done within the community eating which reduces direct health care costs but increases the need for financial support of home and community health services.

All countries have population subgroups who are more vulnerable to health threats than the general population.

A nurse after working two weeks at the site of the largest natural disaster to hit the United Stes, returns home. Which of the following behaviors would suggest the nurse needs professional assistance?

A. The nurse becomes angry when family members quit listening to her ongoing stories about the disaster and the problems there CORRECT B. The nurse gives a presentation at the local college about the disaster and describes how health professionals were able to assist the victims who were injured C. The nurse is moody and feels family demands are not really as important as the other members of her family think they are D. The nurse is very exhausted and asks to have 3 personal days off from employment responsibilities

A student engages in unprotected sex under the influence of alcohol. The student decides to have an HIV test completed the next day. Which of the following results will most likely occur?

A. The results will probably be negative for HIV B. The results will probably be positive for HIV C. The probability of disease is so low there is no reason to be tested D. The test results won't be reliable so soon after exposure CORRECT

Which of the following describes the purpose of surveillance systems today?

A. To obtain data used to fight for increased budgets from taxpayers B. To evaluate the effectiveness of public health programs CORRECT C. To monitor and reduce the incidence of chronic diseases CORRECT D. To note and help prevent occupational exposure and diseases CORRECT

Mental illness

All diagnosable mental disorders (alterations in thinking, mood, or behavior associated with distress or impaired functioning)

Secondary prevention in regard to communicable diseases

Aims to prevent the spread of disease once it occurs-activities center on rapid identification and prompt treatment such as post exposure treatment quarantine

Environmental health assessment

Air, water, land, or food I PREPARE Windshield survey

Virulence

Ability of an agent/infection to produce disease; severity of disease

Mental health

Ability to engage in productive activities and fulfilling relationships with other people, to adapt, to change, and to cope with adversity

Television programs and print articles can inform and increase public awareness about family violence.

Abused women and rape victims benefit from media attention. The media can indirectly lead people to choose violence.

Stimulants

Activate nervous system, increase in alertness Nicotine, cocaine, caffeine, amphetamines These drugs do not give the person more energy, they only make the body expend its own energy sooner and in greater quantities than it normally would

Public health approach to ATOD

Addiction is a health problem Any psychoactive drug can be abused Accurate info can help people make informed decisions People with ATOD problems can be helped

Alcoholism

Addiction to the drug alcohol

Surveillance focuses on the collection of process and outcome data.

Although surveillance was initially devoted to monitoring and reducing the spread of infectious disease, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures.

There are ways to prevent or manage how people and their communities respond to disasters.

Although the number of disasters worldwide continues to grow, the number of lives lost has decreased.

A migrant farmworker is a laborer whose principal employment involves traveling from place to place planting or harvesting agricultural products and living in temporary housing situations.

An estimated 3-5 million migrant farm workers are in the United States. These numbers are controversial because of the inconsistency in defining farm workers and limitations in obtaining data.

Agents of bioterrorism

Anthrax Plague Smallpox Botulism Tularemia Hemorrhagic viruses (Ebola)

HIV antibody test

Antibodies indicate infection Offered in many locations Screening may be confidential or anonymous

Disaster

Any natural or human made incident that causes disruption, destruction, and/or devastation requiring external assistance. There is a range in size and cost. Developing countries experience disproportionate burden from natural disasters.

Surveillance systems in use today are defined as passive, active, sentinel, and special.

Any unusual increase in disease incidence (I.e., new cases) or an unusual event in the community should be investigated.

Rural adults 18 years and older are in poorer health than their urban counterparts; nearly 50% have been diagnosed with at least one major chronic condition. However, they average one less physician visit each year than healthier urban counterparts.

Approximately 26% of rural families live below the poverty level; more than 40% of all rural children younger than 18 years of age live in poverty.

STDs

Are often acquired through behaviors that can be avoided or changed. Focus considerably on disease prevention. Prevention can take the form of vaccine administration, early detection, or teaching clients about abstinence or safer sex. Individuals who live with these chronic infections can transmit them to others.

Determinants of health

Are the range of personal, social and environmental factors that influence health status. Policy making, social factors, where you live, who you live with, health services, are they there, are they accessible, individual behavior, biology and genetics.

New killers are emerging, and old familiar diseases are taking on different, more virulent characteristics.

As people move from one place to another they bring their diseases, levels of immunity and resistance to diseases, and the viruses or bacteria they may harbor that have not emerged as diseases in them.

Many STDs do not produce symptoms in clients.

Aside from death, the most serious complications caused by STDs are pelvic inflammatory disease, infertility, ectopic pregnancy, neonatal morbidity and mortality, and neoplasia.

Teen pregnancy

Asking questions about fertility, pregnancy, provide resources for pregnancy testing and counseling

Roles for nurses in environmental health

Assessment Referral Community involvement and public participation Risk communication Epidemiological investigations Policy development

Poverty had a direct effect on health and well-being across the life span. Poor persons have higher rates of chronic illness, higher infant morbidity and mortality, shorter life expectancy, and more complex health problems.

At present, the following groups often constitute the homeless in both rural and urban areas: families, single mothers, single women, recently unemployed persons, substance abusers, adolescent runaways, mentally ill individuals, and single men.

Barriers to health care in rural populations:

Availability, affordability, accessibility or lack of acceptable services and professionals

Prevention of disasters

Awareness, education, surveillance, immunizations, isolation

What are the documents used for surveillance?

Birth records and death records

Syphilis

Bacterial causation Characterized by lesion or chancres Three stages: Primary = chancre at site of entry Secondary = skin rash Late/latent = nervous system, internal organ damage

Nurses must consider the belief systems and lifestyles of the rural population when assessing, planning, implementing, and evaluating community services.

Barriers to rural health care include the lack of availability, affordability, accessibility, and acceptability of services.

Rape leaves the victim feeling helpless

Best way to prevent rape is to stop it before it happens through education and mentoring programs. Addressing social and cultural influences that promote attacks. Policies that address sexual harrassment.

Dioxin

By product of combusting chlorine compounds (stored in fatty tissue)

Withdrawal symptoms of heroine

CNS hyperactivity, flu like symptoms, anxiety, drug craving...NOT LIFE THREATENING

Psychoactive drugs

Can affect mood, perception, and thought They are used for enjoyment in social and recreational settings and for personal use to self mediate physical or emotional discomfort

Methadone

Can help with withdrawal symptoms

Prolonged pesticide exposure can results in long term effects such as:

Cancer, brain tumors

Data sources for surveillance

Cases reported by clinicians, health care agencies and laboratories to state health departments. Death certificates Administrative data

Tuberculosis

Caused by mycobacterium tuberculosis Transmitted by airborne droplets Causes pulmonary symptoms and wasting Cough, fever, Hemoptysis, chest pain, fatigue, weight loss One step-two step manitou X testing

At risk populations for mental illness

Children and adolescents...need to increase screening Adults...early detection and intervention Adults with serious mental illness are often homeless or in jail Older adults...physical and chronic illness increases rate of depression. MOST AT RISK FOR SUICIDE.

When harvesting is completed, the migrant farmworker becomes simultaneously homeless and unemployed. Forced migration to find employment leaves little time or energy to seek out and improve living standards. Many of them return to their country of origin after the growing season ends.

Children of migrant farm workers may need to work for the family's economic survival.

In rural populations there are fewer school nurses.

Children who work on farms are exposed to fertilizers, chemicals, etc. They are also prone to accidents. (A lot of them are allowed to drive and operate machinery at a young age).

The Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice suggests that surveillance is one of the interventions related to public health nursing practice.

Clinicians, health care agencies, and laboratories report cases to state health departments. Data also come from death certificates and administrative data such as discharge reports and billing records.

Drug diction is often a family problem, not merely an individual problem.

Codependency describes a companion illness tot he addiction of one person in which the codependent member is addicted to the addicted person.

Patterns of occurrence

Common source outbreak Point source Mixed outbreak Intermittent or continuous source

Effective control of communicable diseases requires the use of a multimeter approach focusing on improving host resistance, improving safety of the environment, improving public health systems, and facilitating social and political changes to ensure health for all people.

Communicable disease prevention and control programs must move beyond providing drug treatment and vaccines. Health promotion and education aimed at changing individual and community behavior must be emphasized.

Lack of jobs and low-paying jobs can lead to feelings of inadequacy, despair, and social alienation

Communities differ in the resources and facilities they provide to residents

Key questions in an environmental health assessment should cover past condition in workplace, home, and community. Ask about the job they held longest, current and past. Exposure to liquids, dust, mists, or fumes. Are there any relationships between current symptoms and activities at work or home?

Conduct a windshield survey to assess for potential environmental health risks.

Newborns of women with untreated gonorrhea may have any of the following complications

Conjunctivitis Sepsis Arthritis Meningitis

What are some of the roles that the nurse plays when providing preventative care for communicable diseases?

Counselor Educator Advocate Case manager Primary care provider Community outreach

Nurse roles when working with the homeless or at risk populations with mental illness

Create a trusting environment Show respect, compassion and concern Do not make assumptions Coordinate a network of services and providers Advocate for accessible health care services Focus on prevention Know when to walk beside the client and when to encourage the client to walk ahead Develop a network of support for yourself

Things to keep in mind when planning and implementing care for vulnerable populations:

Create a trusting environment Show respect, compassion, and concern Do not make assumptions Coordinate services and providers Advocate for accessible health care services Focus on prevention Know what resources are available Develop your own support network

MDMA

Ecstasy Club drug, raves Leads to death overheating (raises body temperature, heart rate and blood pressure

Description of poverty

Decreased earnings Increased unemployment rates Changes in the labor force Increase in female-headed households Inadequate education and job skills Inadequate anti poverty programs and welfare benefits Weak enforcement of child support statutes Dwindling social security payments to children Increased numbers of children born to single women

Depression is the leading cause of disability in ages 15-44

Depression is the leading cause of years of productivity loss

Surveillance, what do we do it?

Detect trends, detect spikes, collect data

DOH

Determinants of health

Crack addiction

Develops rapidly and is expensive May lead to criminal activity

Treatment for TB

Direct observed therapy Used when attention non-compliance is suspect ensures ongoing medication regimen For a new or fresh case of tuberculosis the duration of treatment is 6 months. Where for the first 2 months, four drugs Rifampicin, Isoniazid, ethambutol, and pyrazinamide are used and for the next four months, two drugs - Rifampicin and isoniazid are used Treatment is daily and adherence to TB treatment is critical for curing tuberculosis If the treat is not followed, the TB can come back or the TB bacteria can become drug resistant

Being knowledgeable about community resources available to vulnerable populations before a disaster incident ensures a more coordinated response and recovery.

Disaster health and disaster mental health training from an official agency such as the American Red Cross can prepare nurses for the many opportunities that await them in disaster prevention, preparedness, response, and recovery.

The degree of worker stress during disasters depends on the nature of the disaster, the worker's role in the disaster, individual stamina, noise level, adequacy of workspace, potential for physical danger, stimulus overload, and, especially, being exposed to death and trauma.

Disaster shelter nurses are exposed to a variety of physical and emotional complaints, including stress. Stress may be instigated by the shock of the disaster, the loss of personal possessions, the fear of the unknown, living in proximity to strangers, and boredom.

Disruption of public health infrastructure can cause:

Disruption of food, sanitation, water, access to care, can can all lead to increased disease

Synthetic chemicals

Do not beak down and can be found in the body

Hallucinogens

Drugs that stimulate the nervous system and produce varied changes in perception and mood Can cause intoxication and lead to alter perceptions and impaired judgment LSD, MDMA, PCP

Nurses work as partners with vulnerable clients to identify client strengths ad needs and develop intervention strategies designed to break the cycle of vulnerability.

During assessment of vulnerable populations: determine if their needs are being met or not. A lot of people don't realize the amount of stress that they are under.

Factors that can influence whether teen becomes sexually active

Earlier sexual debut, less likely to use birth control Timing of sex education History of sexual victimization Single parent family Neglectful parents and very strict parents

Psychological stress of disaster workers

Early stress, burnout and delayed response

Terms used to define the magnitude of a problem/event

Endemic Hyper endemic Sporadic Epidemic Pandemic Outbreak

Each nursing assessment should include questions and observations about intended and unintended environmental exposures.

Environmental databases facilitate the easy and immediate access to environmental data useful in assessment, diagnosis, intervention, and evaluation.

Federal, state, and local laws and regulations exist to protect citizens from environmental hazards.

Environmental health practice engages multiple disciplines, and nurses are important members of the environmental health team.

Environmental justice

Equal protection from environmental hazards for individuals, groups, or communities regardless of race, ethnicity, or economic status

Increase in poverty/low wage jobs without benefits

Eroding employment opportunities and declining value of public assistance

Ethics (in reducing environmental health risks)

Essential for making ethical decisions regarding environmental health

Migrant farm workers are...

Essential to the U.S. Agricultural industry

What can public health surveillance be used to facilitate?

Estimate the magnitude of a problem (disease or event) Determine geographic distribution of an illness or symptoms Portray the natural history of a disease Detect epidemics;define a problem Generate hypotheses; stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

ATOD abuse and addiction can cause multiple health problems for individuals

Every culture has beliefs and attitudes toward ATOD. These attitudes are influenced by the way society categorizes drugs as either good or bad.

Transmission of HIV

Exposure to blood, semen, vaginal secretions, and breast milk. HIV is not transmitted through casual contact such s touching or hugging someone with HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone with HIV infection.

TB testing

Exposure versus disease PPD testing - read in 48-72 hours Testing is positive or nonreactive Positive testing (>5mm induration) for immunosuppressed, those with HIV, organ transplants, in close contact with person with TB Followed by CXR and sputum TB blood tests (also called interferon-gramma release assays or IGRAs) for those who have had TB vaccine

To intervene effectively, nurses must understand the dynamics of violence and human abuse.

Factors influencing social and community violence include changing social conditions, economic conditions, population density, community facilities, and institutions within a community, such as organized religion, education, the mass communication media, and work.

The definition of poverty varies depending on the source consulted. The federal government defines poverty on the basis of income, family size, age of the head of household and number of children younger than 18 years. Those who are poor insist that poverty has less to do with income and more to do with a lack of family, friends, love and support.

Factors leading to the growing number of poor persons in the United States include decreased earnings, diminishing availability of low-cost housing, increases in the number of households headed by women (women's incomes are traditionally lower than men's), inadequate education, lack of marketable job skills, welfare reform, and reduced Social Security payments to children.

The provision of reproductive health care services to teens requires sensitivity to the special needs of this age group, including knowing about state laws concerning confidentiality and services for birth contro, pregnancy, abortion, and adoption.

Factors such as a history of sexual victimization, family dysfunction, substance use, and failure to use birth control can influence whether a young women becomes pregnant.

Patterns of occurrence can be identified when investigating a disease or event. These patterns are used to define the boundaries of a problem to help investigate possible causes or sources of the problem.

Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors.

Neglect

Failure to meet basic needs (housing, food, clothing, education, and access to health care.

Rural

Farm residency (typically farmers, typically tend to have more kids) very young and the very old are vulnerable populations

Migrant far workers are faced with uncertainty regarding work and housing, inadequate wages, unsafe working conditions, and lack of enforcement regarding legislation for field sanitation and safety regulations.

Farm workers are exposed not only to the immediate effects in the fields (foggy or wet with pesticides) but also to unknown long-term effects of chronic exposure to pesticides.

Families who are homeless or at risk

Fastest growing group of homeless

Poverty guidelines

Federally and state funded programs, determine your eligibility when governments change the health care guidelines (impacts healthcare, they may not have access year to year, as they fluctuate in and out of eligibility.)

Disenfranchisement

Feeling separated from mainstream society (pushed aside)

Preparedness for disasters

Flexibility is key for the nurse Personal Profession Community

We get chemical, biological, and radiological exposures that affect our health in the air we breathe, (carbon dioxide, asbestos), the water (E.coli, radium, lead, can be contaminated with medications) we drink, the food we eat (salmonella), and the products we use. Talcum powder - ovarian cancer.

Focus on the quality of the environment in which. nurses need to know how to assess for environmental health risks and envelop educational and other preventive interventions to help individuals, families, and communities understand and, where possible, decrease the risks

Water-waste discharges into bodies of water, storm water run off

Food prep practices, pesticides, antibiotics, irradiation, GMOs

Why are root cases as important to address as immediate concerns? get to the heart of the matter. It can just be a recurring proble, they'll probably be back. Environment, where they work, where they live, several generations living together crowded in one household. Peal back the layers and make sure we aren't just putting band aids on opening gaping wounds.

For example: addiction/detox, if you don't get to the heart of the matter they're just going to be back, they're going to relapse (a lot of people take substances to treat pain.)

A community's structure can influence the potential for violence.

For example: crowded conditions = greater potential for tension and violence

Access to health care is a national priority that remains unsolved. Access is a problem in rural areas, including farms that rely on migrant workers to ah rest their crops, and in urban inner cities.

For the migrant worker, a language barrier and cultural differences often exist between them and the farm owners and other area residents.

Sexual violence

Forcing a person to take part in a sexual act when they the person does not consent

High risk industries found primarily in rural areas

Forestry Mining Fishing Agriculture

An unusual increase in disease incidence should be investigated.

Functions of surveillance and investigation include detecting cases, estimating the impact of disease or injury, showing the natural history of a health condition, determining the distribution and spread of illness, generating hypotheses, evaluating prevention and control measures, and facilitating planning.

What is active surveillance?

Go out and seek data you wouldn't normally get otherwise

Disaster recovery role of the nurse

Goal is to return to new normal Prolonged effects of disaster may intensify acute and chronic conditions Teach proper hygiene and make sure immunization records are current Be alert for environmental hazards Assess dangers of live or dead animals Case finding and referral

Examples of sexually transmitted diseases

Gonorrhea Syphilis Chlamydia Helped HPV

Adolescents who are homeless or at risk

Greater risk taking behaviors

Two trends are largely responsible for the rise in homelessness over the past 20-25 years

Growing shortage of affordable rental housing A simultaneous increase in poverty/low wage jobs without benefits

All teen pregnancies are

HIGH RISK

Examples of Sexually transmitted diseases

HIV Hepatitis

Testing for HIV

HIV antibody test HIV test counseling Post test counseling

Caring for AIDS patients in the community

HIV patients are more susceptible to opportunistic infections. Identifying resources such as social and financial support services. Interpreting school and work policies. Assisting employers by educating managers about how to deal with ill or infects workers to reduce the risk of breaching confidentiality or wrongful actions such as termination.

Genital herpes

HSV-2 is primary cause of genital herpes Viral-no cure Chronic disease Presents with visible lesions - vesicles to ulcerations Can lead to miscarriage and be passed to newborn Skin, eye, mouth, infection Liver disease Encaphalitis

Depressants

Lower energy level, reduce sensitivity Alcohol, barbiturates, benzodiazepines, opioids

Examples of vector borne diseases

Lyme disease Rocky Mountain spotted fever West Nile

What are some emerging infectious diseases?

Hantavirus pulmonary syndrome HIV/AIDS New influenza viruses West Nile virus Zika virus

HIV/AIDS

Has become one of the world's greatest build health challenges

Definition of poverty

Having insufficient resources to meet basic living expenses

Communicable diseases are preventable. Preventing infection through primary prevention activities is the most cost-effective public health strategy.

Health care professionals must always apply infection control principles and procedures in the work environment. They should strictly practice the universal blood and body fluid precautions strategy to prevent transmission of HIV and other blood-borne pathogens.

Effective intervention measures at the individual and community levels must be aimed at breaking the chain linking the agent, host, and environment. An integrated approach focused on all three factors simultaneously is an ideal goal to strive for but may not be feasible for all diseases.

Health care professionals must constantly be aware of vulnerability to threats posed by emerging infectious diseases. Most of the factors causing the emergence of these diseases are influenced by human activities and behavior.

The life expectancy of the migrant farm workers is 49 years, in contrast to 75 years for other U.S. Residents.

Health problems of migrant farm workers are inked to their work environment, limited access to health services and education, and lack of economic opportunities.

Nurses role in disaster preparedness

Help initiate or update the agency's disaster plan. Provide educational programs and material regarding disasters specific to the area and organize disaster planning meetings. Organize disaster drills. Provide an updated record of vulnerable population within the community. Review individual strategies.

People in a community react differently to a disaster depending on the type, cause, and location of the disaster; its magnitude and extent of damage; its duration; and the amount of warning that was provided.

Helping clients maintain a safe environment and advocating for environmental safety measures in the community are key roles for the nurse during all phases of disaster management.

What is the purpose of surveillance?

Helps public health departments: Determine baseline rates, identify trends and unusual disease patterns. Set priorities for sings care resources Develop and evaluate programs for commonly occurring and universally occurring diseases or events

Diseases that are vaccine preventable

Hepatitis B Diphtheria Pertussis Measles Mumps Rubella Polio Haemophilus influenza Type B meningitis Varicella Strep pneumonia

Stress reactions in the community

Heroic Honeymoon Disillusionment Reconstruction Recovery

Depression in rural areas

High rate of poverty Geographic isolation Insufficient number of mental eh although services Higher endemic level of depression

Secondary prevention depends heavily on careful assessment of the client's use of drugs. Such assessment should be part of all basic health assessments.

High-risk groups include pregnant women, young people, older adults, intravenous drug users, and illicit drug users.

Second hand smoke (side hand smoke)

Higher amounts of toxic and carcinogens, more dangerous than mainstream

Women's health in rural areas (maternal and infants too)

Higher infant and maternal morbidity rates Fewer specialists Extreme variations in pregnancy outcomes Particularly at risk are women who: live near or on Indian reservations, are migrant workers, are of African American descent and live in rural counties of states in the deep South (where poverty is rampant) Are victims of sexual assault

Population characteristics and cultural considerations for rural populations

Higher proportion of whites Higher than average numbers of younger and older residents More likely to be married or widowed Fewer years of formal education Tend to be poorer Higher risk for being underinsured or uninsured

Effects of poverty across the lifespan

Higher rates of chronic disease Higher infant morbidity and mortality Shorter life expectancy More complex health problems More significant complications Greater hospitalization rates Limited access to primary healthcare and specialty care Less access to medications

Poverty effects on children

Higher rates of prematurity and birth defects Low birth weight Higher infant mortality rates Increased incidence of chronic disease Increased incidence of traumatic death Increased risk for homelessness Decreased opportunities for education, income, and occupation

Triage

Highest priority given to victims who have life-threatening injuries but who have high probability of survival. Second those with injuries with systemic complication but are not yet life-threatening. Those with local injuries without immediate complication

Older adults

Highest risk for suicide attempts

Psychological effects of a disaster

Hopelessness, depression, grief, suicide, make referrals to mental health professionals.

Epidemiological triangle

Host Agent Environment

Effects of homelessness on health

Hypothermia and heat-related illnesses Infestations and poor skin integrity Peripheral vascular disease and hypertension Diabetes and nutritional deficits Respiratory infection and chronic obstructive pulmonary diseases Tuberculosis HIV/AIDS Trauma Mental illness Use and abuse of tobacco, alcohol and illicit drugs

Nursing interventions for violence and abuse victims

Identify potential victims of family abuse (because nurses see clients in a variety of settings, such as schools, businesses, homes and clinics). Provide interventions for each level of prevention for individuals, families, and the community. Nurses are mandated reporters of child and older adult abuse.

Passive immunity

Immunization through transfer of a specific antibody

Social conditions such as a fast-paced life, excessive stress, and the availability of drugs influence the incidence of substance abuse.

Important terms to understand when working with individuals, groups, or communities for whom substance abuse is prevalent are drug dependence, drug additiction, alcoholism, psychoactive drugs, depressants, stimulants, marijuana, hallucinogens, and inhalants.

Diseases of travelers

Individuals traveling outside the U.S. Need to be aware of an take precautions against potential diseases they may be exposed to. Traveler may return to the U.S. With an unplanned souvenir, health professionals taking client history need to consider recent travel by the client.

Number one cause of death worldwide is...

Infectious disease, chronic disease

As people live longer, chronic diseases replaced infectious diseases as the leading causes of death.

Infectious diseases are still the number one cause of death worldwide.

Cocaine

Injected or smoked cocaine produces hyper stimulation, alertness, euphoria, and feelings of competence and power Interaction with dopamine seems to be the basis for the addictive patterns

Lack of OSHA regulation for farming and ranching

Injuries are common

Natural immunity

Innate ability to resist an infection

I PREPARE pneumonic for conducting an exposure history

Investigate potential exposures Present work history Residence Environmental concerns Past work history Activities Referrals and resources Educate

Smoking cessation programs

Involve combination of interventions (environment, habits, meds)

Smoking

Is the foremost preventable cause of death in the U.S. Cancer, primarily lungs lips, mouth, and throat Cardiovascular systems Respiratory diseases

Migrant lifestyle

Is unpredictable and difficult, typically following crops, back and forth from north and south *oftentimes illegal Hispanics Feelings of disenfranchisement No work-no pay They need Culturally competent care

STDs affect certain groups in greater numbers. Factors associated with risk include being younger than 25 years, being a. Member of a minority group, residing is an urban setting, being impoverished, and using crack cocaine.

It is important for nurses to educate clients about ways to prevent communicable diseases.

Governmental environmental protection

Manages environmental exposures through the development and enforcements of standards and regulations Educates public about risks and risk reductions

As a nurse caring for patients in a rural setting...

Keep in mind rural characteristics: everyone knows everyone, lines are blurred, lack of specialty care

With vulnerable populations

Know when to walk beside the client and when to encourage the client to walk ahead (life's a dance you learn as you go, sometimes you lead, sometimes you follow)

Example of getting to the root cause of 'at risk'

Lack of health care coverage related to minimum wage job related to lack of education, related to high school drop out, related to poor secondary school experiences, related to gang neighborhood related to living in powerty

Shortage of affordable rental housing

Lack of sufficient subsidized housing High rent burden

Facts about teen pregnancy

Late prenatal care Limited self care knowledge Premature and low birth weight babies More prone to violence Nutrition needs may still be growing themselves Iron deficiency anemia Limited infant care knowledge Stress, school becoming a parent

Pregnant women who are homeless or at risk

Less or no prenatal care, increased STDs, addiction, poorer birth outcomes

Health care providers in rural populations

Live and practice in a particular community for decades May provide care to people who live in several counties Small staff to service large areas There aren't enough providers in rural areas If there's a shortage, providers may practical across several counties

It may also mean seal the room, in other words, take steps to prevent outside air from coming in.

Local authorities may instruct you to shelter in place. If chemical or radiological contaminants are released into the environment.

What to expect at the hospital during a disaster?

Long waits, triage, limited information

Prevalence rates for mental health problems are high, and people are at risk for threats to mental health at all ages across the lifespan.

Low income and minority groups are often at increased risk for mental illness because they may lack access to services.

Child abuse indicators

Low self esteem, depression, somatic symptoms, avoidance behaviors, pretending abuse is not taking place, running away, withdrawing

Housing for migrant farm workers

May be in camps, crowded, near fields, heavy equipment, leading to an easier spread of infection. They can also develop mental health issues from living so closely together

Response to bioterrorism

May not know they have been exposed for a period of time

Pesticide exposure can result in acute effects such as:

Memory loss, difficulty with concentration, abdominal pain, nausea and vomiting

Addiction treatment

Methadone-blocks effects of other opioids and decreases crying. Inpatient, long term residential outpatient.

Scarcity of health professionals, poverty, limited access to services, lack of knowledge, and social isolation have plagued many rural communities for generations.

Migrant workers Access to health care Cultural competence Bias stereotyping

Early signs of stress

Minor tremors, nausea, problems with memory and concentration Suppressing guilt and anger can lead to fatigue, irritability

HIV disproportionality affects

Minorities

Nurses have responsibilities to be informed consumers and to be advocates for citizens in their community regarding environmental health issues.

Models describing the determinants of health acknowledge the role of the environment in health and disease.

Intestinal Parasitic infections

More prevalent in the immunocompromised Pinworms Opportunistic

Chlamydia

Most common reportable infectious disease in the U.S. Can cause PID, ectopic pregnancy, infertility Infects GU tract and rectum Causes conjunctivitis and pneumonia in neonates Oftentimes asymptomatic (dysuria, urinary frequency, purulent vaginal discharge) Silent STD

Vectors

Most common vector borne disease is malaria, Lyme disease

Heroin

Most often recreationally used opioid Tolerance and physical dependence develop quickly Serious complications result from unsanitary administration of the drug and complications due to overdose or the intoxication it can cause

Hepatitis A virus

Most often transmitted through the fecal-oral route; sources may be water, food, or sexual contact; often silent in children

Malaria

Most prevalent vector-born disease worldwide

Marijuana

Most widely used illicit drug in the U.S. Mild euphoria, relaxed feeling, intensity of sensory perception Side effects: dry reddened eyesight increased appetite Long term damage to respiratory tract Psychological dependence can occur with chronic use, but little is known about any potential psychical dependence Because of its illegal status, there is no quality control, and a user may consume contaminated marijuana

Types of disasters

Natural disasters Human-made disasters Chemical Biological Nuclear Radiologic Explosive

Community oriented nursing...

Needs to vary by community

Post test counseling for HIV

Negative: counsel on risk-reduction activities. Make sure the client understand that the txt may not be truly negatives. (It takes 6-12 weeks before evidence of HIV antibody). Positive: counsel about the need for reducing his or her risks and notifying past partners

Abuse of older adults

Neglect, psychological abuse, financial, overmediating

Chewing tobacco or snuff

Nicotine is not destroyed by heat

Deinstitutionalization

Noble idea but failed in execution...not enough resources available to help them all

Violence

Non-accidental acts (interpersonal or intra personal) than result in physical or psychological injury to one or more persons.

Urban

Non-farm residence

Poverty is a primary cause of vulnerability and is a growing problem in the U.S.

Not all private health agencies wish to provide services to vulnerable populations.

The role of the nurse (caring for at risk populations) is developing community prevention programs.

Nurses are in ideal roles to assist (at risk populations) with tertiary presentation for both the addicted person and the family

Brief interventions by a nurse can be as effective as treatment.

Nurses are in ideal roles to assist with tertiary prevention for both the addicted person and the family.

The cost to recover from a disaster has a risen sharply because of the amount of technology that must be restored.

Nurses are increasingly getting involved disaster planning, responses, and recovery through their local health department or local government.

Perpetrators have often been victims themselves or observed use of violent behavior to manage conflict.

Nurses can also take an active role in developing community responses to violence through working on public policy and needed resources.

Primary prevention for substance abuse includes education about drugs and guidelines for use, as well as the promotion of healthy alternatives to drug use either for recreation or to relieve stress.

Nurses can play a key role in developing community prevention programs.

Significant mortality and morbidity result from violence.

Nurses often care for the victims, the perpetrators, and observed use of violent behavior to manage conflict.

Outcomes of vulnerability can be negative, such as lower health status or they may be positive with effective interventions.

Often there is a cycle to vulnerability (it's a cycle, it happens over and over). Sometimes when one problem is solved, another quickly emerges. Leads to feelings of hopelessness.

Alcohol

Oldest and most widely used psychoactive drug in the world About 2/3 of American adults drink alcohol Binge drinking is an issue Chronic alcohol abuse

Caffeine

One of the most widely use psychoactive drugs in the world Found in coffee, soft drinks, various medications Energy drinks Moderate dose can have positive effects High doses however can cause insomnia, irritability, anxiety, cardiac, dysrhythmias, GI symptoms Withdrawal symptoms can include headaches, slowness, occasional depression

Disease surveillance

Ongoing, systematic collection, analysis, interpretation and dissemination of specific data for use in public health

Teens are making better decisions about sex

Overall decrease in teen birth rate over past 20 years

Pelvic inflammatory disease

PID Infections in the reproductive organs, Fallopian tubes, endometrium Can result in infertility Signs and symptoms include: vaginal discharge, unitary frequency, vomiting, and fever Usually results from untreated gonorrhea or chlamydia

Signs and symptoms of inhalant use

Paint or strains on the body or clothes, sores around mouth, red or runny eyes or noses chemical breath odor, drunk/dazed appearance, nausea/loss of appetite, anxiety/irritability, sudden sniffing deaths cardiac dysrhythmia Frostbite from inhaling from pressurized tanks, gas is cold

Early detection of communicable diseases is important because it results in early treatment and prevention of additional transmission to others. Treatment includes effective medications, stress reduction, and proper nutrition.

Partner notification, or contact tracing, is done by identfying, contacting, and ensuring evaluation and treatment of persons exposed to sexual and injectable drug-using partners. Contact tracing is also conducted for tuberculosis and hepatitis A virus.

Drug addiction

Pattern of abuse characterized by overwhelming preoccupation with the use of a drug security its supply and a tendency to relapse if drug is removed. May be both physically and psychologically dependent

Goal of Healthy People 2020 is to eliminate health disparities.

People have different genetic compositions, social and environmental resources, skills, support systems, and access to health services.

Violence and human abuse are not new phenomena, but they are growing community health concerns.

People in communities across the United States are frustrated by increasing levels of violence.

The stress of nurses is compounded if they are both victims and caregivers in a disaster.

People react differently to disasters depending on factors such as their age, cultural background, health status, social support structure, and general adaptability to crisis.

Violence and abuse of family members can happen to any family member: spouse, elder, child, or physically or mentally compromised person.

People who abuse family members were often abused themselves; they react poorly to real or perceived crises. Other factors that characterize the abuser are the way the person was raised and the unique character of that person. Cultural factors should be considered when abuse is suspected.

Low socioeconomic status leads to poor health outcomes

People with lower incomes and less education tend to be at higher risk for health problems. May not have access to adequate health care services. Healthy food can be difficult to get. Low health literacy and low education levels.

Exposure to chemicals in rural settings is common

Pesticide exposure, asbestos

Types of abuse

Physical abuse Sexual abuse Neglect Child abuse Intimate partner abuse Older adult abuse

Vulnerable population groups that are special concern to the nurse

Poor Homeless Pregnant adolescents Migrant workers and immigrants Severely mentally ill individuals Substance abusers-drugs and alcohol Victims of domestic violence and abuse Persons with communicable disease Veterans

Four groups of people who represent members of vulnerable populations that present with complex nursing needs are:

Poor Homeless Pregnant teens Those who are mentally ill

Children who are homeless or at risk

Poorer nutrition, less health care, anxiety, absenteeism

Health status of rural residents

Poorer perception of their overall health and functional status. less likely to engage in preventive behavior More likely to have one or more of the following chronic conditions: heart disease, COPD, hypertension, arthritis, and rheumatism, diabetes, cardiovascular disease, and cancer. Tend to have poorer health and are less likely to seek medical care (everyone knows everyone, HIPAA guidelines are blurred) Traveling time and or distance to ambulatory care services affects access to care.

PCP

Potent anesthetic with CNS stimulant, depressant and hallucinogen properties

Factors leading to the growing number of poor people in the United States include reduced earnings, decreased availability of low-cost housing, more households headed by women, inadequate education, lack of marketable skills, welfare reform, and reduced Social Security payments to children.

Poverty has a direct effect on health and well-being across the life span. Poor people have higher rates of chronic illness and infant morbidity and mortality, shorter life expectancy, and more complex health problems.

Disaster management begins before the disaster occurs

Prevention Preparedness Response Recovery

For many chemical compounds, whether new or familiar, scientific evidence of possible health effects is lacking.

Prevention activities include education, waste minimizing, and land use planning. Control activities include environmental permitting, environmental standards, monitoring, compliance and enforcement, and clean-up and remediation.

Definition of a migrant worker:

Principal employment in past 24 months is in agriculture on a seasonal basis and establishes a temporary abode for this purpose. Some are citizens, others are here illegally

Nurses are increasingly getting involved in disaster planning, response, and recovery through their local health department or local government.

Professional preparedness involves an awareness and understanding of the disaster plan at work and in the community.

Primary prevention in regards to drugs

Promotion of healthy lifestyles and resiliency factors Assisting clients to achieve optimal health Teaching assertiveness and decision making skills Teaching stress reduction and relaxation techniques

Active immunity

Protection by administration of an antigen or having the infection (body works to produce antibodies)

Proper use of PPE

Protects health care providers from exposure

Nurses working in shelters

Provide assessments and referrals Meet health care needs, such as helping clients get prescription glasses, medications, first aid, and appropriate diet adjustments Keep client records Ensure emergency communications Provide a safe environment

(Nursing intervention for vulnerable populations) Trend toward

Providing more comprehensive, family centered services when treating vulnerable population groups: family-centered "one stop" services *hard to reach (get them in) vulnerable population

What are some possible responses to bioterrorism or large-scale infectious disease outbreak?

Quarantine Travel restrictions Disposal of deceased

Response to disasters

Rapid needs assessment-establish sanitation Triage Psychological stress: individuals, community and disaster workers

Recovery is often the hardest part of the disaster

Recovery is about returning to the new normal with the he goal of reaching a level of organization that is s near the level prior to the disaster as is possible. May take months-years. Recovery occurs as all involved agencies pull together to restore the economic and civic life of the community. Government helps with rebuilding. Religion organizations-rebuilding supplies. IRS how to write off losses. CDC continuing surveillance.

Vector borne diseases

Refers to illnesses for which the infectious agent is transmitted by a carrier (vector)

Organized religion

Religion generally teaches nonviolent conflict resolution. However, historically, a seemingly contradictory relationship exists between abuse and religion. (Victimization of women, believe that they must stay married despite abuse).

Reporting of disease data by health care providers, laboratories, and public health workers to state and local health departments is essential if trends are to be accurately monitored.

Requirements for reporting diseases are mandated by law or regulation.

Nurses are often in the forefront of responses to be made in the surveillance process.

Requirements for reporting diseases are mandated by law or regulation. Each state differs on the list of reportable diseases.

Acquired immunity

Resistance as a result of previous natural exposure

Recovery from disasters

Returning to the new normal Ongoing community assessment

Air-indoor air quality

Rising incidence of asthma Carbon monoxide, dusts, models, dust mites, pets, products (aerosols) tobacco smoke

Pregnant women need to know what effect their environment will have on fetal development

Risk assessments determine the probability of a health threat associated with an exposure: point source versus non-point source.

Both case advocacy and class advocacy are important skills for nurses in environmental health practice.

Risk communication is an important skill and must acknowledge the outrage factor experienced by communities with environmental hazards.

Nurses assess individuals, families, and groups to determine which socioeconomic, physical, biological, psychological, and environmental factors are problematic for clients. They work as partners with vulnerable clients to identify client strengths and needs and develop intervention strategies designed to break the cycle of vulnerability.

Rural environments are diverse and different from those in urban areas.

Bullying = even more dangerous with technology, can lead to self harm

School can be a powerful contributor to nonviolence. Educate on conflict resolution, abuse, date rape, etc.

There is a prevailing need in most rural areas especially for the following:

School nurses Family planning services Prenatal care care for individuals with AIDS and their families Emergency care services Children with special needs Mental health services Services for older adults

Secondary prevention for violence and abuse victims

Screening for abuse, provide resources for emergency safe sanctuary

Side stream smoke

Second hand smoke

Gonorrhea

Second most common reportable infection in the U.S. Bacteria Causes inflammation of urethra and cervix Dysuria Can also be asymptomatic Can lead to PID in women Treatment: IM dose of ceftriaxone in combination with oral azithromycin or doxycycline

Primary prevention in regards to communicable diseases

Seeks to reduce the incidence of disease by preventing it before it happens: vaccines, immunization laws, education

It is important to listen to TV or radio to understand whether the authorities wish you to merely remain indoors or to take additional steps to protect yourself and your family.

Self protection includes evacuation, sheltering in place, and personal cleaning and disposal of contaminated clothing.

Nearly all communicable diseases discussed in this chapter are preventable because they are transmitted through specific known behaviors.

Sexually transmitted diseases (STDs) are among the most serious public health problems in the United States. Not only is there an increased incidence of drug-resistant gonococcal infection, but other STDs, such as human papilloma-virus (HPV, genital warts), human immunodeficiency virus (HIV), and herpes simplex virus (HSV) (genetically herpes), are associated with cancer.

Children may experience regressive behaviors in response to stress.

Shelter in place means to are immediate shelter where you are - at home, work, school or in between.

Older adults who are homeless or at risk

Shorter life expectancy, untreated chronic conditions

Intimate partner abuse

Signs of abuse physical gins, emotional signs Abuse is a process - victims tend to blame themselves, concern for others. The nurse must prioritize the safety of person being a used.

Amphetamines

Similar to cocaine but effects last longer and the drugs are cheaper They have a chemical structure similar to adrenaline and noradrenaline and are generally used to decrease fatigued increase mental alertness my suppress appetite and Crete a sense of well being Users are prone to accidents, unsafe sexual practices

Poverty

Social and economic factors predispose people to poverty Poverty and homelessness affect people's health status Poverty is one of the primary causes of vulnerability Persistent poverty, neighborhood poverty Poverty level is determined using the poverty guidelines

Health care is increasingly moving into the community. This began with Deinstitutionalization of the severely mentally ill population and is continuing today as hospitals reduce inpatient stays. Vulnerable population need a wide variety of services, and because these are often provided by multiple community agencies, nurse coordinate and manage the service needs of vulnerable groups.

Socioeconomic problems, including property and social isolation, physiological and developmental aspects of age, poor health status, and highly stressful life experiences predispose people to vulnerability. Vulnerability can become a cycle, with the predisposing factors leading to poor health outcomes, chronic stress, and hopelessness. These outcomes increase vulnerability.

Assessment if vulnerable populations should include:

Socioeconomic resources Preventive head needs Congenital and genetic predisposition to illness Amount of stress Living environment/neighborhood surroundings

In recent years, schools have assumed many responsibilities traditionally assigned to the family (sex education, discipline)

Spanking = some punish hitting or biting with spanking

Child abuse can be physical, emotional, or sexual. Incest is a common and particularly destructive form of child abuse.

Spouse abuse is usually wife abuse. It involves physical, emotional, and frequently sexual abuse within a context of coercive control. It usually increases in severity and frequency and can escalate to homicide of either partner.

Hepatitis B virus

Spread through blood and body fluids; can survive at room temperature for at least 1 week

Hepatitis C virus

Spread through blood or body fluids Most common chronic blood borne infection in the U.S.; leading cause of chronic liver disease, end-stage liver disease, liver cancer, and liver transplants in the U.S.

Drug dependence

State or neuroadaptation caused by chronic, regular use of a drug. Suffer withdrawal symptoms.

Primary prevention for violence and abuse victims

Strengthen the individual and family through education, participate in media campaigns and policies to prevent violence

There is great potent ion for connecting rural providers and consumers with resources outside their community via technology using:

Text messages Tele health (reading images of tests, monitoring ICU patients, heart monitors, and EMU patients) Telephone (face time translators) Video conferencing

Nurses have a critical role in the delivery of care to persons who are high risk. Nurses bring too each client encounter the ability to assess the client in context and intervene in ways that restore, maintain, or promote health.

Substance abuse is the leading national health problem linked to numerous forms of morbidity and mortality.

ATOD is the number one national health problem that causes more deaths, illnesses, and disabilities than any other condition

Substance abuser is not only at risk for personal problems but also may be a threat to the health and safety of family members, co-workers, and other members of the community

Inhalants

Substances often common household chemicals that are inhaled by drug users, they are inhaled from bottle, aerosol cans or soaked cloth Often among the first drugs that young children use dependence on the dose, the user may feel a slight stimulation, less inhibition or even loss of consciousness

A quality surveillance system requires collaboration among a number of agencies and individuals.

Such collaboration promotes the development of a comprehensive plan and a directory of emergency responses and contacts for effective communication and information sharing.

Surveillance is a critical role function for nurses practicing in the community.

Surveillance is important because it generates knowledge of a disease or event outbreak patterns.

Disease surveillance has been a part of public health protection since the 1200s during the investigation of the bubonic plague in Europe.

Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and to improve health.

Vulnerabilty

Susceptibility to actual or potential stressors/problems that may lead to an adverse effect on health. Results from the interaction of internal and external factors that cause a person to be susceptible to poor health.

A key attribute in aiding disaster victims is flexibility.

Symptoms of worker stress during disasters include minor tremors, nausea, decreased concentration, difficulty thinking and remembering, irritability, fatigue, and other somatic disorders.

Nurses play a key role in all aspects of prevention and control of communicable diseases. Close cooperation with other members of the interdisciplinary health care team must be maintained. Mobilizing community participation is essential to successful implementation of programs.

THe successful global eradication of smallpox proved the feasibility of the eradication of communicable diseases. As professionals and concerned citizens of the global village, health care workers must support the current global eradication campaigns against poliomyelitis and drancunculiasis. The latter disease is also known as Guinea worm disease and is caused by drinking unfiltered water containing small crustaceans infected with larvae of D. Medinesis.

Primary prevention drug education

Teaching that no drug completely safe and rest any drug can be abused Helping persons learn how to make informed decisions about their drug use to minimize potential harm

Partnership models, in particular community health primary health care, are effective models to provide a comprehensive continuum of care in environments with scarce resources.

Technology offers many options for providing care to people who live in rural areas.

Restistance

The ability of the host to withstand infection

Suicide

The act or an instant of taking one's own life voluntarily and intentionally. Risk factors: depression, mental disorders, previous attempt, family history.

Child poverty rates are twice as high as those for adults. Children who live in single-parent homes are twice as likely to be poor than those who live with both parents.

The complex health problems of homeless people include the inability to obtain adequate rest, sleep, exercise, nutrition, and medication; exposure; infectious diseases; a cut and chronic illness; infestations; and trauma and mental health problems.

Factors contributing to homelessness include an increase in the number of persons living in poverty, diminishing availability of low-cost housing, increased unemployment, substance abuse, lack of treatment facilities for mentally ill persons, domestic violence, and family situations causing children to run away.

The complex health problems of homes less persons include inability to get adequate rest, exercise, and nutrition; exposure; infectious disease; acute and chronic illness; infestations; trauma; and mental health problems.

Hepatitis A is often silent in children, and children are a significant source of infection to others.

The emergence of multi-drug-resistance TB has prompted the use of directly observed therapy (DOT) in the United States and other countries to ensure adherence with drug treatment regimens.

Where do homeless persons usual receive health care?

The emergency room

The health status of rural population varies, depending on genetic, social, environmental, economic, and political factors.

The incidence of working poor in rural America is higher than in more populated areas.

Lyme disease is

The most common vector borne illness in the U.S.

No single source of information about environmental health is available, nor is there a single resource to which individuals or a community can be referred if they suspect an environmental problem

The number of disasters, both human-made and natural, continues to increase, as does the number of people affected by them.

The cost to recover from a disaster has risen sharply because of the amount of technology that must be restored.

The number of disasters, both human-made and natural, continues to increase, as does the number of people affected by them.

The role of the nurse (caring for at risk populations) is to have knowledge of community resources and how to mobilize them.

The nurses role is also to provide brief interventions, we are not treatment experts. We can provide feedback about risk of drug abuse. Emphasize personal responsibility. Give clear advice to make behavior changes. Provide options. Provide empathy and encouragement to change.

Environmental health practice includes principles of health promotion, disease prevention, and health protection.

The objectives of Healthy People 2020 address targets for the reduction of risk factors and diseases related to environmental causes.

Adolescents, especially those who become pregnant, having special nutritional needs.

The pregnant teen will need support during and after the pregnancy from the family and friends and from the father of the baby.

HIV infection

The primary infections (within about 1 month of contracting the virus). Clinical latency (body shows no symptoms). A final stage of symptomatic disease.

The right to know laws

The public has a right to know about hazardous chemicals in the environment

Risk communication

The right information to the right people at the right time

Each of the data sources has the potential for under reporting or incomplete reporting. However, if there is consistency in the use of surveillance methods, the data collected will show trends in events or disease patterns that may indicate a change needed in a program or a needed prevention intervention to reduce morbidity or mortality.

The sentinel surveillance system provides for the monitoring of key health events when information is not otherwise available or for calculating or estimating disease morbidity in vulnerable populations.

Nurses can identify potential victims of family abuse because they see clients in a variety of settings, such as schools, businesses, homes, and clinics. Treatment of family abuse includes primary, secondary, and tertiary prevention and therapeutic intervention.

The stage of disaster known as recovery occurs as all involved agencies pull together to restore the economic and civic life of the community.

The burden of infectious diseases is high in both human and economic terms. Preventing these diseases must be given high priority in our present health care system.

The successful interaction of the infectious agent, host, and environment is necessary for disease transmission. Knowledge of the characteristics of each of these three factors is important in understanding the transmission, prevention, and control of these diseases.

Health disparities

The wide variations in health services and health status among certain population groups. Your type of insurance, Hispanics and diabetes, African American women and breast cancer, African American males and hypertension and stroke.

Inhalant uses can get high several times in a short period since the inhalants are short acting and have a rapid onset

There is a link between school performance and use of an inhalant

Police Powers are necessary to preserve health and safety

These powers include pubic health surveillance Balance needs of the community with constitutionally protected rights of individuals

Many social and community factors influence violence.

Violence is a learned behavior controlled/allowed by social norms.

Children are especially vulnerable

They breathe more rapidly than adults = great exposure to air pollutant (higher respiratory rate, smaller bodies) Bodies work differently than adults: blood-brain barrier, kidneys, growing bodies

Mental health concerns in vulnerable populations

They delay seeking care. Depression is an issue Domestic violence Not much to do recreationally in rural areas Alcohol, tobacco, and other drug use and abuse

When designing community health programs for those living in rural areas

They must mesh with community's belief system Example: mobile health clinics

Work can be fulfilling and contribute to a sense of well-being, it can also be frustrating and unfulfilling, contributing, to stress that may lead to aggression and violence.

This frustration and resentment may contribute to violent behavior. Workers may have difficulty separating feelings generated at work from those at home. People hesitate to give up jobs even if they are frustrating, boring, or stressful. Particularly true in times of economic downturns.

Vulnerable populations

Those groups with increased risk for developing adverse health outcomes. Many times due to limited resources. Are more likely than the general population to suffer from health disparities.

Emerging infectious diseases are?

Those in which the incidence has actually increased in the past two decades or has the potential to increase in the near future

Incubation

Time interval between invasion and first appearance of signs and symptoms of the disease

Communicable period

Time which an infectious agent may be transferred from an infected person to another person

HIV

Timing of testing, you have to wait to be tested to get a definitive answer

HIV testing counseling

To receive test results, assess risk Discuss risk behaviors and how to avoid engaging in them Develop with the client a risk-reduction plan Establish the follow-up appointment and post test counseling Partner notification and contact tracing

Poverty and homelessness affect the health status of people.

To understand poverty, homelessness, mental illness, and teen pregnancy, consider your personal beliefs and attitudes, clients' perceptions of their condition, and the social, political, cultural, and environmental factors that influence the client's situation.

Advice to nurses caring for the poor

Treat the poor like everyone else Don't be condescending Don't make it obvious that someone is poor Do not prejudge, ask if someone want to pay on their bill Remember that poor people can't always pay for their medicine Suggest programs that might help Poor people need a lot of support Many poor people need to learn how to promote their own health

U.S. Agencies, directives and systems

U.S. Department of homeland security National preparedness guidelines National response plan National incident management system Public health and medical preparedness and the national health security strategy

20% of those with HIV are

Unaware of their infection

HIV is more concentrated in

Urban areas

Substance abuse

Use of any one substance that threatens health or impairs social or economic functioning

Modes of transmission of communicable diseases

Vertical transmission Horizontal transmission Common vehicle Vectors

Lack of insurance is a major contributing factor to vulnerable populations, as it results in limited access to health care.

Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations.

Vulnerable populations are more likely to develop health problems as a result of exposure to risk or to have worse outcomes from those health problems than the population as a whole (Miners, water sources, pollution.)

Vulnerable populations are more sensitive to risk factors because they are often exposed to cumulative risk factors. (Gang violence, micro aggression)

Vulnerable populations are more likely to develop health problems as a result of exposure to risk or to have worse outcomes from those health problems than the population as a whole.

Vulnerable populations are more sensitive to risk factors than those who are more resilient, because they are often exposed to cumulative risk factors. Those populations include poor or homeless persons, pregnant adolescents, migrant workers, severely mentally il individuals, substance abusers, abused individuals, people with communicable diseases, and people with sexually transmitted diseases.

Most of what affects health is not on the individual level.

Vulnerable populations often have worse health outcomes than other people in terms of mobility and mortality.

Vulnerable populations are more likely so suffer from health disparities.

Vulnerable populations results from the combined effects of limited physical, environmental, personal resources, and bio-psychosocial resources, cumulative risk.

Food borne and waterborne diseases

Water in many areas of the world is not potable (drinkable) Diarrheal diseases (Montezuma's revenge)

A healthy environment is essential for optimal health and healthcare.

We often take the environment for granted and may fail to see the hazards in front of us.

Tertiary prevention for violence and abuse victims

When signs an symptoms of abuse are evident-refer to resources

High risk groups: adolescents, older adults, injection drug users, drug use during pregnancy, use of illicit drugs.

Where this is ATOD codependency and family involvement: help families recognize addictions for prompt treatment.

Tertiary prevention in regard to communicable diseases

Works to reduce complications and disabilities through treatment and rehabilitation

Nurses have responsibilities to be informed consumers and to be advocates for citizens in their community regarding environmental health issues.

Write letters to local newspapers responding to environmental health issues affecting the community. Serve as a credible source of information at community gatherings, formal governmental hearings, and professional nursing forums. Volunteer to serve on state, local, or federal commissions. Know the zoning and permit laws that regulate the effects of industry and land use on the community. Read, listen, and ask questions. As informed citizens nurses can lead in fostering community action to address threats to environmental health.

In order to care for them effectively:

You have to understand your own beliefs about these groups. Identify health care needs, barriers to care, and health care services for each of these groups.

To better serve the rural community

You need to understand this community's values, beliefs, way of life to provide best healthcare A provider's attitudes, insights, and knowledge, may lead to mistrust

Wrap around services: comprehensive health services (when available), but social and economic services also provided, either directly or through referrals; in this way, social and economic services that will help ensure effectiveness of health services are wrapped around health services.

You want to get to the root cause of an 'at risk' situation.

What is passive surveillance?

data is just coming in normally