Chapter 23 Public Health Community Based and Home Health Care

A 46-year-old woman has difficulty walking due to osteoporosis and rheumatoid arthritis. The woman takes calcium tablets prescribed by her primary health care provider. She also uses a special herbal oil advertised on television for guaranteed cure of rheumatoid arthritis. What interventions would be helpful for the client?

A community nurse should educate older adults about the management of daily activities, correct body mechanics, availability of mechanical appliances, and adequate rest. The nurse should inform the client about the availability of medical appliances for safe walking. It is not appropriate to direct the client to ignore her primary health care provider; however the nurse may encourage her client to discuss milk as a natural source of calcium with her health care provider. Calcium tablets do not cause kidney stones if taken with adequate fluids. Herbal oils may not have a therapeutic effect so encouraging its use would be inappropriate.

A 54-year-woman is poor and suffering from tuberculosis. It has been found that other people with tuberculosis live in her area. What care should the nurse take when collecting information about the client's medical history?

Asking questions about current medications will help the healthcare provider plan other treatments for the client. It is important to determine whether the illness is in the acute or chronic stage so that caregivers can take necessary precautions and strategize the treatment plan. Making use of the assessment form designed for vulnerable groups helps the caregivers understand their special needs. Assessment of these needs is more important than treating the illness. Often these special needs are the underlying cause of their illness. It is important to take a complete and detailed history that provides all the necessary information about the client and his family to help serve him better. Questions about financial status should be asked to understand the condition of the client better.

A community nurse plans to perform health checkups at a long-term care facility. On visiting the convalescent home, the nurse learns that many of the residents suffer from dementia. What interventions can the nurse take that might be helpful? Select all that apply.

Even though the client has dementia, the nurse's responsibility is to foster dignity. The nurse should also make every effort to protect the client's rights in all aspects. The nurse should train the caregiver on proper techniques of feeding, dressing, and toileting. Teaching correct body postures and exercises may be helpful for arthritic conditions, but not for dementia.

A public health nurse uses Healthy People 2020 to plan care. What does Healthy People 2020 plan to achieve? Select all that apply.

Healthy People 2020is a science-based plan to reduce illness and disability. The plan's focus isto address health care disparity among certain socioeconomic levels and provide funding for much-needed services. The Susan B. Komen Foundation is a philanthropic health-focused foundation that works with providers and researchers to eradicate breast cancer. The World Health Organization (WHO) of the United Nations develops programs to address global health concerns.

A community-based nurse plans to assess the health care needs of a particular community to ensure improved delivery of health care. How should the nurse assess the health care needs of this community? Select all that apply.

Monitoring the health status provides information about the most prevalent health problems of the community. Systematic data collection from various sources helps the nurse to collect information about the factors causing illness in the community. The nurse may also obtain health-related documentation about the community. Planning budget allocation does not help in identifying the health care needs of the community. Even though voluntary reporting is helpful, the nurse should not rely only on this information. The nurse should also look for other factors that affect the health status of the community.

A community nurse is working towards achieving Healthy People 2020. What should be the goal?

One of the goals of Healthy People 2020 is to improve life expectancy and quality of life. Another goal is to eliminate health disparities through an improved delivery of health care services. Therefore, the aim of this community nurse should be to increase the quality of life through better health care services. Assessment of the number of new diseases does not help in achieving health goals. Discovering an AIDS vaccine is the responsibility of research organizations. Training nurses to help them provide better health services is an institutional goal.

Which interventions are provided by public health nurses? Select all that apply.

Public health nursing examines the community as a whole and may perform interventions such as investigating the occurrence of food-borne illnesses. Public health care focuses on populations, so public health nurses may advocate with housing authorities to ensure safe and accessible housing. Public health nurses are expected to design strategies to keep the population healthy. Therefore, the nurses plan multilingual, culturally based immunization clinics to increase participation. A school nurse educates and creates an awareness of childhood obesity among school children by initiating body mass index assessment. The parish nurse educates the parish community on prevention of diseases. These nursing practices fall under the scope of community-based nursing.

Which intervention by the school nurse focuses on secondary prevention of illnesses?

Secondary prevention focuses on early detection of illnesses. The nurse assesses each child's body mass index to address the issue of childhood obesity. Primary prevention of illness involves strategies to prevent the occurrence of disease or disability. The school nurse focuses on prevention of childhood obesity by teaching children to consume healthy food rather than processed foods. The nurse also arranges fitness classes for children as a primary prevention strategy. Tertiary prevention involves providing interventions for people with illness. Monitoring blood glucose levels of a diabetic child is an example of tertiary prevention.

In a community a large number of people have arthritis. What nursing interventions would be helpful in reducing the incidence and impact of arthritis? Select all that apply

Stress is an important factor in the development of arthritis, and the nurse should educate the community about how to manage stress effectively. The nurse should also teach clients about proper body mechanics and how to better manage daily activities as they directly impact joints. There are various mechanical appliances which help people suffering from arthritis. Therefore, clients should be taught about these devices. Advertisements often give false claims of curing arthritis, and the nurse should caution clients against such ads. While positive social interaction is an important part of a client's overall well being, it does not reduce the incidence or impact of arthritis.

A community health nurse is interviewing a client who is diagnosed with tuberculosis. The client is unemployed and has no source of income. The client's spouse is bed-ridden and needs constant care. The client chews tobacco and drinks alcohol in moderation. Which factors should the nurse identify as reasons for the client's poor health? Select all that apply.

The client is obviously stressed both physically and mentally, which could make the individual susceptible to diseases. Poverty, malnourishment, and unhygienic surroundings could lead to infections. The client does not give any history of substance abuse. The client does not seem to have decreased self-esteem.

What roles do nurses play in providing quality care to all populations? Select all that apply.

To have a healthcare system with quality care for all populations, nurses need to practice to the full extent of their education and training, become full partners with physicians and other healthcare providers, and improve data collection, which in turn helps workforce planning and policy making. Medicine, dentistry, dietetics, biostatistics, epidemiology, finance, and health policy makers are a few of the disciplines and collaborative colleagues with whom nurses work in assessing, planning, implementing, and evaluating systems of care for target community groups or populations of interest. Partnering with major insurance providers is not a nursing role.

A nurse is interviewing a female client. The nurse finds that the she is an immigrant and spends a lot of time travelling for work. She is married and has two children. Her husband abuses her often. She earns just enough to feed her children. The nurse understands that the client is vulnerable. What client factors make her vulnerable? Select all that apply.

Vulnerable populations are groups of clients who are more likely to develop health problems as a result of excess health risks, who are limited in access to health care services, or who depend on others for care. The fact that the client is an immigrant, that she is constantly physically abused by her spouse, and has very limited financial resources (just enough to feed her kids) renders her to be vulnerable . People who travel most of the time or have their home far away from their workplace are not necessarily vulnerable.