Comboset 5 -(C228) ATI-Community Health <Tests & Vocab>
Surveillance for bio-terrorism
1- geographic clustering of illness, especially those with clinical signs that resemble an infectious disease outbreak--previously healthy people with unexplained fever accompanied by sepsis, pneumonia, respiratory failure, rash or flaccid paralysis 2-Unusual age distribution for a common disease 3-Large number of cases of acute flaccid paralysis such as seen in Clostridium botulinum
Millennium Development Goals
1. eradicate extreme poverty and hunger 2. achieve universal primary education 3. promote gender equality and empower women 4. reduce child mortality 5. improve maternal health 6. combat HIV/AIDS, malaria, and other diseases 7. ensure environmental sustainability 8. develop a global partnership for development
strategies for health for 2015 (bexar county)
1. evidence-based teen pregnancy prevention-reduce teen birth rate by 15% 2. built environment for active living-reduce physical inactivity by 10% 3. neighbors engaged in health-community asset mapping, action plans and active engagement in 10 neighborhoods 4. blood and sexually transmitted disease-reduce congenital syphilis by 50% and reverse trends in syphilis incidence
Captopril
! report Angioedema-life threatening;
John Snow
"Father of epidemiology"
Public health wheel
For selling health messages R/t epidemiology
What is Lillian Wald famous for (4)
Founded -Community Health Nursing Henry St. Establisment (founder) Children's Bureau Soc Sec. Act Legislation
A nurse observes a client who is pacing and wringing his hands. The client states, "I don't know why, but I've worried every day for over a year that my son will die a horrible death." The nurse identifies that this finding is consistent with which of the following disorders? A. Generalized anxiety disorder B. Panic disorder C. Posttraumatic stress disorder D. Acute stress disorder
A. Generalized anxiety disorder
A nurse working on an acute mental health unit is caring for a client who has posttraumatic stress disorder (PTSD). Which of the following is an expected finding? (Select all that apply.) A. Hallucinations B. Obsessive need to talk about the traumatic event C. Exaggerated displays of emotion D. Recurring nightmares E. Diminished reflexes
A. Hallucinations D. Recurring nightmares
A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? A. Insist that the client stop yelling. B. Request that other staff members remain close by. C. Move as close to the client as possible. D. Walk away from the client.
B. Request that other staff members remain close by.
A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following is an expected finding? (Select all that apply.) A. Sunken fontanelles B. Respiratory distress C. Retinal hemorrhage D. Altered level of consciousness E. An increase in head circumference
B. Respiratory distress C. Retinal hemorrhage D. Altered level of consciousness E. An increase in head circumference
Client ________ - Right to information disclosure, privacy, informed consent, information confidentiality, and participation in treatment decisions.
Client rights - Right to information disclosure, privacy, informed consent, information confidentiality, and participation in treatment decisions.
Community-Oriented Nursing
Client: Community Focus: Health of community as a "whole"
Community-Based Nursing
Client: Individual, family, or groups Focus: Individuals, families, and groups within the community
flooding and health
Climate change intensifies rainfall; heavy rains increase risk of drinking water contamination and illness; floods can force communities to relocate.
What caused these plagues?
Close contact
Educational objectives
Cognitive Affective Psychomotor
Mental health
High risk substance use disorders, high suicide risk.
Nightingale's Theory of Environment
Highlights the relationship between an individual's environment and health. Depicts health as a continuum. Emphasizes preventative care.
IMO
Institute of Medicine
Risk
Probability that an event will occur within a specified period of time
PRO
Professional Review Organization
Peripheral IV should be changed when?
Q 72-96 hours. flushed Q8 and prn.
Foodborne
Salmonellosis, Hepatitis A, Trickinosis, E.coli
What is addiction?
a pattern of pathological, compulsive use of substances that can involve physiological dependence
infectious agent
an organism (virus, Rickettsia, bacteria, fungus, protozoan, helminth, or prion) capable of producing infection or infectious disease
agent
an organism capable of causing disease
importance of IMR (in epidemiology)
because IMR is influenced by a variety of biologic and environmental factors affecting the infant and mother, the IMR is both a direct measure of infant health and an indirect measure of community health as a whole
secondary prevention
begins after a disease or condition is present, although there may be no symptoms; emphasis on screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health
health education program
pamphlets should be written at 8th grade level, not 12; attendance should be voluntary;
windshield survey components
people place location of health services natural environment housing social systems
Who is most at risk for pneumonia?
people of all ages, but the young, older adult clients, and clients who are immunocompromised are more susceptible. Immobility is a contributing factor in the development of pneumonia.Older adult clients are more susceptible to infections and have decreased pulmonary reserves due to normal lung changes, including decreased lung elasticity and thickening alveoli.
A school nurse is scheduling visits with a physical therapist for a child who has cerebral palsy. In which of the following roles is the nurse functioning? a. Direct caregiver b. Consultant c. Case manager d. Counselor
c
A nurse is preparing an education program on disease transmission for employees at a local day care facility. When discussing the epidemiological triangle, the nurse should include which of the following as agents? (Select all that apply.) a. Resource availability b. Ethnicity c. Toxins d. Bacteria e. Altered immunity
c, d
A community health nurse is educating the public on the agents of bioterrorism. Which of the following are Category A biological agents? (Select all that apply.) a. Hantavirus b. Typhus c. Plague d. Tularemia e. Botulism
c, d, e
vectors
can be animals, insects or artropods, and they can transmit infection through biologic and mechanical routes
Cat C bio agents
can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. ■ Examples include hantavirus
goals and objectives in planning community health program
can be written in sequential steps that are required to reach the goal; must be measurable; include a time frame for attaining change; the direction and magnitude of the change; and method of measuring the change
Program Planning: Implementation
carry out the plan
School nurse can involve
case management, community outreach, consultant, counselor, direct caregiver, health educator, researcher
As a ____________, the nurse coordinates comprehensive services for students with complex health needs
case manager
synergism
concept central to the web of causation model, wherein the whole is more than the sum of its separate parts
health economic
concerned with how scarce resources affect the health care industry
impact (summative; short term) evaluation
concerned with the immediate impact of a program on a target group
Discussing stress reduction techniques with employees at an industrial site is a __________prevention strategy.
primary
EPO (exclusive provider organizations)
private financing: clients choose from a list of providers within a contracted organization
environmental health
promotion of safe, healthful living conditions and protection from environmental factors that may adversely affect human health or the ecologic balances essential to long-term human health and environmental quality, whether in the natural or man-made environment
ozone action days
declared on hot, sunny, still days when conditions are most favorable for the accumulation of unhealthy levels of ground-level ozone; forcasted by Texas Commission on Environmental Quality (TCEQ) make their forecasts a day in advance: Austin, Beaumont-Port Arthur, Corpus Christi, Dallas-Fort Worth (where it's called an "Air Pollution Watch"), El Paso, Houston-Galveston-Brazoria (where it's called an "Ozone Watch"), San Antonio (where it's called an "Air Quality Health Alert") and Tyler-Longview-Marshall.
older adults age related health changes
decrease sensitivity to pain due to loss of neurons and fibers; decreased peristalsis, delayed gastric emptying; prebyopia-may require near objects to be held further away in order to be seen; distance vision decreases, narrowing the client's visual field
Chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan)
decrease the intensity of withdrawl symptoms, decrease risk of seizures
Increased blood pressure, tachycardia, and diaphoresis are indicators of
delirium tremens or alcohol withdrawal delirium
traditional categorization of community assessment data (community analysis)
demographic characteristics; geographic characteristics; socioeconomic characteristics; and health resources and services
alcohol use
depressant, dulls the senses to outside stimulation and sedates the inhibitory centers in the brain.
Risk factors for suicide include
depression or other mental disorders, substance use, and intimate partner issues.
acquired immunity
derived from actual exposure to the specific infectious agent, toxin, or appropriate vaccine
windshield survey
descriptive approach that assesses several community components by driving through a community.
epidemiological triangle
study of the relationships among an agent, a host, and an environment
Epidemiology
study of the relationships among an agent, a host, and an environment (epidemiological triangle)
Healthy nutrition should include omega-3 fatty acids for secondary prevention of
diabetes and heart disease
Healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of ______________
diabetes and hyperlipidemia
rotavirus
diarrhea, abd pain, fever 37.4C
Modifiable risk faactors
dietary habits, exercise, home safety
Early manifestations of alzheimers:
difficulty learning new things, forgetful
Small pox
eradicated worldwide since late 1970s, people who were immunized against smallpox before 1982 are now considered to be unprotected, unlike chickenpox, the vesicles of smallpox are more abundant on the face.
utilitarianism
ethical approach to decision making that considers only the outcomes or consequences in determining which choice to make
fidelity
ethical principles: agreement to keep promises
nonmaleficence
ethical principles: avoidance of harm or injury
justice
ethical principles: fairness in care de;livery and use of resources
beneficence
ethical principles: positive actions to help others
autonomy
ethical principles: the right to make one's own personal decisions, even when those decision might not be in that person's own best interest
Beneficence
ex: Assessing risks and benefits when planning interventions
determinants of health
factors which influence an individual's or population's health; influences include the availability and access to: high quality education, nutritious food, decent and safe housing, affordable, reliable public transportation, culturally sensitive health care providers, health insurance, and clean water and non-polluted air
distributive justice
fair distribution of the benefits and burden in society
Homeless population characteristics (not all inclusive)
families with children (fastest growing segment) People who have mental illness (large segment) Older adults with no place to go and no support system
demographic characteristics
family size, age, sex, and ethnic and racial groupings
Anthrax exposure S/S
fever, fatigure, mild chest pain, dry cough. No contagious. fatality is 95-100% if untreated.
Ebola
fever, hemorrhage, vomiting, diarrhea, cough, jaundice, shock. Treatment: no cure, airway management, dialysis, supportive care. Prevention: avoidance of contaminated items/animals
Epidemiological triangle
host-living species that can be affected by a disease-producing entity
q to determine if client is socially isolated
how often do you have visitors come to see you?
Medicade provides:
in and outpatient hospital care. home health. radiology. vaccines for children. family planning. pregnancy-related care. screening. diagnosis. and treatment for young un's.
Health Policy
in contrast, is a set course of action to obtain a desired health outcome for an individual, family, group, community, or society. Policies are made not only by governments, but also by such institutions as a health department or other health care agency, a family, or a professional organization.
Prevention of lead exposure:
increase calcium and iron intake. Wet mop floors. cold water to amek baby formula. don't sand wood.
process (formative) evaluation
initial implementation/development of program; answers: are we doing what we said we would do?
Epi pen
inject medication into the thigh in case of an allergic reaction; can be injected through clothing; first dose of Epi will provide control of symptoms for about 20 mins; after injection is given, transport to hospital; store Epi pen at room temp in dark place (no refrigeration needed); remove gray thing to activate device, leave black thing in place
assault, battery, false imprisonment
intentional torts (3)
battery
intentional torts: intentional and wrongful physical contact with a person that involves an injury or offensive contact (ex. nurse restrains a client and administers an injection against her wishes)
assault
intentional torts: the conduct of one person makes another person fearful and apprehensive (ex. threatening to place an NG tube in someone that refuses to eat)
PT
interprofessional personnel: assesses and plans for clients to increase musculoskeletal function, especially of the lower extremities, to maintain mobility
OT
interprofessional personnel: assesses and plans for th clients to regain ADLs, especially motor skills of the upper extremities
provider
interprofessional personnel: assesses, diagnoses, and treats disease and injury. includes MDs, doctors of osteopathy, APRNs, PAs
dietitian
interprofessional personnel: assesses, plans for, and educates regarding nutrition needs. Designs special diets, supervises meal preparation
pharmacist
interprofessional personnel: providers and monitors medications, supervises pharmacy technicians in states that allow this practice
social worker
interprofessional personnel: works with clients and families by coordinating inpatient and community resources to meet psychosocial and environmental needs that are necessary for discharge and recovery
Best source of information about local safety concerns
interviewing community members
What is epidemiology?
invenstigative study of disease trends in populations to prevent disease and maintain health.
Public health nurse: core function of assessment:
investigating local health hazards.
psychomotor learning domain
involves the performance of skills that require some degree of neuromuscular coordination and emphasize motor skill; in learning a skill, first show learners how to do the skill; next allow learners to practice (teach back or show back approach)
alcohol withdrawal
irritability, tremors, nausea, vomiting, headaches, diaphoresis, anxiety, sleep disturbances, tachycardia, elevated blood pressure. Use benzodiazepines for symptoms.
otitis media
irritable, pulling ear, fever
Population or aggregate
is a collection of individuals who have one or more personal or environmental characteristics in common.
Public Health Nursing
is a specialty because it has a distinct focus and scope of practice, and it requires a special knowledge base.
four-medication TB regimen
isoniazid (Nydrazid), rifampin (Rifadin), pyrazinamide, and ethambutol hydrochloride (Myambutol)
allergic conjuntivitis
itching eyes with stringy discharge and red conjunctiva
HbA1c
know values
civil laws
laws that protect individual rights
begin entry with date and time, legible, no correction fluid, sign
legal guidelines for documentation
informed consent
legal process by which a client has given written permission for a procedure or treatment
continuing
levels of health care: addresses long term or chronic health care needs
secondary
levels of health care: diagnosis and treatment of acute illness and injury
preventive
levels of health care: educating and equipping clients to reduce and control risk factors for disease
primary
levels of health care: emphasizes health promotion such as prenatal and well-baby care, nutrition counseling, disease control
The host
living being that is affected by the agent. (human or animal).
Risk factors for gastric ulcers:
long term NSAID use. Hplori, stress, family, or personal hisotry.
goals
long term group overall learning needs or expected outcomes after instruction or program activities
AIDS
look in mouth for sores.
Medicaide
low socioeconomic status and kids. federal and stage governmental assistance. Priority given to pregnant women, children, and those with disability.
Rape
majority of violence against women is intimate partner violence. Incidence occurs higher in cities, between 8 pm-2 am, on weekends, and in summer months
HbA1c is the best indicator of the average blood glucose level for
the past 120 days. It assists in evaluating treatment effectiveness and compliance.
An epidemic is when
the rate of disease exceeds the usual level of the condition in a defined population
beneficence
to do good and max benefits
surveillance
systematic collection, analysis, and interpretation of data related to the occurrence of disease and the health status of a given population
Principles of MAPP
systems thinking, dialogue, shared vision, data, partnerships and collaboration, strategic thinking, and celebration of successes
Hypertension occurs when
systolic blood pressure is at or above 140 mm Hg or diastolic blood pressure is at or above 90 mm Hg. Normal adult blood pressure is less than 120 mm Hg systolic and 80 mm Hg diastolic.
Providing equipment to practice hands-on skills is an appropriate learning strategy for clients who are ________ learners
tactile-kinesthetic
Education to give to migrant farm workers:
teach about environmental health because of exposure to pesticides. TB screening, skin cancer information, and dental health screening.
med name, dosage, time, route
telephone/verbal prescription: what should you repeat back
The nurse is using_______ prevention when teaching healthy nutrition to clients who have hypertension
tertiary
Centers for Medicare and Medicaid Services (CMS) - Also administers
the Health Insurance Portability and Accountability Act (HIPAA), disability insurance, Aid to Families with Dependent Children (AFDC), and Supplemental Security Income (SSI).
Community assessment is a comprehensive approach that emphasizes
the community as a client.
Suicide
women report attempting suicide more often than men. Rates are highest in men and individuals over the age of 65. Risk factors for suicide include depression or other mental disorders, substance use and intimate partner issues.
The nurse should determine the work practices of employees when conducting a
work site survey
Social and Community factors Influencing Violence
work stress, unemployment, media exposure to violence, crowded living conditions, poverty, feelings of powerlessness, social isolation, lack of community resources
public health policy
works to improve the publics health through legislative action at the local, state and federal level; institutional and legislative efforts to promote health and meet national health objectives...support initiatives that address barriers to health such as poverty, homelessness, unsafe living conditions, abuse and violence, and lack of access to health services
American Red Cross
works with other agencies to provide relief services after a disaster; not responsible for local disaster plan
home health/wound care nurse role
wound care for clients in their home
audiometry
you will have headphones, press button when you hear a sound
Populations at risk for Communicable diseases
young children, older adults, immunosuppressed clients, clients who have a high-risk lifestyle, international travelers, health-care workers
What are some tertiary prevention strategies for substance abuse?
• Assist the client to develop a plan to avoid high-risk situations and to enhance coping and lifestyle changes. • Refer the client to community groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). • Monitor pharmacological management. • Provide emotional support to recovering abusers and their families, including positive reinforcement.
What are some resource barriers to the referral process?
• Attitudes of health care personnel • Costs of services • Physical accessibility of resources • Time limitations • Limited expertise working with culturally diverse populations
Describe the assessment phase of the case management nursing process
• Clarify the problem by evaluating physical needs, psychosocial issues, functional ability, and financial constraints.
What are some tertiary prevention strategies related to infectious diseases?
• Decrease complications and disabilities due to infectious diseases through treatment and rehabilitation. • Monitor treatment compliance, including directly observed therapy. • Prevent reinfection. Identify community resources. Disasters
Describe the diagnosis phase of the case management nursing process
• Determine the cause and precipitating factors. • Identify applicable nursing diagnoses by using the above assessment.
What are the s/sx of botulism?
• Difficulty swallowing • Progressive weakness • Nausea, vomiting, abdominal cramps • Difficulty breathing
Factors influencing an individual's potential for violence
■ History of being abused or exposure to violence ■ Low self-esteem ■ Fear and distrust of others ■ Poor self-control ■ Inadequate social skills ■ Minimal social support/isolation ■ Immature motivation for marriage or childbearing ■ Weak coping skills
Objective data for MI
■ Pallor, and cool, clammy skin ■ Tachycardia and/or heart palpitations ■ Diaphoresis ■ Vomiting ■ Decreased level of consciousness
Risk Factors Essential hypertension
■ Positive family history ■ Excessive sodium intake ■ Physical inactivity ■ Obesity ■ High alcohol consumption ■ African American ■ Smoking ■ Hyperlipidemia ■ Stress
National Health Goals for Older Adults
■ Reductions in ☐ Adults who have musculoskeletal concerns ☐ Older adults who have mental health concerns ☐ Hospitalizations due to heart failure ☐ Substance use in the older adult ☐ Sensory concerns such as hearing loss and cataracts ☐ Hip fractures among older adults ☐ Fall-related deaths ■ Increases in ☐ Screenings for colorectal cancer ☐ Participation in organized health promotion activities ☐ Public reporting of elder maltreatment ☐ Older adults who maintain an active lifestyle
Alcohol, tobacco, and other substance use and addictive disorders can cause multiple health problems, including:
◯ Low birth weight ◯ Congenital abnormalities ◯ Accidents ◯ Homicides ◯ Suicides ◯ Chronic diseases ◯ Violence
National health goals:
◯ Reduction in per capita domestic water usage ◯ Reduction in blood lead levels in children ◯ Reduction in indoor allergens ◯ Reduction in the number of new schools near highways ◯ Increase in schools with policies/practices to promote health and safety
What are defense mechanisms against infections?
◯◯ Natural immunity (from the body's antigen antibody response) ◯◯ Artificial immunity (through vaccination) ■■ Active (vaccination with live, killed, toxoid) ■■ Passive (from antitoxin or antibodies)
What factors affect individuals in vulnerable populations?
◯◯ Poverty ◯◯ Poor self esteem ◯◯ Young or advanced age ◯◯ Chronic stress ◯◯ Emotional instability ◯◯ Environmental factors
What does case management include?
◯◯ Promoting interdisciplinary services and increased client/family involvement. ◯◯ Decreasing cost by improving client outcomes. ◯◯ Providing education to optimize health participation. ◯◯ Advocating for services and client rights.
Pyrazinamide
☐ Observe for hepatotoxicity. ☐ Instruct the client to drink a glass of water with each dose and increase fluids during the day. ☐ Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately. ☐ Advise the client to avoid using alcohol while taking pyrazinamide.
What visual data may be transmitted through telehealth systems?
☐☐ Images of wounds ☐☐ Images of surgical incisions
What are the cardinal signs of addiction?
tolerance and withdrawal
malpractice
tort: ex. nurse administers large dose of medication due to a calculation error. the client has a cardiac arrest and dies
negligence
tort: ex. use fails to implement safety measure for a client at risk for falls
subjective data for stroke
transient symptoms, such as visual disturbances, dizziness, slurred speech, and a weak extremity
Tactile-kinesthetic learners learn through "doing" and methods such as
trial and error, hands-on approaches, and return demonstration. These learners gain "meaning through exploration."
Recognize child abuse
unusual fear of the nurse, injuries not mentioned in hx, fractures including older healed fractures, subdural hematoma, trauma to genitalia, malnourishment or dehydration, inappropriate dress for weather conditions, considered to be a "bad child"
whispered voice test
use your finger to close one ear, tell me when you no longer hear the sound
What to avoid in sunscreen
vitamin A causes skin cancer in laboratory tests Oxybenzone, a hormone disruptor and skin allergen High SPF misleads consumers and offers little additional benefit
In a biohazard incident (with few exceptions,) ________ is the universal antidote.
water For biological hazardous materials, wash skin with copious amounts of water and antibacterial soap.
nursing process, client education, tasks that require nursing judgement
what CAN'T an RN delegate
data, action, response
what does DAR stand for
problem, intervention, evaluation
what does PIE stand for
subjective, objective, assessment, plan
what does SOAP stand for
malpractice
what is professional negligence
report to manager
what should the nurse do if the suspect a coworker of behavior that jeopardizes client care or could indicate a substance use disorder
intestinal parasitic disease prevention of transmission in a daycare
wipe changing tables with a dilute bleach solution between children
late manifestations of alzheimer's:
withdrawal from social activities, loss of langague skills, neglecting personal hygeine.
HbA1c
5% is normal
Tertiary prevention
Decrease complications and disabilities due to infectious diseases through treatment and rehab.
nurse functions a nurse manager when
she supervises a home health aide on proper hygiene care
disorders that increase a client's risk for stroke
Hypertension, diabetes mellitus, smoking, and other related disorders can increase a client's risk for a stroke.
4 goals of health people:
Life: ^ Quality, ^ Longevity Health Equality Healthy Environments All STAGES OF LIFE: ^ Quality ^ Developement ^ Behaviors
APHA developed:
"The Definition and Role of Public Health Nursing in the Delivery of Health Care" to describe the field of specialization
VNA developed:
"The Visiting Nurse Quarterly" initiated a professional communication medium for clinical and organizational concerns.
Health education
"The pedagogy of the oppressed" Community empowerment (WHO) Community as partner model (Betty Neuman)
Health
"extent to which an individual or group is able on the one hand, to realize aspirations and satisfy needs; and on the other hand, to change or cope with the environment." WHO
Incidence (new cases)
# cases in population at a specific time / population total x 1,000
Ca++
9-10.5
T3
90 is normal
What nurses can do to influence health policy
1. Learn the legislative process 2. Stay informed on current issues 3. Identify government representatives 4. Be an active constituent 5. Speak out
8 essential elements of primary health care
1. education for the identification and prevention/control of prevailing health problems 2. proper food supplies and nutrition 3. adequate supply of safe water and basic sanitation 4. maternal and child care, including family planning 5. immunization against the major infectious diseases, prevention and control of locally endemic diseases 6. appropriate treatment of common diseases using appropriate technology 7. promotion of mental health 8. provision of essential drugs
HDL
>40 (males) >50 (females)
Health Education Goals
Help individuals, groups, communities achieve, by own actions/initiative, optimal health Facilitate voluntary actions to promote health Empowerment Advocacy Self-efficacy
Hygia was the god of _____.
Hygiene
In the "I PREPARE" mnemonic, A=
Activities
What does Endemic mean?
Belonging exclusively to a place or group of people; It is present ALL THE TIME
Give 2 examples of a Pandemic disease/infection.
HIV/AIDS Flu A
In the "I PREPARE" mnemonic, I=
Investigate potential exposures
1st school nurse
Lina Rogers
Social learning theory -
Links information to beliefs and values to change or shift the learners' expectations
When did pandemics occur?
Middle Ages
What is Participant observation data collection?
Observation of formal or informal community services
What else was developed during the Classical Time (6)
Pharmacology Flushing H2O Drainage Embalming Pollution Treatment Hygiene Code
Population
a collection of individuals who share one or more personal or environmental characteristics
environment
a combination of physical, biological, and social factors that surround and influence both the agent and the host
Program planning: Assesment
a complete needs assessment and identify community strengths and weaknesses; assess the availability of community resources
Case Management
a nursing care pattern; RN's coordinates a person's care from admission through discharge and into the home setting
TB diagnosis should be considered for any client who has
a persistent cough lasting longer than 3 weeks, chest pain, weakness, weight loss, anorexia, hemoptysis, dyspnea, fever, night sweats, or chills.
Participant observation
observation of formal or informal community activities. Negative - bias, time-consuming
fomites
an inanimate object, material, or substance that acts as a transport agent for a microbe
Case management is
a systematic process of assessment, planning, service coordination, referral, monitoring, and evaluation that meets the multiple service needs of clients.
Community or population
an aggregate who shares one or more personal characteristics within the community is the client in community health nursing
Agent
animate or inanimate object that causes disease
advocacy
basic principles of ethics: support of clients' heart, safety, and personal rights
public policy
applies to all members of society; includes prescribed sanctions for failure to comply; formulated by government bodies; frequently restricts personal choice to improve public welfare
Community based planning
are based on the nursing diagnoses and contain specific goals and interventions for achieving desired outcomes; a process and has to be completed in partnership with the community.
Informant interviews
are direct conversations with individual community members for the purpose of obtaining ideas and opinions
Surveys
are specific questions asked in a written format and do not involve direct conversations with individual community members
geographic characteristics
area boundaries, number and size of neighborhoods, public spaces and roads
someone asks info on their neighbour-like if they have tb
ask: do You have questions about tb?
discharge planning
assess if client can return to previous residence, determine if client will need assistance at home, assess residence to determine if client will need equipment/adaptations, make a referral to social worker for community resources, communicate health status to community service provider
Occupational health nurse
assess the ricks for work-related illness and injury, plan and deliver health and safety services in the workplace, facilitate health promotion activities that lead to a more productive workplace
Facilitating small group discussions is an appropriate learning strategy for clients who are _____ learners
auditory
A community health nurse is determining available and needed supplies in the event of a bioterrorism attack. The nurse should be aware that community members exposed to anthrax will need access to which of the following medications? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Zanamivir (Relenza) d. Fluconazole (Diflucan)
b
The prompt use of _________ at the onset of symptoms can prevent the serious complication of delirium tremens.
benzodiazepines
The nurse manager should include viruses as a ______ when discussing work-related illness and injury
biological agent
Transitions are times of risk for families. Transitions include
birth or adoption of a child, death of a family member, child moving out of the home, marriage of a child, major illness, divorce, and loss of the main family income
Hep B
blood and body fluids. Treat with Alpha interferon.
alcohol use in body
body burns about 0.5 oz of alcohol per hr. alcohol withdrawal appears within 4 to 12 hours.
Streptokinase (Streptase) and alteplase (Activase) are used to
break up blood clots. ■ Thrombolytic agents have similar side effects and contraindications as anticoagulants. ■ For best results, give within 6 hr of infarction
Primary manifestation of syphilis:
chancre.
Transitions require families to
change behaviors, make new decisions, reallocate family roles, learn new skills, and learn to use new resources
affective learning domain
changes in attitudes and the development of values by influencing what learners feel, think, and value
Epidemiological agents
chemical (drugs, toxins) physical (noise, tempurature) Infectious agents (Viruses, bacteria)
Poor hygiene is manifestation of
child neglect
An underweight child is a manifestation of
child neglect.
priority pt
child with vomiting, febrile, petechial rash-meningococcemia-Unstable
Waterborne
cholera, Typhoid fever, bacillary dysentery, Diardia Iamblia
Treatment of anthrax:
ciprofloxacin, doxycycline with vanco and rifampin
Community members exposed to anthrax will need access to
ciprofloxacin. Thismedication is used for the prophylactic treatment of anthrax
The community is the _____ in community health nursing
client
implied consent
consent: client adheres to the instructions the nurse provides
As a __________, a nurse provides information to families, administrators, teachers, and parent-teacher groups to encourage decisions that promote the health of the students
consultant
Why is education inportant:
encourages clients to be independent, and involved in the own care. families can also be involved.
Diabetic shoe teaching:
extend 1/2-5/8 inches longer than the longest toe.
parish nurse role
facilitating substance abuse groups
Coalitions
facilitation of goal achievement through the collaboration of two or more groups
relative risk factor
factor of 1.0 means the risk of disease among the exposed is no different from the risk of disease among the non-exposed; an rr of 2.0 implies that the risk is twice as high, whereas a rr of 0.5 indicates that the exposure factor is associated with 1/2 the risk of disease (protective factor)
social determinants of health
factors which influence an individual's or population's health: complex relationships between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies
Secondary prevention:
focus is on early detection of disease and treatment with goal of limiting severity and adverse effects. includes: screenings (cancer, diabetes, HTN, TB lead exposure) and treatments (STI, TB)
tertiary prevention:
focus is on maximization of recovery after injury or illness. Includes: exercise rehab, nutrition counseling, case management, support groups.
Support groups:
focus on positive person if someone is being negative.
Primary disease prevention:
focus on prevention of the initial occurence of disease or injury. Includes nutrition counseling, family planning, smoking cessation, safety education (seat belt helmet use), prenatal classes.
community-based nursing
focus: individuals and families Activities: management of acute and chronic conditions where individuals, families, groups live, work and attend schools.
NACOSH (national advisory committee on occupational safety and health)
gathers data on the incidence and prevalence of occupational illness and injury. Prevention education related to occupational injury and illness, as well as determining hazards associated with new workplace technologies.
Inate Immunity
genetic / exists in a person without prior contact with an antigen
Epidemiological factors physical environment
geography, water/food supply, presence of reservoirs/vectors
Pertussis:
give antibiotics. check innunization. keep at home until coughing passes.
Herpes zoster
given at 60 years or older
Rotavirus
given during first year of life
suicidal s/s:
giving away belongings, depression, insomnia, lack of social interaction. ASK!
Anthrax
headache, fever, muscle aches, chest discomfort, severe dyspnea, shock. Give: IV Cipro
Biological Factors:
health and disease status, genetics, race, age, gender, causes of death.
medicare
health care financing: program for clients 65 and older and for those with permanent disabilities
medicaid
health care financing: program for clients with low income
In Community-based nursing VS Community-oriented nursing, community oriented nursing involves
health care of individuals, families, and groups (like a "class lesson") to improve the collective health of the community
medicare
health insurance program; 65 years or older, disabled people younger than 65, end stage renal disease or Lou Gehrig disease
Interpreters should have knowledge of
health-related terminology
Diabetes Mellitus for adolescent:
help plan diet, eat snack, within 2 hrs. of physical activity. test ketonswhen sick.
Assurance
makes sure that essential community-wide health services are available. This may include providing essential personal health services for those who would otherwise not receive them.
Secondary manifestation of syphilis:
malaise, maculopapular rash on palms, and lymphadenopathy.
Assault
males more likely to be assaulted, youths at higher risk
In Community-based nursing VS Community-oriented nursing, community-based nursing involves
management of acute and chronic conditions of individuals and individual families in a community setting
portal of entry
means by which an infectious agent enters a new host
portal of exit
means by which an infectious agent is transported from the host
Healthy nutrition should include decreasing the consumption of _______________, which can prevent diabetes and hyperlipidemia.
meats and processed foods
Part B
medical care, diagnostic services, physiotherapy.
secondary data
medical records, health surveys, vital statistics (morbidity/ mortality statistics)
Cognitive learning domain
memory, recognition, understanding, reasoning, application, and problem solving and is divided into hierachical classification of behaviors; hierarchical classification of behaviors (knowledge, comprehension, application, analysis, synthesis and evaluation)
Rates of suicide are highest in
men and individuals over the age of 65.
mode of transmission
method whereby the infectious agent is transmitted from one host (or reservoir) to another host
Cat B bio agents
moderately easy to disseminate and have high morbidity rates and low mortality rates. ■ Examples include typhus and cholera
passive surveillance
more common form of surveillance used by most local and state health departments; health care providers report notifiable conditions
child abuse
more common in homes where intimate partner abuse is present; abused children are more likely to become abusers; no connection between economic status and abuse
Smoking
nicotine creates feeling of alertness and energy.
postpartum blues
normal first 10 days
Homicide
often related to substance use, usually committed by someone known to the victim. Abuse often precedes homicide within families. Increasing among adolescents
Lead exposure:
old homes before 1970.
Medicare:
older than 65 and receiving Social Security, disability benefits for 2 years, have ALS or kidney failure on dialysis or transplant to qualify.
Community forum
open public meeting Strengths: community input Limitations: challenging to get participation
HPV transmission
oral contact; sexual contact;
Hep. A
oral fecal. treat with immunoglobulin and vaccine.
QSEN (quality and safety education for nurses)
organization that assists nursing programs i preparing nurses to provide safe, high-quality care: includes 6 competencies; safety, patient-centered care, evidence based practice, informatics, quality improvement, teamwork/collaboration
disaster preparedness role of nurse
organize community-wide disaster drills; assist people in knowing appropriate procedures to follow during a disaster
Public health
organized community efforts designed to prevent disease and promote health.
epidemic
refers to the unexpected increase of an infectious disease in a geographic are over an extended period of time
Primary care
personal health care that provides first-contact and continuous, comprehensive, and coordinated care.
Lobbyists
persuade of influence legislators. Lobbying may be implemented by an individual, or collectively through professional nursing associations.
A healing spiral fracture is a manifestation of
physical abuse.
Burns on the palms of the hands are a manifestation of
physical abuse.
The nurse manager should include lighting as a ______ when discussing work-related illness and injury
physical agent
The nurse manager should include noise as a ______ when discussing work-related illness and injury
physical agent
occupational nurse role
planning safety services for employees in local workplace
The nurse manager should include stress as an outcome of __________when discussing work-related illness and injury
psychological agents
Oxygen therapy for COPD pt at home
pt should not adjust oxygen; dr has to order it
advance directives
purpose is to communicate a client's wishes regarding end-of-life care should the client become unable to do so
Factors influenced by an individual's culture (note: not a comprehensive list)
religious preferences, family structure, food patterns, health practices and interactions
Mitoxantrone q 3 months for pt with MS
report sore throat-greatest risk is severe infection due to myelosuppression
student at local high school diagnosed with syphilis
report to state health dept;
transfer reports
reports that should include demographic information, medical diagnosis, providers, overview of health status, recent progress, any alternations that may become urgent situations, directives, most recent vitals, meds, allergies, diets, activity, special equipment, advance directives
Epidemiological triangle
reservoir-person, animal, arthropod, plant, soil, substance in which an infectious agent lives
In the "I PREPARE" mnemonic, R=
residence (age of home, heating, recent remodeling, chemical storage, water) OR referrals and resources
Portals of entry
respiratory passages, GI, Skin, mucous membranes, genitourinary tract, eyes, blood vessels
Portals of exit
respiratory secretions, feces, blood, semen, vaginal secretions, saliva, skin lesion exudates
Office of Emergency Management
responsible for a development of a local disaster plan
Analytic epidemiology
searches for the determinants of the patterns observed—the how and why of disease patterns
What are some example of Class B biological agents?
second highest priority because they are moderately easy to disseminate and have moderate morbidity rates and low mortality rates. ■■ Examples include typhus and cholera.
Category B biological agents
second-highest priority because they are moderately easy to disseminate and have high morbidity(disease) rates and low mortality (death) rates. Ex: typhus and cholera
Home health nurses skills
skilled assessment, wound care, lab draws, med education and administration, parenteral nutrition, IV fluids and medication, central line care urinary catheter insertion and maintenance. Must also evaluate the living environment for safety, paying close attention rugs, electrical outlet, and extension cords, use of oxygen, safety devices in the bathroom. Also educate the client when to contact ER.
Census (epidemiology data)
source of epidemiological community data; most comprehensive source of health-related data for the US; age, race, and sex along with factors such as employment, income, migration and education; used to calculate rates (denominator)--collected every 10 yrs
Consultant
specialized knowledge who provides expert advice, services, or information. -seek expertise from health care professionals -seek expertise from health care professionals -seek expertise of other nurses -incorporate recommendations from a consultant -coordinate recommendations from multiple consultants -serve as expert witness -serve as a consultant regarding the health care needs of individuals
nursing informatics
specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice
surveys
specific questions asked in a written format.
objectives
specific, short term, measurable, action oriented behaviors to be met as steps towards achieving the long term goal
community assessment
state officials' observation might be benefiting; national health care trends; data collected from surrounding counties
Prevention of asthma attack:
stay inside dring winter. get flu shot. take rescue meds PRN not daily.
pandemic
steady occurrence of disease over a large geographic area or worldwide, such as malaria
microeconomics
the branch of economics that studies the economy of consumers or households or individual firms; the behavior of individuals and organizations & how this effects prices, costs and resources; behaviors that result from tradeoffs in the use of service and budget limits
What is substance abuse?
the use of any substance (including legal and prescribed) that threatens an individual's health or social and economic functioning
The case manager must be proactive for the client, balancing the impact of the illness against
the cost of care. Increased knowledge of disease processes promotes early intervention and facilitates transition from acute to community-based care
global burden of disease
the disability-adjusted life year (DALY), which is a time-based measure combining years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health
reservoirs
the environment in which a pathogen lives and multiplies
professional negligence
the failure of a person who has professional training to act in a reasonable and prudent manner ( ex. failure to follow professional/facility standards of care, use of equipment in responsible/knowledgable maker, communicating effectively with clients, document care nurses provided)
Nightingale's Theory of Environment
the inter-relationship nursing, health and environment in the health/illness of an individual or community
human capital
the knowledge and skills that workers acquire through education, training, and experience
host
the living being that is affected by the agent.
Community health
the meeting of collective needs through identifying problems and managing interactions within the community itself and between the community and the larger society
Advocacy
the nurse plays the role of informer, supporter, and mediator for the client. Clients are responsible for their own health.
host
the population at risk for developing the disease
Public health nursing
the practice of protecting and promoting the health of populations using knowledge from nursing, social, and public health sciences
host susceptibility
the presence or lack of sufficient resistance to an infectious agent to avoid prevent contracting an infection or acquiring infectious disease
The environment
the setting or surrounding that sustains the host (place of transmission: daycare, body of water, country
indirect transmission
the spread of infection through a vehicle of transmission outside the host
public health genomics
the study and application of knowledge about the elements of the human genome and their functions, including interactions with the environment, in relation to health and disease populations
ethics
the study of conduct and character
morals
the values and beliefs that guide decision making and behavior
Macroeconomics
theory helps one look at national and community issues that affect health care. Example: Focuses on the Big Picture
Microeconomics
theory shows how supply and demand can be used in health care. Example: Supply and Demand Efficiency and effectiveness
Category C biological agents
third-highest priority, emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. Ex: hantavirus
Hepatitis C is spread
through blood and body fluids. eat high carb.
The goal of epidemiology is
to ID and understand the causal factors and mechanisms of disease, disability, and injuries so that effective interventions can be implemented to prevent the occurrence of these adverse processes before they begin or before they progress.
Precise terms to use in making goals and objectives measurable (learning objectives)
to identify; to discuss; to list; to compare and contrast; to state; to decrease by 20%
Category B biological agents are the second-highest priority because they are moderately easy to disseminate and have high morbidity rates and low mortality rates.
typhus and cholera
Recognize elder abuse
unexplained physical injuries, physical neglect, rejection of assistance by caregiver, financial mismanagement, withdrawal.
Priority Health Promotion of HP 20/20
unintentional injury; violence; suicide; tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and STD infection; unhealthy dietary patterns; and inadequate physical activity.
negligence, malpractice
unintentional torts (2)
providers orders
unless a provider writes DNR or AND prescription in the clients medical record, the nurse initiates CPR when the client has no pulse or respirations. the provider consults the client and family prior to administering DNR or AND
Community health work
unstructured, "bigger picture", community is both client and partner, work at every level but especially advocate for primary level with population focus.
family genogram
used to determine the client's non modifiable risk factors
Telehealth
useful in rural areas.
hospital or specific facility
usual settings for secondary and tertiary health care
What is our current state of disease?
v Infections ^ Chronic disease
TB skin testing: false positive:
vaccination with BCG for up to 10 years after.
Lyme disease:
vector borne. reportable disease by state law.
Auditory learners learn through "listening" and methods such as
verbal lectures, discussion, and reading aloud. These learners "interpret meaning while listening."
hep C (HCV)
› Blood › Drug abuse › Sexual contact
"I PREPARE" A mnemonic that is one method of determining current and past environmental exposures. I = __________ potential exposures P = ________ work (exposures, use of personal protective equipment, location of material safety data sheets [MSDS], taking home exposures, trends) R = _________ (age of home, heating, recent remodeling, chemical storage, water) E = ____________ concerns (air, water, soil, industries in neighborhood, waste site or landfill nearby) P = ____ work (exposures, farm work, military, volunteer, seasonal, length of work) A = _________ (hobbies, activities, gardening, fishing, hunting, soldering, melting, burning, eating, pesticides, alternative healing/medicines) R = _________ and resources (ie Poison Control) E = ________ for Environmental Health History
"I PREPARE" A mnemonic that is one method of determining current and past environmental exposures. I = Investigate potential exposures P = Present work (exposures, use of personal protective equipment, location of material safety data sheets [MSDS], taking home exposures, trends) R = Residence (age of home, heating, recent remodeling, chemical storage, water) E = Environmental concerns (air, water, soil, industries in neighborhood, waste site or landfill nearby) P = Past work (exposures, farm work, military, volunteer, seasonal, length of work) A = Activities (hobbies, activities, gardening, fishing, hunting, soldering, melting, burning, eating, pesticides, alternative healing/medicines) R = Referrals and resources (ie Poison Control) E = Educate for Environmental Health History
pt in Hospice care-Denial stage
"I'm looking forward to my daughter's wedding next year"
Lillian Wald
"founder of the Henry Street Settlement and Visiting Nurse Service, which provided nursing and social services and organized educational and cultural activities; considered the founder of public health nursing" - President of the National Organization for Public Health Nursing
Prevalence (existing at a particular time)
# cases in population at a specific time / population total x 1,000
Crude Mortality Rate
# deaths / population total x 1,000
Infant Mortality
# infants (< 1 yr.) specific year / # live births in the same year
infant mortality rate (IMR)
# of infant deaths (before age of 1 yr) during the year is divided by the # of live births (infants born alive) during that year (multiply answer by 1000 to obtain meaningful rate)
Attack Rate
# people developing a certain disease / # people at risk
Modes of Transportation: Waterborne
(fecal contamination of water) ■ Cholera ■ Typhoid fever ■ Bacillary dysentery ■ Giardia lamblia
Modes of Transportation: Airborne
(inhaled by a susceptible host) ■ Measles ■ Chickenpox ■ Tuberculosis (pulmonary or laryngeal) ■ Pertussis ■ Influenza
Modes of Transportation: Vector-borne
(via a carrier such as a mosquito or tick) ■ Lyme disease ■ Rocky Mountain spotted fever ■ Malaria
Epidemiology
*study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection. *relies on statistical evidence to determine the rate of spread of disease and the proportion of people affected. *used to evaluate the effectiveness of disease prevention and health promotion and to determine which goals have been met.
environment
*the setting or surrounding that sustains the host. *Physical *Social
The occupational health nurse works towards the health and safety of workers by:
- Assessing risk for work-related illness and injury - Planning/delivering health and safety services in work - Facilitating health promotion activities for more productive workforce
What are AGENT factors the occupational nurse must be aware of when assessing risk for work-related illness and injury?
- Biological (Virus, bacteria, fungi, blood/airborne path.) - Chemical (Asbestos, smoke) - Mechanical (Musculoskeletal/strains, poor workstation/worker fit, lifting heavy loads - Physical (Temp, vibrations, noise, radiation, lights) - Psychological (Threats to psych burn out/social well being leading to stress/violence)
Family health risk appraisal involves what?
- Biological health risk assessment Genograms used to gather basic information about family/relationships/health and illness patterns - Environmental Risk Ecomaps used to identify family interactions with other groups/orgs. Info gathered on family support system and social risk - Behavioral risk
What are the roles of the school nurse?
- Case manager - Community outreach - Consultant - Counselor - Direct Caregiver - Health educator - Researcher
An Occupational health history should include what?
- Current and past jobs - Current and past exposure to specific agents and any relationship to current symptoms to work activities - Any precipitating factors (Underlying illness, Previous injuries, healthy/unhealthy habits)
A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions are appropriate for the nurse to include in the assessment? (Select all that apply.) A. "What is your relationship like with your family?" B. "Why do you want to lose weight?" C. "Would you describe your current eating habits?" D. "At what weight do you believe you will look better?" E. "Can you discuss your feelings about your appearance?"
A. "What is your relationship like with your family?" C. "Would you describe your current eating habits?" E. "Can you discuss your feelings about your appearance?"
Mg
1.8-3
Public Health Essential Services
1.Monitor health status to identify community health problems. 2.Diagnose and investigate health problems and hazards in the community. 3.Inform, educate, and empower people about health issues.
Public Health Nurse Roles
1.Monitor health status to identify community health problems. 2.Diagnose and investigate health problems and health hazards in the community. 3.Inform, educate, and empower people about health issues. 4.Mobilize community partnerships to identify and solve health problems. 5.Develop policies and plans that support individual and community health efforts. 6.Enforce laws and regulations that protect health and ensure safety. 7.Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8.Assure a competent public health and personal healthcare workforce. 9.Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 10.Research for new insights and innovative solutions to health problems.
How long does the small pox vaccine last?
10 years
BUN
10-20
Sodium
136-145
Hgb
14-18 (males) 12-16 (females)
Platelets
150000-450000
Time: Public Health Laws General Board of Health Increase in Nurses' Role
19th Century
Henry Street Settlement
1st public health nursing practice staffed by both nurses and social workers. (Due to Lillian Wald)
abuse, communicable disease
2 situations that have mandatory reporting
A client will have a positive intradermal TB test within
2 to 10 weeks of exposure to the infection; TB has slow onset
reflection, language, intuition
3 distinct levels of critical thinking
SOAP, PIE, DAR
3 examples of problem-orientated documentation
basic, complex, commitment
3 levels of critical thinking
ADLs, specimen collection, I/O, vitals
3 tasks an RN can delegate to an AP
living will, power of attorney, providers orders
3 types of advance directives
potassium
3.5-5
Albumin
3.8-5
factual (subjective and objective), accurate, complete/current, organized
4 qualities of documentation
manifestations of alcohol withdrawal appears within
4 to 12 hr
Glycosylated hemoglobin (HbA1c) expected reference range is _________
4% to 6%, but an acceptable target for clients who have diabetes may be 6.5% to 8%, with a target goal of less than 7%.
HCT
42-52% (males) 37-47% (females)
knowledge, experience, competence, attitudes, standards
5 components of critical thinking
autonomy, beneficence, fidelity, justice, nonmaleficence
5 ethical principles that pertain to the treatment of clients
right task, right circumstance, right person, right direction, right evaluation
5 rights of delegation
right direction
5 rights of delegation: data, method/timeline for reporting, specific tasks to perform, expected results and expectations for follow-up
right evaluation
5 rights of delegation: provider supervision, provider clear directions, monitor performance, provide feedback, intervene if necessary, evaluate client outcome status, evaluate client care tasks
right task
5 rights of delegation: receptive, requires little supervision, relatively noninvasive
right person
5 rights of delegation: task is within scope of member's practice, team member has necessary training, review performance of the team member
right circumstance
5 rights of delegation: workload of team member, assess and match the complexity of care demands to the skill level of the team member
monitor findings, reinforce client teaching from standard care plan, trach care, suctioning, checking NG tube patency, administering enteral feedings, inserting catheter, administerings meds (except IV in some states)
7 tasks an RN can delegate to an LPN
The recommendation for saturated fat intake is no more than _____% of total daily caloric intake.
7%
fasting glucose
70-110
GFR
90-120
LDL
<100
A newly hired occupational health nurse added industrial facility is performing at initial workplace assessment. Which of the following should the nurse determines when conducting a work site survey? A. Work practices of employees B. Past exposure to specific agents C. Past jobs of individual employees D. Length of time working in current role
A
A nurse developing a community health program is determining barriers to community resource referrals. Which of the following is an example of a resource barrier? A. Costs associated with services B. Decreased motivation C. In adequate knowledge of resources D. Lack of transportation
A
A nurse is working with a client who has systemic lupus erythematosus and recently lost her health insurance. Which of the following is an appropriate action by the nurse in the implementation phase of the case management process? A. Coordinating services to meet the clients needs B. Comparing outcomes with original goals C. Determining the clients financial constraints D. Clarifying roles of interprofessional team members
A
And occupational health is consulting with senior management of a local industrial facility. When discussing work related illness and injury, the nurse should include which of the following as physical agents? Select all that apply. A. Noise B. Age C. Lighting D. Viruses E. Stress
A and C
American Red Cross
A disaster relief organization founded in Washington, D.C. on May 21, 1881 by Clara Barton to aid US military and conduct peace time relief work.
Home Health
A formal regulated program of care delivered by a variety of healthcare professionals in a patients home
Host
A living space capable of being infected or affected by an agent
Primary Health Care Provider
A physician who usually is the first physician to examine a patient and who recommends secondary care physicians with expertise in the patient's specific health problem, if further treatment is needed
A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The goal of treatment during the maintenance phase is prevention of future episodes of MDD." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are used to prevent a relapse of MDD."
A. "Care during the continuation phase focuses on treating continued manifestations of MDD."
A nurse is teaching a client about stress-reduction techniques. Which of the following client statements indicates understanding of the teaching? A. "Cognitive reframing will help me change my irrational thoughts to something positive." B. "Progressive muscle relaxation uses a mechanical device to help me gain control over my pulse rate." C. "Biofeedback causes my body to release endorphins so that I feel less stress and anxiety." D. "Mindfulness allows me to prioritize the stressors that I have in my life so that I have less anxiety."
A. "Cognitive reframing will help me change my irrational thoughts to something positive."
A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "I can promote my client's sense of control by establishing a schedule." B. "Self-assessment will help me cope with emotional reactions to client care." C. "I should practice limit-setting to help prevent client manipulation." D. "Maintaining professional boundaries is a priority of client care."
A. "I can promote my client's sense of control by establishing a schedule."
A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? A. "I'm scared that you're going to leave me." B. "I'll go to group therapy if you'll let me smoke." C. "I need to feel that everyone admires me." D. "I sometimes feel better if I cut myself."
A. "I'm scared that you're going to leave me."
A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? A. "Life isn't worth living if I gain weight." B. "Don't pretend like you don't know how fat I am." C. "If I could be skinny, I know I'd be popular." D. "When I look in the mirror, I see myself as obese."
A. "Life isn't worth living if I gain weight."
A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to this client? A. "Stop screaming, and walk with me outside." B. "Why are you so angry and screaming at everyone?" C. "You will not get your way by screaming." D. "What was going through your mind when you started screaming?
A. "Stop screaming, and walk with me outside."
A nurse is caring for a client who has acute stress disorder and is experiencing severe anxiety. Which of the following statements by the nurse is appropriate? A. "Tell me about how you are feeling right now." B. "You should focus on the positive things in your life to decrease your anxiety." C. "Why do you believe you are experiencing this anxiety?" D. "Let's discuss the medications your provider is prescribing to decrease your anxiety."
A. "Tell me about how you are feeling right now."
A charge nurse is discussing mirtazapine (Remeron) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A. "This medication increases the release of serotonin and norepinephrine." B. "I will need to monitor the client for hyponatremia while taking this medication." C. "This medication is contraindicated for clients who have an eating disorder." D. "Sexual dysfunction is a common adverse effect of this medication."
A. "This medication increases the release of serotonin and norepinephrine."
A nurse is providing teaching to a client who has a new prescription for carbamazepine (Tegretol). Which of the following should the nurse include in the teaching? A. "This medication will help prevent seizures during alcohol withdrawal." B. "Taking this medication will decrease your cravings for alcohol." C. "This medication maintains your blood pressure at a normal level during alcohol withdrawal." D. "Taking this medication will improve your ability to maintain abstinence from alcohol."
A. "This medication will help prevent seizures during alcohol withdrawal."
A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following is the highest priority action by the nurse? A. Placing the client on one-to-one observation B. Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects
A. Placing the client on one-to-one observation
A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following are appropriate to include in the plan of care? (Select all that apply.) A. Priority restructuring B. Monitoring thoughts C. Diaphragmatic breathing D. Journal keeping E. Meditation
A. Priority restructuring B. Monitoring thoughts D. Journal keeping
A nurse is teaching the parents of a child with a new prescription for imipramine (Tofranil) and his parents about indications of toxicity. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Seizures B. Agitation C. Photophobia D. Dry mouth E. Irregular pulse
A. Seizures B. Agitation E. Irregular pulse
A nurse is discussing silent rape reaction with a newly licensed nurse. Which of the following should the nurse identify as a characteristic of this type of reaction? (Select all that apply.) A. Sudden development of phobias B. Development of substance use disorder C. Increased level of anxiety during interview D. Reactivation of a prior physical disorder E. Unwillingness to discuss the sexual assault
A. Sudden development of phobias C. Increased level of anxiety during interview E. Unwillingness to discuss the sexual assau
A nurse is planning a peer group discussion about the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Which of the following is appropriate to include in the discussion? (Select all that apply.) A. The DSM-5 is used to identify mental health disorders. B. The DSM-5 establishes diagnostic criteria. C. The DSM-5 indicates recommended pharmacological treatment. D. The DSM-5 assists nurses in planning care. E. The DSM-5 indicates expected assessment findings.
A. The DSM-5 is used to identify mental health disorders. B. The DSM-5 establishes diagnostic criteria. D. The DSM-5 assists nurses in planning care. E. The DSM-5 indicates expected assessment
A nurse is told during change-of-shift report that a client is stuporous. When assessing the client, which of the following is an expected finding? A. The client arouses briefly in response to a sternal rub. B. The client has a Glasgow Coma Scale score less than 7. C. The client exhibits decorticate rigidity. D. The client is alert but disoriented to time and place.
A. The client arouses briefly in response to a sternal rub. .
A nurse is planning care for a client following surgical implantation of a vagus nerve stimulation (VNS) device. The nurse should plan to monitor for which of the following adverse effects? (Select all that apply.) A. Voice changes B. Seizure activity C. Disorientation D. Dysphagia E. Neck pain
A. Voice changes D. Dysphagia E. Neck pain
A nurse is teaching a client who has a new prescription for imipramine (Tofranil) how to minimize anticholinergic effects. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Void just before taking the medication. B. Increase the dietary intake of potassium. C. Wear sunglasses when outside. D. Change positions slowly when getting up. E. Chew sugarless gum.
A. Void just before taking the medication. C. Wear sunglasses when outside. E. Chew sugarless gum.
Levothyroxine
A/E heat intolerance, hypertension, weight loss, tachicardia
Adaptive Model
ABLE TO ADAPT Medicine beyond treatment of disease: from writings of Dubos. Health means ability to adapt to a changing environment. Disease is failure to adapt. How flexible is someone in a changing environment?
Role-performance Model
ABLE TO DO JOB Medical sociology, work of Parsons. Person is healthy if they can perform their job. Shapes health policies of military, industry. Limited since one person may have many roles.
What has the greatest impact on healthcare?
ACCESS to healthcare
Steps in Teaching/Learning Process
ADDIE Assessment Development of outcomes Development of teaching plan Implementation of teaching plan Evaluation of outcomes (did it work?)
Nursing Process in the community
ADPIE: Assessment Diagnosis (written in different format for the community) Planning Implementation Evaluation
comprehensive, ongoing, discharge
ADPIE: 3 types of planning
assessment
ADPIE: data collection through observation, interviews with client/family, medicals history, comprehensive/focused physical exam, diagnostic and laboratory reports, collaboration
comprehensive planning
ADPIE: initial plan for care of clients based on comprehensive assessments they have completed (ex. do this upon admission to health care facility)
implementation
ADPIE: nurses base the care they provide on assessment data, analysis and the plan of care to select and perform appropriate therapeutic interventions
plan
ADPIE: nurses set priorities, determine client outmodes, select specific nursing interventions
diagnosis (analysis/data collection)
ADPIE: nurses use clinical thinking skills to identify client's health status or problems, interpret or monitor the collected database, reach an appropriate nursing judgment about health status and coping mechanisms and provide direction for nursing care
ongoing planning
ADPIE: planning done throughout the provision of care; while obtaining new information and evaluating responses to care, they modify and individualize the initial plan of care
discharge
ADPIE: planning that is a process of anticipation and planning for a client's needs after discharge
evaluation
ADPIE: step that determines whether or not to modify the plan of care; did the client meet the planned outcomes, where the interventions appropriate and effective, should i modify the outcomes or interventions?
nursing history
ADPIE: when do nurses collect subjective data (client's feelings, perceptions, and descriptions of health status
CRNA
APRN: administers anesthesia and providers care during procedures under the supervision of an anesthesiologist
CNM
APRN: collaborates with one or more providers to deliver care to maternal-newborn clients and their families
NP
APRN: collaborates with one or more providers to deliver nonemergency primary health care in a variety of settings
CBS (clinical nurse specialist)
APRN: typically specializes in a practice setting or a clinical field
Social Enviroment
Access to HC High-Risk working conditions Poverty
______________ - Process of merging with or adopting the traits of a different culture. Adapting to a new culture requires changes in daily living practices. These changes relate to language, education, work, recreation, social experiences, and the health care system.
Acculturation - Process of merging with or adopting the traits of a different culture. Adapting to a new culture requires changes in daily living practices. These changes relate to language, education, work, recreation, social experiences, and the health care system.
Implementation Phase
Action phase Role of community health nurse Social change, community action
Agent - _________: Drugs, Toxins (heavy metals, toxic chemicals, pesticides) - _________: Noise, Temperature (radiation, heat, cold, machinery) - _________: Viruses, Bacteria (bacteria, viruses, fungi, parasites)
Agent - Chemical: Drugs, Toxins (heavy metals, toxic chemicals, pesticides) - Physical: Noise, Temperature (radiation, heat, cold, machinery) - Infectious: Viruses, Bacteria (bacteria, viruses, fungi, parasites)
Epidemiological Triangle
Agent, Host, Environment
Primary Prevention
Aimed at individuals and groups who are susceptible to disease but have no discernible pathological process
Modes of Transportation
Airborne, Foodborne, Waterborne, vector-born, direct contact
Alcohol - Is a _________. - Dulls the senses to outside stimulation and sedates the inhibitory centers in the brain. -The direct effect of alcohol is determined by the blood alcohol level. --- The body burns _._ oz of alcohol per hr. - People who frequently and consistently drink alcohol develop a tolerance, an increased requirement for alcohol to achieve the desired effect.
Alcohol - Is a depressant. - Dulls the senses to outside stimulation and sedates the inhibitory centers in the brain. -The direct effect of alcohol is determined by the blood alcohol level. --- The body burns 0.5 oz of alcohol per hr. - People who frequently and consistently drink alcohol develop a tolerance, an increased requirement for alcohol to achieve the desired effect.
Alcohol Withdrawal - Following prolonged use, manifestations of alcohol withdrawal appears within 4 to __ hours. - Manifestations of withdrawal include: --- Irritability, tremors, nausea, vomiting, headaches, diaphoresis, anxiety, sleep disturbances, _____cardia, ________ blood pressure.
Alcohol Withdrawal - Following prolonged use, manifestations of alcohol withdrawal appears within 4 to 12 hours. - Manifestations of withdrawal include: --- Irritability, tremors, nausea, vomiting, headaches, diaphoresis, anxiety, sleep disturbances, tachycardia, elevated blood pressure.
Alcohol Withdrawal - Increased blood pressure, tachycardia, and diaphoresis are indicators of delirium _______ or alcohol withdrawal delirium. - Prompt use of ________________ at the onset of symptoms can prevent the serious complication of delirium tremens. - It is important to determine the last drink the client has taken in order to accurately assess for signs of withdrawal and delirium tremens.
Alcohol Withdrawal - Increased blood pressure, tachycardia, and diaphoresis are indicators of delirium tremens or alcohol withdrawal delirium. - Prompt use of benzodiazepines at the onset of symptoms can prevent the serious complication of delirium tremens. - It is important to determine the last drink the client has taken in order to accurately assess for signs of withdrawal and delirium tremens.
How quickly does the body process ETOH?
Alcohol is filtered by the liver at about 1 oz per hr.
Environment
All that is internal or external to a given host or agent and that is influenced and influences the host and/or agent
Agent
An animate or inanimate factor that must be present of lacking for disease to condition to develop
What are some secondary preventions strategies for homelessness?
Alleviate existing homelessness by making referrals for financial assistance, food supplements, and health services. ■■ Assist homeless clients in locating temporary shelter. ■■ Assist clients in finding ways to meet long-term shelter needs. ■■ If homeless shelters are not provided in the community, work with government officials to develop shelter programs.
AACN
American Association of Colleges of Nursing
ANA
American Nurses Association
APHA
American Public Health Association
Assessment of Community Health Program Planning, Development, and Management - Collect data bout the community and its members: --- Complete a _____ assessment and identify community strengths and weaknesses. --- Evaluate __________ health data.
Assessment of Community Health Program Planning, Development, and Management - Collect data bout the community and its members: --- Complete a needs assessment and identify community strengths and weaknesses. --- Evaluate secondary health data.
A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of:
Assessment. Pgs 7, 14
Assessment: Applying the Nursing Process during Case Mgt - Clarify the problem by evaluating physical needs, psychosocial issues, functional ability, and financial constraints.
Assessment: Applying the Nursing Process during Case Mgt - Clarify the problem by evaluating physical needs, psychosocial issues, functional ability, and financial constraints.
Elizabethan Poor Law
Assisted the poor and disabled with receiving care
Humanistic theory -
Assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest
Humanistic theory
Assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest.
ACHNE
Association of Community Health Nursing Educators
ASTDN
Association of State and Territorial Directors of Nursing
The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is:
Assurance Pg 14
resource barriers to referral process
Attitudes of health care personnel › Costs of services › Physical accessibility of resources › Time limitations › Limited expertise working with culturally diverse populations
Who originally developed the H2O system?
Aztec Kings
A newly hired public health nurse is familiarizing himself with the levels of disaster management. Which of the following actions is a component of disaster prevention? A. Outlining specific roles of community agencies B. Identified community vulnerabilities C. Prioritizing care of individuals D. Providing stress counseling
B
A nurse is reviewing the various roles of a community health nurse. Which of the following is an example of a nurse functioning as a consultant? A. Advocating for federal funding of local health screening programs B. Updating state officials about health needs of the local community C. Facilitating discussion of the clients ongoing needs with an interprofessional team D. Performing health screenings for high blood pressure at a local health fair
B
A school nurse is plated health promotion and disease prevention activities for the upcoming school year. In which of the following situations is the nurse planning a secondary prevention strategy? A. Place the posters with images of appropriate hand hygiene your restrooms B. Routinely checking students for pediculosis through the school year C. Implement teenage appropriate injury prevention programs for each grade level D. Working with a dietitian to determine carbohydrate count for students who have diabetes mellitus
B
A home healthcare us is discussing portals of entry with the group of newly hired assistive personnel. Which of the following are portals of entry the nurse should discuss? Select all that apply. A. Respiratory secretions B. Skin C. Genitourinary tract D. Saliva E. Mucous membranes
B, C, and E
The nurse is creating partnerships to address health needs within the community. The nurse should be aware that which of the following characteristics must exist for partnerships to be successful? Select all that apply. A. A leading partner with decision-making authority B. Flexibility among the partners would consider a new ideas C. Adherences of partners to ethical principles D. Very in goals for the different partners E. Willingness of partners negotiate rules
B, C, and E
A nurse is caring for a client in restraints. Which of the following statements are appropriate documentation? (Select all that apply.) A. "Client ate most of his breakfast." B. "Client was offered 8 oz of water every hr." C. "Client shouted at assistive personnel." D. "Client received chlorpromazine (Thorazine) 15 mg by mouth at 1000." E. "Client acted out after lunch."
B. "Client was offered 8 oz of water every hr." C. "Client shouted at assistive personnel." D. "Client received chlorpromazine (Thorazine) 15 mg by mouth at 1000." E. "Client acted out after lunch."
A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following is an appropriate response by the nurse? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate."
B. "I am here to provide care and cannot accept this from you."
A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization? A. "I am a superhero and am immortal." B. "I am no one, and everyone is me." C. "I feel monsters pinching me all over." D. "I know that you are stealing my thoughts."
B. "I am no one, and everyone is me."
A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following is appropriate for the nurse to include in the plan of care? (Select all that apply.) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client complaints E. Use a firm approach with communication
B. Offer concise explanations C. Establish consistent limitsE. Use a firm approach with communication
A nurse is caring for a client who is taking phenelzine (Nardil). For which of the following adverse effects should the nurse observe? (Select all that apply.) A. Elevated blood glucose level B. Orthostatic hypotension C. Priapism D. Headache E. Bruxism
B. Orthostatic hypotension
A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (Select all that apply.) A. Lithium carbonate (Lithobid) B. Paroxetine (Paxil) C. Risperidone (Risperdal) D. Haloperidol (Haldol) E. Lorazepam (Ativan)
B. Paroxetine (Paxil) E. Lorazepam (Ativan)
A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following in the teaching? (Select all that apply.) A. Constipation B. Polyuria C. Rash D. Muscle weakness E. Tinnitus
B. Polyuria D. Muscle weakness
A nurse is assessing a 4-year-old child for indications of autism spectrum disorder. For which of the following indications should the nurse assess? A. Impulsive behavior B. Repetitive counting C. Destructiveness D. Somatic problems
B. Repetitive counting
A nurse working in an emergency department is assessing a child who reports abdominal pain. When conducting a head-to-toe assessment, which of the following findings should alert the nurse to possible abuse? (Select all that apply.) A. Abrasions on knees B. Round burn marks on forearms C. Mismatched clothing D. Abdominal rebound tenderness E. Areas of ecchymosis on torso
B. Round burn marks on forearms E. Areas of ecchymosis on torso
Telehealth physical data
BP, weight, Blood O2, Blood glucose, HR, temp, ECG results
Cognitive Domain
BRAIN memory, recognition, understanding, application, problem solving.
A nurse is preparing a community health program on communicable diseases. When discussing modes of transmission, the nurse should include which of the following as an airborne illness? A. Cholera B. Malaria C. Influenza D. Salmonellosis
C
A school nurse is scheduling visits with the physical therapist for a child who has cerebral palsy. In which of the following rolls is that there's functioning? A. Direct care giver B. Consultant C. Case manager D. Counselor
C
A community health nurse is educating the public on the agents of bioterrorism. Which of the following are category a biological agents? Select all that apply. A. hantavirus B. Typhus C. Plague D. Tularemia E. Botulism
C, D, and E
Clients Rights - Right of information disclosure, privacy, informed consent, information confidentiality, and participation in treatment decisions.
Clients Rights - Right of information disclosure, privacy, informed consent, information confidentiality, and participation in treatment decisions.
A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of:
Clinical community health practice
Consultant - Someone with specialized knowledge who provides expert advice, services, or information.
Consultant - Someone with specialized knowledge who provides expert advice, services, or information.
U.S. Department of Homeland Security
Contact in response to threats and hazards by acts of terrorism
Panacea was the god of _______.
Health & Healing
What model: Driven by wondering why pts doen't prevent disease - model explains dynamics.
Health Belief Model
Implementation of Community Health Program Planning, Development, and Management - Carry out the plan: Initiate interventions to achieve goals and objectives according to program plan. --- Monitor the intervention process and the response of the ___________ in terms of its values, needs, and perceptions.
Implementation of Community Health Program Planning, Development, and Management - Carry out the plan: Initiate interventions to achieve goals and objectives according to program plan. --- Monitor the intervention process and the response of the community in terms of its values, needs, and perceptions.
Collecting data
IOSFCW 7 methods Informant interviews Observation Secondary analysis of existing data Focus groups Community forums Windshield surveys
First step in developing community health education plan
Identify population specific learning needs
Development of a community health program plan
Identify the needs of community: assessment. plan the program implement the program evaluate the effectiveness of program.
Implementation: Applying the Nursing Process during Case Mgt - Contact service providers - Provide referral information - Coordinate all services to be provided
Implementation: Applying the Nursing Process during Case Mgt - Contact service providers - Provide referral information - Coordinate all services to be provided
Hospice
Improve quality of life for people who are no longer able to benefit from curative interventions.
Florence Nightengale
In 1860, Nightingale established the first nursing program in London. It was hospital based, but the curriculum contained not only care of the sick, but also public health concepts with their inherent ethical tenets. Many of these programs were associated with religious institutions. Students, therefore, often received ethics courses with a slant toward a particular religion's values.
extreme weather and health
In 2011, thousands of record-breaking extreme weather events harmed communities and health in the US. Climate change is contributing to more intense and frequent extreme weather events.
ANA developed:
In Public Health Nursing: scope and standards of practice.
Levels of Care
Individual - downstream Family Community Population - upstream
Medicare
Individuals must be older than 65 years and receiving Social Security, have been receiving disability benefits for 2 years, have amyotrophic lateral sclerosis and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to qualify for Medicare
Orem Self Care Deficit
Individuals must take action to maintain life and health
Respect for autonomy (definition)
Individuals select those actions that fulfill their goals
Pender Health Promotion Model
Individuals will seek health promotion experiences to improve their well-being
Time: Sanitary Revolution 1st Community Health Surveys
Industrial Revolution
potential indicators of hepatitis
Influenzalike symptoms ■ Fatigue ■ Decreased appetite with nausea ■ Abdominal pain ■ Joint pain ■ Fever ■ Vomiting ■ Dark-colored urine ■ Clay-colored stool ■ Jaundice
Informatics - The combination of nursing science with information and ______________ technologies in the delivery of nursing care. --- (electronic records, hand-held computers and smartphones, meetings can be held electronically.)
Informatics - The combination of nursing science with information and communication technologies in the delivery of nursing care. --- (electronic records, hand-held computers and smartphones, meetings can be held electronically.)
NPH insulin (Humulin N), detemir insulin (Levemir)
Intermediate-acting insulin ☐ Administered for glycemic control between meals and at night. ☐ Not administered before meals to control postprandial rise in blood glucose. ☐ Contains protamine (a protein), which causes a delay in the insulin absorption or onset and extends the duration of action of the insulin. ☐ Administer NPH insulin subcutaneous only and as the only insulin to mix with short-acting insulin. ☐ Administer detemir insulin subcutaneous only and is never mixed with othe
How should community nurses use their resources.
Must benefit the greatest number of citizens.
Epidemiological triangle
Mycobacterium tuberculosis for TB is the Agent (biological, chemical or physical entity that is responsible for the health alteration)
Interpreters
NOT family members. Need to have health-related terminology knowledge. Give teaching material in client's primary language.
What does Epidemic mean?
NOT there all the time; FLARES UPRapid spread and increase of disease; widespread
NCQA
National Committee for Quality Assurrance
Natural immunity
Natural defense mechanisms of the body to resist antigens or toxins
Abuse
Neglect: lack of physical care, such as food, shelter, hygiene. Emotional are (interacting with child), education for child, needed health or dental care.
Healthy People 2020
New topic areas: adolescent health, blood, dementias inc. AD, early/mid childhood, genomics, global health, HAIs, health related QoL and well being, LGBT health, older adults, preparedness, sleep, social determinants. "Prevention Agenda for the Nation"
______________ Theory of Environment -Highlights the relationship between an individual's environment and health. -Depicts health as a continuum -Emphasizes preventive care
Nightingale's Theory of Environment -Highlights the relationship between an individual's environment and health. -Depicts health as a continuum -Emphasizes preventive care
A nurse is advocating for local leaders to place a newly approved community health clinic in an area of the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which of the following ethical principles? a. Distributive justice b. Fidelity c. Respect for autonomy d. Veracity
a
A nurse is conducting a community assessment. Which of the following data collection methods is the nurse using when having direct conversations with individual members of the community? a. Key informant interviews b. Participant observation c. Focus groups d. Health surveys
a
A nurse is using the I PREPARE mnemonic to assess a client's potential environmental exposures. Which of the following is an appropriate question for the nurse to ask to assess for "A" in the mnemonic? a. "What do you like to do for fun?" b. "What year was your residence built?" c. "What jobs have you had in the past?" d. "What industries are near where you live?"
a
A nurse is working with a client who has systemic lupus erythematosus and recently lost her health insurance. Which of the following is an appropriate action by the nurse in the implementation phase of the case management process? a. Coordinating services to meet the client's needs b. Comparing outcomes with original goals c. Determining the client's financial constraints d. Clarifying roles of interprofessional team members
a
American Diabetes Association (ADA) recommends screening a client who has
a BMI greater than 24 and age greater than 45 years, or if a child is overweight and has additional risk factors
this pt is a priority
a client with diabetes mellitus and reports new erythema to the L foot-prevention of infection, common in diabetes foot ulcers
Secondary Prevention
PREVENTION/MAINTENANCE SCREENINGS/EARLY DX Early detection of potential for disease/condition or existence of such while asymptomatic. E.g., screening programs - Pap smears, mammograms, colonoscopy.
report
PT of 15 secs (above normal)
Health Education
Planned learning experiences based on sound theories to provide individuals, groups, communities opportunity to learn info and skills to make quality health decisions
PATCH
Planning Approach to Community Health
What are some primary prevention strategies for homelessness?
Prevent individuals and families from becoming homeless by assisting them in eliminating factors that may contribute to homelessness. ■■ Refer those with underlying mental health disorders to therapy and counseling. ■■ Enhance parenting skills that may prevent young people from feeling the need to run away.
What are some tertiary prevention strategies for homelessness?
Prevent recurrence of poverty, homelessness, and health problems that result in conditions of poverty and homelessness. ■■ Advocate and provide efforts toward political activity to provide needed services for people who are mentally ill and homeless. ■■ Make referrals for employee assistance and educational programs to allow clients who are homeless to eliminate the factors contributing to their homelessness.
How do you define Primary prevention? * Group/Mass Audience Based
Prevention of the initial occurrence of disease or injury
Primary prevention
Prevention of the initial occurrence. Education, immunizations, prenatal classes.
Levels of Prevention
Primary Secondary Tertiary
Care: Before
Primary Prevention
________ Prevention - Strategies that prevent the initial occurrence of disease or injury. Services include health education and counseling, immunizations, and other actions that aim to prevent a potential disease or disability.
Primary Prevention - Strategies that prevent the initial occurrence of disease or injury. Services include health education and counseling, immunizations, and other actions that aim to prevent a potential disease or disability.
LEVELS OF PREVENTION
Primary Prevention Secondary Prevention Tertiary Prevention
Levels of Prevention r/t Public Health
Primary prevention The public health nurse develops a health education program for a population of school-age children that teaches them about the effects of smoking on health. Secondary prevention The public health nurse provides toxin screenings for migrant workers who may be exposed to pesticides. Tertiary prevention The public health nurse provides a diabetes clinic for a defined population of adults in a low-income housing unit of the community.
Levels of Prevention r/t Case Management
Primary prevention Use the information exchange process to increase the client's understanding of how to use the health care system and the health promotion strategies that will maintain health. Secondary prevention Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health. Tertiary prevention Monitor the use of prescription medications and adherence to treatment to reduce risk for illness complications.
LEVELS OF PREVENTION Related to Cardiovascular Disease
Primary prevention- Discuss a low-fat diet and the need for regular physical exercise with clients. Secondary prevention -Implement blood pressure and cholesterol screening; give a treadmill stress test. Tertiary prevention -Provide cardiac rehabilitation, medication, and surgery.
Occupation health nurses's roles
Primary prevention- teaching good nutrition and knowledge of health hazards, immunizations, and use of protective equipment Secondary prevention- ID workplace hazards, early detection through health surveillance and screening, counseling and referral Tertiary prevention- restoration of health through rehab
Mental health prevention
Primary- educate populations regarding mental health issues, teach stress-reduction techniques, parenting classes. Secondary- screen to detect mental health disorders, conduct crisis intervention Tertiary- medication monitoring, interventions, referrals
Prevention
Primary- increasing public awareness Secondary- identify at risk individuals and assist them to reduce sources of stress. screen for substance use. Tertiary- refer client to community groups, AA. Provide emotional abusers including positive reinforcement.
Planning and Prioritization Phase
Priorities established (set by community members) Goals and objectives IDed Community focused interventions
_______ Funding - Health Insurance - Employer benefits - Managed Care: HMO, PPO, Medical savings account
Private Funding - Health Insurance - Employer benefits - Managed Care: HMO, PPO, Medical savings account
PSRO
Professional Standards Review Organization
What is the role of the Missionary Nurse?
Promote health and prevent disease by meeting spiritual, physical, and emotional needs of people across the globe
Case management
Promotes interprofessional services and increased client/family involvement decreases cost by improving client outcomes provides education to optimize health participation advocate for services and client rights
Public Health Nursing
Promoting, protecting health of populations using knowledge from nursing, social and public health sciences. Population focused.
Public health nursing
Promotion and protection of health of populations using knowledge from nursing, social and public health sciences. Population-focused; goals: promotion of health and prevention of disability and disease by creating conditions in which people can be healthy.
Public Health Nursing Goals
Promotion of health and prevention of disease and disability for all through creation of conditions in which people can be healthy.
Proportionate mortality ratio
Proportion of deaths resulting from a specific cause
Acute Care
Provider control Predictable routine Hospital policy Resources available Collaboration and consultation Controlled PT compliance Standardized care
HEALTHY PEOPLE 2020
Provides science based, 10 year national objectives for improving the health of all Americans
Essential Elements of pubic health nursing
Public Health Interventions Wheel: Surveillance Disease and other health event investigation Screening Case Finding Referral and follow-up Case Management Delegated Functions Health teaching Counseling Consultation Collaboration Coalition building Community organizing Advocacy Social marketing Policy development Policy enforcement
Public Health Nursing Practice - Focus of care: Synthesis of nursing and public health theory. - Nursing Activities: Promote, preserve, and maintain the health of populations through disease and disability prevention and health protection of the community as a whole. - Core function: Systematic assessment of the health of populations. Development of policies to support the health of populations. Ensuring that the essential ________ services are available to all persons
Public Health Nursing Practice - Focus of care: Synthesis of nursing and public health theory. - Nursing Activities: Promote, preserve, and maintain the health of populations through disease and disability prevention and health protection of the community as a whole. - Core function: Systematic assessment of the health of populations. Development of policies to support the health of populations. Ensuring that the essential health services are available to all persons
quality improvement
QSEN: care-related and organizational processes that involve the development and implementation of a plan to improve health care services and better met clients' needs
safety
QSEN: minimization of risk factors that could cause injury or harm while promoting high quality care and maintaining a secure environment for clients, self, and others
teamwork/collaboration
QSEN: the delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes
patient centered care
QSEN: the provision of caring and compassionate, culturally sensitive care that addresses clients' physiological, psychological , sociological, spiritual and cultural needs, preferences, and values
EBP
QSEN: the use of current knowledge from research and other credible sources on which to base clinical judgement and client care
informatics
QSEN: the use of information technology as communication and information-gathering tool that supports clinical decision making and scientifically based nursing practice
QSEN
Quality and Safety Education in Nursing
Tertiary Prevention
RESTORATIVE Treatment of existing or symptomatic disease to prevent/delay progress. Treatment after Dx, e.g, cardiac/stroke rehab.
Health Disparity
Racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention.
Lispro insulin (Humalog), aspart insulin (Novolog), glulisine insulin (Apidra)
Rapid-acting insulin ☐ Administer before meals to control postprandial rise in blood glucose. ☐ Onset is rapid, 10 to 30 min depending on which insulin is administered. ☐ Administer in conjunction with intermediate- or long-acting insulin to provide glycemic control between meals and at night.
Epidemic
Rate of disease, injury or other condition exceeds the usual level of that condition
Tertiary prevention
Recovery after an illness. Nutrition counseling, case management, exercise for hypertensive clients.
Tertiary Prevention
Reduce impairments and disabilities, minimize suffering, promote adjustment to immediate condition ,and rehab
Referrals - Referrals for individuals in acute care settings typically are based on the medical diagnosis, or other relevant clinical information. - Resources assist in restoring, maintaining, or promoting health.
Referrals - Referrals for individuals in acute care settings typically are based on the medical diagnosis, or other relevant clinical information. - Resources assist in restoring, maintaining, or promoting health.
Pandemic
Refers to an epidemic that occurs world wide and affects large populations.
Bioterrorism tertiary prevention
Rehab of survivors, monitor medication regimens and referrals, evaluate effectiveness of the bioterrorism plan
Time: Infection Theory Elizabethan Poor Laws
Renaisance
The Shattuck Report 1850
Report by the MA Sanitary Commission - recommended changes to the health system for control and prevention of diseases
Respect for Autonomy - Individuals select those actions that fulfill their goals. -Respecting a client's right to self-______________ (making a decision not to pursue chemotherapy)
Respect for Autonomy - Individuals select those actions that fulfill their goals. -Respecting a client's right to self-determination (making a decision not to pursue chemotherapy)
Respect for autonomy (situation)
Respecting a client's right to self‑determination (making a decision not to pursue chemotherapy)
Local Health Department
Responsible for identifying and intervening to meet health needs of the local community. ◯ Work closely with local officials, businesses, and stakeholders. ◯ Report notifiable communicable diseases to *state* departments of health. ◯ Nurses at the community level typically function in the nursing roles of caregiver, advocate, teacher, coordinator, and consultant. ◯ Funded through local taxes with support from federal and state funds
Direct contact
Sexually transmitted infections (HIV , gonorrhea, syphilis, genital herpes, hepatitis B, C, D), infectious mononucleosis, enterobiasis (pinworm), Impetigo, lice, scabies
characteristics of successful partnerships
Shared power › Shared goals › Integrity › Flexibility › Negotiation
Substance Use Disorders - Cardinal signs of dependence include manifestations of tolerance and withdrawal. --- ______ is also a primary sign of dependence and may include: ----- Defensiveness, lying about use, minimizing use, blaming or rationalizing use, intellectualizing
Substance Use Disorders - Cardinal signs of dependence include manifestations of tolerance and withdrawal. --- Denial is also a primary sign of dependence and may include: ----- Defensiveness, lying about use, minimizing use, blaming or rationalizing use, intellectualizing
Substance Use: Physical Assessment Findings - Vital signs: Varies depending on substance being used. - Appearance: Individual can appear disheveled with an ________ gait. - Eyes: Pupils can appear dilated or pinpoint, red, also ____ eye contact. - Skin: Can be diaphoretic, cool, and/or clammy; needle track marks or spider angiomas may be visible. - Nose: Can be runny, congested, red and/or cauliflower-shaped. - Tremors: Fine or coarse tremors may be present.
Substance Use: Physical Assessment Findings - Vital signs: Varies depending on substance being used. - Appearance: Individual can appear disheveled with an unsteady gait. - Eyes: Pupils can appear dilated or pinpoint, red, also poor eye contact. - Skin: Can be diaphoretic, cool, and/or clammy; needle track marks or spider angiomas may be visible. - Nose: Can be runny, congested, red and/or cauliflower-shaped. - Tremors: Fine or coarse tremors may be present.
American Red Cross
Support emergency rescue and recovery services and is contacted when additional resources are needed by the community.
community nursing diagnosis
Synthesizes assessment data; a dx both describes a situation (state) & Implies an etiology (reason) and has three parts: Description of problem, response, rate; ID of factors etiologically related to problem; Signs/symptoms characteristic of problem
false
T/F a nurse can refer to an incident report in the client's medical record
What 2 things did Robert Koch discover?
TB bacillus Causes of cholera
Telecommunication technologies -Transmission of ________ data includes the following: --- Blood pressure, weight, blood oxygenation, blood glucose, heart rate, temperature, ECG results. -Transmission of _____ data: --- Voice Conversation, heart sounds, lung sounds, bowel sounds -Transmission of ______ data: --- Images of wounds, surgical incisions
Telecommunication technologies -Transmission of physical data includes the following: --- Blood pressure, weight, blood oxygenation, blood glucose, heart rate, temperature, ECG results. -Transmission of audio data: --- Voice Conversation, heart sounds, lung sounds, bowel sounds -Transmission of visual data: --- Images of wounds, surgical incisions
Telehealth - Delivery of quality health care through the use of technology. --- Particularly useful in ______ areas.
Telehealth - Delivery of quality health care through the use of technology. --- Particularly useful in rural areas.
Care: V deterioration
Tertiary Prevention
________ Prevention - Strategies that maximize recovery after an injury or illness.
Tertiary Prevention - Strategies that maximize recovery after an injury or illness.
TJC
The Joint Commission
The Public Health Code of Ethics - Ethical considerations: __________ harm, doing no harm, promoting good, respecting both individual and community rights, respecting autonomy and diversity, and providing confidentiality, competency, trustworthiness, and advocacy.
The Public Health Code of Ethics - Ethical considerations: Preventing harm, doing no harm, promoting good, respecting both individual and community rights, respecting autonomy and diversity, and providing confidentiality, competency, trustworthiness, and advocacy.
Contact when local abilities are unable to properly respond to an incident
The federal emergency management agency
Triage Expectant category (class IV) -
The lowest priority is given to clients who are not expected to live and will be allowed to die naturally. Comfort measures may be provided, but restorative care will not
Psychomotor Domain
DEMONSTRATE Hands on manipulation, "teach back" performance of skills requiring coordination and motor skills.
What vaccines are safe during pregnancy:
DPT
Data Collection - Community Forum: ____ public meeting
Data Collection - Community Forum: Open public meeting
Data Collection - Focus Groups: ________ talk with a representative sample
Data Collection - Focus Groups: Directed talk with a representative sample
Data Collection - _________ interviews: Direct discussion with community members for the purpose of obtaining ideas and opinions from key informants
Data Collection - Informant interviews: Direct discussion with community members for the purpose of obtaining ideas and opinions from key informants
Data Collection - It is a critical community health nursing function. To best identify the health needs of the local community, it is essential to combine several methods of data collection. Relying on only one or two key pieces can result in an incomplete assessment. - Data can be collected by: --- Informant interviews --- Community Forums --- Secondary Data --- Participant Observation --- Windshield Survey --- Focus Groups --- Surveys
Data Collection - It is a critical community health nursing function. To best identify the health needs of the local community, it is essential to combine several methods of data collection. Relying on only one or two key pieces can result in an incomplete assessment. - Data can be collected by: --- Informant interviews --- Community Forums --- Secondary Data --- Participant Observation --- Windshield Survey --- Focus Groups --- Surveys
Data Collection - __________ Observation: Observation of formal or informal community activities
Data Collection - Participant Observation: Observation of formal or informal community activities
Data Collection - __________ Data: Use of existing data (death statistics; birth statistics, census data, mortality, morbidity data, health records, minutes from meetings, prior health surveys) to assess problem
Data Collection - Secondary Data: Use of existing data (death statistics; birth statistics, census data, mortality, morbidity data, health records, minutes from meetings, prior health surveys) to assess problem
Data Collection - Surveys: Specific questions asked in a _______ format
Data Collection - Surveys: Specific questions asked in a written format
Data Collection - __________ Survey: --- Descriptive approach that assesses several community components by driving through a community
Data Collection - Windshield Survey: --- Descriptive approach that assesses several community components by driving through a community
What is an informant interview?
Data collection via direct discussion w/ community members
What is a Community forum?
Data collection via open public meeting
Epidemic
If an infection occurs more frequently than normal within a population.
community based nursing activities
Illness care: Management of acute and chronic conditions in settings where individuals, families, and groups live, work, and "attend" (schools, camps, prisons)
Diagnosis: Applying the Nursing Process during Case Mgt - Determine the cause and _____________ factors. - Identify applicable nursing diagnoses by using the "assessment" step
Diagnosis: Applying the Nursing Process during Case Mgt - Determine the cause and precipitating factors. - Identify applicable nursing diagnoses by using the "assessment" step
Give 2 examples of an Epidemic type disease/infection.
Diptheria Measels
Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is:
Director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system (pg 18-19)
Four levels of disaster management
Disaster Prevention Disaster Preparedness Disaster Response Disaster Recovery
Disasters - Four levels of Disaster Management 1. Disaster prevention 2. Disaster ____________ 3. Disaster response 4. Disaster recovery
Disasters - Four levels of Disaster Management 1. Disaster prevention 2. Disaster preparedness 3. Disaster response 4. Disaster recovery
Example of Primary Prevention
Immunization
How did the Romans influence the Classical Times?
First: to ID Occupational Hazards Aqueduct Sewer
The ________ Report showed __________in US _____schools.
Flexner Shortcomings Medical schools
Who is famous for "pushing" Modern Nursing forward?
Florence Nightengale
Community-Oriented Nursing
Focus of Care: At-risk individuals, families, groups, & Community Nursing Activities: Health care: Determining health needs to improve the collective health of the community
Community-Based Nursing
Focus of Care: Individuals & Families Nursing Activities: Illness care: where individuals, families, and groups live, work, and "attend" (schools, camps, prisons)
Community-oriented nursing
Focus: at risk individuals, families, groups. Community. Activities: determining the health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community.
Public health nursing practice
Focus: synthesis of nursing and public health theory Activities: promote, preserve, and maintain the health of populations through disease and disability prevention and health protection of the community as a whole. Core functions: systematic assessment of the health of populations development of policies to support the health of populations ensuring that essential health services are available to all persons
Community health nursing practice
Focus: synthesis of nursing and public health theory. Activities: Promote, preserve, and maintain the health of populations by the delivery of health services to individuals, families, and groups in order to impact "community health"
Medicaid
Focused on the welfare population;Single parents with dependant children; Aged, blind, and disabled Enacted in 1965; Provides federal matching funds to states to finance care
Follow up with Referrals - Monitoring to determine if the referral was completed. - Assessing whether referral ________ were met. - Determining if the client was satisfied with the referral.
Follow up with Referrals - Monitoring to determine if the referral was completed. - Assessing whether referral outcomes were met. - Determining if the client was satisfied with the referral.
What did the Hygiene Code include/cover during the Classical TIme?
Food H2O
Modes of Transportation: Foodborne
Food infection (bacterial, viral, parasitic infection of food) ☐ Salmonellosis ☐ Hepatitis A ☐ Trichinosis ☐ Escherichia coli (E. coli) ■ Food intoxication (toxins produced through bacterial growth, chemical contamination, or disease-producing substances) ☐ Staphylococcus aureus ☐ Clostridium botulinum
Mary Breckinridge
Founder of the Frontier Nursing Service, in Leslie County, KY; 1st midwifery program in U.S.
analysis of community assessment data
Gather collected data assess completeness of data ID and generate missing data synthesize data and id themes ID community needs and problems ID community strengths and resources
Surveillance
Gathering the who, when, where and what these data elements are then used to answer why
General ________-assessment parameters - Ethnic background, religious preferences, family structure, language, communication needs, education, cultural values, food patterns, health practices.
General cultural-assessment parameters - Ethnic background, religious preferences, family structure, language, communication needs, education, cultural values, food patterns, health practices.
Physical Enviroment
Geography Water/ Food Supply Presence of Reservoirs/ Vectors
GRACE
Geriatric Resources for Assessment and Care of Elders
Population
Group of people having at least one thing in common and who may or may not interact with one another. E.g., night-shift workers, children with CF.
Community
Group of people sharing something, interacting with one another. May exhibit commitment with one another and may share geographic boundary. E.g., a NORC, a school, NYU students.
Eudaimonistic Model
HOLISTIC UPSTREAM Greek origins. R/t Maslow's hierarchy of needs. MOST HOLISTIC Health = actualization/realization of complete fulfillment and development. Illness impedes/prevents self-actualization. Aim to redirect thinking away from mechanistic view toward holistic view. HOLISM, UNITY, INDIVIDUALITY
A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should include that which of the following are influenced by an individual's culture? (Select all that apply.) a. Nutritional practices b. Family structure c. Health care interactions d. Biological variations e. Views about illness
a, b, c, e
A nurse is collecting data to identify health needs in the local community. Which of the following are examples of secondary data the nurse should review? (Select all that apply.) a. Birth statistics b. Previous health survey results c. Windshield survey d. Community forum e. Health records
a, b, e
power of attorney
advance directives: document in which clients designate a health care proxy to make health care decisions for them if they are unable to do so. the proxy can be any competent adult the client chooses
living will
advance directives: legal document that expresses that client's wishes regarding medical treatment in the event he client becomes incapacitates and is facing end-of-life issues
TB skin testing: false negative:
advanced HIV or AIDS, older adult, and up to 9 weeks after exposure.
Change agents
advocate for needed change at local, state, federal level
Weber test
after I place the tuning fork on your scalp, tell me if you hear the sound better in one year or the same in both ears
Rinne test
after placing a tuning fork behind the year, tell me when you no longer hear the sound
Barriers to learning in community education programs
age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, and lack of motivation
(Epidemiological) Susceptible Host factors
age, gender, genetics, ethnicity, immunological status, physiological state, occupation
The nurse should include bacteria as an ______ when discussing the epidemiological triangle
agent
The nurse should include toxins as an ____ when discussing the epidemiological triangle
agent
epidemiologic triangle
agent-host-environment model that is a traditional view of health and disease developed when epidemiology was concerned chiefly with communicable disease; all 3 can coexist-disease occurs with interaction of agent, host and environment
6 ways climate change can impact health
air pollution, extreme heat, infectious disease, drought, flooding, and extreme weather
TB transmission
airborne droplet. requires repeated close contact.
natural immunity
an innate resistance to a specific antigen or toxin
The agent is the
animate or inanimate object that causes the disease
The agent
animate or inanimate object that causes the disease. (bacteria, virus, pesticide, food additive, etc.)
health promotion
assessing the health of our community, planning activities to help our participants to gain some control over their health to improve their health; emphasis on helping people change their lifestyles and move toward a state of optimal health
Public Health Core Functions
assessment, policy development, and assurance.
susceptible
at risk for contracting an infection or developing infectious disease; affected by general health status, personal behaviors, presence of healthy lines of defense, immune system and immunization status
community oriented nursing focus of care
at-risk individuals, families, groups; community
A newly hired public health nurse is familiarizing himself with the levels of disaster management. Which of the following actions is a component of disaster prevention? a. Outlining specific roles of community agencies b. Identifying community vulnerabilities c. Prioritizing care of individuals d. Providing stress counseling
b
A nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following findings is a manifestation of withdrawal? a. Decreased blood pressure b. Diaphoresis c. Pin-point pupils d. Bradycardia
b
A nurse is caring for a client who is from a different culture than himself. When beginning the cultural assessment, which of the following actions should the nurse take first? a. Determine the client's perception of his current health status. b. Gather data about the client's cultural beliefs. c. Determine how the client's culture may impact the effectiveness of nursing actions. d. Gather information about previous client interactions with the health care system.
b
A nurse is completing a needs assessment and beginning analysis of data. Which of the following actions should the nurse take first? a. Determine health patterns within collected data. b. Compile collected data into a database. c. Ensure data collection is complete. d. Identify health needs of the local community.
b
A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care? a. "I don't drive, and my son is only available to take me places in the mornings." b. "I can't take off during the day and the local after-hours clinic is no longer in operation." c. "Only one doctor in my town is a designated provider by my health maintenance organization." d. "I would like to schedule an appointment with the local doctor in my town who speaks Spanish and English."
b
A nurse is reviewing the various roles of a community health nurse. Which of the following is an example of a nurse functioning as a consultant? a. Advocating for federal funding of local health screening programs b. Updating state officials about health needs of the local community c. Facilitating discussion of a client's ongoing needs with an interprofessional team d. Performing health screenings for high blood pressure at a local health fair
b
tracheostomy care post op more than 1 month
clean technique when providing care: tap water to clean inner cannula; insert catheter 5 into the trach tube; placing the tumb over the port applies suction; suction is applied during pulling out of catheder; live the old ties in place until the new ones are secured to prevent accidental dislodging of the trach tube
immunizations for infant
cold or other minor illnesses are not contraindicated to receive immunizations; they can receive acetaminophen for fever after immunization; in case of anaphylactic egg allergy, don't give influenza vaccine; MMR-12 months
Public health nurse: core function of assurance:
collaborate with other agencies to imporove services and ensure competence of health care workers.
The nurse's first action when beginning a cultural assessment is to
collect self-identifying data about the client, including specific information about how the client's cultural beliefs influence family structure, food patterns, religious preferences, and health practices
Part C
combo of part A and B through a private insurance.
Fracking
common but controversial practice among companies that drill underground for oil and natural gas; drillers inject millions of gallons of water, sand, salts and chemicals—all too often toxic chemicals and human carcinogens such as benzene—into shale deposits or other sub-surface rock formations at extremely high pressure, to fracture the rock and extract the raw fuel.
relative risk
compares the risk of developing the health condition for the population exposed to the factor with the risk for the population not exposed to the factor; indicates the benefit that might accrue to the person if the risk factor is removed; rate: incidence among those exposed/incidence rate among those not exposed
significant objective information, logical sequence, no opinion, recent changes in meds/treatments/procedures
components of an effective change-of-shift report
state licensing boards
components of health care system: ensure that health care providers and agencies comply with state regulations
utilization review committees
components of health care system: monitor for appropriate diagnosis and treatment of hospitalized clients
joint commission
components of health care system: sets quality standards for accreditation of health care facilities
vital record linkage (epidemiology data)
connects data and information contained in two or more medical, or mortality records, and other vital event records; provides excellent sources of information on the courses of diseases, demographic data, health are services utilization, fertility, maternal health issues, child health concerns, chronic disease tracking, and the natural history of specific disease or morbidity related events
School nurse as a researcher
contributes to the base of knowledge for school health and educational needs
School nurse as a case manager
coordinates comprehensive services for children who have complex health needs
School nurse: case manager:
coordinates services for children who have complex health needs. EX: scheduling treatments around school shcedule.
As a ________, a nurse develops a trusting relationship with students and provides support on issues affecting their lives.
counselor
Medicaid
coverage for individuals of low socioeconomic status and children, through the combined efforts of federal and state governments. Eligibility is based on household size and income, with priority given to children, pregnant women, and those who have a disability
Medicaid
coverage for low socioeconomic status and children, through the federal and state governments. Eligibility is based on household size and income. Priority to children, pregnant women, and those who are disabled.
Notifiable Disease Reports (epidemiology data)
data collected on diseases based on the ability to cause death, and communicability of the disease; notification of public health officials of diseases posing a threat to large populations provides an initial starting point for local epidemiologic investigations
Vital Statistics (epidemiology data)
data that describe legally registered events such as births, deaths, marriages, and divorces; obtained from CDC's National Center for Health Statistics and U.S. Public health Service--collected on an ongoing basis
standards of care
define and direct the level of care nurses should give, implicate nurses who did not follow these standards in malpractice lawsuits
The Natural Helpers Model
emphasizes the importance of educational and motivational changes at the community level through utilizing community resources, such as a lay health advisor, peer education, or social networks. In this model, the nurse utilizes a natural helper—a member of the community or social network trained to provide information and social support. The person or group can facilitate attitude and healthy behavior changes. Peer education is a type of natural helper intervention.
Focus groups
directed talks with a representative sample of a community, and do not involve direct conversations with individual community members
Outlining specific roles of community agencies is a component of
disaster preparedness.
Identifying community vulnerabilities is a component of
disaster prevention.
Providing stress counseling is a component of
disaster recovery
Prioritizing care of individuals is a component of
disaster response.
endemic
diseases that occur at a consistent, expected level in a geographic area
State Children's Health Insurance Program (SCHIP)
doctor visits, immunizations, hospitalizations, emergency room visits; children 19 years and younger from families who earn to much to qualify for Medicaid but who meet SCHIP eligibility
problem-oriented
documentation formats: consists of a database, problem list, care plan, and process notes
narrative
documentation formats: records information as a sequence of events in a story-like manner
flow chart
documentation formats: shows trends in vitals, blood glucose levels, pain levels, and other frequent assessments
charting by exception
documentation formats: uses standardized forms that identify norms and allows selective documentation of deviations from this enorms
transfer documentation
documentation: medical diagnosis and care provides, demographic info, overview of health status/plan of clare, any alterations that precipitate immediate concern, notification of any assessments or care essential in next few hours, recent vitals/meds, allergies, diet/activity orders, special equipment, advance directives, family involvement
factual
documentation: subjective (direct quote or summary of info from client) and objective (data collected from the senses) no derogatory words or opinions
discharge documentation
documentation: type of discharge, date/time, who went with client, transportation, where client went, summary of client's condition at discharge, description of unresolved difficulties and procedure for follow up, disposition of valuables/meds, discharge instructions
draw inferences (community analysis)
drawing logical conclusion form the evidence once data collected has been categorized, summarized, and compared; synthesize what is known about a community
How to dress a stroke victum:
dress affected side first to limit neglect of that side. use hand mirror to see around self.
Vehicle (Non-living) Vectors
e.g. Clothing, food, water
Intermediary (Living) Vectors
e.g. Mosquitos, fleas, rodents, birds, ticks
Bioterrorism Secondary prevention
early recognition, activate response plan, implement infection control measures - decontamination, protective equipment, SCREEN the populations for exposure, assist and educate the population regarding symptom identification and management, monitor mortality and morbidity.
complementary therapies for acute respiratory disorders
echinacea, large doses of vitamin C, and zinc preparations (lozenges and nasal sprays) may be useful in promoting improved immune response, as well as hand hygiene, and limiting exposure in vulnerable populations
Community-oriented care
emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings.
Pender's Health Promotion Model
emphasizes how individual characteristics and experiences impact health promotion. Each person has personal characteristics, including biological, physical and psychological, and experiences that influence health choices and behaviors. These characteristics can be influenced by the nurse to achieve healthy outcomes.
Healthy People 2020
emphasizes the concept of social determinants of health—that is, the notion that health is impacted by many social, economic, and environmental factors that extend far beyond individual biology of disease. This means that improving health requires a broad approach to including the concept of health in all policies and creating environments where the healthy choice is the easy choice.
Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with:
more than one subpopulation and frequently with the health of the entire community (pg 12)
community analysis
multi-step process used to derive a community nursing diagnosis; phases used are: categorization, summarization, comparison, and inference elaboration
evaluation
must be planned before implementation; measures progress toward goals and learning objectives; revises assessment database and community nursing diagnosis
Indications of carbon monoxide poisoning include
nausea, vomiting, headache, weakness, and unconsciousness
educational program for a community steps in development
needs assessment; develop measurable objectives; select educational strategies appropriate for the audience; implement educational program
nonmaleficence
no harm is done when applying standards of care
Pneumonic Plague
no precautions other than protective.
The home health nurse must evaluate the living environment for safety, paying close attention to
nonsecure rugs, electrical outlets, and extension cords; the use of oxygen; safety devices in the bathroom; and other potential environmental hazards
Secondary prevention
increase early detection through screening and case finding, refer suspected cases of communicable disease for diagnostic confirmation and epidemiological reporting, provide post exposure prophylaxis (hep A, rabies), quarantine clients
Why are toxin and pollution greater in children?
increased RR rate, and drink more fluids thatn adults. kindeys don't work as well.
how to influence maternal health
increased access to prenatal care, to skilled birth attendants, and the prevention of teen and unplanned pregnancies
web of causality
increases or decreases the risk for disease
indications for transfer or discharge
indications for transfer or discharge change in level of care, another setting required for appropriate care, facility does not offer necessary care, client no longer needs inpatient care and is ready to return home
Autonomy
individuals select those actions that fulfill their goals
community based nursing focus of care
individuals; families
how you get direct data during a community assessment
informant interviews, participant observation, windshield surveys
Informatics is the combination of nursing science with
information and communication technologies in the delivery of nursing care
assessment, meds, treatments, education
information to document
discharge instructions
instructions for procedures at home, precautions to take when performing procedures/taking meds, s/s of complications to report, names/numbers of health care providers and community resources, plan for follow up care/therapy
speech language pathologist
interprofessional personnel: evaluates and makes recommendations regarding the impact of disorders or injuries on speech, language, and swallowing. teaches techniques and exercises to improve function
respiratory therapist
interprofessional personnel: evaluates respiratory status and provides respiratory treatments including oxygen therapy, chest physiotherapy, inhalation therapy, and mechanical ventilation
lab technician
interprofessional personnel: obtains specimens of body fluids and performs diagnostic tests
radiological technician
interprofessional personnel: positions clients and performs x-rays and the imaging procedures for providers to review for diagnosis of disorders of various body parts
spiritual support staff
interprofessional personnel: provides spiritual care (pastors, rabbis, priests)
social worker
interprofessional personnel: who should you refer? a nurse is caring for an older adult client who lives alone and is to be discharges in 3 day. He states it is difficult to prepare adequate nutritious meals at home for one person
OT
interprofessional personnel: who should you refer? client has difficulties using an eating utensil with her dominant hand following a stroke
lab technician
interprofessional personnel: who should you refer? provider needs to see clients CBC results immediately
preschooler age
normal to have imaginary friends; set limits for them; 4-6 oz of juice per day acceptable; may begin to have aggressive behavior-normal
Community Health is ______ an _______ response to patient ________.
not episodic demand (in other words it is preventative!)
The use of family members as interpreters is
not advisable because clients may need privacy in discussing sensitive matters
Visual learners learn through "seeing" and methods such as
note taking, video viewing, and presentations. These learners "think in pictures."
the ethical principle of fidelity
involves keeping commitments and following through with promises
Access to health care
is impacted by the availability of services in a community, as well as individual, family, and community circumstances
Double bagging hazardous materials
is not cost effective and is unnecessary unless the outside of a bag becomes contaminated.
Participant observation
is observing formal or informal community activities and does not involve direct conversations with individual community members
the ethical principle of respect for autonomy
is supporting the rights of individuals to determine and pursue personal health care goals
the ethical principle of veracity,
is the concept of telling the truth
Occupational Nursing
is the specialty practice that focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment.
Primary Health Care
it is general in scope, accessible, integrated (including health promotion, disease prevention, cure and care, rehabilitation and palliation), continuous, dependent on teamwork, holistic, personal (focusing on the person rather than the disease), family and community oriented, coordinated, confidential (respecting the client's privacy), and playing an advocacy role.
Mortality rate:
number of deaths divided by population total X 1,000=number per 1,000
Crude mortality rate
number of deaths divided by the population total
Prevalence
number of existing cases of disease in the population
infant mortality rate
number of infant deaths before 1 year of age in a year divided by the numbers of live births in the same year time 1,000
Incidence:
number of new cases in the population at a specific time divided by population total X 1,000= number per 1,000
Incidence
number of new cases of disease
Attack rate:
number of people exposed to a specific agent who develop the disease divided by total number of people exposed.
Chemical in eyes
nurse starts to flush the clients eyes with tepid water - secondary prevention
stage 4 cancer pt-decides to go to hospice
nurse's responsibility is to make referral
Palliative Care
nursing are specialized areas of practice designed to "provide evidence-based physical, emotional, psychosocial, and spiritual or existential care to individuals and families experiencing life-limiting, progressive illness"
home health nurse
nursing care to clients were they reside. this includes traditional homes, assisted living facilities, and nursing homes. Functions as education, provider of skilled nursing interventions, and coordinator of care.
LPN
nursing personnel: collaborate within the nursing process, coordinate plan of care, consult with other team members, recognize the need for referrals to assist with actual or potential problems, possess technical knowledge and skills
RN
nursing personnel: perform assessments, establish nursing diagnoses, goals, and interventions; conduct ongoing client evaluations
witness clients signature on informed consent form (ensure client got all info and understands all info)
nursing role for informed consent
provide info, document client's status, ensure reflection on client's current decisions, inform members of health care team
nursing role in advance directives
Diabetic risk factors
obesity, hypertension, inactivity, hyperlipidemia, cigarette smoking, genetic history, elevated C-reactive protein (CRP), ethnic group, and women who have delivered infants weighing more than 9 lb
Program Planning: Preplaning
obtain community awareness, support, involvement * should not move forward without community support
Secondary level of prevention
obtaining blood pressure on a client being treated for anxiety; screening older adult clients for new-onset depression
socioeconomic characteristics
occupation and income categories, educational attainment, and rental or home ownership patterns
Social Factors:
occupation, activities, marital status, education, income, crime rates, recreation, industry
Social factors:
occupation, activities, marital status, education, income, crime rates, recreation, industry.
social welfare policy
policy that promotes the welfare of the public; child labor laws and income assistance (social security)
exacerbation of asthma in kids
pollutants reduce lung function by inflaming the lining of the lungs; exposure to pollutants in the air can cause flare-ups and may increase the chance of upper respiratory infections, which can worsen asthma symptoms. If allergens in the air are an asthma trigger, pollutants can make the lungs even more sensitive to them.
The following characterizations distinguish public health nursing as a specialty:
population-focused. Community-oriented. There is a health and preventive focus The Interventions are made at the community or population level. Political processes are used as a major intervention strategy to affect public policy and achieve goals. •here is concern for the health of all members of the population/community, particularly vulnerable subpopulations.
what is the focus of a public health nurse:
populations and communities. confidentiality is a big concern. speak in abstract terms.
Cultural factors:
positions, roles, history, values, customs, norms, religion.
Thiazide diuretics, such as hydrochlorothiazide (Microzide), inhibit water and sodium reabsorption, and increase _______excretion
potassium
visual/ auditory learners
power point is fine
Primary prevention
prevent the occurrence of infectious disease, educate the public regarding the need for immunizations, counsel clients traveling to other countries about protection from infectious disease. Refer to immunizations.
Implementing age-appropriate injury prevention programs for each grade level is a________prevention activity
primary
Placing posters with images of appropriate hand hygiene near restrooms is a ______prevention strategy
primary
Providing support programs for new parents is a ________prevention strategy.
primary
The nurse is using ________ prevention when providing influenza immunizations to employees at a local preschool
primary
Local health department
primary focus is the health of its citizens. offer various services and programs. Report notifiable communicable diseases to state departments of health. funded through local taxes with support from federal and state funds.
PPO (Preferred provider organizations)
private financing: clients choose from a list of contracted providers. using non contracted providers increases out-of-pocket cost
MCO (managed care organization)
private financing: primary care providers oversee comprehensive care for enrolled clients and focus on prevention and health promotion
long term care insurance
private financing: providers for long-term care expenses Medicare does not cover
ethical dilemmas
problems that involve more than one choice and stem from the different values and beliefs of the decision makers ex. review of scientific data is not enough to solve the problem, involves a conflict between 2 moral imperatives, answer has a profound effect on situation and client
Active immunity
production of antibodies by the body in response to infection or immunization with a specific antigen
Community health nurses
promote the health and welfare of clients across the lifespan and from diverse populations.
Parish nurse
promotes the health and wellness of populations of faith communities. The population often includes church members and individuals and groups in the geographical community.
Cancer screening for men:
prostate cancer for men over 40, espicially african american men.
What are community health nurses concerned with?
protecting, promoting, preserving and maintaining health, as well as preventing disease.
Herd immunity
protection due to the immunity of most community members making exposure unlikely
Centers of Public Health Preparedness
provide emergency preparedness training to public health employees
home health/hospice nurse role
provide pharmacologic pain management for clients with terminal ilness
autopsy records (epidemiology data)
provide severely biased information; not performed for all deaths, violent deaths are included, and sometimes cause of death is unknown
medical and hospital records (epidemiology data)
provide valuable information for community health research; but do not provide a completely representative or valid picture of community health
national electronic disease surveillance system (epidemiology data)
provides an integrated surveillance system that transmits public health laboratory and clinical data via the Internet; improves the nations ability to identify and track emerging infectious diseases and potential bioterrorism attacks--aids in surveillance and analysis of notifiable diseases (CDC)
world health organization
provides daily information regarding the occurrence of internationally important diseases. Establishes world standards for antibiotics and vaccines. Primarily focuses on health care workforce and education, environment, sanitation, infectious diseases, maternal and child health, and primary care.
Cover Kids TN
provides free, comprehensive health coverage for qualifying children 18 and younger. The coverage includes an emphasis on preventive health services and coverage for physician services, hospital visits, vaccinations, well-child visits, healthy babies program, developmental screenings, mental health, vision and dental care. There are low co-pays for medical services, though well child visits and immunizations are covered at 100 percent.
School nurse: consultant:
provides professional health information.
Goals of Healthy People 20/20
provides science-based, 10 year national objectives for promoting health and preventing disease--1) to eliminate preventable disease, disability, injury, and premature death; 2) to achieve health equity, eliminate disparities, and improve the health of all groups; 3) to create social and physical environments that promote good health for all; and 4) to promote healthy development and healthy behaviors across every stage of life
nurse role as a case manager
providing referral information to clients; facilitation, negotiation and collaboration
Health belief model
purpose is to predict or explain health behaviors. Preventative health to avoid disease. Emphasizes change at the individual level.
mandatory reports of communicable disease
purpose: ensure appropriate medical treatment of disease (Tb), monitor for common-source outbreaks (food borne, hep A), plan and evaluate for control/prevention plans (immunizations), identify outbreaks and epidemics, determine public health priorities based on trends
active surveillance
purposeful, ongoing search for new cases of disease by public health personnel
breach of confidentiality, defamation of character
quasi-intensional torts (2)
Tolerance to nicotine does develop
quickly.
Smallpox
rash appears first on FACE; not on abdomen
child mortality and millennium goal
reduce by 2/3, between 1990 and 2015, the under 5 mortality ratio
herd immunity
refers to a state in which those not immune to an infectious agent will be safe if a certain proportion of the population has been vaccinated or is otherwise immune
efficiency (economics)
refers to producing maximal output, such as a good or service, using a given set of resources (or inputs), such as labor, time, and available money; suggests that inputs used in such a way that there is no better way to produce the service, or output, and that no other improvements can be made
effectiveness (economics)
refers to the extent to which a health care service meets a stated goal or objective, or how well a program or service achieves what is intended; immunization=herd immunity
outbreak
refers to the unexpected occurrence of an infectious disease in a limited geographic area during a limited period of time
ADHD school-age child
reward and consequence system throughout the day-provide positive feedback while trying to minimize negative behaviors; will concentrate better in the morning, not afternoon; limit distractions/no music during study ; have a consistent daily routine
kidney disease pt decides to quit dialysis
role of nurse is to seek clarification why: "What has changed to make you decide this?"
Routinely checking students for pediculosis throughout the school year is a _________ prevention strategy
secondary
Screening a client whose spouse recently died for suicide risk is a _________prevention strategy
secondary
The nurse is using _____ prevention when performing a home safety check at a client's home
secondary
The nurse is using _______ prevention when implementing a program to notify individuals exposed to a communicable disease
secondary
analytic epidemiology
seeks to identify associations between a particular disease or health problem and its etiology; directed toward finding answers to the "how" and "why" of health disease to determine casuality
Missionary nurse
seeks to promote health and prevent disease by meeting spiritual, physical , and emotional needs of people across the globe.
Planning
selecting and carrying out a series of actions to achieve a stated goal.
Cultural awareness includes
self-awareness of one's own cultural background, biases, and differences
nurse functions as an advocate when
serves on a community task force for suicide prevention
Public office
serving society and advocating for change by influencing policy development through public service
The environment is the
setting or surrounding that sustains the host
environment
setting or surrounding that sustains the host
Genital irritation is a manifestation of .
sexual abuse
Characteristics of successful partnerships
shared power, shared goals, integrity, flexibility, negotiation
Category A biological agents are the highest priority agents, posing a risk to national security because they are easily transmitted and have high mortality rates.
smallpox (variola), botulism toxin, anthrax, tularemia, hemorrhagic viral fevers, and plague.
Nicotine is a central nervous system
stimulant, not depressant.
Epidemiology
study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection. Relies on statistical evidence to determine the rate of spread of disease and the proportion of people affected. BROAD understanding of the spread, transmission, and incidence of disease and injury.
Osteoarthritis
take a hot shower or bath daily; consume a well-balanced diet; if overweight, lose some lbs; get 8-10 hrs of sleep at night, and a nap during the day of 1-2 hrs; exercise daily; of high pain days, client should limit repetitions or intensity of activity
genomics
the study of functions and interactions of all genetic material in the genome, including interactions with environmental factors
macroeconomics
the study of the economy as a whole; focuses on the "big picture" -the total, or aggregate (usually a country or nation), of all individuals and organizations; business cycle and economic growth; human capital approach
passive immunity
the temporary resistance that has been donated to the host through transfusions of plasma proteins, immunoglobulins, and antitoxins, or transplacentally from mother to neonate
What are some example of Class C biological agents?
the third highest priority, comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. ■■ Examples include Hantavirus.
prevalence
the total number of people in the population who have the condition at a particular time; rate: (# of existing cases of disease/# of in total population)x100,000
Referrals
to assist in restoring, maintaining, or promoting health.
web of causation
views a health condition as the result not of individual factors but of complex interrelationships of numerous factors interacting to increase or decrease the risk of disease; a number of interrelated variables are almost always involved in the cause of particular outcome
What are some secondary prevention strategies for bioterrorism?
• Early recognition • Activation of bioterrorism response plan in response to a bioterrorist event • Immediate implementation of infection control and containment measures, including decontamination, environmental disinfection, protective equipment, community education/ notification, and quarantines • Screening the population for exposure, assessing rates of infection, and administering vaccines as available • Assisting with and educating the population regarding symptom identification and management (immunoglobulin, antiviral, antitoxins, and antibiotic therapy, depending on the agent) • Monitoring mortality and morbidity
What are some primary prevention strategies related to mental health?
• Educate populations regarding mental health issues. • Teach stress-reduction techniques. • Provide parenting classes. • Provide bereavement support. • Promote protective factors (coping abilities) and risk factor reduction.
What are some primary preventions strategies for migrant health care?
• Educate regarding measures to reduce exposure to pesticides. • Teach regarding accident prevention measures. • Provide prenatal care. • Mobilize preventive services (dental, immunizations).
What are some secondary prevention strategies related to mental health?
• Screen to detect mental health disorders. • Work directly with individuals, families, and groups through the formation of a therapeutic relationship. • Conduct crisis intervention.
What are the s/sx of inhalation anthrax?
• Sore throat • Fever • Muscle aches • Severe dyspnea • Meningitis • Shock
What are the s/sx of ebola?
• Sore throat • Headache • High temperature • Nausea, vomiting, diarrhea • Internal and external bleeding • Shock
6. A nurse is reviewing data that will assist with the development of a program to improve health outcomes of vulnerable populations. Underlying Principles: At least three issues that affect vulnerable populations
●● Violence ●● Substance use disorders ●● Homelessness ●● Mental health issues ●● Poverty ●● Chronic stress ●● Poor self-esteem ●● Access to health care services
Subjective data for MI
◯ Anxiety, feeling of impending doom ◯ Chest pain (substernal or precordial) ■ Pain can radiate down the shoulder or arm, or may present in the form of jaw pain. ■ Pain may be described as a crushing or aching pressure. ◯ Nausea ◯ Dizziness
When caring for clients who experience violence:
◯ Build trust and confidence with a client. ◯ Focus on the client rather than the situation. ◯ Assess for immediate danger. ◯ Provide emergency care as needed. ◯ Develop a plan for safety. ◯ Make needed referrals for community services and legal options. ◯ If abuse has occurred, complete mandatory reporting, following agency guidelines.
Stroke risk factors
◯ Cerebral aneurysm ◯ Arteriovenous malformation (AV) ◯ Diabetes mellitus ◯ Obesity ◯ Hypertension ◯ Atherosclerosis ◯ Hyperlipidemia ◯ Hypercoagulability ◯ Atrial fibrillation ◯ Use of oral contraceptives ◯ Smoking ◯ Cocaine use
Health Problems of Migrant Workers
◯ Dental disease ◯ Tuberculosis ◯ Chronic conditions ◯ Stress, anxiety, and other mental health concerns ◯ Leukemia ◯ Iron deficiency anemia ◯ Stomach, uterine, and cervical cancers ◯ Lack of prenatal care ◯ Higher infant mortality rates
Barriers to Health Care in Rural Areas
◯ Distance from services ◯ Lack of personal/public transportation ◯ Unpredictable weather and/or travel conditions ◯ Inability to pay for care/underinsured/uninsured ◯ Shortage of rural hospitals/health care provider
Steps in the referral process:
◯ Engaging in a working relationship with the client. ◯ Establishing criteria for the referral. ◯ Exploring resources. ◯ Accepting the client's decision to use a given resource. ◯ Making the referral. ◯ Facilitating the referral. ◯ Evaluating the outcome
What are some health care goals to address for vulnerable populations?
◯◯ Encouraging people to use primary care providers for medical services. ◯◯ Increasing the number of people with health insurance. ◯◯ Making access to health care easier for the immigrant population.
What are the steps of a referral process?
◯◯ Engaging in a working relationship with the client ◯◯ Establishing criteria for the referral ◯◯ Exploring resources ◯◯ Accepting the client's decision to use a given resource ◯◯ Making the referral ◯◯ Facilitating the referral ◯◯ Evaluating the outcome
What are some health status considerations of rural residents?
◯◯ Higher infant and maternal morbidity rates ◯◯ Higher rates of chronic illnesses (heart, lung, hypertension, cancer, diabetes mellitus) and motor vehicle crash-related injuries ◯◯ Higher health occupational risks (machinery accidents, skin cancer, respiratory problems due to chemical exposure) ◯◯ Higher rates of suicide ◯◯ High risk of trauma and injuries (falls, amputations, crush injuries, pesticide exposure) ◯◯ Less likely to seek medical care
"I PREPARE" mnemonic
◯◯ I = Investigate potential exposures ◯◯ P = Present work (exposures, use of personal protective equipment, location of material safety data sheets [MSDS], taking home exposures, trends) ◯◯ R = Residence (age of home, heating, recent remodeling, chemical storage, water) ◯◯ E = Environmental concerns (air, water, soil, industries in neighborhood, waste site or landfill nearby) ◯◯ P = Past work (exposures, farm work, military, volunteer, seasonal, length of work) ◯◯ A = Activities (hobbies, activities, gardening, fishing, hunting, soldering, melting, burning, eating, pesticides, alternative healing/medicines) ◯◯ R = Referrals and resources (Environmental Protection Agency, Agency for Toxic Substances & Disease Registry, Association of Occupational and Environmental Clinics, MSDS, OSHA, local health department, environmental agency, poison control) ◯◯ E = Educate (risk reduction, prevention, follow-up)
What are some factors that contribute the mental health of aggregates?
◯◯ Individual coping abilities ◯◯ Stressful life events (exposure to violence) ◯◯ Social events (recent divorce, separation, unemployment, bereavement) ◯◯ Chronic health problems ◯◯ Stigma associated with seeking mental health services
National Health Goals for Children
☐ Reductions in X Dental caries X Obesity X Exposure to secondhand smoke ☐ Increases in X Newborn blood spot screenings and follow-up testing X Access to a medical home X Schools that require health education X Childhood immunizations X Use of child safety restraints X Physical activity
National Health Goals For adolescents
☐ Reductions in X Violent crimes X Initiation of tobacco use X Obesity X Inappropriate weight gain ☐ Increases in X Schools with a breakfast program X Participation in extracurricular activities X Wellness checkups within prior 12 months X Physical activity
The body processes alcohol dependent on several factors, including:
☐ The size and weight of the drinker ☐ Gender (affects metabolism) ☐ Carbonation (increases absorption) ☐ Time elapsed during alcohol consumption ☐ Food in the stomach ☐ The drinker's emotional state
Isoniazid (Nydrazid)
☐ This medication should be taken on an empty stomach. ☐ Monitor for hepatotoxicity and neurotoxicity, such as tingling of the hands and feet. ☐ Vitamin B6 (pyridoxine) is used to prevent neurotoxicity from isoniazide ☐ Advise the client not to drink alcohol while taking isoniazid because it may increase the risk for hepatotoxicity.
Nitroglycerin (Nitrostat) considerations
☐ Used to treat angina and help control blood pressure. ☐ Used cautiously with other antihypertensive medications. ☐ Vasodilators can cause orthostatic hypotension .Remind the client that a headache is a common side effect of this medication. ☐ Encourage the client to sit and lie down slowly.
What diseases are reportable to the CDC?
☐☐ AIDS ☐☐ Anthrax ☐☐ Botulism ☐☐ Cholera ☐☐ Diphtheria ☐☐ Encephalitis ☐☐ Giardiasis ☐☐ Gonorrhea ☐☐ Hepatitis A-D ☐☐ Influenza activity ☐☐ Legionellosis/Legionnaires' disease ☐☐ Leprosy ☐☐ Lyme disease ☐☐ Malaria ☐☐ Meningococcal infections ☐☐ Mumps ☐☐ Pertussis ☐☐ Poliomyelitis ☐☐ Rabies ☐☐ Rocky Mountain spotted fever ☐☐ Rubella ☐☐ Rubeola (measles) ☐☐ Salmonellosis ☐☐ Shigellosis ☐☐ Severe acute respiratory syndrome-associated Coronavirus disease (SARSCoV) ☐☐ Syphilis ☐☐ Smallpox ☐☐ Tetanus ☐☐ Toxic shock syndrome ☐☐ Trichinosis ☐☐ Tuberculosis ☐☐ Typhoid fever ☐☐ Vancomycin-resistant Staphylococcus aureus (VRSA) ☐☐ Varicella (chickenpox)
What physical data may be transmitted through telehealth systems?
☐☐ Blood pressure ☐☐ Weight ☐☐ Blood oxygenation ☐☐ Blood glucose ☐☐ Heart rate ☐☐ Temperature ☐☐ ECG results
What is economic maltreatment?
☐☐ Failure to provide the needs of a victim when adequate funds are available ☐☐ Unpaid bills when another person is managing the finances, resulting in disconnection of heat or electricity
What are ETOH withdrawal s/sx?
☐☐ Irritability ☐☐ Tremors ☐☐ Nausea ☐☐ Vomiting ☐☐ Headaches ☐☐ Diaphoresis ☐☐ Anxiety ☐☐ Sleep disturbances
What is neglect?
☐☐ Physical care, such as feeding ☐☐ The emotional care and/or stimulation necessary for a child to develop normally, such as speaking and interacting with a child ☐☐ An education for a child, such as enrolling a young child in school ☐☐ Needed health or dental care
How the body processes ETOH is dependent on what?
☐☐ The size and weight of the drinker ☐☐ Gender (affects metabolism) ☐☐ Carbonation (increases absorption) ☐☐ Time elapsed during alcohol consumption ☐☐ Food in the stomach ☐☐ The drinker's emotional state
What audio data may be transmitted through telehealth systems?
☐☐ Voice conversation ☐☐ Heart sounds ☐☐ Lung sounds ☐☐ Bowel sounds
The Social Learning Theory
emphasizes the importance of interaction between personal factors, behavior, and the environment. According to the theory, people learn within a social context through concepts such as modeling and observational learning. Applying this theory to health behavior, the nurse knows that learning takes place primarily by observing and imitating the actions of others. The behavior is also influenced by being rewarded and/or punished for these actions.
osteoporosis prevention
encourage the women to participate in weight-bearing activities; sun exposure-ok with precautions; this will increase the absorption of vitamin D (important for bones); vitamin E-no relationship to bone density or prevention of osteoporosis
Referral process
engage in working relationship with client establish criteria for the referral explore resources accept the client's decision to use a given resource (autonomy) make the referral facilitate the referral evaluate the outcome
Hospice nurses
enhances the quality of life through the provision of palliative care, supporting the client and family through the dying process, and providing bereavement support to the family following the client's death. Relief of pain and suffering and enhance of QOL. The hospice nurse may work with the family for up to 1 year following the death of a client.
What does hospice care focus on:
enhancing the quality of life through the provision of palliative care, support through the dying process.
Agencies transmitting or storing electronic health data must take measures to
ensure confidentiality and security of client information
Epidemiological triangle
environment: everything that influences an individual host
The nurse should include resource availability as an _______ _______when discussing the epidemiological triangle
environmental factor
Nonmaleficence
ex: Developing plans of care that include a system for monitoring and evaluating outcomes
Respect for Autonomy
ex: Respecting a client's right to self‑determination (making a decision not to pursue chemotherapy)
ethnical theory
examines principles, ideas, systems, and philosophies that affect judgments about what is right and wrong and good and band examples: utilitarianism, deontology
tort law
example of a civil law that relates to the provision of nursing care
tertiary health care
examples: ICU, oncology centers, burn centers
primary health care
examples: Office/clinical visits, schedules school or work centered screenings
continuing health care
examples: end-of-life care, palliative care, hospice, adult day care, in-home respite care
restorative health care
examples: home health care, rehab, skilled nursing facilities
preventive health care
examples: immunization, stress management, seat belt use
long term care
exception to beginning discharge plan upon admission
public health economics
focuses on producing, distributing, and consuming goods and services as related to public health and where limited public resources might best be spent to save lives or cause the most increase in quality of life
Department of Homeland Security
focuses on protecting US from threats and hazards
tertiary prevention
focuses on restoration and rehab; act to return the community to an optimal level of functioning.
descriptive epidemiology
focuses on the distribution of frequencies and patterns of health events with groups in a population; examine disease patterns and other health-related phenomena according to "person" "place" and "time"
Meningococcal vaccine:
for those living in crowded and close quarters, over 6 weeks old.
cultural imposition
forcing one's group cultural beliefs on others
Evaluation
formative - changes made during process summative - at end, related to outcomes
organizational policy
formed an applies to groups who have similar interests or special interests, such as professional associations-state nurses association or specialty nursing organization that determines governing rules for membership
Lillian Wald
founded the Henry Street Settlement and Visiting Nurse Service which provided nursing and social services and organized educational and cultural activities. She is considered the founder of public health nursing
When are majority of homicides commitedd by?
friend, acquaintance, or family member.
MRSA
good hand hygiene to prevent spread. no treatment available.
institutional policy
governs work sites; based on the institution's mission and goals, and they determine how the institution will function and relate to employees
Category C biological agents are the third-highest priority, comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates.
hantavirus
outcome (long-term) evaluation
has incidence/prevalence changed? determine if change had a lasting and real effect
influenza outbreak preparation
have 2 weeks of water and food at home; antivirals will not prevent transmission but could minimize symptoms; during an outbreak, individuals should receive two injections of H5N1 vaccine 28 days apart; seasonal flu vaccine does not protect from avian influenza
dangers of fracking
leaves behind a toxic sludge that companies and communities must find some way to manage; toxic chemicals used in the fracking process remain stranded underground where they can, and often do, contaminate drinking water, soil and other parts of the environment that support plant, animal and human life; Methane from fracture wells can leak into groundwater, creating a serious risk of explosion and contaminating drinking water supplies
restorative
levels of health care: intermediate follow-up for restoring health
tertiary
levels of health care: provision of specialized and highly technical care
Secondary prevention
limiting severity and adverse effects. Screenings, community assessments.
safety, patient-centered care, EBP, informatics, quality improvement, teamwork/collaboration
list the 6 competencies outlined by QSEN
host
living being that is affected by the agent
The host is the
living being that is affected by the agent.
APEXPH
Assessment Protocol for Excellence in Public Health
Focus groups
directed talk with a representative sample.
Health maintenance organization (HMO)
*a provider arrangement whereby comprehensive care is provided to plan members for a fixed, "per member per month" fee. *Use of designated providers
agent
*animate or inanimate object that causes the disease *Chemical *Physical *Infectious
examples of assurance
*collaborating with community agencies to improve services *ensuring competence of health care workforce
principlism
*dominant theory of ethical decision making *comprised of respect for autonomy, nonmaleficence, beneficence, & distributive justice
functions of parish nurse
*holistic care of populations *personal health counseling *health ed *liaison *facilitate support groups, change, train volunteers *ID spiritual strengths for coping
Health indicators
*mortality rates, disease prevalence, levels of physical activity, obesity, tobacco use, substance use *used to describe the health status of a community and serve as targets for the improvement of a community's health.
four major factors that affect health
*personal behavior (or lifestyle) - have the greatest effect *environmental factors (including physical, social, and economic environments) *human biology **environment and biology accounting for the greatest effect on the development of all illnesses *the health care system—medical services are said to have the least effect.
Preferred provider organization (PPO)
*provider arrangement in which predetermined rates are established for services to be delivered to members.
Diseases transmitted by Waterborne (fecal contamination of water)
Cholera Typhoid fever Giardia lamblia
Primary prevention examples
- Discuss a low-fat diet and the need for regular physical exercise with clients. - when a nurse provides health education and training for daycare workers about issues of health and hygiene, such as proper hand hygiene, diapering, and food preparation and storage - Immunizations, importance of wearing seatbelts, taking folic acid supplementation at preconception to prevent neural tube defects, fluoridation of water supplies to prevent dental caries, and actions taken to reduce human exposure to agents that may cause cancer - Implement a community level program like walking for exercise to assist citizens in improving health behaviors related to lifestyle. - Use the Code of Ethics for Nurses to guide your nursing practice - Use the information exchange process to increase the client's understanding of how to use the health care system and the health promotion strategies that will maintain health. - Complete a family genogram and assess health risks with the family to contract for family health activities to prevent diseases from developing
What is the focus of a hospice nurse?
- Enhancing quality of life through palliative care - Supporting pt. and family through dying process - Bereavement support to family
What steps are involved in ANALYSIS of community assessment data? * GAISII
- Gather data into database - Assess completeness - Identify and generate missing data - Synthesizing data and identifying themes - Identifying community needs and problems - Identifying community strengths and resources
what is Sphere of Intimacy (attribute of community health nurse)
- Greater awareness of the reality of client lives and situations than may be true in other areas of nursing. ie: u see roaches in apt
Secondary prevention examples
- Implement blood pressure and cholesterol screening; give a treadmill stress test. - Health screenings - teach an asthmatic client to recognize and avoid exposure to asthma triggers and assist the family to implement specific protection strategies such as replacing carpets, keeping air systems clean and free of mold, staying inside when the pollution level is high, and avoiding pets. - mammography to detect breast cancer, Papanicolaou (Pap) smears to detect cervical cancer, colonoscopy for early detection of colon cancer, prenatal screening of pregnant women to screen for gestational diabetes - Provide mental health interventions after stressful events. - The public health nurse provides toxin screenings for migrant workers who may be exposed to pesticides. - Implement a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center. - Encourage clients who are pregnant to participate in prenatal care and Special Supplemental Nutrition Program for Women, Infants and Children to increase the number of healthy babies and reduce the costs related to preterm baby care. - Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health. - Assess disaster victims and triage for care. - Investigate an outbreak of flulike illness in a local school. - Provide programs in child development and behavior management for families who have not yet abused their children but whose children are brought to the attention of social authorities for aggressive behavior problems. - Develop a way for homeless individuals to read their TB skin test, if necessary, and to transfer the results back to the facility at which the skin test was administered. - To prevent the spread of disease - Notify partners and trace contacts (HIV)
What are indicators of delirium tremens or alcohol withdrawal delirium? * Assess when patient had last drink * Benzos prevent serious complications
- Increased BP - Tachycardia - Diaphoresis
What are the manifestations of withdrawal that appear within 4-12 hours w/ prolonged users?
- Irritability - Tremors - Nausea - Vomting - HA - Diaphoresis - Anxiety - Sleep disturbances - Tachycardia - Increased BP
What are examples of primary prevention?
- Nutrition education Family planning and sex education Smoking cessation education Communicable disease education Education about health and hygiene issues to specific groups (Day care/Restaurant workers) Safety education (Seat belt/Helmet use) Prenatal classes Providing immunizations Advocating for access to health care, healthy environments
work site walk though or survey should focus on
- Observation of work processes and materials ■ Job requirements ■ Actual and potential hazards ■ Employee work practices (hygiene, waste disposal, housekeeping) ■ Incidence/prevalence of work-related illness/injuries ■ Control strategies to eliminate exposures
What are the components of a Windshield Survey?
- People - Places (Boundaries, Location of health services, Natural environment, Man-made environment, Housing, Social systems)
What are ENVIRONMENTAL factors the occupational nurse must be aware of when assessing risk for work-related illness and injury?
- Physical (heat, odor, ventilation, pollution) - Social (sanitation, overcrowding) - Psychological (Addictions, stress)
What is the role of the Parish Nurse?
- Promote health and wellness of populations of faith communities - Mind, body, and spirit - Personal health counseling - Health education - Liaison between faith community and local resources - Facilitating support groups - Spiritual support
What are the factors that determine alcohols affect on the body?
- Size/wt. of drinker - Gender - Carbonation - Time elapsed during consumption - Food in stomach - Drinkers emotional state
What services do home health nurses provide?
- Skilled assessment - Wound care - Lab draws - Med edu. and admin. - Parenteral nutrition - IV fluids and medication - Central line care - Catheter insertion and maintenance - Coordination/supervision of other health services
Tertiary prevention examples
- enhance rehabilitation from disease, injury, or disability - Provide cardiac rehabilitation, medication, and surgery. - medical treatment - physical and occupational therapy, and rehabilitation - Monitor the use of prescription medications and adherence to treatment to reduce risk for illness complications - Provide health promotion activities to persons with serious and persistent mental illness. - Promote support group participation for those with mental health disabilities. - The public health nurse provides a diabetes clinic for a defined population of adults in a low-income housing unit of the community. - If blood pressure cannot be controlled by diet, refer the client to a physician or nurse practitioner for medication; advise the client to engage in a cardiac program that will oversee diet and exercise. - Participate in home visits to mothers who are at risk for neglecting babies, to reduce the costs related to abuse - Provide health care and treatment for those infected by H1N1 or the new strains of the virus. - Evaluate the incidence or prevalence of obesity among school children after the implementation of the program and provide programs to reduce complications from the condition. - A review of the public health report card indicated that community incidence of complications from vaccine-preventable diseases have declined over a 2-year period after the implementation of the parent education program. - Provide family therapy for abusive families; remove children from the home. - Develop a contract with the family to change nutritional patterns to reduce further complications from the specified health problem. - Provide directly observed medication therapy for people with active TB. - Develop programs to help people reduce or end substance abuse - Regular inspection of hands and feet, as well as using protective footwear and gloves to avoid trauma and infection for leprosy clients who have lost sensation in those areas- developing an individual education plan (IEP) for students with long-term health needs - developing an individual education plan (IEP) for students with long-term health needs
Basic epidemiological concepts include:
- the interrelationships among the agent, host, and environment (the epidemiologic triangle) - the interactions of factors, exposures, and characteristics in a causal web affecting the risk for disease - and the levels of prevention corresponding to stages in the natural history of disease.
What was the Elizabethan Poor Laws?
Church must care for the poor.
PICC line can last?
1 year. flushed daily.
what is Kauffman's 5 Phases of gaining entry into the community
1) Impressing 2) Behaving 3) Swapping 4) Belonging 5) Chilling out
what is ACUTE CARE NURSING (7 things)
1) Provider control 2)Predictable routine 3) Maintenance of hospital policy 4) Resource availability 5) Collegial collaboration and consultation 6) Controlled patient compliance 7) Standardization of care
The Greeks and the Romans were part of the _______ time period.
Classical
When was 1st hospital developed?
Classical Time
CHARACTERISTICS OF A SUCCESSFUL SCREENING PROGRAM
1. Valid (accurate): A high probability of correct classification of persons tested 2. Reliable (precise): Results are consistent from place to place, time to time, and person to person 3. Capable of large group administration: A) Fast in both the administration of the test and the obtaining of results. B) Inexpensive in both personnel required and the materials and procedures used. 4. Innocuous: Few if any side effects, and the test is minimally invasive 5. High yield: Able to detect enough new cases to warrant the effort and expense (yield defined as the amount of previously unrecognized disease that is diagnosed and treated as a result of screening)
five elements to prove negligence
1. duty to provide care as defined by a standard 2. breech of duty by failure to meet standard 3. foreseeability of harm 4. breech of duty has potential to cause harm 5. harm occurs
Educator Skill (education process)
1. gain attention 2. inform the learner of the objectives of instruction 3. stimulate recall of prior learning 4. present the stimulus 5. provide learning guidance 6. elicit performance 7. provide feedback 8. assess performance 9. enhance retention and transfer of knowledge
educational process
1. identify client needs-needs assessment 2. establish educational goals and objectives 3. select appropriate educational strategies 4. develop effective skills as an educator 5. develop effective health education programs
Five methods of collecting data
1. informant interviews 2. participant observation 3. secondary analysis of existing data 4. surveys 5. windshield surveys
A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements by the nurse are appropriate? (Select all that apply.) A. "When did you start hearing the voices?" B. "The voices are not real, or else we would both hear them." C. "It must be scary to hear voices." D. "Are the voices telling you to hurt yourself?" E. "Why are the voices talking to only you?"
A. "When did you start hearing the voices?" C. "It must be scary to hear voices." D. "Are the voices telling you to hurt yourself?"
A nurse is discussing routine follow-up needs for a client who has a new prescription for valproic acid (Depakote). The nurse should inform the client of the need for routine monitoring of which of the following? A. AST/ALT and LDH B. Creatinine and BUN C. WBC and granulocyte counts D. Serum sodium and potassium
A. AST/ALT and LDH
A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the nurse notes that the lithium blood level is 1.2 mEq/L. Which of the following is an appropriate action by the nurse? A. Administer the next dose of lithium carbonate as scheduled. B. Prepare for administration of aminophylline. C. Notify the provider for a possible increase in the dosage of lithium carbonate. D. Request a stat repeat of the client's lithium blood level.
A. Administer the next dose of lithium carbonate as scheduled.
A nurse is caring for an adult client who is the victim of intimate partner abuse. The client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? A. Advise the client about the location of women's shelters. B. Encourage the client to participate in a support group for victims of abuse. C. Implement case management to coordinate community and social services. D. Educate the client about the use of stress management techniques.
A. Advise the client about the location of women's shelters.
A nurse working in an acute mental health facility is caring for a 35-year-old female client who has clinical findings of depression. The client lives at home with her husband and two young children. She currently smokes and has a history of chronic asthma. The nurse should identify which of the following as risk factors for depression for this client? (Select all that apply.) A. Age of 35 years old B. Female gender C. History of chronic asthma D. Currently smokes E. Being married
A. Age of 35 years old B. Female gender C. History of chronic asthma D. Currently smokes
A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply.) A. Auditory hallucination B. Lack of motivation C. Use of clang associations D. Delusion of persecution E. Constantly waving arms F. Flat affect
A. Auditory hallucination C. Use of clang associations D. Delusion of persecution E. Constantly waving arms
A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following should the charge nurse identify as being effectively treated by conventional antipsychotics? (Select all that apply.) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia
A. Auditory hallucinations C. Delusions of grandeur D. Severe agitation
A nurse is caring for a client who has a new prescription for disulfiram (Antabuse) for the treatment of his alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol. This form of treatment is an example of which of the following? A. Aversion therapy B. Flooding C. Biofeedback D. Dialectical behavior therapy
A. Aversion therapy
A nurse is obtaining a health history from the parents of a 12-year-old client who has conduct disorder. Which of the following are expected findings? (Select all that apply.) A. Bullying of others B. Threats of suicide C. Law-breaking activities D. Narcissistic behavior E. Flat affect
A. Bullying of others B. Threats of suicide C. Law-breaking activities
5. A nurse at an urban community health agency is developing an education program for city leaders about homelessness. Which of the following should the nurse include as the fastest-growing segment of the homeless population? A. Families with children B. Adolescent runaways C. Intimate partner abuse victims D. Older adults
A. CORRECT
1. A nurse at a community clinic is conducting a well-child visit with a preschool-age child. The nurse should identify which of the following as a manifestation of child neglect? (Select all that apply.) A. Underweight B. Healing spiral fracture of the arm C. Genital irritation D. Burns on the palms of the hands E. Poor hygiene
A. CORRECT: An underweight child is a manifestation of child neglect. B. INCORRECT: A healing spiral fracture is a manifestation of physical abuse. C. INCORRECT: Genital irritation is a manifestation of sexual abuse. D. INCORRECT: Burns on the palms of the hands are a manifestation of physical abuse. E. CORRECT: Poor hygiene is manifestation of child neglect.
5. A nurse is working with a client who has systemic lupus erythematosus and recently lost her health insurance. Which of the following is an appropriate action by the nurse in the implementation phase of the case management process? A. Coordinating services to meet the client's needs B. Comparing outcomes with original goals C. Determining the client's financial constraints D. Clarifying roles of interprofessional team members
A. CORRECT: Coordinating services to meet the client's needs is an appropriate action by the nurse in the implementation phase of the case management process. B. INCORRECT: Comparing outcomes with original goals is an appropriate action by the nurse in the evaluation phase of the case management process. C. INCORRECT: Determining the client's financial constraints is an appropriate action by the nurse in the assessment phase of the case management process. D. INCORRECT: Clarifying roles of interprofessional team members is an appropriate action by the nurse in the planning phase of the case management process.
4. A nurse developing a community health program is determining barriers to community resource referrals. Which of the following is an example of a resource barrier? A. Costs associated with services B. Decreased motivation C. Inadequate knowledge of resources D. Lack of transportation
A. CORRECT: Costs associated with services are an example of a resource barrier to community referrals. B. INCORRECT: Decreased motivation is an example of a client barrier to community referrals. C. INCORRECT: Inadequate knowledge of resources is an example of a client barrier to community referrals. D. INCORRECT: Lack of transportation is an example of a client barrier to community referrals.
1. A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should include that which of the following are influenced by an individual's culture? (Select all that apply.) A. Nutritional practices B. Family structure C. Health care interactions D. Biological variations E. Views about illness
A. CORRECT: Culture is the beliefs, values, attitudes, and behaviors shared by a group of people and transmitted from generation to generation. Nutritional practices are influenced by an individual's culture. B. CORRECT: Culture is the beliefs, values, attitudes, and behaviors shared by a group of people and transmitted from generation to generation. Family structure is influenced by an individual's culture. C. CORRECT: Culture is the beliefs, values, attitudes, and behaviors shared by a group of people and transmitted from generation to generation. Health care interactions are influenced by an individual's culture. D. INCORRECT: Biological variations are physical, biological and physiological differences between races, and are not influenced by the beliefs, values, and attitudes of an individual. E. CORRECT: Culture is the beliefs, values, attitudes, and behaviors shared by a group of people and transmitted from generation to generation. Views about illness are influenced by an individual's culture.
2. A nurse is advocating for local leaders to place a newly approved community health clinic in an area of the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which of the following ethical principles? A. Distributive justice B. Fidelity C. Respect for autonomy D. Veracity
A. CORRECT: The nurse is advocating for the leaders to uphold the ethical principle of distributive justice, which is the fair distribution of benefits and burden in society. B. INCORRECT: The nurse is not advocating for the leaders to uphold the ethical principle of fidelity, which involves keeping commitments and following through with promises. C. INCORRECT: The nurse is not advocating for the leaders to uphold the ethical principle of respect for autonomy, which is supporting the rights of individuals to determine and pursue personal health care goals. D. INCORRECT: The nurse is not advocating for the leaders to uphold the ethical principle of veracity, which is the concept of telling the truth.
2. An occupational health nurse is consulting with senior management of a local industrial facility. When discussing work-related illness and injury, the nurse should include which of the following as physical agents? (Select all that apply.) A. Noise B. Age C. Lighting D. Viruses E. Stress
A. CORRECT: The nurse manager should include noise as a physical agent when discussing work‑related illness and injury. B. INCORRECT: The nurse manager should include age as a host factor when discussing work-related illness and injury. C. CORRECT: The nurse manager should include lighting as a physical agent when discussing work‑related illness and injury. D. INCORRECT: The nurse manager should include viruses as a biological agent when discussing work-related illness and injury. E. INCORRECT: The nurse manager should include stress as an outcome of psychological agents when discussing work-related illness and injury.
3. A newly hired occupational health nurse at an industrial facility is performing an initial workplace assessment. Which of the following should the nurse determine when conducting a work site survey? A. Work practices of employees B. Past exposure to specific agents C. Past jobs of individual employees D. Length of time working in current role
A. CORRECT: The nurse should determine the work practices of employees when conducting a work site survey. B. INCORRECT: The nurse should determine past exposure to specific agents when conducting an occupational health history on individual workers, not a work site survey. C. INCORRECT: The nurse should determine past jobs of individual employees when conducting an occupational health history on individual workers, not a work site survey. D. INCORRECT: The nurse should determine the length of time working in current role when conducting an occupational health history on individual workers, not a work site survey.
3. A nurse is using the I PREPARE mnemonic to assess a client's potential environmental exposures. Which of the following is an appropriate question for the nurse to ask to assess for "A" in the mnemonic? A. "What do you like to do for fun?" B. "What year was your residence built?" C. "What jobs have you had in the past?" D. "What industries are near where you live?"
A. CORRECT: This is an appropriate question for the nurse to ask when assessing for "A," which represents activities in the mnemonic. B. INCORRECT: This is not an appropriate question for the nurse to ask when assessing for "A" in the mnemonic. This question is appropriate to assess the first "R," which represents residence in the mnemonic. C. INCORRECT: This is not an appropriate question for the nurse to ask when assessing for "A" in the mnemonic. This question is appropriate to assess the second "P," which represents past work in the mnemonic. D. INCORRECT: This is not an appropriate question for the nurse to ask when assessing for "A" in the mnemonic. This question is appropriate to assess the first "E," which represents environmental concerns in the mnemonic.
A nurse is teaching an adolescent client who has a new prescription for clomipramine (Anafranil) for OCD. Which of the following should the nurse teach the client to minimize one of the adverse effects of his medication? A. Eat a diet high in fiber. B. Check temperature daily. C. Take medication first thing in the morning before eating. D. Add extra calories to the diet as between-meal snacks.
A. Eat a diet high in fiber.
A nurse is working in a community mental health facility. Which of the following services are appropriate for clients to receive? (Select all that apply). A. Educational groups B. Medication dispensing programs C. Individual counseling programs D. Detoxification programs E. Crisis intervention
A. Educational groups B. Medication dispensing programs C. Individual counseling programs
A nurse is preparing to provide an educational seminar on stress to other nursing staff. Which of the following is appropriate to include in the discussion? A. Excessive stressors cause the client to experience distress. B. The body's initial adaptive response to stress is denial. C. The absence of stressors results in homeostasis. D. Negative, rather than positive, stressors produce a biological response.
A. Excessive stressors cause the client to experience distress.
1. A nurse manager at a community agency is developing an orientation program for newly hired nurses. When discussing the differences between community-based and community-oriented nursing, the nurse should include which of the following as examples of community-based nursing? (Select all that apply.) A. A home health nurse performing wound care for a client who is immobile B. An occupational health nurse providing classes on body mechanics at a local industrial plant C. A school nurse teaching a student who has asthma about medications D. A parish nurse teaching a class on low-sodium cooking techniques E. A mental health nurse discussing stress management techniques with a support group
A. CORRECT: This is an example of community-based nursing, which involves management of acute and chronic conditions in a community setting. B. INCORRECT: This is an example of community-oriented nursing, which involves health care of individuals, families and groups to improve the collective health of the community. C. CORRECT: This is an example of community-based nursing, which involves management of acute and chronic conditions in a community setting. D. INCORRECT: This is an example of community-oriented nursing, which involves health care of individuals, families and groups to improve the collective health of the community. E. INCORRECT: This is an example of community-oriented nursing, which involves health care of individuals, families and groups to improve the collective health of the community.
A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medications? A. Chlorpromazine (Thorazine) B. Thiothixene (Navane) C. Risperidone (Risperdal) D. Haloperidol (Haldol)
A. Chlorpromazine (Thorazine)
5. A nurse is collecting data to identify health needs in the local community. Which of the following are examples of secondary data the nurse should review? (Select all that apply.) A. Birth statistics B. Previous health survey results C. Windshield survey D. Community forum E. Health records
A. Correct: Birth statistics are an example of secondary data the nurse should review. B. Correct: Previous health survey results are an example of secondary data the nurse should review. C. Incorrect: Windshield surveys are a method of collecting direct data. D. Incorrect: Community forums are a method of collecting direct data. E. Correct: Health records are an example of secondary data the nurse should review.
4. A nurse is conducting a community assessment. Which of the following data collection methods is the nurse using when having direct conversations with individual members of the community? A. Key informant interviews B. Participant observation C. Focus groups D. Health surveys
A. Correct: Informant interviews are direct conversations with individual community members for the purpose of obtaining ideas and opinions. B. Incorrect: Participant observation is observing formal or informal community activities and does not involve direct conversations with individual community members. C. Incorrect: Focus groups are directed talks with a representative sample of a community, and do not involve direct conversations with individual community members. D. Incorrect: Surveys are specific questions asked in a written format and do not involve direct conversations with individual community members.
1. A nurse is preparing to conduct a windshield survey. Which of the following data should the nurse collect as a component of this assessment? (Select all that apply.) A. Ethnicity of community members B. Individuals who hold power within the community C. Natural community boundaries D. Prevalence of disease E. Presence of public protection
A. Correct: The nurse should identify the ethnicity of the people visible in the community as a component a windshield survey. B. Incorrect: Individuals who hold power are identified through formal and informal observations of community activities, as a participant observer. C. Correct: The nurse should identify natural community boundaries as a component a windshield survey. D. Incorrect: Prevalence of disease is incorrect. Disease prevalence is a component of secondary data and is identified through morbidity rates of the community. E. Correct: The nurse should identify the presence of public protection, such as police, fire, and animal control, as a component a windshield survey.
A nurse is discussing acute vs. prolonged stress with a client. Which of the following should the nurse identify as an acute stress response? (Select all that apply.) A. Decreased appetite B. Depressed immune system C. Increased blood pressure D. Panic attacks E. Unhappiness
A. Decreased appetite B. Depressed immune system C. Increased blood pressure E. Unhappiness
A charge nurse is preparing a staff education session on personality disorders. Which of the following should be included as personality characteristics associated with all of the personality disorders? (Select all that apply.) A. Difficulty in getting along with other members of a group B. Belief in the ability to become invisible during times of stress C. Display of defense mechanisms when routines are changed D. Claiming to be more important than other persons E. Difficulty understanding why it is inappropriate to have a personal relationship with staff
A. Difficulty in getting along with other members of a group C. Display of defense mechanisms when routines are changed E. Difficulty understanding why it is inappropriate to have a personal relationship with staff
A nurse is planning care for the termination phase of a nurse-client relationship. Which of the following actions is appropriate to include in the plan of care? A. Discussing ways to use new behaviors B. Practicing new problem-solving skills C. Developing goals D. Establishing boundaries
A. Discussing ways to use new behaviors
A nurse is assessing a client who is suicidal. Which of the following is appropriate for the nurse to ask the client? (Select all that apply.) A. Do you have a plan? B. Have you thought about hurting yourself? C. Do you feel that life is not worth living? D. Why do you want to commit suicide? E. Have you experienced a recent change in your mood?
A. Do you have a plan? B. Have you thought about hurting yourself? C. Do you feel that life is not worth living? E. Have you experienced a recent change in your mood?
1. A nurse is talking to a client who asks for additional information about hospice. Which of the following is an appropriate statement by the nurse? A. "Clients who require skilled nursing care at home qualify for hospice care." B. "One function of hospice is to provide teaching to clients about life-sustaining measures." C. "Hospice assists clients to develop the skills needed to care for themselves independently." D. "A component of hospice care is to control the client's symptoms."
A. INCORRECT: Clients who require skilled nursing care at home qualify for home health. B. INCORRECT: Home health may provide teaching to clients about life-sustaining measures, but this is not a function of hospice. C. INCORRECT: Home health assists clients to develop the skills needed to care for themselves independently. D. CORRECT: Controlling the client's symptoms is a component of hospice care.
2. A nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following findings is a manifestation of withdrawal? A. Decreased blood pressure B. Diaphoresis C. Pin-point pupils D. Bradycardia
A. INCORRECT: Increased, not decreased, blood pressure is a manifestation of alcohol withdrawal. B. CORRECT: Diaphoresis is a manifestation of alcohol withdrawal. C. INCORRECT: Dilated, not pin-point, pupils are a manifestation of alcohol withdrawal. D. INCORRECT: Tachycardia, not bradycardia, is a manifestation of alcohol withdrawal.
2. A nurse is caring for a client who is from a different culture than himself. When beginning the cultural assessment, which of the following actions should the nurse take first? A. Determine the client's perception of his current health status. B. Gather data about the client's cultural beliefs. C. Determine how the client's culture may impact the effectiveness of nursing actions. D. Gather information about previous client interactions with the health care system.
A. INCORRECT: It is important for the nurse to determine the client's perception of his current health status. However, when conducting a cultural assessment, the nurse should perform a different action first. B. CORRECT: The nurse's first action when beginning a cultural assessment is to collect self-identifying data about the client, including specific information about how the client's cultural beliefs influence family structure, food patterns, religious preferences, and health practices. C. INCORRECT: While it is important for the nurse to determine how the client's culture may impact the effectiveness of nursing actions, the nurse must gather other information first. D. INCORRECT: It is important for the nurse to gather information about previous client interactions with the health care system. However, when conducting a cultural assessment, the nurse should perform a different action first.
5. A nurse is interviewing for a position at the local health department. When preparing for the interview, the nurse should find that which of the following are responsibilities of this agency? (Select all that apply.) A. Managing the Women, Infants, and Children program B. Providing education to achieve community health goals C. Coordinating directives from state personnel D. Reporting communicable diseases to the CDC E. Licensing of registered nurses
A. INCORRECT: Managing the Women, Infants, and Children program is a responsibility of state departments of health, not local health departments. B. CORRECT: Providing education to achieve community health goals is a component of identifying and intervening to meet health needs of the local community, which is a responsibility of local health departments. C. CORRECT: Funding for local health departments come from local, state and federal monies, therefore; local health departments are responsible for coordinating directives issued from the state level. D. INCORRECT: Reporting communicable diseases to the CDC is a responsibility of state departments of health, not local health departments. Local health department report communicable diseases to the state department of health. E. INCORRECT: Licensing of registered nurses is incorrect. Licensing of registered nurses is a responsibility of state boards of nursing, not local health departments.
3. A case management nurse at an acute care facility is conducting an initial visit with a client to identify needs prior to discharge home. After developing a working relationship with the client, the nurse is engaging in the referral process. Which of the following should be the first action by the nurse? A. Monitor the client's satisfaction with the referral. B. Provide client information to referral agencies. C. Review available resources with the client. D. Identify referrals that the client needs.
A. INCORRECT: Monitoring the client's satisfaction with the referral is an appropriate action by the nurse. However, another action must occur first in the referral process. B. INCORRECT: Once the client agrees, providing client information to referral agencies is an appropriate action by the nurse. However, another action must occur first in the referral process. C. INCORRECT: Reviewing available resources with the client is an appropriate action by the nurse. However, another action must occur first in the referral process. D. CORRECT: Identifying referrals that the client needs is the first action the nurse should take in the referral process. Identifying the client's needs then allows the nurse and client to focus on specific needs while moving forward in the referral process.
5. A school nurse is planning health promotion and disease prevention activities for the upcoming school year. In which of the following situations is the nurse planning a secondary prevention strategy? A. Placing posters with images of appropriate hand hygiene near restrooms B. Routinely checking students for pediculosis throughout the school year C. Implementing age-appropriate injury prevention programs for each grade level D. Working with a dietician to determine carbohydrate counts for students who have diabetes mellitus
A. INCORRECT: Placing posters with images of appropriate hand hygiene near restrooms is a primary prevention strategy. B. CORRECT: Routinely checking students for pediculosis throughout the school year is a secondary prevention strategy. C. INCORRECT: Implementing age-appropriate injury prevention programs for each grade level is a primary prevention activity. D. INCORRECT: Working with the dietitian to determine carbohydrate counts for students with diabetes is a tertiary prevention activity.
4. A community health nurse is developing strategies to prevent or improve mental health issues in the local area. In which of the following situations is the nurse implementing a tertiary prevention strategy? A. Providing support programs for new parents B. Screening a client whose spouse recently died for suicide risk C. Teaching a client who has schizophrenia about medication interactions D. Discussing stress reduction techniques with employees at an industrial site
A. INCORRECT: Providing support programs for new parents is a primary prevention strategy. B. INCORRECT: Screening a client whose spouse recently died for suicide risk is a secondary prevention strategy. C. CORRECT: Teaching a client who has schizophrenia about medication interactions is a tertiary prevention strategy. D. INCORRECT: Discussing stress reduction techniques with employees at an industrial site is a primary prevention strategy.
1. A nurse is creating partnerships to address health needs within the community. The nurse should be aware that which of the following characteristics must exist for partnerships to be successful? (Select all that apply.) A. A leading partner with decision-making authority B. Flexibility among partners when considering new ideas C. Adherence of partners to ethical principles D. Varying goals for the different partners E. Willingness of partners to negotiate roles
A. INCORRECT: Shared power must exist for a partnership to be successful. B. CORRECT: Flexibility must exist for a partnership to be successful. C. CORRECT: Integrity must exist for a partnership to be successful. D. INCORRECT: Shared goals must exist for a partnership to be successful. E. CORRECT: Negotiation must exist for a partnership to be successful.
4. A nurse is developing a community health education program for a group of clients who have a new diagnosis of diabetes mellitus. Which of the following learning strategies should the nurse include for clients who are auditory learners? A. Showing informational videos B. Providing equipment to practice hands-on skills C. Supplying outlines for note-taking D. Facilitating small group discussions
A. INCORRECT: Showing informational videos is an appropriate learning strategy for clients who are visual learners. B. INCORRECT: Providing equipment to practice hands-on skills is an appropriate learning strategy for clients who are tactile-kinesthetic learners. C. INCORRECT: Supplying outlines for note-taking is an appropriate learning strategy for clients who are visual learners. D. CORRECT: Facilitating small group discussions is an appropriate learning strategy for clients who are auditory learners.
3. A community health nurse is developing an education program on substance use disorders for a group of adolescents. Which of the following should the nurse include when discussing nicotine and smoking? A. Smoking is the fifth-most preventable cause of death in the United States. B. Nicotine is a central nervous system depressant. C. Withdrawal effects from smoking are minimal. D. Tolerance to nicotine develops quickly.
A. INCORRECT: Smoking is the first-most, not fifth-most, preventable cause of death in the United States. B. INCORRECT: Nicotine is a central nervous system stimulant, not depressant. C. INCORRECT: Withdrawal effects from smoking are substantial, not minimal, and increase physical dependence. D. CORRECT: Tolerance to nicotine does develop quickly.
4. A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care? A. "I don't drive, and my son is only available to take me places in the mornings." B. "I can't take off during the day and the local after-hours clinic is no longer in operation." C. "Only one doctor in my town is a designated provider by my health maintenance organization." D. "I would like to schedule an appointment with the local doctor in my town who speaks Spanish and English."
A. INCORRECT: The availability of a family member to provide transportation for a client in the morning is not a barrier to accessing health care. The follow-up appointment should be scheduled during this time frame. B. CORRECT: Inconvenient hours make scheduling a follow-up appointment challenging, and indicates a barrier to accessing health care for this client. C. INCORRECT: A single provider in the local community that is approved by the client's health maintenance organization does not indicate a barrier to accessing health care. The follow-up appointment should be scheduled with this provider. D. INCORRECT: A provider who is bilingual does not indicate a barrier to accessing health care. This increases accessibility for clients who may speak a different language.
4. A school nurse is scheduling visits with a physical therapist for a child who has cerebral palsy. In which of the following roles is the nurse functioning? A. Direct caregiver B. Consultant C. Case manager D. Counselor
A. INCORRECT: The nurse is not functioning in the role of direct caregiver. As a direct caregiver, a nurse provides illness or injury care to children at school. B. INCORRECT: The nurse is not functioning in the role of consultant. As a consultant, a nurse provides information to families, administrators, teachers, and parent-teacher groups to encourage decisions that promote the health of the students. C. CORRECT: The nurse is functioning in the role of case manager. As a case manager, the nurse coordinates comprehensive services for students with complex health needs. D. INCORRECT: The nurse is not functioning in the role of counselor. As a counselor, a nurse develops a trusting relationship with students and provides support on issues affecting their lives.
5. A community health nurse is implementing health programs with several populations in the local area. In which of the following situations is the nurse using primary prevention? A. Performing a home safety check at a client's home B. Teaching healthy nutrition to clients who have hypertension C. Providing influenza immunizations to employees at a local preschool D. Implementing a program to notify individuals exposed to a communicable disease
A. INCORRECT: The nurse is using secondary prevention when performing a home safety check at a client's home. B. INCORRECT: The nurse is using tertiary prevention when teaching healthy nutrition to clients who have hypertension. C. CORRECT: The nurse is using primary prevention when providing influenza immunizations to employees at a local preschool. D. INCORRECT: The nurse is using secondary prevention when implementing a program to notify individuals exposed to a communicable disease.
2. A nurse is reviewing the various roles of a community health nurse. Which of the following is an example of a nurse functioning as a consultant? A. Advocating for federal funding of local health screening programs B. Updating state officials about health needs of the local community C. Facilitating discussion of a client's ongoing needs with an interprofessional team D. Performing health screenings for high blood pressure at a local health fair
A. INCORRECT: This is an example of a nurse functioning as a change agent. B. CORRECT: This is an example of a nurse functioning as a consultant. Community health nurses serve as a consultant regarding the health care needs of individuals, families, and groups within the community served. C. INCORRECT: This is an example of a nurse functioning as a case manager. D. INCORRECT: This is an example of a nurse functioning as a caregiver.
1. A nurse is preparing a community health program on communicable diseases. When discussing modes of transmission, the nurse should include which of the following as an airborne illness? A. Cholera B. Malaria C. Influenza D. Salmonellosis
A. Incorrect: Cholera is waterborne illness. B. Incorrect: Malaria is a vector-borne illness. C. Correct: When discussing modes transmission, the nurse should include influenza as an airborne illness. D. Incorrect: Salmonellosis is a foodborne illness.
Give 2 examples of Tertiary Prevention
Physical therapy Insulin treatment for home use.
4. A community health nurse is educating the public on the agents of bioterrorism. Which of the following are Category A biological agents? (Select all that apply.) A. Hantavirus B. Typhus C. Plague D. Tularemia E. Botulism
A. Incorrect: Hantavirus is a Category C biological agent. B. Incorrect: Typhus is a Category B biological agent. C. Correct: Plague is a Category A biological agent. D. Correct: Tularemia is a Category A biological agent. E. Correct: Botulism is a Category A biological agent.
5. A community health nurse is determining available and needed supplies in the event of a bioterrorism attack. The nurse should be aware that community members exposed to anthrax will need access to which of the following medications? A. Metronidazole (Flagyl) B. Ciprofloxacin (Cipro) C. Zanamivir (Relenza) D. Fluconazole (Diflucan)
A. Incorrect: Metronidazole is used to treat trichomoniasis, skin infections, and septicemia. B. Correct: Community members exposed to anthrax will need access to ciprofloxacin. This medication is used for the prophylactic treatment of anthrax. C. Incorrect: Zanamivir is used to treat influenza. D. Incorrect: Fluconazole is used to treat candidiasis.
3. A newly hired public health nurse is familiarizing himself with the levels of disaster management. Which of the following actions is a component of disaster prevention? A. Outlining specific roles of community agencies B. Identifying community vulnerabilities C. Prioritizing care of individuals D. Providing stress counseling
A. Incorrect: Outlining specific roles of community agencies is a component of disaster preparedness. B. Correct: Identifying community vulnerabilities is a component of disaster prevention. C. Incorrect: Prioritizing care of individuals is a component of disaster response. D. Incorrect: Providing stress counseling is a component of disaster recovery.
2. A home health nurse is discussing portals of entry with a group of newly hired assistive personnel. Which of the following are portals of entry the nurse should discuss? (Select all that apply.) A. Respiratory secretions B. Skin C. Genitourinary tract D. Saliva E. Mucous membranes
A. Incorrect: Respiratory secretions are a portal of exit. B. Correct: Skin is a portal of entry the nurse should discuss. C. Correct: The genitourinary tract is a portal of entry the nurse should discuss. D. Incorrect: Saliva is a portal of exit. E. Correct: Mucous membranes are a portal of entry the nurse should discuss.
3. A nurse is planning a community health program. Which of the following should the nurse include as part of the evaluation plan? A. Determine availability of resources to initiate the plan. B. Gain approval for the program from local leaders. C. Establish a timeline for implementation of interventions. D. Compare program impact to similar programs.
A. Incorrect: The nurse should not include determining availability of resources to initiate the program as part of the evaluation plan; this should be done during the assessment phase. However, when evaluating sustainability of the program, the nurse should determine whether resources are available for continuing the program. B. Incorrect: The nurse should not include gaining approval for the program from local leaders as part of the evaluation plan. This approval should take place as part of the preplanning phase because plans for the program should not move forward without adequate community support. C. Incorrect: The nurse should not include establishing a timeline for implementation of interventions as part of the evaluation plan. Timeline development should occur after determining and selecting the best strategies for meeting the program's goals and objectives. D. Correct: The nurse should include comparing program impact to similar programs as part of the evaluation plan. This comparison assists with determining the efficiency of the program.
2. A nurse is completing a needs assessment and beginning analysis of data. Which of the following actions should the nurse take first? A. Determine health patterns within collected data. B. Compile collected data into a database. C. Ensure data collection is complete. D. Identify health needs of the local community.
A. Incorrect: This is not the first action the nurse should take. In order to determine health patterns within collected data the nurse must take another action first. B. Correct: This is the first action the nurse should take. In order to adequately and appropriately analyze collected data the nurse must first compile collected data into a database. C. Incorrect: This is not the first action the nurse should take. In order to ensure data collection is complete the nurse must take another action first. D. Incorrect: This is not the first action the nurse should take. In order to identify health needs of the local community the nurse must take another action first.
A nurse is making a home visit to a client who has Alzheimer's disease to assess the home for safety. Which of the following are appropriate suggestions to decrease the client's risk for injury? A. Install childproof door locks. B. Place rugs over electrical cords. C. Mark cleaning supplies with colored tape. D. Place the client's mattress on the floor. E. Install light fixtures above stairs.
A. Install childproof door locks. D. Place the client's mattress on the floor. E. Install light fixtures above stairs.
A nurse is working with a client who has recently lost his mother. The nurse recognizes that which of the following factors influence grief and coping ability? (Select all that apply.) A. Interpersonal relationships B. Culture C. Birth order D. Size of family E. Prior experience with loss
A. Interpersonal relationships B. Culture E. Prior experience with loss
A nurse is communicating with a newly admitted client. Which of the following is a barrier to therapeutic communication? A. Offering advice B. Reflecting meaning C. Listening attentively D. Giving information
A. Offering advice
this pt is a priority
Active pulmonary TB, nonadherent to prescribed treatment-nurse has to check if he is breathing ok and and if disease is progressing; also this is a community problem-communicable disease
Natural Immunity
Active: gained by contact with disease Passive: mom to baby
Acquired Immunity
Active: gained via immunization Passive: gained via antibody transfer
Disaster prevention
Activities to prevent natural and man-made disasters, increase surveillance, improve inspections and airport security, strengthening public health processes such as immunizations, isolation, and quarantine. Strengthen barriers to prevent flooding and teaching methods of preventing communicable disease transmission. ID and assess population populations at risk.
ACE
Acute Care for Elders
Advocacy - The nurse plays the role of informer, supporter, and mediator for the client. --- Clients are autonomous beings who have the right to make decisions affecting their own health and welfare. --- Clients have the right to expect a nurse-client relationship that is based on trust, collaboration, and shared respect, related to health, and considerate of their thoughts and feelings. --- Clients are responsible for their own health. --- It is the nurse's responsibility to advocate for resources or services that meet the client's health care needs. --- Advocating for clients requires assertiveness, placing priority on the client's values, and willingness to progress through the chain of command for resolution.
Advocacy - The nurse plays the role of informer, supporter, and mediator for the client. --- Clients are autonomous beings who have the right to make decisions affecting their own health and welfare. --- Clients have the right to expect a nurse-client relationship that is based on trust, collaboration, and shared respect, related to health, and considerate of their thoughts and feelings. --- Clients are responsible for their own health. --- It is the nurse's responsibility to advocate for resources or services that meet the client's health care needs. --- Advocating for clients requires assertiveness, placing priority on the client's values, and willingness to progress through the chain of command for resolution.
Susceptible Host
Age Gender Genetics Ethicity Immunological Status Physiological State Occupation
population-focused nursing
Assessing to determine needs and intervening to protect and promote health, and preventing disease within a specific population
World Health Organization
An international agency that is sponsored by the United Nations. It is the directing and coordinating authority on international health. A primary goal of this organization is to help all the people to attain the highest possible levels of health. The agency compiles international health statistics and info. on disease and publishes health information. It also provides training.
Analysis of Community Assessment Data - Steps: --- Gathering collected data into a composite database. --- Assessing ____________ of data. --- Identifying and generating ________ data. --- Synthesizing data and identifying ______. --- Identifying community needs and problems. --- Identifying community strengths and resources
Analysis of Community Assessment Data - Steps: --- Gathering collected data into a composite database. --- Assessing completeness of data. --- Identifying and generating missing data. --- Synthesizing data and identifying themes. --- Identifying community needs and problems. --- Identifying community strengths and resources
Program Planning: Diagnosis
Analyze data to determine health needs, prioritize health needs of the community
Scabies
Appear as grayish brown, threadlike burrows on the skin. Require private room.
principlism
Approach to problem solving in bioethics that uses the principles of respect for autonomy, beneficence, nonmaleficence, and justice as the basis for organization and analysis
3 functions of Community Health
Assess Policy Development Assurance
What is a windshield survey?
Assessing community components by driving through a community
beneficence (Situation)
Assessing risks and benefits when planning interventions
A nurse is providing teaching to a client who has a new prescription for amitriptyline (Elavil). Which of the following client statements indicates understanding of the teaching? A. "While taking this medication, I'll need to stay out of the sun to avoid a skin rash." B. "I may feel drowsy for a few weeks after starting this medication." C. "I cannot eat my favorite pizza with pepperoni while taking this medication." D. "This medication will help me lose the weight that I have gained over the last year."
B. "I may feel drowsy for a few weeks after starting this medication."
A charge nurse is discussing transcranial magnetic stimulation (TMS) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "TMS is indicated for clients whose depression is not relieved by medication." B. "I will provide postanesthesia care following TMS." C. "TMS is usually performed as an outpatient procedure." D. "I will schedule the client for daily TMS treatments for the first several weeks."
B. "I will provide postanesthesia care following TMS."
A nurse is caring for a client who is on lithium therapy. The client states that he wants to take ibuprofen for osteoarthritis pain relief. Which of the following statements by the nurse is appropriate? A. "That is a good choice. Ibuprofen does not interact with lithium." B. "Regular aspirin would be a better choice than ibuprofen." C. "Lithium decreases the effectiveness of ibuprofen." D. "The ibuprofen will make your lithium level fall too low."
B. "Regular aspirin would be a better choice than ibuprofen.
A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy? A. "Even if my anxiety improves, I will need to continue this therapy for 6 weeks." B. "The therapist will focus on my past relationships during our sessions." C. "Psychoanalysis will help me reduce my anxiety by changing my behaviors." D. "This therapy will address my conscious feelings about stressful experiences."
B. "The therapist will focus on my past relationships during our sessions."
A nurse is evaluating a client's understanding of a new prescription for clonidine (Catapres). Which of the following statements by the client indicates an understanding of the teaching? A. "Taking this medication will help reduce my craving for heroin." B. "While taking this medication, I should keep a pack of sugarless gum." C. "I can expect some diarrhea because of taking this medicine." D. "Each dose of this medication should be placed under my tongue to dissolve."
B. "While taking this medication, I should keep a pack of sugarless gum."
A nurse is caring for a client who has Alzheimer's disease and is beginning to experience noticeable short-term memory loss. When discussing a new prescription for donepezil (Aricept), the nurse should include which of the following in the teaching? A. "You should avoid taking over-the-counter acetaminophen while on donepezil." B. "You can expect the progression of cognitive decline to slow with donepezil." C. "You will be screened for underlying kidney disease prior to starting donepezil." D. "You should stop taking donepezil if you experience nausea or diarrhea."
B. "You can expect the progression of cognitive decline to slow with donepezil."
A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (ACT) group? A. A client in an acute care mental health facility who has fallen several times while running down the hallway B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia C. A client in a day treatment program who says he is becoming more anxious during group therapy D. A client in a weekly grief support group who says she still misses her deceased husband who has been dead for 3 months
B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia
A nurse is teaching a school-age child and his parents about a new prescription for lisdexamfetamine dimesylate (Vyvanse). Which of the following is appropriate for the nurse to include in the teaching? (Select all that apply). A. An adverse effect of this medication is CNS depression. B. Administer the medication right before breakfast. C. Monitor blood pressure while taking this medication. D. Therapeutic effects of this medication will take 1 to 3 weeks to fully develop. E. This medication blocks the effects of dopamine in the brain.
B. Administer the medication right before breakfast. C. Monitor blood pressure while taking this medication.
A nurse is conducting a class for a group of newly licensed nurses on identifying risk factors for suicide. Which of the following individuals should the nurse include as having the highest risk for suicide? (Select all that apply.) A. Older adult females B. Adolescents C. Native Americans D. Clients who have a depressive disorder E. Clients who have hypomania
B. Adolescents C. Native Americans D. Clients who have a depressive disorder
A nurse is speaking with a client who has schizophrenia when he suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to himself. Which of the following actions should the nurse take? A. Stop the interview at this point, and resume later when the client is better able to concentrate. B. Ask the client, "Are you seeing something on the ceiling?" C. Tell the client, "You seem to be looking at something on the ceiling. I see something there, too." D. Continue the interview without comment on the client's behavior.
B. Ask the client, "Are you seeing something on the ceiling?"
A community health nurse is determining available and needed supplies in the event of a bioterrorism attack. The nurse should be aware that community members exposed to anthrax will need access to which of the following medications? A. Metronidazole (flagyl) B. Ciprofloxacin (cipro) C. Zanamivir (relenza) D. Flucanazol ( Diflucan)
B. Cipro
A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (Select all that apply.) A. Lethargy B. Defensive responses to questions C. Disorientation D. Rapid breathing E. Facial grimacing F. Agitation
B. Defensive responses to questions D. Rapid breathing E. Facial grimacing F. Agitation
A nurse is obtaining informed consent for a client who has just learned she must have a breast biopsy. The client is perspiring and pale, has a respiratory rate 30/min, and says, "I don't quite understand what you're trying to tell me." The nurse should assess the client's anxiety as which of the following? A. Mild B. Moderate C. Severe D. Panic
B. Moderate
A nurse is planning group therapy for clients dealing with bereavement. Which of the following should the nurse include in the initial phase? (Select all that apply.) A. Encourage the group to work toward goals. B. Define the purpose of the group. C. Discuss termination of the group. D. Identify informal roles of members within the group. E. Establish an expectation of confidentiality within the group.
B. Define the purpose of the group. C. Discuss termination of the group. E. Establish an expectation of confidentiality within the group.
A nurse is caring for a client who smokes and has lung cancer. The client reports, "I'm coughing because I have that cold that everyone has been getting." Which of the following defense mechanisms is the client using? A. Reaction formation B. Denial C. Displacement D. Sublimation
B. Denial
A charge nurse is reviewing Kübler-Ross: Five Stages of Grief with a group of newly licensed nurses. Which of the following should the charge nurse include in the teaching? (Select all that apply.) A. Endurance B. Denial C. Bargaining D. Anger E. Depression
B. Denial C. Bargaining D. Anger E. Depression
A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Use caffeine in moderation to prevent relapse. B. Difficulty sleeping can indicate a relapse. C. Begin taking your medications as soon as a relapse begins. D. Participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.
B. Difficulty sleeping can indicate a relapse. D. Participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.
A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply.) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing
B. Drooling C. Involuntary arm movements E. Continual pacing
A nurse is performing an admission assessment for a client who has delirium related to an acute urinary tract infection. Which of the following are expected findings? (Select all that apply.) A. History of gradual memory loss B. Family report of personality changes C. Hallucinations D. Unaltered level of consciousness E. Restlessness
B. Family report of personality changes C. Hallucinations E. Restlessness
A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following is an expected finding? (Select all that apply.) A. Bradycardia B. Fine tremors of both hands C. Hypotension D. Vomiting E. Restlessness
B. Fine tremors of both hands D. Vomiting E. Restlessness
A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine (Prozac). Which of the following findings should the nurse report to the provider as an indication of serotonin syndrome? (Select all that apply.) A. Hypothermia B. Hallucinations C. Muscular flaccidity D. Diaphoresis E. Agitation
B. Hallucinations D. Diaphoresis E. Agitation
A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (Select all that apply.) A. Amenorrhea B. Hypokalemia C. Mottling of the skin D. Slightly elevated body weight E. Presence of lanugo on the face
B. Hypokalemia D. Slightly elevated body weight
A nurse working in an emergency department is caring for a client who has bezodiazepine toxicity due to an overdose. Which of the following is the priority nursing action? A. Administer flumazenil (Romazicon) B. Identify the client's level of orientation C. Infuse IV fluids D. Prepare the client for gastric lavage
B. Identify the client's level of orientation
A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following is the highest priority action? A. Respect the client's need for personal space. B. Identify the client's perception of her mental health status. C. Include the client's family in the interview. D. Teach the client about her current mental health disorder.
B. Identify the client's perception of her mental health status.
A nurse is caring for a client on an acute mental health unit. The client reports hearing voices that are telling her to "kill your doctor." Which of the following is the priority action for the nurse to take? A. Use therapeutic communication to discuss the hallucination with the client. B. Initiate one-to-one observation of the client. C. Focus the client on reality. D. Notify the provider of the client's statement.
B. Initiate one-to-one observation of the client.
A nurse is preparing a community education seminar about family violence. When discussing the types of violence, the nurse should include which of the following? A. Refusing to pay bills for a dependant, even when funds are available, is neglect. B. Intentionally causing an older adult to fall is an example of physical violence. C. Striking an intimate partner is an example of sexual violence. D. Failure to provide a stimulating environment for normal development is emotional abuse.
B. Intentionally causing an older adult to fall is an example of physical violence.
A client says, "I plan to commit suicide." Which of the following should be the nurse's priority assessment? A. Client's educational and economic background B. Lethality of the method and availability of means C. Quality of the client's social support D. Client's insight into the reasons for the decision
B. Lethality of the method and availability of means
A nurse is reviewing a newly admitted client's medical record. Which of the following documents is a directive for medical treatment based on the client's wishes? A. Advance directives B. Living will C. Informed consent D. Durable power of attorney for health care
B. Living will
A nurse is conducting a family therapy session. The adolescent son tells the nurse that he plans ways to make his sister look bad so his parents will think he's the better sibling, which he believes will give him more privileges. The nurse should identify this dysfunctional behavior as which of the following? A. Placation B. Manipulation C. Blaming D. Distraction
B. Manipulation
A nurse is conducting chart reviews of multiple clients at a community mental health facility. Which of the following would be an example of client experiencing a maturational crisis? A. Rape B. Marriage C. Severe physical illness D. Job loss
B. Marriage
A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification
B. Splitting
A nurse is performing an admission assessment on an adolescent client who has depression. Which of the following is an expected finding? (Select all that apply.) A. Fear of being alone B. Substance use C. Weight gain D. Irritability E. Aggressiveness
B. Substance use D. Irritability E. Aggressiveness
A nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with another nurse. Which of the following actions should the nurse take first? A. Notify the nurse manager. B. Tell the nurse to stop discussing the behavior. C. Provide an in-service program about confidentiality. D. Complete an incident report.
B. Tell the nurse to stop discussing the behavior.
A nurse is in the working phase of a therapeutic relationship with a client who has methamphetamine use disorder. Which of the following indicates transference behavior? A. The client asks the nurse whether she will go out to dinner with him. B. The client accuses the nurse of telling him what to do just like his ex-girlfriend. C. The client reminds the nurse of a friend who died from a substance overdose. D. The client becomes angry and threatens harm to himself.
B. The client accuses the nurse of telling him what to do just like his ex-girlfriend.
A client says she is experiencing increased stress because her significant other is "pressuring me and my kids to go live with him. I love him, but I'm not ready to do that." She also states that her significant other "keeps nagging at my oldest son, which makes me mad, since he's my son, not his." Which of the following should the nurse recommend to promote a change in the client's situation? A. Learn to practice mindfulness. B. Use assertiveness techniques. C. Exercise regularly. D. Rely on the support of a close friend.
B. Use assertiveness techniques.
A nurse is providing teaching to an adolescent who is to begin taking atomoxetine (Strattera) for ADHD. The nurse should instruct the client to monitor for and report which of the following indications of liver damage? (Select all that apply). A. Mood changes B. Yellowing skin C. Joint pain D. Fever E. Malaise
B. Yellowing skin D. Fever E. Malaise
A nurse decides to put a client who has psychosis in seclusion overnight because the unit is very short‑staffed, and the client frequently fights with other clients. This is an example of A. beneficence. B. a tort. C. a facility policy. D. justice.
B. a tort.
Barriers to Health Care - Inadequate health care insurance - Inability to pay for health care services - Language barriers - Cultural barriers - Lack of health care providers in a community - Geographic isolation - Social isolation - Lack of communication tools - Lack of personal or public transportation to health care facilities - Inconvenient hours - Attitudes of health care personnel toward clients of low socioeconomic status or those with different cultural/ethnic backgrounds - Eligibility requirements for state/federal assistance programs.
Barriers to Health Care - Inadequate health care insurance - Inability to pay for health care services - Language barriers - Cultural barriers - Lack of health care providers in a community - Geographic isolation - Social isolation - Lack of communication tools - Lack of personal or public transportation to health care facilities - Inconvenient hours - Attitudes of health care personnel toward clients of low socioeconomic status or those with different cultural/ethnic backgrounds - Eligibility requirements for state/federal assistance programs.
_______ to Learning - Obstacles include age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, and lack of motivation.
Barriers to Learning - Obstacles include age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, and lack of motivation.
Barriers to health care - Inadequate health care insurance, inability to pay for health care services, language barriers, cultural barriers, lack of health care providers in a community, geographic isolation, lack of communication tools, lack of personal or public transportation to health care facilities, inconvenient hours, attitudes of health care personnel toward clients of low socioeconomic status or those with different cultural/ethnic backgrounds, eligibility requirements for state/federal assistance programs.
Barriers to health care - Inadequate health care insurance, inability to pay for health care services, language barriers, cultural barriers, lack of health care providers in a community, geographic isolation, lack of communication tools, lack of personal or public transportation to health care facilities, inconvenient hours, attitudes of health care personnel toward clients of low socioeconomic status or those with different cultural/ethnic backgrounds, eligibility requirements for state/federal assistance programs.
Barriers to the Referral Process - Client Barriers: --- Lack of motivation, --- inadequate ___________ about community resources, --- inadequate understanding of the ____ for referral, --- accessibility needs, --- priorities, --- finances, --- cultural factors - Resource Barriers: --- Attitudes of health care personnel, --- costs of services, --- ________ accessibility of resources, --- time limitations, --- limited expertise working with culturally diverse populations
Barriers to the Referral Process - Client Barriers: --- Lack of motivation, --- inadequate information about community resources, --- inadequate understanding of the need for referral, --- accessibility needs, --- priorities, --- finances, --- cultural factors - Resource Barriers: --- Attitudes of health care personnel, --- costs of services, --- physical accessibility of resources, --- time limitations, --- limited expertise working with culturally diverse populations
Disaster recovery
Begins when danger no longer exists and needed representatives and agencies are available to assist with rebuilding. Communicable disease and sanitation are important aspects of disaster recovery.
_________ Theory - A learning theory which uses the reinforcement methods to change learners' behaviors.
Behavioral Theory - A learning theory which uses the reinforcement methods to change learners' behaviors.
Metoprolol tartrate (lopressor)
Beta-blockers can cause bradycardia and hypotension. Hold the medication if the apical pulse rate is less than 60/min, and notify the provider. ☐ Avoid giving to clients who have asthma. Cardioselective beta blockers (affect only beta1 receptors) are preferred to minimize effects on the respiratory system. ☐ Use with caution in clients who have heart failure. ☐ Encourage the client to sit and lie down slowly. ☐ Remind the client to notify the provider immediately if shortness of breath, edema, weight gain, or cough occur
Family health appraisals include
Biological risk assessment (genograms, genetic diseases), Environmental risks (including support systems) behavioral risks ( health values, and health perceptions)
Bioterrorism: Agents of Bioterrorism -Category A biological agents --- Highest priority agents, posing a risk to national security because they are easily _________ and have high _________ rates. --- Ex. smallpox, botulism toxin, anthrax [treatment is IV Cipro], tularemia, hemorrhagic viral fevers, and plague - Category B biological agents --- Second-highest priority because they are moderately easy to disseminate and have ____ morbidity rates and ___ mortality rates. --- Ex. typhus and cholera -Category C biological agents --- Third-highest priority, comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. --- Ex. hantavirus
Bioterrorism: Agents of Bioterrorism -Category A biological agents --- Highest priority agents, posing a risk to national security because they are easily transmitted and have high mortality rates. --- Ex. smallpox, botulism toxin, anthrax [treatment is IV Cipro], tularemia, hemorrhagic viral fevers, and plague - Category B biological agents --- Second-highest priority because they are moderately easy to disseminate and have high morbidity rates and low mortality rates. --- Ex. typhus and cholera -Category C biological agents --- Third-highest priority, comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. --- Ex. hantavirus
A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder." B. "ECT is contraindicated for clients who have suicidal ideation." C. "ECT is effective for clients who are experiencing severe mania." D. "ECT is prescribed to prevent relapse of bipolar disorder."
C. "ECT is effective for clients who are experiencing severe mania."
A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates a need for further teaching? A. "A criminal history increases the risk for violence between strangers." B. "Substance use disorder increases the risk for violence." C. "Entering an intimate relationship increases the risk for violence." D. "Pregnancy increases the risk for violence toward the intimate partner."
C. "Entering an intimate relationship increases the risk for violence."
A nurse working in an outpatient clinic is providing teaching to a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I'm menstruating." B. "I will use light therapy 30 min a day to prevent further recurrences of PMDD." C. "I am aware that my PMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active."
C. "I am aware that my PMDD causes me to have rapid mood swings."
A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements indicates the need for further teaching? A. "I will administer prophylactic treatment for sexually transmitted infections like chlamydia." B. "I need to obtain informed consent before the sexual assault nurse examiner obtains forensic evidence." C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder." D. "I should perform a self-assessment before caring for a client who has been raped."
C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder."
A nurse is caring for a client who lost his mother to cancer last month. Which of the following statements made by the nurse is a nontherapeutic response? A. "You sound angry." Anger is a normal feeling associated with loss." B. "Tell me more about your how you are feeling." C. "I understand just how you feel. I felt the same when my mother died." D. "Let's discuss how you have been coping."
C. "I understand just how you feel. I felt the same when my mother died."
A nurse is caring for a client who has bulimia nervosa and who has stopped purging behavior. The client tells the nurse that she is afraid she is going to gain weight. Which of the following is an appropriate response by the nurse? A. "Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet." B. "Instead of worrying about your weight, try to focus on other problems at this time." C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments." D. "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you."
C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments."
A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone (Fanapt). Which of the following client statements indicates understanding of the teaching? A. "I will be able to stop taking this medication as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while taking this medication." D. "This medication is highly addictive and must be withdrawn slowly."
C. "I will be careful not to gain too much weight while taking this medication."
A nurse is caring for a client who is to begin taking fluoxetine (Prozac) for treatment of generalized anxiety disorder. Which of the following statements indicates the client understands the use of this medication? A. "I will take the medication at bedtime." B. "I will follow a low-sodium diet while taking this medication." C. "I will need to discontinue this medication slowly." D. "I will be at risk for weight loss with long-term use of this medication."
C. "I will need to discontinue this medication slowly."
A nurse is talking with a client who is at risk for suicide following the death of his spouse. Which of the following statements by the nurse is appropriate? A. "I feel very sorry for the loneliness you must be experiencing." B. "Suicide is not the appropriate way to cope with loss." C. "Losing someone close to you must be very upsetting." D. "I know how difficult it is to lose a loved one."
C. "Losing someone close to you must be very upsetting."
A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates a need for further teaching? A. "We need to understand that she is not responsible for her disorder." B. "Eliminating any codependent behavior will promote her recovery." C. "She should participate in an Al-Anon group to help her recover." D. "The primary goal of her treatment is abstinence from substance use."
C. "She should participate in an Al-Anon group to help her recover."
A nurse is orienting a new client to a mental health unit. When explaining the unit's community meetings, which of the following statements by the nurse is appropriate? A. "You and a group of other clients will meet to discuss your treatment plans." B. "Community meetings have a specific agenda that is established by staff." C. "You and the other clients will meet with staff to discuss common problems." D. "Community meetings are an excellent opportunity to explore your personal mental health issues."
C. "You and the other clients will meet with staff to discuss common problems."
A nurse is caring for a client who was recently raped. The client states, "I never should have been out on the street alone at night." Which of the following is an appropriate response by the nurse? A. "Your actions had nothing to do with what happened." B. "You should focus on recovery rather than blaming yourself for what happened." C. "You believe this wouldn't have happened if you hadn't been out alone?" D. "Why do feel that you should not have been alone on the street at night?"
C. "You believe this wouldn't have happened if you hadn't been out alone?
A nurse is caring for several clients who are attending community-based mental health programs. Which of the following clients should the nurse plan to visit first? A. A client who recently burned her arm while using a hot iron at home B. A client who requests that her antipsychotic medication be changed due to some new side effects C. A client who says he is hearing a voice that tells him he is not worthy of living anymore D. A client who tells the nurse he experienced symptoms of severe anxiety before and during a job interview
C. A client who says he is hearing a voice that tells him he is not worthy of living anymore
Which of the following is an example of a client who requires emergency admission to a mental health facility? A. A client with schizophrenia who has frequent hallucinations B. A client with symptoms of depression who attempted suicide a year ago C. A client with borderline personality disorder who assaulted a homeless man with a metal rod D. A client with bipolar disorder who paces quickly down the sidewalk while talking to himself
C. A client with borderline personality disorder who assaulted a homeless man with a metal rod
A nurse is working with an established group and identifies various member roles. Which of the following should the nurse identify as an individual role? A. A member who praises input from other members B. A member who follows the direction of other members C. A member who brags about accomplishments D. A member who evaluates the group's performance toward a standard
C. A member who brags about accomplishments
A nurse is caring for a client who takes ziprasidone (Geodon). The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A. Olanzapine (Zyprexa) B. Quetiapine (Seroquel) C. Aripiprazole (Abilify) D. Clozapine (Clozaril) E. Paliperidone (Invega)
C. Aripiprazole (Abilify) D. Clozapine (Clozaril)
A nurse wants to use democratic leadership with a group whose purpose is to learn appropriate conflict resolution techniques. The nurse is correct in implementing this form of group leadership when she demonstrates which of the following actions? A. Observes group techniques without interfering with the group process B. Discusses a technique and then directs members to practice the technique C. Asks for group suggestions of techniques and then supports discussion D. Suggests techniques and asks group members to reflect on their use
C. Asks for group suggestions of techniques and then supports discussion
A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following? A. Narcissistic behavior B. Fear of rejection from staff C. Attempt to reduce anxiety D. Adverse effect of antidepressant medication
C. Attempt to reduce anxiety
A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. When assessing this client, which of the following are expected findings? (Select all that apply.) A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other clients to give him their belongings D. Becomes agitated if his personal area is not neat and orderly E. Blames others for his past and current problems
C. Attempts to convince other clients to give him their belongings E. Blames others for his past and current problems
A nurse in an acute mental health facility is caring for a client who has a severe mental illness and soon will be ready for discharge but still requires supervision much of the time. The client's wife works all day but is home by late afternoon. Which of the following should the nurse suggest as appropriate follow-up care? A. Receiving daily care from a home health aide B. Having a weekly visit from a nurse case worker C. Attending a partial hospitalization program D. Visiting a community mental health center on a daily basis
C. Attending a partial hospitalization program
A nurse is teaching a client who has tobacco use disorder about the use of nicotine gum (Nicorette). Which of the following is appropriate to include in the teaching? A. Chew the gum for no more than 10 min. B. Rinse out the mouth immediately before chewing the gum. C. Avoid eating 15 min prior to chewing the gum. D. Use of the gum is limited to 90 days.
C. Avoid eating 15 min prior to chewing the gum.
A nurse is leading a peer group discussion about the indications for electroconvulsive therapy (ECT). Which of the following is appropriate to include in the discussion? A. Borderline personality disorder B. Acute withdrawal related to a substance use disorder C. Bipolar disorder with rapid cycling D. Dysthymic disorder
C. Bipolar disorder with rapid cycling
3. A nurse is preparing an education program on disease transmission for employees at a local day care facility. When discussing the epidemiological triangle, the nurse should include which of the following as agents? (Select all that apply.) A. Resource availability B. Ethnicity C. Toxins D. Bacteria E. Altered immunity
C. CORRECT D. CORRECT
A nurse is assisting the parents of a school-age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following is an appropriate strategy for the nurse to recommend? (Select all that apply.) A. Allow the child to choose consequences for negative behavior. B. Use role playing to act out unacceptable behavior. C. Develop a reward system for acceptable behavior. D. Encourage the child to participate in school sports. E. Be consistent when addressing unacceptable behavior.
C. Develop a reward system for acceptable behavior. D. Encourage the child to participate in school sports. E. Be consistent when addressing unacceptable behavior.
A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should anticipate prescriptions for which of the following medications to promote long-term abstinence from alcohol? (Select all that apply.) A. Lorazepam (Ativan) B. Diazepam (Valium) C. Disulfiram (Antabuse) D. Naltrexone (Vivitrol) E. Acamprosate (Campral)
C. Disulfiram (Antabuse) D. Naltrexone (Vivitrol) E. Acamprosate (Campral)
A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? A. Chlordiazepoxide (Librium) B. Bupropion (Zyban) C. Disulfiram (Antuse) D. Carbamazepine (Tegretol)
C. Disulfiram (Antuse)
A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following is appropriate when implementing this form of therapy? A. Demonstrate riding in an elevator, and then ask the client to imitate the behavior. B. Advise the client to say "stop" out loud every time he begins to feel an anxiety response related to an elevator. C. Gradually expose the client to an elevator while practicing relaxation techniques. D. Stay with the client in an elevator until his anxiety response diminishes.
C. Gradually expose the client to an elevator while practicing relaxation techniques.
A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following is the priority nursing intervention? A. Orient the client frequently to time, place, and person. B. Offer fluids and nourishing diet as tolerated. C. Implement seizure precautions. D. Encourage participation in group therapy sessions.
C. Implement seizure precautions.
A charge nurse is discussing the characteristics of a nurse-client relationship with a newly licensed nurse. Which of the following are appropriate to include in the discussion? (Select all that apply.) A. The needs of both participants are met. B. An emotional commitment exists between the participants. C. It is goal-directed. D. Behavioral change is encouraged. E. A termination date is established.
C. It is goal-directed. D. Behavioral change is encouraged. E. A termination date is established.
A nurse is assessing a client immediately following an electroconvulsive therapy (ECT) procedure. Which of the following are expected findings? (Select all that apply.) A. Hypotension B. Paralytic ileus C. Memory loss D. Nausea E. Tachycardia
C. Memory loss D. Nausea E. Tachycardia
A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? A. Encourage the client to express her feelings. B. Maintain eye contact with the client. C. Move the client away from others. D. Tell the client that the behavior is not acceptable.
C. Move the client away from others.
A nurse is planning a staff education program on substance use in older adults. Which of the following is appropriate for the nurse to include in the presentation? A. Older adults require higher doses of a substance to achieve a desired effect. B. Older adults commonly use rationalization to cope with a substance use disorder. C. Older adults are at a higher risk for substance use following retirement. D. Older adults develop substance use to mask signs of dementia.
C. Older adults are at a higher risk for substance use following retirement
A nurse is making a home visit to a client who is in the late stage of Alzheimer's disease. The client's spouse, who is the primary caregiver, wishes to discuss concerns about the client's nutrition and the stress of providing care. Which of the following is an appropriate action by the nurse? A. Verify that a current power of attorney document is on file. B. Instruct the client's spouse to offer finger foods to increase oral intake. C. Provide information on resources for respite care. D. Schedule the client for placement of an enteral feeding tube.
C. Provide information on resources for respite care
A nurse assesses a client at a community mental health facility using the SAD PERSONS tool. The nurse knows that this tool provides which of the following data related to a client? A. Current anxiety level B. Problem-solving ability C. Suicide potential D. Mood disturbance
C. Suicide potential
A client tells a student nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always yelling at me and threatening me." Which of the following actions should the nurse take? A. Keep the client's communication confidential, but talk to the client daily, using therapeutic communication to convince him to admit to hiding the knife. B. Keep the client's communication confidential, but watch the client and his roommate closely. C. Tell the client that this must be reported to health care staff because it concerns the health and safety of the client and others. D. Report the incident, but do not inform the client of the intention to do so.
C. Tell the client that this must be reported to health care staff because it concerns the health and safety of the client and others.
A nurse is working on promotion of healthy coping skills with older adult clients who had all previously been hospitalized for severe depression and are now in a residential care facility. The nurse should recognize that this is an example of which of the following? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Mental status examination
C. Tertiary prevention
A nurse is reviewing the medical record of a client who has a new prescription for bupropion (Wellbutrin) for depression. Which of the following findings is the highest priority for the nurse to report to the provider? A. The client has a family history of seasonal pattern depression. B. The client currently smokes 1.5 packs of cigarettes per day. C. The client had a motor vehicle crash last year and sustained a head injury. D. The client has a BMI of 25 and has gained 10 lb over the last year.
C. The client had a motor vehicle crash last year and sustained a head injury.
A nurse is interviewing a 25-year-old client who has a new diagnosis of dysthymia. Which of the following findings should the nurse expect? A. There are wide fluctuations in mood. B. The report of a minimum of five clinical findings of depression. C. The presence of manifestations for at least 2 years. D. There is an inflated sense of self-esteem.
C. The presence of manifestations for at least 2 years.
A nurse is conducting therapy with a several clients and their families. Effective communication with clients and families is based on A. discussing in-depth topics with which the client feels comfortable. B. using silence to avoid unpleasant or difficult topics. C. attending to verbal and nonverbal behaviors. D. requiring the client and family to ask for feedback.
C. attending to verbal and nonverbal behaviors.
Nature of learning
CAP = B F D Cognitive Domain Affective Domain Psychomotor Domain
CIRCLE Model of Spiritual Care - C: - I: - R: - C: - L: - E:
CIRCLE Model of Spiritual Care - C: aring - I: ntuition - R: espect for religious beliefs and practices - C: aution - L: istening - E: motional support
secondary health care
Care in hospital settings, diagnostic centers, emergent care centers
What is the CIRCLE model of spiritual care
Caring Intuition Respect for religious beliefs and practices Caution Listening Emotional Support
School Nursing
Case Managers Engage in Community Outreach Consultants Direct Caregivers Health Educators Carry out research
_________ Theory - Learning theory that uses sensory input and repetition to change learners' patterns of thought, thereby changing behaviors.
Cognitive Theory - Learning theory that uses sensory input and repetition to change learners' patterns of thought, thereby changing behaviors.
What two ways did the Greeks influence the Classical Period? Be specific.
Coined words: Endemic Epidemic 2 goddesses: Hygia Panacea
Give 2 examples of an Endemic disease/infection.
Colds Pnemonia
3 actions of the organization "Healthy People"
Collaboration (increase) Informed Decisions (empower t. to ) Measure (impact of prevention)
1st Nursing & Health School
Columbia University
Health teaching
Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.
______________ - Group of people and institutions that share geographic, civic, and/or social parameters.
Community - Group of people and institutions that share geographic, civic, and/or social parameters.
What were the 4 AREAS Florence Nightengale FOCUSED ON?
Community Sanitation Assessment Analysis
Community Assessment - A comprehensive approach that emphasizes the community as a client. The community assessment and diagnosis are the foundation for community-specific program planning.
Community Assessment - A comprehensive approach that emphasizes the community as a client. The community assessment and diagnosis are the foundation for community-specific program planning.
CBSA
Community Benefit Service Area
CHA
Community Health Assessment
Community Health Diagnoses - Risk of (specific problem or risk in the community) - among (the specific __________ that is affected by the problem or risk) - related to (_________ and weaknesses in the community that influence the problem or risk).
Community Health Diagnoses - Risk of (specific problem or risk in the community) - among (the specific population that is affected by the problem or risk) - related to (strengths and weaknesses in the community that influence the problem or risk).
Community Health Nurse - It is a collaborative role. The desired outcome is to plan, organize, implement, and evaluate ____________ programs that address the specific health needs of the community.
Community Health Nurse - It is a collaborative role. The desired outcome is to plan, organize, implement, and evaluate intervention programs that address the specific health needs of the community.
Community Health Nurse - Role includes: --- Interacting with community partners serving the community at large --- Witnessing the interaction between community __________ and the response of the client to the services --- Identifying future services based upon the visible needs of community members and population groups
Community Health Nurse - Role includes: --- Interacting with community partners serving the community at large --- Witnessing the interaction between community programs and the response of the client to the services --- Identifying future services based upon the visible needs of community members and population groups
Community Health Nurses - In the unique position of being able to: --- identify cases, --- recognize ________ of disease, --- eliminate ________ to disease control, --- provide education and counseling targeted at a disease condition or specific risk factors.
Community Health Nurses - In the unique position of being able to: --- identify cases, --- recognize patterns of disease, --- eliminate barriers to disease control, --- provide education and counseling targeted at a disease condition or specific risk factors.
Community Health Nurses - facilitate continuity of care through case _____________ services. --- These services include focused supervision for individualized care, follow-up, and referrals to appropriate resources.
Community Health Nurses - facilitate continuity of care through case management services. --- These services include focused supervision for individualized care, follow-up, and referrals to appropriate resources.
Community Health Nursing Practice - Focus of Care: Synthesis of nursing and public health theory - Nursing Activities: Promote, preserve, and maintain the health of population by the delivery of health services to individuals, families, and groups in order to impact "community health"
Community Health Nursing Practice - Focus of Care: Synthesis of nursing and public health theory - Nursing Activities: Promote, preserve, and maintain the health of population by the delivery of health services to individuals, families, and groups in order to impact "community health"
What are examples of secondary prevention?
Community assessments Disease surveillance (Communicable diseases) Screenings: Cancer, DM, HTN, Hypercholesterolemia, Sensory Impairments, TB, Lead exposure, Genetic disorders, Metabolic deficiencies in newborns Control of outbreaks
Community as Partner
Community core 8 interacting community subsystems Community stressors/boundaries Normal line of defense LOD = status quo Flexible line of defense - protection vs stressors Lines of resistance LOR - strengths, resources, coping mechanisms
Community ___________ - Occurs when community members, agencies, and businesses, actively participate in the processes of health promotion and disease prevention. - This partnership is critical to the accomplishment of health promotion and disease prevention strategies
Community partnership - Occurs when community members, agencies, and businesses, actively participate in the processes of health promotion and disease prevention. - This partnership is critical to the accomplishment of health promotion and disease prevention strategies
Factors in planning a community program
Community partnership (do they agree); Influences of social, economic, environmental, political issues; Etiologic antecedents; Health needs of at-risk populations (and do they agree with this); Awareness/application of planned change
Community-Based Nursing - Focus of Care: Individuals, Families - Nursing Activities: Illness care: Mgmt of acute and chronic conditions in settings where individuals, families, and groups ____, ____ and attend
Community-Based Nursing - Focus of Care: Individuals, Families - Nursing Activities: Illness care: Mgmt of acute and chronic conditions in settings where individuals, families, and groups live, work and attend
Community-_________ Nursing - Focus of Care: At-risk individuals, families, and groups; Community - Nursing Activities: Health care: Determining health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community
Community-Oriented Nursing - Focus of Care: At-risk individuals, families, and groups; Community - Nursing Activities: Health care: Determining health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community
A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing:
Community-oriented care
Clinical community health practice
Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies.
Milo's framework for prevention
Complements the health belief model. Emphasizes change at the community level. Identifies relationship between health deficits and availability of health-promoting resources. Theorizes that behavior changes within a large number of people can ultimately lead to social change.
Components of a Community Assessment - People: --- Demographic: Distribution, mobility, density, census data --- Biological factors: Health and disease status, genetics, race, age, gender, causes of death --- ______ factors: Occupation, activities, marital status, education, income, crime rates, recreation, industry --- ______ factors: Positions, roles, history, values, customs, norms, religion
Components of a Community Assessment - People: --- Demographic: Distribution, mobility, density, census data --- Biological factors: Health and disease status, genetics, race, age, gender, causes of death --- Social factors: Occupation, activities, marital status, education, income, crime rates, recreation, industry --- Cultural factors: Positions, roles, history, values, customs, norms, religion
Components of a Community Assessment Health systems ■ Economic systems/factors ■ Education systems ■ Religious systems ■ Welfare systems ■ Political systems ■ Recreation systems/factors ■ Legal systems ■ Communication systems/factors ■ Transportation systems ■ Resources and services
Components of a Community Assessment Health systems ■ Economic systems/factors ■ Education systems ■ Religious systems ■ Welfare systems ■ Political systems ■ Recreation systems/factors ■ Legal systems ■ Communication systems/factors ■ Transportation systems ■ Resources and services
Components of a Community Assessment Place or Environment - _______ factors: Geography, terrain, type of community, location of health services, housing, animal control - ______________ factors: Geography, climate, flora, fauna, topography, toxic substances, vectors, pollutants
Components of a Community Assessment Place or Environment - Physical factors: Geography, terrain, type of community, location of health services, housing, animal control - Environmental factors: Geography, climate, flora, fauna, topography, toxic substances, vectors, pollutants
CQI
Continuous Quality Improvement
Nurse Practice Act
Created by legislation known as a state nurse practice act, the board of nursing is made up of nurses and consumers. The functions of this board are described in the nurse practice act of each state and generally include licensing and examination of RNs and licensed practical nurses; licensing and/or certification of advanced practice nurses; approval of schools of nursing in the state; revocation, suspension, or denying of licenses; and writing of regulations about nursing practice and education.
Tenn Care
Created in 1994; Replaces ___ original Medicaid program
________ Theory - Learning theory that uses ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors.
Critical Theory - Learning theory that uses ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors.
What model: 1) Change inequality ----> Change health 2) Clients needs first
Critical Theory Perspective
Cultural ______________ - Provides information to the health care provider about the effect of culture on communication, space and physical contact, time, social organization, and environmental control factors.
Cultural Assessment - Provides information to the health care provider about the effect of culture on communication, space and physical contact, time, social organization, and environmental control factors.
Cultural ____________ - Includes self-awareness of one's own cultural background, biases, and differences.
Cultural Awareness - Includes self-awareness of one's own cultural background, biases, and differences.
Culturally aware nurses -More likely to explore cultural __________ among clients -Better able to understand how personal beliefs impact client care -Able to recognize the meaning of health differs with each culture --- Cultural needs of the client are as important as physical and psychological needs. --- Personal cultural values should not be imposed on the client, and nurses should avoid ethnocentrism and stereotyping in the provision of care
Culturally aware nurses -More likely to explore cultural variations among clients -Better able to understand how personal beliefs impact client care -Able to recognize the meaning of health differs with each culture --- Cultural needs of the client are as important as physical and psychological needs. --- Personal cultural values should not be imposed on the client, and nurses should avoid ethnocentrism and stereotyping in the provision of care
A case management nurse at an acute care facility is conducting an initial visit with a client to identify needs prior to discharge home. After developing a working relationship with the client, the nurse is engaging in the referral process. Which of the following should be the first action by the nurse? A. Monitor the client satisfaction with the referral. B. Provide client information to referral agencies. C. Review available resources with the client. D. Identify referrals that the client needs.
D
A nurse is talking to a client who asks for additional information about hospice. Which of the following is an appropriate statement by the nurse? A. Clients who require skilled nursing care at home qualify for hospice care B. One function of hospice is to provide teaching to clients about life-sustaining measures C. Hospice assist clients to develop skills needed to care for themselves independently D. A component of hospice care is to control the clients symptoms
D.
A nurse working in a pediatric clinic is caring for a preschool-age child who has a new diagnosis of ADHD. When teaching the parent about this disorder, which of the following statements should the nurse include in the teaching? A. "Behaviors associated with ADHD must be present prior to age 3." B. "This disorder is characterized by argumentativeness." C. "Below-average intellectual functioning is associated with ADHD." D. "Because of this disorder, your child is at an increased risk for injury."
D. "Because of this disorder, your child is at an increased risk for injury."
A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? A. "Assign the client to a private room." B. "Document the client's behavior every hour." C. "Allow the client to keep perfume in her room." D. "Ensure that the client swallows medication."
D. "Ensure that the client swallows medication."
A nurse in a long-term care facility is caring for a resident who has major neurocognitive disorder and attempts to wander out of the building. The client states, "I have to get home." Which of the following is an appropriate response by the nurse? A. "You have forgotten that this is your home." B. "You cannot go outside without a staff member." C. "Why would you want to leave? Aren't you happy with your care?" D. "I am your nurse. Let's walk together to your room."
D. "I am your nurse. Let's walk together to your room."
A nurse is discussing free association as a therapeutic tool with a client who has major depressive disorder. Which of the following client statements indicates understanding of this technique? A. "I will write down my dreams as soon as I wake up." B. "I may begin to associate my therapist with important people in my life." C. "I can learn to express myself in a nonaggressive manner." D. "I should say the first thing that comes to my mind."
D. "I should say the first thing that comes to my mind
When a family asks a nurse for reassurance about a client's condition, which of the following is an appropriate response? A. "I think your son is getting better. What have you noticed?" B. "I'm sure everything will be okay. It just takes time to heal." C. "I'm not sure what's wrong. Have you asked the doctor about your concerns?" D. "I understand you're concerned. Let's discuss what concerns you specifically."
D. "I understand you're concerned. Let's discuss what concerns you specifically."
A nurse is providing teaching for a client who is scheduled to receive electroconvulsive therapy (ECT) for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching? A. "It is common to treat depression with ECT before trying medications." B. "I can have my depression cured if I receive a series of ECT treatments." C. "I will have seizures lasting 1½ to 2 min during ECT." D. "I will receive a muscle relaxant to protect me from injury during ECT."
D. "I will receive a muscle relaxant to protect me from injury during ECT."
A nurse is discussing normal uncomplicated grief with a client who recently lost a child. Which of the following statements made by the client requires additional intervention? A. "I may experience feelings of resentment." B. "I may withdraw from others." C. "It is possible to experience changes in sleep." D. "It is possible to experience suicidal thoughts."
D. "It is possible to experience suicidal thoughts."
A nurse is discussing the use of methadone (Dolophine) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "Methadone is a replacement for the client's opioid addiction." B. "Methadone reduces the unpleasant effects associated with abstinence syndrome." C. "Methadone can be used during opioid withdrawal and to maintain abstinence." D. "Methadone increases the client's risk for acetaldehyde syndrome."
D. "Methadone increases the client's risk for acetaldehyde syndrome."
A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's adult daughter, which of the following statements is the highest priority to report to the provider? A. "My mother has diabetes that is controlled by her diet." B. "My mother recently completed a course of prednisone for acute bronchitis." C. "My mother received her flu vaccine last month." D. "My mother is currently on furosemide for her congestive heart failure."
D. "My mother is currently on furosemide for her congestive heart failure."
A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates the need for further teaching? A. "Rape is a crime of aggression." B. "Acquaintance rape often involves alcohol." C. "Both men and women can be victims of rape." D. "The majority of rapists are unknown to the victims."
D. "The majority of rapists are unknown to the victims."
A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "To assess cognitive ability, I should ask the client to count backward by 7." B. "To assess affect, I should observe the client's facial expression." C. "To assess language ability, I should instruct the client to write a sentence." D. "To assess remote memory, I should have the client repeat a list of objects."
D. "To assess remote memory, I should have the client repeat a list of objects."
A nurse is caring for a client who states, "I'm so stressed at work because of my coworker. He expects me to finish his work because he's too lazy!" When discussing appropriate communication, which of the following statements by the client to his coworker indicates client understanding? A. "You really should complete your own work. I don't think it's right to expect me to complete your responsibilities." B. "Why do you expect me to finish your work? You must realize that I have my own responsibilities." C. "It is not fair to expect me to complete your work. If you continue, then I will report your behavior to our supervisor." D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."
D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."
A nurse is conducting group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive communication? A. "I wish you would not make me angry." B. "I feel angry when you leave me." C. "It makes me angry when you interrupt me." D. "You'd better listen to me."
D. "You'd better listen to me."
A nurse is caring for a client who is experiencing moderate anxiety. Which of the following is an appropriate nursing intervention when trying to give necessary information to the client? A. Reassure the client that everything will be okay. B. Use a low-pitched voice and speak slowly. C. Ignore the client's anxiety so that she will not be embarrassed. D. Demonstrate a calm manner while using simple and clear language.
D. Demonstrate a calm manner while using simple and clear language.
A nurse is assessing a client who is the victim of sexual assault. Which of the following findings indicate the client is experiencing an initial impact reaction of rape-trauma syndrome? (Select all that apply.) A. Genitourinary soreness from the assault B. Difficulties with low self-esteem C. Sleep disturbances D. Emotional outbursts E. Difficulty making decisions
D. Emotional outbursts E. Difficulty making decisions
A nurse working on an acute mental health unit forms a group to focus on self-management of medications. At each of the meetings, two of the members use the opportunity to discuss their common interest in gambling on sports. This is an example of which of the following? A. Triangulation B. Group process C. Subgroup D. Hidden agenda
D. Hidden agenda
A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing actions is appropriate to include in the client's plan of care? A. Allow the client to select preferred meal times. B. Establish consequences for purging behavior. C. Provide the client with a high-fat diet at the start of treatment. D. Implement one-to-one observation during meal times.
D. Implement one-to-one observation during meal times.
A charge nurse is conducting a class on therapeutic communication to a group of newly licensed nurses. Which of the following responses by the newly licensed nurse requires additional teaching regarding nonverbal communication? A. Personal space B. Posture C. Eye contact D. Intonation
D. Intonation
A nurse is planning care for a client who has a mental health disorder. Which of the following is appropriate to include as a psychobiological intervention? A. Assist the client with systematic desensitization therapy. B. Teach the client appropriate coping mechanisms. C. Assess the client for comorbid health conditions. D. Monitor the client for adverse effects of medications.
D. Monitor the client for adverse effects of medications.
A nurse in an acute mental health facility is caring for a client who is experiencing a mixed episode of bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior. B. Administer prescribed medications as scheduled. C. Provide the client with step-by-step instructions during hygiene activities. D. Monitor the client for escalating behavior.
D. Monitor the client for escalating behavior.
A nurse is caring for a school age child who has a new prescription for methylphenidate (Daytrana) to treat ADHD. Which of the following should the nurse teach the client and family about this medication? A. Apply the patch once daily at bedtime. B. Take the medication orally with food every 12 hr. C. Take a second dose of the medication orally at bedtime. D. Remove the patch each day after 9 hr.
D. Remove the patch each day after 9 hr.
A nurse working in a mental health clinic is providing teaching to a client who has a new prescription for diazepam (Valium) for generalized anxiety disorder. Which of the following is appropriate for the nurse to include in the teaching? A. 3 to 6 weeks of treatment is required to achieve therapeutic benefit. B. Combining alcohol with diazepam will produce a paradoxical response. C. Diazepam has a lower risk for dependency than other antianxiety medications. D. Report confusion as a potential indication of toxicity.
D. Report confusion as a potential indication of toxicity.
A nurse is communicating with a client on the acute mental health facility. The client states, "I can't sleep. I stay up all night." The nurse responds, "You are having difficulty sleeping?" Which of the following therapeutic communication techniques is the nurse demonstrating? A. Offering general leads B. Summarizing C. Focusing D. Restating
D. Restating
A nurse is caring for a client who is experiencing a panic attack. Which of the following is an appropriate nursing intervention? A. Discuss new relaxation techniques. B. Show the client how to change his behavior. C. Distract the client with a television show. D. Stay with the client, and remain quiet.
D. Stay with the client, and remain quiet.
Defense Mechanism -____ immunity --- protection due to the immunity of most community members making exposure unlikely -Natural immunity --- natural defense mechanisms of the body to resist specific antigens or toxins -Acquired immunity --- develops through actual ________ to the infectious agent --- active ------ __________ of antibodies by the body in response to infection or immunization with a specific antigen --- passive ------ ________ of antibodies to the host either transplacentally from mother to newborn, or through transfusions of immunoglobulins, plasma proteins, or antitoxins
Defense Mechanism -Herd immunity --- protection due to the immunity of most community members making exposure unlikely -Natural immunity --- natural defense mechanisms of the body to resist specific antigens or toxins -Acquired immunity --- develops through actual exposure to the infectious agent --- active ------ production of antibodies by the body in response to infection or immunization with a specific antigen) --- passive ------ transfer of antibodies to the host either transplacentally from mother to newborn, or through transfusions of immunoglobulins, plasma proteins, or antitoxins
Case Management
Defined in public health nursing as the ability to "optimize self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. •Knowledge of community resources and financing methods •Written and oral communication and documentation skills •Negotiation and conflict-resolution skills •Critical thinking processes to identify and prioritize problems from the view of the provider and client •Application of evidence-based practices and outcome measures
Community-focused nursing
Delivery of nursing care to improve health of an entire community - bigger picture, deals with prevention and population at systems level.
Substance use disorders
Denial: defensiveness, lying about use, minimize use, blaming use, intellectualizing.
Distributive Justice
Determining eligibility for health care services based on income and fiscal resources
Distributive Justice (situation)
Determining eligibility for health care services based on income and fiscal resources
Program Planning: Planning
Develop interventions, Establish goals and objectives for the selected solution, select strategies/interventions to meet the objectives
Nonmaleficence (situation)
Developing plans of care that include a system for monitoring and evaluating outcomes
What is Joseph Lister famous for?
Developing: Wound Care Surgery
Development of a Community Health Education Plan 1. Identify __________-specific learning needs. --- Consider population-specific concerns and effect of health needs on the population to determine the priority learning need. 2. Select aspects of learning ______ to use in the educational program based on the identified learning need. 3. Identify ________ to learning and learning styles 4. Design the educational program. 5. Implement the education program. --- Ensure an ___________ that is conducive to learning 6. Evaluate the achievement of learning objectives and the effectiveness of instruction.
Development of a Community Health Education Plan 1. Identify population-specific learning needs. --- Consider population-specific concerns and effect of health needs on the population to determine the priority learning need. 2. Select aspects of learning theories to use in the educational program based on the identified learning need. 3. Identify barriers to learning and learning styles 4. Design the educational program. 5. Implement the education program. --- Ensure an environment that is conducive to learning 6. Evaluate the achievement of learning objectives and the effectiveness of instruction.
_____________ Theory - Learning theory that uses techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge.
Developmental Theory - Learning theory that uses techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge.
DRGs
Diagnosis Related Groups
Diagnosis of Community Health Program Planning, Development, and Management - Identify and prioritize health _____ of the community: --- Analyze data to determine health needs. --- Work with community members, local health professionals and administrators to develop priorities and establish outcomes.
Diagnosis of Community Health Program Planning, Development, and Management - Identify and prioritize health needs of the community: --- Analyze data to determine health needs. --- Work with community members, local health professionals and administrators to develop priorities and establish outcomes.
Discharge Planning - Is an essential component of the continuum of care, and is ongoing assessment that anticipates the ______ needs of the client. - Requires ongoing communication between the client, nurse, providers, family, and other health care providers. - The goal is to enhance the well-being of the client by establishing appropriate options for meeting the health care needs of the client. - Discharge planning begins at __________.
Discharge Planning - Is an essential component of the continuum of care, and is ongoing assessment that anticipates the future needs of the client. - Requires ongoing communication between the client, nurse, providers, family, and other health care providers. - The goal is to enhance the well-being of the client by establishing appropriate options for meeting the health care needs of the client. - Discharge planning begins at admission.
What is a pandemic?
Disease throughout ENTIRE: Country, Continent, OR World
Demographic
Distribution, mobility, density, census data, racial distrubution
Distributive Justice - Fair distribution of the ________ and burden in society is based on the needs and contributions of its members. This principle requires that consistent with the dignity and worth of its members and within the limits imposed by its resources, a society must determine a minimal level of goods and services to be available to its members. - Determining _________ for health care services based on income and fiscal resources
Distributive Justice - Fair distribution of the benefits and burden in society is based on the needs and contributions of its members. This principle requires that consistent with the dignity and worth of its members and within the limits imposed by its resources, a society must determine a minimal level of goods and services to be available to its members. - Determining eligibility for health care services based on income and fiscal resources
______are often first-line medications to treat hypertension
Diuretics
Public health nursing specialists are interested in which of the following topic(s)?
Evaluation of an outreach program for at-risk pregnant teenagers Community subpopulations with high rates of type 2 diabetes Prevalence of hypertension among various age, race, and gender groups
PDCA
Plan-Do-Check-Act
Chemical Agents
Drugs Toxins
Streptomycin sulfate (Streptomycin)
Due to its high level of toxicity, this medication should be used only in clients who have multidrug-resistant TB (MDR-TB)It can cause ototoxicity, so monitor hearing function and tolerance often. Report significant changes in urine output and renal function studies.
What is the meaning of secondary prevention?
Early detection and treatment of disease with the goal of limiting severity and adverse effects
Secondary Prevention
Early diagnosis and prompt interventions to limit disabilities Example: Pap smear, mammogram, physical;Screening, Testing
things that decrease a risk for stroke
Early treatment of hypertension, maintenance of blood glucose within expected range, and refraining from smoking Maintaining a healthy weight and getting regular exercise
What is being done early with Secondary Prevention?
Early: Detection Treatment
Observed that deathrates were assocated with Class and Occupation
Edward Chadwick
Who developed the first vaccine, what was it to vaccinate against?
Edward Jenner Small pox
________ discovered vaccinations for _________ during the Sanitary Revolution.
Edward Jenner Small pox (via exposure to cow pox)
Emergency Preparedness
Effective disaster plans are designed by those with knowledge of the work processors and materials, the workers and workplace, and the resources of the community.
Epidemiological Process - Phase: Gather information from a variety of sources in order to narrow down the possibilities. - The nurse assess all possible sites for amassing information related to the disease process. The nurse evaluates the plausibility of the proposed hypothesis.
Epidemiological Process - Phase: Gather information from a variety of sources in order to narrow down the possibilities. - The nurse assess all possible sites for amassing information related to the disease process. The nurse evaluates the plausibility of the proposed hypothesis.
If a disease of infection is ALWAYS present in a population, what is it called?
Endemic
Assurance
Ensuring healthy populations Appropriate and accessible services for all Healthful physical environment Stable ecosystem Strong, supportive, non exploitive membership Extensive participation in decision making Members' basic needs provided for. Access to resources and opportunities for interaction Sustainable vital economy Maintain connectedness with cultural and biological heritages Provide governance structures that promote health.
Environment - _______: Geography, water/food supply, presence of reservoir/vectors - _______: Access to health care(resource availability), high-risk working conditions, poverty ________ (temperature, rainfall) • Plant and animal life (agents, reservoirs or habitats for agents) • Human population distribution (crowding, social support) • Socioeconomic factors (education, resources, access to care) • Working conditions (levels of stress, noise, satisfaction)
Environment - Physical: Geography, water/food supply, presence of reservoir/vectors - Social: Access to health care(resource availability), high-risk working conditions, poverty Climate (temperature, rainfall) • Plant and animal life (agents, reservoirs or habitats for agents) • Human population distribution (crowding, social support) • Socioeconomic factors (education, resources, access to care) • Working conditions (levels of stress, noise, satisfaction)
In the "I PREPARE" mnemonic, E=
Environmental Concerns OR Educate
____________ Health - Refers to the influence of environmental conditions on the development of disease or injury.
Environmental Health - Refers to the influence of environmental conditions on the development of disease or injury.
Environmental Risks - ______ (lead, pesticides, mercury, solvents, asbestos, and radon. - ___ pollution (carbon monoxide, particulate matter, ozone, lead, aerosols, nitrogen dioxide, sulfur dioxide, and tobacco smoke. - _____ pollution (Wastes, erosion after mining or timbering,and run-off from chemicals added to the soil.
Environmental Risks - Toxins (lead, pesticides, mercury, solvents, asbestos, and radon. - Air pollution (carbon monoxide, particulate matter, ozone, lead, aerosols, nitrogen dioxide, sulfur dioxide, and tobacco smoke. - Water pollution (Wastes, erosion after mining or timbering,and run-off from chemicals added to the soil.
If a disease or infection FLARES UP, what is it called?
Epidemic
Epidemic - Rate of disease ________ the usual level of the condition in a defined population
Epidemic - Rate of disease exceeds the usual level of the condition in a defined population
Epidemiological Calculations - Incidence: Number of ___ cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000 - Prevalence: Number of _______ cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000 - Crude Mortality Rate: Number of deaths ÷ population total x 1,000 = _____ per 1,000 - Infant Mortality Rate: Number of infant deaths before _ year of age in a year ÷ numbers of live births in the same year x 1,000 = _____ per 1,000 - Attack Rate: Number of people exposed to a specific agent who _______ the disease ÷ total number of people __________
Epidemiological Calculations - Incidence: Number of new cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000 - Prevalence: Number of existing cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000 - Crude Mortality Rate: Number of deaths ÷ population total x 1,000 = _____ per 1,000 - Infant Mortality Rate: Number of infant deaths before 1 year of age in a year ÷ numbers of live births in the same year x 1,000 = _____ per 1,000 - Attack Rate: Number of people exposed to a specific agent who develop the disease ÷ total number of people exposed
Epidemiological Process - Phase: Using the gathered data, formulate a possible theory. - At this time, the nurse projects and explores the possible explanations
Epidemiological Process - Phase: Using the gathered data, formulate a possible theory. - At this time, the nurse projects and explores the possible explanations
Epidemiological Process - Phase: Determine the nature, extent, and possible significance of the problem. - During this phase of the process, the nurse collects information from as many sources as possible. This information is then used to determine the ______ of the problem.
Epidemiological Process - Phase: Determine the nature, extent, and possible significance of the problem. -During this phase of the process, the nurse collects information from as many sources as possible. This information is then used to determine the scope of the problem.
Epidemiological Process - Phase: Gather information from a variety of sources in order to narrow down the possibilities. - The nurse assess all possible sites for amassing information related to the disease process. The nurse evaluates the plausibility of the proposed hypothesis.
Epidemiological Process - Phase: Gather information from a variety of sources in order to narrow down the possibilities. -The nurse assess all possible sites for amassing information related to the disease process. The nurse evaluates the plausibility of the proposed hypothesis.
Epidemiological Process - Phase: Put the plan into action - Using all available means, the nurse puts the plan for __________ the disease into action.
Epidemiological Process - Phase: Put the plan into action - Using all available means, the nurse puts the plan for controlling the disease into action.
Epidemiological Process - Phase: _______ and follow up. - Synthesizes evaluation data into a format that is understandable. The nurse evaluates successes and failures and bases follow-up on the evaluation information.
Epidemiological Process - Phase: Report and follow up. - Synthesizes evaluation data into a format that is understandable. The nurse evaluates successes and failures and bases follow-up on the evaluation information.
Epidemiological Triangle - Agent: Animate or inanimate object that _____ the disease - Host: Living being that is ___________ by the agent - ____________: Setting or surrounding that sustains the host
Epidemiological Triangle - Agent: Animate or inanimate object that causes the disease - Host: Living being that is affected by the agent - Environment: Setting or surrounding that sustains the host
Epidemiology - Is the study of health-related ______ in populations for the purposes of disease prevention, health maintenance, and health protection. - Relies on statistical evidence to determine the rate of spread of disease and the proportion of people affected. - Involves the study of the relationships among an ____ , a ____, and an _____________ - Their interaction determines the development and cessation of communicable diseases, and they form a web of causality, which increases or decreases the risk for disease.
Epidemiology - Is the study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection. - Relies on statistical evidence to determine the rate of spread of disease and the proportion of people affected. - Involves the study of the relationships among an agent, a host, and an environment - Their interaction determines the development and cessation of communicable diseases, and they form a web of causality, which increases or decreases the risk for disease.
Planning health education
Establish outcomes - measurable Mutual goal setting with community as client
Clara Barton
Established The Red Cross, Launched the American Red Cross in 1881. An "angel" in the Civil War, she treated the wounded in the field.
Florence Nightingale
Established a training school for nurses, Established sanitary nursing care units. Founder of modern nursing. began professional education of nursing.
Marine Hospital
Established by Congress Facility became the Public Health Service
utilitarianism
Ethical theory based on the weighing of morally significant outcomes or consequences regarding the overall maximizing of good and minimizing of harm for the greatest number of people.
deontology
Ethical theory that bases moral obligation on duty and claims that actions are obligatory irrespective of the good or bad consequences that they produce. Because humans are rational, they have absolute value. Therefore, persons should always be treated as ends in themselves and never only as means.
Program Planning: Evaluation
Evaluate strengths/ weaknesses of program, determine achievement of desired outcomes, examine adequacy, efficiency, and cost effectiveness
Evaluation of Community Health Program Planning, Development, and Management - Evaluate strengths and weaknesses of the program. - Determine achievement of desired ________. - Examine the adequacy, efficiency, appropriateness, and cost benefit of the program. - Recommend and implement modifications to better meet the needs of the community. - Share findings and recommendations with community members and __________. - Ongoing evaluation is necessary in order to ensure program success and meet the changing needs of the community.
Evaluation of Community Health Program Planning, Development, and Management - Evaluate strengths and weaknesses of the program. - Determine achievement of desired outcomes. - Examine the adequacy, efficiency, appropriateness, and cost benefit of the program. - Recommend and implement modifications to better meet the needs of the community. - Share findings and recommendations with community members and stakeholders. - Ongoing evaluation is necessary in order to ensure program success and meet the changing needs of the community.
Evaluation: Applying the Nursing Process during Case Mgt - Monitor the client to determine whether services are still ___________ - Monitor the care provided by the different agencies, comparing against: --- Original projected outcomes --- Physical needs --- Psycho-social needs --- Financial needs --- Client and family ____________
Evaluation: Applying the Nursing Process during Case Mgt - Monitor the client to determine whether services are still appropriate - Monitor the care provided by the different agencies, comparing against: --- Original projected outcomes --- Physical needs --- Psycho-social needs --- Financial needs --- Client and family satisfaction
Affective Domain
FEELINGS attitudes, values:appreciates, chooses, accepts - role play, talk to s.o., feelings.
Disaster response
FEMA, CDC, U.S. Department of Homeland Security, American Red Cross, Office of Emergency Management, public health system. If a federal emergency is declared, the National Response Framework is activated and provides direction for an organized, effective national response.
Distributive Justice (definition)
Fair distribution of the benefits and burden in society is based on the needs and contributions of its members
Faith Community Nurse - Works with a group of clients who share common faith traditions. - Most religions have practices that are important to health and healing, and many follow specific practices when caring for an ill or dying member.
Faith Community Nurse - Works with a group of clients who share common faith traditions. - Most religions have practices that are important to health and healing, and many follow specific practices when caring for an ill or dying member.
Parish Nursing
Faith community nursing, also known as parish nursing, is a concept that began in the late 1960s in the United States when increasing numbers of churches employed registered nurses to provide holistic, preventive health care to congregation members. Faith community nursing is a model of care that uses nurses based within faith communities such as churches and synagogues to provide health services to the members of those communities.
Community Health Nursing
Familiar and comfortable environment for PT Routine more determined by PT Diverse resources Autonomy, choice in HC decisions for PT by PT
hep A (HAV)
Fecal-oral route › Ingestion of contaminated food or water › Close personal contact with an infected individual (use PPE with incontinent patients)
Government Health Care Functions
Federal, state, and local governments carry out five health care functions, which fall into the general categories of direct services, financing, information, policy setting, and public protection.
Health Belief Model - Is an individual-level model that can be used to plan programs if you think the motivation of learners might be a concern. - Purpose is to predict or explain health behaviors - Assumes that preventive health behaviors are taken primarily for the purpose of ______ disease - Emphasizes change at the individual level - Describes likelihood of taking action to _____ disease based on: Perceived susceptibility, seriousness, and threat of a disease. Modifying factors (knowledge level). Cues to action (media campaigns, disease impact on family/friends, recommendation from health care professionals). Perceived benefits minus perceived barriers to taking action
Health Belief Model - Is an individual-level model that can be used to plan programs if you think the motivation of learners might be a concern. - Purpose is to predict or explain health behaviors - Assumes that preventive health behaviors are taken primarily for the purpose of avoiding disease - Emphasizes change at the individual level - Describes likelihood of taking action to avoid disease based on: Perceived susceptibility, seriousness, and threat of a disease. Modifying factors (knowledge level). Cues to action (media campaigns, disease impact on family/friends, recommendation from health care professionals). Perceived benefits minus perceived barriers to taking action
Health Belief Model - The HBM includes six components that attempt to answer the question of what motivates an individual to do something. These components are (1) perceived ___________ ("Will something happen to me?"), (2) perceived __________ ("If something does happen to me, will it be a big problem?"), (3) perceived _________ ("If I do what is suggested, will it really help me?"), (4) perceived _________ ("Assuming I do what is suggested, will there be barriers that will be unpleasant, costly, and so forth?"), (5) cues to ________ ("What might motivate me to actually do something?"), and (6) self-_________ ("Can I really do this?")
Health Belief Model - The HBM includes six components that attempt to answer the question of what motivates an individual to do something. These components are (1) perceived susceptibility ("Will something happen to me?"), (2) perceived severity ("If something does happen to me, will it be a big problem?"), (3) perceived benefits ("If I do what is suggested, will it really help me?"), (4) perceived barriers ("Assuming I do what is suggested, will there be barriers that will be unpleasant, costly, and so forth?"), (5) cues to action ("What might motivate me to actually do something?"), and (6) self-efficacy ("Can I really do this?")
HMO
Health Management Organizations
HEDIS
Health Plan Employer Data and Information Set
HRQoL
Health Risk and Quality of Life
Community oriented nursing activities
Health care: Determining health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community
Health indicators - are often used to describe the health status of a community and serve as targets for the improvement of a community's health. - EXAMPLE: _________ rates, disease prevalence, levels of physical activity, obesity, tobacco use, substance use)
Health indicators - are often used to describe the health status of a community and serve as targets for the improvement of a community's health. - EXAMPLE: Mortality rates, disease prevalence, levels of physical activity, obesity, tobacco use, substance use)
Newest Vital Sign
Health literacy test: being able to read food labels.
impact of health promotion
Health promotion impacts communities; health promotion activities can also impact an entire system; involves all levels of prevention to promote health across the lifespan.
Healthy People - Coordinated by the United States Department of Health and Human Services, along with other federal agencies, and transitioned to Healthy People 2020 in January 2010.
Healthy People - Coordinated by the United States Department of Health and Human Services, along with other federal agencies, and transitioned to Healthy People 2020 in January 2010.
________ People - Initiated in 1979, and every 10 years, publishes the national health objectives that serve as a guide for promoting health and preventing disease.
Healthy People - Initiated in 1979, and every 10 years, publishes the national health objectives that serve as a guide for promoting health and preventing disease.
extreme heat and health
Heat waves send thousands to emergency rooms and cost health care systems millions of dollars; climate change brings longer, more intense heat waves.
Phases of emotional reaction during a disaster
Heroic - intense excitement and concern for survival. Rush for assistance. Honeymoon- affected individuals being to bond and relive their experiences. Disillusionment - responders may experience depression and exhaustion. Delays in receiving aid. Reconstruction- involves adjusting to a new reality and continued rebuilding of the area. Counseling may be needed.
Triage Emergent category (class I) -
Highest priority is given to clients who have life-threatening injuries but also have a high possibility of survival once they are stabilized
Kauffman's Five Phases
IBSBC Impressing Behaving - building rapport Swapping - sharing information Belonging - becoming part of the group Chilling out - near end of relationship, beginning longer term partnership with the community.
Home Health Nurse - Provide health care services to clients where they reside: traditional homes, assisted living facilities, and nursing homes. -Is a educator, provider of skilled nursing interventions, and coordinator of care - Must evaluate the living environment for ______ --- paying close attention to non-secure rugs, electrical outlets, and extension cords; the use of oxygen; safety devices in bathrooms - Provides follow-up care after an acute hospital stay. --- Educate the client and the family regarding ____________ or adverse reactions. ------ Include when to contact the agency, ER, PCP - Provides education that encourages clients to be independent and to be involved in their own care. --- allows families to be involved in the care and decision-making regarding their family members.
Home Health Nurse - Provide health care services to clients where they reside: traditional homes, assisted living facilities, and nursing homes. -Is a educator, provider of skilled nursing interventions, and coordinator of care - Must evaluate the living environment for safety --- paying close attention to non-secure rugs, electrical outlets, and extension cords; the use of oxygen; safety devices in the bathrooms - Provides follow-up care after an acute hospital stay. --- Educate the client and the family regarding complications or adverse reactions. ------ Include when to contact the agency, ER, PCP - Provides education that encourages clients to be independent and to be involved in their own care. --- allows families to be involved in the care and decision-making regarding their family members.
Homelessness: Population Characteristics - Families with children (____est growing segment) - People who have ______ illness (large segment)
Homelessness: Population Characteristics - Families with children (fastest growing segment) - People who have mental illness (large segment)
Hospice Nurse - Focuses on enhancing the _______ of life through the provision of palliative care, supporting the client and family through the dying process, and providing bereavement support to the family following the client's death. - Uses an interprofessional approach. - Controlling ________ is a priority. - Helping the family transition from an expectation of recovery to acceptance of death is an important aspect of providing hospice care. - May continue to work with the family for up to _ year following the death of the client.
Hospice Nurse - Focuses on enhancing the quality of life through the provision of palliative care, supporting the client and family through the dying process, and providing bereavement support to the family following the client's death. - Uses an interprofessional approach. - Controlling symptoms is a priority. - Helping the family transition from an expectation of recovery to acceptance of death is an important aspect of providing hospice care. - May continue to work with the family for up to 1 year following the death of the client.
Medicare Part A
Hospital Insurance
Host Age, gender, genetics, ethnicity, immunological status, physiological state, occupation Genetic susceptibility • ____________ characteristics (age, sex) • __________ characteristics (immunological status) • __________ factors (diet, exercise)
Host Age, gender, genetics, ethnicity, immunological status, physiological state, occupation Genetic susceptibility • Immutable characteristics (age, sex) • Acquired characteristics (immunological status) • Lifestyle factors (diet, exercise)
Epidemiological Triangle
Host - Agent - Environment and (Vector)
Epidemiological triangle
Host, agent, & environment Ex: Host-Person; Agent- Mosquito; Environment- swampy environment in tropical region; disease- malaria
drought and health
Hotter days and nights, and changing rainfall patterns reduce water supply quantity and quality, and diminish food security.
infectious diseases and health
Hotter summers can make disease-carrying insects more active, for longer seasons; illnesses like dengue, West Nile, and Lyme can spread into new areas
Questions to track outcome (MAPP)
How do we track? How do we affect public policy? How do we promote a sense of community? How do we assure access to care? How do we encourage healthy lifestyles? How do we provide a safe environment?
____________ Theory - Learning theory that assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest.
Humanistic Theory - Learning theory that assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest.
Period: LOWEST disease rate
Hunting
Potential for abuse
Hx or being abused or exposed to violence, low self-esteem, fear and distrust of others, poor self-control, inadequate social skills, minimal social support, immature miscarriage, weak coping skills.
Interpreters - Use of family members as interpreters is not advisable because clients may need privacy in discussing sensitive matters. - Client preferences should be considered when selecting the age and ___ of interpreters. - Should not be from the same community as client. - Health teaching material should be available in the client's primary language. - Federal govt mandates require agencies to have a plan that will improve access to federal health care programs for individuals with limited English proficiency.
Interpreters - Use of family members as interpreters is not advisable because clients may need privacy in discussing sensitive matters. - Client preferences should be considered when selecting the age and sex of interpreters. - Should not be from the same community as client. - Health teaching material should be available in the client's primary language. - Federal govt mandates require agencies to have a plan that will improve access to federal health care programs for individuals with limited English proficiency.
Interprofessional Team - Essential to providing _______ care. --- Nurses, physical therapists, occupational therapists, home health aides, social workers, and dietitians may be part of the interprofessional care provided in the home.
Interprofessional Team - Essential to providing holistic care. --- Nurses, physical therapists, occupational therapists, home health aides, social workers, and dietitians may be part of the interprofessional care provided in the home.
Tertiary Prevention
Interventions aimed at limiting the disability and interventions that enhance rehab from disease, injury or disability
Secondary Prevention
Interventions designed to increase the probability that a person with as disease will have the condition diagnosed early enough that treatment is likely to result in cure
Population-focused care
Interventions for a defined "at risk" population (e.g. people with hypertension, weight problems)
Population-focused care
Interventions for health promotion, disease prevention to shape a community's overall health status.
What does "I PREPARE" stand for?
Investigate Present work Residence Environmental concerns Past work Activities Referrals Educate
Epidemiology
Investigate the distribution or patterns of health events in populations and the factors that influence those patterns. Focuses on populations rather than treatment of disease in individuals.
Primary health care (PHC)
It includes a comprehensive range of services including public health; prevention; and diagnostic, therapeutic, and rehabilitative services. PHC is essential care made universally accessible to individuals and families in a community. PHC encourages self-care and self-management in health and the social welfare of daily life. PHC does not provide a focus on incidence of disease, pathophysiology of disease, or individual orders for care.
What was the first medical school and who funded it?
John Hopkins Rockerfeller
Discovered that Cholera was being spread by a contaminated water pump.
John Snow
JACHO
Joint Commission on Accreditation of Healthcare Organizations
JCAH
Joint Commission on Accreditation of Hospitals
Client barriers to referral process
Lack of motivation › Inadequate information about community resources › Inadequate understanding of the need for referral › Accessibility needs › Priorities › Finances › Cultural factors
Leading Causes of Communicable Disease - acute respiratory infections (including pneumonia and influenza), - AIDS, - diarrheal diseases, - tuberculosis, - malaria - measles.
Leading Causes of Communicable Disease - acute respiratory infections (including pneumonia and influenza), - AIDS, - diarrheal diseases, - tuberculosis, - malaria - measles.
Communicable diseases
Leading causes of death are acute respiratory infections (pneumonia and influenza), AIDS, diarrheal diseases, tuberculosis, malaria, measles.
Learning Styles - _______ learners: learn through "seeing" and methods such as note taking, video viewing, and presentations. "think in pictures" - __________: learn through "listening", methods such as verbal lectures, discussion, and reading aloud. "Interpret meaning while listening." - Tactile-___________: "doing", methods such as trial and error, hands-on approaches, and return demonstration. "meaning through exploration."
Learning Styles - Visual learners: learn through "seeing" and methods such as note taking, video viewing, and presentations. "think in pictures" - Auditory: learn through "listening", methods such as verbal lectures, discussion, and reading aloud. "Interpret meaning while listening." - Tactile-kinesthetic: "doing", methods such as trial and error, hands-on approaches, and return demonstration. "meaning through exploration."
Established: Well Child Assessments Stats in Massachusetts Child Healthcare Reform
Lemuel Shattack
Infection Theory - Who?
Lewenhoek
Who were the 2 influential nurses in the US?
Lilian wald Mary Brewster
general nursing care for hepatitis
Limit the client's activity in order to promote hepatic healing. ◯ Provide a high-carbohydrate, high-calorie, low- to moderate-fat, and low- to moderate-protein diet, and small, frequent meals to promote nutrition and healing. ◯ To promote hepatic rest and the regeneration of tissue, administer only necessary medications. ◯ Educate the client and family regarding measures to prevent the transmission of the disease with others at home (avoid sexual intercourse until hepatitis antibody testing is negative, avoid alcohol, avoid over-the-counter medications or herbal medications, use proper hand hygiene)
Social learning theory
Links information to beliefs and values to change or shift the learners' expectations.
Local Health Department - The primary focus of a _____ health department is the health of its citizens. - Responsible for identifying and intervening to meet health needs of the local community - Work closely with local officials, businesses, and stakeholders - Report notifiable communicable _______ to state departments of health - Nurses at the community level typically function in the nursing roles of caregiver, advocate, teacher, coordinator, and consultant
Local Health Department - The primary focus of a local health department is the health of its citizens. - Responsible for identifying and intervening to meet health needs of the local community - Work closely with local officials, businesses, and stakeholders - Report notifiable communicable diseases to state departments of health - Nurses at the community level typically function in the nursing roles of caregiver, advocate, teacher, coordinator, and consultant
Glargine insulin (Lantus)
Long-acting insulin ☐ Administered once daily, anytime during the day but always at the same time each day. ☐ Glargine insulin forms microprecipitates that dissolves slowly over 24 hr and maintains a steady blood sugar level with no peaks or troughs. ☐ Administer glargine insulin subcutaneous only and never administer IV.
Who developed the vaccination to Rabies?
Louis Pasteur
Vector-borne
Lyme disease, rocky mountain spotted fever, malaria
MEDICARE - Provides health coverage for individuals of ___ socioeconomic status and children, through the combined efforts of federal and state governments. - Eligibility is based on household ____ and income, with priority given to children, pregnant women, and those who have a disability. - Provides inpatient and outpatient hospital care, laboratory and radiology services, home health care, vaccines for children, family planning, pregnancy-related care, and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services for those younger than 21 years.
MEDICARE - Provides health coverage for individuals of low socioeconomic status and children, through the combined efforts of federal and state governments. - Eligibility is based on household size and income, with priority given to children, pregnant women, and those who have a disability. - Provides inpatient and outpatient hospital care, laboratory and radiology services, home health care, vaccines for children, family planning, pregnancy-related care, and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services for those younger than 21 years.
MEDICARE Requirements: - Must be older than __ - Receiving Social Security, have been receiving benefits for _ years, have amyotrophic lateral sclerosis and receive disability benefits, or have _____ failure and be on maintenance dialysis or had a kidney transplant to qualify for Medicare.
MEDICARE Requirements: - Must be older than 65 - Receiving Social Security, have been receiving benefits for 2 years, have amyotrophic lateral sclerosis and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to qualify for Medicare.
Clinical Model
MOST LIMITING DOWNSTREAM Health extreme = absence of S/S of disease/disability as IDed by medical science This model = downstream pattern of thinking rather than upstream which is holistic.
MCO
Managed Care Organizations
State Departments of health
Manages WIC program; reports notifiable communicable disease within the state *to the CDC*
State departments of Health
Manages women, infants and children (WIC) program oversees children's health insurance program, which offers expanded health coverage to uninsured children whose families do not qualify for Medicaid. Establishes public health policies. Provides assistance to public health departments. Responsible for the administration of the medicaid program. Reports notifiable communicable disease within the state to the CDC.
Community-Based Nursing Responsibilities
Managing acute or chronic conditions among individual clients and families. Care is family-centered Setting is community based
What is Tertiary prevention? * Individually based
Maximization of recovery after an injury or illness (rehabilitation)
Beneficence (Definition)
Maximize possible benefits and minimize possible harms.
What Model: Manufacture of disease ---> Change Behavior----> V Morbidity
McKinley's Model
Diseases transmitted by Airborne
Measles Chickenpox Streptococcal infection Tuberculosis Pneumonia Flu
Airborne
Measles, chickenpox, tuberculosis, pertussis, influenza
Prevalence proportion
Measure of existing disease in a population at a particular time divided by total population X 1000
Rate
Measure of frequency of a health event in different populations at certain periods
Primary Prevention
Measures that actively promote health, prevent illness, and provide protection. Example: Health Promotion and Education; Targets essentially well populations
Medicare Part B
Medical Insurance Example: Physcians
Medicare - Part A: _______ care, ____ care, limited skilled nursing care - Part B: medical care, diagnostic services, physiotherapy - Part C: aka Medicare Advantage-combo of _ and _ provided through private insurance company. - Part D: prescription ____ coverage
Medicare - Part A: hospital care, home care, limited skilled nursing care - Part B: medical care, diagnostic services, physiotherapy - Part C: aka Medicare Advantage-combo of A and B provided through private insurance company. - Part D: prescription drug coverage
Medicare Part C
Medicare Advantage Plans Example: Plans that supplement A & B
During the 19th C. what was the goal of the public health laws (4)?
Mental Physical Prevention Control DIsease
What did Infection Theory discover?
Micro-organisms, not the associated disease
Time: Beginning of Modern Public Health
Middle Ages
When did Monastaries and Churches start helping with hygiene/health?
Middle Ages
Milio's Framework for Prevention - Compliments the health belief model - Emphasizes change at the community level - Identifies relationship between health deficits and availability of health-promoting resources - Theorizes that behavior changes within a ______ number of people can ultimately lead to social change.
Milio's Framework for Prevention - Compliments the health belief model - Emphasizes change at the community level - Identifies relationship between health deficits and availability of health-promoting resources - Theorizes that behavior changes within a large number of people can ultimately lead to social change.
what model: Policies Drive Change
Milios Prevention
What are the 3 MACROscopic Theories?
Milios Prevention Critical Theory Perspective McKINleys model
Missionary Nurse - Seeks to promote health and prevent disease by meeting spiritual, physical, and emotional needs of people across the globe. - These nurses may be career missionaries, or may serve as short-term, volunteer, or part-time missionaries.
Missionary Nurse - Seeks to promote health and prevent disease by meeting spiritual, physical, and emotional needs of people across the globe. - These nurses may be career missionaries, or may serve as short-term, volunteer, or part-time missionaries.
What is "I Prepare"
Mnemonic for determining current and past environmental exposures
MAPP
Mobilizaing for Action through Planning & Partnerships; this tool helps communities improve health and quality of life through community-wide strategic planning; communities seek to achieve optimal health by identifying and using their resources wisely, taking into account their unique circumstances and needs, and forming effective partnerships for strategic action
MAPP
Mobilizing For Action Through Planning and Partnership
CIRCLE
Model of Spiritual Care - the foundation of Parish nursing
Modes of Transmission of Communicable Diseases -Airborne (inhaled by a susceptible host) --- measles, chicken pox, tuberculosis, pertussis, influenza -Foodborne --- Salmonellosis, Hepatitis A, Trichinosis, Escherichia coli --- Food intoxication: toxins produced through bacterial growth, chemical contamination, or disease-producing substances -Waterborn --- _____ contamination of water --- Cholera, typhoid fever, bacillary dysentery, giardia lamblia -______-borne --- via a carrier such as a mosquito or tick ---Lyme disease, rocky mountain spotted fever, malaria -Direct contact --- transmission of infectious agent from infected host susceptible host via direct contact --Sexually transmitted infections, infectious mononucleosis, enterobiasis, impetigo, lice, scabies
Modes of Transmission of Communicable Diseases -Airborne (inhaled by a susceptible host) --- measles, chicken pox, tuberculosis, pertussis, influenza -Foodborne --- Salmonellosis, Hepatitis A, Trichinosis, Escherichia coli --- Food intoxication: toxins produced through bacterial growth, chemical contamination, or disease-producing substances -Waterborn --- fecal contamination of water --Cholera, typhoid fever, bacillary dysentery, giardia lamblia -Vector-borne --- via a carrier such as a mosquito or tick ---Lyme disease, rocky mountain spotted fever, malaria -Direct contact --- transmission of infectious agent from infected host susceptible host via direct contact --Sexually transmitted infections, infectious mononucleosis, enterobiasis, impetigo, lice, scabies
Self breast exam
Monitor for any change in size, contour, dimpling. Perform exam every month, 2 to 3 days after your period. Use finger pads of the three middle fingers.
Transtheoretical Model
Most common learning theory Stages of Change Precontemplation - resistance; don't see problem Contemplation - know there's a problem and thinking about it Preparation - decision making; prepared for action, e.g., cutting down on cigarettes. Action - modifies behavior/environment to overcome problem. Takes lots of time and energy. W/D S/S now. Maintenance - constant work to avoid relapse.
Pertussis
Nighttime cough with sudden inspirations and a high-pitched sound. Paroxysm coughing with eyes bulging and tongue protruding Thick mucous plug that may dislodge with coughing Early symptoms can last for 1 to 2 weeks and usually include: Runny nose Low-grade fever (generally minimal throughout the course of the disease) Mild, occasional cough Apnea — a pause in breathing (in infants) A client with known or suspected pertussis is placed on droplet precautions. A private room is required, but a room with negative air pressure is not required. A mask is worn when the nurse is within 3 ft of the client. A surgical mask is placed on the client during transport to another area of the facility. Gloves (clean) are worn when handling soiled linen, but sterile gloves are not necessary. A gown should be worn if the nurse's clothing or skin may be contaminated with body secretions or excretions.
Pediculosis capitis (head lice)
Nits that are shed into the environment are capable of hatching for up to 10 days. Pets do not transmit or carry lice.
Nonmaleficence (definition)
No harm is done when applying standards of care
Physical Agents
Noise Temp.
Nonmaleficence - No _____ is done when applying standards of care. - Developing plans of care that include a system for monitoring and evaluation outcomes
Nonmaleficence - No harm is done when applying standards of care. - Developing plans of care that include a system for monitoring and evaluation outcomes
Crude Mortality Rate
Number of deaths divided by population X 1000= ____ per 1000
Crude Mortality rate
Number of deaths ÷ population total x 1,000 = _____ per 1,000
Prevalence:
Number of existing cases in the population at a specific time divided by population total X 1,000= number per 1,000
Prevalence calc
Number of existing cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000
Infant Mortality Rate
Number of infant deaths before 1 year of age in a single year divided by the number of live births in the same year X 1000= ____ per 1000
Infant mortality rate
Number of infant deaths before 1 year of age in a year ÷ numbers of live births in the same year x 1,000 =_____ per 1,000
Incident rate
Number of new cases in events in a population at a specific time divided by population total X 1000 = _____ per 1000
Incidence calc
Number of new cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000
Attack Rate
Number of people exposed to a specific agent who develop the disease divided by total number of people exposed
Attack rate
Number of people exposed to a specific agent who develop the disease ÷ total number of people exposed
Nursing Actions Related to Consultations - Initiate the necessary consults or notify the provider of the client's needs so the provider can initiate a consult - Seek expertise from health care professionals representing a variety of disciplines - Request ______ opinions of key community members, agency leaders, and other professionals.
Nursing Actions Related to Consultations - Initiate the necessary consults or notify the provider of the client's needs so the provider can initiate a consult - Seek expertise from health care professionals representing a variety of disciplines - Request expert opinions of key community members, agency leaders, and other professionals.
Nursing Actions Related to Consultations - See expertise of other nurse, specialty nurses, or advanced practice nurses - Incorporate recommendations from multiple consultants to ensure client ______ - Serve as expert witnesses in _____ proceedings. - Serve as a consultant regarding the health care needs of individuals, families, and groups within the community served.
Nursing Actions Related to Consultations - See expertise of other nurse, specialty nurses, or advanced practice nurses - Incorporate recommendations from multiple consultants to ensure client safety - Serve as expert witnesses in legal proceedings. - Serve as a consultant regarding the health care needs of individuals, families, and groups within the community served.
Community Health Nursing Practice
Nursing Activities: Promote, preserve, and maintain the health of populations by the delivery of health services to individuals, families, and groups in order to impact "community health."
Public Health Nursing Practice
Nursing Activities: Promote, preserve, and maintain the health of populations through disease and disability prevention and health protection of the community as a whole.
Community Based Nursing
Nursing care is family centered, which means that the nurse works to improve the competencies of families to enable them to take better care of themselves. The nurse pays particular attention to the uniqueness of each family and works to plan the most useful interventions. Cultural diversity is taken into account, as are the situations and stressors facing the person or the family at a given time. The nurse promotes client autonomy and helps clients learn to do as much as possible for themselves.
Community-based nursing
Nursing care provided outside of acute care setting. Care for families, individuals within a community. At individual, "hands on" level. Does not require public health background.
Nursing's Role in Health Policy - Change Agents: Advocate for needed change at the local, state, or federal level. - Lobbyists: Persuade or influence ___________. --- Lobbying may be implemented by an individual, or collectively through professional nursing associations. - Coalitions: Facilitation of goal achievement through the collaboration of ___ or more groups. - Public Office: Serving society and advocating for change by influencing policy development through public service.
Nursing's Role in Health Policy - Change Agents: Advocate for needed change at the local, state, or federal level. - Lobbyists: Persuade or influence legislators. --- Lobbying may be implemented by an individual, or collectively through professional nursing associations. - Coalitions: Facilitation of goal achievement through the collaboration of two or more groups. - Public Office: Serving society and advocating for change by influencing policy development through public service.
What are examples of Tertiary Prevention?
Nutrition counseling Exercise rehabilitation Case management (Chronic/Mental illness) Physical and occupational therapy Support groups Exercise for HTN clients (individual)
Occupational Health Nurse Roles - Primary, Secondary, Tertiary prevention. - An occupational health history provides the framework for a nurse to begin to assess a worker for possible exposure to health hazards. - Goal --- to identify agents and host factors that place the worker at risk, --- identify ways to eliminate or minimize ________ --- prevent potential health problems.
Occupational Health Nurse Roles - Primary, Secondary, Tertiary prevention. - An occupational health history provides the framework for a nurse to begin to assess a worker for possible exposure to health hazards. - Goal --- to identify agents and host factors that place the worker at risk, --- identify ways to eliminate or minimize exposure --- prevent potential health problems.
____________ Nurse - Essential for this nurse to develop partnerships with workplace admins, industrial hygienists, safety specialists, occupational medicine physicians, human resource departments, union representatives, and health insurance agencies. - Works toward the health and safety of workers.
Occupational Nurse - Essential for this nurse to develop partnerships with workplace admins, industrial hygienists, safety specialists, occupational medicine physicians, human resource departments, union representatives, and health insurance agencies. - Works toward the health and safety of workers.
Occupational Safety and Health Act of 1970 -Occupational Health and Safety Administration (OSHA) --- Develops and enforces workplace health ___________ to protect the safety and health of workers. -National Advisory Committee on Occupational Safety and Health (NACOSH) --- Gathers and disseminates data on the incidence and __________ of occupational illness and injury. --- This agency is also responsible for __________ education related to occupational injury and illness, as well as determining hazards associated with new workplace technologies.
Occupational Safety and Health Act of 1970 -Occupational Health and Safety Administration (OSHA) --- Develops and enforces workplace health regulations to protect the safety and health of workers. -National Advisory Committee on Occupational Safety and Health (NACOSH) --- Gathers and disseminates data on the incidence and prevalence of occupational illness and injury. --- This agency is also responsible for prevention education related to occupational injury and illness, as well as determining hazards associated with new workplace technologies.
Contact for non-biological or chemical incident
Office of Emergency Management
A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to:
Opinions that nursing should focus on the provision of direct client care and services. (pg) 18
Hepatitis A
Oral-Fecal Route: Risk Factors: Ingestion of contaminated food/water Daycares and communal living facilities Ingestion of food prepared by a hepatitis-infected person who does not practice proper sanitation precautions Travel/residence in underdeveloped country (using tap water to clean food products, drinking contaminated water)
What model: Nurses do for patient, if they cannot?
Orems Self-Care Model
What are the 2 MICROscopic theories?
Orems Self-Care Model Health Belief MODel
Other Drugs -Stimulants: caffeine, amphetamines, methamphetamines, and cocaine. -Depressants: Barbiturates, benzodiazepines, chloral hydrate, and GHB. -Opiates: morphine, heroin, codeine, and fentanyl -Hallucinogens (psychedelics) produce anxiety, paranoia, impaired judgment, and hallucinations. -Inhalants: volatile substances that are inhaled. --- Death may result from acute cardiac dysrhthmias or asphyxiation.
Other Drugs -Stimulants: caffeine, amphetamines, methamphetamines, and cocaine. -Depressants: Barbiturates, benzodiazepines, chloral hydrate, and GHB. -Opiates: morphine, heroin, codeine, and fentanyl -Hallucinogens (psychedelics) produce anxiety, paranoia, impaired judgment, and hallucinations. -Inhalants: volatile substances that are inhaled. --- Death may result from acute cardiac dysrhthmias or asphyxiation.
Health Disparity Factors
Outcomes of mass illness, high death rates, or disabilities Safety, crime, and the prevalence of violence Access to exercise and nutritional information and classes Quality of environmental surroundings and waste removal Economic and employment rates, education levels, and culture
Transtheoretical Model: Stages of Change
PCPAM Precontemplation Contemplation Preparation Action Maintenance
Primary Prevention
PREVENTION Stay well and avoid problem Reduction of risk factors before occurrence of disease condition/injury E.g., exercise, brushing teeth, condoms, immunizations, nutrition.
If a disease is affecting a large % of a population, what is this called?
Pandemic
Parish Nurse - Promote the health and wellness of populations of faith communities. --- Parish nurses work closely with pastoral care staff, professional health care members, and lay volunteers to provide a holistic approach to healing - Functions of the parish nurse --- Personal health counseling: health-risk appraisals, spiritual assessments, support for numerous acute and chronic, actual and potential health problems --- Health education: available resources, classes, individual and group teaching --- _______ between faith community and local resources --- Facilitating support groups --- Help identify spiritual strengths for ______
Parish Nurse - Promote the health and wellness of populations of faith communities. --- Parish nurses work closely with pastoral care staff, professional health care members, and lay volunteers to provide a holistic approach to healing - Functions of the parish nurse --- Personal health counseling: health-risk appraisals, spiritual assessments, support for numerous acute and chronic, actual and potential health problems --- Health education: available resources, classes, individual and group teaching --- Liaison between faith community and local resources --- Facilitating support groups --- Help identify spiritual strengths for coping
Topic of Interest for Public Health Nurse:
Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders
Partnerships with Legislative Bodies - To facilitate needed change, it is important for nurses to stay informed of current policy and laws that influence both the health of the community and nursing practice. - Nurses also should advocate for policies that protect public health or offer solutions to community problems.
Partnerships with Legislative Bodies - To facilitate needed change, it is important for nurses to stay informed of current policy and laws that influence both the health of the community and nursing practice. - Nurses also should advocate for policies that protect public health or offer solutions to community problems.
Phases of MAPP
Phase 1: organizing for success, partnership development Phase 2: visioning Phase 3: The MAPP assessments Phase 4: Identifying strategic issues Phase 5: developing goals and strategies Phase 6: the action cycle
Phases of emotional reaction during a disaster - Heoric: --- Intense excitement and concern for survival. --- Often a rush of ________ from outside the area is present. -Honeymoon: --- Affected individuals begin to ____ and relive their experiences. -Disillusionment: --- __________ may experience depression and exhaustion. --- Phase contains unexpected ______ in receiving aid. -Reconstruction: --- Involves adjusting to a new _______ and continued rebuilding of the area. --- Counseling is sometimes needed. --- Those affected being looking ahead.
Phases of emotional reaction during a disaster - Heoric: --- Intense excitement and concern for survival. --- Often a rush of assistance from outside the area is present. -Honeymoon: --- Affected individuals begin to bond and relive their experiences. -Disillusionment: --- Responders may experience depression and exhaustion. --- Phase contains unexpected delays in receiving aid. -Reconstruction: --- Involves adjusting to a new reality and continued rebuilding of the area. --- Counseling is sometimes needed. --- Those affected being looking ahead.
Planning of Community Health Program Planning, Development, and Management - Develop ___________ to meet identified outcomes: ---- Establish goals and objectives for the selected solution. ------ Objectives are behaviorally stated, measurable, and include a target date for achievement. --- Select strategies/interventions to meet the objectives. --- Establish a timetable. --- Identify who will assume ___________ for each intervention. --- Determine available and needed resources to implement interventions. --- Assess the personnel needed and any special ________ they may require --- Determine funding opportunities and develop a budget. --- Plan for program evaluation.
Planning of Community Health Program Planning, Development, and Management - Develop interventions to meet identified outcomes: ---- Establish goals and objectives for the selected solution. ------ Objectives are behaviorally stated, measurable, and include a target date for achievement. --- Select strategies/interventions to meet the objectives. --- Establish a timetable. --- Identify who will assume responsibility for each intervention. --- Determine available and needed resources to implement interventions. --- Assess the personnel needed and any special training they may require --- Determine funding opportunities and develop a budget. --- Plan for program evaluation.
Planning: Applying the Nursing Process during Case Mgt - In conjunction with the interprofessional team, determine the following: --- ______________ of identified problems --- Possible outcomes for the client --- Advantages and disadvantages of possible outcomes --- What role each participant will play --- Impact on the client in each of the areas listed for the assessment
Planning: Applying the Nursing Process during Case Mgt - In conjunction with the interprofessional team, determine the following: --- Prioritization of identified problems --- Possible outcomes for the client --- Advantages and disadvantages of possible outcomes --- What role each participant will play --- Impact on the client in each of the areas listed for the assessment
Community Assessment
Population assessment Primary informants Gaining entry (Kauffman's 5 phases)
Population-focused nursing - Purpose is assessing the needs and intervening to protect and promote health, and preventing disease within a specific __________. (Individuals at risk for hypertension, individuals without health insurance, individuals with a specific knowledge deficit)
Population-focused nursing - Purpose is assessing the needs and intervening to protect and promote health, and preventing disease within a specific population. (Individuals at risk for hypertension, individuals without health insurance, individuals with a specific knowledge deficit)
The role and goals of the community health nursing practice can best be described as:
Population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. Pgs 15-17
Portals of Entry and Exit of Communicable Diseases - Portals of _____: --- Respiratory passages, gastrointestinal tract, skin, mucous membranes, genitourinary tract, eyes, blood vessels. - Portals of ____: --- Respiratory secretions, feces, blood, semen vaginal secretions, saliva, skin lesion exudates
Portals of entry: Respiratory passages, gastrointestinal tract, skin, mucous membranes, genitourinary tract, eyes, blood vessels. Portals of exit: Respiratory secretions, feces, blood, semen vaginal secretions, saliva, skin lesion exudates
Period of Plagues.
Pre-industrial
When was a working H2O system used (during our periods studied)?
Pre-industrial
PPO
Preferred Provider Organizations
Bioterrorism Primary prevention
Prepare with drills, vaccines, and ensuring availability of antibiotics for exposure prophylaxis. design a response plan, id the chain of command, define nursing roles, set up protocols.
Preplanning of Community Health Program Planning, Development, and Management - Brainstorm Ideas: --- Gain entry into community and establish trust, obtain community awareness, support, and involvement
Preplanning of Community Health Program Planning, Development, and Management - Brainstorm Ideas: --- Gain entry into community and establish trust, obtain community awareness, support, and involvement
Part D
Prescription drug coverage.
Medicare Part D
Prescription drug reimbursement plans offered to Medicare beneficiaries
In the "I PREPARE" mnemonic, P=
Present work OR Past work
air pollution and health
Rising heat worsens smog. Burning coal and oil emits carbon and particle pollution; plants produce more allergenic pollen, affecting respiratory health threats like asthma.
Community Diagnosis (pt of nursing process for the community)
Risk of (specific problem or health risk ) Among (specific group or population affected by the problem/risk) Related to (strengths and weaknesses in the community that influence the specific problem or health risk in the community)
Community Diagnosis
Risk of X Among X group/population
Roles for Nurses in Environmental Health - Facilitate _____ participation - Perform individual and population risk assessments. - Implement risk communication - Conduct _____________ investigations - Participate in policy development
Roles for Nurses in Environmental Health - Facilitate public participation - Perform individual and population risk assessments. - Implement risk communication - Conduct epidemiological investigations - Participate in policy development
Captopril
S/E weight loss, bradicardia,
Diseases transmitted by Foodborne (bacterial, viral, parasitic infection of food)
Salmonellosis Hepatitis A Trichinosis E Coli
What was medical practice based on during "pre-recorded" times?
Sanitation Supersition
School Nursing: Roles -Case manager: __________ comprehensive services for children who have complex health needs. -Community outreach: planning and collaboration between the educational system and other community agencies -Consultant: assists students, families, and personnel in information gathering and decision‑making about a variety of health needs and resources -Counselor -Direct caregiver: provides nursing care to ill or injured children at school. -Health educator -Researcher: contributes to the base of knowledge for school health and educational needs.
School Nursing: Roles -Case manager: coordinates comprehensive services for children who have complex health needs. -Community outreach: planning and collaboration between the educational system and other community agencies -Consultant: assists students, families, and personnel in information gathering and decision‑making about a variety of health needs and resources -Counselor -Direct caregiver: provides nursing care to ill or injured children at school. -Health educator -Researcher: contributes to the base of knowledge for school health and educational needs.
What was the impact of the Flexner Report?
Schools had to teach GERM THEORY
Example of Secondary Prevention
Screenings (to detect .....treat)
Triage Urgent category (class II) -
Second-highest priority is given to clients who have major injuries that are not yet life-threatening and usually can wait 45 to 60 min for treatment
Care: Early
Secondary Prevention
_____________ Prevention - Strategies that lead to early detection and treatment of disease with the goal of limiting severity and adverse effects.
Secondary Prevention - Strategies that lead to early detection and treatment of disease with the goal of limiting severity and adverse effects.
psychosocial
admission process: alcohol, tobaccos, drug, caffeine use, history of mental illness, history of abuse, history of homelessness, home situation, significantothers
Shigellosis
Shigellosis is spread when the bacteria in feces (stool) or on soiled fingers are ingested. Poor hand-washing habits and eating contaminated food may cause the condition. Shigellosis is often found in day care centers, nursing homes, refugee camps, and other places where conditions are crowded and sanitation is poor. Contact precautions require: A private room or a room with other clients with the same infection. Gloves and gowns worn by the caregivers and visitors. Disposal of infectious dressing material into a single,nonporous bag without touching the outside of the bag.
Regular insulin (Humulin R, Novolin R)
Short-acting insulin ☐ Administer 30 to 60 min before meals to control postprandial hyperglycemia.
______ is the most important preventable cause of death in the United States, according to the Centers for Disease Control and Prevention
Smoking
Social Learning - Learning theory that links information to beliefs and values to change or shift the learners' expectations.
Social Learning - Learning theory that links information to beliefs and values to change or shift the learners' expectations.
Special Populations - Community health nurses care for these vulnerable populations who are subject to issues such as: --- Violence, substance use disorders, mental health issues/illnesses, homelessness, rural and migrant health. --- These individual have difficulty _________ health care.
Special Populations - Community health nurses care for these vulnerable populations who are subject to issues such as: --- Violence, substance use disorders, mental health issues/illnesses, homelessness, rural and migrant health. --- These individual have difficulty accessing health care.
PPE for radiological incidents
Staff should wear water-resistant gowns, double-glove, and fully cover their bodies with caps, booties, masks, and goggles
Reinkemeyer's stages of planned change
Stage 1: Identification and development of felt need and desire for change Stage 2: Development of a change relationship between the community health nurse and the community Stage 3: Clarification or diagnosis of the community's problem, need, or objective Stage 4: Examination of alternative routes and tentative goals and intention of actions (planning)
State Boards of Nursing - Development and oversight of the state's nurse _______ act - Licensure of registered and licensed practical nurses - Oversight of the state's _______ of nursing
State Boards of Nursing - Development and oversight of the state's nurse practice act - Licensure of registered and licensed practical nurses - Oversight of the state's schools of nursing
State Departments of Health - Manages the Women, Infants and Children (WIC) program - Oversees Children's Health Insurance Program (CHIP), which offers expanded health coverage to uninsured children whose families do not quality for Medicaid - Establishes public health _________ - Provides assistance/support for local health departments - ___________ for the administration of the Medicaid program - _______ notifiable communicable disease within the state to the CDC.
State Departments of Health - Manages the Women, Infants and Children (WIC) program - Oversees Children's Health Insurance Program (CHIP), which offers expanded health coverage to uninsured children whose families do not quality for Medicaid - Establishes public health policies - Provides assistance/support for local health departments - Responsible for the administration of the Medicaid program - Reports notifiable communicable disease within the state to the CDC.
vitals, height, weight, allergies, meds
admission process: baseline data
Disaster preparedness
Stem from threats and vulnerabilities identified in the prevention level, and should coordinate community efforts as well as outline specific roles of local agencies. This level of management includes preparedness of natural or man-made disasters. Create an action plan and determine alternative methods of communication, highlight evacuation plans, ID local and distant meeting places, disaster kit. Set up communication protocol; should provide access to American Red Cross, and state and federal government agencies. Disaster drills.
Steps in Analysis Community Assessment Data 1. Gathering collected data into a composite database. 2. Assessing __________ of data. 3. Identifying and generating _______ data. 4. Synthesizing data and identifying ______. 5. Identifying community needs and problems. 6. Identifying community strengths and _________.
Steps in Analysis Community Assessment Data 1. Gathering collected data into a composite database. 2. Assessing completeness of data. 3. Identifying and generating missing data. 4. Synthesizing data and identifying themes. 5. Identifying community needs and problems. 6. Identifying community strengths and resources.
Steps in the Referral Process 1. Engaging in a working relationship with the client. 2. Establishing ________ for the referral. 3. Exploring resources. 4. Accepting the client's decision to use a given resource. 5. Making the referral. 6. ___________ the referral. 7. Evaluating the outcome.
Steps in the Referral Process 1. Engaging in a working relationship with the client. 2. Establishing criteria for the referral. 3. Exploring resources. 4. Accepting the client's decision to use a given resource. 5. Making the referral. 6. Facilitating the referral. 7. Evaluating the outcome.
Steps of Data Collection - Collection of self-identifying data about the client's ethnic background, religious preference, family structure, food patterns, and health. - Posing questions that address the client's perceptions of his health needs. - Identification of how cultural factors may impact the effectiveness of nursing interventions.
Steps of Data Collection - Collection of self-identifying data about the client's ethnic background, religious preference, family structure, food patterns, and health. - Posing questions that address the client's perceptions of his health needs. - Identification of how cultural factors may impact the effectiveness of nursing interventions.
Facilitate learning
Stimulate senses Active learning Comfortable Learner's readiness? Relevant information Repetition Learning should be positive Start simple, go to complex Generalize and pace appropriately
Secondary Prevention -
Strategies that lead to early detection and treatment of disease with the goal of limiting severity and adverse effects (pick this if you see "screenings" or safety checks)
Tertiary Prevention -
Strategies that maximize recovery after an injury or illness
Primary Prevention -
Strategies that prevent the initial occurrence of disease or injury (pick this if you see "education" or "immunizations")
What is an aggregate?
Sub-population
Triage Nonurgent category (class III) -
The next highest priority is given to clients who have minor injuries that are not life-threatening and do not need immediate attention
Oxygen Therapy
The nurse should post "Oxygen in Use" signs to alert others, know where the closest fire extinguisher is located, reinforce to the client and others about fire hazard of smoking during oxygen use, and check that all electric machinery is grounded. The client should wear a cotton gown instead of synthetic or wool since those fibers can generate static electricity. Volatile and flammable materials such as alcohol and acetone should not be used near clients receiving oxygen
Community Health Assessment
The process of examining the health data related to a community to identify health issues and to implement community-based health benefit programs.
Case Fatality Rate
The proportion of persons diagnosed with a particular disorder who die with a specified period
nutrition
admission process: current diet, any chewing or swallowing problems, recent weight gain/loss
Tobacco Use -Smoking is the most important preventable cause of death in the U.S. -Nicotine is a stimulant that temporarily creates a feeling of alertness and energy --- _________ to nicotine develops quickly -Cigarette smoking results in deep inhalation of smoke, which poses the greatest health risk (cancer, cardiovascular disease, respiratory disease) -Cigars, pipes, and smokeless tobacco increase the risk of _______ of the lips, mouth, and throat. -Secondhand smoke poses considerable health risks (respiratory disease, lung cancer) to nonsmokers.
Tobacco Use -Smoking is the most important preventable cause of death in the U.S. -Nicotine is a stimulant that temporarily creates a feeling of alertness and energy --- Tolerance to nicotine develops quickly -Cigarette smoking results in deep inhalation of smoke, which poses the greatest health risk (cancer, cardiovascular disease, respiratory disease) -Cigars, pipes, and smokeless tobacco increase the risk of cancers of the lips, mouth, and throat. -Secondhand smoke poses considerable health risks (respiratory disease, lung cancer) to nonsmokers.
TQM
Total Quality Management
Gross National Product (GNP)
Total value of goods and services
Gross Domestic Product
Total value of goods and services produced in 1 year Example: Plus services performed by foreign subjects in the US Minus services performed in other countries by US citizens
What 3 things led to increased disease in Industrial cities?
Transient Workers ^ Waste Poor work conditions
Proportions
Type of ratio that includes numerator and denominator OR a percent
Types of Violence Within Communities - Abuse: Physical abuse occurs when pain or harm results ---Toward an infant or child (shaken baby syndrome) ---Toward a domestic partner, such as striking or strangling the partner ---Toward an older adult in the home (elder abuse), such as pushing an older adult parent and causing her to fall.
Types of Violence Within Communities - Abuse: Physical abuse occurs when pain or harm results ---Toward an infant or child (shaken baby syndrome) ---Toward a domestic partner, such as striking or strangling the partner ---Toward an older adult in the home (elder abuse), such as pushing an older adult parent and causing her to fall.
Types of Violence Within Communities - Assault --- _____ are more likely to be assaulted. --- Youths are at a significantly higher risk.
Types of Violence Within Communities - Assault --- Males are more likely to be assaulted. --- Youths are at a significantly higher risk.
Types of Violence Within Communities - Economic Maltreatment --- Failure to provide the needs of a victim when adequate funds are available. --- _______ bills when another person is managing the finances. --- Theft of or misuse of money or property.
Types of Violence Within Communities - Economic Maltreatment --- Failure to provide the needs of a victim when adequate funds are available. --- Unpaid bills when another person is managing the finances. --- Theft of or misuse of money or property.
Types of Violence Within Communities - Homicide: --- most committed by someone known to the victim and occur during an argument. --- _____ often precedes homicide within families. --- Rates are __________ among adolescents.
Types of Violence Within Communities - Homicide: --- most committed by someone known to the victim and occur during an argument. --- Abuse often precedes homicide within families. --- Rates are increasing among adolescents.
Types of Violence Within Communities - Neglect: Includes the failure to provide... --- Physical care, such as food, shelter, and hygiene --- Emotional care and/or stimulation necessary to achieve developmental _________, such as speaking and interacting with a child --- _________ for a child --- Needed health or dental care
Types of Violence Within Communities - Neglect: Includes the failure to provide... --- Physical care, such as food, shelter, and hygiene --- Emotional care and/or stimulation necessary to achieve developmental milestones, such as speaking and interacting with a child --- Education for a child --- Needed health or dental care
health history
admission process: current illness, current meds, prior illness, chronic disease, surgery, previous hospitalization, other relevant data
Types of Violence Within Communities - Rape --- Often unreported. --- Includes date and marital rape. --- Majority of violence against women is intimate partner violence. --- Incidence is higher in cities, between 8 pm and 2 am, on the weekends, and in the ______ month.
Types of Violence Within Communities - Rape --- Often unreported. --- Includes date and marital rape. --- Majority of violence against women is intimate partner violence. --- Incidence is higher in cities, between 8 pm and 2 am, on the weekends, and in the summer month.
Types of Violence Within Communities - Suicide --- Women report _________ suicide more often than men. --- Rates of suicide are highest in men and individual over the age of __. --- Risk factors for suicide include depression or other mental disorders, substance use, and intimate partner issues.
Types of Violence Within Communities - Suicide --- Women report attempting suicide more often than men. --- Rates of suicide are highest in men and individual over the age of 65. --- Risk factors for suicide include depression or other mental disorders, substance use, and intimate partner issues.
U.S Department of Health and Human Services -Under the direction of the Secretary of ______ -Funded through federal _____
U.S Department of Health and Human Services -Under the direction of the Secretary of Health -Funded through federal taxes
Sheppard-Towner Act
U.S. Act of Congress providing federal funding for maternity and child care, a response to the lack of adequate medical care for women and children
The federal agency most responsible for improving the health status of the American people is the:
U.S. Department of Health and Human Services.
Federal health agencies
U.S. department of health and human services -under direction of the secretary of health -funded through federal taxes Consists of Children and Families, community living, Medicare and medicaid, HIPPA, SSI, AFDC
What is Secondary Data?
Use of existing data - Death/Birth stats - Census data - Mortality/Morbidity data - Health records - Meeting minutes - Prior health surveys
Secondary data collection
Use of existing data (death statistics; birth statistics; census data; mortality, morbidity data; health records; minutes from meetings; prior health surveys) to assess problem › Database of prior concerns/needs of population › Ability to trend health issues over time › Possibility that data may not represent current situation › Can be time-consuming
Critical theory -
Use of ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors
Critical theory
Use of ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors.
Behavioral theory -
Use of reinforcement methods to change learners' behaviors
Behavioral theory
Use of reinforcement methods to change learners' behaviors.
Cognitive theory -
Use of sensory input and repetition to change learners' patterns of thought, thereby changing behaviors
Cognitive theory
Use of sensory input and repetition to change learners' patterns of thought, thereby changing behaviors.
Developmental theory -
Use of techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge
Developmental theory
Use of techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge.
Nursing care for stroke
VS q1-2 hr; cardiac monitor, monitor LOC, elevate head of bed, institute seizure precautions
Period: Animals increased the disease rate
Villages
Underlying principles that affect vulnerable populations
Violence ● Substance use disorders ● Homelessness ● Mental health issues ● Poverty ● Chronic stress ● Poor self-esteem ● Access to health care services
Infectious Agent
Viruses Bacteria
VNA
Visiting Nurses Association
Telehealth audio data
Voice conversation, heart sounds, lung sounds, bowel sounds
Institute of Medicine IOM defined public health as:
What society does collectively to ensure the conditions in which people can be healthy.
safety assessments
admission process: history of falls, sensory deficits (vision, hearing), use of assistive devices
A newly hired occupational health nurse at an industrial facility is performing an initial workplace assessment. Which of the following should the nurse determine when conducting a work site survey? a. Work practices of employees b. Past exposure to specific agents c. Past jobs of individual employees d. Length of time working in current role
a
A nurse at an urban community health agency is developing an education program for city leaders about homelessness. Which of the following should the nurse include as the fastest-growing segment of the homeless population? a. Families with children b. Adolescent runaways c. Intimate partner abuse victims d. Older adults
a
A nurse developing a community health program is determining barriers to community resource referrals. Which of the following is an example of a resource barrier? a. Costs associated with services b. Decreased motivation c. Inadequate knowledge of resources d. Lack of transportation
a
Population at Risk of Communicable Diseases - List a few?
Young children, older adults, immunosuppressed clients, clients who have a high-risk lifestyle, international travelers, health care workers.
Third-Party payer
With the beginning of the insurance (or third-party payer) system, health care costs were set by payers, and they determined the type of care or service that would be offered and its price.
What 2 things is Rathbone famous for?
Working with Nightengale Educate Health Nurses
World Health Organization (WHO) - Provides daily information regarding the ___________ of internationally important diseases. - Establishes world _________ for antibiotics and vaccines. - The WHO primarily focuses on the health care workforce and education, environment, sanitation, infectious diseases, maternal and child health, and primary care.
World Health Organization (WHO) - Provides daily information regarding the occurrence of internationally important diseases. - Establishes world standards for antibiotics and vaccines. - The WHO primarily focuses on the health care workforce and education, environment, sanitation, infectious diseases, maternal and child health, and primary care.
Client education regarding response to chest pain:
X Stop activity and rest. X Place nitroglycerin tablet under tongue to dissolve (quick absorption). X If pain is unrelieved in 5 min, the client should call 911 or be driven to an emergency department. X The client can take up to two more doses of nitroglycerin at 5-min intervals.
risk for exposure to radon
You can be exposed to higher levels of radon at work if you are a uranium miner, a hard rock miner, or work in tunnels, power stations, public baths, or spas.
A community
a group of people and institutions that share geographic, civic, and/or social parameters.
Ethical decision making: utilitarian aproach
a public health nurse examines potential negative consequences of proposed public policy
radon (Rn)
a radioactive gas that is formed naturally from the radioactive decay of uranium in rocks and soil; it can remain in the soil, move to the soil surface and enter the air, or enter groundwater; colorless, odorless, and tasteless, but extremely toxic; when cooled below the freezing point, it becomes phosphorescent, in yellow and orange-red tones.
As a ___________, a nurse provides illness or injury care to children at school
direct caregiver
A nurse manager at a community agency is developing an orientation program for newly hired nurses. When discussing the differences between community-based and community-oriented nursing, the nurse should include which of the following as examples of community-based nursing? (Select all that apply.) a. A home health nurse performing wound care for a client who is immobile b. An occupational health nurse providing classes on body mechanics at a local industrial plant c. A school nurse teaching a student who has asthma about medications d. A parish nurse teaching a class on low-sodium cooking techniques e. A mental health nurse discussing stress management techniques with a support group
a, c
A nurse is preparing to conduct a windshield survey. Which of the following data should the nurse collect as a component of this assessment? (Select all that apply.) a. Ethnicity of community members b. Individuals who hold power within the community c. Natural community boundaries d. Prevalence of disease e. Presence of public protection
a, c, e
A nurse at a community clinic is conducting a well-child visit with a preschool-age child. The nurse should identify which of the following as a manifestation of child neglect? (Select all that apply.) a. Underweight b. Healing spiral fracture of the arm c. Genital irritation d. Burns on the palms of the hands e. Poor hygiene
a, e
An occupational health nurse is consulting with senior management of a local industrial facility. When discussing work-related illness and injury, the nurse should include which of the following as physical agents? (Select all that apply.) a. Noise b. Age c. Lighting d. Viruses e. Stress
a,c
Epidemiological factors social environment
access to health care, high-risk working conditions, poverty
outbreak of scabies suspected
action for nurse to take First: determine incidence rate (nursing process)
What to look for in sunscreen
active ingredients (zinc oxide, titanium dioxide, Mexoryl SX or avobenzone-3%) SPF 15-50, depending on your skin tone and sun intensity Lotions, not sprays or powder Water-resistant for the beach or pool
bioethics
addresses dilemmas that arise form advancing science and technology such as stem-cell research, organ transplantation, gender reassignment, reproductive technologies (in vitro, surrogate)`
nurse functions as a clinician when
administers immunization to a group of migrant workers; conducts cholesterol screening at a senior center
A school nurse is planning health promotion and disease prevention activities for the upcoming school year. In which of the following situations is the nurse planning a secondary prevention strategy? a. Placing posters with images of appropriate hand hygiene near restrooms b. Routinely checking students for pediculosis throughout the school year c. Implementing age-appropriate injury prevention programs for each grade level d. Working with a dietician to determine carbohydrate counts for students who have diabetes mellitus
b
A nurse is interviewing for a position at the local health department. When preparing for the interview, the nurse should find that which of the following are responsibilities of this agency? (Select all that apply.) a. Managing the Women, Infants, and Children program b. Providing education to achieve community health goals c. Coordinating directives from state personnel d. Reporting communicable diseases to the CDC e. Licensing of registered nurses
b, c
A home health nurse is discussing portals of entry with a group of newly hired assistive personnel. Which of the following are portals of entry the nurse should discuss? (Select all that apply.) a. Respiratory secretions b. Skin c. Genitourinary tract d. Saliva e. Mucous membranes
b, c, e
A nurse is creating partnerships to address health needs within the community. The nurse should be aware that which of the following characteristics must exist for partnerships to be successful? (Select all that apply.) a. A leading partner with decision-making authority b. Flexibility among partners when considering new ideas c. Adherence of partners to ethical principles d. Varying goals for the different partners e. Willingness of partners to negotiate roles
b, c, e
family member caring for another family member that has cancer
barrier to care: the primary wage earner in the family recently became unemployed
advocacy, responsibility, accountability, confidentiality
basic principles of ethics
accountability
basic principles of ethics: ability to answer for one's own actions
confidentiality
basic principles of ethics: protection of privacy without diminishing access to high-quality care
responsibility
basic principles of ethics: willingness to respect obligations and follow through on promises
Advocacy
begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem. This is accomplished by building relationships with the appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome)
Healthy nutrition should include lowering LDL_____________ , which can prevent diabetes and hyperlipidemia.
by decreasing intake of saturated fats
A community health nurse is developing strategies to prevent or improve mental health issues in the local area. In which of the following situations is the nurse implementing a tertiary prevention strategy? a. Providing support programs for new parents b. Screening a client whose spouse recently died for suicide risk c. Teaching a client who has schizophrenia about medication interactions d. Discussing stress reduction techniques with employees at an industrial site
c
A community health nurse is implementing health programs with several populations in the local area. In which of the following situations is the nurse using primary prevention? a. Performing a home safety check at a client's home b. Teaching healthy nutrition to clients who have hypertension c. Providing influenza immunizations to employees at a local preschool d. Implementing a program to notify individuals exposed to a communicable disease
c
A nurse is preparing a community health program on communicable diseases. When discussing modes of transmission, the nurse should include which of the following as an airborne illness? a. Cholera b. Malaria c. Influenza d. Salmonellosis
c
School nurse
case manager - coordinates comprehensive services for children who have complex health needs. Community outreach - strives to meet the needs of all school-age children by cooperative planning and collaboration between the educational system. Consultant - assists students, families, and personnel in information gathering and decision-making about a variety of health needs and resources. Counselor - supports students on health needs direct caregiver - provides nursing care to all ill or injured children at school health educator - helps prepare children, families, school personnel and the community to make well-informed health decisions
benefits of MAPP
creates a healthy community; increases visibility of public health; manages change; stronger public health infrastructure; builds stronger partnerships; builds public health leadership; creates advocates
basic
critical thinking: a nurse trusts the experts and thinks concretely based on the rules; results from limited nursing knowledge and experience, as well as inadequate critical thinking process
intuition
critical thinking: inner sensing that facts do not currently support something, should spark the nurse to search the data to confirm or disprove the feeling
complex
critical thinking: nurse begins to express autonomy by analyzing and examining data to determine the best alternative; results from an increase in nursing knowledge, experience, intuition, and more flexible attitudes
commitment
critical thinking: nurse expects to make choices without help from others and fully assumes the responsibility of those choices
language
critical thinking: precise, clear language demonstrating focused thinking and communicating unambiguous messages and expectations to clients and other health care team members
reflection
critical thinking: purposefully thinking back or recalling a situation to discover its meaning and gain insight into the event: why did I say or do this, did the original plan of care achieve optimal outcomes?
competence
critical thinking: scientific methods, problem solving, decision making, diagnostic reasoning/inference, clinical decision making, nursing process
experience
critical thinking: understanding of clinical situations, recognizes/analyzes cues for relevance, incorporates experience into intuition
humility
critical thinking; attitudes: acknowledges weaknesses
responsibility
critical thinking; attitudes: adheres to standards of practice
independence
critical thinking; attitudes: analyzes ideas for logical reasoning
perseverance
critical thinking; attitudes: continues to work at a problem until there is a resolution
discipline
critical thinking; attitudes: develops a systematic approach to thinking
confidence
critical thinking; attitudes: feels sure of abilities
fairness
critical thinking; attitudes: is objective and nonjudgemental
integrity
critical thinking; attitudes: practices truthfully and ethically
risk taking
critical thinking; attitudes: takes calculated changes in finding better solutions to problems
A case management nurse at an acute care facility is conducting an initial visit with a client to identify needs prior to discharge home. After developing a working relationship with the client, the nurse is engaging in the referral process. Which of the following should be the first action by the nurse? a. Monitor the client's satisfaction with the referral. b. Provide client information to referral agencies. c. Review available resources with the client. d. Identify referrals that the client needs.
d
A community health nurse is developing an education program on substance use disorders for a group of adolescents. Which of the following should the nurse include when discussing nicotine and smoking? a. Smoking is the fifth-most preventable cause of death in the United States. b. Nicotine is a central nervous system depressant. c. Withdrawal effects from smoking are minimal. d. Tolerance to nicotine develops quickly.
d
A nurse is developing a community health education program for a group of clients who have a new diagnosis of diabetes mellitus. Which of the following learning strategies should the nurse include for clients who are auditory learners? a. Showing informational videos b. Providing equipment to practice hands-on skills c. Supplying outlines for note-taking d. Facilitating small group discussions
d
A nurse is planning a community health program. Which of the following should the nurse include as part of the evaluation plan? a. Determine availability of resources to initiate the plan. b. Gain approval for the program from local leaders. c. Establish a timeline for implementation of interventions. d. Compare program impact to similar programs.
d
A nurse is talking to a client who asks for additional information about hospice. Which of the following is an appropriate statement by the nurse? a. "Clients who require skilled nursing care at home qualify for hospice care." b. "One function of hospice is to provide teaching to clients about life-sustaining measures." c. "Hospice assists clients to develop the skills needed to care for themselves independently." d. "A component of hospice care is to control the client's symptoms."
d
informant interviews
direct discussion with community members for the purpose of obtaining ideas and opinions from key informants. Strengths: no cost Limitations: built-in bias
National health goals are
derived from scientific data and trends collected during the prior decade. These goals are based on those issues that are considered major risks to the health and wellness of the United States' population
Descriptive epidemiology
describes the distribution of disease, death, and other health outcomes in the population according to person, place, and time—the who, where, and when of disease patterns.
The Theory of Planned Behavior, or Theory of Reasoned Action
describes the individual's attitude toward a behavior reflects the individual's expected consequences of that behavior. According to this model, actions are influenced by people around the individual and the individual's perception of the ability to control the behavior.
The Health Belief Model
describes the individual's perception of the threat of illness. The perception of benefits that any action might bring to the individual or barriers or problems to taking action. Population-based nurses can learn an individual's beliefs and perceptions of illness to to modify health behaviors and choices.
State boards of nursing
development and oversight of the state's nurse practice act. Licensure of registered and licensed practical nurses. Oversight of the state's schools of nursing.
OSHA
develops and enforces workplace health regulations to protect the safety and health of workers
Acquired immunity
develops through actual exposure to the infectious agent
Botulism
difficulty swallowing, weakness, nausea, vomiting, difficulty breathing. Give: airway management, antitoxin, eliminate the toxin, supportive care
what are some non-pharmacologic measures to reduce stress/anxiety for the dying:
dim lights, reduce, noise, cool cloth on forehead, light and brief massaging on arm or hand.
medicaid
healthcare, insurance assistance, nursing home coverage; low-income residents and pregnant women, a parent or relative caretaker of a dependent child under age 19, the blind, people with a disability or with a family member in their household with a disability, or people aged 65 years or older
substance abuse program education for adolescents
help students develop skills for resisting peer pressure
What does a fan accomlish?
helps stimulate trigeminal nerve which helps decrease feeling of dyspnea.
What vaccines are not safe during pregnancy:
herpes zoster, varicella, and MMR
Smallpox
high fever, fatigue, severe headache, rash (BEGINS of face and tongue, quickly spreads to trunk, arms, legs, hands, feet) then turns into pus-filled lesions, vomiting. Give: treatment - no cure, supportive care- hydration, pain meds, antipyretics. Prevention: vaccine (10 years of immunity)
Cat A bio agents
highest priority agents smallpox (variola), botulism toxin, anthrax, tularemia, hemorrhagic viral fevers (Ebola!), and plague
What are some example of Class A biological agents?
highest priority agents, posing a risk to national security because they are easily transmitted and have high mortality rates. ■■ Examples include smallpox (variola), botulism toxin, anthrax, tularemia, hemorrhagic viral fevers, and plague.
Bioterrorism Category A biological agents
highest priority, posing risk to national security because easily transmitted and have high mortality rates. Ex: smallpox (variola), botulism, anthrax, tularemia, hemorrhagic viral fevers, plague
ginkgo balboa:
hinders coagulation. not for patients using warfarin.
Medicare part A
hospital care, home care, limited skilled nursing care
The nurse manager should include age as a _____ when discussing work-related illness and injury
host factor
The nurse should include altered immunity as a ___ ____ when discussing the epidemiological triangle
host factor
The nurse should include ethnicity as a _____ _______when discussing the epidemiological triangle
host factor
TB transmission education for newly diagnosed patient
household members should take Isoniazid (INH) for 6 to 12 months; no need to use disposable utensils for pt; no need to isolate household members
Loop diuretics, such as furosemide (Lasix), decrease sodium reabsorption and increase potassium excretion. Monitor the client closely for
hypokalemia
compare (community analysis)
identification of data gaps, incongruencies, and omissions; comparative data are needed to determine if a pattern or trend exits or if data do not seem correct and if revalidation of original information is required
standards for discharge education
identify safety concerns at homes, review s/s of potential complications, provide # for provider, provide name and # for community resource,s dietary guidelines, amount/frequency of therapies, how to take meds and why adherence is important
The five phases of the educational process
identifying educational needs establishing educational goals and objectives selecting appropriate educational methods implementing the educational plan and evaluating the educational process and product
Telehealth visual data
images of wounds, images of surgical incisions
Meningococcal conjugate
immunization given at 11-12 years of age
direct transmission
implies the immediate transfer of an infectious agent form an infected host or reservoir to a portal of entry in the human host through physical contact such as touching, biting, kissing, or sexual contact
primary prevention
improves the health and well being of the community, making it less vulnerable to stressors; health promotion programs, programs that focus on protection from specific disease; usually nonspecific and directed toward raising the general healthy of the total community
Occupational health
occupational host - worker characteristics, such as job inexperience, age, and pregnancy occupational agent - biological agents (viruses, bateria, fungi, pathogens), chemical (smoke), mechanical agents (musculoskeletal or other strains from repetitive motions, poor workstation worker fit, lifting heavy loads), physical agents (temperature extremes, vibrations, noise, radiation, lighting), physiological agent (threats to psychological or social well-being resulting in work-related stress, burnout, and violence) Occupational environment factors - physical (heat, odor, pollution), social (sanitation, overcrowding) psychological (addictions, stress)
Acculturation is the process
of merging with or adopting the traits of a different culture. Adapting to a new culture requires changes in daily living practices. These changes relate to language, education, work, recreation, social experiences, and the health care system
Medicare
older than 65 and receiving social security, have been receiving disability benefits for 2 years, have amytrophic lateral sclerosis, and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to qualify. Part A - hospital care, home care, limited skilled nursing care Part B - medical care, diagnostic services, physiotherapy Part C - Medicare advantage plan - is a combo of Part A and Part B and is provided through a private insurance company Part D - Prescription drug coverage
summarize (community analysis)
once categorization method has been selected, the next task is to summarize the data within each category; both summary statements and summary measures, such as rates, charts, and graphs, are required
Tertiary level of prevention
teaching a client with RA measures to prevent joint deformities
within 24 hours
telephone/verbal prescription: when must the provider sign
ethnocentrism
tendency of people to view the world from the perspective of their own cultural background and viewpoint
Teaching a client who has schizophrenia about medication interactions is a ________prevention strategy
tertiary
Working with the dietitian to determine carbohydrate counts for students with diabetes is a ________ prevention activity
tertiary
information literacy
the ability to recognize when information is needed as well as the skills to find, evaluate, and use needed information effectively
Evaluation
the methods used to determine if a service is needed and will be used, whether a program to meet that need is carried out as planned, and whether the service actually helps the people it is intended to help.
incidence
the number of people in a population who develop the condition during a specified period of time (number of new cases over a period of time; rate: (# of new cases of disease/total population at risk)x100,000
Passive immunity
transfer of antibodies to the host either transplacentally from mother to newborn, or through transfusions of immunoglobulins, plasma proteins, or antitoxins
Public health nurse: core function of policy development:
updatinglocal policies and support community health efforts.
hip arthroplasty postop
use assistive devices to retrieve items that are on the floor; no pillow under the knees; use incentive spirometer q 2hrs while awake; apply antiembolic stockings before getting out of bed
Oxygen therapy-copd pt
use before activity, non petroleum moisturizer for lips and nares, contact dr if SOB often
asthma client with prescribed inhaled corticosteroid and prednisone
use metered-dose inhaler attached to a spacer when taking corticosteroids; pace activities depending on his breathing-based on the effort required for breathing; avoid environmental triggers; report the highest of three peak expiratory flow rates (not the average); take prednisone until prescription is complete
COPD malnourished pt
use milk instead of water when making soup-will increase protein intake and calories; maintain an upright position such as High Fowler or the orthopneic position; foods high in protein-such as eggs are good; limit liquid intake at meal times
Secondary data
use of existing data (death statistics, birth statistics, census data, mortality, health records) Strengths: ability to trend health issues over time Limitations: data might not represent current situation
Showing informational videos is an appropriate learning strategy for clients who are ___ learners
visual
Supplying outlines for note-taking is an appropriate learning strategy for clients who are ______ learners
visual
When is partner violence most likely to occur?
when abused partner tries to leave.
invasive procedures, surgery
when must a client provide written consent
upon admission
when should you start the discharge plan
active immunity
when the body produces its own antibodies against an antigen, either as result of infection with the pathogen or introduction of the pathogen in a vaccine
Epidemic
when the rate of disease exceeds the usual level of the condition in a defined population
other RNs, LPNS, AP
who can an RN delegate to
local or state health department
who do nurses report communicable disease to
what is UPSTREAM thinking
why treat people...w/o changing what makes them sick?
Faith community nurse
work with a group of clients who share common faith traditions. Circle model of spiritual care: CIRCLE Caring Intuition Respect for religious beliefs and practices Caution Listening Emotional support
What are some tertiary prevention methods for reducing societal violence?
• Establish parameters for long-term follow-up and supervision. • Make resources in the community available to the client (telephone numbers of crisis lines and shelters). • If court systems are involved, work with parents while the child is out of the home (in foster care). • Refer to mental health professionals for longterm assistance. • Provide grief counseling to families of suicide or homicide victims. • Develop support groups for caregivers and victims of violence. • Advocate for legislation designed to assist older adult independence and caregivers and to increase funding for programs that supply services to low-income, at-risk individuals.
What are the s/sx of smallpox?
• High fever • Fatigue • Severe headache • Rash (begins on face and tongue, quickly spreading to the arms and legs, then hands and feet, within 24 hr) that turns to pus-filled lesions • Vomiting • Delirium • Excessive bleeding
What are some secondary prevention methods for reducing societal violence?
• Identify and screen those at risk for abuse and individuals who are potential abusers. • Assess and evaluate any unexplained bruises or injuries of any individual. • Screen all pregnant women for potential abuse. This may be the one time in some women's lives that they may access the health care system on a regular basis. • Refer sexual assault or rape victims to a local emergency department for assessment by a sexual assault abuse team. Caution the client not to bathe following the assault because it will destroy physical evidence. • Assess and counsel anyone contemplating suicide or homicide and refer the individual to the appropriate services. • Support and educate the offender, even though a report must be made. • Assess and help offenders address and deal with the stressors that may be causing or contributing to the abuse, such as mental illness or substance abuse. • Alert all involved about available resources within the community.
What are some secondary prevention strategies for substance abuse?
• Identify at-risk individuals and assist them to reduce sources of stress, including possible referral to social services to eliminate financial difficulties or other sources of stress. • Screen individuals for excessive substance use.
Describe the planning phase of the case management nursing process
• In conjunction with the client and family, determine: ◯◯ Possible outcomes for the client ◯◯ Advantages and disadvantages of possible outcomes ◯◯ What role each participant will play ◯◯ Impact on the client in each of the areas listed for the assessment
What are some secondary prevention strategies related to infectious diseases?
• Increase early detection through screening and case finding. • Refer suspected cases of communicable disease for diagnostic confirmation and epidemiologic reporting. • Treat postexposure infections (hepatitis A, rabies). • Quarantine clients when necessary.
What are some primary prevention strategies for substance abuse?
• Increase public awareness, particularly among young people, regarding the hazards and addictive qualities of substance abuse (e.g., public education campaigns, school education programs). • Encourage development of life skills.
What are some client barriers to the referral process?
• Lack of motivation • Inadequate information about community resources • Inadequate understanding of the need for referral • Accessibility needs • Priorities • Finances • Cultural factors
Describe the evaluation phase of the case management nursing process
• Monitor the care provided by the different agencies, comparing against: ◯◯ Original projected outcomes ◯◯ Physical needs ◯◯ Psychosocial needs ◯◯ Financial needs ◯◯ Client and family satisfaction
What are some tertiary prevention strategies related to mental health?
• Perform medication monitoring. • Provide mental health interventions. • Make referrals to various groups of professionals, including support groups. • Maintain the client's level of function to prevent relapse or frequent rehospitalization. • Identify behavioral, environmental, and biological triggers that may lead to relapse. • Assist the client in planning a regular lifestyle and minimizing sources of stress. • Educate the client and family regarding medication side effects, potential interactions
What are considered Health Care services?
• Physicians • Acute-care settings • Primary care sites • Health departments • Long-term facilities • Homecare services • Rehabilitation services • Physical therapy services • Occupational therapy services • Specialty service agencies • Pharmacies
What are some primary prevention strategies for bioterrorism?
• Preparation with bioterrorism drills, vaccines, and antibiotics for exposure prophylaxis • Bioterrorism planning ◯◯ Design a bioterrorist response plan using the most probable biological agent in the local area. ◯◯ Assess and locate the local facilities that have Level I, Level II, Level III, and Level IV biosafety gear. ◯◯ Identify the chain of command for reporting bioterrorist attacks. ◯◯ Define the nursing roles in the event of a bioterrorist attack. ◯◯ Set up protocols for different biosafety levels of infection control and containment.
What are some primary prevention strategies related to infectious diseases?
• Prevent the occurrence of infectious disease. • Educate the public regarding the need for immunizations, federal and state vaccination programs, and immunization laws such as the "no-shots, no school" legislation. • Counsel clients traveling to other countries about protection from infectious diseases. Refer clients to the health department for information about mandatory immunizations. • Educate the public regarding prevention of disease and ways to eliminate risk factors for exposure, such as hand hygiene, universal precautions, proper food handling and storage, and use of condoms.
What are considered support services?
• Psychological services • Churches • Support groups • Life care planners • Medical equipment providers • Meal delivery services • Transportation services
What are some tertiary prevention strategies for bioterrorism?
• Rehabilitation of survivors • Monitoring medication regimens and referrals • Evaluating the effectiveness and timeliness of the bioterrorism plan
What are some secondary preventions strategies for migrant health care?
• Screen for pesticide exposure. • Screen for skin cancer. • Screen for chronic preventable diseases. • Screen for communicable diseases.
What are some primary prevention methods for reducing societal violence?
• Teach alternative methods of conflict resolution • Organize parenting classes to provide anticipatory guidance of expected age-appropriate behaviors, appropriate parental responses, and forms of discipline. • Educate clients about community services that are available to provide protection from violence. • Promote public understanding about the aging process and about safeguards to ensure a safe and secure environment for older adults in the community. • Assist in removing or reducing factors that contribute to stress by referring caretakers of older adult clients to respite services, assisting an unemployed parent in finding employment, or increasing social support networks for socially isolated families. • Encourage older adults and their families to safeguard their funds and property by getting more information about a financial representative trust, durable power of attorney, a representative payee, and joint tenancy. • Teach individuals that no one has a right to touch or hurt another person, and make sure they know how to report cases of abuse.
Describe the intervention phase of the case management nursing process
• The case manager: ◯◯ Contacts service providers ◯◯ Provides referral information ◯◯ Coordinates all services to be provided ◯◯ Monitors the client to determine if services are still appropriate
What are some tertiary preventions strategies for migrant health care?
• Treat for symptoms of pesticide exposure. • Mobilize primary care and emergency services.
Which communicable diseases cause most communicable disease-related deaths?
• pneumonia • diarrheal diseases • tuberculosis • malaria • measles • HIV/AIDS.
What are the three levels of disaster management?
• preparedness • response • recovery
hep B (HBV)
› Blood › Unprotected sex with infected individual › Infants born to infected mothers › Contact with infected blood › Injection drug users
hep D (HDV)
› Coinfection with HBV › Injection drug users › Unprotected sex with infected individual
hep E (HEV)
› Fecal-oral route › Ingestion of contaminated food or water
Metformin HCI (Glucophage)
› Take with food to decrease adverse GI effects. › Instruct the client to take vitamin B12 and folic acid supplements. › Contact the provider if manifestations of lactic acidosis develop (myalgia, sluggishness, somnolence, and hyperventilation). › May take during pregnancy for gestational diabetes. › Never crush or chew the medication
Milio's Framework for Prevention
›› Complements the health belief model ›› Emphasizes change at the community level ›› Identifies relationship between health deficits and availability of health‑promoting resources ›› Theorizes that behavior changes within a large number of people can ultimately lead to social change
anthrax manifestations
›› Headache ›› Fever ››Muscle aches ›› Chest discomfort ›› Severe dyspnea ›› Shock
Smallpox manifestations
›› High fever ›› Fatigue ›› Severe headache ›› Rash (begins on face and tongue, quickly spreading to the trunk, arms, and legs, then hands and feet) that turns to pus‑filled lesions ›› Vomiting
anthrax tx
›› IV ciprofloxacin (Cipro) prophylactically for exposure or high risk of exposure ›› Antibiotics do not stop disease progression.
Nightingale's Theory of Environment
›› the relationship between an individual's environment and health ›› Depicts health as a continuum ›› Emphasizes preventive care
Health Belief Model
›› to predict or explain health behaviors ›› preventive health behaviors are taken primarily for the purpose of avoiding disease ›› Emphasizes change at the individual level ›› Describes the likelihood of taking an action to avoid disease based on: »»Perceived susceptibility, seriousness, and threat of a disease »»Modifying factors (e.g., demographics, knowledge level) »»Cues to action (e.g., media campaigns, disease impact on family/friends, recommendations from health care professionals) »»Perceived benefits minus perceived barriers to taking action
work-related illness/injury control strategies often include
■ Engineering ■ Altering work practices ■ Providing personal protective equipment and education to prevent future injuries ■ Workplace monitoring ■ Health screening ■ Employee-assistance programs ■ Job-task analysis ■ Design, risk management, and emergency preparedness
National Health Goals for Families
■ Reductions in ☐ Barriers to access ☐ Allergic content within the home ☐ Families that are unable to have a child or maintain a pregnancy ☐ Passive smoke exposure ☐ Household hunger ■ Increases in ☐ Health education provided by an agency (Head Start, school system, college, places of employment, health departments) ☐ Home testing for radon ☐ Health insurance coverage ☐ Individuals who have a usual primary care provider
National Health Goals for Men
■ Reductions in ☐ Death from cancer specific to men, such as prostate ☐ Incidence of HIV and AIDS ☐ Fatal and nonfatal injuries ■ Increases in ☐ Participation in aerobic and muscle-strengthening activities ☐ Ability to identify warning signs of a heart attack and stroke
National health goals for Women
■ Reductions in ☐ Diseases involving bone, such as osteoporosis ☐ Death from cancer such as breast, ovarian, and cervical ☐ Sexual violence ■ Increases in ☐ Number of planned pregnancies versus unplanned ☐ Those who receive early and adequate prenatal care ☐ The number of mothers who breastfeed ☐ Ability to identify warning signs of a heart attack and stroke
Portals of entry
■ Respiratory passages ■ Gastrointestinal tract ■ Skin ■ Mucous membranes ■ Genitourinary tract ■ Eyes ■ Blood vessels
Portals of exit
■ Respiratory secretions ■ Feces ■ Blood ■ Semen ■ Vaginal secretions ■ Saliva ■ Skin lesion exudates
Nursing Care for TB
■ Wear an N95 or HEPA respirator when caring for clients who are hospitalized with TB. ■ Place the client in a negative airflow room, and implement airborne precautions. ■ Use barrier protection when the risk of hand or clothing contamination exists. ■ Have the client wear an N95 or HEPA respirator if transportation to another department is necessary. The client should be transported using the shortest and least busy route. ■ Teach the client to cough and expectorate sputum into tissues that are disposed of by the client into provided sacks. ■ Encourage fluid intake and a well-balanced diet for adequate caloric intake. ■ Encourage foods that are rich in protein, iron, and vitamin C.
What is the CIRCLE model of spiritual care
■■ C aring ■■ I ntuition ■■ R espect for religious beliefs and practices ■■ C aution ■■ L istening ■■ E motional support
Which diseases have waterborne transmission?
■■ Cholera ■■ Typhoid fever ■■ Giardia lamblia
What may be included in denial?
■■ Defensiveness ■■ Lying about use ■■ Minimizing use ■■ Blaming or rationalizing use ■■ Intellectualizing
What are factors that influence an individual's potential for violence?
■■ History of being abused or exposure to violence ■■ Low self-esteem ■■ Fear and distrust of others ■■ Poor self-control ■■ Inadequate social skills ■■ Immature motivation for marriage or childbearing ■■ Weak coping skills
Which diseases have vector-borne transmission?
■■ Lyme disease ■■ Rocky Mountain spotted fever ■■ Malaria
Which diseases have airborne transmission?
■■ Measles ■■ Chickenpox ■■ Streptococcal infection ■■ Tuberculosis ■■ Pneumonia ■■ Influenza
What are some examples of portals of exit?
■■ Respiratory system ■■ Feces ■■ Blood ■■ Semen/vaginal secretions ■■ Saliva ■■ Skin
What are some examples of portals of entry?
■■ Respiratory system ■■ Gastrointestinal tract ■■ Skin ■■ Mucous membranes
Which diseases have foodborne transmission?
■■ Salmonellosis ■■ Hepatitis A ■■ Trichinosis ■■ Escherichia coli (E. coli)
Which diseases have direct contact transmission?
■■ Sexually transmitted diseases (HIV, gonorrhea, syphilis, genital herpes, hepatitis B, C, D) ■■ Infectious mononucleosis ■■ Impetigo, lice, scabies
What are some s/sx of substance abuse?
■■ Vital signs - Blood pressure, pulse, and temperature can be elevated, while respirations can be rapid, shallow, and depressed. ■■ Appearance - Individual can appear disheveled with an unsteady gait. ■■ Eyes - Pupils can appear dilated or pinpoint, red, also poor eye contact. ■■ Skin - Can be diaphoretic, cool, and/or clammy; needle track marks or spider angiomas may be visible. ■■ Nose - Can be runny, congested, red and/or cauliflower-shaped. ■■ Tremors - Fine or coarse tremors may be present.
6. A nurse is developing programs to promote the health of families in the local community. Related Content: Three characteristics of families.
●● Family characteristics ◯◯ Members communicate well and listen to each other. ◯◯ There is affirmation and support for all members. ◯◯ Members teach respect for others. ◯◯ There is a sense of trust. ◯◯ Members play and share humor together. ◯◯ Members interact with one another. ◯◯ There is a shared sense of responsibility. ◯◯ There are traditions and rituals. ◯◯ Members seek help for their problems.
6. A school nurse is planning prevention activities for students within the school system. Nursing Interventions: ●● Two primary prevention activities the nurse should plan
●● Primary Prevention Activities ◯◯ Teaching healthy heart curriculum (nutrition, exercise, not smoking) ◯◯ Educating about dental health ◯◯ Discussing safety (seat belts, bicycle helmets, stranger safety) ◯◯ Administering immunizations ◯◯ Teaching about communicable disease transmission ◯◯ Sex education ◯◯ Advocating for safe playground equipment ◯◯ Substance use prevention education
6. A nurse is developing programs to promote the health of families in the local community. Underlying Principles: ●● Two national health goals that apply to families.
●● Reductions in ◯◯ Barriers to access ◯◯ Allergic content within the home ◯◯ Families that are unable to have a child or maintain a pregnancy ◯◯ Exposure to secondhand smoke ◯◯ Household hunger ●●Increases in ◯◯ Health education provided by an agency ◯◯ Home testing for radon ◯◯ Health insurance coverage ◯◯ Individuals with a usual primary care provider
6. A school nurse is planning prevention activities for students within the school system. Nursing Interventions: ●● Two secondary prevention activities the nurse should plan
●● Secondary Prevention Activities ◯◯ Performing tuberculin skin tests ◯◯ Performing routine checks for pediculosis ◯◯ Taking measures to control communicable disease outbreaks ◯◯ Screening for lead exposure ◯◯ Implementing scoliosis screenings ◯◯ Identifying students at risk for suicide or self-harm ◯◯ Performing vision and hearing screenings ◯◯ Checking heights and weights ◯◯ Identifying child abuse or neglect
6. A school nurse is planning prevention activities for students within the school system. Nursing Interventions: ●● Two tertiary prevention activities the nurse should plan
●● Tertiary Prevention Activities ◯◯ Teaching about allergic triggers for students with asthma ◯◯ Administering medications to treat chronic conditions (asthma, diabetes, seizure disorders) ◯◯ Monitoring glucose levels and administering insulin to students who have diabetes ◯◯ Discussing and planning for nutritional needs of students who have diabetes ◯◯ Developing communication methods for students with autism
6. A nurse is developing programs to promote the health of families in the local community. Underlying Principles: ●● Two times families experience transition.
●● Times of transition ◯◯ Birth of a child ◯◯ Adoption of a child ◯◯ Death of a family member ◯◯ Child moving from the home ◯◯ Child getting married ◯◯ Major illness of a family member ◯◯ Divorce of a family member ◯◯ Loss of the main source of family income
risk factors for acute respiratory disorders
◯ Extremely young and advanced age ◯ Recent exposure to viral, bacterial, or influenza infections ◯ Lack of current immunization status (pneumonia, influenza) ◯ Exposure to plant pollen, molds, animal dander, foods, medications, and environmental contaminants Tobacco smoke ◯ Substance use (alcohol, cocaine) ◯ Chronic lung disease (asthma, emphysema) ◯ Immunocompromised status ◯ Presence of a foreign body ◯ Conditions that increase the risk of aspiration (dysphagia) ◯ Impaired ability to mobilize secretions (decreased level of consciousness, immobility, recent abdominal or thoracic surgery) ◯ Inactivity and immobility ◯ Mechanical ventilation (ventilator-acquired pneumonia)
Risk factors for TB
◯ Frequent and close contact with an untreated individual ◯ Lower socioeconomic status and homelessness ◯ Immunocompromised status (HIV, chemotherapy, kidney disease, diabetes, Crohn's disease) ◯ Poorly ventilated, crowded environments (prisons, long-term care facilities) ◯ Advanced age ◯ Recent travel outside of the United States to areas where TB is endemic ◯ Substance use ◯ Health care occupation that involves performance of high-risk activities (respiratory treatments, suctioning, coughing procedures)
Steps in analysis of community assessment data include:
◯ Gathering collected data into a composite database. ◯ Assessing completeness of data. ◯ Identifying and generating missing data. ◯ Synthesizing data and identifying themes. ◯ Identifying community needs and problems. ◯ Identifying community strengths and resources.
Health Status of Rural Residents
◯ Higher infant and maternal morbidity rates ◯ Higher rates of diabetes mellitus ◯ More likely to be obese ◯ Less likely to meet physical activity recommendations ◯ Higher rates of suicide ◯ Increased trauma/injuries from lightning, farm machinery, drowning, and boating, snowmobile, all-terrain vehicle, and motorcycle crashes ◯ Increased occupational-associated risks (agriculture, fishing, mining, and construction are the most dangerous industries) ◯ Less likely to seek preventive care
Barriers to health care include:
◯ Inadequate health care insurance ◯ Inability to pay for health care services ◯ Language barriers ◯ Cultural barriers ◯ Lack of health care providers in a community ◯ Geographic isolation ◯ Social isolation ◯ Lack of communication tools (e.g., telephones) ◯ Lack of personal or public transportation to health care facilities ◯ Inconvenient hours ◯ Attitudes of health care personnel toward clients of low socioeconomic status or those with different cultural/ethnic backgrounds ◯ Eligibility requirements for state/federal assistance programs
Risk factors for MI/Angina
◯ Male gender or postmenopausal women ◯ Hypertension ◯ Tobacco use ◯ Hyperlipidemia ◯ Metabolic disorders (diabetes mellitus, hyperthyroidism) ◯ Methamphetamine or cocaine use ◯ Stress (occupational, physical exercise, sexual activity)
Veterans Health Issues
◯ Mental health conditions (posttraumatic stress disorder, traumatic stress reactions, anger, depression) ◯ Substance use and addiction disorders ◯ Suicide ◯ Infectious diseases ◯ Exposures to herbicides, chemicals, and radiation ◯ Traumatic brain injuries ◯ Spinal cord injuries ◯ Traumatic amputations ◯ Cold injury ◯ Military sexual trauma ◯ Hearing impairments ◯ Visual impairments
Culturally aware nurses are:
◯ More likely to explore cultural variations among clients. ◯ Better able to understand how personal beliefs impact client care. ◯ Able to recognize the meaning of health differs with each culture.
Issues in Migrant Health
◯ Poor and unsanitary working and housing conditions ◯ Exposure to environmental pesticides ◯ Less access to dental, mental health, and pharmacy services ◯ Inability to afford care ◯ Availability of services (distance, transportation, hours of service, health record tracking) ◯ Language barriers and cultural aspects of health care
Case management nursing includes the following:
◯ Promoting interprofessional services and increased client/family involvement. ◯ Decreasing cost by improving client outcomes. ◯ Providing education to optimize health participation. ◯ Advocating for services and client rights.
Recognizing Actual or Potential Child Abuse/Neglect
◯ Unexplained injury ◯ Unusual fear of the nurse and others ◯ Injuries/wounds not mentioned in history ◯ Fractures, including older healed fractures ◯ Presence of injuries/wounds/fractures in various stages of healing ◯ Subdural hematomas ◯ Trauma to genitalia ◯ Malnourishment or dehydration ◯ General poor hygiene or inappropriate dress for weather conditions ◯ Considered to be a "bad child"
Community Assessment: Social and Community Factors Influencing Violence
◯ Work stress ◯ Unemployment ◯ Media exposure to violence ◯ Crowded living conditions ◯ Poverty ◯ Feelings of powerlessness ◯ Social isolation ◯ Lack of community resources (playgrounds, parks, theaters)
What are some characteristics of homeless populations?
◯◯ Adults who are unemployed, earn low wages, or are migrant workers ◯◯ Female heads of household ◯◯ Families with children (fastest growing segment) ◯◯ People who are mentally ill (large segment) Care of Special Populations RN Community Health nursing 73 ◯◯ People who abuse alcohol or other substances ◯◯ Abandoned children ◯◯ Adolescent runaways ◯◯ Older adults with no one to care for them
What steps must the nurse take when caring for clients who experience violence?
◯◯ Build trust and confidence with a client. ◯◯ Focus on the client rather than the situation. ◯◯ Assess for immediate danger. ◯◯ Provide emergency care as needed. ◯◯ Develop a plan for safety. ◯◯ Make needed referrals for community services and legal options. ◯◯ If abuse has occurred, complete mandatory reporting, following agency guidelines.
What are common health problems of migrant workers?
◯◯ Dental disease ◯◯ Tuberculosis ◯◯ HIV ◯◯ Depression and other mental health problems ◯◯ Domestic violence ◯◯ Lack of prenatal care ◯◯ Higher infant mortality rates
What are some barriers to health care in rural areas?
◯◯ Distance from services ◯◯ Lack of personal/public transportation ◯◯ Unpredictable weather and/or travel conditions ◯◯ Inability to pay for care/underinsured/uninsured ◯◯ Shortage of rural hospitals/health care providers
What is the nurse's role in regard to consultants?
◯◯ Initiate the necessary consults or notify the primary care provider of the client's needs so the consult can be initiated. ◯◯ Provide the consultant with all pertinent information about the problem (information from the client/family, the client's medical records). ◯◯ Incorporate the consultant's recommendations into the client's plan of care. ◯◯ Facilitate coordination of the consultant's recommendations with other health care providers' recommendations to protect the client from conflicting and potentially dangerous orders.
What is involved in assessment of a bioterrorism threat?
◯◯ Is the population at risk for sudden high disease rates? ◯◯ Is the vector that normally carries a specific disease available in the geographical area affected? ◯◯ Is there a potential delivery system within the community?
How does a community health nurse recognize a bioterrorism event?
◯◯ Is there a rapidly increasing disease incidence in a normally healthy population? ◯◯ Is a disease occurring that is unusual for the area? ◯◯ Is an endemic occurring at an unusual time? For example, is there an outbreak of influenza in the summer? ◯◯ Are there large numbers of people dying rapidly with similar presenting symptoms? ◯◯ Are there any individuals presenting with unusual symptoms? ◯◯ Are there unusual numbers of dead or dying animals, unusual liquids/vapors/odors?
What health problems can be included with ETOH, tobacco and other drug use?
◯◯ Low birth weight ◯◯ Congenital abnormalities ◯◯ Accidents ◯◯ Homicides ◯◯ Suicides ◯◯ Chronic diseases ◯◯ Violence
What are some follow-up considerations to referrals?
◯◯ Monitoring to determine if the referral was completed. ◯◯ Assessing whether referral outcomes were met. ◯◯ Determining if the client was satisfied with the referral.
What is the role of the community nurse in the event of a bioterrorism attack?
◯◯ Participate in planning and preparation for immediate response to a bioterrorist event. ◯◯ Identify potential biological agents for bioterrorism. ◯◯ Survey for and report bioterrorism activity (usually to the local health department). ◯◯ Promptly participate in measures to contain and control the spread of infections resulting from bioterrorist activity.
What are some migrant health issues?
◯◯ Poor and unsanitary working and housing conditions ◯◯ Less access to dental, mental health, and pharmacy services ◯◯ Inability to afford care ◯◯ Availability of services (distance, transportation, hours of service, health record tracking) ◯◯ Language (majority speak Spanish) and cultural aspects of health care
What are signs and symptoms of potential child abuse?
◯◯ Unexplained injury ◯◯ Unusual fear of the nurse and others ◯◯ Evidence of injuries not mentioned in history (old burns, scars, ecchymosis, human bite marks) ◯◯ Fractures, including older healed fractures ◯◯ Subdural hematomas ◯◯ Trauma to genitalia ◯◯ Malnourishment or dehydration ◯◯ General poor hygiene or inappropriate dress for weather conditions ◯◯ Considered to be a "bad child"
What are signs and symptoms of potential elder abuse?
◯◯ Unexplained or repeated physical injuries ◯◯ Physical neglect and unmet basic needs ◯◯ Rejection of assistance by caregiver ◯◯ Financial mismanagement ◯◯ Withdrawal and passivity ◯◯ Depression
What are common health conditions of homeless persons?
◯◯ Upper respiratory disorders ◯◯ Tuberculosis ◯◯ Skin disorders (athlete's foot) and infestations (scabies, lice) ◯◯ Alcoholism/drug abuse ◯◯ HIV/AIDS ◯◯ Assault and rape ◯◯ Mental illness ◯◯ Dental caries ◯◯ Hypothermia and heat-related illnesses ◯◯ Malnutrition
Vulnerable populations are subject to which issues?
◯◯ Violence ◯◯ Substance abuse ◯◯ Mental health ◯◯ Homelessness ◯◯ Rural and migrant health
What are some social and community factors that influence violence?
◯◯ Work stress ◯◯ Unemployment ◯◯ Media exposure to violence ◯◯ Crowded living conditions ◯◯ Poverty ◯◯ Feelings of powerlessness ◯◯ Social isolation ◯◯ Lack of community resources (playgrounds, parks, theaters)
Which populations are at risk for communicable disease?
◯◯ Young children ◯◯ Older adults ◯◯ Immunosuppressed clients ◯◯ Intravenous drug users ◯◯ Health care workers
occupational health history elicits information on
☐ Current and past jobs ☐ Current and past exposure to specific agents and any relationship of current symptoms to work activities ☐ Any precipitating factors, such as underlying illness, previous injuries, and healthy or unhealthy habits
Economic Maltreatment
☐ Failure to provide the needs of a victim when adequate funds are available ☐ Unpaid bills when another person is managing the finances ☐ Theft of or misuse of money or property
Manifestations of withdrawal include the following:
☐ Irritability ☐ Tremors ☐ Nausea ☐ Vomiting ☐ Headaches ☐ Diaphoresis ☐ Anxiety ☐ Sleep disturbances ☐ Tachycardia ☐ Elevated blood pressure
Leading causes of death in adolescents
☐ Motor vehicle/other unintentional injuries ☐ Homicide ☐ Suicide
Rifampin (Rifadin)
☐ Observe for hepatotoxicity. ☐ Inform the client that urine and other secretions will be orange. ☐ Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately. ☐ Inform the client this medication may interfere with the efficacy of oral contraceptives.
Ethambutol (Myambutol)
☐ Obtain baseline visual acuity tests. ☐ Determine color discrimination ability. ☐ This medication should not be given to children younger than 13 years of age. ☐ Instruct the client to report changes in vision immediately.
leading causes of death in children
☐ Perinatal conditions/congenital anomalies ☐ Sudden Infant Death Syndrome (SIDS) ☐ Motor vehicle/other unintentional injuries
Neglect includes the failure to provide:
☐ Physical care, such as food, shelter, and hygiene ☐ Emotional care and/or stimulation necessary to achieve developmental milestones, such as speaking and interacting with a child ☐ Education for a child ☐ Needed health or dental care