Community Health Exam 2 (8, 9, 12, 13)
smallpox
-caused by the variola virus; is a classic example of a communicable disease control success story -the variola virus had been associated with devastating epidemics throughout the centuries -smallpox became endemic in Europe in the 18th century and was responsible for 300-500 million deaths worldwide -smallpox first responded to a crude vaccine that was developed in the 18th century
Class 0 of TB
-no TB exposure; not infected -no history of TB exposure and no evidence of M. tuberculosis infection or disease -negative reaction to tuberculin skin test (TST) or interferon gamma release assay (IGRA)
Specific Vulnerabilities
- Pregnant women: children's exposures begin in utero - Infants and children (hand-to-mouth exploration and crawling on the floor) - chronic disease arising from complex interactions between the environment and genes
the Butterfield Upstream Model for Population Health (BUMP)
- developed by Dr. Butterfield - applies an upstream public health nursing approach to environmental risks by giving nurses the framework to address the determinants of health and health inequities that influence health outcomes across a population Specific points that are part of the BUMP framework are: -Assessing and analyzing the environmental exposures - Establishing health goals that include a multisector approach - Determining where interventions will have the greatest impact - Aligning with community partners - Measuring effectiveness of interventions
advocacy
*is a process, not an outcome* pleading the case of another or championing a cause -self advocacy, individual advocacy, community/public health advocacy, legislative advocacy
Events that remind us of the impact of the built and natural environments
- Lead contamination in the drinking water in Flint, Michigan; growing piles of plastics in our oceans; wildfires in the western United States and in northern Europe; and the hurricanes and severe flooding in the southeast United States
genital herpes
-an STI caused by the herpes simplex virus types 1 and 2 and is one of the most common STIs in the United States -most genital herpes infections are caused by the HSV-2; however, rates of HSV-1 genital herpes are increasing among college students -HSV-1 is the virus that causes cold sores and spreads from the mouth to the genitals through oral sex
hepatitis B
-both an acute and chronic serious disease and is a global problem -route of transmission: percutaneous or mucosal exposure to infected blood or body fluids -prognosis: a lifelong chronic infection (rarely resolving) possibly causing cirrhosis (scarring) of the liver, liver cancer, liver failure, and death -immunization is the most effective way of preventing HBV transmission; almost all infections would be prevented if hepatitis B vaccines were administered to all newborns and infants -C/PHN have an important role in the prevention and control of hepatitis B by encouraging immunization compliance, particularly following up on immunization of infants born to mothers with chronic HBV status, and consistent adherence to universal precautions
tertiary prevention
-care and treatment of the infected person, isolation and quarantine of the infected person, and safe handling and control of infectious wastes
communicable disease
-caused by an infectious agent, such as a virus or bacteria, and can be transmitted from one source to another -transmission to a susceptible host can occur directly either from person to person or animal to human, or transmission may occur indirectly through a reservoir such as contaminated water
hepatitis A
-caused by infection with the hepatitis A virus -route of transmission: fecal-oral (person to person), with an incubation period of 28 days
incubation period
-onset of symptoms may occur within a few hours after exposure or not until days or even weeks later, depending on the microorganism -this time between exposure and onset of symptoms is called the incubation period
Yersinia pestis
Bubonic Plague (Black Death)
Induration of 15 or more millimeters
considered positive for: -people with no risk factors for TB
when conducting the interview:
-*maintain a neutral and nonjudgmental attitude to elicit information more readily, especially when discussing highly sensitive topics, such as sexually transmitted infection (STI)* -arrange to call or meet with the person, depending on department protocol and/or disease being addressed -introduce yourself and explain the purpose of the confidential nature of the interview -elicit what the individual knows about the disease to assess knowledge base and guide education -gather information using a disease-specific questionnaire, if available, and note any possible sources of the disease or additional infected contacts
When investigating a disease outbreak, prior to contacting an individual for an interview:
-*review the information received from the mandated reporter for completeness* -*clarify whether the disease is suspect (meeting certain clinical criteria) or lab confirmed* -*review the case definition (criteria an individual must meet to be considered to have the disease)* -Review the disease information (reservoir, incubation and infectious periods, symptoms, and treatment), know the methods of control, and be prepared to provide education to the client while also conducting the investigation -Review the disease-specific questionnaire, if applicable, to better understand the intent of the investigation and to identify questions to ask the client, allowing you to focus and putting the client at ease. -If no questionnaire exists, write a narrative report including the information related to onset of illness, symptoms, medical evaluation, treatment if received, recovery state, and individuals the person has been in contact with, depending upon the nature of the disease
HIV/AIDS
-HIV is a retrovirus that attacks the body's immune system -although there is no cure for HIV/AIDS, HIV infection is now treated with antiretroviral therapy (ART), which can reduce the viral load to the point that it is undetectable, thus reducing the risk of transmission of the virus by 96%
class 3 of TB
-TB clinically active -positive culture for M. tuberculosis -positive reaction to TST or IGRA, plus clinical, bacteriological, or radiographic evidence of current active TB
class 1 of TB
-TB exposure; no evidence of infection -history of exposure to M. tuberculosis -negative reaction to TST or IGRA (given at least 8-10 weeks after exposure)
screening of TB
-TB infection can be detected by screening through either a skin test or blood testing -the tests can only be used to identify a person who has been infected at some point; they do not differentiate between latent and active disease
class 2 of TB
-TB infection; no TB disease (latent) -positive reaction to TST or IGRA -negative bacteriological studies (smear and cultures) -no bacteriological or radiographic evidence of active TB disease
tuberculosis (TB)
-TB is a disease primarily of the lungs and larynx, caused by the Mycobacterium tuberculosis (MTB) complex, M. africanum, M. tuberculosis, and M. canettii. These are all Gram-positive bacilli -routes of transmission: airborne and spread of droplet nuclei (e.g., via coughing, sneezing, laughing, yelling, singing), in which one inhales the bacilli exhaled by a person with viable TB bacilli in the sputum -sites of infection: apex of the lung (most common), kidney, brain, bone, lymphatic channels -process: two basic stages, latent and active; classification according to symptoms -communicability: depends on duration of the exposure with the infected person as well as the proximity or closeness and ventilation within the space where the exposure occurred -incubation period: approx. 10-12 weeks
class 5 of TB
-TB suspected -signs and symptoms of active TB disease, but medical evaluation not complete
TB burden in 3 categories
-TB, multidrug-resistant TB, and TB with HIV coinfection -HIV infection contributes dramatically to the development of active TB and is the leading killer of HIV-positive positive
vaccine
-a preparation made from either a live organism or an inactivated form of the organism -live attenuated vaccines are made from weakened wild virus organisms that are able to replicate but generally do not make the person ill
pneumonia
-a pulmonary infection that causes inflammation of the lobes of the lungs, bronchial tree, or interstitial space -people most susceptible to pneumonia are infants, the elderly, and people with a history of chronic diseases, a compromised immune system, or any condition affecting the anatomic or physiologic integrity of the lower respiratory tract -malnutrition and smoking also increase risk -community-acquired pneumonia is a significant cause of morbidity and mortality -hospital admissions and mortality related to pneumonia are far more common among people older than age 65; the mortality rate is approx. 50% -although this is not a reportable infectious disease, it can nevertheless have a great impact upon the community
TB exposure
-most individuals exposed to people with TB do not become infected -of those who do, all but about 5-10% remain disease free; the remaining 90% harbor the organism in a latent stage -although not infectious, they represent a persistent pool of potential cases in a population
hepatitis C
-causes a complex infection of the liver and is one of the leading-known causes of liver disease in the United States -route of transmission (most common): direct contact with infected blood via shared IV needles, reuse or inadequate sterilization of medical equipment, or transfusion of unscreened blood or blood products -testing is recommended for: people who have injected drugs, even if only once; people who received transfusions or organ transplants before 1992 or blood from a positive donor; people who received clotting factors before 1987, are undergoing chronic hemodialysis, or have persistently elevated alanine aminotransferase levels; people diagnosed with HIV/AIDS
chlamydia
-chlamydia trichromatic (CT) infections are the most commonly reported notifiable STI in the United States -recommended screening guidelines: -yearly for all women who are sexually active and 25 years or younger -for women older than 25 years who have a new sexual partner or multiple partners or a partner who has been diagnosed with an STI -all pregnant women at their first obstetrical visit -for men who have sex with men in settings with high rates of CT infection
care and treatment
-communicable diseases require care and treatment specific to the disease, and the nurse needs to: -understand the disease, the treatment, and follow-up requirements, and the educational component to discuss with the infected person -use information resources such as the CDC, stage agency policies, and protocols provided by local public health agencies
infection control measures
-hand washing -use of PPE -safe handling of contaminated sharp equipment -appropriate disposal of potentially infectious materials -community sanitation -pest control -vaccines -antimicrobial medications
immunization campaigns
-immunization campaigns targeting specific subgroups can be effective if they include: -community assessment for the target group(s) -assessment of and planning for the needs of the target group(s), such as: transportation, language interpreters, childcare, literacy
vehicles (indirect transmission)
-indirect transmit an infectious agent include food, water, biologic products (blood), and fomites (inanimate objects such as handkerchiefs, bedding, surgical scalpels, or needles) -or the vehicle may provide an environment in which the agent grows, multiplies, or produces toxin - improperly canned foods -examples: Botulinum toxin by Clostridium botulinum
airborne transmission
-infectious agents are carried by dust or droplet nuclei and suspended in air -examples: Measles virus, tuberculosis
influenza and pandemic preparedness
-influenza A virus causes the most severe and widespread disease (pandemic) and undergoes minor genetic mutations from year to year, referred to as *antigenic drift*, and drastic transformations periodically, referred to as *antigenic shift* -influenza B virus causes milder disease outbreaks, and they change or mutate at a slower rate -influenza C virus is connected with only sporadic cases of older respiratory disease -influenza D viruses do not cause illness in people but do affect cattle
diagnosis of active TB
-initially based on the presence of acid-fast bacilli in the sputum -confirmation is determined by a culture that reveals MTB -the culture test also provides information about drug susceptibility that informs the decisions for treatment -the nurse should conduct a full examination, including obtaining a chest x-ray and reviewing the person's history of risk factors and symptoms
role of C/PHN in disease control
-knowledge of communicable diseases is fundamental to the practice of C/PHN because these diseases typically spread through communities of people -involves: teaching important and effective preventive measures to community members; advocating for those affected; protecting the well-being of uninfected persons (including health care workers and nurses themselves); and controlling communicable disease in populations and groups
droplet spread
-large, short-range aerosols produced by sneezing, coughing, or even talking -examples: pertussis, meningococcal infection
enforced compliance
-legally, the responsibilities of public health officials in communicable disease control include the police power to enforce compliance with treatment or restrictions the activity of infectious people to protect the welfare of others -regulations that enforce compliance with disease prevention strategies are a justifiable restriction if the measures proposed are demonstrably effective and grounded in ethical principles
active immunity
-long-term (sometimes lifelong) resistance to a specific disease-causing organism -it can also be acquired naturally or artificially -naturally acquired active immunity occurs when a person contracts a disease, whereas artificial immunity occurs when a person receives an inoculation of an antigen through a vaccine
herd immunity
-or community immunity, is central to understanding immunization as a means of protecting community health -the immunity level present in a particular group or community of people -if only a few immune persons exist within a community (i.e., if herd immunity is low), then the spread of disease is more likely -however, if there are more individuals in the community who are immunized (i.e., if herd immunity is high), this helps minimize the chance that an unvaccinated person will likely become ill
class 4 of TB
-previous TB disease (not clinically active) -may have past medical history of TB disease -abnormal but stable radiographic findings -positive reaction to the TST or IGRA -negative bacteriologic studies (smear and cultures) -no clinical or radiographic evidence of current active TB disease
direct contact
-sexual contact, kissing, skin-to-skin contact, bites, contact with soil or vegetation contaminated with infectious organisms -examples: gonorrhea, herpes, rabies, hookworm
passive immunity
-short-term resistance to a specific disease-causing organism -may be acquired naturally (as with newborns through maternal antibody transfer) or artificially through inoculation with pooled human antibody that gives temporary protection
syphilis
-syphilis is a systemic infection caused by the spirochete Treponema pallidum -penicillin is the treatment of choice for syphilis -the nurse should instruct patients to avoid sexual contact until the treatment is completed and the lesions have resolved and to encourage contacts to receive treatment
gonorrhea
-the causative agent of gonorrhea is the gonococcus bacteria -- Neisseria gonorrheoeae -gonorrhea is the second-most commonly reported notifiable disease in the United States
food and water related illness
-the contamination can occur: -at the source (e.g., animal waste being introduced into the food or water chain) -through unsanitary food handling or practices (e.g., ingestion of fecal material, fecal-oral route) -due to food storage at improper temperatures, allowing microorganisms to grow -most commonly, exposure to contaminated food or water results in symptoms related to GI function, including diarrhea, N/V, stomach cramps, and bloating
treatment for hep C
-the goal is to cure, and the success rate depends on the strain of the virus and the type of treatment given -treatment is rapidly changing with the introduction of direct-acting antivirals (DAA) like Vosevi that can be administered to all regardless of genotyping
initial point of notification of a communicable disease
-the local health department or agency -if a person is identified in one jurisdiction but was exposed in another, the health agency receiving the report should notify the health agency where the exposure occurred, so an investigation can be conducted in the originating region -in most states, reporting known or suspected cases of a reportable disease is generally considered to be an obligation of: physicians, dentists, nurses, veterinarians, pharmacists, other health professionals; medical examiners; administrators of hospitals, clinics, nursing homes, schools, and nurseries
The WHO's definition of surveillance
-the ongoing and systematic collection, analysis, and interpretation of health data -surveillance allows for early identification of public health emergencies and evaluation of the effectiveness of public health interventions and is used to help inform policy changes -contact tracing can identify additional people who are also affected -the nurse or other local investigator sends information obtained during the interview to the next higher level of government for analysis and interpretation -if an outbreak is occurring, properly addressing it may require assistance from the next level of government
immunization
-the process whereby a person is made immune or resistant to an infectious disease, typically by administration of a vaccine
evolution of communicable disease control
-three of the top ten causes of death worldwide continue to be infectious diseases -in 2016, lower respiratory infections, as a group, were the fourth-leading cause, responsible for 3.0 million global deaths -even though the worldwide number of deaths attributed to diarrhea and TB have declined, these diseases are still responsible for the deaths of 1.4 million and 1.3 million people, respectively
modes of transmission
-transmission of a communicable disease describes how disease is passed from person to person or from another source to a person -this spread can occur by *direct transmission* or *indirect transmission* methods -direct: reservoir --> host by direct contact or droplet spread -indirect: host by suspended air particles, inanimate objects (vehicles), or animate intermediaries (vector)
vector transmission
-vectors are living organisms that can transmit infectious diseases to humans -insects, a common type of vector, carry disease on their feet or expel it through their digestive tract -this mechanical transmission does not require the infectious organism to multiply -insects can also transmit disease when the infectious agent has propagated within the insect, which is known as biological transmission -this requires an incubation period for the infectious agent to be passed to the host
infectious waste
-waste that is capable of producing an infectious disease provided it contain pathogens with sufficient virulence and quantity so that exposure to the waste by a susceptible host could result in an infectious disease -requirements for medical waste disposal are for waste to be segregated into categories of: -used and unused sharps -cultures, specimens, and stocks of infectious agents -human blood and blood products -human pathologic, isolation, and animal waste
As evidence of environmental impact on our health continues to grow, it is important for nurses in all practice settings to be knowledgeable of___________and____________ and__________to best protect and promote the health of the populations in the nurse's care.
1) environmental risks 2) the relationship of exposures to disease and illness, prevention measures 3) growing scientific evidence
two approaches in primary prevention
1. education using mass media with targeted health messages to aggregates 2. immunizations
investigating outbreaks involves three types of data
1. epidemiologic data: patterns in the geographic distribution, time of onset, and past incidents of illnesses; associated exposures to food, infected people, or other sources of disease; clusters of unrelated sick people who share a common event 2. traceback data: common points of contamination in the distribution chain, identified by reviewing records collected from restaurants and stores where sick people ate or shopped; findings of environmental assessment in food production facilities, farms, and restaurants identifying food safety risks 3. food and environmental testing data: specimens collected from suspected food items and sent to the lab for processing and identification of the organism; specimens processed through the CDC surveillance system, PulseNet, which is designed to identify organisms that may come from the same source, allowing outbreaks to be identified and sources to be eliminated
three types of data involved in investigating outbreaks
1. epidemiologic data: patterns in the geographic distribution, time of onset, and past incidents of illnesses; associated exposures to foods, infected people, or other sources of disease; clusters of unrelated sick people who share a common event (e.g., eating at the same restaurant, shopping at the same store, attending the same concert) 2. traceback data: common points of contamination in the distribution chain, identified by reviewing records collected from restaurants and stores where sick people ate or shopped; findings of environmental assessment in food production facilities, farms, and restaurants identifying food safety risks 3. food and environmental testing data: specimens collected from suspected food items and sent to the lab for processing and identification of the organisms that may come from the same source, allowing outbreaks to be identified and sources to be eliminated
steps of disease investigation
1. identify additional people who might be infected (surveillance) 2. determine the possible source of infection and means of transmission 3. identify others who are at risk so screening and prevention measures can be implemented 4. prevent further transmission 5. monitor the response to these interventions disease investigation requires a systematic approach
four distinct phases of syphilis
1. primary: a primary lesion called a chancre appears as a painless ulcer at the site where the infection entered the body, lasts 3-6 weeks, and heals regardless of medical treatment 2. secondary: after 4-6 weeks, a more generalized secondary macular-to-papulosquamous skin eruption develops, classically appearing on the soles of the feet, palms of the hands, and trunk, often accompanied by a fever, sore throat, lymphadenopathy, and fatigue 3. latent: by this phase, the spirochete has invaded the CNS but there may not be any S/S of infection for weeks to years 4. tertiary: 1/3 spinal fluid, deafness, meningitis, cranial nerve palsy, or even death
Social Determinants of Health
According to the WHO, social determinants of health are defined as "the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels" - addresses social factors that contribute to health disparities,
Types of Toxic Exposure
Air Water: Poverty is linked with lack of access to clean water and sanitation. Food Toxic waste Radiation--ioninzing and nonionizing
mosquito-borne diseases
California serogroup viruses, Chikungunya virus, Dengue viruses, Eastern equine encephalitis virus, Malaria plasmodium, St. Louis encephalitis virus, West Nile virus, Yellow fever virus, Zika virus
Florence Nightingale
Played a large role in the occupational and environmental health movement in nursing-----called industrial nursing Identified the relationship between the patient environment and health highlighted the importance of incorporating environmental health into nursing practice because of her work, nurses consider the environment of the home, hospital, or community as a factor to promote and restore health
false
T/F: a painless ulcer called a chancre appears during the latent stage of syphilis
vector
T/F: a(n) ________ is a nonhuman living organism that can transmit diseases to humans, such as an animal or insect
false (correct: quarantine)
T/F: isolation refers to restrictions placed on healthy contacts of an infectious case for the duration of the incubation period to prevent disease transmission if infection should develop
true
T/F: the injectable influenza vaccine is inactivated
true
T/F: the predictive value of screening tests increases as the prevalence of the disease increases
true
T/F: validity refers to the test's ability to accurately identify those with the disease
Flint, Michigan water contamination
The public health of citizens in Flint, Michigan, was compromised in April 2014 when, in an attempt to save money, the city changed its water supply from Lake Huron water supplied by Detroit to the Flint River.
T/F: Drinking water is available in two forms: surface water and groundwater.
True Both are potential sources of contamination or pollution. Surface water includes lakes, streams, and municipal reservoirs
direct
_____ transmission occurs by immediate transfer or infectious agents from a reservoir to a new susceptible host
airborne
_____ transmission occurs through droplet nuclei
Health risk assessment
a systematic evaluation of risk of a specific exposure. It involves four steps: (1) identification of the hazard (2) exposure assessment (determining how are people exposed, who is at risk, and who is most vulnerable) (3) characterization of the health risk (determining whether the risk exists, how the exposure presents in humans, and what the toxic levels of exposure are) (4) risk management
induration of 5 or more millimeters
considered positive for: -HIV-infected persons -recent contact of persons with infectious TB -people who have fibrotic changes on a chest radiograph -patients with organ transplants and other immunosuppressed patients
induration of 10 or more millimeters
considered positive for: -people who have come to the United States within the last 5 years from areas of the world where TB is common (Asia, Africa, Eastern Europe, Russia, or Latin America) -injection drug users -myobacteriology lab workers -people who live or work in high-risk congregate settings -people with certain medical conditions that place them at high risk for TB -children younger than 5 years of age
ring
containing an outbreak by rapidly isolating and vaccinating people who have had close, face-to-face contact with the victim is known as _____ vaccination
education
health education in primary prevention is directed both at helping individuals understand their risk and at promoting healthy behaviors
vector-borne diseases
diseases from mosquito, tick, and flea bites have increased threefold between 2004 and 2016
four D's
disruption, deprivation, disease, and death
Home Assessment
looking for safety hazards in the home Assess for the following: - Tobacco smoke - Asbestos - Presence of a carbon monoxide detector and heating sources - lead paint risk - water source and the possibility of lead pipes - carbon monoxide - formaldehyde - mold - radon - pharmaceutical waste - pesticides/pests It should assess nearby environmental hazards such as coal-fired power plants, farms, industries, brownfields, toxic waste sites, highways, and contaminated waterways
quarantine
refers to restrictions placed healthy contacts of an infectious case for the duration of the incubation period to prevent disease transmission if infection should develop
isolation
refers to separation of the infected persons (or animals) from others for the period of communicability to limit the transmission of the infectious agent to susceptible persons
secondary prevetnion
screening and disease case and contact investigation and notification -screening: used in community/public health and disease prevention to describe programs that provide disease-testing opportunities to detect disease in groups of asymptomatic, apparently healthy individuals
Health Disparities
serious concern for overall health in the US and globally great inequities occur between the environments of people with higher incomes and those of low-income communities, people of color, and tribal and indigenous populations. Disparities that are directly correlated with environmental exposures include rates of asthma among children, elevated blood lead levels (EBLLs), cancers that are linked to environmental exposures, and lung diseases among adults.
social determinants of health
the conditions in which people are born, grow, live, work, and age--shaped by the distribution of money, power, and resources at global national and local levels -education -housing conditions -safe and active transportation -access to health care services -access to healthy food -employment and income -neighborhood environment and safety -quality of built environment (parks, buildings, green spaces)
Bioaccumulation
the process where toxins accumulate in greater concentration in an organism than the rate of elimination. Toxins can accumulate from direct exposure or from eating contaminated food products.
Toxicology
the study of the adverse effects of chemical, physical, or biological agents on living organisms and the ecosystem, including the prevention and amelioration of such adverse effects
incubation
the time interval between exposure and the onset of symptoms is called the ______ period
