Community Health Midterm Study Guide

Sources of Lead Poisoning

- Air - Soil - Water - Homes - Toys - Ceramics - Pipes and plumbing - Solders - Gasoline - Cosmetics

Self-care management: Symptom monitoring

- Assess HF symptoms on each visit - vital signs, weight, dyspnea, lung sounds, fatigue, appetite, peripheral & abdominal edema chest pain, SPO2, sleep disturbances, dry cough, activity tolerance, dehydration (orthostatic hypotension) - Educate pts./caregivers to improve abilities to recognize, interpret & act on early symptoms. Use teach-back to assess learning - Use Remote pt. Monitoring as tool for daily, repeated, serial assessments of specific symptoms - Utilize Stoplight/Zone tools to help pts. interpret & act on symptom changes - Help pt./caregiver to identify 1-2 achievable goals

Understand all aspects of the role of care coordinator assumed by the home health nurse on slides

- Assess for need for ADL assist and establish plan of care (bathing, grooming, dressing, med reminder, simple exercises, weigh, vs, report and change) - Orient and supervise HHA - Assess and refer for PT, OT, SPT, medical social worker - Order durable medical equipment - Assess need for assist with IADLs - Refer for homemaker - Knowledge of community resources, how to refer = Transportation, Food stamps, and Fuel assistance

Health effects of Lead Poisoning

- Behavior and learning problems - Lower IQ and Hyperactivity - Anemia - Hearing Problems - Slowed growth - Premature birth - Reduced growth of fetus - Hypertension - Decreased kidney function - Reproductive problems

Medication management

- Complex medication regimes: Polypharmacy - Teach medication regime, assess understanding (teach-back) and ability to take meds (show me) - Provide written instructions - Have patient/family maintain a current list of meds - Have patient bring all meds to MD appointments - Establish pre-fill, administration, and storage process - Assess effectiveness of meds - Teach and assess side effects - Advocate for simplification

Self-care management: Physical Activity

- Discuss physical activity program & goals w/physician & patient. - Refer to PT to establish exercise regimen to improve strength, duration, endurance & safety - Refer to OT for energy conservation techniques & adaptive equipment - Teach simple exercises for limited mobility pts. - Frequent movement (q hr), short duration, gradual increase - Avoid fatigue - Consider referral to an outpatient cardiac rehabilitation program

Diabetes self-management

- Education Key Nursing Intervention in Diabetes Disease Management - Assess previous education, knowledge, and skill - Assess current level and promote self-management - Prevent complications - Primary or secondary diagnosis - Need for review/tune-up - Assess Blood glucose - Assess vital signs, heart and lung sounds - Teach self-management - Assess and teach Signs/symptoms of hypo/hyperglycemia - Assess for complications - Teach annual screenings

Multilevel Interventions on slide and pg 193-194 of text (p. 292-293 e-book)

- The most successful interventions are those that combine interventions at more than one system level - Disease prevention at the upstream or mainstream level amplifies the impact of interventions on population health - Different system levels 1.) Upstream: at the societal, environmental, or policy level 2.) Mainstream: at the population or community level 3.) Downstream: at the individual level; one-on-one interventions do little to address the social or environmental determinants of population health

Healthy People 2020 know the new focal areas on slides

- US gives more support to individuals rather than community; focus on the need to cure instead of prevention - Health indicators: PA, obesity, tobacco/substance use, MH, sexual behaviors, immunizations, abuse/neglect - New focal areas: adolescents, genomic, older health, sleep health - Adolescent Health - Genomics - Global Health - Lesbian, gay, bisexual and transgender health - Older Adults - Preparedness - Sleep Health - Social Determinants of Health

assess every visit

- Vital signs, Lung sounds - Assess weight and edema - Request weight log to assess pt. ability to log daily weights - Cardiovascular assessment w/focus on HF signs & symptoms - Pain status - Changes in medication orders or usage - Pt knowledge of medications to avoid that exacerbate HF - Pt ability to manage co-morbid conditions (DM, COPD, depression) - Nutrition - Mental status/anxiety/depression - Any falls since last visit - Functional ability - Learning ability/readiness for change - Barriers to adherence - O2 saturation, safety & usage. - Advanced Planning & palliative care conversation if pt. appropriate

Call/speak to pt. on day of dc from facility to ask:

- Who is helping you at home? - Has your breathing changed since you got home or have you had any chest pain? - Were all of your prescribed medications obtained? Any questions about them? - Do you feel safe &/or do you need a visit today/this evening? _ Extent of family involvement; identified informal caregiver - Do you know who to call if your symptoms change?

COPD- Chronic Bronchitis/ Emphysema

1.) manifests around 60y/o 2.) Primary cause: smoking 3.) Emphysema: alveolar structure changes, leads to impaired gas exchange - Goals: prevention, early diagnosis, know S/Sx management, avoid exacerbation - Assessment: infection control, vitals, O2 Sat, daily weights, how many pillows they need to sleep - Treatment: small frequent meals, avoid fatty/spicy foods, medication management, monitor fluid intake, limit alcohol and caffeine, smoke cessation

Case management

coordination of a plan or process to bring health services and the self-care capabilities of the client together as a common whole is a cost-effective way

Teaching

develops a health education plan and teach clients and other caregivers leading to behavior change

Counseling

develops an interpersonal relationship with the client to increase his or her capabilities to address or solve issues

Health Disparities

differences in healthcare and health outcomes experienced by one population compared with another, frequently associated with race/ethnicity and socioeconomic status

Delegation

direct care tasks an RN entrusts to other appropriate personnel

Web of causation

epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness - Identifies all possible antecedent factors that could influence the development or prevention of a particular health condition - Provides multiple entry points for intervention, but also has the capacity to demonstrate the interrelationship of different factors

Wheel of causation

epidemiological model that de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biologic, and social environments Interaction between the host and environment are major determinant of health status

Coalition-building

fosters, mobilizes, and participates in community wide alliances to achieve a specific goal

VNAA CHF Zone tool

green, yellow, red

Community organizing

helps community groups to identify common problems or goals, mobilizes resources, and develops and implements strategies for reaching those goals

Screening (3 types)

identifies individuals with unrecognized risk factors or asymptomatic conditions 1.) Mass: screen general population for a single risk (chol in a shopping mall) or multiple health risks (health fair at job site) 2.) Targeted: process to promote screening to a discrete subgroup within the population (those at risk for HIV) 3.) Periodic: process to screen a discrete but healthy subgroup of the population on a regular basis, over time, for predictable risks or problems (breast and cervical cancer screening, well-child)

Case-finding

locates individuals and families with identified risk factors and connects them with resources

Outreach

locates populations at risk, provides information, identifies possible actions, and identifies access to services

Crude rate

measurement of the occurrence of the health problem or condition being investigated in the entire population

Epidemiologic triad

model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment - Host is the client whose health is of concern (person, family, group of high risk people, community) - Agents are an element or force that can initiate or perpetuate a health problem under proper conditions - Environment is the context where the host and agent interact - absolute/nonmodifiable risk factors: age, race, genetic makeup, etc - variable/modifiable risk factors: lifestyle, exercise level, nutrition, health knowledge, motivation, etc

Surveillance

monitors health events through ongoing, systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions

Specific rate

more detailed and calculated according to smaller subgroups of the population in the denominator, subgroups such as age/sex and importance of person, place, and time in describing an outbreak

Methods of Data collection

multi- methods: upstream (societal/policy level), midstream (community level), downstream (individual level) 1.) Key Informant interviews: direct discussion of ideas and opinions 2.) Community Forum: Open Public Meeting 3.) Focus Group: Directed talk with representative sample 4.) Surveys: Specific questions asked in written format 5.) Participant Observation: Observe formal or informal community activities 6.) Windshield Survey: Descriptive approach assesses several community components while driving or walking through a community

Health Literacy and Teach-back (2-3 questions) Focus on slides and Health Literacy Universal Precautions p. 123-124 (p. 195-197 in e-book) and Table 5.3 p. 124 (p. 197 in e-book).

- Health Literacy: The degree to which individuals have the capacity to obtain, process and understand basic health information and services to make appropriate health decisions (Ratzan & Parker, 2000) - Clear provider communication is critical. Providing Information. Asking questions - What strategies should the nurse use when teaching/sharing health information. What is universal health care precautions - Ealth Literacy Universal Precautions: Structuring the delivery of care as if everyone may have limited health literacy 1.) You cannot tell by looking 2.) Higher literacy skills ≠ understanding 3.) Anxiety can reduce ability to manage health information 4.) Everyone benefits from clear communications - Teach Back Method: 1.) Ensuring agreement and understanding about the care plan is essential to achieving adherence 2.) "I want to make sure I explained it correctly. Can you tell me in your words how you understand the plan?"Can you tell me what the medicine is for? 3.) Some evidence that use of teach-back is associated with better diabetes control

How to lower Lead Exposure

- Inspect maintain all painted surfaces - Keep home clean and dust-free - Use wet-moping and wiping - Use cold water to prepare food and drinks - Flush water outlets used for drinking and food prep - Wash children's hands, bottles, pacifiers and toys often - Check for recalls of toys and ceramics - Ensure well balanced diet, Children with healthy diets experience less effects - Safe process for renovations and repairs: contractor lead-safe certified

Self-management of Diabetes

- Insulin injection/medications - Glucose monitoring/log - Diet and portion control - Foot care - Exercise

Environmental Justice includes

- Issues of political and economic power - Healthy Homes - Healthy Schools - Healthy Communities - Vulnerability to the Environment

Review slides on Flint water crisis and know general elements, do not need to know the entire timeline, the main points from all the posted articles (particularly NPR articles, and what we discussed in class, how it happened, how to prevent, who was most affected, how to intervene, environmental injustice, who held responsible (not names, but roles) (2-3 questions) The slide on "Other Issues and Outcomes" summarizes some of this information, review it carefully.

- Legionnaires Disease (bacterial pneumonia): Largest outbreak in US history: at least 90 ill with 12 reported fatalities. Delay in notifying Public of Risk - E.coli outbreak - Fertility rates dropped by 12% and miscarriages increased - Increased need for Head Start - Home values drop - 8 government officials charged, mostly plea deals or charges dropped. Spoke of new investigation, Bill introduced to extend statute of limitations in criminal misconduct cases involving public officials (2019) - Two businesses charged - Right to submit Civil suits against state and local officials upheld by Supreme Court. "Qualified Immunity" not a protection - Spike in students needing Special Education more than twice the national average. Lawsuits to gain needed services - $97 million in Concerned Pastor's suit settlement - Pipe inspections and replacements 90% complete; Millions$$; construction halted in March2020 due to Covid, restarted in June - Michigan to pay $600 million to victims - Faith and trust is government lost

Understand the Program of all-inclusive care (PACE) model. Definition, how financed, criteria to join, services provided all on slides

- Long-term care and financing innovation focused on keeping older adult at home in their community - Financed by Medicare and Medicaid (or Medicare and private pay) - Must be 55 or older and certified by state as eligible for care in a nursing home, and live in the program's defined geographic area - Provides comprehensive health and social services - Interdisciplinary approach - Adult day health center based - Care management - Primary and specialty care

Medication reconciliation

- Many discrepancies at transition points (14.1-94% clients at least one discrepancy) - Discrepancies can lead to adverse events and patient harm - Process of comparing a patient's medication orders to all the meds that patient has been taking - Done to avoid med errors such as omissions, duplications, dosing errors or drug interactions - Should be done at every transition in care

Home Safety Assessment

- Medication Safety - Fall Prevention - Fire safety - Assess all rooms in the house - Security (Locks, windows) - Complete Safety Checklist - Assess for Abuse or Neglect

Determining Health impact slide, think about duration, frequency, and bioavailability related to exposure

- Not an exact science - Toxicology - Exposure estimate: attempt to determine a person's level of exposure - Duration, Frequency, and Bioavailability of contaminant - Exposure estimate compared to health guideline, if level above guideline, chance exposure could cause health effect (EPA and other gov. agencies develop guidelines).

Primary Data vs. Secondary Data

- Primary Data: new data that may include community forums, focus groups, key informants, participant observation, and surveys - Secondary Data: existing data can often be used to identify the community's strengths and weaknesses, to determine assets and liabilities, and to describe, along with available community resource, the amount of disease/disability or health in a population

visit planning (particularly HF)

- Provide agency name & contact info. - Admit w/in 24 hours of facility discharge - Plan SN, Rehab & HHA schedule - Visit frequencies for weeks 1-4 a.) 3 RN visits the 1st week (frontloading, consecutive visits best) then 1-3 times/week . The more visits able to make the better. b.) At least 1 in home visit in 1st week from each of ordered therapies, then 1-2 times/week - Phone contact on days in between visits - Implement Tele-health by 2nd day, if using - Physician follow-up/appt. made w/in 7-10 days of dc

Assessment of contaminants, determining risk on slide

- Risk Assessment: Process to determine the likelihood or probability that adverse effects will occur in a group of people because of exposure to an environmental contaminant. - RISK = Hazard + EXPOSURE - If hazard present but exposure blocked, there is no risk. - EXPOSURE PATHWAY: A process by which someone is exposed to a contaminant that originates from a specific source. - If the pathway is not complete, or it can be disrupted, the contaminant of concern should not affect human health.

Patient education (1 question) use slide and Ashton and Oermann article Assessment section, pg 289-290 and Box 1 on p. 291,

- Written materials, when used alone, will not adequately inform. - Patients prefer receiving key messages from their clinician with accompanying pamphlets. - Focus needs to be "need-to-know" & "need-to do" - Patients with low literacy tend to ask fewer questions. Ask Me3 - Bring a family member and medication to appointments. - Planning and Implementation 1.) Goals and objectives: clear and simple 2.) Knowledge 3.) Psychomotor skill 4.) Educational Resources: readability = Content. Literacy demand, Graphics, Layout and type, Learning stimulation and motivation, and Cultural appropriateness - Evaluation 1.) Evaluate understanding of information and ability to perform skills = Teach-back and Show Me: Demonstration 2.) Revision of education plan = Use of different resources and Involve family members

Rates

- the primary measurement used to describe the occurrence and existence (quantity) of a state of health in a specific group of people in a given time period; probability that an event will occur again, used as a predictor - Occurence and quantity of a state of health in a specific group in a given period of time

Understand that the case management role can differ within the specific setting on slide

1.) A collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost effective outcomes (Box 12.1 Case Manger's Role, p. 248, e-book 371) - In-hospital Care management for discharge planning - Care management within insurance plans/HMOs - Care management in Home Health 2.) Box 12.1: A case manager's responsibilities include the following functions: - Advocacy and education- ensuring that the client has a representative who can speak up and represent their needs for neede services and education - Clinical care coordination/facilitation- coordinating multiple aspects of care to ensure that the client progresses - continuity/transition management- transitioning of the client to the appropriate level of care needed - utilization/financial management- managing resources utilization and reimbursement for services - Performance and outcomes management- monitoring and, if needed, tinervening to achieve desired goals and outcomes for both the client and the hospital - Psychosocial management- assessign and addressing psychosocial needs, including individual, familial, and environmental - Research and practice development- identifying practice improvements and using evidence based data to influence needed practice changes

Know the difference between ADLs and IADLs and who provides those services

1.) ADLs (Activities of Daily Living) = basic self-care tasks - The six basic ADLs are eating, bathing, dressing, toileting, mobility, and grooming. - Eating includes feeding oneself and getting all the vitamins and nutrients needed to stay healthy. - Bathing includes cleaning one's body and the ability to get in and out of the tub or shower safely. - Dressing oneself means not only physically putting on clothes, but also choosing the appropriate attire for the weather. - Toileting is both using the toilet independently and also recognizing the urge to use the restroom. - Mobility envelops walking, transferring (moving from the bed to a wheelchair), and climbing up or down stairs, if necessary. - Grooming is brushing teeth, combing hair, and maintaining personal hygiene. 2.) IADLs (Instrumental Activities of Daily Living) = slightly more complex skills - They include managing finances, handling transportation, shopping, preparing meals, using the telephone or other communication devices, managing medications, doing laundry, housework, and basic home maintenance. - Difficulty managing these tasks are common in patients with early stages of dementia. These task are performed by non-skilled workers

Understand the differences between "other services" Adult day care, social day care, congregate housing, and assisted living on slides and assisted living in text p. 256-257 (p. 384-385 in e-book).

1.) Adult Day Care: provides nursing care, personal care, nutrition, podiatry, socialization 2.) Social Day Care: provides supervision, socialization, nutrition 3.) Congregate Housing (Senior Housing) 4.) Assisted Living: provides personal care, nursing care, meals, homemaking

3 categories of environmental factors

1.) Biologic: plants, animals, and the toxins they produce (includes pathogenic microorganisms, vectors that carry infectious agents, and reservoirs infectious agents are found) 2.) Physical: light, heat, air, atmospheric pressure, radiation, geologic factors, structures in the environment 3.) Social: culture, technology, educational opportunities, political systems, demographic characteristics, sociologic factors, adn economic and legal systems

Asset-based and Collaborative Model of Assessment on slides and in text pg 241-242 (p. 362-364 e-book).

1.) Collaborative Model: an approach to assessment that begins with planning that includes representative parties of a population, including service organizations, corporations, and government officials Emphasizes interdisciplinary nature of the task Assessment includes nurses as well as social workers in collaboration with community residents Members of population have an active voice in identifying issues and in making decisions about what is needed Drawback: time consuming 2.) Asset-based assessment: attention is directed to community strengths and resources as a primary approach to community assessment A community asset (or resource) is anything that can be used to improve the quality of community life ( person, physical structure or place, community service) Empowers community, improves relationships, can change perspective, philosophical approach Can change the perspective on how one conducts an assessment within community The strengths and positive aspects of the community are measured in conjunction with what is needed or not actualized

Understand the difference between incidence and prevalence

1.) Incidence Rate: new cases over a given period of time - # of new cases in specified time/population at risk in same time period - Relative risk ratio: ratio of incidence rate in exposed group and incidence rate in non-exposed group - Mortality rate: death rate 2.) Prevalence Rate: people with existing condition at a given point in time - New AND existing cases - # of existing cases in a specific time/ population at risk in the same time period

Public Health Nursing Interventions

1.) Surveillance 2.) Outreach 3.) Screening 4.) Case-finding 5.) Referral and follow-up 6.) Investigation of disease and other health events 7.) Case management 8.) Delegation 9.) Teaching 10.) Counseling 11.) Consultation 12.) Collaboration 13.) Coalition-building 14.) Community organizing 15.) Advocacy 16.) Social marketing 17.) Policy development 18.) Policy enforcement

Five phases of the home visit on slides

1.) Initiating the Visit: Assessing referral, contacting the patient, scheduling the visit within 24 hours 2.) Preparation: Paperwork, equipment, directions, personal safety 3.) Actual Visit: establishing a relationship (need to be welcomed back), consider cultural factors, assessment, oral and written instructions, assess home safety, assess meds, fall risk, abuse and neglect, collaboratively establish POC 4.) Terminating the Visit: Assess understanding of all teaching/instructions, discuss any referrals, schedule next visit, review emergency plan and how to contact health care providers, emergency #s at phone 5.) Post-visit Planning/Documentation: Complete any referrals, all documentation, planning for future visits, obtain any needed prior approvals

Healthy diet for reducing effects of Lead Poisoning

1.) Iron-rich foods - Chicken - Lean red meats - Iron-fortified cereals - Dried fruit (raisins, prunes) 2.) Calcium-rich foods - Milk - Yogurt - Cheese - Green leafy vegs (spinach, kale) 3.) Vit C-rich foods - Oranges, orange juice - Grapefruit grapefruit juice - Tomatoes, tomato juice - Green peppers

Understand Medicare Criteria for Home health services: part-time, intermittent, skilled, homebound, plan of care, necessity, attestation of face-to-face visit by MD who supervises the plan of care, possible indications of homeboundedness (reasons why leaving home is taxing, listed on VNA handout). This information is on the slides, the posted handouts and in the text p. 250-251 (p. 375-376 in e-book) (Financing and Regulation of Homecare)-254 (p. 380 in e-book) (medical necessity)

1.) Medicare criteria for home health services - Home health agency providing services must be medicare certified - The client's need must be for eligible home health services such as intermittent skilled nursing care, physical therapy (PT), speech therapy (SPT), continued occupational therapy (OT can only be initiated if client is receiving one of the other skilled services).(Table 12.1 Skilled vs Nonskilled care, p. 254, e-book 380) - Medical social service and home health aide services are only covered if the client qualified for skilled nursing, PT or SPT. - You must be under the care of a doctor (have been seen recently) who establishes and reviews the plan of care (POC), which is agency generated using the Outcome and Assessment Information Set (OASIS). POC covers 60 days and then must renew and recertify POC - Initial orders come on referral from hospital, quality varies - MD must certify that the client needs at least one of the covered skilled services (needed and reasonable) - The need for skilled service must be part-time and intermittent (24 hour care not covered, difficult to get coverage for daily visits) 2hours - The client must be certified by MD as homebound, meaning it's a taxing effort to leave the house and only leaves fro medical appointments or short, infrequent non-medical reasons, such as religious services, hair appointment, family holiday. Clients going to adult daycare are still eligible for home health services 2.) Medicare Criteria - Nursing, PT and SPT can begin independently - OT, Medical Social Service, and HHA can only begin if Nursing, PT or SPT are already providing care. - OT can continue (if needed) even if Nursing, PT and SPT have ended. (cannot begin alone, but can end alone) - Medical Social Service and HHA must discontinue if no other skilled service remains (cannot begin or end alone)

Self-care management: Meds and diet

1.) Medication management - Prescription and OTC (herbs) - Finances - Reminders - Self-administration system 2.) Sodium restriction - Reading labels - Food preparation 3.) Fluid restriction - How to measure, monitor, and document - Alcohol and caffeine consumption

Understand the role and functions of the interdisciplinary team in skilled home health (PT, OT etc) on slides and p. 255 in text (p. 382 in e-book).

1.) Nursing: Registered nurses with varied specialty backgrounds 2.) Rehabilitation - Physical Therapist: help restore strength, flexibility, ambulation, coordination, gross motor function of clients disabled by an accident or illness - Occupational Therapist: work with clients to help them regain skills they need to function in their day-to-day activities (bathing, grooming, dressing, meal prep), advise on use of adaptive equipment, fine motor skills - Speech Therapists: Help clients regain their ability to produce and understand speech, facilitate communication and swallowing skills 3.) Social Worker: help client cope with the medical, functional, emotional, personal relationships, environmental and financial challenges of living in their own homes. Provide counseling and access to community services 4.) Home Health Aide (HHA); assists with ADLs (simple exercises, vital signs, med reminder etc)

Obesogenic and Salutogenic Environments on slide and pg 194 in text (294 in e-book)

1.) Obsogenic environment is one that promotes or contributes to the problem (ie: a community that promotes and contributes to obesity) 2.) Salutogenic environments reduce the vulnerability to illness and promote enhanced levels of well-being (ie: schools only offer healthy food options and physical activity is incorporated into school curriculum)

Components of Community Assessment

1.) People - Demographic - Biological factors - Social factors - Cultural Factors 2.) Place or Environment - Physical factors - Environmental factors 3.) Social Systems - Health, economic, education, religious, welfare, political, recreation, transportation, legal, communication, resources

Specific rate is described by what three things?

1.) Person (who is experiencing the illness/condition?) 2.) Place (where is it occurring?) 3.) Time (when does it appear?)

5 groups of agents

1.) Physical: heat, trauma 2.) Chemical: pollutants, medications, drugs 3.) Nutritional: absence/excess water, vitamins, fats, proteins, and carbohydrates 4.) Psychosocial: stress, social isolation, social support 5.) Biologic: bacteria, viruses, arthropods, toxins, conditions that interfere with the normal function of the body

Three levels of prevention

1.) Primary prevention protects against risks to health. Keeps problem from occurring. Immunizations 2.) Secondary preventions detects and treats problems in their early stages. Implemented after problem has begun. Screening 3.) Tertiary prevention limits further negative effects from a problem. Keeps existing problem from getting worse. Implemented after disease or injury has occurred. Focuses on rehab and recovery to optimal level of functioning Cardiac Rehab, Substance use disorder Rehab, Support Groups

Difference between skilled and non-skilled nursing care on table 12.1, p. 254 (p. 380 in e-book)

1.) Skilled - A full range of nursing, rehabilitation, social work, and home health aid services offered by a provider in a client's home. - Certified Home Health Care Agency: Medicare certified can provide and bill under Medicare, Medicaid, and private insurers - Clients must fit specific criteria - Extensive documentation is critical - Assessment of lungs and weight if a client diagnosed with CHF - Teaching a newly diagnosed diabetic client how to fill insulin syringes or use an insulin pen - Management of care given to a client postcerebrovascular accident by speech therapy, PT, an dhome health aide services - Changing a complicated wet-to-dry dressing on a client's abdomen - Monitoring the fluctuating blood pressure of an elderly man who has just started taking antihypertensive meds 2.) Nonskilled - Changing a dry dressing - Teaching the client's significant other/spouse how to pay healthcare bills - Managing care of a home health aide after all healthcare skilled needs have been stabilized - Pouring medications in plastic labled containers - Visiting the client to decrease loneliness

Environmental health

A field of public health science that focuses on how the environment influences human health

PANDEMIC

An epidemic that affects several countries or continents

EPIZOOTIC

An excess over the expected occurrence of a disease in an animal population Disease transmits from animal to human

EPIDEMIC

An increase over the usual occurrence of a disease in a geographical area

OUTBREAK

Increase in small geographic area or among a small group of people

Knowledge gained from video Unnatural Causes

UNNATURAL CAUSES is a documentary that explores how population health is shapedby the social and economic conditions in which we are born, live and work. Through portraits of individuals and families across the United States, the series reveals the root causes and extent of our alarming health inequities and searches for solutions. Along the way it confronts the inadequacy of conventional explanations like genetics, individual behaviors or even access to quality health care. we need to focus more on prevention rather than cures/intervention - Deal w/ the problem after the fact - Try to promote healthy habits/decisions to keep people healthy

Characteristics of PHN

Public health nurses focus on improving population health in the environments where people live, work, learn, and play. 1.) a focus on the health needs of an entire population, including inequities and the unique needs of sub-populations 2.) assessment of population health using a comprehensive, systematic approach; 3.) attention to multiple determinants of health 4.) an emphasis on primary prevention 5.) application of interventions at all levels—individuals, families, communities, and the systems that impact their health.

Assessment of Environmental Health (Exposure History): IPREPARE on slide, know what to assess for each step

I= Investigate potential exposures P=Present work (exposures, protective equip, MSDS) R=Residence (age of home, heating, recent remodeling, chemical storage, water) E=Environmental concerns (air, water, soil, industries, waste site or landfill nearby) P=Past work (exposures, farm work, military, volunteer, seasonal, length of work) A=Activities (hobbies, gardening, fishing, hunting, smoldering, pesticides, melting, burning, food eaten R= Referrals and resources (EPA, Agency for Toxic Substance & Disease Registry, OSHA, CDC, local health dept, poison control E=Educate (risk reduction, prevention, follow-up

Precautionary principle

If something has the potential to cause harm to humans or the environment, then precautionary measures should be taken even if there is a lack of scientific evidence

Understand the purpose and services provided directly by the Area Agencies on Aging (nonskilled side) on slides

Principal responsibility is to provide a collection of supportive services designed to help older adults remain independent and in their own homes. - Non-Skilled side: IADLs and ADLS - Information and Referral: Entitlement programs (food stamps, fuel assistance, MassHealth, Assisted Living, Nursing home - Case managers: Social workers - Assessment and intervention with Cases of Older Adult Abuse and Neglect - Homemakers - Nurse assess and supervise - PCA (not as skilled as HHAs)s - PCAs/companions - Congregate meal sites - Home delivered meals

Definition of Epidemiology

Study of the distribution and determinants of states of health and illness in human populations; used both as a research methodology for studying states of health and illness, and as a body of knowledge that results from the study of a specific state of health or illness.

Changes in epidemiology (morbidity and mortality from early 1900 to now, what is the shift)

Techniques in epidemiology now include all aspects of health including wellness (and how to keep people that way). Some areas that have benefitted by principles of epidemiology: - Chronic disease - Psychosocial problems - Occupational injuries - Environmental effect - Health service planning and evaluation

Environmental Justice

The belief that no group of people should bear a disproportionate share of negative environmental health consequences (regardless of race, culture, or income)

Relative risk ratio

The ratio of the incidence rate in the exposed group and the incidence rate in the nonexposed group.

Toxicology

The study of the adverse effects of chemical, biological agents on people, animals, and the environment

ENDEMIC

The usual prevalence of a disease in a geographic area

Advocacy

acts on behalf of clients who have lost control of factors that affect their health and a need is unmet; strengthens clients' capacity to act

Referral and follow-up

assists in identifying and accessing necessary resources to prevent or resolve problems

What the basic formula of rates?

box 7.1 pg 155 in text (p. 240 in e-book) rate= # of conditions or events within a designated period of time x base multiple of 10 Populations at risk during the same period of time

Case fatality rate

calculated by dividing the number of deaths from a specific disease by the number of poeple living with that disease during the year, and multiplying by 100

Policy enforcement

compels others to comply with the laws, rules, regulations, and ordinances created in conjunction with policy development

Health Inequities

poverty, income and wealth inequality, poor quality of life, racism, sexism, and low socioeconomic conditions are major risk factors - Polluted environment, inadequate housing, no mass transportation, lack of education and unsafe work conditions - Result of systematic and unjust distribution of critical conditions

Policy development

promotes beneficial social changes that influence the health of groups and populations

Consultation

seeks information and generates solutions to health problems or issues through problem-solving

Adjusted rate

statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another

Heart Failure

structural/functional impairment of ventricular filling or ejection of blood - Manifestations: dyspnea, fatigue, limited exercise tolerance, fluid restriction, edema, pulmonary/splanchnic congestion - 3 RN visits in the first week, then 1-3 visits/week - At least 1 in home visit in 1st week from each of ordered therapies, then 1-2 times/week - Assessment: vitals, heart and lung sounds, S/Sx of HF, medications, daily weights, nutrition, O2 Sat, comorbidities, education - Treatment: sodium restrictions, fluid restriction, medication management - Refer to PT/OT to exercises

Investigation of disease and other health events

systematically gathers and analyzes data about threats to population health, determines the source, identifies cases and those at risk, and determines control measures

Bioavailability

the amount of a substance that is absorbed or becomes available at the site of physiological activity. Helps determine the "dose" of a certain contaminant that will cause a health effect.

Social Determinants of Health

the conditions in which people are born, grow, live, work, and age. They are shaped by distribution of power, money, resources

Social marketing

uses marketing principles and technology to design programs to address needs of the client

Collaboration

works with people or representatives of organizations to achieve a common goal

Public Health Nursing Definition

· Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. · Public health nursing is a specialty practice within nursing and public health. It focuses on improving population health by emphasizing prevention, and attending to multiple determinants of health. Often used interchangeably with community health nursing, this nursing practice includes advocacy, policy development, and planning, which addresses issues of social justice. With a multi-level view of health, public health nursing action occurs through community applications of theory, evidence, and a commitment to health equity. · Public health nursing practice is guided by the American Nurses Association Public Health Nursing: Scope & Standards of Practice 2 and the Quad Council of Public Health Nursing Organizations' Core Competencies for Public Health Nurses.