Exam 3

Substance abuse myths

"An alcoholic is a "skid row bum," yet less than 5% of addicted persons fit this description "If you teach people about drugs, they will abuse them." It is actually more likely that people without knowledge, will abuse them "Addiction is a sin or moral failing." Now recognized as a health problem involving biopsychosocial factors; people do not intend to become addicted. Addiction is a disease

Personal Responsibility and Work Opportunity Reconciliation Act of 1996

"Welfare Reform"

Medicaid/CHIP Participation Rates

% of eligible children enrolled Illinois (Dec. 2015) - 96.2% All Kids - for families exceeding income eligibility for Medicaid/CHIP a family of four that earns between $50,700 and $77,112 a year pays a $40 monthly premium per child, and a $10 co-pay per physician visit.

Child poverty rate -what is the federal poverty level -child poverty rates are highest among whom? -does it very state to state

(Federal Poverty Level/family of 4 = $24,858.) (two adults, two children) Children under age 18- 18% (2017) Child poverty rates are highest among black, Latino, and American Indian children. Official child poverty rates range from 8.2% in New Hampshire to 22% in Mississippi. 11% of young children (0-9) are in poverty

To make our family action plan happen, we need to ...

(List five things in the order they need to have happen.)

Men's Health concerns

***Lack of health screenings Reluctant to consult primary care provider/seek care Not well connected to health care system Dangerous employment Cancers unique to men Prostate cancer Testicular cancer Depression Erectile dysfunction

Factors Contributing to Vulnerability results from what?

*Combined effects of limited resources* -Physical-such as poverty & social support -Environmental-working in a hazardous environment -Personal-(human capital-strengths, knowledge, and skills that enable one to live a productive, happy life) -Biopsychosocial-(such as presence of illness, genetic predispositions

Immunization recommendations

*Japan and great britian stopped giving the vaccine and it became a huge issue again

Healthy People 2020 and health disparities are described as

*health equity as attaining the highest possible level of Health for all people*

What is deep poverty

- Income below 50% of federal poverty line U.S. Family of 3 - less than $9276

Public Health Nurse's Role

-Batterers' interventions -Often effective for motivated individuals -Most effective if they— Are part of a coordinated community response Involve appropriate risk assessment and management practices Are of adequate structure and duration Are court mandated and closely monitored Involve training and close supervision of the staff implementing the program Partnering with the community Understand cultural differences. Lead in planning, implementing, and evaluating programmatic change Screening Use of effective screening protocols, institutional support, staff training, access to services/referrals Safety planning

2008 Physical Activity Guidelines for Americans

-Children and adolescents should do 60 minutes (1 hour) or more of physical activity daily -For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous intensity aerobic activity

Health Risk

-inherited biological risk -environmental risks -behavioral risk

Denver II screening tool -what ages -addresses what -this is not what -it cannot generate what

0-6 years Addresses: social contact, fine motor skill, language, and gross motor skill) Not an IQ test Not a predictor of outcome Cannot generate a diagnosis Not a substitute for testing Just compares children of the same age

Sexual Abuse

1 in 4 female children and 1 in 10 males experience some form by the age of 18 Department of Children & Family Services investigate; ALL Nurses are Mandated Reporters

To develop a baseline for a presentation at the local women's club about the status of women's health in the community, a community-oriented nurse researches national vital statistics to establish the leading cause of women's deaths in the United States. In the United States, the leading cause of death for women is: a. cancer. b. heart disease. c. stroke. d. infectious disease.

1. ANS: B Heart disease is the leading cause of death for both men and women. The lifetime risk for stroke is higher in women (~1 in 5) than men (~1 in 6). Since women live longer than men and strokes increase with age, more women are likely to die from stroke than men. Cancer is the second leading cause of death in the United States surpassed only by heart disease.

. A nurse volunteering at a local homeless shelter notes that many of the clients have acute and chronic illnesses and are in need of primary health care services. The most effective strategy to consider when networking with homeless individuals, families, or populations is to: a. form a community partnership to establish a clinic for homeless persons. b. create a trusting environment and establish a therapeutic relationship. c. collaborate with the local United Way to obtain funding for primary care services. d. dialogue with local clergy to address the unmet primary care need for homeless persons.

1. ANS: B Nurses need to be able to work with poor and homeless clients to promote, maintain, and restore health. Nurses must be prepared to look at the whole picture: the person, the family, and the community interacting with the environment. In working with the homeless, it is important to create a trusting environment. Trust is essential to the development of a therapeutic relationship with poor or homeless persons. Many clients and families have been disappointed by interactions with health care and social systems. They are now mistrustful and see little hope for change. Establishing a trusting relationship lays the foundation for a more comprehensive assessment of clients' perception of their health care needs and a determination of factors that may contribute to their current health status issues.

A community assessment reveals a high incidence of alcohol-related chronic liver disease and cirrhosis in the local community. A primary prevention harm-reduction program would focus on: a. detoxification, addiction treatment, and codependency. b. drug education, drug treatment, and recovery. c. polysubstance abuse, assessment of recreational drug use, and drug testing. d. promotion of a healthy lifestyle and resilience factors, and drug education.

1. ANS: D The harm reduction approach to alcohol, tobacco, and other drug (ATOD) problems focuses on health promotion and disease prevention. Primary prevention for ATOD problems includes the promotion of healthy lifestyles and resiliency factors, and education about drugs and guidelines for their use. Nurses are ideally prepared to use health promotion strategies such as encouraging healthy alternatives to indiscriminate, careless, and often dangerous drug use practices and providing education about drugs to decrease harm from irresponsible or unsafe drug use

top 5 reason for infant mortality

1. Birth defects 2. Preterm and LBW 3. SIDs 4. preg complications 5. injuries

Testicular cancer is commonly found in which age-group?

10-14 years 15-40 years 41-50 years 51-70 years

Effects of homelessness on health care outcomes can be devastating and may include which of the following? (Select all that apply.) a. Higher incidence of acute and chronic disease b. Higher risk of physical trauma c. Crisis-oriented health care, usually in emergency departments d. Reduced eligibility for entitlement/assistance programs e. Lack of awareness of care options

10. ANS: A, B, C, E Homelessness is correlated with poor health outcomes. The incidence of acute and chronic illness, acquired immune deficiency syndrome (AIDS), and trauma is significantly higher among homeless persons. Although homeless persons are at higher risk for physiological problems, they have greater difficulty accessing health care services. Health care is usually crisis oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens. Health problems of homeless clients are often directly related to poor preventive health care services. In addition to facing challenges related to self-care, homeless people usually give lower priority to health promotion and health maintenance than to obtaining food and shelter. They spend most of their time trying to survive. Just getting money to buy food is a major challenge. Although some homeless persons are eligible for entitlement programs such as Temporary Assistance for Needy Families (TANF), Women, Infants, and Children (WIC), or Social Security, others must beg for money, sell plasma or blood products, steal, sell drugs, or engage in prostitution. Barriers to treatment include lack of awareness of treatment options, lack of available space in treatment facilities, inability to pay for treatment, lack of transportation, nonsupportive attitudes of service providers, and lack of coordinated services.

. A community-oriented nurse is developing goals for a community health center's senior center. The goals should focus on which of the following? (Select all that apply.) a. Meeting social and recreation needs b. Helping elders accept the inevitability of the debilitation of aging c. Maximizing functional status and minimizing functional decline d. Implementing secondary and tertiary prevention measures

10. ANS: A, C, D Senior centers were developed in the 1940s to provide social and recreational activities. Now many centers are multipurpose, offering recreation, education, counseling, therapies, hot meals, and case management, as well as health screening and education. Nurses caring for elder populations strive to help maximize functional status and minimize functional decline. Senior centers are effective platforms for nurses to provide interventions related to primary, secondary, and tertiary prevention, health promotion and maintenance, and disease prevention. Senior centers are multipurpose and provide safe, stimulating recreational opportunities. Many of the changes traditionally associated with aging can be delayed or prevented by positive health practices and proactive intervention.

When conducting a nursing assessment of a child, the nurse should be aware that indicators of potential or actual child abuse may include which of the following? (Select all that apply.) a. Cognitive impairment b. Unusual fear of the nurse and others c. Injuries not mentioned in history d. Seems to need to take care of the parent e. Evidence of general poor care

10. ANS: B, C, D, E A national survey estimated that in 2011, 742,000 unique reports of children and adolescents who were subjected to neglect, medical neglect, physical and sexual abuse, and emotional maltreatment. Of these children, 78% were victims of neglect; 18% were victims of physical abuse, 10% were sexually abused, and 8% were psychologically maltreated. The remaining 2% were medically neglected. This is probably a conservative figure, since only the most severe cases are reported. Careful assessments through both observation and discussion can help in determining the presence of indicators that require further investigation. When conducting a nursing assessment of the child, the nurse should be aware of indicators of potential or actual abuse in the child as well as indicators in the family and its environment.

Marijuana (Cannabis sativa or C. indica) is the most widely used illicit drug in the United States. Which of the following are facts about marijuana of which the nurse should be aware? (Select all that apply.) a. It decreases appetite. b. Tolerance and physical dependence can develop. c. It is highly toxic. d. It can be a safe therapeutic agent. e. It may be contaminated.

10. ANS: B, D, E Compared with other psychoactive drugs, marijuana has little toxicity and is one of the safest therapeutic agents known. Because of its status as an illicit drug, however, there is little quality control, and a user may consume contaminated marijuana that may cause problems. Both tolerance and physical dependence can develop; however, withdrawal is benign. Side effects include dry and reddened eyes, increased appetite, dry mouth, drowsiness, and mild tachycardia. Adverse effects include anxiety, disorientation, and paranoia.

STDs

19 million new STD infections per year Almost half occur in people 15 to 24 years of age. Many cases go undiagnosed

Diabetes -ratio of adults that have DM -What complications are associated with this disease -how many Healthy People 2020 goals with this

19.7 million people with DM in 2010 1 in 12 to 13 adults has DM Costs the United States $174 billion each year Many complications associated with DM Heart disease, stroke, hypertension, retinopathy, kidney disease, neuropathy, amputations, and dental disease At least 18 Healthy People 2020 goals related to DM

What time period is more important doe developing life long eating habits?

1st six years of life

Which of the following best represents the concept of homelessness as crisis poverty? a. Man with chronic alcoholism and drug abuse living in a halfway house b. Recently unemployed man evicted from his apartment c. Teenager living on the streets and abusing drugs d. Woman with schizophrenia who is living in a shelter

2. ANS: B Crisis poverty is a conception of homelessness that views the homeless as people whose lives are generally marked by hardship and struggle. For this group, homelessness is often transient or episodic. Their homelessness may result from lack of employment opportunities, lack of education, obsolete job skills, and/or domestic violence.

Counseling regarding hormone replacement therapy (HRT) should include the following information: a. menopause is a result of hormone deficiency, and therefore HRT is appropriate for all women to treat all symptoms. b. HRT should be used to prevent osteoporosis only among women who are unable to take non-estrogen medication. c. research concludes that HRT does prevent heart disease in menopausal women. d. HRT should be considered for prevention of osteoporosis in all women.

2. ANS: B For decades, many U.S. women used HRT, even though HRT remained untested by rigorous scientific study. A clinical trial launched in 1991, the Women's Health Initiative, set out to test specific effects HRT had on women's health, especially its effect on heart disease and osteoporosis. Researchers concluded that HRT did not prevent heart disease and that to prevent heart disease women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol intake, maintain a healthy body weight, and be physically active. Scientists also concluded that HRT should be used to prevent osteoporosis only among women who are unable to take non-estrogen medications.

Primary prevention programs for adolescents at risk for ATOD problems should focus on: a. encouraging competitiveness and success in aggressive sports. b. encouraging focus on short-term solutions rather than long-term planning. c. screening and treating psychiatric disorders and influencing social norms. d. teaching adolescents to "just say no."

2. ANS: C Family-related factors such as genetics, family stress, parenting styles, and child victimization appear to be the variables with the greatest influence on substance abuse among adolescents. The presence of a psychiatric disorder (especially a mood disorder) and behavioral problems is also associated with substance abuse among adolescents; peer pressure is a less influential factor. Effective social influence-based prevention programs should focus on effective screening and treatment of psychiatric disorders and modification of social norms to reduce adolescents' social motivation to begin using ATOD.

Poverty rate for children is

21.8% higher than for any other age group

A client acknowledges that his cocaine use is damaging his career and marriage, but the client has not investigated local treatment options. The nurse encourages the client to weigh the pros and cons of the drug problem and think about the solution to the problem, because the nurse recognizes that the client is in the change stage of: a. action. b. contemplation. c. precontemplation. d. preparation.

3. ANS: B The role of the nurse in assessing individuals is to determine their readiness for change in acknowledging a problem and seeking treatment and recovery. The stages of change are precontemplation, contemplation, preparation, action, and maintenance. The strategies used by the nurse depend on the specific stage of change the client is in. At the contemplation stage of change, the individual is aware that a problem exists and is seriously thinking of overcoming it, but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the advantages and disadvantages of the problem and consider the solution to the problem.

At the request of a local senior women's group, a nurse is developing an osteoporosis primary prevention program. An appropriate strategy for the program would be to: a. design a nurse-directed program instead of a peer-directed program. b. encourage exercise and consideration of HRT. c. promote diets rich in calcium and vitamin D and daily weight-bearing exercise. d. promote swimming and supplementation with calcium and vitamin D.

3. ANS: C Among women older than age 50 years in the United States, approximately one in two will experience an osteoporosis-related fracture at some point in their lifetime. Primary prevention measures include consumption of a diet rich in calcium and vitamin D, and supplementation with calcium and vitamin D only if needed. Weight-bearing exercise is also important in maintaining bone density. Weight-bearing exercise includes activities such as walking, running, stair climbing, and weight lifting. Swimming is not a weight-bearing exercise. Limiting alcohol consumption and avoiding smoking are also important. Community-oriented nursing includes empowerment of community members as peer educators and change agents.

Deinstitutionalization of chronically ill individuals from publicly funded psychiatric hospitals had the unintended consequence of: a. moving clients to readily available community-based care. b. shortening hospital stays in mental health facilities. c. increasing the funding for community-based services. d. increasing the number of homeless persons.

3. ANS: D Deinstitutionalization of chronically mentally ill individuals from public psychiatric hospitals increased the number of homeless persons. The intent was to move clients from public psychiatric hospitals to community-based treatment centers. However, adequate community-based services were not funded. Few of the intended community mental health centers were ever built.

family caregivers are what percentage of american

30% of American adults -Most provide care for someone 50 or older -Most are themselves over 50 (12% older than 65) Growing trend: children as caregivers -Affects children's health and school performance

Healthy People 2020 and health disparities emphasis is on what

38 topic areas address elimination of health disparities. Included: emphasis on access, chronic health issues, injury & violence prevention, environmental health, food safety, health information technologies, immunizations, infectious diseases, and public health infrastructure

To detect the presence of the leading cause of disease burden for women in the United States, a screening program for women would include: a. blood pressure screening, mammography, and dietary assessment. b. testing for HIV/AIDS and sexually transmitted diseases. c. pap smear, screening for smoking, and assessment for exposure to violence. d. questions about a family history of depression, employment status, and chronic diseases.

4. ANS: A Chronic disease has become a public health problem of great proportions with the most common and costly chronic diseases being heart disease, diabetes, stroke, cancer, and arthritis. Chronic disease is the leading cause of preventable deaths, disability, and decreased quality of life. Heart disease is the leading cause of death for both men and women. Uncontrolled hypertension leads to heart attack, stroke, kidney damage, and a host of other complications and only two-thirds of people with hypertension are aware that have high blood pressure because there are no associated symptoms. Cancer is the second leading cause of death in the United States. Early screening and detection, promotion of healthy lifestyles, expanding access to services, and improving cancer treatments will help reduce the burden of cancer and disparities. Screening activities (secondary prevention) make a difference in death rates and early detection can promote a cure, whereas late detection typically ensures a poor prognosis. Overweight and obesity are topics addressed numerous times in Healthy People 2020 because of their link to many chronic health diseases (risk factor for diabetes and heart disease). A dietary assessment, along with physical and psychological assessments, helps nurses to identify women at-risk for appropriate referrals.

A truck driver says, "At first I was just using 'meth' at parties, but now I think about it all the time and how am I going to get some." The term that best describes this individual's use behavior is: a. drug addiction. b. drug dependence. c. recreational drug use. d. substance abuse.

4. ANS: A Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with using a drug (compulsive use) and securing its supply, and a strong tendency to relapse if the drug is removed. Frequently addicts are physically dependent on the drug, but there appears to be an added psychological component that is responsible for the intense cravings and subsequent relapse

Within the impoverished older adult population, the most vulnerable group may be: a. elderly couples living in poverty with serious chronic illnesses. b. elderly men with alcoholism and limited incomes. c. homeless older adults. d. newly widowed, low-income elderly women.

4. ANS: C Homeless older adults are the most vulnerable of the impoverished older adult population. They have long lived in poverty, have fewer supportive relationships, and are likely to have become homeless as a result of catastrophic events. Life expectancy for homeless older adults is significantly lower than that for older housed adults. Permanent physical deformities, often secondary to poor or absent medical care, are common among homeless older adults. Homeless older adults suffer from untreated chronic conditions, including tuberculosis, hypertension, arthritis, cardiovascular disease, injuries, malnutrition, poor oral health, and hypothermia. As with younger homeless persons, older adults who are homeless must focus their energy on survival, which leaves little time for health promotion activities.

In comparison with women, men: a. incur more work-related injuries. b. experience lower survival rates in the first year after myocardial infarction. c. metabolize alcohol more efficiently. d. more actively initiate preventive health care interventions.

5. ANS: A Men are often employed in dangerous jobs and incur more work-related injuries than women. Men do not participate in health care to the same level as women, apparently because of the traditional masculine gender role learned through socialization. Men are socialized to ignore pain, be self-reliant, and be achievement oriented. Large numbers of men do not receive the health screenings intended to prevent and identify disease.

A nurse working in a clinic in an inner city with high poverty and unemployment rates recognizes the need for programs for women because impoverished women are at higher risk for: a. decreased access to social services. b. poorer health status. c. exposure to environmental toxins. d. poorer academic success.

5. ANS: B The relationship between poverty and health is significant. Poverty presents a formidable obstacle to positive health across the life span. Those in lower income groups have poorer health status, and those with poor health have decreased ability to work and improve their socioeconomic status.

A very toxic psychoactive drug that is a stimulant, causes tolerance to develop within hours, and has dangerous health impacts for those in the vicinity during use is: a. alcohol. b. crack cocaine. c. nicotine. d. volatile solvents.

5. ANS: C Nicotine is a stimulant to which the body quickly develops a tolerance. For regular smokers, tolerance develops within hours, compared with days for heroin or months for alcohol. Smoke is damaging when inhaled directly. Sidestream smoke, also called secondhand smoke, contains greater concentrations of toxic and carcinogenic compounds than mainstream or firsthand smoke.

HIV/AIDs

50,000 new cases of HIV/AIDS African Americans: 44% Hispanics: 21%

Statistics Related to Violence

55,000 people die each year in the U.S. as a result of violence-related injuries Homicide is the 2nd leading cause of death of individuals 15-24 years of age Homicide is the 3rd leading cause of death for individuals 1-4 and 25-34 Homicides committed by intimate partners account for 14% of all homicides; 70% of victims are female

A recent movie release portrays a female drug user living with her abusive boyfriend, who has two children by different women, in a rundown inner city neighborhood with high levels of poverty and unemployment. This portrayal best describes the influence of which class of factors on societal responses to poverty and homelessness? a. Cultural b. Environmental c. Political d. Social

6. ANS: A Individual perceptions of poverty and poor persons are rooted in social, political, cultural, and environmental factors. Societal responses to poverty and homeless persons (what actions are taken to assist them) are deeply rooted in history, and that history has helped to shape cultural attitudes. Cultural attitudes affect, and are affected by, the discourses in various media. Portrayals of poor people as lazy and shiftless folk, desperate persons, criminals, and slackers living off of public assistance influence what we believe to be true about poor persons.

In following the principles of nursing interventions with violent families, nurses should: a. avoid provoking the perpetrator by initially suggesting that the victim leave the relationship. b. indicate zero tolerance for any further violence, degradation, or exploitation of family members. c. provide assurances that the family's confidentiality will not be violated. d. threaten to report child abuse to the authorities.

6. ANS: B The five principles of providing care to families who are experiencing violence include intolerance for violence, respect and care for all family members, safety as a first priority, absolute honesty, and empowerment. Nurses must clearly indicate that any further violence, degradation, and exploitation of family members will not be tolerated, but that all family members are respected, valued human beings. However, everyone must understand that the safety of every family member is the first priority. In all states, nurses are required by law to report child abuse, even when it is only suspected, and in most states they must also report elder abuse and felony assaults. Referral to protective service agencies should be viewed as enlisting another source of help. Absolute honesty about what will be reported to officials, what the family can expect, what the nurse is entering into the records, and what the nurse is feeling is

Although all men are at risk for developing prostate cancer, those at greatest risk are men who: a. have erectile dysfunction. b. fail to undergo prostate-specific antigen testing or digital rectal screening. c. are African American. d. have multiple sex partners.

6. ANS: C According to the National Cancer Institute, approximately 15% of men will be diagnosed with prostate cancer in their lifetime. It is the most common non-skin cancer and the second leading cause of cancer deaths in the United States. African American men have higher rates of prostate cancer compared to all races. Prostate cancer is linked to changes in the DNA of a prostate cancer cell and high levels of male hormones, but the exact cause of prostate cancer is unknown.

Some health care organizations, like the American Nurses' Association, American Public Health Association (APHA), and several state nurses' associations, passed formal resolutions to support the use of medicinal marijuana based on its low level of toxicity, dependence, or addiction, and therapeutic safety and benefits especially in the control of pain. These resolutions have impacted changes in state legislation but to date, despite formal petition in 2002 to remove cannabis from the Drug Enforcement Agency's (DEA) Schedule I of Controlled Substances, and an extensive review and report by the Department of Health and Human Services (DHHS) in 2010, a DEA final ruling has not been received. This collective action by health care organizations to influence policymakers to put the emphasis on health care instead of law enforcement can best be described as: a. assessment. b. advocacy. c. education. d. surveillance.

6. ANS: C The greatest challenge for nurses and nursing is to influence policy makers to put the emphasis on health care instead of law enforcement in addressing ATOD problems, which are a major health care problem in this country. Through evidence-based practice nurses can demonstrate the effectiveness of health promotion, disease prevention, and drug-education programs. Nurses can also provide accurate information about the effects of psychoactive drugs, guidelines for their use, and the negative impacts of taking a law enforcement approach to ATOD problems. In this case, working to ensure public access to the appropriate therapeutic/medicinal use of marijuana under the supervision of a physician is advocating for the availability of a safe and effective therapeutic agent for client treatment.

An occupational health nurse establishes a local business-sponsored smoking cessation clinic that incorporates the use of nicotine replacement therapy, behavioral treatments, and support groups. This strategy best exemplifies: a. population-focused tertiary prevention. b. individual-focused primary prevention. c. primary prevention education. d. secondary early detection.

7. ANS: A Tertiary prevention related to substance abuse focuses on the development of programs to help reduce or end substance abuse. Nurses can be active in smoking prevention programs for individuals as well as in community efforts to help people quit smoking. Fewer than 10% of those who try to quit smoking on their own are able to stop for a year. Interventions that include medications (nicotine replacement therapy) and behavioral treatments appear most promising. The most effective way to get people to stop smoking and prevent relapse is through multiple interventions and continuous reinforcement, and most smokers must make several attempts at cessation before they are successful.

A nurse case manager identifies a potential health outcomes concern for a 1 year old with special needs living in an impoverished neighborhood, because this child is at increased risk for: a. developmental delays. b. ear infections. c. frequent colds and infections. d. irritability.

7. ANS: A Young children (0-5 years of age) are at highest risk for the most harmful effects of poverty. Good nutrition during the first years of life is crucial for normal cognitive development. Unfortunately, many children live in poverty during their early childhood years. The brain is directly affected by environmental stimulation during a critical time that extends from the prenatal period through early childhood. Among the risk factors that impede cognitive development in young children are inadequate nutrition, maternal substance abuse, maternal depression, environmental hazards, trauma, and abuse. Unfortunately, poor children often have greater exposure to risk factors such as these. Poverty increases the likelihood of chronic diseases, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron-deficiency anemia, and elevated blood lead levels.

A new primary health clinic is established in a predominantly African American neighborhood to address the top causes of mortality in the local adult population. The nurse at the clinic uses a community-focused nursing process to plan interventions aimed at reducing the incidence of: a. cardiovascular accident, lung cancer, and alcoholism. b. depression, alcohol abuse, and obesity. c. heart disease, stroke, and homicide. d. mental illness, drug and alcohol abuse, and heart disease.

7. ANS: C African Americans in 2009 had the highest death rates from heart disease and stroke compared with other racial and ethnic populations. They also had the highest death rates from homicide, with rates among African American males highest across all age groups among males (Centers for Disease Control and Prevention (CDC) Health Disparities and Inequalities Report, 2013).

When working with the poor or homeless, to develop effective nursing interventions the nurse should evaluate clients and populations in the context of: a. environment. b. improvement in the quality of services. c. human dignity. d. nursing theories.

8. ANS: A The foundation of nursing theories is the assumption that human beings have inherent dignity and worth. Nursing is based on valuing individuals, promoting health, respecting and restoring dignity, and improving the quality of life of individuals, families, and aggregates. Conflicts in values, beliefs, and perceptions often arise when nurses work with persons from different social, cultural, and economic backgrounds. A lack of agreement between the professional's and the client's perceptions of need can lead to conflict. As a result of this conflict, clients may fail to follow the prescribed treatment protocol. The nurse may then inaccurately interpret the client's behavior as resistance, lack of cooperation, or noncompliance. Nurses should evaluate clients and populations in the context of the environment to develop effective nursing interventions. Care must be multidimensional and should include consideration of biological, psychological, social, political, cultural, environmental, economic, and spiritual factors.

To improve the health of frail elderly, community-based nursing programs will need to address: a. racial/ethnic and sociological disparities. b. culture, ethnicity, and race. c. media and marketing initiatives that target elderly concerns regarding quality of life and degree of disability. d. national vital statistics on morbidity and mortality.

8. ANS: A The prevalence of frailty in the older population poses a major public health dilemma since the majority of this group will reside in a community setting, placing new demands on health care systems, family caregivers, and community resources. To improve the health of frail elderly, community-based nursing programs will need to address racial/ethnic and socioeconomic disparities.

Violent crimes in the United States include rape, robbery, homicide, and assault. Although rates are decreasing, the long-term consequences of victimization reveal troubling trends that best support the realization that violence must be addressed as which of the following? a. Community and public health problem b. Legal and political concern c. Medical and health care concern d. Nursing concern

8. ANS: A Violence should be considered a community and public health problem because violence results in significant mortality and morbidity, contributing to health care costs; exposure to violence as either a victim or witness can predict violent behavior in the future (violence begets violence); health care professionals have been slow to develop a response to violence; community factors contribute to violence; and evidence-based interventions have demonstrated that violence can be decreased or prevented and the community's capacity to respond to violence can be increased.

Americans rely heavily on prescription drugs and over-the-counter drugs to relieve or mask anxiety, tension, fatigue, and physical and emotional pain. Attitudes toward ATOD problems in our society today are influenced by this "quick fix" attitude, as well as by the myth that: a. alcoholism is a disease. b. any drug can be abused. c. biopsychosocial factors affect addiction. d. there are good drugs and bad drugs.

8. ANS: D Attitudes are developed through cultural learning and personal experiences. Attitudes toward ATOD problems are influenced by the way society inappropriately categorizes drugs as either good or bad. In the United States, "good" drugs are over-the-counter drugs or those prescribed by a health care provider as medicine, yet this makes them no less problematic or addictive. "Bad" drugs are illegal drugs, and people who use these drugs are considered criminals, regardless of whether or not the drug use has caused problems. Americans rely heavily on the "quick fix" and take pills to deal with their problems or negative feelings. Although alcoholism and drug addiction have been recognized as a disease, many people, including health care providers, have failed to change their attitudes and accept alcoholics and addicts as ill persons in need of health care.

When working with battered women, the nurse needs to know that research suggests that the response to abuse is a process that moves from: a. commitment to the relationship to leaving to start a new life. b. emotional degradation to financial dependence to dominance. c. heated argument to hitting to battering. d. self-blame to fear to terror.

9. ANS: A Nursing research suggests that the response to battering is a process that occurs over time in which the victim's emotional and behavioral reactions change. At first there is a great need to minimize the seriousness of the abuse, ascribe external blame, accept the partner's remorse, blame oneself, experience a moral conflict about leaving, hide the violence, placate the partner, and lose the sense of self, until finally concern about children or personal fear of death tips the balance to a decision to leave the abusive relationship.

A client receiving morphine on a regular basis for pain management must be gradually weaned off the drug to avoid withdrawal symptoms. This best illustrates the state of neuroadaptation known as: a. biopsychosocial effects. b. drug addiction. c. drug dependence. d. substance abuse.

9. ANS: C Drug dependence is a state of neuroadaptation—a physiological change in the central nervous system—caused by the long-term administration of a drug. In drug dependence, continued use of the drug becomes necessary to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use and procurement of a drug and a strong tendency to relapse if the drug is removed. Although addicts frequently are physically dependent on a drug, there is also a psychological component that causes the intense cravings and relapse. In general, anyone can develop drug dependence as a result of regular administration of drugs that alter the central nervous system; however, only 7-15% of the drug-using population will develop a drug addiction.

To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses must first: a. apply epidemiologic principles for prevention. b. develop resource expertise in the community. c. examine their personal beliefs, values, and experiences. d. understand the federal criteria and guidelines for poverty.

9. ANS: C To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses need to understand poverty as a concept with historical, social, political, economic, biological, psychological, and spiritual dimensions. Understanding the concepts of poverty and homelessness begins with an examination of one's own beliefs, values, and personal experience.

Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual's or group's: a. cycle of dependency. b. health literacy. c. level of income. d. race and ethnicity.

: B A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client's ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.

Vulnerable populations are those considered to be

@ greater risk for poor health status and have poor access to health care

Nurses must be aware of the incidence of incest, its signs and symptoms, and the psychological and physical trauma it causes. One fact relevant to comprehensive nursing assessment is that incest: a. occurs in all races, religious groups, and socioeconomic classes. b. often occurs in father-son relationships. c. occurs only in father-daughter relationships. d. never occurs in stepparent-child relationships.

A Father-daughter incest is the type of incest reported most frequently, and stepfathers are considered the most common perpetrators of father-daughter incest. Very little is known about female perpetrators, but mothers do engage in child sexual abuse. Incest occurs in all races, religious groups, and socioeconomic classes. Nurses must be aware of this fact to conduct comprehensive assessments that take into account the incidence of incest, signs and symptoms, and the psychological and physical trauma it causes.

Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as: a. frail older adults. b. low-income families with newborns. c. poor clients discharged from acute care. d. clients requiring intravenous antibiotics.

A One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act's more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.

A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as: a. advocacy. b. empowerment. c. partnership. d. social justice.

A The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients' preferences are accommodated

Older Americans Act of 1965

A U.S. law that guarantees certain benefits to elderly citizens, including healthcare, retirement income, and protection against abuse.

what is family health

A dynamic relative state of well-being that includes the biological, psychological, spiritual, sociological, and cultural factors of the family system Holistic approach Dysfunctional families Balanced families Family flexibility Family cohesion

Americans with Disabilities Act of 1990

A law that requires employers and public facilities to make "reasonable accommodations" for people with disabilities and prohibits discrimination against these individuals in employment.

Drug dependence

A state of neuroadaptation; a physiological change in the central nervous system caused by the chronic, regular administration of a drug. Continued use is necessary to prevent withdrawal symptoms is a physiologic change in the central nervous system (CNS) caused by the chronic, regular administration of a drug. Although it leads to a state of neuroadaptation, it differs from drug addiction and substance abuse, which are driven by intense cravings. Both are associated with symptoms of withdrawal on abrupt discontinuation.

Diabetes mortality rates continue to rise for all ethnic and socioeconomic groups, but evidence shows that which of the following are true? (Select all that apply.) a. Addressing the diabetic epidemic involves more than a focus on individual factors. b. Community-based education programs have done little to address the problem. c. Complications and mortality rates are highest among low-income and minority groups. d. Selection of healthy food options is both an availability issue and an education issue. e. Standard of living does not affect decision making.

A, C, D Diabetes is a serious public health problem and is epidemic in the United States. One in 12 adults in the United States has diabetes, and for every three people who have been diagnosed with diabetes, there is another who does not know he or she has it. Research supports the importance of also addressing social and economic factors related to health and well-being when treating diabetes. These social determinants of health include the characteristics of clients' communities, such as income distribution, educational level, and segregation. This broader perspective also includes attention to policies that affect the availability of healthy foods.

Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Better access to health care services but poor health outcomes b. Greater likelihood of exposure to risk factors c. Multiple risk factors but equal health outcomes d. Worse health outcomes

ANS: B, D Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population

Covered Preventive Screening Services for Adults

Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked Alcohol Misuse screening and counseling Aspirin use for men and women of certain ages Blood Pressure screening for all adults Cholesterol screening for adults of certain ages or at higher risk Colorectal Cancer screening for adults over 50 Depression screening for adults Type 2 Diabetes screening for adults with high blood pressure Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence. Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 - 1965 HIV screening for all adults at higher risk Diet counseling for adults at higher risk for chronic disease Lung cancer screening for adults 55 - 80 at high risk for lung cancer because they're heavy smokers or have quit in the past 15 years Obesity screening and counseling Sexually transmitted infection (STI) prevention counseling for adults at higher risk Syphilis screening for adults at higher risk Tobacco Use screening for all adults and cessation interventions for tobacco users

CHARACTERISTICS of RURAL CLIENTS

Activity / Achievement Group conformity Traditional Values/ roles Work Conservative Slower to change Depend on each other Spiritual Town is the Center of Trade

Alcoholism

Addiction specific to alcohol; chronic & progressive disease in which a person's use continues despite problems it causes

Health Disparities affect which adults

Adults of color Incarcerated adults Lesbian/gay/bisexual adults Adults with physical and mental disabilities Impoverished adults Frail elderly

HTN -affects how many US adults -uncontrolled HTN leads to -how many are unaware that they have it

Affects one in three U.S. adults Uncontrolled HTN leads to the following: Heart attack Stroke Kidney damage and the like 18% are unaware they have it Racial, ethnic, and socioeconomic differences

Disparities in infant mortality, what is race are fetal and maternal issues more prevalent in?

African Americans

Cardiovascular Disease (CVD) is the leading cause of death for whom

African Americans American Indians Alaska Natives Hispanics Whites 23 Healthy People 2020 objectives focus on CVD

Poverty among whom is three times greater than that of white, non-Hispanic children.

African-American and Hispanic children

Mortality is higher for what races than causcasians

African-Americans and Hispanics

Inherited biological risk

Age-related risks Social and physical environment risks

Pediatric Symptom Checklist (PSC) -ages -assess what -how many questions -how long does it take to complete

Ages 4 - 18 assessment tool to identify cognitive, emotional, and behavioral problems in children and adolescents 35 questions 5 minutes to complete this one includes adolescents and looks at their mental health

Covering of Preventative Services

All Marketplace health plans and many other plans must cover the following list of preventive services without charging a copayment or coinsurance. This is true even without meeting yearly deductible. IMPORTANT These services are free only when delivered by a doctor or other provider in the plan's network.

Family and Medical Leave Act of 1993

Allows employees to take a total of 12 weeks' leave during any 12-month period for the birth of a child or serious health condition of the employee

Heart disease affects which gender more

Although it strikes men and women in nearly equal numbers and generally affects them in the same ways, it raises heart disease risk in women more than in men

Common mental health problems in children

Anxiety disorders Autism spectrum disorders Depression Bipolar disorder Conduct disorder Oppositional defiance disorder Substance abuse

Food deserts

Areas where it is difficult to find affordable, healthy food options. More common in highly populated low-income urban neighborhoods where there are fewer grocery stores/transportation options to seek out other food choices. Contribute to obesity in these areas bc people resort to buying cheap, highly caloric foods

Nurses can do the following with substance abuse

Assess the health of the community and its citizens. Prioritize needs. Identify local resources. Collaborate with others to develop strategies that will improve the underlying health of the community.

Health Risk Appraisal

Assessing for factors associated with an increased likelihood of an unhealthy event -For example, illness, such as cancer, or an unhealthy event, such as an automobile accident Youth Behavioral Health Risk Appraisal instrument

Primary prevention for violence

Assessment for risk factors Individual and family strategies

A nurse is educating a client about reducing her risk factors for the development of colorectal cancer. Which of the following lifestyle changes should the nurse recommend? Increase in consumption of dairy products Reduction in consumption of processed meats Decrease in exposure to the sun Increase in sedentary lifestyle

B

An unemployed individual with acquired immune deficiency syndrome (AIDS) develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to: a. barriers to access. b. cascade effects. c. cumulative risk. d. socially based inequity.

B Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.

Professional nursing organizations recommend that all women be routinely screened for domestic violence when they: a. come to the emergency department with physical trauma. b. come to any health care setting. c. repeatedly visit their primary care provider with symptoms of depression or anxiety. d. report increased financial stress in the home.

B Studies indicate that only a small percentage of battered women in emergency departments and other health care settings are identified as such and treated for the abuse, despite the significant prevalence of domestic violence. Battered women seek treatment in a number of ways and may be unaware of the relationship between their symptoms and the violence in their lives. Professional nursing associations (e.g., American Nurses Association; Emergency Nurses Association; Association of Women's Health, Obstetric and Neonatal Nurses; American College of Nurse-Midwives) recommend that all women be routinely screened for domestic violence each time they come to a health care setting. For the battered woman and the staff to begin to make the connection between her life situation and the presenting complaints, the nurse must ask direct questions in a supportive, open, and concerned manner.

Criticism of current child support policies

Based on assumption that noncustodial parents are working full time Requires custodial parent to assign all financial support from the noncustodial parent to equal the amount that the family receives from TANF

Process of the contract with the family

Beginning phase Working phase Termination phase

Understanding the Concept of Homelessness

Being homeless, no matter how long it lasts, is a life-altering traumatic event that creates major stress in any person's life (Substance Abuse & Mental Health Services Administration (SAMHSA)

Cultural Attitudes and the Media's Influence

Beliefs and perspectives that a society values Media Discourses -A way to communicate thoughts and attitudes through literature, film, art, television, newspapers, and the Internet. Media portrayal of people who are poor are influenced by cultural attitudes You are conducting health screening at a homeless shelter and one of the patients asks you for money for bus fare. Do you give it to her? You are in the home of an older person, and there are many roaches on the kitchen floor. What are your obligations in terms of the patient's home environment? Where do you sit if he offers you a chair? What is your opinion of individual versus societal responsibility for health and well-being? In other words, who is responsible for helping poor and homeless persons? Is it society's responsibility? Is it up to poor/homeless persons to help themselves? What interventions would you initiate for a population of poor or homeless families in a local shelter? Would you begin with health screening or elsewhere? How could you effectively advocate for a group of medically indigent men? What do you think about your community conducting a town meeting to consider building a homeless shelter?

Consequences of poverty

Besides economic outcomes, there are physical, psychological, and spiritual ones People who are poor are more likely to live in dangerous environments, eat less nutritious foods, & have many stressors

Increasing number of nontraditional roles such as

Blended households Single (never married) mothers Divorced mothers Single fathers Grandparents raising grandchildren

Community-level factors that influence violence and human abuse are: a. bullying, gangs, and corporal punishment. b. job boredom and unemployment rate. c. population density, sense of cohesiveness, and diversity. d. poverty, recreational facilities, and access to health care.

C A community's population, resources, and facilities can influence violence and human abuse. Density, poverty, and diversity are population-level factors that affect the incidence of violence and are related to issues such as overcrowding, lack of economic opportunity, racial tension, and overt racism. A community sense of cohesiveness may reduce crime, provide support, and promote harmony. Community resources and facilities provided to residents offer socially acceptable outlets for a variety of feelings, including aggression, but their presence alone does not prevent violence or crime.

In caring for a rape victim/survivor, the nurse should be aware that the client will initially exhibit: a. anger and fear with repeated recounting of the sequence of events during the assault. b. crying, shouting, and hysteria followed by helplessness and self-blame. c. different responses that vary from client to client and may include emotional withdrawal, silence, and/or repeated verbal description of the event. d. symptoms of early onset posttraumatic stress disorder.

C People react to rape differently, depending on personality, past experiences, background, and support received after the trauma. Some survivors cry, shout, or discuss the experience. Others withdraw and fear discussing the attack. A noncritical atmosphere should be created in which survivors are encouraged to talk about what happened and to express their feelings and fears. The nurse needs to engage in nonjudgmental listening.

ASPECTS OF VULNERABILITY -comes from what -can be reversed by

COMES FROM A FEELING OF LACK OF POWER, LIMITED CONTROL, VICTIMIZATION, DISADVANTAGED STATUS, DISENFRANCHISEMENT, AND HEALTH RISKS CAN BE REVERSED BY OBTAINING RESOURCES TO INCREASE RESILIENCE

Early identification and intervention for persons with ATOD problems—

Can prevent many harmful physical, emotional, and social consequences May prevent abuse patterns from developing into addiction

Chronic pesticide exposure

Cancer Parkinson's Infertility or sterility Liver and renal damage COPD

Nursing roles when working with vulnerable population groups

Case manager Health educator Counselor Direct care provider Population health advocate Community assessor/developer Monitor and evaluate care Advocate Health program planner Participant in development of health policies Nursing interventions are designed to help vulnerable populations gain resources needed for better health and reduction of risk factors

What is CHIP?

Children's Health Insurance Program. that works towards getting people the services that need that normally cant get coverage but need it.

Adult Health Concerns

Chronic disease Cardiovascular disease Hypertension Stroke Diabetes Mental health Cancer Sexually transmitted diseases (STDs)/HIV/AIDS Weight control

Persistent poverty -what is it and who does it affect

Chronic state; fewer (~16%) Older, with disabilities, addictions, severe mental or chronic physical illness Significant family difficulties

Poverty

Chronic stress r/t lack of funds, unemployment, and poor education can lead to maladaptive physical responses and disease Federal definition of poverty is used to determine eligibility for program such as Medicaid, WIc, & welfare assistance Federal poverty guideline are set for a family of 4: If above this, may still be unable to pay living expenses, yet are not eligible for assistance People who are poor are more likely to live in hazardous environments, work hi-risk jobs, have less nutritious diets, and multiple stressors. There are often no resources for unexpected expenses (furnace goes out, car dies, major appliances malfunction)

Working with Families for Healthy Outcomes

Collecting pre-encounter data Determining where to meet the family Making an appointment with the family Planning for your own safety Interviewing the family: defining the problem Family assessment instruments Family health literacy Designing family interventions Evaluating the plan

Mental Illness -common form of what -Gender differences -community education needs -the stigma

Common form of disability 2012 statistics (U.S.) 43.7 million adults with mental illness 9.6 million categorized as serious Gender differences -Men have higher suicide rate. -Women have higher incidence of depression and anxiety. Community education needs -Dispel stereotypes and fears. -Broadcast positive attributes of individuals. Mental illness is generally viewed by society in a negative manner. This social stigma or mark of shame leads to guilt, low self-esteem, social isolation, and ultimately to poorer health

Rural:

Communities with less than 99 people per square mile or less than 20,000 residents

Essential elements of high-quality chronic disease care

Community Health system Self-management support Delivery system design Decision support Clinical information systems

Secondary Levels of prevention in relation to vulnerable populations

Conduct screenings to assess for obesity and/or diabetes or hypertension

Effects of Population and violence

Contributions to violence -Density, poverty, and diversity, particularly racial tension and overt racism One's perception of safety in a community -Can be influenced by racism and perceptions of criminality High-population-density communities can positively or negatively influence violence Gangs Highly diverse populations -Differences may become disruptive.

Making Use of Media to decrease violence

Convey campaigns against violence Heighten public awareness of family violence Reduce stigma of victimization Underline importance of how violence is portrayed Conversely, violence seen on TV, movies, video games, and music (mass media) increases the likelihood of aggressive and violent behavior, particularly in children and adolescents

Micropolitan County

Counties that do not meet Standard Metropolitan Statistical area criteria of a central city of at least 50,000 residents

Role of the Nurse with all Vulnerable Populations

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

Two Broad Categories of Homelessness in the United States

Crisis poverty and Persistent Poverty

Migrant Housing

Crowded conditions Lack of individual sanitation, bathing, and laundry facilities; lack of screens on windows, fans and heaters Near dangerous farm machinery Located next to fields sprayed by pesticides

A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her to take an extended leave from work to care for a family member? A. Personal Responsibility and Work Opportunity Reconciliation Act B. Women's Health Equity Act (WHEA) C. Temporary Assistance for Needy Families (TANF) D. Family and Medical Leave Act (FMLA)

D

Which of the following factors has the largest impact on health disparities among all populations? Ethnicity Education level Lifestyle choices Poverty

D

In conducting a nursing assessment of new parents the nurse should be aware of the warning signs of actual or potential abuse, including: a. history of adolescent depression and suicidal thoughts. b. intermittent religious affiliations. c. lack of legal marital status. d. verbal aggressiveness or detachment.

D Nurses are in key positions to predict and deal with abusive tendencies. By understanding the factors contributing to the development of abusive behaviors, nurses can identify abuse-prone families and target specific interventions to eliminate or minimize the risk for abuse through primary prevention strategies.

The most effective primary prevention intervention to reduce the incidence of child abuse is: a. adolescent role playing of the realities of parenting. b. education of grandparents on the risk factors and indicators of child abuse. c. provision of parenting classes for college students. d. provision of parenting and conflict-management classes for survivors of child abuse.

D Parents who were themselves abused or witnessed abuse or other types of family violence are at markedly higher risk of abusing their own children. Primary prevention of abuse includes strengthening individuals and families so they can cope more effectively with multiple life stressors and demands, and reducing the destructive elements in the community that support and encourage violence. Strengthening parenting skills and teaching successful conflict resolution are specific areas to target to provide new learning and correct earlier childhood influences.

The setting and the environment factors that affect the following

Daily stressors such as fast pace of life, competition at school or workplace, and pressure to accumulate material possessions Bombarded by advertisements by pharmaceutical, alcohol, and tobacco companies Lower socioeconomic background, lack of education, & limited employment possibilities make it seem like life's opportunities are out of reach, so turn to drugs to numb pain or escape from what they perceive as a hopeless situation. Drug dealing may seem a way to avoid poverty & unemployment

Factors Affecting Growing Number of Poor Persons in the United States

Decreased earnings Increased unemployment rates Changes in the labor force Increase in female-headed households Inadequate education and job skills Inadequate antipoverty programs Inadequate welfare benefits Weak enforcement of child support statutes Dwindling Social Security payments to children Increased numbers of children born to single women Trade deficits, debt, involvement in wars Outsourcing of American jobs

Stewart B. McKinney Homeless Assistance Act of 1987

Defines a homeless person as an individual who lacks a fixed, regular, and adequate night-time residency or utilizes one of the following: -A supervised, temporary public or private shelter -A temporary residence for individuals intended to be institutionalized -A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings This definition generally refers to persons who are homeless on the streets, are in shelters, or face eviction within 1 week.

Family Violence and Abuse

Development of abusive patterns -Upbringing -Increased stress Types of intimate partner and family violence -Physical -Sexual

What should nurses consider when administering the screenings?

Development theories

Nursing Roles for adults

Direct care Providing self-care information Contributing to supervision of paraprofessionals Interdisciplinary collaboration on care decisions Assessing for and developing community resources Referral to best community resources

Historically, a contradictory relationship exists between abuse and religion

Disapproval of divorce Churches slow to recognize domestic violence

illegal immigrants do not qualify for what

Do not quality for public benefits Do not qualify for health care

Understanding the Epidemic of substance abuse

Drug overdose deaths continue to increase in the U.S. From 1999-2017, more than 700,000 have died from an overdose; 400,000 of these involved an opioid, including prescription and illicit opioids 68% of the more than 70,000 deaths in 2017 involved an opioid 130 Americans die every day from an opioid dose States with the highest death rates from drug overdoses in 2017 were W. Virginia, Ohio, Pennsylvania, District of Columbia, and Kentucky. Many states saw significant increases in death rates from overdoses, including Illinois

What are psychoactive drugs

Drugs that affect mood, perception, and thought

Historical Perspectives on Adult Health -1900s -1920s -1980s -1990

Early 1900s: Women's health focused on reproduction and women's roles as mothers. 1920s: Women's health expanded to address family planning and reproductive health (beginning of birth control movement). 1980s: U.S. Public Health Service (PHS) Task Force on Women's Health Issues 1990: Society for Women's Research

The near poor

Earn slightly above poverty level; income inadequate but ineligible for Medicaid and similar services

family functions

Economic function Reproductive function Socialization function Affective function Health care function

Primary Prevention for adults

Education through Primary health care provider and social media: Nutrition Exercise Stress Management Drug abuse Immunizations Flu vaccines annually Pneumococcal vaccine 65 years and older 2 Types TDAP once TD every 10 years Meningococcal once over age 19 Herpes Zoster once over age 65

Secondary prevention for violence

Effective screening of families and individuals Telephone crisis lines Respite care

PDMP: Prescription Drug Monitoring Programs

Electronic database that tracks controlled substance prescriptions in a state Naloxone used for emergency rescue after an overdose; IM, subQ, IV, or intranasal

Mental health barriers in children

Embarrassment **Inadequate number of practitioners specializing in pediatric mental health Coordination of care

Patient Protection and Affordable Care Act of 2010

Employers with more than 50 employees must provide health insurance

What could impact the scores/results of the screenings?

Environment, mood, what is going on with them that day

4 Domains of Chronic Disease Prevention

Epidemiology and surveillance refers to systems that are used to track chronic diseases and their risk factors. Environmental approaches refers to changes in policies and physical surroundings to make the healthy choice the easy choice. Health care system interventions refers to improvements in care that allow doctors to diagnose chronic diseases earlier and to manage them better. Community programs linked to clinical services refers to those that help patients prevent and manage their chronic diseases, with guidance from their doctor

Migrant Farmworkers

Estimated 1-3 million in the U.S. Considered a vulnerable population because of lifestyle and lack of resources Health problems are linked to work, housing environments, limited access to health services, education, and lack of economic opportunities Children of workers are affected by disruptive and challenging lifestyle

Chronic illness in children -examples -goal -what should we advocate for

Examples: Down Syndrome, spina bifida, cerebral palsy, asthma, ADHD, DM, congenital heart disease, cancer, hemophilia, AIDS Goal: Optimal health & functioning Identify barriers to this for individuals, families, communities Support groups Advocating: improved access to resources; improved environment Educating those involved so that needs can be met - family functioning is improved

neglect

Failure to provide the person with the goods or services needed

Family systems theory

Families are social systems; thus, nurses can learn much from a systems approach.

If plan is not working, identify barriers

Family apathy Family indecision Nurse-imposed ideas Negative labeling and the like

Four Approaches to Family Nursing

Family as context Family as client Family as a system Family as a component of society

Neuman systems model

Family health is defined in terms of system stability as characterized by five interacting sets of factors: Physiological Psychological Sociocultural Developmental Spiritual

Family Crisis

Family lacks or loses the ability to cope with a specific event or multiple events and becomes disorganized or dysfunctional -Demands of the situation exceed the resources of the family

Social and Family Policy Challenges

Family medical leave (1993) Debate as to what constitutes a family Teen pregnancy prevention Health care insurance Affordable Care Act (2010)

During a home visit you want to give an accurate assessment of the following?

Family structure Natural or home environment Behavior in that environment

ecomap

Family unit in relation to other units or subsystems in the community

Primary levels of prevention for rural and migrant workers

Farm safety Teach safe pesticide use/ handling Mobile record system Immunization days at the elevator or schools Mobile clinics Migrant camps: Hygiene

Immunization barriers

Fear of the unknown

Consumer Price Index:

Federal poverty guidelines are updated annually to be consistent with the consumer price index (CPI), also called the cost-of-living index. The CPI is a measure of the average change over time in the prices paid by households for a fixed market basket of consumer goods and services, including housing; electricity; food; clothing; fuels; doctor, dentist, and drug charges; transportation; and other goods and services that people buy for day-to-day living.

Disenfranchisement

Feeling of separation from mainstream society-person does not seem to have emotional connection with any group

Births -fertility rates differ how -cultural values and kids -what is the average age for first birth

Fertility rates differ by race and ethnicity. Not all cultures value limiting the number of children in a family. Increase in mother's age at first birth Average is 25.4 years of age Substantial increase in number of children born outside of marriage

Effects of alcohol

Fetal alcohol syndrome (FAS) or fetal alcohol effects (FAEs)

Rise in Opioid Death Rates can be Outlined in 3 Distinct Waves

First wave began with increased prescribing of opioids in the 1990's with overdose deaths involving prescription opioids Second wave began in 2010 with rapid increases in overdose deaths involving heroin Third wave began in 2013 with significant increases in overdose deaths involving synthetic opioids-particularly those involving illicitly-manufactured fentanyl. The illicitly-made fentanyl market continues to change and can now be found in combination with heroin, counterfeit pills, and cocaine

Family development and life cycle theory

Focuses on predicted stresses of families as they change and transition over time

Bullying

Forms -Physical -Psychological -Intimidation -Verbal -Exclusion Occurs across ethnicities and ages Can be an Antecedent to domestic violence

Rural woman have what?

Generally have less income, education, and socioeconomic status; lower access to care

Neighborhood poverty

Geographically defined areas of high poverty characterized by run-down housing, high unemployment rates, and poorer health outcomes

Abuse during pregnancy -Heath implications for the woman -Health risks for infant

Greater risk for sexually transmitted diseases (STDs) (condom refusal) Risk of spontaneous abortion/premature delivery Increased risk for depression and substance abuse Spontaneous abortion Premature delivery Low birth weight Small for gestational age Drug exposure in utero

Effects of Illicit prescription drugs

Growing area of concern; overdose death rates have more than tripled in the United States since 1990

Health Issues of rural populations

HTN CVD COPD CA DM Arthritis and rheumatism Physical limitations Utilization patterns of health care Sources of care, and time and distance to services

Poverty-

Having insufficient financial resources to meet basic living expenses. This includes food, shelter, clothing, transportation, and medical care

social policy

Health care access and coverage, low-income housing, social security, welfare, food stamps, pension plans, affirmative action, and education

Agency Resources Found in Most Communities:

Health departments Community mental health centers Volunteer organizations Food and clothing banks Missions and shelters Nurse-managed clinics Social service agencies Church-sponsored assistance Free clinics and other community services

Top 10 Leading Causes of Death - Adults

Heart disease Cancer Chronic lower respiratory diseases Accidents (unintentional injuries) Stroke (cerebrovascular diseases) Alzheimer's disease Diabetes Influenza and Pneumonia Nephritis, nephrotic syndrome, and nephrosis Intentional self-harm (suicide

Chronic Disease's most common in adults

Heart disease Diabetes Stroke Cancer Arthritis such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems. As of 2012, about half of all adults—117 million people—had one or more chronic health conditions. One of four adults had two or more chronic health conditions. Seven of the top 10 causes of death in 2010 were chronic diseases. Two of these chronic diseases—heart disease and cancer—together accounted for nearly 48% of all deaths. Obesity is a serious health concern. During 2009-2010, more than one-third of adults, or about 78 million people, were obese (defined as body mass index [BMI] ≥30 kg/m2). Nearly one of five youths aged 2-19 years was obese (BMI ≥95th percentile). Arthritis is the most common cause of disability. Of the 53 million adults with a doctor diagnosis of arthritis, more than 22 million say they have trouble with their usual activities because of arthritis. Diabetes is the leading cause of kidney failure, lower-limb amputations other than those caused by injury, and new cases of blindness among adults'

Immunizations covered for adults

Hepatitis A Hepatitis B Herpes Zoster Human Papillomavirus Influenza (Flu Shot) Measles, Mumps, Rubella Meningococcal Pneumococcal Tetanus, Diphtheria, Pertussis Varicella

Minority women have a higher incidence of what

Higher incidence of diabetes, hypertension, overweight, obesity, asthma, HIV/AIDS, sexually transmitted infections (STIs)

COMMUNITY HEALTH FOR MIGRANT WORKERS

Higher infant mortality High parasitic infections rates [50% of population] Risk for developing hepatitis is 300 times that for non-migrant workers Reasons for seeking healthcare: skin infections, muscle strain/sprain, URIs Leading causes of M&M are infectious diseases such as TB and HIV

Characteristics of Rural Populations in the U.S.

Higher proportion of whites with regional variations Higher proportion of younger & older residents Tend to be poorer than urban counterparts Per 2016 census data: 65% live in the state of their birth Only 19.5% have a bachelor's degree or higher 61.9% are married More residents under 18 and over 65 than in urban settings 18 years or older most likely to be or have been married Older adults more likely to be widowed 7.3% are uninsured Average income of $52,386 23.8% have no Internet access!!

Poverty Effects on Health and Well-Being

Higher rates of the following: Chronic illness Infant morbidity and mortality Shortened life expectancy Complex health problems Complications from chronic diseases Physical limitation from chronic diseases Hospitalization

bioecological systems theory

How the settings in which a developing child lives interact with the child's biological characteristics to influence development

During a home visit you want to provide opportunities to do the following?

Identify barriers. Identify supports for reaching family health promotion goals.

Attitudes-influenced by society categorization- what people consider as "bad drugs"

Illegal drugs Persons who use are considered "criminals"

Poverty and Tertiary prevention

Implement programs for needle exchange Tertiary prevention for homelessness includes comprehensive case management, physical and mental health services, emergency shelter housing, needle exchange programs, and drug and alcohol treatment. An important prerequisite for population-focused practice is a sound understanding of the sociopolitical milieu in which problems occur. Nurses can influence politicians and other policy makers at the federal, state, and local levels about the plight of vulnerable homeless populations in their community.

Disparities in Infant Mortality

In 2014, the IMR for non-Hispanic black infants was more than twice the IMR for non-Hispanic white infants.

Older Adults and Poverty-only population whose poverty levels increased from previous year

In 2016, 18% of older adults (65 years of age and older) living alone, lived in poverty. High prevalence rates for the following conditions: -Chronic illness and complications -Disability -Food insecurity Less likely to do the following: Access resources Seek preventive care

Seven FACTORS THAT AFFECT HEALTH ACCORDING TO THE World Health Organization (WHO)

Income and social status: Higher income is associated with better health Education: Low education linked to poorer health, increased stress, & lower self-confidence Physical environment: safe water, clean air; , health workplaces, safer homes, communities and roads, good employment and working conditions especially when the person has control, all affect health Social support networks: Family, friends, community as well as cultural, customs, traditions, and beliefs affect health Genetics/personal behavior and coping skills Health services access: Both access & use affect health Gender: Men & women have different diseases at different ages

Elder Abuse prevention

Increased training in screening and awareness Screening Evidence-based guidelines available at Hartford Center: www.nursing.uiowa.edu/Hartford/nurse/ebp.htm

Morbidity

Increasing prevalence of chronic diseases and other conditions associated with aging High prevalence of adults with risk factors

Concept of poverty

Individual perceptions of poverty are rooted in social, political, cultural, and environmental factors Personal beliefs-ideas about the world that a person believes to be true; beliefs are rooted in social values Our attitudes toward poor people are influenced by societal & cultural values related to personal responsibility and accountability

Persistent poverty

Individuals who remain poor for long periods and is multigenerational

what is a critical indicator of a country's overall health?

Infant mortality associated factors: maternal health, socioeconomic circumstances, quality/access to medical care, and community health practices

Ages & Stages Questionnaire (ASQ3) -what years -addresses what? -Not what? -Pros about it -cannot generate what

Infant to 5 y/o Addresses 5 areas: communication, gross motor, fine motor, problem solving, and personal-social Quick to administer Easy/fast to grade Not an IQ test Not a predictor of outcome Cannot generate a diagnosis Not a substitute for testing more emotional and social not predictive of what they child will do in future measures risk

Secondary Prevention substance abuse

Institute early detection programs in schools and workplace Assessing for alcohol, tobacco, and other drug problems Drug testing Referral to treatment High-risk groups -Adolescents -Older adults -Injection drug users -Drug use during pregnancy -Persons who use illicit drugs

The web of causation model:

Interaction among many variables creates a more powerful combination of factors that predispose the person to illness.

Practice Considerations for migrant workers

Knowledge of cultural background of workers Educate on resources and access Encouraging record keeping Pesticide Exposure Assessment Equipment safety, including seat belt use Teaching Advocate for safety

Children in poverty are at risk for the following

Lack of adequate nutrition and brain development Maternal substance abuse or depression Exposure to environmental toxins Trauma and abuse Lower-quality daily care Box 33-1 Poverty increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. Furthermore, children of poverty are more likely than nonpoor children to be hungry and suffer from fatigue, dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism.

Trends contributing to growth in homelessness (past 20 to 25 years)

Lack of affordable housing has led to the following: -Overcrowding -Substandard housing -Increased homelessness Increase in poverty, loss of U.S. jobs Deinstitutionalization of chronically mentally ill individuals from public psychiatric hospitals in the 1980's increased homeless numbers Goal was to replace hospitals with community-based care Governments failed to allocate funds for these centers Persons with severe mental illness account for nearly 30% of all homeless people in U.S.

Mortality

Life expectancy

Family Demographics

Living arrangements Marriage, divorce, and cohabitation Births Parenting Immigration Family caregivers

MEN OR WOMEN are 28 percent more likely than the other gender to be hospitalized for congestive heart failure.

MEN

MEN OR WOMEN are 32 percent more likely than the other gender to be hospitalized for long-term complications of diabetes

MEN

MEN or WOMEN are 24 percent less likely than the other gender to have visited a doctor within the past year.

MEN

Men or women are 24 percent more likely than the other gender to be hospitalized for pneumonia

MEN

Which gender is Parkinson's disease seen more in?

MEN -50 percent more in men than women

Effects of Tobacco

Mainstream smoke Sidestream (second-hand) smoke

Children of Migrant Farm Workers

Malnutrition-Vitamin A & iron deficiencies due to diet Infectious diseases Dental caries-due to prolonged bottle feeding & bottle propping, limited access to fluoride and oral health care Inadequate immunizations Pesticide exposure Injuries Overcrowding and poor housing conditions Disruption of social and school life

Secondary Prevention Screening specifically for women

Mammograms annually over age 40 Teach breast self exams Dexa scan over age 65 Pap Smears 3-5 years until age 65.

Crisis Poverty

Marked by hardship and struggle Often transient or episodic Brief stays in shelters Tend to be younger and represent the majority

Acute pesticide exposure

Memory loss Neuromuscular symptoms Pharyngeal and nasal irritation N/V, diarrhea, cramps Use of personal protective equipment is not prevalent

How the environment affects men vs women

Men and women are often exposed to differing environmental factors because of upbringing, employment, cultural or tradition variations Men and women may respond differently to environmental factors.

Mens Health- how do men evaluate their health

Men evaluate their health experiences by their accomplishments and overall physical shape and conditioning Important health outcome—for men to focus on their total health and on strategies for staying healthy

Adverse Childhood Events

Negative experiences that - constrain future life options, but also create opportunities for development

17th-century England Views of poverty

No stigma for living in poverty because nearly everyone lived in poverty

Which groups are we more likely to see high blood pressure in? The rate of diagnosed diabetes in seen in what group more What group is more likely to be obese What are differences in life expectancy

Non-Hispanic blacks are 40% more likely to have high blood pressure than are non-Hispanic whites, and they are less likely to manage this condition. The rate of diagnosed diabetes is 77% higher among non-Hispanic blacks, 66% higher among Hispanics, and 18% higher among Asians than among non-Hispanic whites. American Indians and Alaska Natives are 60% more likely to be obese than non-Hispanic whites. Life expectancy for non-Hispanic blacks is 75.1 years, compared to 78.9 years for non-Hispanic whites

Urban

Non-rural & higher population density; more than 99 persons per square mile or at least 20,000, but less than 50,000

Poverty varies by state

North Dakota - 5% Mississippi - 18% South Carolina - 16% Kentucky & West Virginia - 14%

Period prevalence counts

Number of people who are homeless over a given period of time

Point-in-time counts

Number of persons who are homeless on a given day or during a given week

The Nurse's Role in Adult Health

Nurse as educator Client advocate Case manager Family Nurse Practitioner PROMOTE PREVENTION

What helps achieve the transition of care of family members

Nurses' hours match family schedules Family member bringing companion to office visits -Enhances shared decision making -Improves sharing of information Involving family in client's care -Improves self-management of care -Results in fewer medication errors Improves health outcomes

Tertiary Prevention for violence

Nursing actions: therapeutic family interventions Nursing interventions specific to female partner abuse

Attitudes-influenced by society categorization- what people consider as "good" drugs

Over-the-counter (OTC) drugs Those prescribed by a health care provider as "medicine" Americans rely heavily on drugs to relieve or mask anxiety, tension, stress, fatigue, and physical or emotional pain Looking for a "quick fix" and take pills to deal with negative feelings & problems

Childhood obesity -what is considered overweight vs obese

Overweight: >85th percentile <95th percentile Obese: =/>95th percentile

Secondary Prevention specifically for men

PSA

Indicators of child abuse

Passive neglect-malnutrition or other problems Emotional abuse-yelling, continually demeaning or criticizing (extreme debasement of feelings)

Community care settings for adults

Patient-centered medical homes Senior centers Adult day health Home health, palliative care, and hospice Assisted living Long-term care and rehabilitation

Drug addiction

Pattern of abuse characterized by overwhelming preoccupation with use of a drug, securing its supply, and a high tendency to relapse if the drug is removed

Industrial Revolution view of poverty

People became more mobile. Became more difficult to differentiate between the deserving and undeserving poor

Elizabethan poor laws

People born within the boundaries of the community should be given assistance; needy travelers would not be given assistance and often sent back to their original community to be help by "their own folk"

Health status of rural populations not fully understood

Perceived health status-those who live rurally have a poorer perception of their overall health Less likely to engage in prevention behaviors, thus exposure to risk is greater Less likely to have routine screenings such as pap smears, BP checks, breast exams & colorectal screenings Higher rate of alcohol consumption, smoking, obesity Less likely to engage in routine physical activity during leisure time Less likely to wear seatbelts

Signs of abuse

Physical marks Low self-esteem, depression, PTSD May not be recognized as a form of abuse

Types of Child neglect

Physical, emotional, medical, and educational, sexual

Types of elder abuse

Physical, sexual, emotional, financial/material abuse; neglect; abandonment

health status can affect vulnerability how?

Physiologic changes can predispose Life experiences -Especially childhood trauma-see next slide -Levels of stress (positive to toxic) Protective social factors Locus of control-confidence in own ability to control their behavior, not dependent on others

What are the two ways of acquiring homeless numbers

Point-in-time counts Period prevalence counts Many homeless people are hard to find. These methods typically undercount those who are homeless because they fail to visit many locations where those who are homeless stay

Effects of Homelessness on Health

Poor health is a cause and an outcome of homelessness Health is affected across the lifespan Homelessness has significant impact on at-risk populations: Pregnancy Childhood Adolescents Older adults

Working Conditions:

Poor record keeping by employers Receive below minimum wages Subject to high injury rates No worker compensation to pay for injuries sustained on the job

Examples of Vulnerable Groups

Poor/low income homeless individuals Pregnant teens Migrant workers Persons with mental health problems Persons who abuse substances Persons with communicable diseases People who are HIV-positive People who have hepatitis B Persons who have been incarcerated Hospitalzed people Poorly educated Elderly Those with chronic disease Children Those who live alone Special needs people People who suffer from abuse Immigrants Those with sexually transmitted diseases try to elminate the words "poor" or "low-come"

Poor neighborhoods are linked with the following:

Poorer general health status Higher mortality rates Higher rates of disability, injury, and violence Less access to healthy food and health care Fewer opportunities for good employment Inadequate transportation Problems related to police brutality Poor housing conditions

Strong relationship between poverty and health creates a cycle

Poorer health status Decreased ability to work Minority women

Substance abuse poses as a risk how

Poses a risk personally and can be a threat to health & safety of family members, coworkers, and community members

Increased occurrence of cohabitation

Potential for negative child well-being Parental separation 5 times more likely than for married couples Increase in unstable living situations (higher number of transitions) Higher rate of poverty in cohabitating families

Effects of Marijuana

Potential respiratory tract damage

Income alone does not define

Poverty

Factors leading to homelessness

Poverty Lack of affordable housing Decrease in governmental support programs Domestic violence Mental illness Substance abuse

examples of limitations in physical and environmental resources

Poverty, limited social support, and working in a hazardous environment

Educating a MOPS (Mothers of Preschool Children) group about poison prevention Primary Secondary Tertiary

Primary

Offer healthy cooking classes for families in the community. Primary Secondary Tertiary

Primary

Healthy People 2020 on STDs

Promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent STDs and their complications.

Primary Prevention with substance abuse

Promotion of healthy lifestyles and resiliency factors; focus on how to resist getting involved in substance abuse Drug education and guidelines for use Health promotion strategies such as promoting & facilitating healthy alternatives to dangerous drug use practices

Poverty and Primary prevention

Provide health education for prevention of diseases related to multiuse of needles include affordable housing, housing subsidies, effective job-training programs, employer incentives, preventive health care services, multisystem case management, birth control services, safe sex education, needle exchange programs, and counseling programs. Nurses can form networks with other health professionals to educate policy makers and the public about the value of these preventive services. These programs could prevent homelessness from occurring at all, which would prevent many of its devastating sequelae.

Biopsychosocial Model of Addiction

Provides a framework for understanding addiction as being the result of the interaction of multiple factors Biological; biochemistry Psychological; mood, personality, behaviors Social; cultural, familial, medical, socioeconomic

Racial and Ethnic Approaches to Community Health (REACH) program

REACH Risk Factor Surveys, which gather health and behavior-related information from select REACH communities about chronic diseases, diet, exercise, preventive services, and adult immunizations, indicated that: From 2009 to 2011, cholesterol screening increased among African Americans 74% to 78%, Hispanics 58% to 71%, and Asians 53% to 72% in REACH communities, while screening decreased or remained constant among the same population groups nationwide. From 2001 to 2009, the percentage of Hispanics who reported having hypertension and were taking medication for it increased from less than half to more than two-thirds. During the same period, pneumonia vaccination rates increased from 50.5% to 60.5% in black communities, from 46.0% to 58.5% in Hispanic communities, from 37.5% to 59.7% in Alaskan/Pacific Islander communities, and from 67.3% to 78.7% in Native American communities. http://www.cdc.gov/nccdphp/dch/programs/reach/program_impact/index.htm

Homicide-death resulting from use of force against another person/intentional

Rate for males nearly four times that of females Non-Hispanic blacks account for nearly half of deaths by homicide

car seat rules

Rear facing until two

Metropolitan County

Regions with a central city of 50,000 or more residents

Tertiary Prevention for Adults

Regular treatment for diseases Support groups for healthier living Referrals to community agencies

Women's Health concerns

Reproductive health Preconceptual counseling Gestational diabetes Menopause Breast cancer Osteoporosis Intimate partner violence Urinary incontinence

What area is mortality highest in

Rural More rural, higher adult rate -Occupational injuries Especially high among children and young adults -Unintentional Injuries/ MVAs

Poverty and Secondary prevention

Screen clients for early detection of drug use; screen for diseases that may result from injection drug use Secondary preventive services target persons on the verge of homelessness as well as those who are newly homeless. Examples include supportive and emergency housing, targeted case management, housing subsidies, soup kitchens and meal sites, and comprehensive physical and mental health services. Nurses can work with homeless and near-homeless aggregates to provide education about existing services and prioritize strategies for influencing public policy that will provide more comprehensive services for homeless and near-homeless persons.

Secondary Prevention for Adults

Screening for high blood pressure Starting age 20 yrs.; every 2 yrs. if <120/80 Cholesterol annually over age 35 Over age 20 with risk factors Waist Circ. with cardiac risk, BMI >25; Starting age 20 yrs. Screening for diabetes (Fasting glucose or HgbA1C) Colonoscopy age 50 years Every 10 years Screening for drug abuse Screening for obesity; Wt./BMI Starting age 20 yrs.; every healthcare visit Screening for depression Screening for intimate partner violence

Cancer -how prevalent -What do we do to reduce the burden of cancer

Second leading cause of U.S. deaths Overall costs of cancer in 2009 $216.6 billion Needed to reduce the burden of cancer -Early screening and detection -Promotion of healthy lifestyles -Expansion of access to services -Improvement in cancer treatments

Providing lead screening services for at-risk populations Primary Secondary Tertiary

Secondary

Paradigm Shift

Shift from "war on drugs" to an approach that includes role of treatment National drug policies need to be more comprehensive rather than focusing on law enforcement strategies

Those who are homeless are hard to find since they may:

Sleep in boxcars, on building roofs, in doorways, or under freeways or pedestrian overpasses. Stay temporarily with family or friends. Refuse to be interviewed or deliberately hide the fact that they are homeless. Have only short or intermittent episodes of being without a home. May not fit in a general category. For example, patterns of homelessness differ in large versus small cities, and in rural versus urban areas.

Rural Occupation

Small businesses that don't fall under OSHA guidelines More very old and very young operating heavy equipment with minimal training

Stewart B. McKinney Homeless Assistance Act of 1987

Small, inadequate funding for outpatient services Interagency Council on Homeless (ICH) Coordinates federal homeless activities 19 agencies (Housing and Urban Development [HUD] housing, WIC, TANF, etc.)

Environmental risks

Social aspects Physical aspects

Genetic predisposition:

Some individuals are predisposed to alcoholism & other drug addiction; their chemical makeup triggers the disease process by consuming the drug

Resilience

Some members of vulnerable populations do not succumb to the health risks that impinge on them. It is important to learn what factors help these people to resist, or have resilience to, the effects of vulnerability. capacity to recover quickly from difficult conditions, adaptability

Secondary levels of prevention for rural and migrant workers

Standards for pesticide use Screenings on site Smoking cessation classes and materials Occupational exposure history Domestic violence screenings

FRAMES Strategies

Strategies-used in brief interventions to reduce use or follow thru with treatment Feedback: provide the client direct feedback about the potential or actual personal risk or impairment related to drug use Responsibility: emphasize personal responsibility for change Advice: provide clear advice to change risky behavior Menu: provide a menu of options or choices for changing behavior Empathy: provide a warm, reflective, empathetic, and understanding approach Self-efficacy: provide encouragement and belief in the client's ability to change

Patient Self-Determination Act of 1991

Supports ethical principle of **autonomy** Uses Advance Directives Living will Durable medical power of attorney Do-not-resuscitate (DNR) order

Withdrawal

Symptom set caused by abruptly discontinuing a substance

In recent years, schools have assumed many responsibilities traditionally assigned to the family:

Teaching sexual development Disciplining children Serving as a safe haven Addressing issues of bullying Cyber-bullying via social media

Alcohol, tobacco, and other drugs (ATODs)

Term is a reminder of which are the leading drug problems Alcohol is the oldest & most widely used psychoactive drug in the world; it's abuse contributes to top 3 causes of death-heart disease, cancer, and stroke Smoking is the foremost preventable cause of death & disease in U.S.; one in five deaths are attributable to cigarettes. Nearly 500,000 deaths per year are caused by complications of cigarette smoking Marijuana is the most widely used illicit drug in the U.S. Psychological dependence can occur with chronic use, but little is known about potential physical dependence

Name the level of prevention... Replacing the water pipes to affected homes in Flint Mi Primary Secondary Tertiary

Tertiary

Clustering of Five Health-Related Behaviors for Chronic Disease Prevention Among Adults

The 5 behaviors were defined as currently not smoking cigarettes, meeting the aerobic physical activity recommendation, consuming no alcohol or only moderate amounts, maintaining a normal body mass index (BMI), and sleeping at least 7 hours per 24-hour period. Evidence from the Behavioral Risk Factor Surveillance System (BRFSS)

evaluation of the plan of the family. What do you need to determine

The plan is working. The plan is working fast enough to address the problem. The plan is addressing only part of the problem. The plan needs to be revised based on changes.

Stroke -what has happened to the occurence since the 1950s -what gender is more likely to die from stroke and why -healthy people 2020 goal with strokes

U.S. occurrence: decreased since the 1950s 2002: 7 million 2010: 6.8 million Women more likely to die from stroke -Live longer than men -Stroke events increase with age Healthy People 2020 objective Reduce stroke deaths to 48 in 100,000

family assessment tools need to have what qualities

Uncomplicated language (fifth-grade level) Takes 10 to 15 minutes to complete Relatively easy and quick to score Renders valid data for decision making Diversity sensitive -genograms -ecomaps

BMI (body mass index)

Underweight - Less than 18.5 Normal - 18.5 - 24.9 Overweight - 25 - 29.9 Obese - 30 - 39.9

Work-associated links to violence

Unemployment-may precipitate aggressive outbursts Changing patterns of employment Frustration with jobs that are repetitive, boring, and lacking in stimulation/t Women who experience intimate partner violence may lose their jobs because of harassment or stalking from their abuser; they have more absenteeism r/t continual stress, absenteeism, and decreased job performance

How does the U.S. compare globally with infant mortality?

United States - 5.9 infant deaths/1000 live births Illinois: since 1990, infant mortality decreased 48% from 11.9 to 6.3 deaths per 1,000 live births.

Functional health literacy techniques

Use black ink on white paper. Use short sentences. Use bullets no longer than seven items. Write information at the fifth-grade reading level. Remove all extra words. Print in upper- and lowercase letters. If using a computer, use 14-point font with a high-contrasting Arial (or other sans serif) typeface. Have plenty of white space.

Substance abuse definition

Use of any substance that threatens a person's health or impairs social or economic functioning

Abuse as a process

Victim initially downplays/denies seriousness; period of self-blame; moral conflict: leave or stay? As violence escalates, abuser's remorse lessens Moment of leaving the relationship is moment of greatest risk for homicide

MEN or WOMEN tend to be affected by chronic disease at younger ages

WOMEN

Designing Family Interventions

We need the following type of help We need the following information We need the following supplies We need to contact the following people To make our family action plan happen, we need to ...

Environmental Health - the 'built environment' issues for children

Where the child lives directly impacts their health Indoor air pollution - formaldehyde, benzene, allergens, tobacco smoke, carbon monoxide, radon, dust mites, mold Outdoor air pollution - ozone, particulate matter, formaldehyde, benzene, allergens, tobacco smoke Water - nitrates, pesticides, lead, community/private wells Home - lead, building materials, neighborhood Community - walkability, safety *lead!!!

Differentiating between "deserving poor" and "undeserving poor"

Widowed women, orphaned children, laborers injured on the job, and persons with chronic illnesses "not caused by personal failure" were considered deserving of public assistance Alcoholics, prostitutes, mentally ill persons, and those considered to be lazy were deemed "underserving and denied any type of assistance

MEN OR WOMEN live longer, but live longer with greater disability and less social protection

Women live longer than men but do so with greater disability and less social protection (for example, as pensioners) than men.

Social and Community Factors Influencing Violence include:

Work Education Media Organized religion Population Community facilities

Contracting with Families

Working agreement that is continuously renegotiable and may or may not be written -Contingency contract -Noncontingency contract

A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely: a. educate about self-care and the women's rights as employees. b. establish a partnership with a community to initiate a community health center. c. help identify new cases and ensure that clients receive proper treatment. d. teach how to lobby state legislators.

a Helping clients understand their rights to protect from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability

What impact does poverty have on adolescent health?

a lot of extra stress, may be working earlier and having to grow up early to help provide for their siblings and family,

Intimate partner violence

a more appropriate term, is more inclusive than spouse abuse or wife abuse (not always a wife or spouse)

Social Determinants of Health-

a range of social, political, and economic factor Socioeconomic status Geographic location Living conditions Social class Education Environmental factors Nutrition Stress Prejudice Lead to resource constraints, poor health and health risk. WHO states "whether people are healthy or not, is determined by their circumstances and environment

Which of the following factors are cited as obstacles to improving men's health? SATA Reluctance to consult their primary care provider Emphasis of physical strength and competitiveness on masculinity Lack of a primary care provider Lack of access to health care by African American and Hispanic men Emphasis on the male role as the head of the family

a, b, c

Past a year of age, what is the biggest injury for children?

accidents

Advocacy

action taken on behalf of another

Social justice-

advantaged & less-advantaged treated in the same manner includes egalitarianism and equality

What is the greatest risk factor for physical abuse

age -youths are significantly more at risk

Human capital:

all of the strengths, knowledge, and skills that enable a person to live a productive, happy life. People with little education have less human capital because their choices are more limited than those of people with higher levels of education

Anorexia Nervosa

an eating disorder characterized by an inability to maintain normal weight, an intense fear of gaining weight, and distorted body perception

Bulimia

an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise

Health status indicators

are the quantitative or qualitative measures used to describe the level of well-being or illness present in a defined population or to describe related attributes or risk factors. They can be represented in the form of rates, such as mortality and morbidity, or proportions, such as percentages of a given population that receive immunizations.

The population group that is likely to be the MOST vulnerable is: a. children with a family history of sickle cell disease and hypertension. b. homeless pregnant teens in a substance abuse program. c. nNative Americans at risk for diabetes. d. overweight children.

b A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk and to have worse outcomes from these health problems than the rest of the population. That is, the interaction among many variables creates a more powerful combination of factors that predispose the person to illness. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Examples of vulnerable populations of concern to nurses are persons who are poor and homeless, people with special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, persons with communicable diseases and those who are risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

chronic noncommunicable diseases are predominantly from

behavior or lifestyle diseases

A nurse is caring for a client who is considered obese. Which of the following best describes this client? An individual with a body mass index (BMI) of 15 An individual with a BMI of 20 An individual with a BMI of 30 An individual with a BMI of 25

c

After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family's children may qualify for enrollment in the state children's health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations? a. Carrying out primary prevention b. Setting family-centered, culturally sensitive goals c. Trying to minimize the "hassle factor" d. Using the MAP-IT approach

c Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with nonrestrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the "hassle factor."

In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to: a. assure access to health care for elderly Americans. b. build hospitals to care for the medically indigent. c. insure children without health insurance. d. provide supplementary income for citizens with disabilities.

c Title XXI of the Social Security Act, passed in 1998, established the State Children's Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.

Vulnerability is multidimensional, and one of the primary contributors to vulnerability is: a. gender. b. race and ethnicity. c. resource limitations. d. urban or rural residency.

c Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, and occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual's ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.

Wrap-around services:

comprehensive health services are available and social and economic services are "wrapped around" these services not always available

What is legislation?

consists of laws that regulate health care and promote health. Nursing practice and the care provided are impacted by policy and legislation.

People with preexisting illnesses have less physical ability to

cope with stress.

Substance abuse is associated with what issues

deaths, illnesses, and disabilities Associated with neonatal issues such as low birth weight and congenital abnormalities, accidents, homicides, suicides, and chronic diseases such as CV disease, cancer, lung diseases, hepatitis, HIV/AIDS & mental illness. Family violence and family disruption are prevalent

Tertiary Levels of prevention in relation to vulnerable populations

develop an exercise program for those identified with increased blood sugar or increased blood pressure

Adolescents developmental considerations for injury

driving, car accidents, want independence, and violence is a big reason for injury. Boys are two times more likely to have these accidents than girls. Violence and substance use go hand and hand at this age. Homicide is the second leading cause of death. *anticipatory guidance.

Why should nurses administer developmental screenings?

early identification. We can look at these and see if something is a problem before it becomes a big problem

toddlers and preschoolers developmental considerations for injury

eating everything. Dont know cause and effect, they dont understand the effect of things. like putting a bead in their nose. They have the largest number of nonfatal injuries

Nurses' self-assessment:

examine own attitudes before working with clients

Natural history of disease model

explains HOW ASPECTS OF PHYSIOLOGY & THE ENVIRONMENT, INCLUDING PERSONAL HABITS MAKE IT MORE LIKELY A PERSON WILL DEVELOP A PARTICULAR HEALTH PROBLEM, SUCH AS SMOKERS BEING @ RISK FOR LUNG CANCER some factors make it more likely that a person will develop particular health problems.

Temporary Assistance for Needy Families (TANF)

federal program by which grants are given to states to fund welfare

Divorce is higher for what number of marriage?

first Divorce rate for people 50 years or older doubled between 1990 and 2010

Comprehensive services

focus on more than one health problem or concern (Ex: offering lab & dental services in same location as medical appointment)

Obesity contributing causes

genetics modifiable risk factors

Increase in custodial single fathers may result in

greater attention to noncustodial mothers who do not contribute to the financial support of their children

Obesity consequences

heart disease, diabetes, stroke, alzheimer's, hypertension, certain cancers -physiological -psychological

Wagner's Chronic Care Model

identifies the essential elements of a health care system that encourage high-quality chronic disease care. These elements are the community, the health system, self-management support, delivery system design, decision support, and clinical information systems.

Perceptions of addicts:

immoral, weak, or irresponsible persons who should try harder to help themselves. Yet alcoholism (1954 by the American Medical Association) and drug addition are considered diseases

Immunization Contraindications

immunocompromised children

What is health policy

is action taken by public and private agencies to promote health. It is a reflection of the values held in society and can greatly influence the health of the citizens overall.

age and vulnerability

is related to vulnerability: very young and very old are less able to adapt physiologically to stressors

synthetic cannabinoids

lab produced chemical cannabinoids- k2

School age children developmental considerations for injury

lowest rate of mortality from injuries. They understand cause and effect principle. Give helmets! esp with scooters, bikes. Why dont kids use helmets? Peer pressure, parents involvement, Do they the parents encourage them to wear it? do their parents wear them?

Health researchers focused on issues predominantly towards whom

men

Suicide is seen more in whom

men

Violence leads to significant

mortality and morbidity Many factors in a community can support or minimize violence. Changing social conditions, multiple demands on people, economic conditions, and social institutions influence the level of violence and human abuse. The following discussions of selected current social conditions help to explain factors that influence violent behavior.

In 2010, 20% of all U.S. births were to whom

mothers born outside the country

What must nurses understand about policy and legislation?

must understand how policy and legislation, along with other system factors such as social, cultural, and economic forces, can be incorporated into planning care for clients and use their skills as collaborators and communicators to improve health policy.

Sam is a 4 y/o boy brought to the clinic by his mother for his 4 y/o well child check and immunizations. Sam will be attending the local Head Start program in the fall. He is the oldest of 3 children & his siblings are 9mo. & 35 mo. His mother is a single parent who works as a waitress at a local restaurant. Sam & his siblings are insured by Medicaid. Mom is 24 y/o and the family lives with the maternal grandparents. Sam's mother is in good health, does not smoke or abuse drugs. Sam has been watched by his grandmother since birth and is exposed to cigarette smoke in the home by both grandparents. On the developmental exam, Sam is very cooperative, eager to please & speaks clearly. His development is significant for failure to identify three colors, count to 5, or recognize any letters. His gross motor skills are appropriate but he only scribbles when given a crayon. Sam reports enjoying TV with his family for fun. On physical exam, Sam is >95 percentile BMI for age/gender but no other abnormal exam findings are noted. Hearing & vision are normal for age.

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What is having the largest growth?

people living alone

abuse

physical or emotional harm to someone

What is a primary cause of vulnerability

poverty

Chronic disease is leading cause of

preventable deaths, disability, and decreased quality of life

Primary Levels of prevention in relation to vulnerable populations

provide culturally sensitive health teaching about diet and exercise

Harm reduction model

public health approach originally used in Great Britain Addiction is a health problem. Any psychoactive drug can be abused. Accurate information can help people make responsible decisions about drug use. People who have alcohol, tobacco, and other drug problems can be helped.

Health Disparities

refers to wide variations in health services and health status among populations

who may delay seeking care

single people living alone

Risk-epi term:

some people have higher probability of illness than others Epidemiologic triangle-agent, host & environment interact to produce illness/poor health

Vulnerable population group

subgroup of population more likely to develop health problems as a result of exposure to risk, will have worse outcomes. Ex: exposure to lead paint used in manufacturing or social hazards such as violence

What is vulnerability

susceptibility to actual or potential stressors that may lead to an adverse effect

financial exploitation

taking advantage of an older person for monetary or personal benefit

Infant developmental considerations for injury

tend to fall a lot, body is not proportional, small airawy (need to watch positioning)

World health organization and healthy people 2020 list 3 overall determinants of health

the economic & social environment The physical environment The person's individual characteristics and behaviors Individuals may not be able to directly control many of the determinants of health; this is directly related to vulnerability

Set: Refers to what?

the individual using the drug + the individual's expectations include unconscious expectations about the drug being used.

The moment of greatest risk of homicide in an abusive intimate relationship is

the moment the victim actually leaves the relationship Although low self-esteem is often a sign of chronic abuse, not everyone who has low self-esteem is being abused. It is more often the victim, not the abuser, who initially goes through a period of self-blame. Later, as concerns grow, he or she faces a moral conflict: leave or stay? Finally, as violence escalates, an abuser's remorse lessens.

Why are children more at risk from environmental hazards?

they eat things, they have no caution and they think everything is safe. This changes with their growth.

Immunization legislation

timeline of when to get vaccines -has to be at least 365 days from the last one

what can be a problem with older singles

transportation

what has happened to the number of households since 1940

tripled

Poverty threshold guidelines:

used primarily for statistical purposes

Federal Income Poverty Guidelines-

used to determine eligibility for government programs (see guidelines in power point on Vulnerability -Medicaid -Temporary Assistance to Needy Families (TANF) -Women, Infants, and Children (WIC)

cumulative risks

vulnerable folks often experience multiple risks concurrently

food landscape and obesity

what kind of availability of foods are there. In a lot of low income areas, they lack fruits and veggies. Family dollars stores don't have fresh foods, just boxed and refrigerated foods

Built environment and obesity

whats already there, what has been built around you

Depression is seen more in who

women

There are gaps in knowledge and awareness on Heart Disease Particularly in whom

women

Who do we see osteoporosis in more?

women

CDC's Environmental Hazards and Effects Program (EHEP)

works to protect the health and quality of life of all people in the United States. We look at how the environment affects our health through environmental epidemiology, collect and share environmental health data, and provide support to state and local environmental health practitioners. We also plan for and respond to natural, chemical, and radiation disasters. We are especially committed to protecting the health of those most vulnerable to certain environmental hazards—children, the elderly, and people with chronic health conditions.

The U.S. Department of Labor defines a Migrant Farm Worker as

—a seasonal farmworker who must travel to do farm work & is unable to return to a permanent residence within the same day Seasonal farmworker-returns to his permanent residence, works at least 25 days & does not work year-round