(C228) ATI-Community Health <Combo-1>
Public health nursing practice: -Who is the focus of care? -What are the nursing activities, including the core functions?
-Focus of care: synthesis of nursing and public health theory -Nursing activities are to promote, preserve, and maintain the health of population through disease and disability prevention and health protection of community as a whole. -Core functions: systematic assessment of health of population, devotion of policies to support the health of populations, and ensuring essential health services available to everyone.
-What things influence the host? -What things influence the physical and social environment? -What things influence chemical, physical, and infectious agents?
-Host: age, gender, genetics, ethnicity, immunological status, physiological state, occupation -Physical environment: geography, water/food supply, presence of reservoirs/vectors -Social environment: access to health care, high-risk working conditions, poverty -Chemical agents: drugs and toxins -Physical agents: noise and temperature -Infectious agents: viruses and bacteria
Nonmaleficence: -Definition -Situation
-No harm is done with applying standards of care. -Developing plans of care that include a system for monitoring and evaluation outcomes.
Mental health disorders
Affective (bipolar, major depression) Anxiety (OC, panic, phobia, PTSD) Schizophrenia Dementia Conduct disorders Eating disorders
Homeless population
Adults who are unemployed, earn low wages or migrant workers Female HOH's families with children (fastest growing) Mentally ill (large segment) Alcohol/substance abusers Abandoned children/adolescent runaways Older adults with noone to care for them
community based nursing activities
Illness care: Management of acute and chronic conditions in settings where individuals, families, and groups live, work, and "attend" (schools, camps, prisons)
Ten Great Public Health Achievements
Immunizations, Motor Vehicle Safety, Control of Infectious Diseases, Safer and Healthier Foods, Healthier Mothers and Babies, Family Planning, Flouridation of Drinking Water, Tobacco as a Health Hazard, and Declines in Deaths from Heart Diesase and Stroke
Milio's framework for prevention: -What does it complement? -What does it emphasize? -What relationship does it identify? -What does it theorize?
Milio's framework for prevention: -Compliments the health belief model -Emphasizes change at the community level -Relationship b/w health deficits and availability of heath promoting resources -Behavior changes w/in a large number of people can ultimately lead to social change
Self breast exam
Monitor for any change in size, contour, dimpling. Perform exam every month, 2 to 3 days after your period. Use finger pads of the three middle fingers.
Objective 5:
Name barriers to acceptance of community and prevention oriented, population focused practice
community nursing diagnosis
Synthesizes assessment data; a dx both describes a situation (state) & Implies an etiology (reason) and has three parts: Description of problem, response, rate; ID of factors etiologically related to problem; Signs/symptoms characteristic of problem
What is the critical theory?
Use of ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors
A nurse manager at a community agency is developing an orientation program for newly hired nurses. When discussing the differences between community-based and community-oriented nursing, the nurse should include which of the following as examples of community-based nursing? (Select all that apply.) a. A home health nurse performing wound care for a client who is immobile b. An occupational health nurse providing classes on body mechanics at a local industrial plant c. A school nurse teaching a student who has asthma about medications d. A parish nurse teaching a class on low-sodium cooking techniques e. A mental health nurse discussing stress management techniques with a support group
a, c
A nurse is preparing to conduct a windshield survey. Which of the following data should the nurse collect as a component of this assessment? (Select all that apply.) a. Ethnicity of community members b. Individuals who hold power within the community c. Natural community boundaries d. Prevalence of disease e. Presence of public protection
a, c, e
An occupational health nurse is consulting with senior management of a local industrial facility. When discussing work-related illness and injury, the nurse should include which of the following as physical agents? (Select all that apply.) a. Noise b. Age c. Lighting d. Viruses e. Stress
a,c
When a nurse focuses intervention strategies on the structural dimension of community health, they are directed toward: a. Health services b. Primary prevention c. Health promotion d. Secondary prevention
a. Health services
When completing a community assessment, the nurse will: a. Identify community needs and clarify problems. b. Determine the weaknesses of a community. c. Perform the core functions of public health nursing. d. Assess individual needs within a community.
a. Identify community needs and clarify problems.
Which characteristic is an indicator of community health process? a. Participation and community action b. Live birth rate c. Racial distribution d. Socioeconomic levels
a. Participation and community action
A screening for diabetes revealed 20 previously diagnosed diabetics and 10 probable new cases, which were later confirmed, for a total of 30 cases. This is called: a. Prevalence b. Incidence c. Attack d. Morbidity
a. Prevalence
As a result of an outbreak of influenza in a community, a nurse encourages members of the community to receive the influenza vaccine. Which level of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Multifactorial prevention
a. Primary prevention
Avian Influenza
aka bird flu. may need to stay at home for up to two weeks to prevent the spread of disease. -antivirals can minimize symptoms -flu vaccination does not protect -need 2 injection of h5n1 28 days apart when an outbreak occurs
infant mortality rate
number of infant deaths before 1 year of age in a year / number of live births in same year
infant mortality rate
number of infant deaths before 1 year of age in a year divided by the numbers of live births in the same year time 1,000
Incidence:
number of new cases in the population at a specific time divided by population total X 1,000= number per 1,000
attack rate
number of people exposed to a specific agent who develop the disease / total number of people exposed
Attack rate:
number of people exposed to a specific agent who develop the disease divided by total number of people exposed.
Chemical in eyes
nurse starts to flush the clients eyes with tepid water - secondary prevention
benefits of MAPP
creates a healthy community; increases visibility of public health; manages change; stronger public health infrastructure; builds stronger partnerships; builds public health leadership; creates advocates
Priority Health Promotion of HP 20/20
unintentional injury; violence; suicide; tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and STD infection; unhealthy dietary patterns; and inadequate physical activity.
cognitive theory
use of sensory input and repetition to change learner's patterns of thought, thereby changing behaviors
developmental theory
use of techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge
Primary Prevention
using general and specific measures in a population to promote health and prevent the development of disease in those who are disposed of developing a certain condition
health determinants
varied factors that affect the health of individuals, range from aspects of the social and economic environment to the physical environment, and individual characteristics or behaviors
Lyme disease:
vector borne. reportable disease by state law.
What are some tertiary prevention strategies for substance abuse?
• Assist the client to develop a plan to avoid high-risk situations and to enhance coping and lifestyle changes. • Refer the client to community groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). • Monitor pharmacological management. • Provide emotional support to recovering abusers and their families, including positive reinforcement.
What are some primary prevention strategies related to mental health?
• Educate populations regarding mental health issues. • Teach stress-reduction techniques. • Provide parenting classes. • Provide bereavement support. • Promote protective factors (coping abilities) and risk factor reduction.
What are some primary preventions strategies for migrant health care?
• Educate regarding measures to reduce exposure to pesticides. • Teach regarding accident prevention measures. • Provide prenatal care. • Mobilize preventive services (dental, immunizations).
Prevalence (existing disease)
# existing cases / pop total x 1000 (per 1,000)
The Shattuck Report
1850 - Mass. Sanitary Commission recommended changes to health system such as control of communicable diseases, alcohol, and teaching of preventative healthcare
First nursing school opened
1879 - based on Nightingales model
Nonmaleficence
Do no harm
Assault
Male more likely victim youths at increased risk
Tertiary prevention
Maximization of recovery after an injury or illness (rehab)
Medicare Part D
Prescription drug coverage
Portals of exit
Respiratory Feces Blood Semen/vaginal secretions Saliva Skin
Developmental theory
focus on human developmental stage and methods that are age specific and age appropriate - "readiness to learn"
Environmental factors
geography, climate, flora, fauna, topography, toxic substances, vectors, pollutants
Cultural awareness
self-awareness of one's own cultural background, biases and differences
Surveys
specific questions asked in written format - random sampling
Secondary data
use of existing data (death stats, birth stats, census data, mortality, morbidity) to assess problem - trend health issues over time
Medicare Part A
Hospital care, home care, limited skilled nursing care
Autonomy
Individuals select those actions that fulfill their goals
Beneficence
Maximize benefits and minimize potential harm
Airborne transmission
Measles chickenpox Streptococcal infection TB Pneumonia Flu
Medicare Part B
Medical care, diagnostic services, physiotherapy
World Health Organization (WHO)
Provides daily information regarding occurrence of internationally important diseases Est. world standards for ABO's and vaccines Primarily focuses on health care workforce and education, environment, sanitation, infectious diseases, maternal and child health and primary care
Secondary prevention
Survey for health conditions that may be environmentally related, monitor chemical exposure at job site, assess homes, schools, work sites in community for hazards
Substance abuse
The use of any substance (including legal and prescribed) that threatens an individuals health or social and economic functioning
Occupational health nurse
Works toward health and safety of workers by assessing risks, planning and delivering health/safety services and facilitating health promotion activities that lead to a more productive work force Primary prevention - teaching Secondary prevention - early detection through health surveillance and screening Tertiary prevention - restoration of health through rehab and limited duty
Distributive justice
fair distribution of benefits and burden in society
Behavioral theory
focus on changing behavior through use of reinforcement methods
Social learning theory
focus on changing learner's expectations and beliefs through methods that link information to beliefs and values
Physical factors
geography, terrain, type of community, location of health services, housing, animal control
Biological factors
health and disease status, genetics, race, age, gender, causes of death
Community forum
open public meeting
Epidemiology
study of disease trends in populations for the purposes of disease prevention and health maintenance - spread and transmission, study relationship among agent, host and environment
I= Investigate potential exposure P= Present work (exposure, use of personal protective equiptment, location of material safety data sheets (MSDS), taking home exposures, trends R= Residence E= Environmental concerns P= Past work A= Activities R= Referrals and resources E= Educate
"I PREPARE" mnemonic is a method of determining current and past environmental exposures. What does each letter stand for?
Health education
"The pedagogy of the oppressed" Community empowerment (WHO) Community as partner model (Betty Neuman)
Health
"extent to which an individual or group is able on the one hand, to realize aspirations and satisfy needs; and on the other hand, to change or cope with the environment." WHO
Incidence (new case)
# new cases / pop total x 1000 (per 1,000)
infant mortality rate (IMR)
# of infant deaths (before age of 1 yr) during the year is divided by the # of live births (infants born alive) during that year (multiply answer by 1000 to obtain meaningful rate)
Modes of Transportation: Waterborne
(fecal contamination of water) ■ Cholera ■ Typhoid fever ■ Bacillary dysentery ■ Giardia lamblia
Modes of Transportation: Airborne
(inhaled by a susceptible host) ■ Measles ■ Chickenpox ■ Tuberculosis (pulmonary or laryngeal) ■ Pertussis ■ Influenza
Modes of Transportation: Vector-borne
(via a carrier such as a mosquito or tick) ■ Lyme disease ■ Rocky Mountain spotted fever ■ Malaria
The occupational health nurse works towards the health and safety of workers by:
- Assessing risk for work-related illness and injury - Planning/delivering health and safety services in work - Facilitating health promotion activities for more productive workforce
What are AGENT factors the occupational nurse must be aware of when assessing risk for work-related illness and injury?
- Biological (Virus, bacteria, fungi, blood/airborne path.) - Chemical (Asbestos, smoke) - Mechanical (Musculoskeletal/strains, poor workstation/worker fit, lifting heavy loads - Physical (Temp, vibrations, noise, radiation, lights) - Psychological (Threats to psych burn out/social well being leading to stress/violence)
Family health risk appraisal involves what?
- Biological health risk assessment Genograms used to gather basic information about family/relationships/health and illness patterns - Environmental Risk Ecomaps used to identify family interactions with other groups/orgs. Info gathered on family support system and social risk - Behavioral risk
What are the roles of the school nurse?
- Case manager - Community outreach - Consultant - Counselor - Direct Caregiver - Health educator - Researcher
An Occupational health history should include what?
- Current and past jobs - Current and past exposure to specific agents and any relationship to current symptoms to work activities - Any precipitating factors (Underlying illness, Previous injuries, healthy/unhealthy habits)
When the nurse is explaining to a client the specifications for safety in the home, which of the following topics and illustrations should be discussed? Choose all that apply. a. Electrical hazards b. A lamp with a frayed cord c. Monthly income with the client d. Support system of the clients e. Cooking habits that may precipitate a fire f. Appropriate as well as inappropriate clothing
- Electrical hazards - A lamp with a frayed cord - Cooking habits that may precipitate a fire - Appropriate as well as inappropriate clothing Rationale: Nurses must focus on safety and survival first. Safety assessment in the home is a nursing responsibility. Upon entering the home and on a continuing basis, it is imperative that the nurse alert the family to unsafe and hazardous conditions, suggest remedies and document in the clinical record the family's response to the nurse's suggestions. Nursing Process: Evaluation Client Need: Safe and Effective Care Cognitive Level: Application Objective: Provide client care in community-based settings and the home. Strategy: Use Maslow's Hierarchy of needs for prioritization to choose the best selection.
What steps are involved in ANALYSIS of community assessment data? * GAISII
- Gather data into database - Assess completeness - Identify and generate missing data - Synthesizing data and identifying themes - Identifying community needs and problems - Identifying community strengths and resources
What are indicators of delirium tremens or alcohol withdrawal delirium? * Assess when patient had last drink * Benzos prevent serious complications
- Increased BP - Tachycardia - Diaphoresis
What are the manifestations of withdrawal that appear within 4-12 hours w/ prolonged users?
- Irritability - Tremors - Nausea - Vomting - HA - Diaphoresis - Anxiety - Sleep disturbances - Tachycardia - Increased BP
What are examples of primary prevention?
- Nutrition education Family planning and sex education Smoking cessation education Communicable disease education Education about health and hygiene issues to specific groups (Day care/Restaurant workers) Safety education (Seat belt/Helmet use) Prenatal classes Providing immunizations Advocating for access to health care, healthy environments
work site walk though or survey should focus on
- Observation of work processes and materials ■ Job requirements ■ Actual and potential hazards ■ Employee work practices (hygiene, waste disposal, housekeeping) ■ Incidence/prevalence of work-related illness/injuries ■ Control strategies to eliminate exposures
What are the components of a Windshield Survey?
- People - Places (Boundaries, Location of health services, Natural environment, Man-made environment, Housing, Social systems)
What are ENVIRONMENTAL factors the occupational nurse must be aware of when assessing risk for work-related illness and injury?
- Physical (heat, odor, ventilation, pollution) - Social (sanitation, overcrowding) - Psychological (Addictions, stress)
What is the role of the Parish Nurse?
- Promote health and wellness of populations of faith communities - Mind, body, and spirit - Personal health counseling - Health education - Liaison between faith community and local resources - Facilitating support groups - Spiritual support
Functional Status
- Proportion of adults reporting that their general health is good - Average number of days (in the past 30 days) for which adults report that their physical or mental health was not good
Quality of Life
- Proportion of adults satisfied with health care system in the community - Proportion of person satisfied with the quality of life in the community
What are the factors that determine alcohols affect on the body?
- Size/wt. of drinker - Gender - Carbonation - Time elapsed during consumption - Food in stomach - Drinkers emotional state
What services do home health nurses provide?
- Skilled assessment - Wound care - Lab draws - Med edu. and admin. - Parenteral nutrition - IV fluids and medication - Central line care - Catheter insertion and maintenance - Coordination/supervision of other health services
What interventions should be implemented for Ms. Lidzy?
- Teach the importance of maintain clear uncluttered walkways throughout home. - Encourage to remove loose rugs, and to use other sources of color (such as flowers or curtains). - Evaluate ability to safely get from bed to toilet at nighttime. (Provide nightlight) - Evaluate client's use of her walker and teach appropriate technique if client is using it incorrectly. - Evaluate client for physical therapy assessment for safety in the home.
Sociodemographic Characteristics
- distribution of the population by age and race/ethnicity - number and proportion of persons in groups such as migrants, homeless or the non-English speaking, for whom access to community services and resources may be concern - Number and proportion of proportion of persons aged 25 and older with less than a high school education - Ratio of the number of students graduating from high school to the number of students who entered ninth grade 3 years previously - Median household income - Proportion of children less than 15 years of age living in families at or below poverty level - Unemployment rate - Number and proportion of single parent families - Number and proportion of persons without health insurance
Educational Preparation for Public Health Nursing
- masters degree necessary to sit for certification
Public Health in America
- prevents epidemics and the spread of disease -protects against environmental hazards - prevents injuries - promotes and encourages healthy behaviors - Responds to diasters and assists communities in recovery - Ensures the quality and accessibility of health services
What are community health nurses concerned with and what do those concerns reflect?
-Community health nurses are concerned with protecting, promoting, preserving, and maintaining health, as well as preventing disease. -These concerns reflect the ethical principle of promoting good and preventing harm.
-Describe how community health nurses work: facilities, limitations, etc.
-Community health nurses practice in the community. They usually have a facility from which they work (community health clinic, health department, etc.) but aren't limited to institutional settings.
-What is a community? -Do communities vary in their characteristics and health needs? -What is a community's health determined by?
-Community- group of people and institutions that share geographic, civic, and/or social parameters. -Communities vary in the characteristics and health needs. -Community's health is determined by the degree to which the community's collective health needs are identified and met.
Autonomy: -Definition -Situation
-Individuals select those actions that fulfill their goals. -Respecting a client's right to self-determination (making a decision not to pursue chemo)
Bioterrorism Incidents
-Inhalational Anthrax: cause headache, fever, muscle ache, chest discomfort, shock. treat with IV cipro, antibiotics don't stop disease progression -Botulism: dif swallowing, weakness, nausea, vomiting ab cramps, dif breathing. treat with airway management, antitoxin, elim of toxin, supportive care -smallpox: high fever, fatigue, severe headache, rash that appears on face first, pus filled lesions, vomiting. no cure. supportive care and prevention with vaccine -ebola: fever, hemorrhage, vomiting, diarrhea, cough, jaundice, shock. no cure. airway management, dialysis, supportive care, prevention
Beneficence: -Definition -Situation
-Maximize possible benefits and minimize possible harms. -Assessing risks and benefits when planning interventions.
Aggregates of the Community
-children and adolescent: health concerns, screening/ prevention, national health goals, community education -women: reproductive health, heart disease, diabetes, malignant neoplasm. screening for height and weight, blood pressure, cholesterol, dental health, pap, mammograms, sigmoidoscopy, vaccinations, immunizations, diabetes, HIB, skin cancer. reduction in osteoporosis, cancer, sexual violence. increase in planned pregnancies, prenatal care, breastfeeding, early warning signs of stroke -men: heart disease, malignant neoplasm, unintentional injury, lung disease, liver disease. screening for height and weight, BP, dental health, digital rectal exam, sigmoidoscopy, immunizations, diabetes, HIV, skin cancer, cholesterol. reduce cancer deaths, HIV and aids, fatal injuries. fincrease in muscle strengthening activities, identifying warning signs of stroke -older adults: heart disease, cancer, stroke, COPD, pneumonia, flu, substance use. screeen blood pressure, height and weight, dental health, sigmoidoscopy, mammogram, pap smear, vision, hearing, substance use, immunization, functional assessments, meds, osteoporsosi, diabetes, skin cancer
Application of ethical principles to community health
-respect for autonomy: individuals select actions that fulfill their goals -nonmaleficience: no harm is done when applying care -beneficience: maximize possible benefits and minimize possible harms, assess risks and benefits when planning interventions -distributive justice: fair distribution of benefits and burden in society based on needs and contributions of its members
Secondary Data
-use of existing data to assess problem (census, healt records, prior health surveys) -ability to trend health issues over times -data may not rep current situation, can be time consuming
PICC line can last?
1 year. flushed daily.
What are the steps to develop a community health education plan?
1) Identify population-specific learning needs. 2) Consider population-specific concerns and effect of health needs on the population to determine the priority learning need. 3) Select aspects of learning theories to use in the educational program based on the identified learning need. 4) Identify barriers to learning, and learning styles. 5) Design the education program. 6) Implement the education program. Ensure an environment that is conducive to learning 7) Evaluate the achievement of learning objectives and the effectiveness of instruction.
What are the 7 phases of the epidemiological process?
1) determine the nature, extent, and possible significance of the problem. 2) using the gathered data, formulate a possible theory 3) Gather info from a variety of sources in order to narrow down the possibilities 4) Make the plan 5) Put the plan into action 6) Evaluate the plan 7) Report and follow up
What nurses can do to influence health policy
1. Learn the legislative process 2. Stay informed on current issues 3. Identify government representatives 4. Be an active constituent 5. Speak out
Core Competencies
1. Monitor health status to identify community health problems 2. Diagnose and investigate health problems and hazards in the community 3. Inform, educate, and empower people about health issues 4. Mobilize community partnerships to identify and solve health problems 5. Develop policies and plans that support individual and community health efforts 6 Enforce laws and regulations that protect health and ensure safety 7.Link people to personal health services and ensure the provision of health care that is otherwise unavailable 8. Ensure a competent public health and personal health care workforce 9. Evaluate effectiveness, accesibility, and quality of personal population-based seves 10. Research for new insights and innovative solutions to health problems
Eight Principles of Public Health Nursing
1. The client or "unit of care" is the population 2. The primary obligation is to achieve the greatest good for the greatest number of people or the population as a whole 3. The processes used by public health nurses include working with clients as an equal partner 4. Primary prevention is the priority in selecting appropriate activities 5. Selecting strategies that create healthy environmental, social, and economic conditions in which population may thrive is the focus 6. There is an obligation to actively reach out to all who might benefit from a specific activity or service 7. Optimal use of available resource to assure the best overall improvement in the health of the population is a key element 8. Collaboration with a variety of other professions, organization, and entities is the most effective way to promote and protect the health of the people
Questions asked about assessment
1. Whether there are a needs assessment process in place that described the health status of the community needs 2. Whether there has been a survey of environmental risk factors 3. Whether an analysis has been done of "the determinants and contributing factors of priority health needs, adequacy of of existing health resources, and the population groups most affected."
8 essential elements of primary health care
1. education for the identification and prevention/control of prevailing health problems 2. proper food supplies and nutrition 3. adequate supply of safe water and basic sanitation 4. maternal and child care, including family planning 5. immunization against the major infectious diseases, prevention and control of locally endemic diseases 6. appropriate treatment of common diseases using appropriate technology 7. promotion of mental health 8. provision of essential drugs
Millennium Development Goals
1. eradicate extreme poverty and hunger 2. achieve universal primary education 3. promote gender equality and empower women 4. reduce child mortality 5. improve maternal health 6. combat HIV/AIDS, malaria, and other diseases 7. ensure environmental sustainability 8. develop a global partnership for development
strategies for health for 2015 (bexar county)
1. evidence-based teen pregnancy prevention-reduce teen birth rate by 15% 2. built environment for active living-reduce physical inactivity by 10% 3. neighbors engaged in health-community asset mapping, action plans and active engagement in 10 neighborhoods 4. blood and sexually transmitted disease-reduce congenital syphilis by 50% and reverse trends in syphilis incidence
Educator Skill (education process)
1. gain attention 2. inform the learner of the objectives of instruction 3. stimulate recall of prior learning 4. present the stimulus 5. provide learning guidance 6. elicit performance 7. provide feedback 8. assess performance 9. enhance retention and transfer of knowledge
educational process
1. identify client needs-needs assessment 2. establish educational goals and objectives 3. select appropriate educational strategies 4. develop effective skills as an educator 5. develop effective health education programs
Assessment
1.) Monitor health status to identify community health problems 2. Diagnose and investigate health problems and health hazards in the community
Population level questions
1.) What is the presence of hypertension among various age, race, and sex groups? 2.) Which subpopulations have the highest rates of untreated hypertensions
National Priorities Partnership
1.) Working with communities to promote wide use of best practices to enable healthy live and well being 2.) Promote the most effective prevention, treatment, and intervention leading causes of mortality, starting with cardiovascular disease 3.) Ensure person- and family centered care 4. ) Make care safer 5.) Promote effective communication and care coordination 6.) Make quality care more affordable for individuals families, employers developments by developing and spreading new healthcare delivery methods
Patient Protection and Affordable Care Act are provisions that address health promotion and prevention of disease and disability. Including
1.) establishment of the National Prevention, Health Promotion, and Public Health Council to coordinate federal prevention, wellness, and public health activities and to develop a national strategy to improve the nation's health 2.) creation of a Prevention and Public Health Fund to expand and sustain funding for prevention and public health programs 3.) improvements of preventive efforts by , including immunization recommended by the U.S Preventive Service Task force grants and technical assistance for wellness program
Mg
1.8-3
BUN
10-20
Sodium
136-145
Hgb
14-18 (males) 12-16 (females)
Platelets
150000-450000
A client will have a positive intradermal TB test within
2 to 10 weeks of exposure to the infection; TB has slow onset
Veterans
25 mil in US. 2 mil women, 9 mil >65. -veterans health include hospitals, outpatient clinics, home health services, hospice and palliative care, nursing omes, residential rehab, readjustment counseling -vet health issues: mental health, substance use and addiction, suicide, infectious disease, exposure to herbs, chemicals, and radiation, traumatic brain injury, spinal cord injury, traumatic amputations, cold injury, military sexual trauma, hearing loss, vision impair
Policy Development
3.) Inform, educate, and empower people about health issues 4.) Mobilize community partnerships to identify and solve health problems 5.) Develop policies and plans that support individual and community health efforts
potassium
3.5-5
Albumin
3.8-5
manifestations of alcohol withdrawal appears within
4 to 12 hr
Glycosylated hemoglobin (HbA1c) expected reference range is _________
4% to 6%, but an acceptable target for clients who have diabetes may be 6.5% to 8%, with a target goal of less than 7%.
HCT
42-52% (males) 37-47% (females)
Assurance
6. Enforce laws and regulations that protect health and ensure safety 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable 8.) Assure a competent public health and personal health care workforce 9.) Evaluate effectiveness, accessibility, and quality of personal and population-based health services
The recommendation for saturated fat intake is no more than _____% of total daily caloric intake.
7%
fasting glucose
70-110
Ca++
9-10.5
GFR
90-120
LDL
<100
HDL
>40 (males) >50 (females)
What does this describe: an aggregate who shares one or more personal characteristic
A population
The nurse is evaluating a client's environment at home. Which of the following observations in the home would require further demonstration and education with the client? a. Medications in a daily planner box and a list of all of his home medications. b. A small night light in the hallway as well as an overhead light. c. A small throw rug in the living room to cover an exposed extension cord. d. A small pantry with a variety of non-perishable foods.
A small throw rug in the living room to cover an exposed extension cord. Rationale: Safety assessment in the home is a nursing responsibility and a legal requirement. Nurses cannot close their eyes to any unsafe practices in the home. Upon entering the home and on a continuing basis, it is imperative that the nurse is alert for any hazardous or unsafe conditions. Nursing Process: Evaluation Client Need: Safe and effective Care Cognitive Level: Application Objective: Apply the nursing process to care of the client in the home. Strategy: Use Maslow's Hierarchy of needs for prioritization to choose the best selection.
A nurse is discussing routine follow-up needs for a client who has a new prescription for valproic acid (Depakote). The nurse should inform the client of the need for routine monitoring of which of the following? A. AST/ALT and LDH B. Creatinine and BUN C. WBC and granulocyte counts D. Serum sodium and potassium
A. AST/ALT and LDH
A nurse is communicating with a newly admitted client. Which of the following is a barrier to therapeutic communication? A. Offering advice B. Reflecting meaning C. Listening attentively D. Giving information
A. Offering advice
A nurse is teaching the parents of a child with a new prescription for imipramine (Tofranil) and his parents about indications of toxicity. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Seizures B. Agitation C. Photophobia D. Dry mouth E. Irregular pulse
A. Seizures B. Agitation E. Irregular pulse
A nurse is discussing silent rape reaction with a newly licensed nurse. Which of the following should the nurse identify as a characteristic of this type of reaction? (Select all that apply.) A. Sudden development of phobias B. Development of substance use disorder C. Increased level of anxiety during interview D. Reactivation of a prior physical disorder E. Unwillingness to discuss the sexual assault
A. Sudden development of phobias C. Increased level of anxiety during interview E. Unwillingness to discuss the sexual assau
A nurse is planning a peer group discussion about the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Which of the following is appropriate to include in the discussion? (Select all that apply.) A. The DSM-5 is used to identify mental health disorders. B. The DSM-5 establishes diagnostic criteria. C. The DSM-5 indicates recommended pharmacological treatment. D. The DSM-5 assists nurses in planning care. E. The DSM-5 indicates expected assessment findings.
A. The DSM-5 is used to identify mental health disorders. B. The DSM-5 establishes diagnostic criteria. D. The DSM-5 assists nurses in planning care. E. The DSM-5 indicates expected assessment
A nurse is planning care for a client following surgical implantation of a vagus nerve stimulation (VNS) device. The nurse should plan to monitor for which of the following adverse effects? (Select all that apply.) A. Voice changes B. Seizure activity C. Disorientation D. Dysphagia E. Neck pain
A. Voice changes D. Dysphagia E. Neck pain
Adaptive Model
ABLE TO ADAPT Medicine beyond treatment of disease: from writings of Dubos. Health means ability to adapt to a changing environment. Disease is failure to adapt. How flexible is someone in a changing environment?
availability of services in a community as well as individual, family, and community circumstances
Access to health care is impacted by what factors?
Implementation Phase
Action phase Role of community health nurse Social change, community action
In the "I PREPARE" mnemonic, A=
Activities
Disaster prevention
Activities to prevent natural and man-made disasters, increase surveillance, improve inspections and airport security, strengthening public health processes such as immunizations, isolation, and quarantine. Strengthen barriers to prevent flooding and teaching methods of preventing communicable disease transmission. ID and assess population populations at risk.
ACE
Acute Care for Elders
Last name
Address clients by their ____ unless given permission to do otherwise
What three things are needed to advocate for the clients?
Advocating for clients requires assertiveness, placing priority on the client's values, and willingness to progress through the chain of command for resolution.
What barriers must nurses take into account when designing community education programs?
Age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, and lack of motivation
Epidemiological triangle: What are the 3 components?
Agent, host, environment
What is the agent? Host? Environment?
Agent- animate or inanimate object that causes the disease. H0st- living being that is affected by the agent. Environment- setting or surrounding that sustains the host.
Modes of Transportation
Airborne, Foodborne, Waterborne, vector-born, direct contact
How quickly does the body process ETOH?
Alcohol is filtered by the liver at about 1 oz per hr.
What are some secondary preventions strategies for homelessness?
Alleviate existing homelessness by making referrals for financial assistance, food supplements, and health services. ■■ Assist homeless clients in locating temporary shelter. ■■ Assist clients in finding ways to meet long-term shelter needs. ■■ If homeless shelters are not provided in the community, work with government officials to develop shelter programs.
AACN
American Association of Colleges of Nursing
APHA
American Public Health Association
Categories of Public Health competencies
Analytic/assessment Policy development/ program planning Communication Cultural competency Community dimensions of practice Basic public health sciences Financial planning and management Leadership and systems thinking
Program Planning: Diagnosis
Analyze data to determine health needs, prioritize health needs of the community
A nurse is advocating for local leaders to place a newly approved community health clinic in an area of the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which of the following ethical principles? A. Distributive justice B. Fidelity C. Respect for autonomy D. Veracity
Answer: A A: Correct- distributive justice is fair distribution of benefits and burden in society B: Incorrect. Fidelity involves keeping commitments and following through with promises. C: Incorrect. Autonomy is supporting the rights of individuals to determine and pursue personal HC goals. D: Incorrect. Veracity is the concept of telling the truth.
Scabies
Appear as grayish brown, threadlike burrows on the skin. Require private room.
Windshield Survey Components Place: Natural environment
Are there geographic features that may harm the community? Are there plants or animals that could harm or threaten the health of the community?
Windshield Survey Components Place: Social systems
Are there social services, clinics, hospitals, dentists, and health care providers available within the community? Are there ample schools within the community? Are they in good repair or disrepair? Are there parks or areas of recreations? What places of worship are within the community? What services are provided by local religious groups, schools, community centers, and activity or recreation centers? Is there public transportation? What grocery stores or other stores are within the community? Is public protection evident (police, fire, EMS services, animal control)?
Evaluation: How do you evaluate the progress towards achieving the goal?
Assess the client and client's spouse for understanding of the potential safety hazards. Can they now identify the risks? Is the home now free from potential hazards Have the client and spouse remained free from injury?
What is a windshield survey?
Assessing community components by driving through a community
beneficence (Situation)
Assessing risks and benefits when planning interventions
APEXPH
Assessment Protocol for Excellence in Public Health
Humanistic theory -
Assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest
What is the humanistic theory?
Assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest.
ACHNE
Association of Community Health Nursing Educators
ASTDN
Association of State and Territorial Directors of Nursing
resource barriers to referral process
Attitudes of health care personnel › Costs of services › Physical accessibility of resources › Time limitations › Limited expertise working with culturally diverse populations
A nurse is conducting a class for a group of newly licensed nurses on identifying risk factors for suicide. Which of the following individuals should the nurse include as having the highest risk for suicide? (Select all that apply.) A. Older adult females B. Adolescents C. Native Americans D. Clients who have a depressive disorder E. Clients who have hypomania
B. Adolescents C. Native Americans D. Clients who have a depressive disorder
Community Health Program Planning, Development, and Management Preplanning
Brainstorm ideas. Activities: Gain entry into community and establish trust. Obtain community awareness, support, and involvement. Coordinate collaborations that have similar interest in addressing identified problems
A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following is the priority nursing intervention? A. Orient the client frequently to time, place, and person. B. Offer fluids and nourishing diet as tolerated. C. Implement seizure precautions. D. Encourage participation in group therapy sessions.
C. Implement seizure precautions.
Focus on Quality and Safety Education For Nurses
Client centered care, teamwork and collaboration, evidenced based practice, quality improvement, safety, informatics
Who/what is the client in CHN?
Client is a community or a population w/in the community
What do client rights include?
Client rights include the right to info disclosure, privacy, informed consent, info confidentiality, and participation in TX decisions
Case Study: The Case of Safety First for Home Health
Client's Name: Glenda Lidzy Abstract: Glenda Lidzy is an 82 yr old female requiring home health following a lengthy illness. As the home health nurse, you are assigned to her initial assessment, and to develop a plan of care for her. Objectives: - Compare and contrast the roles of the nurse providing home care with the roles of the nurse in medical-surgical nursing. - Explain the purpose of rehabilitation in healthcare. Glenda Lidzy is an 82 year old female discharged home following a lengthy hospitalization due to urosepsis. Due to prolonged bed rest, she has less overall strength and stamina and will need help resuming ADLs. Her PMH is unremarkable, with the exception of diabetes which was discovered during her recent hospitalization. She has osteoarthritis, requiring the use of a walker to ambulate, and is able to move all extremities fairly well. Glenda lives alone, and has strong family support as well. She will need IV antibiotic therapy to continue for 2 weeks. She has a PICC (peripherally inserted central catheter) in her right upper arm. You are the home health nurse assigned to care for Ms. Lidzy.
-Are clients autonomous beings? -Do clients have the right to make decisions affecting their own health and welfare? -Are clients responsible for their own health?
Clients are autonomous beings, have the right to make decisions affecting their own health and welfare, and are responsible for their own health.
Educational objectives
Cognitive Affective Psychomotor
Community Health Program Planning, Development, and Management Assessment
Collect data about the community and its members. Activities: Complete a needs assessment and identify community strengths and weaknesses. Assess the availability of community resources. Evaluate secondary health data.
CBSA
Community Benefit Service Area
CHA
Community Health Assessment
evaluating the adequacy of health services within the community and the accessibility
Community assessment should include:
What are examples of secondary prevention?
Community assessments Disease surveillance (Communicable diseases) Screenings: Cancer, DM, HTN, Hypercholesterolemia, Sensory Impairments, TB, Lead exposure, Genetic disorders, Metabolic deficiencies in newborns Control of outbreaks
Milo's framework for prevention
Complements the health belief model. Emphasizes change at the community level. Identifies relationship between health deficits and availability of health-promoting resources. Theorizes that behavior changes within a large number of people can ultimately lead to social change.
culture and health care
Congruency between which two practices is essential for the well- being of the client.
U.S. Department of Homeland Security
Contact in response to threats and hazards by acts of terrorism
CQI
Continuous Quality Improvement
Objective 3:
Contrast clinical nursing practice with population practice in the community
A nurse working in a pediatric clinic is caring for a preschool-age child who has a new diagnosis of ADHD. When teaching the parent about this disorder, which of the following statements should the nurse include in the teaching? A. "Behaviors associated with ADHD must be present prior to age 3." B. "This disorder is characterized by argumentativeness." C. "Below-average intellectual functioning is associated with ADHD." D. "Because of this disorder, your child is at an increased risk for injury."
D. "Because of this disorder, your child is at an increased risk for injury."
A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? A. "Assign the client to a private room." B. "Document the client's behavior every hour." C. "Allow the client to keep perfume in her room." D. "Ensure that the client swallows medication."
D. "Ensure that the client swallows medication."
A nurse in a long-term care facility is caring for a resident who has major neurocognitive disorder and attempts to wander out of the building. The client states, "I have to get home." Which of the following is an appropriate response by the nurse? A. "You have forgotten that this is your home." B. "You cannot go outside without a staff member." C. "Why would you want to leave? Aren't you happy with your care?" D. "I am your nurse. Let's walk together to your room."
D. "I am your nurse. Let's walk together to your room."
A nurse is conducting group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive communication? A. "I wish you would not make me angry." B. "I feel angry when you leave me." C. "It makes me angry when you interrupt me." D. "You'd better listen to me."
D. "You'd better listen to me."
Psychomotor Domain
DEMONSTRATE Hands on manipulation, "teach back" performance of skills requiring coordination and motor skills.
What vaccines are safe during pregnancy:
DPT
What is an informant interview?
Data collection via direct discussion w/ community members
What is a Community forum?
Data collection via open public meeting
Tertiary prevention
Decrease complications and disabilities due to infectious diseases through treatment and rehab.
Case Management
Defined in public health nursing as the ability to "optimize self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. •Knowledge of community resources and financing methods •Written and oral communication and documentation skills •Negotiation and conflict-resolution skills •Critical thinking processes to identify and prioritize problems from the view of the provider and client •Application of evidence-based practices and outcome measures
Community-focused nursing
Delivery of nursing care to improve health of an entire community - bigger picture, deals with prevention and population at systems level.
Substance use disorders
Denial: defensiveness, lying about use, minimize use, blaming use, intellectualizing.
Objective 2:
Describe specialization in public health nursing and other nurse roles in the community and the practice goals of each
Objective 4:
Describe what is meant by community and prevention oriented, population focused practice.
Data Collection Windshield Survey
Descriptive approach that assesses several community components by driving through a community Strengths: Provides a descriptive overview of a community Limitations: Need for a driver so the nurse can visualize and document the community elements May be time-consuming Results based only on visualization and does not include input from community members
Distributive Justice (situation)
Determining eligibility for health care services based on income and fiscal resources
Community Health Program Planning, Development, and Management Planning
Develop interventions to meet indented outcomes Activities: Determine possible solutions to meet the health needs and select the best option. Establish goals and objectives for the selected solution. Objectives are behaviorally stated, measurable, and include a target date for achievement. Select strategies/interventions to meet the objectives. Plan a logical sequence for interventions by establishing a timetable. Identify who will assume responsibility for each intervention. Determine available and needed resources to implement interventions. Assess the personnel needed and any special training they may require for screening or providing education. Determine funding opportunities for needed interventions and develop a budget. Plan for program evaluation.
Program Planning: Planning
Develop interventions, Establish goals and objectives for the selected solution, select strategies/interventions to meet the objectives
Nonmaleficence (situation)
Developing plans of care that include a system for monitoring and evaluating outcomes
DRGs
Diagnosis Related Groups
Data Collection Informant Interviews
Direct discussion with community members for the purpose of obtaining ideas and opinions from key informants Strengths: Minimal cost Participants serving as future supporters Offer insight into beliefs and attitudes of community members Reading/writing of participants not required Personal interaction may elicit more detailed responses Limitations: Built-in bias Meeting time and place
Data Collection Focus Groups
Directed talk with a representative sample Strengths: Possibility of participants being potential supporters Provides insight into community supports Reading/writing of participants not required Limitations: Possible discussion of irrelevant issues Challenging to get participants Requires strong facilitator Difficult to ensure that sample is truly representative of the overall community Time-consuming to transcribe discussion
Four levels of disaster management
Disaster Prevention Disaster Preparedness Disaster Response Disaster Recovery
Demographic
Distribution, mobility, density, census data, racial distrubution
______are often first-line medications to treat hypertension
Diuretics
Streptomycin sulfate (Streptomycin)
Due to its high level of toxicity, this medication should be used only in clients who have multidrug-resistant TB (MDR-TB)It can cause ototoxicity, so monitor hearing function and tolerance often. Report significant changes in urine output and renal function studies.
What assessment will be performed to obtain a complete picture of the client's self-care status?
During the visit, much of the assessment process centers on collecting the information requested on the tools and forms contained in the agency's admission packet. These packets usually include a physical and psychosocial database; a medication sheet; forms for pain assessment, spiritual assessment, and financial assessment; and a family roster. It is extremely important that the data collected be as complete and accurate as possible and reflects subjective, objective, current, and historical information. Through interviewing, direct observation, and physical assessment, the nurse can achieve the goal of the initial visit, namely, to gain as clear and accurate a clinical picture of the client as possible.
What is the meaning of secondary prevention?
Early detection and treatment of disease with the goal of limiting severity and adverse effects
Secondary prevention
Early detection of disease and treatments with goal of limiting severity and SE's
things that decrease a risk for stroke
Early treatment of hypertension, maintenance of blood glucose within expected range, and refraining from smoking Maintaining a healthy weight and getting regular exercise
Assurance
Ensuring healthy populations Appropriate and accessible services for all Healthful physical environment Stable ecosystem Strong, supportive, non exploitive membership Extensive participation in decision making Members' basic needs provided for. Access to resources and opportunities for interaction Sustainable vital economy Maintain connectedness with cultural and biological heritages Provide governance structures that promote health.
In the "I PREPARE" mnemonic, E=
Environmental Concerns OR Educate
Tertiary prevention
Environmental Health Nursing Interventions: Individual level= Refer homeowners to lead abatement resources and educate asthmatic clients about environmental triggers. Community level= become active in consumer and health-related organizations and legislation related to environmental health issues and support cleanup of toxic waste sites and removal of other hazards.
Primary prevention
Environmental Health Nursing Interventions: Individual level= educate individuals to reduce environmental hazards. Community level= educate groups to reduce environmental hazards, advocate for safe air and water, support programs for waste reduction and recycling, and advocate for waste reduction and effective waste management
What involves the study of the relationships among an agent, host, and an environment?
Epidemiology
Planning health education
Establish outcomes - measurable Mutual goal setting with community as client
Affective Domain
FEELINGS attitudes, values:appreciates, chooses, accepts - role play, talk to s.o., feelings.
Disaster response
FEMA - federal emergency management agency OEM - office of emergency management American Red Cross Nursing: triage, immunize, shelter nursing (into recovery)
Disaster response
FEMA, CDC, U.S. Department of Homeland Security, American Red Cross, Office of Emergency Management, public health system. If a federal emergency is declared, the National Response Framework is activated and provides direction for an organized, effective national response.
Distributive Justice (definition)
Fair distribution of the benefits and burden in society is based on the needs and contributions of its members
analysis of community assessment data
Gather collected data assess completeness of data ID and generate missing data synthesize data and id themes ID community needs and problems ID community strengths and resources
GRACE
Geriatric Resources for Assessment and Care of Elders
Population
Group of people having at least one thing in common and who may or may not interact with one another. E.g., night-shift workers, children with CF.
Community
Group of people sharing something, interacting with one another. May exhibit commitment with one another and may share geographic boundary. E.g., a NORC, a school, NYU students.
Eudaimonistic Model
HOLISTIC UPSTREAM Greek origins. R/t Maslow's hierarchy of needs. MOST HOLISTIC Health = actualization/realization of complete fulfillment and development. Illness impedes/prevents self-actualization. Aim to redirect thinking away from mechanistic view toward holistic view. HOLISM, UNITY, INDIVIDUALITY
HMO
Health Management Organizations
HEDIS
Health Plan Employer Data and Information Set
HRQoL
Health Risk and Quality of Life
Health belief model: -What is the purpose? -Purpose of preventive health behaviors? -Emphasizes change at what level? -Describes the likelihood of taking an action to avoid disease based on what 4 things?
Health belief model: -Purpose is to predict or explain health behaviors -Preventive health behaviors- primarily taken to avoid disease -Emphasizes change at the individual level -Describes the likelihood of taking an action to avoid disease based on: 1)Perceived susceptibility, seriousness, and threat of a disease 2)Modifying factors (e.g., demographics, knowledge level) 3)Cues to action (media campaigns, disease impact on family/friends, recommendations from HCP) 4) Perceived benefits minus perceived barriers to taking action
Community oriented nursing activities
Health care: Determining health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community
Adolescents
Health concerns: MVA, unintentional injury, homicide, suicide Screening: height/weight, dental health, Pap smear (F), chlamydia (F), rubella (F), substance abuse, immunization, mental health Goals: healthy weight, avoid exposure, immunize, safety, exercise in schools, lead-based paint testing
Men
Health concerns: heart disease, cancer (prostate, testicular, skin, colorectal), accidents, lung disease, liver disease Screening: Height/weight, BP, dental health, DRE, FOB, immunization, DM, HIV, skin cancer, cholesterol (35-64) Goals: reduction in cancer death, HIV/AIDS, violent death - increase in participation in active pregnancy prevention, ID of heart disease early warning signs
Women
Health concerns: reproductive health, heart disease, DM, cancer (breast, cervical, ovarian, colorectal) Screening: height/weight, BP, cholesterol (45-64), dental health, pap, mammogram, FOB/sigmoidoscopy (>50), rubella (child bearing), immunization, DM, HIV, skin cancer Goals: reduction in bone disease, cancer deaths and sexual assaults - increased planned pregnancies vs unplanned, early/adequate prenatal care, breastfeeding, ID of heart disease early warning signs
What are some examples of preventive services?
Health education and counseling, immunizations, and other actions that aim to prevent a potential disease or disability
Newest Vital Sign
Health literacy test: being able to read food labels.
impact of health promotion
Health promotion impacts communities; health promotion activities can also impact an entire system; involves all levels of prevention to promote health across the lifespan.
Components of a Community Assessment Social systems
Health systems Economic systems/factors Education systems Religious systems Welfare systems Political systems Recreation systems/factors Legal systems Communication systems/factors Transportation systems Resources and services
extreme heat and health
Heat waves send thousands to emergency rooms and cost health care systems millions of dollars; climate change brings longer, more intense heat waves.
Health Education Goals
Help individuals, groups, communities achieve, by own actions/initiative, optimal health Facilitate voluntary actions to promote health Empowerment Advocacy Self-efficacy
Phases of emotional reaction to disaster
Heroic - Occurs at the time of the disaster, intense excitement and concern for survival Honeymoon - post-disaster period (2 weeks to 2 months), feel support from government Disillusionment - several months to a year or more, unexpected delays in receiving aid Reconstruction - several years, attempt to rebuild
Phases of emotional reaction during a disaster
Heroic - intense excitement and concern for survival. Rush for assistance. Honeymoon- affected individuals being to bond and relive their experiences. Disillusionment - responders may experience depression and exhaustion. Delays in receiving aid. Reconstruction- involves adjusting to a new reality and continued rebuilding of the area. Counseling may be needed.
Mental health
High risk substance use disorders, high suicide risk.
Rural/migrant health
Higher infant/maternal morbidity Chronic illness Occupational risks Increased suicide rate High risk trauma/injury Less likely to seek medical care
Triage Emergent category (class I) -
Highest priority is given to clients who have life-threatening injuries but also have a high possibility of survival once they are stabilized
drought and health
Hotter days and nights, and changing rainfall patterns reduce water supply quantity and quality, and diminish food security.
Assessment of Environmental Health
I PREPARE to determine exposure -I: investigate potential exposures -P: present work (exposure, PPE, location of material safety data sheets, home exposure, trends) -R: Residence -E: Enviro concerns (water, air, soil, waste) -P: Past work (exposure, farm, military, volunteer) -A: Activities (hobbies, gardening, fishing, hunting, burning) -R: Referrals and resources -E: Educate (risk reduction ,prevention)
"I Prepare" Model (assessment of environmental health)
I- investigate potential exposures P- present work (exposure, use of PPE, MSDS location, etc) R- residence (age of home, heating, recent remodel) E- environmental concerns (air, waiter, soil, waste) P- past work A- activities (hobbies, etc) R- referrals and resource E- educate
Kauffman's Five Phases
IBSBC Impressing Behaving - building rapport Swapping - sharing information Belonging - becoming part of the group Chilling out - near end of relationship, beginning longer term partnership with the community.
Collecting data
IOSFCW 7 methods Informant interviews Observation Secondary analysis of existing data Focus groups Community forums Windshield surveys
Community Health Program Planning, Development, and Management Diagnosis
Identify and prioritize health needs of the community Activities: Analyze data to determine health needs. Work with community members, local health professionals and administrators to develop priorities and establish outcomes. In setting priorities among identified community problems, consider the following: Community awareness of the problem Available readiness to acknowledge and address the problem Available expertise/fiscal resources Severity of the problem Amount of time needed for problem resolution.
What type of things do community nurses do?
Identify cases, recognize patterns of disease, eliminate barriers to disease control, and provide education and counseling targeted at a disease condition or specific risk factors.
First step in developing community health education plan
Identify population specific learning needs
Development of a community health program plan
Identify the needs of community: assessment. plan the program implement the program evaluate the effectiveness of program.
extreme weather and health
In 2011, thousands of record-breaking extreme weather events harmed communities and health in the US. Climate change is contributing to more intense and frequent extreme weather events.
Medicare
Individuals must be older than 65 years and receiving Social Security, have been receiving disability benefits for 2 years, have amyotrophic lateral sclerosis and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to qualify for Medicare
Orem Self Care Deficit
Individuals must take actions to maintain life and health. Can be performed by the individual, with guidance or by a caregiver
Respect for autonomy (definition)
Individuals select those actions that fulfill their goals
Pender health promotion model
Individuals will seek health promotion experiences in order to improve their well-being
potential indicators of hepatitis
Influenzalike symptoms ■ Fatigue ■ Decreased appetite with nausea ■ Abdominal pain ■ Joint pain ■ Fever ■ Vomiting ■ Dark-colored urine ■ Clay-colored stool ■ Jaundice
IMO
Institute of Medicine
Population-focused care
Interventions for health promotion, disease prevention to shape a community's overall health status.
What does "I PREPARE" stand for?
Investigate Present work Residence Environmental concerns Past work Activities Referrals Educate
In the "I PREPARE" mnemonic, I=
Investigate potential exposures
Alcohol withdrawal
Irritability, tremors, nausea, vomiting, HA, diaphoresis, anxiety, sleep disturbance commonly begin after 6 hr cessation Increased HR/BP - tachycardia indicator of possible DT's Determine last drink client has taken to accurately assess for SS withdrawal/DT
Windshield Survey Components Place: Housing
Is the housing of acceptable quality? How old are the homes? Are there single or multifamily dwellings? Is the housing in good repair or disrepair? Is there vacant housing?
What does the interaction of the epidemiological triangle determine?
It determines the development and cessation of communicable diseases, and they form a web of causality, which increases or decreases the risk for disease.
What does the Public Health Code of Ethics identify?
It identifies the ethical practice of public health
When does community partnership occur?
It occurs when community members, agencies, and businesses actively participate in the processes of health promo and disease prevention
What does epidemiology provide a broad understanding of? What is that information an important component of?
It provides a broad understanding of the spread, transmission, and incidence of disease and injury. This information is an important component of community assessment and program planning.
Whose responsibility is it to advocate for resources or services that meet the client's health care needs?
It's the nurse's responsibility to advocate for resources or services that meet the client's health care needs.
Client barriers to referral process
Lack of motivation › Inadequate information about community resources › Inadequate understanding of the need for referral › Accessibility needs › Priorities › Finances › Cultural factors
Communicable diseases
Leading causes of death are acute respiratory infections (pneumonia and influenza), AIDS, diarrheal diseases, tuberculosis, malaria, measles.
general nursing care for hepatitis
Limit the client's activity in order to promote hepatic healing. ◯ Provide a high-carbohydrate, high-calorie, low- to moderate-fat, and low- to moderate-protein diet, and small, frequent meals to promote nutrition and healing. ◯ To promote hepatic rest and the regeneration of tissue, administer only necessary medications. ◯ Educate the client and family regarding measures to prevent the transmission of the disease with others at home (avoid sexual intercourse until hepatitis antibody testing is negative, avoid alcohol, avoid over-the-counter medications or herbal medications, use proper hand hygiene)
What is the social learning theory?
Links info to beliefs and values to change or shift the learners' expectations
Social learning theory -
Links information to beliefs and values to change or shift the learners' expectations
Glargine insulin (Lantus)
Long-acting insulin ☐ Administered once daily, anytime during the day but always at the same time each day. ☐ Glargine insulin forms microprecipitates that dissolves slowly over 24 hr and maintains a steady blood sugar level with no peaks or troughs. ☐ Administer glargine insulin subcutaneous only and never administer IV.
Vector-borne
Lyme disease, rocky mountain spotted fever, malaria
Clinical Model
MOST LIMITING DOWNSTREAM Health extreme = absence of S/S of disease/disability as IDed by medical science This model = downstream pattern of thinking rather than upstream which is holistic.
Institue of Medicine: Improving Health in the Community: A Role for Performance Monitoring (1997)
Major outcome was Community Health Improvement Process (CHIP) method for improving the health of improving the health of the population on a community wide basis
MCO
Managed Care Organizations
State Departments of health
Manages WIC program; reports notifiable communicable disease within the state *to the CDC*
State departments of Health
Manages women, infants and children (WIC) program oversees children's health insurance program, which offers expanded health coverage to uninsured children whose families do not qualify for Medicaid. Establishes public health policies. Provides assistance to public health departments. Responsible for the administration of the medicaid program. Reports notifiable communicable disease within the state to the CDC.
What is Tertiary prevention? * Individually based
Maximization of recovery after an injury or illness (rehabilitation)
Beneficence (Definition)
Maximize possible benefits and minimize possible harms.
Airborne
Measles, chickenpox, tuberculosis, pertussis, influenza
What is "I Prepare"
Mnemonic for determining current and past environmental exposures
MAPP
Mobilizaing for Action through Planning & Partnerships; this tool helps communities improve health and quality of life through community-wide strategic planning; communities seek to achieve optimal health by identifying and using their resources wisely, taking into account their unique circumstances and needs, and forming effective partnerships for strategic action
MAPP
Mobilizing For Action Through Planning and Partnership
Suicide
More reports for women, but men more likely to die
Transtheoretical Model
Most common learning theory Stages of Change Precontemplation - resistance; don't see problem Contemplation - know there's a problem and thinking about it Preparation - decision making; prepared for action, e.g., cutting down on cigarettes. Action - modifies behavior/environment to overcome problem. Takes lots of time and energy. W/D S/S now. Maintenance - constant work to avoid relapse.
What will be your goal for Ms. Lidzy in terms of her safety while in the home?
Ms. Lidzy will have no injury (falls) while at home (timeframe).
How should community nurses use their resources.
Must benefit the greatest number of citizens.
Interpreters
NOT family members. Need to have health-related terminology knowledge. Give teaching material in client's primary language.
Abuse
Neglect: lack of physical care, such as food, shelter, hygiene. Emotional are (interacting with child), education for child, needed health or dental care.
Healthy People 2020
New topic areas: adolescent health, blood, dementias inc. AD, early/mid childhood, genomics, global health, HAIs, health related QoL and well being, LGBT health, older adults, preparedness, sleep, social determinants. "Prevention Agenda for the Nation"
What are three examples of CHN theories?
Nightingale's theory of environment Health belief model Milio's framework for prevention
Nightingale's Theory of environment: -What relationship does it highlight? -What does it depict health as? -What does it emphasis?
Nightingale's theory of environment: -Highlights the relationship b/w an individual's environment and health -Depicts health as a continuum -Emphasizes preventive care
Pediculosis capitis (head lice)
Nits that are shed into the environment are capable of hatching for up to 10 days. Pets do not transmit or carry lice.
Nonmaleficence (definition)
No harm is done when applying standards of care
What is the crude mortality rate?
Number of deaths divided by population total x 1,000 = _____ per 1,000
Crude Mortality rate
Number of deaths ÷ population total x 1,000 = _____ per 1,000
Prevalence:
Number of existing cases in the population at a specific time divided by population total X 1,000= number per 1,000
What is the prevalence?
Number of existing cases in the population at a specific time divided by population total x 1,000 = ____ per 1,000
Prevalence calc
Number of existing cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000
What is the infant mortality rate?
Number of infant deaths before 1 year of age in a year divided by numbers of live births in the same year x 1,000 = _____ per 1,000
Infant mortality rate
Number of infant deaths before 1 year of age in a year ÷ numbers of live births in the same year x 1,000 =_____ per 1,000
Community Based Nursing
Nursing care is family centered, which means that the nurse works to improve the competencies of families to enable them to take better care of themselves. The nurse pays particular attention to the uniqueness of each family and works to plan the most useful interventions. Cultural diversity is taken into account, as are the situations and stressors facing the person or the family at a given time. The nurse promotes client autonomy and helps clients learn to do as much as possible for themselves.
Community-based nursing
Nursing care provided outside of acute care setting. Care for families, individuals within a community. At individual, "hands on" level. Does not require public health background.
What provides the basis for care of the community and family?
Nursing theory
Nightingales theory of environment
Nursing, health and environment have a correlation the health and illness of an individual or community
What are examples of Tertiary Prevention?
Nutrition counseling Exercise rehabilitation Case management (Chronic/Mental illness) Physical and occupational therapy Support groups Exercise for HTN clients (individual)
Data Collection Participant Observation
Observation of formal or informal community activities Strengths: indication of community priorities, environmental profile, and identification of power structures Limitations: Bias Time-consuming Inability to ask questions of participants
What is Participant observation data collection?
Observation of formal or informal community services
Occupational safety and health act of 1970
Occupational safety and health administration (OSHA) develops and enforces workplace health regulations to protect the safety and health of workers National advisory committee on occupational safety (NIOSH) gathers and disseminates data on incidence and prevalence of occupational illness and injury
Contact for non-biological or chemical incident
Office of Emergency Management
Homicide
Often related to substance abuse when committed by strangers Most are committed by friend acquaintance or family member during an argument Rates increasing among adolescents
Rape
Often underreported Increased reports in cities between 8pm and 2am on weekends and during the summer
Data Collection Community Forum
Open public meeting Strengths: Opportunity form community input Minimal cost Limitations: Difficulty finding a convenient time and place Potential to drift from the issue Challenging to get adequate participation Possibility that a less vocal person may be reluctant to speak
Frontier nursing service
Opened by Mary Breckinridge - travel to remote area via horseback Developed midwifery
Hepatitis A
Oral-Fecal Route: Risk Factors: Ingestion of contaminated food/water Daycares and communal living facilities Ingestion of food prepared by a hepatitis-infected person who does not practice proper sanitation precautions Travel/residence in underdeveloped country (using tap water to clean food products, drinking contaminated water)
Health Disparity Factors
Outcomes of mass illness, high death rates, or disabilities Safety, crime, and the prevalence of violence Access to exercise and nutritional information and classes Quality of environmental surroundings and waste removal Economic and employment rates, education levels, and culture
Transtheoretical Model: Stages of Change
PCPAM Precontemplation Contemplation Preparation Action Maintenance
Primary Prevention
PREVENTION Stay well and avoid problem Reduction of risk factors before occurrence of disease condition/injury E.g., exercise, brushing teeth, condoms, immunizations, nutrition.
Secondary Prevention
PREVENTION/MAINTENANCE SCREENINGS/EARLY DX Early detection of potential for disease/condition or existence of such while asymptomatic. E.g., screening programs - Pap smears, mammograms, colonoscopy.
Components of a Community Assessment People
People: Demographic - Distribution, mobility, density, census data Biological factors - Health and disease status, genetics, race, age, gender, causes of death Social factors - Occupation, activities, marital status, education, income, crime rates, recreation, industry Cultural factors - Positions, roles, history, values, customs, norms, religion
Health Care Resource Consumption
Per capita health spending for Medicare beneficiaries- the Medicare adjusted average per capita cost (AAPCC)
Phases of MAPP
Phase 1: organizing for success, partnership development Phase 2: visioning Phase 3: The MAPP assessments Phase 4: Identifying strategic issues Phase 5: developing goals and strategies Phase 6: the action cycle
Epidemiological Process
Phases: determine nature, extent and significance of the problem --> using data, formulate a theory --> gather information from a variety of sources to narrow possibilities --> make the plan --> put the plan into action --> eval the plan --> report and follow up
PDCA
Plan-Do-Check-Act
Health Education
Planned learning experiences based on sound theories to provide individuals, groups, communities opportunity to learn info and skills to make quality health decisions
What does effective community health education require?
Planning
PATCH
Planning Approach to Community Health
Community Assessment
Population assessment Primary informants Gaining entry (Kauffman's 5 phases)
PPO
Preferred Provider Organizations
Bioterrorism Primary prevention
Prepare with drills, vaccines, and ensuring availability of antibiotics for exposure prophylaxis. design a response plan, id the chain of command, define nursing roles, set up protocols.
Part D
Prescription drug coverage.
In the "I PREPARE" mnemonic, P=
Present work OR Past work
How do you define Primary prevention? * Group/Mass Audience Based
Prevention of the initial occurrence of disease or injury
Primary prevention
Prevention of the initial occurrence. Education, immunizations, prenatal classes.
Levels of Prevention
Primary Secondary Tertiary
Levels of Prevention r/t Public Health
Primary prevention The public health nurse develops a health education program for a population of school-age children that teaches them about the effects of smoking on health. Secondary prevention The public health nurse provides toxin screenings for migrant workers who may be exposed to pesticides. Tertiary prevention The public health nurse provides a diabetes clinic for a defined population of adults in a low-income housing unit of the community.
Occupation health nurses's roles
Primary prevention- teaching good nutrition and knowledge of health hazards, immunizations, and use of protective equipment Secondary prevention- ID workplace hazards, early detection through health surveillance and screening, counseling and referral Tertiary prevention- restoration of health through rehab
What is the role of the Missionary Nurse?
Promote health and prevent disease by meeting spiritual, physical, and emotional needs of people across the globe
Parish nurses
Promote health and wellness of populations of faith communities - often includes church members and individuals/groups in community Personal health counseling, health education, liaison between faith community and local resources, facilitator support groups, spiritual support
Case management
Promotes interprofessional services and increased client/family involvement decreases cost by improving client outcomes provides education to optimize health participation advocate for services and client rights
Case management
Promoting interdisciplinary services and increased client/family involvement Decreasing cost by improving client outcomes Providing education to optimize health participation Advocating for services and client rights
Public Health Nursing
Promoting, protecting health of populations using knowledge from nursing, social and public health sciences. Population focused.
Public health nursing
Promotion and protection of health of populations using knowledge from nursing, social and public health sciences. Population-focused; goals: promotion of health and prevention of disability and disease by creating conditions in which people can be healthy.
Public Health Nursing Goals
Promotion of health and prevention of disease and disability for all through creation of conditions in which people can be healthy.
Health Risk Factors
Proportion of 2 year old children who have received all age appropriate vaccines, as recommended by Advisory Committee on Immunization Practices - Proportion of adults aged 65 and older who have been immunized for pneumococcal, proportion who have been immunized in the past 12 months for influenza - portion of the population that smoke, by age, race, and sex appropriate - proportion of the population 18 years or older who are obese - Number and type of U.S. Environmental Protection Agency air quality standards not met - Proportion of assessed rivers, lakes, and estuaries that support beneficial uses (swimming and approved fishing)
Acute Care
Provider control Predictable routine Hospital policy Resources available Collaboration and consultation Controlled PT compliance Standardized care
Medicaid
Provides financial assistance to states and counties to pay for health care services for older adults with low socioeconomic status, clients with disabilities and families with dependent children
Medicare
Provides hospital and medical insurance to individuals who are 65 years and older, permanently disabled and/or have end-stage renal failure
Essential Elements of pubic health nursing
Public Health Interventions Wheel: Surveillance Disease and other health event investigation Screening Case Finding Referral and follow-up Case Management Delegated Functions Health teaching Counseling Consultation Collaboration Coalition building Community organizing Advocacy Social marketing Policy development Policy enforcement
What are the purposes of population-focused nursing?
Purposes of population-focused nursing: -Assessing to determine needs -Intervening to protect and promote health -Preventing disease w/in a specific population (people at risk for HTN, people w/o insurance, people w/knowledge deficits, etc.)
Peripheral IV should be changed when?
Q 72-96 hours. flushed Q8 and prn.
QSEN
Quality and Safety Education in Nursing
Tertiary Prevention
RESTORATIVE Treatment of existing or symptomatic disease to prevent/delay progress. Treatment after Dx, e.g, cardiac/stroke rehab.
Lispro insulin (Humalog), aspart insulin (Novolog), glulisine insulin (Apidra)
Rapid-acting insulin ☐ Administer before meals to control postprandial rise in blood glucose. ☐ Onset is rapid, 10 to 30 min depending on which insulin is administered. ☐ Administer in conjunction with intermediate- or long-acting insulin to provide glycemic control between meals and at night.
Tertiary prevention
Recovery after an illness. Nutrition counseling, case management, exercise for hypertensive clients.
Tertiary prevention
Refer home owner to lead abatement resources, educate asthmatic clients about environmental triggers, toxic waste clean up
A client is being admitted to an institutional based home care agency. Who is the responsible coordinator to the client's case? a. Social Worker b. Registered Nurse c. Client and their family d. Home care aides
Registered Nurse Rationale: Home care agency personnel typically include administrators, managers, care providers and business office staff. The responsibility of the case coordination remains with the registered nurse which also may be called the case manager. Nursing Process: Assessment Client Need: Safe and Effective Care Cognitive Level: Application Objective: Provide client care in community-based settings and the home. Strategy: Identify the core issue to prevent distraction of incorrect choices.
Bioterrorism tertiary prevention
Rehab of survivors, monitor medication regimens and referrals, evaluate effectiveness of the bioterrorism plan
Respect for autonomy (situation)
Respecting a client's right to self‑determination (making a decision not to pursue chemotherapy)
Portals of entry
Respiratory GI Skin Mucous membranes
Local Health Department
Responsible for identifying and intervening to meet health needs of the local community. ◯ Work closely with local officials, businesses, and stakeholders. ◯ Report notifiable communicable diseases to *state* departments of health. ◯ Nurses at the community level typically function in the nursing roles of caregiver, advocate, teacher, coordinator, and consultant. ◯ Funded through local taxes with support from federal and state funds
air pollution and health
Rising heat worsens smog. Burning coal and oil emits carbon and particle pollution; plants produce more allergenic pollen, affecting respiratory health threats like asthma.
On your initial home visit with Glenda, you notice her apartment is cluttered, with many colorful rag rugs scattered about her apartment. When you ask about them, she states, "I love the color, my house is so drab". What nursing diagnosis will help plan her safety?
Risk for injury (falls) related to clutter and use of rugs. Ms. Lidzy uses a walker, and has mobility issues. Clutter and rugs add to the problem. It is helpful to allow her to see the danger these pose, rather than come in and tell her she needs to clean the place up! Are there other ways to add color without rugs? Could you develop a plan to de-clutter (especially in terms of her route to the restroom)?
Overview
Role of CH nurse in community health program planning and evaluation is a collaborative leadership role. Desired outcome is to plan, organize, implement, and evaluate intervention programs, that address the specific health needs of the community. Community health program planning should reflect the priorities set as a result of analysis of community assessment data. Priorities are established based not he extent of the problem (community members perception of health needs, percent of population affected by the problem), the relevance of the problem to the public (degree of risk, economic loss), and the estimated impact of intervention (improvement of health outcome, adverse effects).
Direct contact
STDs (HIV, gonorrhea, syphilis, genital herpes, hep B, C, D) Infectious mononucleosis Impetigo, lice, scabies
Foodborne
Salmonellosis Hep A Trichnosis E. coli
Foodborne
Salmonellosis, Hepatitis A, Trickinosis, E.coli
What are national health goals derived from? What are these goals based on
Scientific data and trends collected during the prior decade. These goals are based on those issues that are considered major risks to the health and wellness of the US population.
Category B biological agents
Second highest priority - moderately easy to disseminate and have moderate morbidity rates and low mortality rates Typhus, cholera
Triage Urgent category (class II) -
Second-highest priority is given to clients who have major injuries that are not yet life-threatening and usually can wait 45 to 60 min for treatment
What is secondary prevention? What are some examples?
Secondary prevention is early detection and TX of disease w/the goal of limiting severity and adverse effects. Community assessments, disease surveillance (communicable diseases), screenings, control of outbreaks of communicable diseases
Direct contact
Sexually transmitted infections (HIV , gonorrhea, syphilis, genital herpes, hepatitis B, C, D), infectious mononucleosis, enterobiasis (pinworm), Impetigo, lice, scabies
characteristics of successful partnerships
Shared power › Shared goals › Integrity › Flexibility › Negotiation
Shigellosis
Shigellosis is spread when the bacteria in feces (stool) or on soiled fingers are ingested. Poor hand-washing habits and eating contaminated food may cause the condition. Shigellosis is often found in day care centers, nursing homes, refugee camps, and other places where conditions are crowded and sanitation is poor. Contact precautions require: A private room or a room with other clients with the same infection. Gloves and gowns worn by the caregivers and visitors. Disposal of infectious dressing material into a single,nonporous bag without touching the outside of the bag.
Regular insulin (Humulin R, Novolin R)
Short-acting insulin ☐ Administer 30 to 60 min before meals to control postprandial hyperglycemia.
______ is the most important preventable cause of death in the United States, according to the Centers for Disease Control and Prevention
Smoking
Indicators Used to Develop a Community Health Profile:
Sociodemographic Characateristics Health Status Health Risk Factors Health Care Resource Consumption Functional Status Quality of Life
Toxins, Air pollution, and Water pollution
Some environmental risks that can be found in some communities or patient homes.
Data Collection Surveys
Specific questions asked in written format Strengths: Data collected on client population and problems Random sampling Available as written or online format Contact with participants not required Limitations: Low response rate Expensive Time-consuming Possibility of the collection of superficial data Requires reading/writing abilities of participants
PPE for radiological incidents
Staff should wear water-resistant gowns, double-glove, and fully cover their bodies with caps, booties, masks, and goggles
Reinkemeyer's stages of planned change
Stage 1: Identification and development of felt need and desire for change Stage 2: Development of a change relationship between the community health nurse and the community Stage 3: Clarification or diagnosis of the community's problem, need, or objective Stage 4: Examination of alternative routes and tentative goals and intention of actions (planning)
Objective 6
State key opportunities for community and prevention oriented, population focused practice
Objective 1:
State the mission of and core functions of public health and the essential public health services and the quality performance standards program in public health
Disaster preparedness
Stem from threats and vulnerabilities identified in the prevention level, and should coordinate community efforts as well as outline specific roles of local agencies. This level of management includes preparedness of natural or man-made disasters. Create an action plan and determine alternative methods of communication, highlight evacuation plans, ID local and distant meeting places, disaster kit. Set up communication protocol; should provide access to American Red Cross, and state and federal government agencies. Disaster drills.
Facilitate learning
Stimulate senses Active learning Comfortable Learner's readiness? Relevant information Repetition Learning should be positive Start simple, go to complex Generalize and pace appropriately
Tertiary Prevention
Stopping deterioration in a patient, a relapse, or disability and dependency by anticipatory nursing and medical care
Secondary Prevention
Stopping the progress of disease by early detection and treatment, thus reducing prevalence and chronicity
Secondary Prevention -
Strategies that lead to early detection and treatment of disease with the goal of limiting severity and adverse effects (pick this if you see "screenings" or safety checks)
Tertiary Prevention -
Strategies that maximize recovery after an injury or illness
Primary Prevention -
Strategies that prevent the initial occurrence of disease or injury (pick this if you see "education" or "immunizations")
Strategies for and Barriers to Implementing Community Health Programs
Strategies: thorough assessment, interpret data, collaborate, commuicate, sufficient resources, logical planning, skilled leadership -Barriers: inadequate assessment, miconstrued data, no involvement in community partners, impaired communication, inadequate resource, lack of planning, poor leadership
What do successful screening programs provide?
Successful screening programs provide accurate, reliable results, can be inexpensively and quickly administered to large groups, and produce few if any side effects
What is tertiary prevention? What are some examples?
Tertiary prevention is maximization of recovery after an injury or illness (rehab). Nutrition counseling, exercise rehab, case mgmt. (chronic illness, mental illness), PT and OT, support groups, exercise for hypertensive clients (individual)
TJC
The Joint Commission
Culture
The beliefs, values, attitudes, and behaviors shared by a group of people and transmitted from generation to generation. This greatly influences the link between an individuals health beliefs and practices.
HIPAA, disability insurance, aid to families with dependent children, and supplemental security income
The centers for Medicare and Medicaid Services (CMS) also administers what?
Analysis of Community Assessment Data
The community health nurse plays an active role in assessment, data interpretation, and problem identification. Steps in analysis of community assessment data include: Gathering collected data in a composite database. Assessing completeness of data. Identifying and generating missing data. Synthesizing data and identifying themes. Identifying community needs and problems. Identifying community strengths and resources. Problem analysis is completed for each identified problem. Frequently, work groups are formed to examine individual problems and develop solutions.
What is the development of community partnerships critical to?
The development of community partnerships is critical to the accomplishment of health promo and disease prevention strategies
Contact when local abilities are unable to properly respond to an incident
The federal emergency management agency
Planning and Intervention: What are the goals for the diagnosis of Risk for Injury? What interventions will you implement?
The goals are for the client and spouse to remain free from injury and to be able to identify and correct potential safety hazards. Interventions include: - Alert the client and spouse to the unsafe and hazardous conditions - Offer suggestions to correct the unsafe and hazardous conditions - Assess the client and spouse for understanding of the hazards - Document how the client and spouse respond to the suggestions - Maintain respect and courtesy during the instructions and suggestions to the client and spouse - Establish a home safety list for the client.
Triage Expectant category (class IV) -
The lowest priority is given to clients who are not expected to live and will be allowed to die naturally. Comfort measures may be provided, but restorative care will not
Triage Nonurgent category (class III) -
The next highest priority is given to clients who have minor injuries that are not life-threatening and do not need immediate attention
Oxygen Therapy
The nurse should post "Oxygen in Use" signs to alert others, know where the closest fire extinguisher is located, reinforce to the client and others about fire hazard of smoking during oxygen use, and check that all electric machinery is grounded. The client should wear a cotton gown instead of synthetic or wool since those fibers can generate static electricity. Volatile and flammable materials such as alcohol and acetone should not be used near clients receiving oxygen
Community Health Assessment
The process of examining the health data related to a community to identify health issues and to implement community-based health benefit programs.
Acculturation
The process of merging with or adopting the traits of a different culture. Adapting to a new culture requires changes in daily living practices. These changes relate to language, education, work, recreation, social experiences, and the health care system.
Example of Tertiary Prevention
The public health nurse develops a diabetes clinic in which nursing care including educational programs for nutrition and self-care are provided for a defined population of adults in a low income housing unit of the community
Example of secondary prevention
The public health nurse develops a program of toxin screenings for migrant workers who may be exposed to pesticides and refers for treatment those who are found to be positive for high levels
What is an epidemic?
The rate of disease exceeds the usual level of the condition in a defined population
What is epidemiology?
The study of health-related trends in populations for the purpose of disease prevention, health maintenance, and health protection.
How do tactile-kinesthetic learners best learn?
They learn through "doing" and methods such as trial and error, hands-on approaches, and return demonstration. They gain "meaning through exploration"
How do auditory learners best learn?
They learn through "listening" and methods such as verbal lectures, discussion, and reading aloud. They "interpret meaning while listening"
How do visual learners best learn?
They learn through "seeing" and methods such as note taking, video viewing, and presentations. They "think in pictures"
Strategies for and Barriers to Implementing Community Health Programs: Helpful Strategies
Thorough assessment Accurate interpretation of data Collaboration with community partners Effective communication patterns Sufficient resources Logical planning skilled leadership
Signs of addiction
Tolerance, withdrawal, denial
TQM
Total Quality Management
Families
Transitions are times of risk Family health risk appraisal: biological, environmental, behavioral risk assessment Goals: reductions in barriers to access, allergic content in home, families unable to have children, passive smoke exposure, household hunger - increase in agency-provided education on health related issues, home testing for radon and lead
Federal health agencies
U.S. department of health and human services -under direction of the secretary of health -funded through federal taxes Consists of Children and Families, community living, Medicare and medicaid, HIPPA, SSI, AFDC
US Dept. of Health & Human Services
Under direction of secretary of health, funded through federal taxes 12 agencies
Issues in migrant health
Unsanitary housing/working conditions Less access to dental, mental health, pharmacy services Inability to afford care Availability of services Language
What is Secondary Data?
Use of existing data - Death/Birth stats - Census data - Mortality/Morbidity data - Health records - Meeting minutes - Prior health surveys
Data Collection Secondary Data
Use of existing data (death statistics; birth statistics; census data; mortality, morbidity data; health records; minutes from meetings; prior health surveys) to assess problem Strengths: Database of prior concerns/needs of population Ability to trend health issues over time Limitations: Possibility that data may not represent current situation Can be time-consuming
Secondary data collection
Use of existing data (death statistics; birth statistics; census data; mortality, morbidity data; health records; minutes from meetings; prior health surveys) to assess problem › Database of prior concerns/needs of population › Ability to trend health issues over time › Possibility that data may not represent current situation › Can be time-consuming
Critical theory -
Use of ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors
Behavioral theory -
Use of reinforcement methods to change learners' behaviors
What is the behavioral theory?
Use of reinforcement methods to change learners' behaviors
Cognitive theory -
Use of sensory input and repetition to change learners' patterns of thought, thereby changing behaviors
What is the cognitive theory?
Use of sensory input and repetition to change learners' patterns of thought, thereby changing behaviors
What is the developmental theory?
Use of techniques specific to learners' developmental stages to determine readiness to learn, and impart knowledge
Developmental theory -
Use of techniques specific to learners' developmental stages to determine readiness to learn, and to impart knowledge
Underlying principles that affect vulnerable populations
Violence ● Substance use disorders ● Homelessness ● Mental health issues ● Poverty ● Chronic stress ● Poor self-esteem ● Access to health care services
Telehealth audio data
Voice conversation, heart sounds, lung sounds, bowel sounds
CH 5: Care of Special Populations
Vulnerable populations: subject to violence, substance use disorders, mental health issues, homelessness, rural and migrant health -factors: poverty, dif acccess healthcare, young or advanced age, chronic stress, environmental factors GOALS: increase number of people with PCP, with health insurance, reduce those with delay in health and prescribed meds
Windshield Survey Components Place: Man-made Environment
What industries are within the communities? Could these pose a threat to the health of community workers or the community itself? Is there easy access to health care facilities? Are the roads adequate and marked well?
Windshield Survey Components Place: Location of health services
Where are the major health facilities located? What health care facilities are necessary for the community but are not within the community?
Windshield Survey Components Place: Boundaries
Where is the community located? What are its boundaries? Are there natural boundaries?
State Board of Nursing
Which State Health Agency works with the development and oversight of the state's nurse practice act, licensure of registered and licensed practical nurses, and oversight of the state's schools of nursing?
WHO (World Health Organization)
Which international health organization provides daily info on occurrence of important international diseases, establishes world standards for antibiotics and vaccines, and primarily focuses on health care workforce and education, environment, sanitation, infectious diseases, maternal and child health, and primary care?
Windshield Survey Components People
Who is on the street? What is their general appearance (age, dress, well-nourished, obese, frail, unkempt)? What are they doing? What is the origin, ethnicity, or race of the people? How are the different groups (subgroups) residentially located? Is there any evidence of drug abuse, violence, disease, mental illness? Are there any animals or pets in the community?
Client education regarding response to chest pain:
X Stop activity and rest. X Place nitroglycerin tablet under tongue to dissolve (quick absorption). X If pain is unrelieved in 5 min, the client should call 911 or be driven to an emergency department. X The client can take up to two more doses of nitroglycerin at 5-min intervals.
Care Plans
You are a home health nurse visiting a new client for the first time. The client, Russell Ford, is a 67-year-old male with cancer. He has refused chemotherapy and radiation, but wants care for pain management and nutrition. Mr. Ford lives with his wife, Paula, age 62. The Fords have 2 grown sons who live in the same town. Upon entering the client's home, you immediately note the house has numerous unsafe and hazardous conditions.
environment
a combination of physical, biological, and social factors that surround and influence both the agent and the host
Program planning: Assesment
a complete needs assessment and identify community strengths and weaknesses; assess the availability of community resources
Policy intervention is both
a core function of public health and a core intervention strategy used by public health nursing specialists.
Impairment
a disturbance in structure or function resulting from physiologic or psychologic abnormalities
What is addiction?
a pattern of pathological, compulsive use of substances that can involve physiological dependence
TB diagnosis should be considered for any client who has
a persistent cough lasting longer than 3 weeks, chest pain, weakness, weight loss, anorexia, hemoptysis, dyspnea, fever, night sweats, or chills.
radon (Rn)
a radioactive gas that is formed naturally from the radioactive decay of uranium in rocks and soil; it can remain in the soil, move to the soil surface and enter the air, or enter groundwater; colorless, odorless, and tasteless, but extremely toxic; when cooled below the freezing point, it becomes phosphorescent, in yellow and orange-red tones.
After identifying the boundaries of a community, what is the next step the nurse should take in completing a community assessment? a. Gather relevant existing data and generating missing data. b. Plan interventions that benefit the entire community. c. Formulate nursing diagnoses. d. Evaluate the interventions that were used.
a. Gather relevant existing data and generating missing data
Change for the community as client must often occur at several levels because: a. Health problems caused by lifestyle are multidimensional. b. Most individuals can change their habits alone. c. Aggregates are responsible for social change. d. Geographic areas often have health risks that the nurse must identify.
a. Health problems caused by lifestyle are multidimensional.
A nurse schedules an appointment with a physician who has a practice in the community to learn more about the community's beliefs regarding childhood immunizations. This is known as: a. Informant interview b. Participant observation c. Secondary analysis d. Windshield survey
a. Informant interview
Immunization for measles is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion
a. Primary prevention
An example of tertiary prevention is: a. Rehabilitative job training b. Parenting education c. Testicular self-examination d. Family counseling
a. Rehabilitative job training
When a nurse examines birth and death certificates during an epidemiologic investigation, what data category is being used? a. Routinely collected data b. Data collected for other purposes but useful for epidemiologic research c. Original data collected for specific epidemiologic studies d. Surveillance data
a. Routinely collected data
A nurse who uses such data as minutes from a community meeting is using: a. Secondary analysis b. Informant interviews c. A survey d. A windshield survey
a. Secondary analysis
A nurse may define a community as a(n) (select all that apply): a. Social group determined by geographic boundaries b. Group of people who share common values and interests c. Group of people defined by their interactions d. Individual with a specific health concern
a. Social group determined by geographic boundaries b. Group of people who share common values and interests
Epidemiological factors social environment
access to health care, high-risk working conditions, poverty
What to look for in sunscreen
active ingredients (zinc oxide, titanium dioxide, Mexoryl SX or avobenzone-3%) SPF 15-50, depending on your skin tone and sun intensity Lotions, not sprays or powder Water-resistant for the beach or pool
core public health function assessment includes
activities that involve collecting, analyzing and disseminating information on both the health status and the health-related aspects of a community or a specific population
The emphasis on *community-based nursing practice* is a
acute chronic care and the provision of comprehensive, coordinated, and continuous services.
Conveying Cultural Sensitivity
address clients by last name, introduce name and position, be honest about culture knowledge, use language that is sensitive, find out what clients know about their health problems, incorporate their pref into care, NO assumptions, encourage questions, respect values, beliefs and practice, show respect
TB skin testing: false negative:
advanced HIV or AIDS, older adult, and up to 9 weeks after exposure.
Change agents
advocate for needed change at local, state, federal level
barriers to community education programs
age cultural barriers poor reading and comprehension skills language barriers barriers to access lack of motivation
6 ways climate change can impact health
air pollution, extreme heat, infectious disease, drought, flooding, and extreme weather
Surveys
are specific questions asked in a written format and do not involve direct conversations with individual community members
geographic characteristics
area boundaries, number and size of neighborhoods, public spaces and roads
Occupational health nurse
assess the ricks for work-related illness and injury, plan and deliver health and safety services in the workplace, facilitate health promotion activities that lead to a more productive workplace
beneficence
assessing risks and benefits when planning interventions
health promotion
assessing the health of our community, planning activities to help our participants to gain some control over their health to improve their health; emphasis on helping people change their lifestyles and move toward a state of optimal health
Public health core functions at all levels of government
assessment policy development assurance
humanistic theory
assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest
susceptible
at risk for contracting an infection or developing infectious disease; affected by general health status, personal behaviors, presence of healthy lines of defense, immune system and immunization status
community oriented nursing focus of care
at-risk individuals, families, groups; community
Facilitating small group discussions is an appropriate learning strategy for clients who are _____ learners
auditory
A community health nurse is determining available and needed supplies in the event of a bioterrorism attack. The nurse should be aware that community members exposed to anthrax will need access to which of the following medications? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Zanamivir (Relenza) d. Fluconazole (Diflucan)
b
A newly hired public health nurse is familiarizing himself with the levels of disaster management. Which of the following actions is a component of disaster prevention? a. Outlining specific roles of community agencies b. Identifying community vulnerabilities c. Prioritizing care of individuals d. Providing stress counseling
b
When conducting informant interviews in a small community, the nurse would most likely contact: a. The state department of health for death records b. A local priest for congregation information c. Surrounding communities for crime comparison d. The Centers for Disease Control and Prevention (CDC) for illnesses in the area
b. A local priest for congregation information
Which is an example of an epidemic? a. "Bird" flu in China b. Adult obesity in the United States c. An isolated case of smallpox in Africa d. The nursing shortage in the United States
b. Adult obesity in the United States
The most important predictor of overall mortality is: a. Race b. Age c. Gender d. Income
b. Age
An epidemiologist wanting to know what caused severe diarrhea and vomiting in several people at a local banquet would be using: a. Descriptive epidemiology b. Analytic epidemiology c. Distribution d. Determinants
b. Analytic epidemiology
Nurses incorporate epidemiology into their practice and function in epidemiologic roles through (select all that apply): a. Policy making and enforcement b. Collection, reporting, analysis, and interpretation of data c. Environmental risk communication d. Documentation on patient charts and records
b. Collection, reporting, analysis, and interpretation of data c. Environmental risk communication d. Documentation on patient charts and records
In which situation does the nurse need to be aware of the potential for selection bias? a. Determining the population to be studied b. Considering how the participants will enter the study c. Studying cause and effect relationships d. Documenting results of the study
b. Considering how the participants will enter the study
A community that has residents who are very involved in its activities and encourage activities that promote the health of the community displays which condition of community competence? a. Commitment b. Participation c. Articulateness d. Effective communication
b. Participation
Which nursing diagnosis is written at the community-level? a. Risk of hypertension related to poor diet and sedentary lifestyle b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider d. Ineffective coping related to multiple stressors as evidenced by client crying and stating she has no support system
b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity
Which is an example of an agent in the epidemiologic triangle? a. Human population distribution b. Salmonella c. Genetic susceptibility d. Climate
b. Salmonella
A nurse cares for the community as the client when focusing on: a. Providing care for aggregates living in the community b. The collective good of the population c. The provision of care for families in the home setting d. Providing health education in the community
b. The collective good of the population
A public health nurse is collecting data about the biological aspects of community health. What data will the nurse collect? a. Race/ethnicity b. Traditional morbidity and mortality rates c. Policy making and social change d. Homicide rates
b. Traditional morbidity and mortality rates
Which method of data collection is being used as a nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation? a. Participant observation b. Windshield survey c. Survey d. Informant interviews
b. Windshield survey
importance of IMR (in epidemiology)
because IMR is influenced by a variety of biologic and environmental factors affecting the infant and mother, the IMR is both a direct measure of infant health and an indirect measure of community health as a whole
secondary prevention
begins after a disease or condition is present, although there may be no symptoms; emphasis on screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health
The prompt use of _________ at the onset of symptoms can prevent the serious complication of delirium tremens.
benzodiazepines
The nurse manager should include viruses as a ______ when discussing work-related illness and injury
biological agent
Genogram
biological health risk assessment - gather basic info about family, relationships within family, health and illness patterns Can ID repetitious diseases with genetic component (cancer, heart disease, DM)
Transitions are times of risk for families. Transitions include
birth or adoption of a child, death of a family member, child moving out of the home, marriage of a child, major illness, divorce, and loss of the main family income
Hep B
blood and body fluids. Treat with Alpha interferon.
alcohol use in body
body burns about 0.5 oz of alcohol per hr. alcohol withdrawal appears within 4 to 12 hours.
Streptokinase (Streptase) and alteplase (Activase) are used to
break up blood clots. ■ Thrombolytic agents have similar side effects and contraindications as anticoagulants. ■ For best results, give within 6 hr of infarction
Ch 1: Overview of Community Health Nursing
broad field that allows nurses to practice in a wide variety of settings. -promote the health and welfare of clients across the lifespan and from diverse populations -nurses in the community should understand the foundations of community health, principles, health promotion and disease prevention
Healthy nutrition should include lowering LDL_____________ , which can prevent diabetes and hyperlipidemia.
by decreasing intake of saturated fats
A nurse is preparing a community health program on communicable diseases. When discussing modes of transmission, the nurse should include which of the following as an airborne illness? a. Cholera b. Malaria c. Influenza d. Salmonellosis
c
A school nurse is scheduling visits with a physical therapist for a child who has cerebral palsy. In which of the following roles is the nurse functioning? a. Direct caregiver b. Consultant c. Case manager d. Counselor
c
A nurse is preparing an education program on disease transmission for employees at a local day care facility. When discussing the epidemiological triangle, the nurse should include which of the following as agents? (Select all that apply.) a. Resource availability b. Ethnicity c. Toxins d. Bacteria e. Altered immunity
c, d
A community health nurse is educating the public on the agents of bioterrorism. Which of the following are Category A biological agents? (Select all that apply.) a. Hantavirus b. Typhus c. Plague d. Tularemia e. Botulism
c, d, e
A nurse is told that a screening test has high specificity. This means that the test: a. Provides precise and consistent readings b. Accurately identifies those with the condition or trait c. Accurately identifies those without the trait d. Has a high level of false positives
c. Accurately identifies those without the trait
The type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome is a(n): a. Case control study b. Cross-sectional study c. Cohort study d. Experimental study
c. Cohort study
Public health professionals refer to three levels of prevention as tied to specific stages in the: a. Epidemiologic triangle b. Web of causation c. Natural history of disease d. Surveillance process
c. Natural history of disease
A nurse who reads the local community newspaper is using which method to gather data about the community? a. Informant interview b. Survey c. Participant observation d. Windshield survey
c. Participant observation
What are the critical attributes in the definition of community? a. Families, groups, and health organizations b. Health needs, geographical boundaries, and target population c. People, place, and functions d. Populations and health resources
c. People, place, and functions
The proportion of persons with positive test results who actually have a disease, interpreted as the probability that an individual with a positive test result has the disease, is the: a. Sensitivity b. Specificity c. Positive predictive value d. Negative predictive value
c. Positive predictive value
Which data source provides information about the function of the community? a. Maps b. Census data c. State departments, business and labor, local library d. Civic groups
c. State departments, business and labor, local library
Vocational rehabilitation of a person with a neuromuscular disease is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion
c. Tertiary prevention
vectors
can be animals, insects or artropods, and they can transmit infection through biologic and mechanical routes
Cat C bio agents
can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. ■ Examples include hantavirus
4 Pillars of Population health
care management quality and safety health policy public health
Primary manifestation of syphilis:
chancre.
Transitions require families to
change behaviors, make new decisions, reallocate family roles, learn new skills, and learn to use new resources
Sheppard-Towner Act
changed course of maternal newborn care
affective learning domain
changes in attitudes and the development of values by influencing what learners feel, think, and value
Epidemiological agents
chemical (drugs, toxins) physical (noise, tempurature) Infectious agents (Viruses, bacteria)
Poor hygiene is manifestation of
child neglect
An underweight child is a manifestation of
child neglect.
Waterborne
cholera, Typhoid fever, bacillary dysentery, Diardia Iamblia
Treatment of anthrax:
ciprofloxacin, doxycycline with vanco and rifampin
Community members exposed to anthrax will need access to
ciprofloxacin. Thismedication is used for the prophylactic treatment of anthrax
responsible
clients are ___ for their own health
secondary prevention
community assessments screenings disease surveillance
In *community-oriented nursing practice* the nurse provides health care through
community diagnosis and investigation of major health and environmental problems, health surveillance, and monitoring evaluation of community population health status for the
Families
community oriented nursing practice. enagage in assessment, planning ,developement and evaluation. -home visits allow for observation of barriers to health -family crisis: when a family is not able to cope with an event. resources inadequate for demands of the situation -healthy family: good communication, affirmation and support among members, sense of trust, members play and share together, members interact with eachother, shared sense of responsibility, traditions and rituals, seek help for problems -risk appraisal: biologic, enviro risk, behavioral risk
public health facilities should focus on
community oriented population care
As a __________, a nurse provides information to families, administrators, teachers, and parent-teacher groups to encourage decisions that promote the health of the students
consultant
Consultation
consultants provide expert advice in a partiular area, consultation is requested to help determine what treatment/services are needed (ex- cardiologist, psychiatrist)
School nurse as a researcher
contributes to the base of knowledge for school health and educational needs
School nurse as a case manager
coordinates comprehensive services for children who have complex health needs
School nurse: case manager:
coordinates services for children who have complex health needs. EX: scheduling treatments around school shcedule.
Referrals, Discharge Planning & case management
coordinating individualized health care without disruption. manage services: follow up and referral
As a ________, a nurse develops a trusting relationship with students and provides support on issues affecting their lives.
counselor
Medicaid
coverage for individuals of low socioeconomic status and children, through the combined efforts of federal and state governments. Eligibility is based on household size and income, with priority given to children, pregnant women, and those who have a disability
Medicaid
coverage for low socioeconomic status and children, through the federal and state governments. Eligibility is based on household size and income. Priority to children, pregnant women, and those who are disabled.
An example of an attack rate is the: a. Number of cases of cancer recorded at a medical center b. Number of people who died of cholera in India in a given year c. Number of beef cattle inoculated against mad-cow disease on a farm d. Proportion of people becoming ill after eating at a fast-food restaurant
d. Proportion of people becoming ill after eating at a fast-food restaurant
A nurse plans on implementing a community-wide influenza immunization program. Which factor should the nurse consider when implementing this program? a. The number of community members who have already received the immunization b. The existence of formal groups in the community c. Public policy that mandates influenza immunization for certain populations d. The community's readiness to participate in the program
d. The community's readiness to participate in the program
Notifiable Disease Reports (epidemiology data)
data collected on diseases based on the ability to cause death, and communicability of the disease; notification of public health officials of diseases posing a threat to large populations provides an initial starting point for local epidemiologic investigations
Vital Statistics (epidemiology data)
data that describe legally registered events such as births, deaths, marriages, and divorces; obtained from CDC's National Center for Health Statistics and U.S. Public health Service--collected on an ongoing basis
ozone action days
declared on hot, sunny, still days when conditions are most favorable for the accumulation of unhealthy levels of ground-level ozone; forcasted by Texas Commission on Environmental Quality (TCEQ) make their forecasts a day in advance: Austin, Beaumont-Port Arthur, Corpus Christi, Dallas-Fort Worth (where it's called an "Air Pollution Watch"), El Paso, Houston-Galveston-Brazoria (where it's called an "Ozone Watch"), San Antonio (where it's called an "Air Quality Health Alert") and Tyler-Longview-Marshall.
Chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan)
decrease the intensity of withdrawl symptoms, decrease risk of seizures
provider care emphasizes
defining and resolving a problem for the individual
Risk factors for suicide include
depression or other mental disorders, substance use, and intimate partner issues.
acquired immunity
derived from actual exposure to the specific infectious agent, toxin, or appropriate vaccine
National health goals are
derived from scientific data and trends collected during the prior decade. These goals are based on those issues that are considered major risks to the health and wellness of the United States' population
health determinants (social ecological model)
describes the interaction between behavior and health
Windshield survey
descriptive approach that assesses several community components by driving through a community
what are some non-pharmacologic measures to reduce stress/anxiety for the dying:
dim lights, reduce, noise, cool cloth on forehead, light and brief massaging on arm or hand.
As a ___________, a nurse provides illness or injury care to children at school
direct caregiver
Informant interviews
direct discussion with community members for purpose of obtaining ideas and opinions from key informants
informant interviews
direct discussion with community members for the purpose of obtaining ideas and opinions from key informants. Strengths: no cost Limitations: built-in bias
Informant Interviews
direct discussion with community members to obtain ideas and opinions -minimal cost, participants serve as future supporters, offer insight, reading/ writing of participants not required, personal interaction elicit more response -built in bias, meeting time and place limitation
Focus group
directed talk with a representative sample
Culture Assessment
effect of culture on communication, space and physical contact, time, social organization, enviro control factors -assess: ethnic background, religious preferences, family structure, language, communication needs, education, cultural values, food patterns, health practices -3 steps of data collection: ethnic background, religious pref, family structure, food patterns, health practice. ask qs that access clients perception of health needs. identify how culture may impact nursing
Diabetic shoe teaching:
extend 1/2-5/8 inches longer than the longest toe.
demographic characteristics
family size, age, sex, and ethnic and racial groupings
Anthrax exposure S/S
fever, fatigure, mild chest pain, dry cough. No contagious. fatality is 95-100% if untreated.
Ebola
fever, hemorrhage, vomiting, diarrhea, cough, jaundice, shock. Treatment: no cure, airway management, dialysis, supportive care. Prevention: avoidance of contaminated items/animals
community-oriented nursing
focus = at-risk individuals, families, and groups determining health needs of a community, and intervening at the individual, family, and group level to improve the collective health of a community
community-based nursing
focus = individuals & families management of acute and chronic conditions in settings where individuals, families, and groups live, work, and attend (schools, camps, prisons)
population focused
free living as opposed to those who are institutionalized
When are majority of homicides commitedd by?
friend, acquaintance, or family member.
Analysis of Community Assessment Data
gathering collected data into composite database, assessing completeness of data, identifying and generating missing data, synthesizing data and identifying themes, identifying community needs and problems, identifying community strengths and resources
NACOSH (national advisory committee on occupational safety and health)
gathers data on the incidence and prevalence of occupational illness and injury. Prevention education related to occupational injury and illness, as well as determining hazards associated with new workplace technologies.
Nurses who deliver *community based care* are
generalists or specialists in maternal/infant, pediatric, adult, or psychiatric/mental health nursing
Hospice Care
generally refers to 'a way of caring for people near the end of their journey through life, faced with dying and in need of refuge' (Vines and Hartzell, 1981)
Epidemiological factors physical environment
geography, water/food supply, presence of reservoirs/vectors
Pertussis:
give antibiotics. check innunization. keep at home until coughing passes.
Herpes zoster
given at 60 years or older
Rotavirus
given during first year of life
suicidal s/s:
giving away belongings, depression, insomnia, lack of social interaction. ASK!
MRSA
good hand hygiene to prevent spread. no treatment available.
institutional policy
governs work sites; based on the institution's mission and goals, and they determine how the institution will function and relate to employees
community
group of people and institutions that share geographic, civic, and/or social parameters
outcome (long-term) evaluation
has incidence/prevalence changed? determine if change had a lasting and real effect
Anthrax
headache, fever, muscle aches, chest discomfort, severe dyspnea, shock. Give: IV Cipro
Biological Factors:
health and disease status, genetics, race, age, gender, causes of death.
In Community-based nursing VS Community-oriented nursing, community oriented nursing involves
health care of individuals, families, and groups (like a "class lesson") to improve the collective health of the community
Coordinated School Health programs
health education, physical education, health services, nutrition services, counseling, psych and social services, promote health for staff, facilitate family and community involvement
The nurse should include ethnicity as a _____ _______when discussing the epidemiological triangle
host factor
Environmental health history
housing residence, age, location, school, day care, work. ocupations of household measures, tobacco smoke presence? -remodeling activities -hobbies in home -exposure to chem -pets in home, healthy? -lead exposure -drinking water source -sewage and waste -pesticides -where children play
Loop diuretics, such as furosemide (Lasix), decrease sodium reabsorption and increase potassium excretion. Monitor the client closely for
hypokalemia
compare (community analysis)
identification of data gaps, incongruencies, and omissions; comparative data are needed to determine if a pattern or trend exits or if data do not seem correct and if revalidation of original information is required
Telehealth visual data
images of wounds, images of surgical incisions
Meningococcal conjugate
immunization given at 11-12 years of age
direct transmission
implies the immediate transfer of an infectious agent form an infected host or reservoir to a portal of entry in the human host through physical contact such as touching, biting, kissing, or sexual contact
Technology and Community nursing
increases life expectatncy, impacts communities and health outcomes -informatics: combines nursing with information and communication in health records, databases, billing, electronic meeting, chat rooms -telehealth: quality health care through technology, skilled nursing transferring info to providers, home care increased using this, balance with hands on care -transmit: vitals, glucose, ECG results, voice convos, heart sounds, lung sounds and bowel sounds, images of wounds, and surgical incision
Autonomy
individuals select those actions that fulfill their goals
community based nursing focus of care
individuals; families
Community-oriented nursing practice
is a philosophy of nursing service delivery that involves the generalist or specialist public health community health nurse.
Access to health care
is impacted by the availability of services in a community, as well as individual, family, and community circumstances
Double bagging hazardous materials
is not cost effective and is unnecessary unless the outside of a bag becomes contaminated.
Participant observation
is observing formal or informal community activities and does not involve direct conversations with individual community members
the ethical principle of respect for autonomy
is supporting the rights of individuals to determine and pursue personal health care goals
the ethical principle of veracity,
is the concept of telling the truth
Population health
is the distribution of health outcomes within a population, the determinants that influence the distribution and the policies and interventions that affect the determinants.
four-medication TB regimen
isoniazid (Nydrazid), rifampin (Rifadin), pyrazinamide, and ethambutol hydrochloride (Myambutol)
nurse's
it is the ____ responsibility to advocate for resources or services that meet the client's health care needs
Cultural competence
knowing, appreciating and considering the culture of someone else in resolving problems
"business of managed care"
learning to define a population
dangers of fracking
leaves behind a toxic sludge that companies and communities must find some way to manage; toxic chemicals used in the fracking process remain stranded underground where they can, and often do, contaminate drinking water, soil and other parts of the environment that support plant, animal and human life; Methane from fracture wells can leak into groundwater, creating a serious risk of explosion and contaminating drinking water supplies
Disaster recovery
length of time it takes involved agencies to restore economic and civil life to a community - time it takes individuals to become functioning person within community again Plague and sanitation controls important PTSD and delayed stress reactions common
Secondary prevention
limiting severity and adverse effects. Screenings, community assessments.
social learning theory
links info to beliefs and values to change or shift the learners' expectations
host
living being affected by the agent
host
living being that is affected by the agent
The host is the
living being that is affected by the agent.
The host
living being that is affected by the agent. (human or animal).
Risk factors for gastric ulcers:
long term NSAID use. Hplori, stress, family, or personal hisotry.
goals
long term group overall learning needs or expected outcomes after instruction or program activities
AIDS
look in mouth for sores.
Medicaide
low socioeconomic status and kids. federal and stage governmental assistance. Priority given to pregnant women, children, and those with disability.
Vector-borne
lyme disease rocky mountain spotted fever malaria
Rape
majority of violence against women is intimate partner violence. Incidence occurs higher in cities, between 8 pm-2 am, on weekends, and in summer months
Secondary manifestation of syphilis:
malaise, maculopapular rash on palms, and lymphadenopathy.
Assault
males more likely to be assaulted, youths at higher risk
portal of entry
means by which an infectious agent enters a new host
portal of exit
means by which an infectious agent is transported from the host
Healthy nutrition should include decreasing the consumption of _______________, which can prevent diabetes and hyperlipidemia.
meats and processed foods
Part B
medical care, diagnostic services, physiotherapy.
Cognitive learning domain
memory, recognition, understanding, reasoning, application, and problem solving and is divided into hierachical classification of behaviors; hierarchical classification of behaviors (knowledge, comprehension, application, analysis, synthesis and evaluation)
Rates of suicide are highest in
men and individuals over the age of 65.
mode of transmission
method whereby the infectious agent is transmitted from one host (or reservoir) to another host
Cat B bio agents
moderately easy to disseminate and have high morbidity rates and low mortality rates. ■ Examples include typhus and cholera
passive surveillance
more common form of surveillance used by most local and state health departments; health care providers report notifiable conditions
community analysis
multi-step process used to derive a community nursing diagnosis; phases used are: categorization, summarization, comparison, and inference elaboration
evaluation
must be planned before implementation; measures progress toward goals and learning objectives; revises assessment database and community nursing diagnosis
Indications of carbon monoxide poisoning include
nausea, vomiting, headache, weakness, and unconsciousness
Smoking
nicotine creates feeling of alertness and energy.
The use of family members as interpreters is
not advisable because clients may need privacy in discussing sensitive matters
Visual learners learn through "seeing" and methods such as
note taking, video viewing, and presentations. These learners "think in pictures."
crude mortality rate
number of deaths
Participant observation
observation of formal or informal community activities. Negative - bias, time-consuming
Program Planning: Preplaning
obtain community awareness, support, involvement * should not move forward without community support
socioeconomic characteristics
occupation and income categories, educational attainment, and rental or home ownership patterns
Social Factors:
occupation, activities, marital status, education, income, crime rates, recreation, industry
Social factors
occupation, activities, marital status, education, income, crime rates, recreation, industry
Social factors:
occupation, activities, marital status, education, income, crime rates, recreation, industry.
Occupational health
occupational host - worker characteristics, such as job inexperience, age, and pregnancy occupational agent - biological agents (viruses, bateria, fungi, pathogens), chemical (smoke), mechanical agents (musculoskeletal or other strains from repetitive motions, poor workstation worker fit, lifting heavy loads), physical agents (temperature extremes, vibrations, noise, radiation, lighting), physiological agent (threats to psychological or social well-being resulting in work-related stress, burnout, and violence) Occupational environment factors - physical (heat, odor, pollution), social (sanitation, overcrowding) psychological (addictions, stress)
community partnership
occurs when community members, agencies, and businesses actively participate in the process of health promotion and disease prevention critical to the accomplishment of health promotion and disease prevention strategies
Acculturation is the process
of merging with or adopting the traits of a different culture. Adapting to a new culture requires changes in daily living practices. These changes relate to language, education, work, recreation, social experiences, and the health care system
Homicide
often related to substance use, usually committed by someone known to the victim. Abuse often precedes homicide within families. Increasing among adolescents
Lead exposure:
old homes before 1970.
Medicare:
older than 65 and receiving Social Security, disability benefits for 2 years, have ALS or kidney failure on dialysis or transplant to qualify.
windshield survey components
people place location of health services natural environment housing social systems
Who is most at risk for pneumonia?
people of all ages, but the young, older adult clients, and clients who are immunocompromised are more susceptible. Immobility is a contributing factor in the development of pneumonia.Older adult clients are more susceptible to infections and have decreased pulmonary reserves due to normal lung changes, including decreased lung elasticity and thickening alveoli.
Lobbyists
persuade of influence legislators. Lobbying may be implemented by an individual, or collectively through professional nursing associations.
A healing spiral fracture is a manifestation of
physical abuse.
Burns on the palms of the hands are a manifestation of
physical abuse.
Primary prevention
prevention of initial occurence of disease or injury. nutrition education, family planning and sex ed, smoking cessation education, communicable disease education, health and hygiene issues, safety education, prenatal classes, providing immunizations, advocating for access to health care, healthy environments
primary prevention
prevention of the initial occurrence of disease or injury
Primary prevention
preventions of initial occurrence of disease or injury
Case Management
promoting services and client family involvement, decreasing cost, providing education, advocating for services collaboration, communication skills -assess: clarify problem by evaluating physical, psychosocial, functional and financial needs -diagnose: determine cause and factors: -planning: prioritize probs, possible outcome,s advantages, role of participants, impact on client -implementation: contact service providers, referrals, coordinate services -evaluation: montiro client and agencies comparing projected outcomes, needs, satisfaction
Home health nurse
provide care in the home
Epidemic
rate of disease exceeds usual level of condition
child mortality and millennium goal
reduce by 2/3, between 1990 and 2015, the under 5 mortality ratio
National Health Care Goals
reduce toxic air, waterborne disease, domestic water use, blood lead levels in kids, pesticide exposure, indoor allergens, homes with lead based paint, exposure to chem and pollutants, number of new schools near highways, global burden of disease d/t enviro concerns increase: alternate mode of transportation, days that beaches are open and safe for swimming, recycling of waste, testing for lead based paint in 1978 housing, monitor for disease or conditions caused by enviro hazards, homes with radon mitigation, schools with practices to promote health/ safety
herd immunity
refers to a state in which those not immune to an infectious agent will be safe if a certain proportion of the population has been vaccinated or is otherwise immune
assessment
refers to systematically collecting data on the population, monitoring the population's health status, and *making information available about the health community*
effectiveness (economics)
refers to the extent to which a health care service meets a stated goal or objective, or how well a program or service achieves what is intended; immunization=herd immunity
Missionary nurses
seek to promote health and prevent disease by meeting spiritual, physical and emotional needs of people across globe culture and language barriers often impact provision of care
Policy intervention in public arenas
seeks to build constituencies that can help bring a change in public health
Cultural awareness includes
self-awareness of one's own cultural background, biases, and differences
tertiary prevention
stopping detioration in a patient, a elapse or diability and dependency by anticipatory nursing
secondary care
stopping the progress of the disease by early detection and treatment
Epidemiology
study of health related trends in population for the purpose of disease prevention, health maintenance and health promotion -relies on statistics to determine rate of spread of disease, people affected, effectiveness of prevention and health promotion, goals met -spread, transmission and incidence of disease and injury -nurses are in a position of identifying cases, recognizing disease paterns, eliminate barriers, provide education targeted at disease or risk factors -study of relationships among an agent, host and environment --> agent is the cause of disease, host is the living being, environment is the setting of host
epidemiology
study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection
Epidemiology
study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection. Relies on statistical evidence to determine the rate of spread of disease and the proportion of people affected. BROAD understanding of the spread, transmission, and incidence of disease and injury.
Epidemiology
study of the relationships among an agent, a host, and an environment (epidemiological triangle)
chronic care management
supports health promotion and disease prevention, would lead to better short and long term health outcomes
Education to give to migrant farm workers:
teach about environmental health because of exposure to pesticides. TB screening, skin cancer information, and dental health screening.
Ethnocentrism
tendency of people to view the world from the perspective of their own cultural background and viewpoint
Teaching a client who has schizophrenia about medication interactions is a ________prevention strategy
tertiary
The nurse is using_______ prevention when teaching healthy nutrition to clients who have hypertension
tertiary
Working with the dietitian to determine carbohydrate counts for students with diabetes is a ________ prevention activity
tertiary
Centers for Medicare and Medicaid Services (CMS) - Also administers
the Health Insurance Portability and Accountability Act (HIPAA), disability insurance, Aid to Families with Dependent Children (AFDC), and Supplemental Security Income (SSI).
information literacy
the ability to recognize when information is needed as well as the skills to find, evaluate, and use needed information effectively
Community assessment is a comprehensive approach that emphasizes
the community as a client.
host
the population at risk for developing the disease
public health genomics
the study and application of knowledge about the elements of the human genome and their functions, including interactions with the environment, in relation to health and disease populations
genomics
the study of functions and interactions of all genetic material in the genome, including interactions with environmental factors
macroeconomics
the study of the economy as a whole; focuses on the "big picture" -the total, or aggregate (usually a country or nation), of all individuals and organizations; business cycle and economic growth; human capital approach
Community health work
unstructured, "bigger picture", community is both client and partner, work at every level but especially advocate for primary level with population focus.
Recognize child abuse
unusual fear of the nurse, injuries not mentioned in hx, fractures including older healed fractures, subdural hematoma, trauma to genitalia, malnourishment or dehydration, inappropriate dress for weather conditions, considered to be a "bad child"
Public health nurse: core function of policy development:
updatinglocal policies and support community health efforts.
Homeless health conditions
upper respiratory disorders TB skin disorders (athlete's foot), infestations (lice, scabies) Alcoholism/drug abuse HIV/AIDS assault and rape mental illness dental caries hypothermia, heat related illnesses Malnutrition
Secondary data
use of existing data (death statistics, birth statistics, census data, mortality, health records) Strengths: ability to trend health issues over time Limitations: data might not represent current situation
critical theory
use of ongoing discussion and inquiry to increase learners' depth of knowledge, thereby changing thinking and behaviors
behavioral theory
use of reinforcement methods to change learner's behaviors
Telehealth
useful in rural areas.
Auditory learners learn through "listening" and methods such as
verbal lectures, discussion, and reading aloud. These learners "interpret meaning while listening."
web of causation
views a health condition as the result not of individual factors but of complex interrelationships of numerous factors interacting to increase or decrease the risk of disease; a number of interrelated variables are almost always involved in the cause of particular outcome
What are some tertiary preventions strategies for migrant health care?
• Treat for symptoms of pesticide exposure. • Mobilize primary care and emergency services.
Objective data for MI
■ Pallor, and cool, clammy skin ■ Tachycardia and/or heart palpitations ■ Diaphoresis ■ Vomiting ■ Decreased level of consciousness
Stroke risk factors
◯ Cerebral aneurysm ◯ Arteriovenous malformation (AV) ◯ Diabetes mellitus ◯ Obesity ◯ Hypertension ◯ Atherosclerosis ◯ Hyperlipidemia ◯ Hypercoagulability ◯ Atrial fibrillation ◯ Use of oral contraceptives ◯ Smoking ◯ Cocaine use
National Health Goals for Children
☐ Reductions in X Dental caries X Obesity X Exposure to secondhand smoke ☐ Increases in X Newborn blood spot screenings and follow-up testing X Access to a medical home X Schools that require health education X Childhood immunizations X Use of child safety restraints X Physical activity
Cultural competence: areas for self assessment
-aware of culture and view of others, cultural sensitive assessment, knowledge to develop culturally appropriate nursing interventions, goal in learning about diverse population
A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medications? A. Chlorpromazine (Thorazine) B. Thiothixene (Navane) C. Risperidone (Risperdal) D. Haloperidol (Haldol)
A. Chlorpromazine (Thorazine)
A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following are appropriate to include in the plan of care? (Select all that apply.) A. Priority restructuring B. Monitoring thoughts C. Diaphragmatic breathing D. Journal keeping E. Meditation
A. Priority restructuring B. Monitoring thoughts D. Journal keeping
A nurse is talking with a client who is at risk for suicide following the death of his spouse. Which of the following statements by the nurse is appropriate? A. "I feel very sorry for the loneliness you must be experiencing." B. "Suicide is not the appropriate way to cope with loss." C. "Losing someone close to you must be very upsetting." D. "I know how difficult it is to lose a loved one."
C. "Losing someone close to you must be very upsetting."
Community Health Nursing
Familiar and comfortable environment for PT Routine more determined by PT Diverse resources Autonomy, choice in HC decisions for PT by PT
Modes of Transportation: Foodborne
Food infection (bacterial, viral, parasitic infection of food) ☐ Salmonellosis ☐ Hepatitis A ☐ Trichinosis ☐ Escherichia coli (E. coli) ■ Food intoxication (toxins produced through bacterial growth, chemical contamination, or disease-producing substances) ☐ Staphylococcus aureus ☐ Clostridium botulinum
Older adults
Health concerns: heart disease, cancer, cerebrovascular disease, COPD, pnuemonia and influenza Screening: BP, H/W, dental health, FOB, mammogram, pap, vision/hearing, substance abuse, immunization, functional assessment, medication hx, osteoporosis, DM, skin cancer Goals: reduction in musculoskeletal concerns, mental health concerns, cardiac hospitalizations, substance abuse, sensory converns - increase in review of meds to reduce polypharmacy, older adults maintaining active lifestyle
Levels of Care
Individual - downstream Family Community Population - upstream
Factors contributing to mental health
Individual coping ability Stressful life event (exposure to violence) Social events (divorce, separation, unemployment, bereavement) Chronic health problem Stigma
JCAH
Joint Commission on Accreditation of Hospitals
What are some basics for client advocacy?
Nurse plays the role of the informer, supporter, and mediator for the client.
What is primary prevention? What are some examples?
Primary prevention is prevention of the initial occupancy of disease or injury. Nutrition education, family planning and sex ed., smoking cessation education, communicable disease education, education about health and hygiene issues to specific groups (day care workers, restaurant workers), safety education (seat belt use, helmet use), prenatal classes, providing immunizations, advocating for access to health care, healthy environments
PRO
Professional Review Organization
risk for exposure to radon
You can be exposed to higher levels of radon at work if you are a uranium miner, a hard rock miner, or work in tunnels, power stations, public baths, or spas.
Populations at risk for communicable disesases
Young children older adults immunocompromised clients IV drug users Health care workers
Which statement is true about mortality rates? Mortality rates: a. Are informative only for fatal diseases b. Provide information about existing disease in the population c. Are calculated using a population estimate at year-end d. Reveal the risk of getting a particular disease
a. Are informative only for fatal diseases
The main characteristics of partnership are: a. Awareness, flexibility, and distribution of power b. Rights, responsibilities, and consensus c. Commitment, participation, and articulation d. Collaboration, advocacy, and utility
a. Awareness, flexibility, and distribution of power
An outbreak of a gastrointestinal illness from a food-borne pathogen is an example of a(n): a. Attack rate b. Point epidemic c. Secular trend d. Event-related cluster
b. Point epidemic
A community that demonstrates commitment would most likely support the development of a: a. Community club to facilitate community involvement b. Children's recreation program c. Curb-side recycling program and community-based education about recycling d. Cooperative agreement with a neighboring city to share needed services
c. Curb-side recycling program and community-based education about recycling
A nurse is trying to increase participation in a free colorectal screening program for middle-aged adults who lack health insurance. Which implementation mechanism would be most effective? a. Small interacting groups b. Health policy c. Lay advisors d. Mass media
d. Mass media
To understand the causes of health and disease, epidemiology studies: a. Individuals b. Families c. Groups d. Populations
d. Populations
Increased blood pressure, tachycardia, and diaphoresis are indicators of
delirium tremens or alcohol withdrawal delirium
traditional categorization of community assessment data (community analysis)
demographic characteristics; geographic characteristics; socioeconomic characteristics; and health resources and services
alcohol use
depressant, dulls the senses to outside stimulation and sedates the inhibitory centers in the brain.
windshield survey
descriptive approach that assesses several community components by driving through a community.
Federal and state initiatives: 2010 Patient Protection and Affordable Care Act (ACA)
designed to increase care; raised concern about availability of adequate numbers of professional personnel to provide services, particularly in primary care and strained health care facilities.
distributive justice
determining eligibility for health care services based on income and fiscal resources
Acquired immunity
develops through actual exposure to the infectious agent
State Children's Health Insurance Program (SCHIP)
doctor visits, immunizations, hospitalizations, emergency room visits; children 19 years and younger from families who earn to much to qualify for Medicaid but who meet SCHIP eligibility
draw inferences (community analysis)
drawing logical conclusion form the evidence once data collected has been categorized, summarized, and compared; synthesize what is known about a community
How to dress a stroke victum:
dress affected side first to limit neglect of that side. use hand mirror to see around self.
secondary prevention
early detection and treatment of disease with the goal of limiting severity and adverse effects
Bioterrorism Secondary prevention
early recognition, activate response plan, implement infection control measures - decontamination, protective equipment, SCREEN the populations for exposure, assist and educate the population regarding symptom identification and management, monitor mortality and morbidity.
Primary prevention
educate individuals to reduce environmental hazards, advocate safe air/water, support waste reduction/recycling
What does hospice care focus on:
enhancing the quality of life through the provision of palliative care, support through the dying process.
Agencies transmitting or storing electronic health data must take measures to
ensure confidentiality and security of client information
The nurse should include resource availability as an _______ _______when discussing the epidemiological triangle
environmental factor
Deontology
ethical theory based on the idea that actions are based on moral rules or duties regardless of the consequences
tertiary prevention
focuses on restoration and rehab; act to return the community to an optimal level of functioning.
Nightingales theory of environment
highlights relationship between individuals environment and health -depicts health as a continuum -emphasizes preventive care
ginkgo balboa:
hinders coagulation. not for patients using warfarin.
psychomotor learning domain
involves the performance of skills that require some degree of neuromuscular coordination and emphasize motor skill; in learning a skill, first show learners how to do the skill; next allow learners to practice (teach back or show back approach)
tertiary prevention
maximization of recovery after an injury or illness
Block Nursing
nursing care provided to people who live on the same block as the nurse
Primary care
prevention
Cancer screening for men:
prostate cancer for men over 40, espicially african american men.
In the "I PREPARE" mnemonic, R=
residence (age of home, heating, recent remodeling, chemical storage, water) OR referrals and resources
What are the cardinal signs of addiction?
tolerance and withdrawal
Showing informational videos is an appropriate learning strategy for clients who are ___ learners
visual
hep C (HCV)
› Blood › Drug abuse › Sexual contact
Portals of entry
■ Respiratory passages ■ Gastrointestinal tract ■ Skin ■ Mucous membranes ■ Genitourinary tract ■ Eyes ■ Blood vessels
Alcohol, tobacco, and other substance use and addictive disorders can cause multiple health problems, including:
◯ Low birth weight ◯ Congenital abnormalities ◯ Accidents ◯ Homicides ◯ Suicides ◯ Chronic diseases ◯ Violence
Leading causes of death in adolescents
☐ Motor vehicle/other unintentional injuries ☐ Homicide ☐ Suicide
What is neglect?
☐☐ Physical care, such as feeding ☐☐ The emotional care and/or stimulation necessary for a child to develop normally, such as speaking and interacting with a child ☐☐ An education for a child, such as enrolling a young child in school ☐☐ Needed health or dental care
How the body processes ETOH is dependent on what?
☐☐ The size and weight of the drinker ☐☐ Gender (affects metabolism) ☐☐ Carbonation (increases absorption) ☐☐ Time elapsed during alcohol consumption ☐☐ Food in the stomach ☐☐ The drinker's emotional state
A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply.) A. Auditory hallucination B. Lack of motivation C. Use of clang associations D. Delusion of persecution E. Constantly waving arms F. Flat affect
A. Auditory hallucination C. Use of clang associations D. Delusion of persecution E. Constantly waving arms
Health Promotion and disease prevention
-primary, secondary and tertiary -national health goals based on scientific data and trends -healthy people initiated in 1979 and every 10 years publishes national health objectives -coordinated by US department of health -national goals guide the nurse in developing health promotion strategies to improve individual and community health -community health nurse actively helps people change lives to move toward optimal health -preventive services: health education and counseling, immunizations, other actions -preventive services in multiple community settings -plan and implement screening for at risk
Epidemiological Triangle
-relationships among an agent, host and environment. interaction determines development and cessation of communicable diseases, forming a web which increases or decreases the risk for disease HOST: age, gender, genetics, ethnicity, immune status, physiological state, occupation AGENT: chemical (drugs, toxins), physical (noise, temperature), infectious agents (viruses, bacteria) ENVIRONMENT: geography, water/ food supply, presence of reservoirs, access to health care, high risk working conditions, poverty
A nurse is discussing acute vs. prolonged stress with a client. Which of the following should the nurse identify as an acute stress response? (Select all that apply.) A. Decreased appetite B. Depressed immune system C. Increased blood pressure D. Panic attacks E. Unhappiness
A. Decreased appetite B. Depressed immune system C. Increased blood pressure E. Unhappiness
A charge nurse is preparing a staff education session on personality disorders. Which of the following should be included as personality characteristics associated with all of the personality disorders? (Select all that apply.) A. Difficulty in getting along with other members of a group B. Belief in the ability to become invisible during times of stress C. Display of defense mechanisms when routines are changed D. Claiming to be more important than other persons E. Difficulty understanding why it is inappropriate to have a personal relationship with staff
A. Difficulty in getting along with other members of a group C. Display of defense mechanisms when routines are changed E. Difficulty understanding why it is inappropriate to have a personal relationship with staff
A nurse is making a home visit to a client who has Alzheimer's disease to assess the home for safety. Which of the following are appropriate suggestions to decrease the client's risk for injury? A. Install childproof door locks. B. Place rugs over electrical cords. C. Mark cleaning supplies with colored tape. D. Place the client's mattress on the floor. E. Install light fixtures above stairs.
A. Install childproof door locks. D. Place the client's mattress on the floor. E. Install light fixtures above stairs.
A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following is the highest priority action by the nurse? A. Placing the client on one-to-one observation B. Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects
A. Placing the client on one-to-one observation
A client says, "I plan to commit suicide." Which of the following should be the nurse's priority assessment? A. Client's educational and economic background B. Lethality of the method and availability of means C. Quality of the client's social support D. Client's insight into the reasons for the decision
B. Lethality of the method and availability of means
Community Health Nursing: -Is it broad or specific? -Wide variety of settings or limited? -Do they promote health and welfare of pts? -Specific age groups? -Diverse populations or specific cultures? -Nurses working in the community should have an understanding of what 3 things?
Community Health Nursing: -broad -wide variety of settings -allows nurses to practice in wide variety of settings -Promote health and welfare of clients -across the lifespan -Nurses working in the community should understand the foundations of CHN, the principles of CHN, and health promo and disease prevention
Community as Partner
Community core 8 interacting community subsystems Community stressors/boundaries Normal line of defense LOD = status quo Flexible line of defense - protection vs stressors Lines of resistance LOR - strengths, resources, coping mechanisms
Prevalence
number of existing cases of disease in the population
Community Health education
nurses provide education to promote maintain adn restore health -account for barriers: age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, lack of motivation
Parish Nursing
nurses work with the pastor and staff of a faith community to promote health and healing through counseling, referrals, teaching, and assessment of health care needs
home health nurse
nursing care to clients were they reside. this includes traditional homes, assisted living facilities, and nursing homes. Functions as education, provider of skilled nursing interventions, and coordinator of care.
Community or population
an aggregate who shares one or more personal characteristics within the community is the client in community health nursing
infectious agent
an organism (virus, Rickettsia, bacteria, fungus, protozoan, helminth, or prion) capable of producing infection or infectious disease
Agent
animate or inanimate object that causes disease
A home health nurse is discussing portals of entry with a group of newly hired assistive personnel. Which of the following are portals of entry the nurse should discuss? (Select all that apply.) a. Respiratory secretions b. Skin c. Genitourinary tract d. Saliva e. Mucous membranes
b, c, e
To effectively complete the evaluation phase, the nurse must have: a. Demonstrated the ability to improve the health of the participants b. Developed measureable objectives and goals before implementation c. Encouraged full participation by community members d. Improved the health of the population through the program
b. Developed measureable objectives and goals before implementation
To analyze the problem of increased adolescent alcohol use in the community, a nurse brings together several groups of people to address the issue. These groups come together at the same time to work on identifying potential causes of the problem, but do not interact during the process. Which model is the nurse applying? a. Delphi technique b. Program planning model c. Community-as-partner model d. Community empowerment model
b. Program planning model
Screening for hearing defects is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion
b. Secondary prevention
A group of nursing students forms a student nursing association to provide support while they are enrolled in a nursing program. This is known as a community of: a. Place b. Special interest c. Problem ecology d. Function
b. Special interest
social determinants of health
factors which influence an individual's or population's health: complex relationships between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies
community health nursing practice
focus = synthesis of nursing and public health theory promote, preserve, and maintain the health of populations by the delivery of health services to individuals, families, and groups in order to impact community health
public health nursing practice
focus = synthesis of nursing and public health theory promote, preserve, and maintain the health of populations through disease and disability prevention and health protection of the community as a whole core functions - assessment, development of policies, ensuring that essential health services are available
Secondary prevention:
focus is on early detection of disease and treatment with goal of limiting severity and adverse effects. includes: screenings (cancer, diabetes, HTN, TB lead exposure) and treatments (STI, TB)
tertiary prevention:
focus is on maximization of recovery after injury or illness. Includes: exercise rehab, nutrition counseling, case management, support groups.
Community Oriented Nursing
focus on at risk individuals, families, groups and community nursing: health care to determine health needs of a community and intervene at the individual, family and group level to improve the collective health of the community
Clinical Prevention Services
focus on disease prevention; health promotion and protection; and on primary, secondary, and tertiary health services..
Humanistic theory
focus on feelings and relationships, methods based on principle that learners do what's in their best interest
Population focus
focus on patient as an individual in a family as part of subpopulation
Support groups:
focus on positive person if someone is being negative.
Evaluation
formative - changes made during process summative - at end, related to outcomes
Federal response plan
government plan hat includes FEMA, US Public health service and CDC to guide the coordination of efforts in response to disaster
Interpreters should have knowledge of
health-related terminology
Medicare part A
hospital care, home care, limited skilled nursing care
The nurse manager should include age as a _____ when discussing work-related illness and injury
host factor
Prevention of lead exposure:
increase calcium and iron intake. Wet mop floors. cold water to amek baby formula. don't sand wood.
Secondary prevention
increase early detection through screening and case finding, refer suspected cases of communicable disease for diagnostic confirmation and epidemiological reporting, provide post exposure prophylaxis (hep A, rabies), quarantine clients
Why are toxin and pollution greater in children?
increased RR rate, and drink more fluids thatn adults. kindeys don't work as well.
Health Status
infant death rate by race/ethnicity - numbers of deaths or age adjusted death rates for motor vehicle crashes, work related injuries, suicide, homicide, lung cancer, breast cancer, cardiovascular diseases, and all causes of age, race and sex as appropriate - reported incidence of AIDs measles, tuberculosis, and primary and secondary syphilis, by age, race, and sex as appropriate -births to adolescents (ages (10 to 17) as a proportion of total live births - rate of confirmed abuse and neglect
process (formative) evaluation
initial implementation/development of program; answers: are we doing what we said we would do?
What is epidemiology?
invenstigative study of disease trends in populations to prevent disease and maintain health.
Public health nurse: core function of assessment:
investigating local health hazards.
the ethical principle of fidelity
involves keeping commitments and following through with promises
The nurse should determine the work practices of employees when conducting a
work site survey
What are some secondary prevention strategies related to mental health?
• Screen to detect mental health disorders. • Work directly with individuals, families, and groups through the formation of a therapeutic relationship. • Conduct crisis intervention.
What are some health care goals to address for vulnerable populations?
◯◯ Encouraging people to use primary care providers for medical services. ◯◯ Increasing the number of people with health insurance. ◯◯ Making access to health care easier for the immigrant population.
What are some factors that contribute the mental health of aggregates?
◯◯ Individual coping abilities ◯◯ Stressful life events (exposure to violence) ◯◯ Social events (recent divorce, separation, unemployment, bereavement) ◯◯ Chronic health problems ◯◯ Stigma associated with seeking mental health services
Vulnerable populations are subject to which issues?
◯◯ Violence ◯◯ Substance abuse ◯◯ Mental health ◯◯ Homelessness ◯◯ Rural and migrant health
occupational health history elicits information on
☐ Current and past jobs ☐ Current and past exposure to specific agents and any relationship of current symptoms to work activities ☐ Any precipitating factors, such as underlying illness, previous injuries, and healthy or unhealthy habits
Economic Maltreatment
☐ Failure to provide the needs of a victim when adequate funds are available ☐ Unpaid bills when another person is managing the finances ☐ Theft of or misuse of money or property
Manifestations of withdrawal include the following:
☐ Irritability ☐ Tremors ☐ Nausea ☐ Vomiting ☐ Headaches ☐ Diaphoresis ☐ Anxiety ☐ Sleep disturbances ☐ Tachycardia ☐ Elevated blood pressure
Rifampin (Rifadin)
☐ Observe for hepatotoxicity. ☐ Inform the client that urine and other secretions will be orange. ☐ Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately. ☐ Inform the client this medication may interfere with the efficacy of oral contraceptives.
Pyrazinamide
☐ Observe for hepatotoxicity. ☐ Instruct the client to drink a glass of water with each dose and increase fluids during the day. ☐ Advise the client to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately. ☐ Advise the client to avoid using alcohol while taking pyrazinamide.
National Health Goals For adolescents
☐ Reductions in X Violent crimes X Initiation of tobacco use X Obesity X Inappropriate weight gain ☐ Increases in X Schools with a breakfast program X Participation in extracurricular activities X Wellness checkups within prior 12 months X Physical activity
The body processes alcohol dependent on several factors, including:
☐ The size and weight of the drinker ☐ Gender (affects metabolism) ☐ Carbonation (increases absorption) ☐ Time elapsed during alcohol consumption ☐ Food in the stomach ☐ The drinker's emotional state
Isoniazid (Nydrazid)
☐ This medication should be taken on an empty stomach. ☐ Monitor for hepatotoxicity and neurotoxicity, such as tingling of the hands and feet. ☐ Vitamin B6 (pyridoxine) is used to prevent neurotoxicity from isoniazide ☐ Advise the client not to drink alcohol while taking isoniazid because it may increase the risk for hepatotoxicity.
Chapter Review
- In contrast to community health, which focuses on the health of a population, community-based care focuses on individual and family healthcare needs. Services are provided in many different settings and by various programs, including community centers and clinics, day care programs, parish nursing, and Meals-on-Wheels. - Factors affecting health in the community include social support systems, community healthcare structures, the environment, and economic resources. - Home care is defined as services for people who are recovering, disabled, or chronically ill and who are in need of treatment or support to function effectively in the home environment. - Two special components of home care are hospice care and respite care. - The home care system includes agencies, clients, referral sources, physicians, reimbursement sources, and legal considerations. - The roles of the home care nurse include advocate, provider of direct care, educator, and coordinator of services. - Nursing interventions to ensure competent care include those used to establish trust and rapport, proceed slowly, set goals and boundaries, assess the home environment, set priorities, promote learning, limit distractions, put safety first, and control infection. - Rehabilitation is the process of learning to live to one's maximum potential with a chronic health impairment and its resultant disability.
Distributive justice: -Definition -Situation
-Fair distribution of the benefits and burden in society is based on the needs and contributions of its members. -Determining eligibility for health care services based on income and fiscal resources.
Community-oriented nursing: -Who is the focus of care? -What are the nursing activities?
-Focus of care: at risk individuals, family, groups as well as community. -Nursing activities are r/t health care: determining health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community.
Community based nursing: -Who is the focus of care? -What are the nursing activities?
-Focus of care: individuals and families -Nursing activities are r/t illness care: mgmt. of acute and chronic conditions in settings where individuals, families, and groups live, work, and "attend" (schools, camps, prisons)
Community health nursing practice: -Who is the focus of care? -What are the nursing activities?
-Focus of care: synthesis of nursing and public health theory -Nursing activities are to promote, preserve, and maintain health of populations by the delivery of health services to individual, family, and groups in order to impact "community health"
Millie's framework for prevention
-complements health belief model -emphasizes change at the community level -IDs relationship between health deficits and availability of health-promoting resources
Roles for Nurse in Environmental Health
-facilitate public participation, perform individual and population risk assessments, implement risk communication, conduct epidemiological investigations, participate in policy development
A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The goal of treatment during the maintenance phase is prevention of future episodes of MDD." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are used to prevent a relapse of MDD."
A. "Care during the continuation phase focuses on treating continued manifestations of MDD."
A nurse is teaching an adolescent client who has a new prescription for clomipramine (Anafranil) for OCD. Which of the following should the nurse teach the client to minimize one of the adverse effects of his medication? A. Eat a diet high in fiber. B. Check temperature daily. C. Take medication first thing in the morning before eating. D. Add extra calories to the diet as between-meal snacks.
A. Eat a diet high in fiber.
A nurse is working in a community mental health facility. Which of the following services are appropriate for clients to receive? (Select all that apply). A. Educational groups B. Medication dispensing programs C. Individual counseling programs D. Detoxification programs E. Crisis intervention
A. Educational groups B. Medication dispensing programs C. Individual counseling programs
A nurse is preparing to provide an educational seminar on stress to other nursing staff. Which of the following is appropriate to include in the discussion? A. Excessive stressors cause the client to experience distress. B. The body's initial adaptive response to stress is denial. C. The absence of stressors results in homeostasis. D. Negative, rather than positive, stressors produce a biological response.
A. Excessive stressors cause the client to experience distress.
Nursing Process in the community
ADPIE: Assessment Diagnosis (written in different format for the community) Planning Implementation Evaluation
A nurse is preparing an education program on disease transmission for employees at a local day care facility. When discussing epidemiological triangle, the nurse should include which of the following as agents? (Select all that apply.) A. Resource availability B. Ethnicity C. Toxins D. Bacteria E. Altered immunity
Answer: C and D. A: Incorrect- resource availability is r/t environment B: Incorrect- ethnicity is r/t host C: Correct- toxins are r/t agents D: Correct- bacteria is r/t agents E: Incorrect- altered immunity is r/t host
A community health nurse is implementing health programs with several populations in the local area. In which of the following situations is the nurse using primary prevention? A. Performing a home safety check in a client's home. B. Teaching healthy nutrition to clients how have HTN. C. Providing influenza immunization to employees at a local preschool. D. Implementing a program to notify individuals exposed to communicable disease.
Answer: C. A: Incorrect- performing a home safety check is secondary prevention B: Incorrect- teaching healthy nutrition to clients with HTN is tertiary prevention C: Correct- immunizations is a primary prevention task. D: Incorrect- notifying exposed individuals is secondary prevention
A nurse is developing a community health education program for a group of clients who have a new diagnosis of DM. Which of the following learning strategies should the nurse include for clients who are auditory learners? A. Showing informational videos B. Providing equipment to practice hands-on skills C. Supplying outlines for note-taking D. Facilitating small group discussions
Answer: D A: Incorrect- this is for visual learners B: Incorrect- this is for tactile-kinesthic learners C: Incorrect- this is for visual learners D: Correct- this is for auditory learners
The nurse has completed an initial visit with a home bound client in whom she has obtained biographical information during the interview; as well as collecting information regarding the client. This process applies to: a. Assessment Process. b. Diagnosis Process. c. Planning Process. d. Evaluation Process.
Assessment Process. Rationale: The nursing process used in home care is not different from that practiced in any other setting. The unique challenges of home care present themselves chiefly in the implementation step. Assessment in the home includes the nurse assessment, and data collection which focuses chiefly around the first home visit. During the visit, much of the assessment process centers around collecting the information, including a medication sheet; forms for pain; psychosocial database and spiritual assessment as well as financial assessment. Nursing Process: Implementation Client Need: Physiological Integrity Cognitive Level: Application Objective: Apply the nursing process to care of the client in the home. Strategy: Use knowledge of the nursing process and the process of elimination to make the correct selection.
A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following in the teaching? (Select all that apply.) A. Constipation B. Polyuria C. Rash D. Muscle weakness E. Tinnitus
B. Polyuria D. Muscle weakness
A nurse is assessing a 4-year-old child for indications of autism spectrum disorder. For which of the following indications should the nurse assess? A. Impulsive behavior B. Repetitive counting C. Destructiveness D. Somatic problems
B. Repetitive counting
A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? A. Insist that the client stop yelling. B. Request that other staff members remain close by. C. Move as close to the client as possible. D. Walk away from the client.
B. Request that other staff members remain close by.
A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following is an expected finding? (Select all that apply.) A. Sunken fontanelles B. Respiratory distress C. Retinal hemorrhage D. Altered level of consciousness E. An increase in head circumference
B. Respiratory distress C. Retinal hemorrhage D. Altered level of consciousness E. An increase in head circumference
Inadequate health care insurance, inability to pay for health care services, language barriers, cultural barriers, lack of health care providers in a community, geographic isolation, social isolation, lack of communication tools, lack of personal or public transportation to health care facilities, inconvenient hours, attitudes of HCP toward clients of low socioeconomic status or with different cultural/ethnic backgrounds, and eligibility requirements for state/federal assistance programs.
Barriers that community members, particularly vulnerable populations, encounter when accessing health services
A nurse is working on promotion of healthy coping skills with older adult clients who had all previously been hospitalized for severe depression and are now in a residential care facility. The nurse should recognize that this is an example of which of the following? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Mental status examination
C. Tertiary prevention
A nurse is reviewing the medical record of a client who has a new prescription for bupropion (Wellbutrin) for depression. Which of the following findings is the highest priority for the nurse to report to the provider? A. The client has a family history of seasonal pattern depression. B. The client currently smokes 1.5 packs of cigarettes per day. C. The client had a motor vehicle crash last year and sustained a head injury. D. The client has a BMI of 25 and has gained 10 lb over the last year.
C. The client had a motor vehicle crash last year and sustained a head injury.
flooding and health
Climate change intensifies rainfall; heavy rains increase risk of drinking water contamination and illness; floods can force communities to relocate.
What challenge do community health nurses face?
Community health nurses address the challenges of autonomy and providing ethical care
Factors in planning a community program
Community partnership (do they agree); Influences of social, economic, environmental, political issues; Etiologic antecedents; Health needs of at-risk populations (and do they agree with this); Awareness/application of planned change
A nurse is discussing free association as a therapeutic tool with a client who has major depressive disorder. Which of the following client statements indicates understanding of this technique? A. "I will write down my dreams as soon as I wake up." B. "I may begin to associate my therapist with important people in my life." C. "I can learn to express myself in a nonaggressive manner." D. "I should say the first thing that comes to my mind."
D. "I should say the first thing that comes to my mind
A nurse is assessing a client who is the victim of sexual assault. Which of the following findings indicate the client is experiencing an initial impact reaction of rape-trauma syndrome? (Select all that apply.) A. Genitourinary soreness from the assault B. Difficulties with low self-esteem C. Sleep disturbances D. Emotional outbursts E. Difficulty making decisions
D. Emotional outbursts E. Difficulty making decisions
A client with diabetes mellitus notifies the home health nurse that his sharps container at home is full and needs to be replaced before he gives himself another injection of insulin. The nurse tells the client that she will not be able to visit him today. What is the safest recommendation that the nurse can make to the client regarding the sharps container? a. Instruct the client to wrap each syringe in a paper towel and put the towel at the bottom of the trash can. b. Dispose of the syringes in a thick liquid detergent bottle after using the syringe and replace the lip on the bottle. c. Recap the needle after using the syringe and store it in a plastic bag until the next nurses visit. d. Wipe the needle off with an alcohol swab and re-use the syringe until the nurse returns on her next visit.
Dispose of the syringes in a thick liquid detergent bottle after using the syringe and replace the lip on the bottle. Rationale: Safety is very important for the client as well as those caring for the client. The disposal of toxic medications and sharp objects (such as needles used for injections) is also a safety issue in the home. The nurse should teach the client regarding safety and educate the family as well whenever. Option A is unsafe; all needles should be placed in some form of sharps containers so that people are not exposed to needlestick injuries. Options C and D are incorrect because recapping needles and wiping off needles to reuse them places the individual at risk for a needlestick injury and blood-borne diseases. Nursing Process: Implementation Client Need: Safe Effective Care Environment Cognitive Level: Analysis Objective: Provide client care in community-based settings and the home. Strategy: Use nursing knowledge and the process of elimination to make the correct selection.
Cultural assessment
Ethic background, religious preferences, family structure, language, communication needs, education, cultural values, food patterns, health practices
What do the principles for guiding CHN include?
Ethical considerations Advocacy Epidemiology Epidemiological calculations Epidemiological triangle Epidemiological process Community-based health education
What do ethical considerations include?
Ethical considerations include preventing harm, doing no harm, promoting good, respecting both individual and community rights, respecting autonomy and diversity, and providing confidentiality, competency, trustworthiness, and advocacy
Program Planning: Evaluation
Evaluate strengths/ weaknesses of program, determine achievement of desired outcomes, examine adequacy, efficiency, and cost effectiveness
What is Healthy People?
Every 10 years it publishes the national health objectives that serve as a guide for promoting health and preventing disease.
Community Health Program Planning, Development, and Management Evaluation
Examine the success of the interventions. Evaluate strengths and weaknesses of the program. Determine achievement of desired outcomes. Examine the adequacy, efficiency, appropriateness, and cost benefit of the program. Recommend and implement modifications to better meet the needs of the community. Share findings and recommendations with community members and stakeholders. Ongoing evaluation is necessary in order to ensure program success and meet the changing needs of the community.
hep A (HAV)
Fecal-oral route › Ingestion of contaminated food or water › Close personal contact with an infected individual (use PPE with incontinent patients)
Positive changes in health care:
Federal and state initiatives, private market forces, the development of scientific knowledge and new technologies, and the expectations of the public are bringing about changes in the health care system
Disaster preparedness
Federal response plan ID and assessment of at risk pop's (resources, isolation) Plan for possibility of worldwide pandemics individual plan should include: action plan with communication, evac route, disaster kit Mass casualty drills
Children (0-12 yrs)
Health concerns: perinatal conditional/congenital anomalies, SIDS, MVA, unintentional injury Screening: height/weight, vision, immunization status, dental health At birth: hemoglobinopathy, phenylalanine, T4, TSH Goals: healthy weight, avoid exposure, immunize, safety, exercise in schools, lead-based paint testing
Nightingale's Theory of Environment
Highlights the relationship between an individual's environment and health. Depicts health as a continuum. Emphasizes preventative care.
Factors Affecting Susceptibility to Illness and Injury
Host factor: worker characteritics (experience, age, pregnancy) -agent factors: biological agents, chemical agents, mechanical agents, physical agents, psych agents -Environmental factors: physical factors, social factors, psych factors
infectious diseases and health
Hotter summers can make disease-carrying insects more active, for longer seasons; illnesses like dengue, West Nile, and Lyme can spread into new areas
Questions to track outcome (MAPP)
How do we track? How do we affect public policy? How do we promote a sense of community? How do we assure access to care? How do we encourage healthy lifestyles? How do we provide a safe environment?
Potential for abuse
Hx or being abused or exposed to violence, low self-esteem, fear and distrust of others, poor self-control, inadequate social skills, minimal social support, immature miscarriage, weak coping skills.
disorders that increase a client's risk for stroke
Hypertension, diabetes mellitus, smoking, and other related disorders can increase a client's risk for a stroke.
Strategies for and Barriers to Implementing Community Health Programs: Barriers
Inadequate assessment Inadequate or misconstructed data No involvement with community partners Impaired communication Inadequate resources Lack of planning Poor leadership
Medicare
Individuals must be >65 and receiving SS, have been receiving disability benefits for 2 years, have amyotrophic lateral sclerosis and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to qualify. Four parts are included: Part A= (Hospital/home care, limited skilled nursing care) Part B= (medical care, diagnostic services, physiotherapy) Part C= (Also known as the Medicare Advantage plan- is a combination of Part A and Part B and is provided through a private insurance company) Part D= (prescription drug coverage)
NPH insulin (Humulin N), detemir insulin (Levemir)
Intermediate-acting insulin ☐ Administered for glycemic control between meals and at night. ☐ Not administered before meals to control postprandial rise in blood glucose. ☐ Contains protamine (a protein), which causes a delay in the insulin absorption or onset and extends the duration of action of the insulin. ☐ Administer NPH insulin subcutaneous only and as the only insulin to mix with short-acting insulin. ☐ Administer detemir insulin subcutaneous only and is never mixed with othe
health related terminology
Interpreters need to have knowledge of ______. It is not advisable to use a family member as an interpreter. Interpreters should not be from the same community as the client. Client preferences should be considered when selecting the age and sex of interpreters.
JACHO
Joint Commission on Accreditation of Healthcare Organizations
Two broad efforts to address quality improvement in last 20 years
National Public Health Performance Standards Program and the accreditation process for local and state health departments local governments can access evaluation services from National Public Health Performance Standards
Natural immunity
Natural defense mechanisms of the body to resist antigens or toxins
Defense mechanisms
Natural immunity - antigen/antibody response Artificial immunity - through vaccination (active: live/killed/toxoid, passive: antitoxin, antibodies)
What is the incidence?
Number of new cases in the population at a specific time divided by population total x 1,000= ____ per 1,000
Incidence calc
Number of new cases in the population at a specific time ÷ population total x 1,000 = _____ per 1,000
What is the attack rate?
Number of people exposed to a specific agent who develop the disease divided by total number of people exposed
Strategies for Rural and Migrant Health Care
PRIMARY: education about pesticide exposure, accident prevention, prenatal care, dental and immunization prevention -SECONDARY: screen for pesticide exposure, skin cancer, chronic disease, communicable disease TERTIARY: treat for pesticide exposure, mobilize primary care and emergency service
Levels of Prevention r/t Case Management
Primary prevention Use the information exchange process to increase the client's understanding of how to use the health care system and the health promotion strategies that will maintain health. Secondary prevention Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health. Tertiary prevention Monitor the use of prescription medications and adherence to treatment to reduce risk for illness complications.
Planning and Prioritization Phase
Priorities established (set by community members) Goals and objectives IDed Community focused interventions
PSRO
Professional Standards Review Organization
Community Diagnosis
Risk of X Among X group/population
Rural and Migrant Health
Rural Residents: higher infant and maternal morbidity rates & diabetes, obesity, less likely to be phys active, higher suicide. increased injuries, increased occupational risks, less likely to seek prev care -barriers: distance, lack of transportation, unpredictable weather, inability to pay for care, shortage of rural hospitals -migrant worker health probs: dental disease, TB, chronic conditions, stress, anxiety, leukemia, anemia, cancers, lack of prenatal care, higher infant mortality
Nursing care for stroke
VS q1-2 hr; cardiac monitor, monitor LOC, elevate head of bed, institute seizure precautions
A nurse is working with a client who has systemic lupus erythematosus and recently lost her health insurance. Which of the following is an appropriate action by the nurse in the implementation phase of the case management process? a. Coordinating services to meet the client's needs b. Comparing outcomes with original goals c. Determining the client's financial constraints d. Clarifying roles of interprofessional team members
a
American Diabetes Association (ADA) recommends screening a client who has
a BMI greater than 24 and age greater than 45 years, or if a child is overweight and has additional risk factors
A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should include that which of the following are influenced by an individual's culture? (Select all that apply.) a. Nutritional practices b. Family structure c. Health care interactions d. Biological variations e. Views about illness
a, b, c, e
A nurse is collecting data to identify health needs in the local community. Which of the following are examples of secondary data the nurse should review? (Select all that apply.) a. Birth statistics b. Previous health survey results c. Windshield survey d. Community forum e. Health records
a, b, e
A nurse at a community clinic is conducting a well-child visit with a preschool-age child. The nurse should identify which of the following as a manifestation of child neglect? (Select all that apply.) a. Underweight b. Healing spiral fracture of the arm c. Genital irritation d. Burns on the palms of the hands e. Poor hygiene
a, e
John Snow is called the "father of epidemiology" because of his work with: a. Cholera b. Malaria c. Polio d. Germ theory
a. Cholera
A study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is called: a. Cross-sectional b. Ecological c. Case-control d. Cohort
a. Cross-sectional
Access to Health Care
advocate for improved access -evaluate adequacy of health services within community, identify barriers encountered including: inadequate health insurance, inability to pay for services, language and culture barriers, lack of health care providers, geographic isolation, social isolation, lack of communication tools, lack of personal or public transportation, inconvenient hours, attitudes of health care personnel toward clients of low socioeconomic status
Mental Health
affective disorders (bipolar, major depression), anxiey (OCD, panic, phobias, PTSD), schizophrenia, dementia, conduct disorders, eating disorders -factors contributing: coping ability, life e vents, social events, chronic health probs, stigma with seeking service
Barriers to learning in community education programs
age, cultural barriers, poor reading and comprehension skills, language barriers, barriers to access, and lack of motivation
(Epidemiological) Susceptible Host factors
age, gender, genetics, ethnicity, immunological status, physiological state, occupation
The nurse should include bacteria as an ______ when discussing the epidemiological triangle
agent
The nurse should include toxins as an ____ when discussing the epidemiological triangle
agent
epidemiologic triangle
agent-host-environment model that is a traditional view of health and disease developed when epidemiology was concerned chiefly with communicable disease; all 3 can coexist-disease occurs with interaction of agent, host and environment
Informant interviews
are direct conversations with individual community members for the purpose of obtaining ideas and opinions
A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care? a. "I don't drive, and my son is only available to take me places in the mornings." b. "I can't take off during the day and the local after-hours clinic is no longer in operation." c. "Only one doctor in my town is a designated provider by my health maintenance organization." d. "I would like to schedule an appointment with the local doctor in my town who speaks Spanish and English."
b
A nurse is reviewing the various roles of a community health nurse. Which of the following is an example of a nurse functioning as a consultant? a. Advocating for federal funding of local health screening programs b. Updating state officials about health needs of the local community c. Facilitating discussion of a client's ongoing needs with an interprofessional team d. Performing health screenings for high blood pressure at a local health fair
b
A school nurse is planning health promotion and disease prevention activities for the upcoming school year. In which of the following situations is the nurse planning a secondary prevention strategy? a. Placing posters with images of appropriate hand hygiene near restrooms b. Routinely checking students for pediculosis throughout the school year c. Implementing age-appropriate injury prevention programs for each grade level d. Working with a dietician to determine carbohydrate counts for students who have diabetes mellitus
b
Epidemiologic studies of diseases conducted by nurses during the twentieth century were influenced by the (select all that apply): a. Increasing rate of poverty b. Declining child mortality rates c. Overcrowding in major cities d. Development of new vaccinations
b. Declining child mortality rates d. Development of new vaccinations
Which data would be useful for a nurse to collect when assessing safety in a community? Select all that apply. a. Number of billboards in the area b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurse's own observations
b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurse's own observations
A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. What type of data is being collected? a. Quantitative b. Qualitative c. Focus-groups d. Survey
b. Qualitative
The probability an event will occur within a specified period of time is called: a. Rate b. Risk c. Epidemiology d. Epidemic
b. Risk
A community health nurse is developing strategies to prevent or improve mental health issues in the local area. In which of the following situations is the nurse implementing a tertiary prevention strategy? a. Providing support programs for new parents b. Screening a client whose spouse recently died for suicide risk c. Teaching a client who has schizophrenia about medication interactions d. Discussing stress reduction techniques with employees at an industrial site
c
A community health nurse is implementing health programs with several populations in the local area. In which of the following situations is the nurse using primary prevention? a. Performing a home safety check at a client's home b. Teaching healthy nutrition to clients who have hypertension c. Providing influenza immunizations to employees at a local preschool d. Implementing a program to notify individuals exposed to a communicable disease
c
When writing a community-level diagnosis, "Among" refers to the: a. Specific problem or health risk faced by the community b. Characteristics of the community c. Community client experiencing the risk or problem d. Likelihood that the problem will be solved
c. Community client experiencing the risk or problem
Voters have recently decided to have fluoride added to the city water system. Epidemiologists wanting to study the effect of fluoride on dental caries would be conducting a(n): a. Ecological study b. Double-blind study c. Community trial d. Screening
c. Community trial
Program Planning: Implementation
carry out the plan
School nurse
case manager - coordinates comprehensive services for children who have complex health needs. Community outreach - strives to meet the needs of all school-age children by cooperative planning and collaboration between the educational system. Consultant - assists students, families, and personnel in information gathering and decision-making about a variety of health needs and resources. Counselor - supports students on health needs direct caregiver - provides nursing care to all ill or injured children at school health educator - helps prepare children, families, school personnel and the community to make well-informed health decisions
School Nurse
case manager, community outreach, consultant, counselor, direct caregiver, health educator, researcher
The community is the _____ in community health nursing
client
nurse-client relationship
client shave the right to expect a ____ _____ that is based on trust, collaboration, and shared respect
autonomous
clients are ____ beings who have the right to make decisions affecting their own health
United states health care expenditures =
clinical
Public health nurse: core function of assurance:
collaborate with other agencies to imporove services and ensure competence of health care workers.
Part C
combo of part A and B through a private insurance.
A nurse is developing a community health education program for a group of clients who have a new diagnosis of diabetes mellitus. Which of the following learning strategies should the nurse include for clients who are auditory learners? a. Showing informational videos b. Providing equipment to practice hands-on skills c. Supplying outlines for note-taking d. Facilitating small group discussions
d
Telehealth
delivery of quality health care through the use of telecommunication technologies particularly useful in rural areas increasing use in home health services
nonmaleficence
developing plans of care that include a system for monitoring and evaluating outcomes
State boards of nursing
development and oversight of the state's nurse practice act. Licensure of registered and licensed practical nurses. Oversight of the state's schools of nursing.
OSHA
develops and enforces workplace health regulations to protect the safety and health of workers
Healthy nutrition should include omega-3 fatty acids for secondary prevention of
diabetes and heart disease
Healthy nutrition should include increasing dietary fiber to control weight gain and decrease the risk of ______________
diabetes and hyperlipidemia
Early manifestations of alzheimers:
difficulty learning new things, forgetful
Botulism
difficulty swallowing, weakness, nausea, vomiting, difficulty breathing. Give: airway management, antitoxin, eliminate the toxin, supportive care
Focus groups
directed talk with a representative sample.
endemic
diseases that occur at a consistent, expected level in a geographic area
Demographic
distribution, mobility, density, census data
Secondary Prevention
early detection and treatment of disease with the goal of limiting severity and adverse effects -community assessments, disease surveillance, screening (cancer, diabetes, hypertension, hypercholesterolemia, TB, lead exposure, genetic disorders), control of outbreaks of communicable disease
complementary therapies for acute respiratory disorders
echinacea, large doses of vitamin C, and zinc preparations (lozenges and nasal sprays) may be useful in promoting improved immune response, as well as hand hygiene, and limiting exposure in vulnerable populations
IOM :public health workers should be
educated, informatics, genomics, cultural competence, community based participatory research, policy, law, global health , and ethics- in order to address the emerging public health issues
Recommend that categories be used by
educators for curriculum review and development and by agency administrators for workforce
Home Health Agencies
either public or private organizations engaged in providing skilled nursing and other therapeutic services in the client's home
Why is education inportant:
encourages clients to be independent, and involved in the own care. families can also be involved.
Referral process
engage in working relationship with client establish criteria for the referral explore resources accept the client's decision to use a given resource (autonomy) make the referral facilitate the referral evaluate the outcome
Hospice Nurse
enhance quality of life through palliative care, supporting client and family through dying process, providing bereavement support to family after death -home, hospice center, hospital, long term care -not aimed toward cure. relief of pain and suffering -care for entire family -interprofesional approach, control symptoms, directed by provider, managed by nurse, volunteer for nonmedical care, postmortem bereavement, help family transition from recovery to acceptance of death
Small pox
eradicated worldwide since late 1970s, people who were immunized against smallpox before 1982 are now considered to be unprotected, unlike chickenpox, the vesicles of smallpox are more abundant on the face.
Principles of Community Health Nursing
ethical considerations, advocacy, epidemiology, calculations, edimiological triangle, epidemiologcal process, community based health education
Disasters
event causing human suffering and demands more resources than available to community. man made, naturally occurring, combingation -Disaster PREVENTION: surveillance, airport security, public health immunization and quarantine, flood barriers, demographic, identify and assess at risk populations -Disaster PREP: national state and local lev. coordinate community efforts, prep for disaster, action plan, disasiter kit, meeting place, communication protocol, drills -Disaster RESPONSE: federal emergency management, CDC, homeland security, red cross, public helath. assess disaster, number affected, fresh water and food, sanitation -Disaster RECOVERY: when danger no longer exists. until economic and civil life is restored, sanitation control, PTSD common.reactions: heroic, honeymoon, disillusionment, reconstruction
Coalitions
facilitation of goal achievement through the collaboration of two or more groups
relative risk factor
factor of 1.0 means the risk of disease among the exposed is no different from the risk of disease among the non-exposed; an rr of 2.0 implies that the risk is twice as high, whereas a rr of 0.5 indicates that the exposure factor is associated with 1/2 the risk of disease (protective factor)
determinants of health
factors which influence an individual's or population's health; influences include the availability and access to: high quality education, nutritious food, decent and safe housing, affordable, reliable public transportation, culturally sensitive health care providers, health insurance, and clean water and non-polluted air
distributive justice
fair distribution of the benefits and burden in society
Homeless population characteristics (not all inclusive)
families with children (fastest growing segment) People who have mental illness (large segment) Older adults with no place to go and no support system
Public Health Nursing Practice
focus same as community health nursing -nursing to promote preserve and maintain the health of population through disease and disability prevention and health protection of community as a whole -core functions: systematic assessment of the health of population, develop policies to support the health of populations, ensure that essential health services are avialbale to all
community-based nursing
focus: individuals and families Activities: management of acute and chronic conditions where individuals, families, groups live, work and attend schools.
Community Based Nursing
focus: individuals and families. -nursing is illness care: manage acute and chronic conditions in setting where individuals, families and groups live work and attend (schools, camps, prisons)
Community Health Nursing Practice
focus: synthesis of nursing and public health theory -nursing to promote, preserve and maintain the health of populations by the delivery of health services to individuals, families and groups in order to impact community health
public health economics
focuses on producing, distributing, and consuming goods and services as related to public health and where limited public resources might best be spent to save lives or cause the most increase in quality of life
descriptive epidemiology
focuses on the distribution of frequencies and patterns of health events with groups in a population; examine disease patterns and other health-related phenomena according to "person" "place" and "time"
Meningococcal vaccine:
for those living in crowded and close quarters, over 6 weeks old.
medicare
health insurance program; 65 years or older, disabled people younger than 65, end stage renal disease or Lou Gehrig disease
Three key components of population health
health outcomes, health determinants, and policies
What does a fan accomlish?
helps stimulate trigeminal nerve which helps decrease feeling of dyspnea.
Defense Mechanisms
herd immunity: protection due to immunity of community members making exposure unlikely -Natural immunity: natural mechanisms of the body to resist specific antigens -acquired: develops through exposure --> active: product antibodies in response to infection. passive: transfer antibodies to host from mom to baby, Ig, plasma protein or antitoxins
What vaccines are not safe during pregnancy:
herpes zoster, varicella, and MMR
Smallpox
high fever, fatigue, severe headache, rash (BEGINS of face and tongue, quickly spreads to trunk, arms, legs, hands, feet) then turns into pus-filled lesions, vomiting. Give: treatment - no cure, supportive care- hydration, pain meds, antipyretics. Prevention: vaccine (10 years of immunity)
The nurse should include altered immunity as a ___ ____ when discussing the epidemiological triangle
host factor
primary prevention
improves the health and well being of the community, making it less vulnerable to stressors; health promotion programs, programs that focus on protection from specific disease; usually nonspecific and directed toward raising the general healthy of the total community
Medicade provides:
in and outpatient hospital care. home health. radiology. vaccines for children. family planning. pregnancy-related care. screening. diagnosis. and treatment for young un's.
how to influence maternal health
increased access to prenatal care, to skilled birth attendants, and the prevention of teen and unplanned pregnancies
alcohol withdrawal
irritability, tremors, nausea, vomiting, headaches, diaphoresis, anxiety, sleep disturbances, tachycardia, elevated blood pressure. Use benzodiazepines for symptoms.
In Community-based nursing VS Community-oriented nursing, community-based nursing involves
management of acute and chronic conditions of individuals and individual families in a community setting
Tertiary Prevention
maximize recovery after injury or illness -rehab, nutrition counseling, exercise rehab, case maangement, physical and OT, support groups, exercise for hypertensive clients
Osteoarthritis Education
need to get 8-10 hours of sleep nightly and 1-2 hours during the day. -weight loss can reduce severity of disease -hot shower or bath may help with pain -exercise daily. on high pain days limits reps
Substance Use Disorders
negatively affect family, public safety and economy. dependence: pattern of pathological, compulsive disorders involving physiological and psych dependence -denial= defensive, lying, minimizing use, blaming, intellectualizing -health probs involved: low birth weight, congenital abnormalities, accidents, homicides, suicides, chronic disease, violence ALCOHOL: most commonly used substance, depressant. tolerance. withdrawal= irritable, tremors, nausea, vomit, headache, sweating, anxiety, sleep disturb, tachycardia, hypertension (determine when last drink was) TOBACCO: nicotine is stimulant= alertness & energy, tolernace Stimulants-caffeine, amphetamines, meth, cocaine Depressants: barbiturates, benzos, chloral hydrate, GHB Opiates: morphine, heroin, codeine, fentanyl Hallucinogens: LSD, PCP, ecstasy Inhalants: huffede
nonmaleficence
no harm is done when applying standards of care
Pneumonic Plague
no precautions other than protective.
The home health nurse must evaluate the living environment for safety, paying close attention to
nonsecure rugs, electrical outlets, and extension cords; the use of oxygen; safety devices in the bathroom; and other potential environmental hazards
Mortality rate:
number of deaths divided by population total X 1,000=number per 1,000
Crude mortality rate
number of deaths divided by the population total
prevalence
number of existing cases in population at a specific time
incident
number of new cases in population at a specific time
Incidence
number of new cases of disease
Medicare
older than 65 and receiving social security, have been receiving disability benefits for 2 years, have amytrophic lateral sclerosis, and receive disability benefits, or have kidney failure and be on maintenance dialysis or had a kidney transplant to qualify. Part A - hospital care, home care, limited skilled nursing care Part B - medical care, diagnostic services, physiotherapy Part C - Medicare advantage plan - is a combo of Part A and Part B and is provided through a private insurance company Part D - Prescription drug coverage
summarize (community analysis)
once categorization method has been selected, the next task is to summarize the data within each category; both summary statements and summary measures, such as rates, charts, and graphs, are required
Discharge Planning
ongoing assessment to anticipate future needs. communication between client, nurse, provider, family. enhance the wellbeing of the client by establishing optinos for meeting health care needs. -begins at admission
Community Forum
open public meeting -opportunity for community input w. minimal cost -weakness: dif finding place and time, potential to drift from issue, challenge to get adequate participation, less vocal person may not speak
Community forum
open public meeting Strengths: community input Limitations: challenging to get participation
Hep. A
oral fecal. treat with immunoglobulin and vaccine.
The nurse manager should include lighting as a ______ when discussing work-related illness and injury
physical agent
The nurse manager should include noise as a ______ when discussing work-related illness and injury
physical agent
Task Force On Community Prevention Services
place and works to provide evidence baed findings and recommendations about a variety of community preventive services programs and policies to prevent morbidity and mortality
social welfare policy
policy that promotes the welfare of the public; child labor laws and income assistance (social security)
exacerbation of asthma in kids
pollutants reduce lung function by inflaming the lining of the lungs; exposure to pollutants in the air can cause flare-ups and may increase the chance of upper respiratory infections, which can worsen asthma symptoms. If allergens in the air are an asthma trigger, pollutants can make the lungs even more sensitive to them.
Core Functions Project (U.S. Public Health Service)
population based public health programs support the goals of providing a foundation for clinical prevention services.
public health nursing
population focused, community oriented, health and prevention focus, interventions are made at the community or population level, there is a concern for the health of the population/ community, particularly vulnerable subpopulations
what is the focus of a public health nurse:
populations and communities. confidentiality is a big concern. speak in abstract terms.
Cultural factors
positions, roles, history, values, customs, norms, religion
Cultural factors:
positions, roles, history, values, customs, norms, religion.
Thiazide diuretics, such as hydrochlorothiazide (Microzide), inhibit water and sodium reabsorption, and increase _______excretion
potassium
Health Belief Model
predict or explain health behaviors -assumes that preventive health behaviors are taken primarily for the purpose of avoiding disease -emphasizes change at individual level -describes likelihood of taking an action to avoid disease based on: susceptibility, seriousness, threat of disease -modifying factors, cues to actions, perceived benefits minus perceived barriers to taking action
Ethical Considerations
prevent harm, promote good, respect individual and community rights, autonomy and diversity, promote confidentiality, competency, trustworthiness, advovacy -protect, promote, preserve and maintain good and prevent harm -balance indivdual rights vs. community groups -address challenges of autonomy and provide ethical care. right to info disclosure, privacy and informed consent, info confidentiality and participate in treatmnet decisions
Primary prevention
prevent the occurrence of infectious disease, educate the public regarding the need for immunizations, counsel clients traveling to other countries about protection from infectious disease. Refer to immunizations.
In *community-oriented nursing practice* the nurse provides health with the purpose of
preventing diseases and disability and promoting protecting and maintaing health to create conditions in which people can be healthy
public health emphasis
prevention of disease and prevention
Discussing stress reduction techniques with employees at an industrial site is a __________prevention strategy.
primary
Implementing age-appropriate injury prevention programs for each grade level is a________prevention activity
primary
Placing posters with images of appropriate hand hygiene near restrooms is a ______prevention strategy
primary
Providing support programs for new parents is a ________prevention strategy.
primary
The nurse is using ________ prevention when providing influenza immunizations to employees at a local preschool
primary
Community health nursing practice
promote, preserve and maintain health of populations by delivery of health services to individuals, families and groups in order to impact "community health"
Foundations of Community Health Nursing
provide the basis for care of the community and family. principles guide nurses in providing high quality care.
medical and hospital records (epidemiology data)
provide valuable information for community health research; but do not provide a completely representative or valid picture of community health
national electronic disease surveillance system (epidemiology data)
provides an integrated surveillance system that transmits public health laboratory and clinical data via the Internet; improves the nations ability to identify and track emerging infectious diseases and potential bioterrorism attacks--aids in surveillance and analysis of notifiable diseases (CDC)
world health organization
provides daily information regarding the occurrence of internationally important diseases. Establishes world standards for antibiotics and vaccines. Primarily focuses on health care workforce and education, environment, sanitation, infectious diseases, maternal and child health, and primary care.
School nurse: consultant:
provides professional health information.
Goals of Healthy People 20/20
provides science-based, 10 year national objectives for promoting health and preventing disease--1) to eliminate preventable disease, disability, injury, and premature death; 2) to achieve health equity, eliminate disparities, and improve the health of all groups; 3) to create social and physical environments that promote good health for all; and 4) to promote healthy development and healthy behaviors across every stage of life
The nurse manager should include stress as an outcome of __________when discussing work-related illness and injury
psychological agents
population heaht vs. public health
public health is a cure population health that focuses on determinants of health in communities, preventive interventions and education, and individual and collective health advocacy. population health broad set of concerns rather than on just these specific activities.
Example of Primary Prevention
public health nurse develops a health education program for a population of school age children that teaches them about the effects of smoking cessation on health
Health belief model
purpose is to predict or explain health behaviors. Preventative health to avoid disease. Emphasizes change at the individual level.
active surveillance
purposeful, ongoing search for new cases of disease by public health personnel
Tolerance to nicotine does develop
quickly.
policy development
refers to the need to provide leadership in developing policies that support the health of the population including the use of the scientific base making decisions about policy
epidemic
refers to the unexpected increase of an infectious disease in a geographic are over an extended period of time
outbreak
refers to the unexpected occurrence of an infectious disease in a limited geographic area during a limited period of time
epidemiological triangle
relationships among an agent, a host, and an environment
Factors influenced by an individual's culture (note: not a comprehensive list)
religious preferences, family structure, food patterns, health practices and interactions
autonomy
respecting a client's right to self-determination (making a decision not to pursue chemo)
Portals of entry
respiratory passages, GI, Skin, mucous membranes, genitourinary tract, eyes, blood vessels
Portals of exit
respiratory secretions, feces, blood, semen, vaginal secretions, saliva, skin lesion exudates
Referrrals
restoring, maintaining or promoting health. linking client with community and self care measures -health care services: physicians, acute care, primary care, health departments, ling term, home care, rehab, PT< OT, specialty services, pharmacy -support: psych, church, support groups, life care planner, med equipment provider, meal delivery, transportation -engage in a relationship, establish referral, resources, accept decision to use a resource, facilitate referral, evaluate outcome -BARRIERS: lack of motivation, inadequate info or understanding, accessibility, priorities, finances, culture. attitudes of healt hcare personnel, cost, physical accessibility, time limitiations, limited expertise
Category B biological agents
second-highest priority because they are moderately easy to disseminate and have high morbidity(disease) rates and low mortality (death) rates. Ex: typhus and cholera
Routinely checking students for pediculosis throughout the school year is a _________ prevention strategy
secondary
Screening a client whose spouse recently died for suicide risk is a _________prevention strategy
secondary
Consultant
specialized knowledge who provides expert advice, services, or information. -seek expertise from health care professionals -seek expertise from health care professionals -seek expertise of other nurses -incorporate recommendations from a consultant -coordinate recommendations from multiple consultants -serve as expert witness -serve as a consultant regarding the health care needs of individuals
microeconomics
the branch of economics that studies the economy of consumers or households or individual firms; the behavior of individuals and organizations & how this effects prices, costs and resources; behaviors that result from tradeoffs in the use of service and budget limits
The case manager must be proactive for the client, balancing the impact of the illness against
the cost of care. Increased knowledge of disease processes promotes early intervention and facilitates transition from acute to community-based care
Disability
the degree of observable and measurable impairment
global burden of disease
the disability-adjusted life year (DALY), which is a time-based measure combining years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health
Principalism
the dominant approach to ethical decision making. principles of respect for autonomy, nonmaleficience, beneficience & distributive justice
reservoirs
the environment in which a pathogen lives and multiplies
human capital
the knowledge and skills that workers acquire through education, training, and experience
Contracting
the negotiation of a cooperative working agreement between the nurse and client that is continuously renegotiated
incidence
the number of people in a population who develop the condition during a specified period of time (number of new cases over a period of time; rate: (# of new cases of disease/total population at risk)x100,000
Advocacy
the nurse plays the role of informer, supporter, and mediator for the client. Clients are responsible for their own health.
HbA1c is the best indicator of the average blood glucose level for
the past 120 days. It assists in evaluating treatment effectiveness and compliance.
host susceptibility
the presence or lack of sufficient resistance to an infectious agent to avoid prevent contracting an infection or acquiring infectious disease
Morality
the principle of right & wrong based on social and generational experiences
Rehabilitation
the process of learning to live to one's maximum potential with a chronic impairment and its resultant functional disability
An epidemic is when
the rate of disease exceeds the usual level of the condition in a defined population
client advocacy
the role of informer, supporter, and mediator for client
The environment
the setting or surrounding that sustains the host (place of transmission: daycare, body of water, country
indirect transmission
the spread of infection through a vehicle of transmission outside the host
passive immunity
the temporary resistance that has been donated to the host through transfusions of plasma proteins, immunoglobulins, and antitoxins, or transplacentally from mother to neonate
Handicap
the total adjustment to disability that limits functioning at a normal level
prevalence
the total number of people in the population who have the condition at a particular time; rate: (# of existing cases of disease/# of in total population)x100,000
What is substance abuse?
the use of any substance (including legal and prescribed) that threatens an individual's health or social and economic functioning
Category C biological agents
third highest priority - comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce and/or have high potential for high morbidity and mortality rates Hantavirus
Category C biological agents
third-highest priority, emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. Ex: hantavirus
Hepatitis C is spread
through blood and body fluids. eat high carb.
Referrals
to assist in restoring, maintaining, or promoting health.
beneficence
to do good and max benefits
Precise terms to use in making goals and objectives measurable (learning objectives)
to identify; to discuss; to list; to compare and contrast; to state; to decrease by 20%
Environmental Risks
toxins (lead, pesticieds, mercury, solvents, asbestos, radon) -air pollution -water pollution
Passive immunity
transfer of antibodies to the host either transplacentally from mother to newborn, or through transfusions of immunoglobulins, plasma proteins, or antitoxins
subjective data for stroke
transient symptoms, such as visual disturbances, dizziness, slurred speech, and a weak extremity
Ch 7: Continuity of Care
transition from inpatient to outpatient. use technology to maintain care. partnerships essential in improving health. among individuals, families, community agencies, citizen groups -partnering entities: individual, family, community agency, civic organization, citizen group, educational setting, political office, employment bureau -successful parternship: shared power and goals, integrity, flexibility, negotiation
Tactile-kinesthetic learners learn through "doing" and methods such as
trial and error, hands-on approaches, and return demonstration. These learners gain "meaning through exploration."
Referrals
typically based on medical diagnosis or other relevant clinical information assist in restoring, maintaining or promoting health
Homelessness
unemployed, low wage, migrant workers, female heads of house, families with children, people with mental illness, veterans, substance use and addictive disorders, unaccompanied youth, runaways, intimate partner violence abuse, HIV/AIDs, older adults with no place to go -health issues: upper resp disorders, TB, skin disorders, substance use disorders, HIV/ AIDS, trauma, mental illness, dental caries, hypothermia, malnutrition
Populations at risk for Communicable diseases
young children, older adults, immunosuppressed clients, clients who have a high-risk lifestyle, international travelers, health-care workers
Subjective data for MI
◯ Anxiety, feeling of impending doom ◯ Chest pain (substernal or precordial) ■ Pain can radiate down the shoulder or arm, or may present in the form of jaw pain. ■ Pain may be described as a crushing or aching pressure. ◯ Nausea ◯ Dizziness
Nightingale's Theory
-highlights relationship between an individual's environment and health -depicts health as a continuum -emphasizes preventive care
Role-performance Model
ABLE TO DO JOB Medical sociology, work of Parsons. Person is healthy if they can perform their job. Shapes health policies of military, industry. Limited since one person may have many roles.
Steps in Teaching/Learning Process
ADDIE Assessment Development of outcomes Development of teaching plan Implementation of teaching plan Evaluation of outcomes (did it work?)
Transmission of Communicable Disease
AIRBORNE: measles, chickenpox, TB, pertussis, influenza FOODBORNE: salmonella, hep A, trichinosis, E coli staph, c dif WATERBORNE: (fecal contram of water) cholera, typhoid fever, bacillary dysentery, giardia VECTOR: lyme disease, rocky mountain spotted fever, malaria --> lyme appears as a erythematous ring with a white center, mild fever, fatigue, muscle aches DIRECT CONTACT: STI, mono, pinworm, impetigo, lice, scabies
Telehealth physical data
BP, weight, Blood O2, Blood glucose, HR, temp, ECG results
Cognitive Domain
BRAIN memory, recognition, understanding, application, problem solving.
Is it easy or hard to balance individual and community rights?
Balancing individual rights vs rights of community groups is a challenge.
As you go to Glenda's home for the first time, describe how you will set boundaries for the nurse-client relationship.
Because nurses are invited into homes they must realize they are guests. The environment belongs to the client, who retains control. If the client has had home health before, he/she has a clearer picture of your role in their care, but if they have not, you will need to "set the stage" for your visits. Some ways to do this: ask the client what days and times are most convenient for them. As much as possible, work around these times—be on time! Help the client understand what you will be doing each visit, and why. Involve family members who will be jointly caring for client. Allow client to ask questions, and provide a contact number for you should they need to contact you. It is important to specify when they can use that contact #, so that calls are appropriate.
Disaster recovery
Begins when danger no longer exists and needed representatives and agencies are available to assist with rebuilding. Communicable disease and sanitation are important aspects of disaster recovery.
What are the 6 learning theories used in CHN?
Behavioral theory Cognitive theory Critical theory Developmental theory Humanistic theory Social learning theory
Family health appraisals include
Biological risk assessment (genograms, genetic diseases), Environmental risks (including support systems) behavioral risks ( health values, and health perceptions)
A nurse is discussing normal uncomplicated grief with a client who recently lost a child. Which of the following statements made by the client requires additional intervention? A. "I may experience feelings of resentment." B. "I may withdraw from others." C. "It is possible to experience changes in sleep." D. "It is possible to experience suicidal thoughts."
D. "It is possible to experience suicidal thoughts."
Why do nurses regularly provide health education?
In order to promote, maintain, and restore the health of populations
What are some of the epidemiological calculations?
Incidence Prevalence Crude mortality rate Infant mortality rate Attack rate
-What does epidemiology rely on to determine there rate of spread of disease and the proportion of people affected? -What is it also used to evaluate?
It relies on statistical evidence to determine the rate of spread of disease and the proportion of people affected. -It is also used to evaluate the effectiveness of disease prevention and health promo activities and to determine the extent to which goals have been met.
NCQA
National Committee for Quality Assurrance
Components of a Community Assessment Place or environment
Physical factors - Geography, terrain, type of community, location of health services, housing, animal control Environmental factors - Geography, climate, flora, fauna, topography, toxic substances, vectors, pollutants
What are some primary prevention strategies for homelessness?
Prevent individuals and families from becoming homeless by assisting them in eliminating factors that may contribute to homelessness. ■■ Refer those with underlying mental health disorders to therapy and counseling. ■■ Enhance parenting skills that may prevent young people from feeling the need to run away.
Mental health prevention
Primary- educate populations regarding mental health issues, teach stress-reduction techniques, parenting classes. Secondary- screen to detect mental health disorders, conduct crisis intervention Tertiary- medication monitoring, interventions, referrals
Prevention
Primary- increasing public awareness Secondary- identify at risk individuals and assist them to reduce sources of stress. screen for substance use. Tertiary- refer client to community groups, AA. Provide emotional abusers including positive reinforcement.
Levels of Communicable Disease Prevention
Primary: prevent disease spread, education on immunization, travel to other countries, hand hygiene and precautions Secondary: increase screening and case finding, refer cases for diagnostic findings, provide post exposure prophylaxis, quarantine clients Tertiary: decrease complications and disabilities of disease, monitor treatment, identify community resources
Assessment and Diagnosis: What further assessment of the client's home is necessary? Based on the information provided, what is the immediate priority diagnosis?
You immediately note hazardous conditions, so a thorough evaluation of the home is necessary to evaluate the presence of further hazards. Determine if the clients are aware these hazards pose a health risk. Determine if the client, spouse, or another person has experienced an injury related to the hazards. The priority diagnosis is Risk for Injury related to unsafe and hazardous conditions of the home.
A newly hired occupational health nurse at an industrial facility is performing an initial workplace assessment. Which of the following should the nurse determine when conducting a work site survey? a. Work practices of employees b. Past exposure to specific agents c. Past jobs of individual employees d. Length of time working in current role
a
A nurse at an urban community health agency is developing an education program for city leaders about homelessness. Which of the following should the nurse include as the fastest-growing segment of the homeless population? a. Families with children b. Adolescent runaways c. Intimate partner abuse victims d. Older adults
a
A nurse developing a community health program is determining barriers to community resource referrals. Which of the following is an example of a resource barrier? a. Costs associated with services b. Decreased motivation c. Inadequate knowledge of resources d. Lack of transportation
a
A nurse is advocating for local leaders to place a newly approved community health clinic in an area of the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which of the following ethical principles? a. Distributive justice b. Fidelity c. Respect for autonomy d. Veracity
a
A nurse is conducting a community assessment. Which of the following data collection methods is the nurse using when having direct conversations with individual members of the community? a. Key informant interviews b. Participant observation c. Focus groups d. Health surveys
a
TB transmission
airborne droplet. requires repeated close contact.
An example of primary prevention is: a. Pap smear b. Blood pressure screening c. Diet and exercise d. Physical therapy
c. Diet and exercise
population or aggregate
collection of individuals who have one or more personal or environmental characteristic in common - members of a community = geopgraphy
Focus Groups
directed talk with a rep sample -participants may be supporters, insight into community support, reading not required -limit: irrelevant issue discussion, challenging to get participants, requires strong facilitator, dif to ensure sample is truly representative of overall community, time consuming
Focus groups
directed talks with a representative sample of a community, and do not involve direct conversations with individual community members
tertiary prevention
nutrition counseling exercise rehab case management support groups exercise for HTN clients PT/OT
primary prevention
nutrition education family planning and sex ed smoking cessation educations prenatal classes immunizations safety educations
Diabetic risk factors
obesity, hypertension, inactivity, hyperlipidemia, cigarette smoking, genetic history, elevated C-reactive protein (CRP), ethnic group, and women who have delivered infants weighing more than 9 lb
Local health department
primary focus is the health of its citizens. offer various services and programs. Report notifiable communicable diseases to state departments of health. funded through local taxes with support from federal and state funds.
Occupational Health Nurse Role
primary prevention: teach good nutrition, provide immunization information, use protective equipment -secondary prevention: identify workplace hazards, early detection, prompt treatment, counsel and referral, prevent further limits -tertiary: restore health through rehab and strategies and limited duty programs
Bioterrorism Levels of Prevention
primary: prep with bioterrorism drill, vaccine, antibiotics, design plan, identify chain of command, nursing roles, protocol -secondary: recognize, activate response, implement infect control, screen population, assist with education on managmenet, monitor mortality and morbidity -tertiary:rehab survivors, monitor meds, evaluate effectiveness
Strategies for Improving Mental Health
primary: support, educate about mental health issues, teach stress reduction, parenting classes, coping abilities second: screen to detect disorder, crisis intervention tertiary: med monitoring, mental health intervention, referrals, maintain level of function to prevent relapse, assist in planning a regular lifestyle
population-focused practice
problems are defined by assessments or diagnoses) and solutions (interventions), such as policy development or providing a particular prevention service
Cultural Imposition
process of forcing ones cultural beliefs on others
environment
setting or surrounding that sustains the host
Recognize elder abuse
unexplained physical injuries, physical neglect, rejection of assistance by caregiver, financial mismanagement, withdrawal.
TB skin testing: false positive:
vaccination with BCG for up to 10 years after.
You are evaluating a new graduate in the home care setting. Which of the following statements made by the nurse would require further assessment of the problem prior to her next visit with the client? a. "I see that no one wears shoes in your home, so I will remove mine also." b. "Let's talk about your medications again before I leave to make sure you understand everything." c. "If you have problems while at home, you need to make sure you contact the agency before the office closes at the end of the day." d. "I am going to leave a detailed copy of all of the things we have covered today for you to review whenever you have time."
"If you have problems while at home, you need to make sure you contact the agency before the office closes at the end of the day." Rationale: Nursing practice in the home setting is a unique experience that differs in many ways from nursing practice in a hospital setting. Because clients and nurses most often meet during periods of vulnerability and crisis, the nurse provides a great deal of information; therefore the nurse should be well educated because the nurse is a great link between the client and the physician. The family and the client have support from the agency anytime needed because there is always someone to assist the client whenever necessary. If the new graduate tells the client that they can only notify the office during business hours, this is inaccurate, and will require more education with the graduate. Nursing Process: Evaluation Client Need: Physiological Integrity Cognitive Level: Application Objective: Compare and contrast the roles of the nurse providing home care with the roles of the nurse in medical-surgical nursing discussed in Chapter 1. Strategy: Use communication concepts and the process of elimination to make the correct selection.
Medicare Part C
"Medicare advantage plan" combination of A/B, provided through private insurance company
What is the focus of a hospice nurse?
- Enhancing quality of life through palliative care - Supporting pt. and family through dying process - Bereavement support to family
Areas Considered Essential for the Preparation of Specialists in Public Health Nursing
- Epidemiology - Biostatistics - Nursing theory - Management theory - Change theory - Economics - Politics - Public Health Administration - Community Assessment Program planning and evaluation Interventions at the aggregate level Research History of Public Health
Community Health Program Planning, Development, Management
-Preplan: brainstorm ideas, gain entry into community and trust, obtain awareness, coordinate collaborations -Assessment: collect data about community and members, complete a needs assessment, strengths and weaknesses, evaluate health data -Diagnosis: identify and prioritize health needs of community -Planning: develop interventions to meet identified outcomes -Implementation: carry out the plan -Evaluation: examine success of intervention (strengths and weaknesses, achievement, recommendations, share findings)
Environmental Health Nursing Interventions
-Primary: educate on reducing hazards, adovate for safe water and air, support programs for waste reduction -Secondary: survey for health conditions related to enviro, obtain enviro health history, monitor for chem exposure, screen kids 6 months - 5 years for blood lead levels. assess homes, schools, work sites, community -Tertiary: refer home owners to lead abatement resources, educate asthmatic clients about enviro triggers, become active in consumer and health orgs, support cleanup of toxic waste sites
-What are health indicators? -What are some examples? -What do they serve as targets for?
-Used to describe the health status of a community. -Health indicators- mortality rates, disease prevalence, levels of physical activity, obesity, tobacco and substance use -Serve as targets for the improvement of a community's health.
Health Care Orgs and Financing
-WORLD health org: provides infor about international disease, standards for vaccines and antibiotics. focus on health care workforce and education, environment, sanitation, infectious disease, maternal and child health -FEDERAL health agencies: US department of HHS, funded through taxes, includes admin for children and families, admin for community living, medicaid and medicare -agency for healthcare research and quality -CDC to prevent and control disease -agency for toxic substances and disease -FDA -Health resources and service admin -indian health services -national institute of health (biomedical research) -substance abuse and mental health services -veterans health admin to finance military persons -STATE HEALTH: manages WIC programs, children health insurance program, public health policies, assists local health dep, state board of nursing to oversee nurse practice act, licensure, states school of nursing -LOCAL HEALTH: health of citizens, identify community needs, report disease to state, local tax funding. office of emergency management responsible for emergency response plan -PRIVATE health: health insurance, employer benefits, managed care (HMOs, preferred provider orgs, medical savings)
Community Assessment: Individual, Family, Aggregates
-approach to emphasize community as a client, foundation for program planning -nurse helps to develop and implement strategies. assesses needs of community by interacting with community partners, witnessing interaction between community programs and response of clients to services, identifying future services based on visible needs of community members Community assessment includes: people (demographic, biologic factors, social factors, cultural factors -place or environment: physical factors, enviro factors -social systems: health, economic, education, religious, welfate, political, recreational, legal, communication, transportation, resources and services
Learning Theories in Community Health
-behavioral: reinforcement methods to change learners behaviors -cognitive: use sensory input and repetition to change learners patterns of thoughts and behaviors -critical theory: use ongoing discussion and inquiry to increase learners depth of knowledge and change thinking and behaviors -developmental theory: use techniques specific to learners developmental stages to determine readiness to learn and impart knowledge -humanistic theory: assist learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest -social learning: links info to beliefs and values to change or shift the learners expectations
Windshield Survey
-descriptive approach assessing several community components by driving through a community -descriptive overview of community: people, place, natural environment, boundaries, location of health services, man made environment, housing, social systems -need a driver, may be time consuming, only based on visual
Chapter 2: Factors Influencing Community Health
-family,culture, social and environmental factors, access to health care, financing -culture is the beliefs, values, attitudes and behviors shared by a group of people and transmitted -enviro health refers to influence of environment conditions of development of disease -access to care impacted by availability of services in a community, individual, family and community
Develop Community Health Education Plan
-identify population specific learning need -consider specific concerns and effect of health needs on population -select aspects of learning theories to use in educational program based on identified learning needs -identify barriers to learning and learning styles -design educational program: short and long term learning objectives, select apprpriate educational method based on learning objectives and assessment of participants learning style , content appropriate to objective, eval method -implement program -evaluate
Epidemiological calculation
-incidence: number new cases in population at a time/ population total x 1000 -prevalnce: number of existin cases in the population ata time / population total x 1000 -crude mortality rate: number of deaths / population total x 1000 -infant mortality rate: number of infants deaths before 1 year of age / number live births in same year x1000 -attack rate: number of people exposed to an agent who develop disease / total number of people exposed
Tracheostomy Care
-leave old ties in place until new ones are secured -use clean technique to clean inner cannula if placed over a month ago -place thumb over suction port to suction -insert catheter 5 cm into trach tube
health belief model
-predict or explain health behaviors -assumes that preventive health behaviors are taken primarily for the purse of avoiding disease -emphasizes change at the individual level
Public Health Nurse Roles
1.Monitor health status to identify community health problems. 2.Diagnose and investigate health problems and health hazards in the community. 3.Inform, educate, and empower people about health issues. 4.Mobilize community partnerships to identify and solve health problems. 5.Develop policies and plans that support individual and community health efforts. 6.Enforce laws and regulations that protect health and ensure safety. 7.Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8.Assure a competent public health and personal healthcare workforce. 9.Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 10.Research for new insights and innovative solutions to health problems.
The nurse is assessing the following clients. Which one of these clients in the clinic would be a candidate for a day care program? a. A client diagnosed with terminal cancer two weeks age with a poor Prognosis. b. A client who is bed bound after a recent fractured hip. c. A client who lives with her daughter and forgets to take her medications when her daughter is at work in the daytime. d. A client who has diabetes and needs to have her dressing changed to her left leg three times a week.
A client who lives with her daughter and forgets to take her medications when her daughter is at work in the daytime. Rationale: Day care programs, such as senior centers, are usually located where people gather for social, nutritional and recreational purposes. They may provide care for older adults with physical disabilities or mild Alzheimer's disease while family caregivers are at work. These programs vary among communities. Meals may also be provided at a low cost. Nursing Process: Evaluation Client Need: Safe; Effective Care Environment Cognitive Level: Analysis Objective: Provide client care in community-based settings and the home. Strategy: Use nursing knowledge and the process of elimination to make the correct selection.
A nurse is teaching a client about stress-reduction techniques. Which of the following client statements indicates understanding of the teaching? A. "Cognitive reframing will help me change my irrational thoughts to something positive." B. "Progressive muscle relaxation uses a mechanical device to help me gain control over my pulse rate." C. "Biofeedback causes my body to release endorphins so that I feel less stress and anxiety." D. "Mindfulness allows me to prioritize the stressors that I have in my life so that I have less anxiety."
A. "Cognitive reframing will help me change my irrational thoughts to something positive."
A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "I can promote my client's sense of control by establishing a schedule." B. "Self-assessment will help me cope with emotional reactions to client care." C. "I should practice limit-setting to help prevent client manipulation." D. "Maintaining professional boundaries is a priority of client care."
A. "I can promote my client's sense of control by establishing a schedule."
A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? A. "I'm scared that you're going to leave me." B. "I'll go to group therapy if you'll let me smoke." C. "I need to feel that everyone admires me." D. "I sometimes feel better if I cut myself."
A. "I'm scared that you're going to leave me."
A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? A. "Life isn't worth living if I gain weight." B. "Don't pretend like you don't know how fat I am." C. "If I could be skinny, I know I'd be popular." D. "When I look in the mirror, I see myself as obese."
A. "Life isn't worth living if I gain weight."
A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to this client? A. "Stop screaming, and walk with me outside." B. "Why are you so angry and screaming at everyone?" C. "You will not get your way by screaming." D. "What was going through your mind when you started screaming?
A. "Stop screaming, and walk with me outside."
A nurse is caring for a client who has acute stress disorder and is experiencing severe anxiety. Which of the following statements by the nurse is appropriate? A. "Tell me about how you are feeling right now." B. "You should focus on the positive things in your life to decrease your anxiety." C. "Why do you believe you are experiencing this anxiety?" D. "Let's discuss the medications your provider is prescribing to decrease your anxiety."
A. "Tell me about how you are feeling right now."
A charge nurse is discussing mirtazapine (Remeron) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A. "This medication increases the release of serotonin and norepinephrine." B. "I will need to monitor the client for hyponatremia while taking this medication." C. "This medication is contraindicated for clients who have an eating disorder." D. "Sexual dysfunction is a common adverse effect of this medication."
A. "This medication increases the release of serotonin and norepinephrine."
A nurse is providing teaching to a client who has a new prescription for carbamazepine (Tegretol). Which of the following should the nurse include in the teaching? A. "This medication will help prevent seizures during alcohol withdrawal." B. "Taking this medication will decrease your cravings for alcohol." C. "This medication maintains your blood pressure at a normal level during alcohol withdrawal." D. "Taking this medication will improve your ability to maintain abstinence from alcohol."
A. "This medication will help prevent seizures during alcohol withdrawal."
A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions are appropriate for the nurse to include in the assessment? (Select all that apply.) A. "What is your relationship like with your family?" B. "Why do you want to lose weight?" C. "Would you describe your current eating habits?" D. "At what weight do you believe you will look better?" E. "Can you discuss your feelings about your appearance?"
A. "What is your relationship like with your family?" C. "Would you describe your current eating habits?" E. "Can you discuss your feelings about your appearance?"
A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements by the nurse are appropriate? (Select all that apply.) A. "When did you start hearing the voices?" B. "The voices are not real, or else we would both hear them." C. "It must be scary to hear voices." D. "Are the voices telling you to hurt yourself?" E. "Why are the voices talking to only you?"
A. "When did you start hearing the voices?" C. "It must be scary to hear voices." D. "Are the voices telling you to hurt yourself?"
A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the nurse notes that the lithium blood level is 1.2 mEq/L. Which of the following is an appropriate action by the nurse? A. Administer the next dose of lithium carbonate as scheduled. B. Prepare for administration of aminophylline. C. Notify the provider for a possible increase in the dosage of lithium carbonate. D. Request a stat repeat of the client's lithium blood level.
A. Administer the next dose of lithium carbonate as scheduled.
A nurse is caring for an adult client who is the victim of intimate partner abuse. The client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? A. Advise the client about the location of women's shelters. B. Encourage the client to participate in a support group for victims of abuse. C. Implement case management to coordinate community and social services. D. Educate the client about the use of stress management techniques.
A. Advise the client about the location of women's shelters.
A nurse working in an acute mental health facility is caring for a 35-year-old female client who has clinical findings of depression. The client lives at home with her husband and two young children. She currently smokes and has a history of chronic asthma. The nurse should identify which of the following as risk factors for depression for this client? (Select all that apply.) A. Age of 35 years old B. Female gender C. History of chronic asthma D. Currently smokes E. Being married
A. Age of 35 years old B. Female gender C. History of chronic asthma D. Currently smokes
A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following should the charge nurse identify as being effectively treated by conventional antipsychotics? (Select all that apply.) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia
A. Auditory hallucinations C. Delusions of grandeur D. Severe agitation
A nurse is caring for a client who has a new prescription for disulfiram (Antabuse) for the treatment of his alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol. This form of treatment is an example of which of the following? A. Aversion therapy B. Flooding C. Biofeedback D. Dialectical behavior therapy
A. Aversion therapy
A nurse is obtaining a health history from the parents of a 12-year-old client who has conduct disorder. Which of the following are expected findings? (Select all that apply.) A. Bullying of others B. Threats of suicide C. Law-breaking activities D. Narcissistic behavior E. Flat affect
A. Bullying of others B. Threats of suicide C. Law-breaking activities
A nurse is planning care for the termination phase of a nurse-client relationship. Which of the following actions is appropriate to include in the plan of care? A. Discussing ways to use new behaviors B. Practicing new problem-solving skills C. Developing goals D. Establishing boundaries
A. Discussing ways to use new behaviors
A nurse is assessing a client who is suicidal. Which of the following is appropriate for the nurse to ask the client? (Select all that apply.) A. Do you have a plan? B. Have you thought about hurting yourself? C. Do you feel that life is not worth living? D. Why do you want to commit suicide? E. Have you experienced a recent change in your mood?
A. Do you have a plan? B. Have you thought about hurting yourself? C. Do you feel that life is not worth living? E. Have you experienced a recent change in your mood?
A nurse observes a client who is pacing and wringing his hands. The client states, "I don't know why, but I've worried every day for over a year that my son will die a horrible death." The nurse identifies that this finding is consistent with which of the following disorders? A. Generalized anxiety disorder B. Panic disorder C. Posttraumatic stress disorder D. Acute stress disorder
A. Generalized anxiety disorder
A nurse working on an acute mental health unit is caring for a client who has posttraumatic stress disorder (PTSD). Which of the following is an expected finding? (Select all that apply.) A. Hallucinations B. Obsessive need to talk about the traumatic event C. Exaggerated displays of emotion D. Recurring nightmares E. Diminished reflexes
A. Hallucinations D. Recurring nightmares
A nurse is working with a client who has recently lost his mother. The nurse recognizes that which of the following factors influence grief and coping ability? (Select all that apply.) A. Interpersonal relationships B. Culture C. Birth order D. Size of family E. Prior experience with loss
A. Interpersonal relationships B. Culture E. Prior experience with loss
A nurse is told during change-of-shift report that a client is stuporous. When assessing the client, which of the following is an expected finding? A. The client arouses briefly in response to a sternal rub. B. The client has a Glasgow Coma Scale score less than 7. C. The client exhibits decorticate rigidity. D. The client is alert but disoriented to time and place.
A. The client arouses briefly in response to a sternal rub. .
A nurse is teaching a client who has a new prescription for imipramine (Tofranil) how to minimize anticholinergic effects. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Void just before taking the medication. B. Increase the dietary intake of potassium. C. Wear sunglasses when outside. D. Change positions slowly when getting up. E. Chew sugarless gum.
A. Void just before taking the medication. C. Wear sunglasses when outside. E. Chew sugarless gum.
A nurse manager at a community agency is developing an orientation program for newly hired nurses. When discussing the differences between community-based and community-oriented nursing, the nurse should include which of the following as examples of community-based nursing? (Select all that apply.) A. A home health nurse performing wound care for a client who is immobile. B. An occupational health nurse providing classes on body mechanics at a local industrial plant. C. A school nurse teaching a student who has asthma about medications. D. A parish nurse teaching a class on low-sodium cooking techniques. E. A mental health nurse discussing stress mgmt. techniques with a support group.
Answer: A and C. A: Correct- community based nursing involves mgmt. of acute and chronic conditions in a community setting B: Incorrect- this is community-oriented nursing, which involves health care of individuals, families, and groups to improve the collective health of the community. C: Correct- community based nursing involves mgmt. of acute and chronic conditions in a community setting D: Incorrect- this is community oriented nursing E: Incorrect- this is community oriented nursing
A nurse is assessing a client immediately following an electroconvulsive therapy (ECT) procedure. Which of the following are expected findings? (Select all that apply.) A. Hypotension B. Paralytic ileus C. Memory loss D. Nausea E. Tachycardia
C. Memory loss D. Nausea E. Tachycardia
A nurse is caring for a client in restraints. Which of the following statements are appropriate documentation? (Select all that apply.) A. "Client ate most of his breakfast." B. "Client was offered 8 oz of water every hr." C. "Client shouted at assistive personnel." D. "Client received chlorpromazine (Thorazine) 15 mg by mouth at 1000." E. "Client acted out after lunch."
B. "Client was offered 8 oz of water every hr." C. "Client shouted at assistive personnel." D. "Client received chlorpromazine (Thorazine) 15 mg by mouth at 1000." E. "Client acted out after lunch."
A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following is an appropriate response by the nurse? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate."
B. "I am here to provide care and cannot accept this from you."
A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization? A. "I am a superhero and am immortal." B. "I am no one, and everyone is me." C. "I feel monsters pinching me all over." D. "I know that you are stealing my thoughts."
B. "I am no one, and everyone is me."
A nurse is providing teaching to a client who has a new prescription for amitriptyline (Elavil). Which of the following client statements indicates understanding of the teaching? A. "While taking this medication, I'll need to stay out of the sun to avoid a skin rash." B. "I may feel drowsy for a few weeks after starting this medication." C. "I cannot eat my favorite pizza with pepperoni while taking this medication." D. "This medication will help me lose the weight that I have gained over the last year."
B. "I may feel drowsy for a few weeks after starting this medication."
A charge nurse is discussing transcranial magnetic stimulation (TMS) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "TMS is indicated for clients whose depression is not relieved by medication." B. "I will provide postanesthesia care following TMS." C. "TMS is usually performed as an outpatient procedure." D. "I will schedule the client for daily TMS treatments for the first several weeks."
B. "I will provide postanesthesia care following TMS."
A nurse is caring for a client who is on lithium therapy. The client states that he wants to take ibuprofen for osteoarthritis pain relief. Which of the following statements by the nurse is appropriate? A. "That is a good choice. Ibuprofen does not interact with lithium." B. "Regular aspirin would be a better choice than ibuprofen." C. "Lithium decreases the effectiveness of ibuprofen." D. "The ibuprofen will make your lithium level fall too low."
B. "Regular aspirin would be a better choice than ibuprofen.
A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy? A. "Even if my anxiety improves, I will need to continue this therapy for 6 weeks." B. "The therapist will focus on my past relationships during our sessions." C. "Psychoanalysis will help me reduce my anxiety by changing my behaviors." D. "This therapy will address my conscious feelings about stressful experiences."
B. "The therapist will focus on my past relationships during our sessions."
A nurse is evaluating a client's understanding of a new prescription for clonidine (Catapres). Which of the following statements by the client indicates an understanding of the teaching? A. "Taking this medication will help reduce my craving for heroin." B. "While taking this medication, I should keep a pack of sugarless gum." C. "I can expect some diarrhea because of taking this medicine." D. "Each dose of this medication should be placed under my tongue to dissolve."
B. "While taking this medication, I should keep a pack of sugarless gum."
A nurse is caring for a client who has Alzheimer's disease and is beginning to experience noticeable short-term memory loss. When discussing a new prescription for donepezil (Aricept), the nurse should include which of the following in the teaching? A. "You should avoid taking over-the-counter acetaminophen while on donepezil." B. "You can expect the progression of cognitive decline to slow with donepezil." C. "You will be screened for underlying kidney disease prior to starting donepezil." D. "You should stop taking donepezil if you experience nausea or diarrhea."
B. "You can expect the progression of cognitive decline to slow with donepezil."
A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (ACT) group? A. A client in an acute care mental health facility who has fallen several times while running down the hallway B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia C. A client in a day treatment program who says he is becoming more anxious during group therapy D. A client in a weekly grief support group who says she still misses her deceased husband who has been dead for 3 months
B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia
A nurse is teaching a school-age child and his parents about a new prescription for lisdexamfetamine dimesylate (Vyvanse). Which of the following is appropriate for the nurse to include in the teaching? (Select all that apply). A. An adverse effect of this medication is CNS depression. B. Administer the medication right before breakfast. C. Monitor blood pressure while taking this medication. D. Therapeutic effects of this medication will take 1 to 3 weeks to fully develop. E. This medication blocks the effects of dopamine in the brain.
B. Administer the medication right before breakfast. C. Monitor blood pressure while taking this medication.
A nurse is speaking with a client who has schizophrenia when he suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to himself. Which of the following actions should the nurse take? A. Stop the interview at this point, and resume later when the client is better able to concentrate. B. Ask the client, "Are you seeing something on the ceiling?" C. Tell the client, "You seem to be looking at something on the ceiling. I see something there, too." D. Continue the interview without comment on the client's behavior.
B. Ask the client, "Are you seeing something on the ceiling?"
A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (Select all that apply.) A. Lethargy B. Defensive responses to questions C. Disorientation D. Rapid breathing E. Facial grimacing F. Agitation
B. Defensive responses to questions D. Rapid breathing E. Facial grimacing F. Agitation
A nurse is planning group therapy for clients dealing with bereavement. Which of the following should the nurse include in the initial phase? (Select all that apply.) A. Encourage the group to work toward goals. B. Define the purpose of the group. C. Discuss termination of the group. D. Identify informal roles of members within the group. E. Establish an expectation of confidentiality within the group.
B. Define the purpose of the group. C. Discuss termination of the group. E. Establish an expectation of confidentiality within the group.
A nurse is caring for a client who smokes and has lung cancer. The client reports, "I'm coughing because I have that cold that everyone has been getting." Which of the following defense mechanisms is the client using? A. Reaction formation B. Denial C. Displacement D. Sublimation
B. Denial
A charge nurse is reviewing Kübler-Ross: Five Stages of Grief with a group of newly licensed nurses. Which of the following should the charge nurse include in the teaching? (Select all that apply.) A. Endurance B. Denial C. Bargaining D. Anger E. Depression
B. Denial C. Bargaining D. Anger E. Depression
A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Use caffeine in moderation to prevent relapse. B. Difficulty sleeping can indicate a relapse. C. Begin taking your medications as soon as a relapse begins. D. Participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.
B. Difficulty sleeping can indicate a relapse. D. Participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.
A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply.) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing
B. Drooling C. Involuntary arm movements E. Continual pacing
A nurse is performing an admission assessment for a client who has delirium related to an acute urinary tract infection. Which of the following are expected findings? (Select all that apply.) A. History of gradual memory loss B. Family report of personality changes C. Hallucinations D. Unaltered level of consciousness E. Restlessness
B. Family report of personality changes C. Hallucinations E. Restlessness
A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following is an expected finding? (Select all that apply.) A. Bradycardia B. Fine tremors of both hands C. Hypotension D. Vomiting E. Restlessness
B. Fine tremors of both hands D. Vomiting E. Restlessness
A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine (Prozac). Which of the following findings should the nurse report to the provider as an indication of serotonin syndrome? (Select all that apply.) A. Hypothermia B. Hallucinations C. Muscular flaccidity D. Diaphoresis E. Agitation
B. Hallucinations D. Diaphoresis E. Agitation
A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (Select all that apply.) A. Amenorrhea B. Hypokalemia C. Mottling of the skin D. Slightly elevated body weight E. Presence of lanugo on the face
B. Hypokalemia D. Slightly elevated body weight
A nurse working in an emergency department is caring for a client who has bezodiazepine toxicity due to an overdose. Which of the following is the priority nursing action? A. Administer flumazenil (Romazicon) B. Identify the client's level of orientation C. Infuse IV fluids D. Prepare the client for gastric lavage
B. Identify the client's level of orientation
A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following is the highest priority action? A. Respect the client's need for personal space. B. Identify the client's perception of her mental health status. C. Include the client's family in the interview. D. Teach the client about her current mental health disorder.
B. Identify the client's perception of her mental health status.
A nurse is caring for a client on an acute mental health unit. The client reports hearing voices that are telling her to "kill your doctor." Which of the following is the priority action for the nurse to take? A. Use therapeutic communication to discuss the hallucination with the client. B. Initiate one-to-one observation of the client. C. Focus the client on reality. D. Notify the provider of the client's statement.
B. Initiate one-to-one observation of the client.
A nurse is preparing a community education seminar about family violence. When discussing the types of violence, the nurse should include which of the following? A. Refusing to pay bills for a dependant, even when funds are available, is neglect. B. Intentionally causing an older adult to fall is an example of physical violence. C. Striking an intimate partner is an example of sexual violence. D. Failure to provide a stimulating environment for normal development is emotional abuse.
B. Intentionally causing an older adult to fall is an example of physical violence.
A nurse is reviewing a newly admitted client's medical record. Which of the following documents is a directive for medical treatment based on the client's wishes? A. Advance directives B. Living will C. Informed consent D. Durable power of attorney for health care
B. Living will
A nurse is conducting a family therapy session. The adolescent son tells the nurse that he plans ways to make his sister look bad so his parents will think he's the better sibling, which he believes will give him more privileges. The nurse should identify this dysfunctional behavior as which of the following? A. Placation B. Manipulation C. Blaming D. Distraction
B. Manipulation
A nurse is conducting chart reviews of multiple clients at a community mental health facility. Which of the following would be an example of client experiencing a maturational crisis? A. Rape B. Marriage C. Severe physical illness D. Job loss
B. Marriage
A nurse is obtaining informed consent for a client who has just learned she must have a breast biopsy. The client is perspiring and pale, has a respiratory rate 30/min, and says, "I don't quite understand what you're trying to tell me." The nurse should assess the client's anxiety as which of the following? A. Mild B. Moderate C. Severe D. Panic
B. Moderate
A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following is appropriate for the nurse to include in the plan of care? (Select all that apply.) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client complaints E. Use a firm approach with communication
B. Offer concise explanations C. Establish consistent limitsE. Use a firm approach with communication
A nurse is caring for a client who is taking phenelzine (Nardil). For which of the following adverse effects should the nurse observe? (Select all that apply.) A. Elevated blood glucose level B. Orthostatic hypotension C. Priapism D. Headache E. Bruxism
B. Orthostatic hypotension
A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (Select all that apply.) A. Lithium carbonate (Lithobid) B. Paroxetine (Paxil) C. Risperidone (Risperdal) D. Haloperidol (Haldol) E. Lorazepam (Ativan)
B. Paroxetine (Paxil) E. Lorazepam (Ativan)
A nurse working in an emergency department is assessing a child who reports abdominal pain. When conducting a head-to-toe assessment, which of the following findings should alert the nurse to possible abuse? (Select all that apply.) A. Abrasions on knees B. Round burn marks on forearms C. Mismatched clothing D. Abdominal rebound tenderness E. Areas of ecchymosis on torso
B. Round burn marks on forearms E. Areas of ecchymosis on torso
A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification
B. Splitting
A nurse is performing an admission assessment on an adolescent client who has depression. Which of the following is an expected finding? (Select all that apply.) A. Fear of being alone B. Substance use C. Weight gain D. Irritability E. Aggressiveness
B. Substance use D. Irritability E. Aggressiveness
A nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with another nurse. Which of the following actions should the nurse take first? A. Notify the nurse manager. B. Tell the nurse to stop discussing the behavior. C. Provide an in-service program about confidentiality. D. Complete an incident report.
B. Tell the nurse to stop discussing the behavior.
A nurse is in the working phase of a therapeutic relationship with a client who has methamphetamine use disorder. Which of the following indicates transference behavior? A. The client asks the nurse whether she will go out to dinner with him. B. The client accuses the nurse of telling him what to do just like his ex-girlfriend. C. The client reminds the nurse of a friend who died from a substance overdose. D. The client becomes angry and threatens harm to himself.
B. The client accuses the nurse of telling him what to do just like his ex-girlfriend.
A nurse is caring for a client who lost his mother to cancer last month. Which of the following statements made by the nurse is a nontherapeutic response? A. "You sound angry." Anger is a normal feeling associated with loss." B. "Tell me more about your how you are feeling." C. "I understand just how you feel. I felt the same when my mother died." D. "Let's discuss how you have been coping."
C. "I understand just how you feel. I felt the same when my mother died."
A client says she is experiencing increased stress because her significant other is "pressuring me and my kids to go live with him. I love him, but I'm not ready to do that." She also states that her significant other "keeps nagging at my oldest son, which makes me mad, since he's my son, not his." Which of the following should the nurse recommend to promote a change in the client's situation? A. Learn to practice mindfulness. B. Use assertiveness techniques. C. Exercise regularly. D. Rely on the support of a close friend.
B. Use assertiveness techniques.
A nurse is providing teaching to an adolescent who is to begin taking atomoxetine (Strattera) for ADHD. The nurse should instruct the client to monitor for and report which of the following indications of liver damage? (Select all that apply). A. Mood changes B. Yellowing skin C. Joint pain D. Fever E. Malaise
B. Yellowing skin D. Fever E. Malaise
A nurse decides to put a client who has psychosis in seclusion overnight because the unit is very short‑staffed, and the client frequently fights with other clients. This is an example of A. beneficence. B. a tort. C. a facility policy. D. justice.
B. a tort.
Metoprolol tartrate (lopressor)
Beta-blockers can cause bradycardia and hypotension. Hold the medication if the apical pulse rate is less than 60/min, and notify the provider. ☐ Avoid giving to clients who have asthma. Cardioselective beta blockers (affect only beta1 receptors) are preferred to minimize effects on the respiratory system. ☐ Use with caution in clients who have heart failure. ☐ Encourage the client to sit and lie down slowly. ☐ Remind the client to notify the provider immediately if shortness of breath, edema, weight gain, or cough occur
A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder." B. "ECT is contraindicated for clients who have suicidal ideation." C. "ECT is effective for clients who are experiencing severe mania." D. "ECT is prescribed to prevent relapse of bipolar disorder."
C. "ECT is effective for clients who are experiencing severe mania."
A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates a need for further teaching? A. "A criminal history increases the risk for violence between strangers." B. "Substance use disorder increases the risk for violence." C. "Entering an intimate relationship increases the risk for violence." D. "Pregnancy increases the risk for violence toward the intimate partner."
C. "Entering an intimate relationship increases the risk for violence."
A nurse working in an outpatient clinic is providing teaching to a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I'm menstruating." B. "I will use light therapy 30 min a day to prevent further recurrences of PMDD." C. "I am aware that my PMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active."
C. "I am aware that my PMDD causes me to have rapid mood swings."
A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements indicates the need for further teaching? A. "I will administer prophylactic treatment for sexually transmitted infections like chlamydia." B. "I need to obtain informed consent before the sexual assault nurse examiner obtains forensic evidence." C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder." D. "I should perform a self-assessment before caring for a client who has been raped."
C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder."
A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following? A. Narcissistic behavior B. Fear of rejection from staff C. Attempt to reduce anxiety D. Adverse effect of antidepressant medication
C. Attempt to reduce anxiety
A nurse is caring for a client who has bulimia nervosa and who has stopped purging behavior. The client tells the nurse that she is afraid she is going to gain weight. Which of the following is an appropriate response by the nurse? A. "Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet." B. "Instead of worrying about your weight, try to focus on other problems at this time." C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments." D. "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you."
C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments."
A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone (Fanapt). Which of the following client statements indicates understanding of the teaching? A. "I will be able to stop taking this medication as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while taking this medication." D. "This medication is highly addictive and must be withdrawn slowly."
C. "I will be careful not to gain too much weight while taking this medication."
A nurse is caring for a client who is to begin taking fluoxetine (Prozac) for treatment of generalized anxiety disorder. Which of the following statements indicates the client understands the use of this medication? A. "I will take the medication at bedtime." B. "I will follow a low-sodium diet while taking this medication." C. "I will need to discontinue this medication slowly." D. "I will be at risk for weight loss with long-term use of this medication."
C. "I will need to discontinue this medication slowly."
A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates a need for further teaching? A. "We need to understand that she is not responsible for her disorder." B. "Eliminating any codependent behavior will promote her recovery." C. "She should participate in an Al-Anon group to help her recover." D. "The primary goal of her treatment is abstinence from substance use."
C. "She should participate in an Al-Anon group to help her recover."
A nurse is orienting a new client to a mental health unit. When explaining the unit's community meetings, which of the following statements by the nurse is appropriate? A. "You and a group of other clients will meet to discuss your treatment plans." B. "Community meetings have a specific agenda that is established by staff." C. "You and the other clients will meet with staff to discuss common problems." D. "Community meetings are an excellent opportunity to explore your personal mental health issues."
C. "You and the other clients will meet with staff to discuss common problems."
A nurse is caring for a client who was recently raped. The client states, "I never should have been out on the street alone at night." Which of the following is an appropriate response by the nurse? A. "Your actions had nothing to do with what happened." B. "You should focus on recovery rather than blaming yourself for what happened." C. "You believe this wouldn't have happened if you hadn't been out alone?" D. "Why do feel that you should not have been alone on the street at night?"
C. "You believe this wouldn't have happened if you hadn't been out alone?
A nurse is caring for several clients who are attending community-based mental health programs. Which of the following clients should the nurse plan to visit first? A. A client who recently burned her arm while using a hot iron at home B. A client who requests that her antipsychotic medication be changed due to some new side effects C. A client who says he is hearing a voice that tells him he is not worthy of living anymore D. A client who tells the nurse he experienced symptoms of severe anxiety before and during a job interview
C. A client who says he is hearing a voice that tells him he is not worthy of living anymore
Which of the following is an example of a client who requires emergency admission to a mental health facility? A. A client with schizophrenia who has frequent hallucinations B. A client with symptoms of depression who attempted suicide a year ago C. A client with borderline personality disorder who assaulted a homeless man with a metal rod D. A client with bipolar disorder who paces quickly down the sidewalk while talking to himself
C. A client with borderline personality disorder who assaulted a homeless man with a metal rod
A nurse is working with an established group and identifies various member roles. Which of the following should the nurse identify as an individual role? A. A member who praises input from other members B. A member who follows the direction of other members C. A member who brags about accomplishments D. A member who evaluates the group's performance toward a standard
C. A member who brags about accomplishments
A nurse is caring for a client who takes ziprasidone (Geodon). The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A. Olanzapine (Zyprexa) B. Quetiapine (Seroquel) C. Aripiprazole (Abilify) D. Clozapine (Clozaril) E. Paliperidone (Invega)
C. Aripiprazole (Abilify) D. Clozapine (Clozaril)
A nurse wants to use democratic leadership with a group whose purpose is to learn appropriate conflict resolution techniques. The nurse is correct in implementing this form of group leadership when she demonstrates which of the following actions? A. Observes group techniques without interfering with the group process B. Discusses a technique and then directs members to practice the technique C. Asks for group suggestions of techniques and then supports discussion D. Suggests techniques and asks group members to reflect on their use
C. Asks for group suggestions of techniques and then supports discussion
A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. When assessing this client, which of the following are expected findings? (Select all that apply.) A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other clients to give him their belongings D. Becomes agitated if his personal area is not neat and orderly E. Blames others for his past and current problems
C. Attempts to convince other clients to give him their belongings E. Blames others for his past and current problems
A nurse in an acute mental health facility is caring for a client who has a severe mental illness and soon will be ready for discharge but still requires supervision much of the time. The client's wife works all day but is home by late afternoon. Which of the following should the nurse suggest as appropriate follow-up care? A. Receiving daily care from a home health aide B. Having a weekly visit from a nurse case worker C. Attending a partial hospitalization program D. Visiting a community mental health center on a daily basis
C. Attending a partial hospitalization program
A nurse is teaching a client who has tobacco use disorder about the use of nicotine gum (Nicorette). Which of the following is appropriate to include in the teaching? A. Chew the gum for no more than 10 min. B. Rinse out the mouth immediately before chewing the gum. C. Avoid eating 15 min prior to chewing the gum. D. Use of the gum is limited to 90 days.
C. Avoid eating 15 min prior to chewing the gum.
A nurse is leading a peer group discussion about the indications for electroconvulsive therapy (ECT). Which of the following is appropriate to include in the discussion? A. Borderline personality disorder B. Acute withdrawal related to a substance use disorder C. Bipolar disorder with rapid cycling D. Dysthymic disorder
C. Bipolar disorder with rapid cycling
A nurse is assisting the parents of a school-age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following is an appropriate strategy for the nurse to recommend? (Select all that apply.) A. Allow the child to choose consequences for negative behavior. B. Use role playing to act out unacceptable behavior. C. Develop a reward system for acceptable behavior. D. Encourage the child to participate in school sports. E. Be consistent when addressing unacceptable behavior.
C. Develop a reward system for acceptable behavior. D. Encourage the child to participate in school sports. E. Be consistent when addressing unacceptable behavior.
A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should anticipate prescriptions for which of the following medications to promote long-term abstinence from alcohol? (Select all that apply.) A. Lorazepam (Ativan) B. Diazepam (Valium) C. Disulfiram (Antabuse) D. Naltrexone (Vivitrol) E. Acamprosate (Campral)
C. Disulfiram (Antabuse) D. Naltrexone (Vivitrol) E. Acamprosate (Campral)
A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? A. Chlordiazepoxide (Librium) B. Bupropion (Zyban) C. Disulfiram (Antuse) D. Carbamazepine (Tegretol)
C. Disulfiram (Antuse)
A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following is appropriate when implementing this form of therapy? A. Demonstrate riding in an elevator, and then ask the client to imitate the behavior. B. Advise the client to say "stop" out loud every time he begins to feel an anxiety response related to an elevator. C. Gradually expose the client to an elevator while practicing relaxation techniques. D. Stay with the client in an elevator until his anxiety response diminishes.
C. Gradually expose the client to an elevator while practicing relaxation techniques.
A charge nurse is discussing the characteristics of a nurse-client relationship with a newly licensed nurse. Which of the following are appropriate to include in the discussion? (Select all that apply.) A. The needs of both participants are met. B. An emotional commitment exists between the participants. C. It is goal-directed. D. Behavioral change is encouraged. E. A termination date is established.
C. It is goal-directed. D. Behavioral change is encouraged. E. A termination date is established.
A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? A. Encourage the client to express her feelings. B. Maintain eye contact with the client. C. Move the client away from others. D. Tell the client that the behavior is not acceptable.
C. Move the client away from others.
A nurse is planning a staff education program on substance use in older adults. Which of the following is appropriate for the nurse to include in the presentation? A. Older adults require higher doses of a substance to achieve a desired effect. B. Older adults commonly use rationalization to cope with a substance use disorder. C. Older adults are at a higher risk for substance use following retirement. D. Older adults develop substance use to mask signs of dementia.
C. Older adults are at a higher risk for substance use following retirement
A nurse is making a home visit to a client who is in the late stage of Alzheimer's disease. The client's spouse, who is the primary caregiver, wishes to discuss concerns about the client's nutrition and the stress of providing care. Which of the following is an appropriate action by the nurse? A. Verify that a current power of attorney document is on file. B. Instruct the client's spouse to offer finger foods to increase oral intake. C. Provide information on resources for respite care. D. Schedule the client for placement of an enteral feeding tube.
C. Provide information on resources for respite care
A nurse assesses a client at a community mental health facility using the SAD PERSONS tool. The nurse knows that this tool provides which of the following data related to a client? A. Current anxiety level B. Problem-solving ability C. Suicide potential D. Mood disturbance
C. Suicide potential
A client tells a student nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always yelling at me and threatening me." Which of the following actions should the nurse take? A. Keep the client's communication confidential, but talk to the client daily, using therapeutic communication to convince him to admit to hiding the knife. B. Keep the client's communication confidential, but watch the client and his roommate closely. C. Tell the client that this must be reported to health care staff because it concerns the health and safety of the client and others. D. Report the incident, but do not inform the client of the intention to do so.
C. Tell the client that this must be reported to health care staff because it concerns the health and safety of the client and others.
A nurse is interviewing a 25-year-old client who has a new diagnosis of dysthymia. Which of the following findings should the nurse expect? A. There are wide fluctuations in mood. B. The report of a minimum of five clinical findings of depression. C. The presence of manifestations for at least 2 years. D. There is an inflated sense of self-esteem.
C. The presence of manifestations for at least 2 years.
A nurse is conducting therapy with a several clients and their families. Effective communication with clients and families is based on A. discussing in-depth topics with which the client feels comfortable. B. using silence to avoid unpleasant or difficult topics. C. attending to verbal and nonverbal behaviors. D. requiring the client and family to ask for feedback.
C. attending to verbal and nonverbal behaviors.
Nature of learning
CAP = B F D Cognitive Domain Affective Domain Psychomotor Domain
What is the CIRCLE model of spiritual care
Caring Intuition Respect for religious beliefs and practices Caution Listening Emotional Support
CIRCLE model of spiritual care
Caring Intuition Respect for religious beliefs and practices Caution Listening Emotional support
Community Health Program Planning, Development, and Management Implementation
Carry out the plan Activities: Initiate interventions to achieve goals and objectives according to program plan. Monitor the intervention process and the response of the community in terms of its values, needs, and perceptions.
Bioterrorism
Category A:highest priority agents, posing risk to national security due to high mortality: smallpox, botulism, anthrax, tularemia, hemmorhagic viral fever, plaque B: second highest priority, high morbidity, low morality: typhus & cholera C: pathogens for mass dissemination, easy to produce, potential for high mortality: hantavirus -nurse: plan and prep for respose, identify agent, report activity, control and contain
Waterborne
Cholera Typhoid Giardia lamblia
Community Assessment: Individual, Family Aggregates
Community assessment is a comprehensive approach that emphasizes the community as a client. Community assessment and diagnosis are the foundation for community-specific program planning. CH nurse is key player in assessing the needs of the community. This role includes: Interacting with community partners serving the community at large. Witnessing the interaction between community programs and the response of the client to the services. Identifying future services based upon the visible needs of the community members and population groups.
Chapter 4: Practice Settings and Aggregates
Community health nurses practice in diverse setting: home health, hospice nurses, occupational health nurses, parish nurses, school nurses, case managers -aggregates receive services: infancy to death, families, groups within the community
Community-oriented vs. Community-based nursing
Community oriented - health of the community as a "whole," client = the community Community based - health of individuals, families and groups within a community, client = individual, families or groups
When a family asks a nurse for reassurance about a client's condition, which of the following is an appropriate response? A. "I think your son is getting better. What have you noticed?" B. "I'm sure everything will be okay. It just takes time to heal." C. "I'm not sure what's wrong. Have you asked the doctor about your concerns?" D. "I understand you're concerned. Let's discuss what concerns you specifically."
D. "I understand you're concerned. Let's discuss what concerns you specifically."
A nurse is providing teaching for a client who is scheduled to receive electroconvulsive therapy (ECT) for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching? A. "It is common to treat depression with ECT before trying medications." B. "I can have my depression cured if I receive a series of ECT treatments." C. "I will have seizures lasting 1½ to 2 min during ECT." D. "I will receive a muscle relaxant to protect me from injury during ECT."
D. "I will receive a muscle relaxant to protect me from injury during ECT."
A nurse is discussing the use of methadone (Dolophine) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "Methadone is a replacement for the client's opioid addiction." B. "Methadone reduces the unpleasant effects associated with abstinence syndrome." C. "Methadone can be used during opioid withdrawal and to maintain abstinence." D. "Methadone increases the client's risk for acetaldehyde syndrome."
D. "Methadone increases the client's risk for acetaldehyde syndrome."
A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's adult daughter, which of the following statements is the highest priority to report to the provider? A. "My mother has diabetes that is controlled by her diet." B. "My mother recently completed a course of prednisone for acute bronchitis." C. "My mother received her flu vaccine last month." D. "My mother is currently on furosemide for her congestive heart failure."
D. "My mother is currently on furosemide for her congestive heart failure."
A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates the need for further teaching? A. "Rape is a crime of aggression." B. "Acquaintance rape often involves alcohol." C. "Both men and women can be victims of rape." D. "The majority of rapists are unknown to the victims."
D. "The majority of rapists are unknown to the victims."
A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "To assess cognitive ability, I should ask the client to count backward by 7." B. "To assess affect, I should observe the client's facial expression." C. "To assess language ability, I should instruct the client to write a sentence." D. "To assess remote memory, I should have the client repeat a list of objects."
D. "To assess remote memory, I should have the client repeat a list of objects."
A nurse is caring for a client who states, "I'm so stressed at work because of my coworker. He expects me to finish his work because he's too lazy!" When discussing appropriate communication, which of the following statements by the client to his coworker indicates client understanding? A. "You really should complete your own work. I don't think it's right to expect me to complete your responsibilities." B. "Why do you expect me to finish your work? You must realize that I have my own responsibilities." C. "It is not fair to expect me to complete your work. If you continue, then I will report your behavior to our supervisor." D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."
D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."
A nurse is caring for a client who is experiencing moderate anxiety. Which of the following is an appropriate nursing intervention when trying to give necessary information to the client? A. Reassure the client that everything will be okay. B. Use a low-pitched voice and speak slowly. C. Ignore the client's anxiety so that she will not be embarrassed. D. Demonstrate a calm manner while using simple and clear language.
D. Demonstrate a calm manner while using simple and clear language.
A nurse working on an acute mental health unit forms a group to focus on self-management of medications. At each of the meetings, two of the members use the opportunity to discuss their common interest in gambling on sports. This is an example of which of the following? A. Triangulation B. Group process C. Subgroup D. Hidden agenda
D. Hidden agenda
A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing actions is appropriate to include in the client's plan of care? A. Allow the client to select preferred meal times. B. Establish consequences for purging behavior. C. Provide the client with a high-fat diet at the start of treatment. D. Implement one-to-one observation during meal times.
D. Implement one-to-one observation during meal times.
A charge nurse is conducting a class on therapeutic communication to a group of newly licensed nurses. Which of the following responses by the newly licensed nurse requires additional teaching regarding nonverbal communication? A. Personal space B. Posture C. Eye contact D. Intonation
D. Intonation
A nurse is planning care for a client who has a mental health disorder. Which of the following is appropriate to include as a psychobiological intervention? A. Assist the client with systematic desensitization therapy. B. Teach the client appropriate coping mechanisms. C. Assess the client for comorbid health conditions. D. Monitor the client for adverse effects of medications.
D. Monitor the client for adverse effects of medications.
A nurse in an acute mental health facility is caring for a client who is experiencing a mixed episode of bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior. B. Administer prescribed medications as scheduled. C. Provide the client with step-by-step instructions during hygiene activities. D. Monitor the client for escalating behavior.
D. Monitor the client for escalating behavior.
A nurse is caring for a school age child who has a new prescription for methylphenidate (Daytrana) to treat ADHD. Which of the following should the nurse teach the client and family about this medication? A. Apply the patch once daily at bedtime. B. Take the medication orally with food every 12 hr. C. Take a second dose of the medication orally at bedtime. D. Remove the patch each day after 9 hr.
D. Remove the patch each day after 9 hr.
A nurse working in a mental health clinic is providing teaching to a client who has a new prescription for diazepam (Valium) for generalized anxiety disorder. Which of the following is appropriate for the nurse to include in the teaching? A. 3 to 6 weeks of treatment is required to achieve therapeutic benefit. B. Combining alcohol with diazepam will produce a paradoxical response. C. Diazepam has a lower risk for dependency than other antianxiety medications. D. Report confusion as a potential indication of toxicity.
D. Report confusion as a potential indication of toxicity.
A nurse is communicating with a client on the acute mental health facility. The client states, "I can't sleep. I stay up all night." The nurse responds, "You are having difficulty sleeping?" Which of the following therapeutic communication techniques is the nurse demonstrating? A. Offering general leads B. Summarizing C. Focusing D. Restating
D. Restating
A nurse is caring for a client who is experiencing a panic attack. Which of the following is an appropriate nursing intervention? A. Discuss new relaxation techniques. B. Show the client how to change his behavior. C. Distract the client with a television show. D. Stay with the client, and remain quiet.
D. Stay with the client, and remain quiet.
Secondary prevention
Environmental Health Nursing Interventions: Individual level= survey for health conditions that may be related to environmental and occupational exposures, obtain environmental health histories of individuals, monitor workers for levels of chemical exposures at job sites, and screen children 6 months to 5 years for blood lead levels. Community level= survey for health conditions that may be related to environmental and occupational exposures and assess homes, schools, work sites, and the community for environmental hazards.
Cognitive theory
Focus on changing thought patterns through methods offering a variety of sensory input and repetition
Critical theory
Focus on increasing depth of knowledge through use of methods such as discussion and inquiry
Community-oriented nursing
Focus: at risk individuals, families, groups. Community. Activities: determining the health needs of a community, and intervening at the individual, family, and group level to improve the collective health of the community.
Public health nursing practice
Focus: synthesis of nursing and public health theory Activities: promote, preserve, and maintain the health of populations through disease and disability prevention and health protection of the community as a whole. Core functions: systematic assessment of the health of populations development of policies to support the health of populations ensuring that essential health services are available to all persons
Community health nursing practice
Focus: synthesis of nursing and public health theory. Activities: Promote, preserve, and maintain the health of populations by the delivery of health services to individuals, families, and groups in order to impact "community health"
Public health wheel
For selling health messages R/t epidemiology
Cultural awareness
Includes self awareness of one's own cultural background, biases, and differences. Nurses need to be culturally aware so that we will be more likely to explore cultural variations among clients, better understand how personal beliefs impact client care, and be able to recognize the meaning of health differs with each culture.
Medicaid
Medicaid provides health care coverage for individuals of low socioeconomic status and children, through the combined efforts of federal and state governments. Eligibility is based on household size and income, with priority given to children, pregnant women, and those who have a disability. Also provides inpatient and outpatient hospital care, lab and radiology services, home health care, vaccines for children, family planning, pregnancy related care, and early and periodic screening, diagnosis, and treatment (EPSDT) services for those younger than 21.
A home care nursing is visiting a 72 year old patient who is concerned about paying medical bills. The nurse understands this client is eligible for which benefit: a. Medicaid. b. Medicare. c. Community based health services. d. Social support group.
Medicare. Rationale: Medicare and Medicaid are health assistance programs created by 1965 Social Security amendments. Medicare is a federal health insurance plan for acute care needs of the disabled and those over the age of 65 years of age. This plan will be over hospitals, long term care facilities as well as the home. Medicaid is a state-run health insurance program with limited incomes. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Application Objective: Describe services and settings for healthcare consumers receiving community-based and home care. Strategy: Use nursing knowledge and the process of elimination to make the correct selection.
Medicare and Medicaid
Medicare: 65 and older, social security, disability for 2 yrs, ALS, kidney failure, kidney transplant or dialysis. includes hospital care, home care, limited skilled nursing. medical care, diagnostics, physiotherapy. private insurance. prescription drug coverage Medicarid: low socioeconomic status and children (federal and state gov funds). based on household size, income (priority to pregnant women, children, disability). inpatient & outpatient services, radiology, labs, home care, vaccines, family planning ,early and periodic screening, diagnosis, treatment <21
Pertussis
Nighttime cough with sudden inspirations and a high-pitched sound. Paroxysm coughing with eyes bulging and tongue protruding Thick mucous plug that may dislodge with coughing Early symptoms can last for 1 to 2 weeks and usually include: Runny nose Low-grade fever (generally minimal throughout the course of the disease) Mild, occasional cough Apnea — a pause in breathing (in infants) A client with known or suspected pertussis is placed on droplet precautions. A private room is required, but a room with negative air pressure is not required. A mask is worn when the nurse is within 3 ft of the client. A surgical mask is placed on the client during transport to another area of the facility. Gloves (clean) are worn when handling soiled linen, but sterile gloves are not necessary. A gown should be worn if the nurse's clothing or skin may be contaminated with body secretions or excretions.
The physician has discharged a client from the acute care facility. The client needs to have a dressing changed to his right lower extremity once a day for the next seven days. Which of the following interventions should the nurse select to plan the patient's discharge? a. Teach the client the dressing change prior to discharge. b. Ask the physician to cancel the discharge until the leg wound heals. c. Notify social services to set up home care visits for the dressing changes. d. Notify the parish nurse in the area to change the dressing in the home once the client is discharged.
Notify social services to set up home care visits for the dressing changes. Rationale: Home care services the disabled or chronically ill person who is in need of treatment or support to function effectively in the home environment. Home care encompasses health and social services provided to the chronically ill as well as persons recovering in his or her own home. The client could change his own dressing at home if he had good dexterity and had the supplies, but the staff would have to do extensive teaching in order to discharge him home to do the dressing. The best choice is to allow the home care agencies to start the treatments upon discharge and follow the client's progress. Nursing Process: Evaluation Client Need: Safe; Effective Care Environment Cognitive Level: Analysis Objective: Compare and contrast the roles of the nurse providing home care with the roles of the nurse in medical-surgical nursing discussed in Chapter 1. Strategy: Identify key words in the question or stem to select the right answer.
Attack rate
Number of people exposed to a specific agent who develop the disease ÷ total number of people exposed
Strategies to Reduce Societal Violence
PRIMARY: conflict resolution, anger management, parenting classes, ed about comunity services, ensure safe environment for elderly, assist in removing factors that contribute to stress by referring to caretaker of older adult clients, elderly safe guard funds, DPOA SECONDARY: screen at risk individuals, assess bruises, screen all pregnant, refer victims to ED, assess suicide contemplation, suprport offender, address stressor TERTIARY: establish long term follow up, make resources in community available, refer to mental health, grief counsel, support groups
Strategies to Reduce Substance Use Disorders
PRIMARY: increase public awareness, encourage development of life skills SECONDARY: identify at risk individuals to reduce sources of stress, screen for substance use TERTIARY: assist with developing a plan to avoid high risk situations, refer to community groups (AA), monitor phar, emotional support
Abuse
Physical violence - when pain or harm results towards an infant or child, domestic partner or an older adult Sexual violence Emotional violence Neglect Economic maltreatment
What are some tertiary prevention strategies for homelessness?
Prevent recurrence of poverty, homelessness, and health problems that result in conditions of poverty and homelessness. ■■ Advocate and provide efforts toward political activity to provide needed services for people who are mentally ill and homeless. ■■ Make referrals for employee assistance and educational programs to allow clients who are homeless to eliminate the factors contributing to their homelessness.
Community Health Diagnosis
Problems identified by community assessments are often stated as community health diagnoses. Community nursing diagnoses incorporate information from the community assessment, general nursing knowledge, and epidemiological concepts (especially the concept or risk in a population). Community nursing diagnoses often are written in the following format: Risk of (specific problem or risk in the community) among (the specific population that is affected by the problem or risk) related to (strengths and weaknesses in the community that influence the problem or risk).
You are the nurse making a home care visit when the client tells you that he does not have enough money to get all of his new prescriptions filled at the pharmacy. Which of the following resources would be able to assist with the client's problem? a. Social Support b. Community Health Care System c. Community Centers d. Day Care Programs
Social Support Rationale: A person's social support system consists of the people who lend assistance to meet the client's financial, personal, physical or emotional needs. The nurse needs to know what support is available for health care of her clients and family with understanding of their cultural and ethnic backgrounds as well. Nursing Process: Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Application Objective: Describe the components of the home health care system, including agencies, clients, referrals, nursing care, physicians, reimbursement, and legal considerations. Strategy: Identify the core issue to prevent distraction of incorrect choices.
American Red Cross
Support emergency rescue and recovery services and is contacted when additional resources are needed by the community.
Botulism
Symptoms: difficulty swallowing, progressive weakness, n/v, abd cramps, difficulty breathing Tx: Airway management, antitoxin, elimination of toxin
Smallpox
Symptoms: high fever, fatigue, severe HA, rash (begins on face/tongue and spreads to arms/legs then hands/feet), vomiting, delirium, excessive bleeding Tx: no cure, supportive care (hydration, pain, antipyretics), prevention (vaccine - 10 yr immunity)
Ebola
Symptoms: sore throat, HA, high temperature, n/v, diarrhea, internal and external bleeding, shock Tx: no cure, supportive care (minimize invasive procedures), prevention, vaccine in testing phase
Inhalation anthrax
Symptoms: sore throat, fever, muscle aches, severe dyspnea, meningitis, shock Tx: IV ciprofloxacin
A nurse is using the I PREPARE mnemonic to assess a client's potential environmental exposures. Which of the following is an appropriate question for the nurse to ask to assess for "A" in the mnemonic? a. "What do you like to do for fun?" b. "What year was your residence built?" c. "What jobs have you had in the past?" d. "What industries are near where you live?"
a
fomites
an inanimate object, material, or substance that acts as a transport agent for a microbe
natural immunity
an innate resistance to a specific antigen or toxin
Assessment also includes
an ongoing effort to monitor the health status of the community or population and the services provided
agent
an organism capable of causing disease
The agent is the
animate or inanimate object that causes the disease
agent
animate or inanimate object that causes the disease
The agent
animate or inanimate object that causes the disease. (bacteria, virus, pesticide, food additive, etc.)
public policy
applies to all members of society; includes prescribed sanctions for failure to comply; formulated by government bodies; frequently restricts personal choice to improve public welfare
Community based planning
are based on the nursing diagnoses and contain specific goals and interventions for achieving desired outcomes; a process and has to be completed in partnership with the community.
A nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following findings is a manifestation of withdrawal? a. Decreased blood pressure b. Diaphoresis c. Pin-point pupils d. Bradycardia
b
A nurse is caring for a client who is from a different culture than himself. When beginning the cultural assessment, which of the following actions should the nurse take first? a. Determine the client's perception of his current health status. b. Gather data about the client's cultural beliefs. c. Determine how the client's culture may impact the effectiveness of nursing actions. d. Gather information about previous client interactions with the health care system.
b
A nurse is completing a needs assessment and beginning analysis of data. Which of the following actions should the nurse take first? a. Determine health patterns within collected data. b. Compile collected data into a database. c. Ensure data collection is complete. d. Identify health needs of the local community.
b
A nurse is interviewing for a position at the local health department. When preparing for the interview, the nurse should find that which of the following are responsibilities of this agency? (Select all that apply.) a. Managing the Women, Infants, and Children program b. Providing education to achieve community health goals c. Coordinating directives from state personnel d. Reporting communicable diseases to the CDC e. Licensing of registered nurses
b, c
A nurse is creating partnerships to address health needs within the community. The nurse should be aware that which of the following characteristics must exist for partnerships to be successful? (Select all that apply.) a. A leading partner with decision-making authority b. Flexibility among partners when considering new ideas c. Adherence of partners to ethical principles d. Varying goals for the different partners e. Willingness of partners to negotiate roles
b, c, e
When studying chronic disease, the multifactorial etiology of illness is considered. What does this imply? a. Genetics and molecular structure of disease is paramount. b. Single organisms that cause a disease, such as cholera, must be studied in more detail. c. Focus should be on the factors or combinations and levels of factors contributing to disease. d. The recent rise in infectious disease is the main focus.
c. Focus should be on the factors or combinations and levels of factors contributing to disease.
A nurse surveys the school nurses in a community to determine their roles in the schools because this data is not available. The nurse is engaging in the process of data: a. Collection b. Gathering c. Generation d. Interpretation
c. Generation
goals and objectives in planning community health program
can be written in sequential steps that are required to reach the goal; must be measurable; include a time frame for attaining change; the direction and magnitude of the change; and method of measuring the change
School nurse can involve
case management, community outreach, consultant, counselor, direct caregiver, health educator, researcher
As a ____________, the nurse coordinates comprehensive services for students with complex health needs
case manager
School nurse
case manager, community outreach, consultant, counselor, direct caregiver, health educator, researcher Primary prevention - assess/teach health knowledge, immunization status Secondary prevention - assess those who become ill/injured, assess all during emergencies, screening for early detection, assess children to detect abuse/neglect, assess for evidence of mental illness, suicide, violence Tertiary prevention - assess children with disabilities, assess children with long-term health needs at school
Advocacy
client advocate is the role of the community health nurse. nurse plays the role of informer, supporter, mediator for the client. -clients who are autonomous beings who have the right to make decisions affecting their own health and welfare -clients have the right to expect a nurse client relationship based on trust, collaboration, and shared respect, related to health and considerate of their thoughts and feelings. clients are responsible for their own health -nurses responsibility to advocate for resources or services that meet the clients health care needs -advocating for clients requires assertiveness, placing priority on the clients values and willingness to progress through the chain of command for resolution
Ch 3: Community Health Program Planning
collaborative leadership role -nurse should plan, organize, implement and evaluate intervention programs that address specific health needs of the community -program planning should reflect priorities of community assessment -established based on perception of health needs, percent of population affected by problem, relevance of problem to the public, estimated impact of intervention
The nurse's first action when beginning a cultural assessment is to
collect self-identifying data about the client, including specific information about how the client's cultural beliefs influence family structure, food patterns, religious preferences, and health practices
population health management:
combination of information gathered to define problems and build awareness and the strategies to address needs
Fracking
common but controversial practice among companies that drill underground for oil and natural gas; drillers inject millions of gallons of water, sand, salts and chemicals—all too often toxic chemicals and human carcinogens such as benzene—into shale deposits or other sub-surface rock formations at extremely high pressure, to fracture the rock and extract the raw fuel.
CH 6: Communicable Disease, Disaster, and Bioterrorism
communicable disease is an international health concern -nurses have unique skills to plan for and respond to natural and man made disasters
Essentials of Community Nursing
community: group of people and institutions that share geographic, civic or social parameters -communities vary in their characteristics and health needs -health is determined by the degree to which the community's collective health needs are identified and met -health indicators often used to describe the helath status of community and serve as targets for improvement -community health nurses practice in the community. have a facility from which they work but their practice is not limited to institutional settings -community is the client -community partnership occurs when community members, agencies and businesses actively participate in the process of health promotion and disease prevention -development of community partnerships is critical to the accomplishment of health promotion and disease prevention strategies -assess to determine needs and intervene to protect & promote health, preventing disease within a specific population
relative risk
compares the risk of developing the health condition for the population exposed to the factor with the risk for the population not exposed to the factor; indicates the benefit that might accrue to the person if the risk factor is removed; rate: incidence among those exposed/incidence rate among those not exposed
Milio's Framework for Prevention
complements health belief model. emphasizes change at the community level. identifies relationship between health deficits and availability of health promoting resources -theorizes that behavior changes within a large number of people can ultimately lead to social change
Hospice nurse
comprehensive care delivery system for the terminally ill that is usually implemented when the client is not expected to live longer than 6 months - may continue to work with family up to one year after the death of the client
Health Maintenance organizations (HMOs)
comprehensive care is provided to members by a set of designated providers
synergism
concept central to the web of causation model, wherein the whole is more than the sum of its separate parts
community oriented
concern for the connection between the health status of the population and the environment in which the population lives community strives to achieve core public health functions
health economic
concerned with how scarce resources affect the health care industry
impact (summative; short term) evaluation
concerned with the immediate impact of a program on a target group
Family and Cultural Care
congruency between culture and health care is essential to the wellbeing of the clent. -comunity health nurses need to consider variations in culture, uniqueness needs to be considered, familiar with cultures in community -acculturation: merging/ adopting traits of a different culture. change in daily living in language, education, work, recreation, social experience, and health care system -culture awareness: self awareness of ones own cultural background, biases and differences --> these nurses are more likely to explore cultural variations in clients, understand how personal beliefs impact care, recognize meaning of health differs within cultures -do not stereotype -nurses need to be responsive to needs of client from dif cultures
vital record linkage (epidemiology data)
connects data and information contained in two or more medical, or mortality records, and other vital event records; provides excellent sources of information on the courses of diseases, demographic data, health are services utilization, fertility, maternal health issues, child health concerns, chronic disease tracking, and the natural history of specific disease or morbidity related events
A case management nurse at an acute care facility is conducting an initial visit with a client to identify needs prior to discharge home. After developing a working relationship with the client, the nurse is engaging in the referral process. Which of the following should be the first action by the nurse? a. Monitor the client's satisfaction with the referral. b. Provide client information to referral agencies. c. Review available resources with the client. d. Identify referrals that the client needs.
d
A community health nurse is developing an education program on substance use disorders for a group of adolescents. Which of the following should the nurse include when discussing nicotine and smoking? a. Smoking is the fifth-most preventable cause of death in the United States. b. Nicotine is a central nervous system depressant. c. Withdrawal effects from smoking are minimal. d. Tolerance to nicotine develops quickly.
d
A nurse is planning a community health program. Which of the following should the nurse include as part of the evaluation plan? a. Determine availability of resources to initiate the plan. b. Gain approval for the program from local leaders. c. Establish a timeline for implementation of interventions. d. Compare program impact to similar programs.
d
A nurse is talking to a client who asks for additional information about hospice. Which of the following is an appropriate statement by the nurse? a. "Clients who require skilled nursing care at home qualify for hospice care." b. "One function of hospice is to provide teaching to clients about life-sustaining measures." c. "Hospice assists clients to develop the skills needed to care for themselves independently." d. "A component of hospice care is to control the client's symptoms."
d
A collection of individuals who have in common one or more personal or environmental characteristics is the definition of a(n): a. Community b. Group c. Family d. Aggregate
d. Aggregate
The factors, exposures, characteristics, and behaviors that determine patterns of disease are described using: a. Descriptive epidemiology b. Analytic epidemiology c. Distribution d. Determinants
d. Determinants
Which characteristic is an indicator of community health structure? a. Infant mortality rate b. Effective communication c. Crime rate d. Emergency room utilization
d. Emergency room utilization
What intervention would be the most appropriate for the nurse to use when trying to develop community partnerships? a. Involve only the community residents. b. Use nurses as the source of information and leadership. c. Rely on the power of local officials. d. Include a variety of disciplines.
d. Include a variety of disciplines.
An example of secondary prevention is: a. Rehabilitation b. Avoidance of high-risk behaviors c. Immunization d. Mammogram
d. Mammogram
The interaction between an agent, a host, and the environment is called: a. Natural history of disease b. Risk c. Web of causality d. The epidemiologic triangle
d. The epidemiologic triangle
Which would be considered a serious epidemic of influenza? a. 50 cases b. 100 cases c. 500 cases d. Unable to determine
d. Unable to determine
Outlining specific roles of community agencies is a component of
disaster preparedness.
Identifying community vulnerabilities is a component of
disaster prevention.
Providing stress counseling is a component of
disaster recovery
Prioritizing care of individuals is a component of
disaster response.
Home Health Care
encompasses both health and social services provided to the chronically ill, disabled, or recovering person in his or her own home. Home care is usually provided when a person needs help that cannot be provided by a family member or friend
Community
encompassing a specific geographic area, a community may be a small neighborhood in a major urban city or a large area of rural residents. Communities have in common the characteristics of people, area, social interaction, and common ties
Hospice nurses
enhances the quality of life through the provision of palliative care, supporting the client and family through the dying process, and providing bereavement support to the family following the client's death. Relief of pain and suffering and enhance of QOL. The hospice nurse may work with the family for up to 1 year following the death of a client.
Primary disease prevention:
focus on prevention of the initial occurence of disease or injury. Includes nutrition counseling, family planning, smoking cessation, safety education (seat belt helmet use), prenatal classes.
health systems concerns
focus on quality and safety of services, warning about bioterrorism, and global public health threats such as infectious diseases and contaminated foods.
organizational policy
formed an applies to groups who have similar interests or special interests, such as professional associations-state nurses association or specialty nursing organization that determines governing rules for membership
medicaid
healthcare, insurance assistance, nursing home coverage; low-income residents and pregnant women, a parent or relative caretaker of a dependent child under age 19, the blind, people with a disability or with a family member in their household with a disability, or people aged 65 years or older
Diabetes Mellitus for adolescent:
help plan diet, eat snack, within 2 hrs. of physical activity. test ketonswhen sick.
Category A biological agents
highest priority - risk to national security because they are easily transmitted and have high mortality rates Smallpox, botulism, anthrax, tularemia, hemorrhagic viral fevers, plague
Cat A bio agents
highest priority agents smallpox (variola), botulism toxin, anthrax, tularemia, hemorrhagic viral fevers (Ebola!), and plague
Bioterrorism Category A biological agents
highest priority, posing risk to national security because easily transmitted and have high mortality rates. Ex: smallpox (variola), botulism, anthrax, tularemia, hemorrhagic viral fevers, plague
Practice Settings: Home Health
home health nurse: nursing home, traditional home, assisted living -work as part of team, holistic care. nurses, pt, OT, home health aids, social workers and dieticians part of the care -provide skilled assessment, wound care, lab draws, med education, parenteral nutrition, IV fluids & meds, central line care, urinary catheter insertion and maintenance, coordination of other participants in health -evaluate living environment for safety - older adults= increase fall risk -ask about food in home, help with household activities, living alone, support system, set up and dispense of medications, access to health care -encourage clients to be independent and involved
Violence
homicide, assault, rape (higher in cities 8pm-2am weekend summer), suicide (higher among men >65), abuse, sexual violence, emotional violence, neglect, economic maltreatment -factors for abuse: history of being abused, low self esteem, fear and distrust, poor self control, inadequate social skills, minimal social support, immature motivation, weak coping skills -factors for violence: work stress, unemployment, media, crowded living, poverty, powerlessness, social isolation, lack of community resources
Professional education
in nursing, medicine, and other clinical disciplines focuses primarily on developing competence in decision making at the individual client level by assessing health status, making management decisions (ideally with client), and evaluating the effects of care.
Three methods of direct data for community assessment
informant interview, participant observation, windshield survey
Informatics is the combination of nursing science with
information and communication technologies in the delivery of nursing care
Partnerships with Legislative Bodies
nurses must stay informed on current policy and laws that influence health of community. advocate for policies that protect public health. -change agent: advocate for needs at local state and federal level -lobbyist: influence legislator -coalition: facilitate goal achievement by collaborating two groups -public office: serve society and advocate for change by influencing policy development
Home Health Nursing
nursing care to acute and chronically ill clients of all ages in their home while integrating community health nursing principles that focus on environmental, psychosocial, economic, cultural, and personal health factors affecting an individual's and family's health status
Community-Based Nursing
nursing centered on individual and family health care needs. The nurse practicing community-based care provides direct services to individuals to manage acute or chronic health problems and to promote self-care. The care is provided in the local community
Participant observation
observation of formal or informal community activities
Participant Observation
observation of formal or informal community activities -indicates community priorities, environmental profile, identification of power structures -limits: bias, time consuming, cant ask questions
Levels of Prevention in School Nursing
primary; assess knowledge regarding health issues (hand hygiene, healthy food choices, injury prevention, substance dependency), immunization status of children -secondary: assess children who become ill or injured at school, assess during emergencies, perform screening for early deterction of disease (vision and hearing, height and weight, oral health, scoliosis, infestations, general physical exams) assess children to detect child abuses or neglect, assess for evidence of mental illness, suicide and violence -tertiary: assess children with disabilities, assess children w long term health needs at school (provide care for disorders) e
Community Health Diagnoses
probs identified by community assessments -incorporate info from community assessment, general nursing knowledge and epidemiological concepts
Acculturation
process of learning a new culture, requires changes in daily living practices
Active immunity
production of antibodies by the body in response to infection or immunization with a specific antigen
Occupational Health Nurse
promote health and prevent occupational injury and illness -improve workplace, expenditure decreased by less sick time use, fewer worker compensation claims, decreased use of group health coverage -cost effective and high quality care: partner with hygenists, safety specialists, occupational medicine, HR< union reps and health insurance -assess risk for work related injury, plan and delivery health and safety services in the workplace, facilitate health promotion activities that lead to a more productive workforce -Obtain occupational health history: current and past jobs, exposure, underlying illness, previous injuries, healthy or unhealthy habits -work site walk though: observation of process and materials, job requirements, actual and potential hazards, employees -control strategies to reduce exposure based on work related injury or illness (engineering, altering work practices, PPE, workplace monitoring, health screening, employee assistance, job task) -protection from violence and work related injuries from falls, environmental hazards, burns -occupational health and legislations (OSHA, NACOSH, workers comp)
Public health nursing practice
promote, preserve and maintain health of populations through disease and disability prevention and health protection of the community as a whole Core functions: systematic assessment of health of pop's, devo. policies to support health of pop's, ensure essential health services are available to all persons
Parish nurse
promotes the health and wellness of populations of faith communities. The population often includes church members and individuals and groups in the geographical community.
environmental health
promotion of safe, healthful living conditions and protection from environmental factors that may adversely affect human health or the ecologic balances essential to long-term human health and environmental quality, whether in the natural or man-made environment
What are community health nurses concerned with?
protecting, promoting, preserving and maintaining health, as well as preventing disease.
Herd immunity
protection due to the immunity of most community members making exposure unlikely
autopsy records (epidemiology data)
provide severely biased information; not performed for all deaths, violent deaths are included, and sometimes cause of death is unknown
efficiency (economics)
refers to producing maximal output, such as a good or service, using a given set of resources (or inputs), such as labor, time, and available money; suggests that inputs used in such a way that there is no better way to produce the service, or output, and that no other improvements can be made
The nurse is using _____ prevention when performing a home safety check at a client's home
secondary
The nurse is using _______ prevention when implementing a program to notify individuals exposed to a communicable disease
secondary
analytic epidemiology
seeks to identify associations between a particular disease or health problem and its etiology; directed toward finding answers to the "how" and "why" of health disease to determine casuality
Missionary nurse
seeks to promote health and prevent disease by meeting spiritual, physical , and emotional needs of people across the globe.
Home Care
services for recovering, disabled, or chronically ill people in need of treatment or support to function effectively in the home environment (National Association for Home Care); services for the purpose of promoting, maintaining, or restoring health or of maximizing the level of independence while minimizing the effects of disability and illness, including terminal illness (U.S. Department of Health and Human Services)
Public office
serving society and advocating for change by influencing policy development through public service
The environment is the
setting or surrounding that sustains the host
Community-based nursing practice is a
setting specific practice whereby care is provided for clients and families where they live, work, and attend school
environment
setting/surrounding that sustains the host
Genital irritation is a manifestation of .
sexual abuse
Characteristics of successful partnerships
shared power, shared goals, integrity, flexibility, negotiation
Respite Care
short-term or intermittent home care, often using volunteers. These services exist primarily to give the family member or friend who is the primary caregiver some time off from care
Home health nurses skills
skilled assessment, wound care, lab draws, med education and administration, parenteral nutrition, IV fluids and medication, central line care urinary catheter insertion and maintenance. Must also evaluate the living environment for safety, paying close attention rugs, electrical outlet, and extension cords, use of oxygen, safety devices in the bathroom. Also educate the client when to contact ER.
cottage industry
small business; industry an industry whose labor force is small or may consist of family units working at home with their own equipment; a single-purpose industry.
Consultations
someone with knowledge who provides expert advice -initiate consult, seek expertise, request opinions, incorporate recommendations, serve as expert
Census (epidemiology data)
source of epidemiological community data; most comprehensive source of health-related data for the US; age, race, and sex along with factors such as employment, income, migration and education; used to calculate rates (denominator)--collected every 10 yrs
nursing informatics
specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice
surveys
specific questions asked in a written format.
Surveys
specific questions in written format. data collected on client population and problems, random sampling, available as written or online format, contact with participants not required -limit: low response rate, expensive, time consuming, superficial data, reading/ writing needed
objectives
specific, short term, measurable, action oriented behaviors to be met as steps towards achieving the long term goal
Workers compensation acts
state-level legislation that regulates financial compensation to workers suffering from injuries or illness resulting from the workplace
Prevention of asthma attack:
stay inside dring winter. get flu shot. take rescue meds PRN not daily.
pandemic
steady occurrence of disease over a large geographic area or worldwide, such as malaria
Nicotine is a central nervous system
stimulant, not depressant.
Prevention and Control of Communicable Disease
systematic collection and analysis of data regarding infectious disease -nationally notifiable disease: anthrax, botulism, cholera, diphtheria, giardiasis, gonorrhea, hep a-c, hiv, flu, legionnaires, lyme, malaria, meningitis, mumps, pertussis, polio,rabies, rubella, salmonella, SARs, shigella, smallpox, syphilis, tetanus, TB, typhoid fever, vanco GOALS: reduce infection transmitted through food, HIV, aids, deaths from HIV, vaccine preventable disease, antibiotic courses for ear infections -increase in consumers with food safety, surviving >3 yrs with aids, TB testing for HIV, HIV education, condom use, immunization and flu shots, shingles immunizations
surveillance
systematic collection, analysis, and interpretation of data related to the occurrence of disease and the health status of a given population
Principles of MAPP
systems thinking, dialogue, shared vision, data, partnerships and collaboration, strategic thinking, and celebration of successes
Hypertension occurs when
systolic blood pressure is at or above 140 mm Hg or diastolic blood pressure is at or above 90 mm Hg. Normal adult blood pressure is less than 120 mm Hg systolic and 80 mm Hg diastolic.
Providing equipment to practice hands-on skills is an appropriate learning strategy for clients who are ________ learners
tactile-kinesthetic
Supplying outlines for note-taking is an appropriate learning strategy for clients who are ______ learners
visual
Learning styles
visual: learn through seeing, not taking, video viewing, presentations -auditoy: listening, verbal lectures, discussion, reading outloud, interpret meaning while listening -tactile-kinesthetic learners: learn through doing, trial and error, hands on approaches, return demonstrations
What to avoid in sunscreen
vitamin A causes skin cancer in laboratory tests Oxybenzone, a hormone disruptor and skin allergen High SPF misleads consumers and offers little additional benefit
In a biohazard incident (with few exceptions,) ________ is the universal antidote.
water For biological hazardous materials, wash skin with copious amounts of water and antibacterial soap.
Using and Interpreter
when a nurse or client cant understand the others language. -knowledge of health terms. family members as interpreters not advisable -consider client preferences. shouldnt be from same community as client -teaching materials in clients language
When is partner violence most likely to occur?
when abused partner tries to leave.
active immunity
when the body produces its own antibodies against an antigen, either as result of infection with the pathogen or introduction of the pathogen in a vaccine
Epidemic
when the rate of disease exceeds the usual level of the condition in a defined population
late manifestations of alzheimer's:
withdrawal from social activities, loss of langague skills, neglecting personal hygeine.
subpopulations
within the larger population such as high risk infants under the age 1 year, unmarried pregnant adolescents, or individuals exposed to a particular event
Suicide
women report attempting suicide more often than men. Rates are highest in men and individuals over the age of 65. Risk factors for suicide include depression or other mental disorders, substance use and intimate partner issues.
Social and Community factors Influencing Violence
work stress, unemployment, media exposure to violence, crowded living conditions, poverty, feelings of powerlessness, social isolation, lack of community resources
Faith community nurse
work with a group of clients who share common faith traditions. Circle model of spiritual care: CIRCLE Caring Intuition Respect for religious beliefs and practices Caution Listening Emotional support
public health policy
works to improve the publics health through legislative action at the local, state and federal level; institutional and legislative efforts to promote health and meet national health objectives...support initiatives that address barriers to health such as poverty, homelessness, unsafe living conditions, abuse and violence, and lack of access to health services
Faith Community Nurse
works with clients who share common faith traditions. practices that are important to health and healing. -caring and spirituality, CIRCLE model of nursing (caring, intuition, respect for religion beliefs, caution, listening, emotional support Missionary nurse: promote health and disease prevention by meeting spiritual, physical and emotional needs of people across the globe. -Parish nurse; promote health and wellness of faith communities (church members) & individuals. work closely with pastoral care staff, professional health care members to provide holistic approach
Communicable Disease
worldwide communicable disease is responsible for the deaths of millions each year. -leading causes: acute respiratory infections, AIDS, diarrheal disease, TB, measles, malaria POP at risk: young children, older adults, immunosuppressed clients, high risk lifestyle, international travelers, health care workers e -CDC reccomends immunizations
What are some tertiary prevention methods for reducing societal violence?
• Establish parameters for long-term follow-up and supervision. • Make resources in the community available to the client (telephone numbers of crisis lines and shelters). • If court systems are involved, work with parents while the child is out of the home (in foster care). • Refer to mental health professionals for longterm assistance. • Provide grief counseling to families of suicide or homicide victims. • Develop support groups for caregivers and victims of violence. • Advocate for legislation designed to assist older adult independence and caregivers and to increase funding for programs that supply services to low-income, at-risk individuals.
What are some secondary prevention methods for reducing societal violence?
• Identify and screen those at risk for abuse and individuals who are potential abusers. • Assess and evaluate any unexplained bruises or injuries of any individual. • Screen all pregnant women for potential abuse. This may be the one time in some women's lives that they may access the health care system on a regular basis. • Refer sexual assault or rape victims to a local emergency department for assessment by a sexual assault abuse team. Caution the client not to bathe following the assault because it will destroy physical evidence. • Assess and counsel anyone contemplating suicide or homicide and refer the individual to the appropriate services. • Support and educate the offender, even though a report must be made. • Assess and help offenders address and deal with the stressors that may be causing or contributing to the abuse, such as mental illness or substance abuse. • Alert all involved about available resources within the community.
What are some secondary prevention strategies for substance abuse?
• Identify at-risk individuals and assist them to reduce sources of stress, including possible referral to social services to eliminate financial difficulties or other sources of stress. • Screen individuals for excessive substance use.
What are some primary prevention strategies for substance abuse?
• Increase public awareness, particularly among young people, regarding the hazards and addictive qualities of substance abuse (e.g., public education campaigns, school education programs). • Encourage development of life skills.
What are some tertiary prevention strategies related to mental health?
• Perform medication monitoring. • Provide mental health interventions. • Make referrals to various groups of professionals, including support groups. • Maintain the client's level of function to prevent relapse or frequent rehospitalization. • Identify behavioral, environmental, and biological triggers that may lead to relapse. • Assist the client in planning a regular lifestyle and minimizing sources of stress. • Educate the client and family regarding medication side effects, potential interactions
What are some secondary preventions strategies for migrant health care?
• Screen for pesticide exposure. • Screen for skin cancer. • Screen for chronic preventable diseases. • Screen for communicable diseases.
What are some primary prevention methods for reducing societal violence?
• Teach alternative methods of conflict resolution • Organize parenting classes to provide anticipatory guidance of expected age-appropriate behaviors, appropriate parental responses, and forms of discipline. • Educate clients about community services that are available to provide protection from violence. • Promote public understanding about the aging process and about safeguards to ensure a safe and secure environment for older adults in the community. • Assist in removing or reducing factors that contribute to stress by referring caretakers of older adult clients to respite services, assisting an unemployed parent in finding employment, or increasing social support networks for socially isolated families. • Encourage older adults and their families to safeguard their funds and property by getting more information about a financial representative trust, durable power of attorney, a representative payee, and joint tenancy. • Teach individuals that no one has a right to touch or hurt another person, and make sure they know how to report cases of abuse.
hep B (HBV)
› Blood › Unprotected sex with infected individual › Infants born to infected mothers › Contact with infected blood › Injection drug users
hep D (HDV)
› Coinfection with HBV › Injection drug users › Unprotected sex with infected individual
hep E (HEV)
› Fecal-oral route › Ingestion of contaminated food or water
Metformin HCI (Glucophage)
› Take with food to decrease adverse GI effects. › Instruct the client to take vitamin B12 and folic acid supplements. › Contact the provider if manifestations of lactic acidosis develop (myalgia, sluggishness, somnolence, and hyperventilation). › May take during pregnancy for gestational diabetes. › Never crush or chew the medication
work-related illness/injury control strategies often include
■ Engineering ■ Altering work practices ■ Providing personal protective equipment and education to prevent future injuries ■ Workplace monitoring ■ Health screening ■ Employee-assistance programs ■ Job-task analysis ■ Design, risk management, and emergency preparedness
Factors influencing an individual's potential for violence
■ History of being abused or exposure to violence ■ Low self-esteem ■ Fear and distrust of others ■ Poor self-control ■ Inadequate social skills ■ Minimal social support/isolation ■ Immature motivation for marriage or childbearing ■ Weak coping skills
Risk Factors Essential hypertension
■ Positive family history ■ Excessive sodium intake ■ Physical inactivity ■ Obesity ■ High alcohol consumption ■ African American ■ Smoking ■ Hyperlipidemia ■ Stress
National Health Goals for Older Adults
■ Reductions in ☐ Adults who have musculoskeletal concerns ☐ Older adults who have mental health concerns ☐ Hospitalizations due to heart failure ☐ Substance use in the older adult ☐ Sensory concerns such as hearing loss and cataracts ☐ Hip fractures among older adults ☐ Fall-related deaths ■ Increases in ☐ Screenings for colorectal cancer ☐ Participation in organized health promotion activities ☐ Public reporting of elder maltreatment ☐ Older adults who maintain an active lifestyle
National Health Goals for Families
■ Reductions in ☐ Barriers to access ☐ Allergic content within the home ☐ Families that are unable to have a child or maintain a pregnancy ☐ Passive smoke exposure ☐ Household hunger ■ Increases in ☐ Health education provided by an agency (Head Start, school system, college, places of employment, health departments) ☐ Home testing for radon ☐ Health insurance coverage ☐ Individuals who have a usual primary care provider
National Health Goals for Men
■ Reductions in ☐ Death from cancer specific to men, such as prostate ☐ Incidence of HIV and AIDS ☐ Fatal and nonfatal injuries ■ Increases in ☐ Participation in aerobic and muscle-strengthening activities ☐ Ability to identify warning signs of a heart attack and stroke
National health goals for Women
■ Reductions in ☐ Diseases involving bone, such as osteoporosis ☐ Death from cancer such as breast, ovarian, and cervical ☐ Sexual violence ■ Increases in ☐ Number of planned pregnancies versus unplanned ☐ Those who receive early and adequate prenatal care ☐ The number of mothers who breastfeed ☐ Ability to identify warning signs of a heart attack and stroke
Portals of exit
■ Respiratory secretions ■ Feces ■ Blood ■ Semen ■ Vaginal secretions ■ Saliva ■ Skin lesion exudates
Nursing Care for TB
■ Wear an N95 or HEPA respirator when caring for clients who are hospitalized with TB. ■ Place the client in a negative airflow room, and implement airborne precautions. ■ Use barrier protection when the risk of hand or clothing contamination exists. ■ Have the client wear an N95 or HEPA respirator if transportation to another department is necessary. The client should be transported using the shortest and least busy route. ■ Teach the client to cough and expectorate sputum into tissues that are disposed of by the client into provided sacks. ■ Encourage fluid intake and a well-balanced diet for adequate caloric intake. ■ Encourage foods that are rich in protein, iron, and vitamin C.
What may be included in denial?
■■ Defensiveness ■■ Lying about use ■■ Minimizing use ■■ Blaming or rationalizing use ■■ Intellectualizing
What are factors that influence an individual's potential for violence?
■■ History of being abused or exposure to violence ■■ Low self-esteem ■■ Fear and distrust of others ■■ Poor self-control ■■ Inadequate social skills ■■ Immature motivation for marriage or childbearing ■■ Weak coping skills
What are some s/sx of substance abuse?
■■ Vital signs - Blood pressure, pulse, and temperature can be elevated, while respirations can be rapid, shallow, and depressed. ■■ Appearance - Individual can appear disheveled with an unsteady gait. ■■ Eyes - Pupils can appear dilated or pinpoint, red, also poor eye contact. ■■ Skin - Can be diaphoretic, cool, and/or clammy; needle track marks or spider angiomas may be visible. ■■ Nose - Can be runny, congested, red and/or cauliflower-shaped. ■■ Tremors - Fine or coarse tremors may be present.
When caring for clients who experience violence:
◯ Build trust and confidence with a client. ◯ Focus on the client rather than the situation. ◯ Assess for immediate danger. ◯ Provide emergency care as needed. ◯ Develop a plan for safety. ◯ Make needed referrals for community services and legal options. ◯ If abuse has occurred, complete mandatory reporting, following agency guidelines.
Health Problems of Migrant Workers
◯ Dental disease ◯ Tuberculosis ◯ Chronic conditions ◯ Stress, anxiety, and other mental health concerns ◯ Leukemia ◯ Iron deficiency anemia ◯ Stomach, uterine, and cervical cancers ◯ Lack of prenatal care ◯ Higher infant mortality rates
Barriers to Health Care in Rural Areas
◯ Distance from services ◯ Lack of personal/public transportation ◯ Unpredictable weather and/or travel conditions ◯ Inability to pay for care/underinsured/uninsured ◯ Shortage of rural hospitals/health care provider
Steps in the referral process:
◯ Engaging in a working relationship with the client. ◯ Establishing criteria for the referral. ◯ Exploring resources. ◯ Accepting the client's decision to use a given resource. ◯ Making the referral. ◯ Facilitating the referral. ◯ Evaluating the outcome
risk factors for acute respiratory disorders
◯ Extremely young and advanced age ◯ Recent exposure to viral, bacterial, or influenza infections ◯ Lack of current immunization status (pneumonia, influenza) ◯ Exposure to plant pollen, molds, animal dander, foods, medications, and environmental contaminants Tobacco smoke ◯ Substance use (alcohol, cocaine) ◯ Chronic lung disease (asthma, emphysema) ◯ Immunocompromised status ◯ Presence of a foreign body ◯ Conditions that increase the risk of aspiration (dysphagia) ◯ Impaired ability to mobilize secretions (decreased level of consciousness, immobility, recent abdominal or thoracic surgery) ◯ Inactivity and immobility ◯ Mechanical ventilation (ventilator-acquired pneumonia)
Risk factors for TB
◯ Frequent and close contact with an untreated individual ◯ Lower socioeconomic status and homelessness ◯ Immunocompromised status (HIV, chemotherapy, kidney disease, diabetes, Crohn's disease) ◯ Poorly ventilated, crowded environments (prisons, long-term care facilities) ◯ Advanced age ◯ Recent travel outside of the United States to areas where TB is endemic ◯ Substance use ◯ Health care occupation that involves performance of high-risk activities (respiratory treatments, suctioning, coughing procedures)
Steps in analysis of community assessment data include:
◯ Gathering collected data into a composite database. ◯ Assessing completeness of data. ◯ Identifying and generating missing data. ◯ Synthesizing data and identifying themes. ◯ Identifying community needs and problems. ◯ Identifying community strengths and resources.
Health Status of Rural Residents
◯ Higher infant and maternal morbidity rates ◯ Higher rates of diabetes mellitus ◯ More likely to be obese ◯ Less likely to meet physical activity recommendations ◯ Higher rates of suicide ◯ Increased trauma/injuries from lightning, farm machinery, drowning, and boating, snowmobile, all-terrain vehicle, and motorcycle crashes ◯ Increased occupational-associated risks (agriculture, fishing, mining, and construction are the most dangerous industries) ◯ Less likely to seek preventive care
Barriers to health care include:
◯ Inadequate health care insurance ◯ Inability to pay for health care services ◯ Language barriers ◯ Cultural barriers ◯ Lack of health care providers in a community ◯ Geographic isolation ◯ Social isolation ◯ Lack of communication tools (e.g., telephones) ◯ Lack of personal or public transportation to health care facilities ◯ Inconvenient hours ◯ Attitudes of health care personnel toward clients of low socioeconomic status or those with different cultural/ethnic backgrounds ◯ Eligibility requirements for state/federal assistance programs
Risk factors for MI/Angina
◯ Male gender or postmenopausal women ◯ Hypertension ◯ Tobacco use ◯ Hyperlipidemia ◯ Metabolic disorders (diabetes mellitus, hyperthyroidism) ◯ Methamphetamine or cocaine use ◯ Stress (occupational, physical exercise, sexual activity)
Veterans Health Issues
◯ Mental health conditions (posttraumatic stress disorder, traumatic stress reactions, anger, depression) ◯ Substance use and addiction disorders ◯ Suicide ◯ Infectious diseases ◯ Exposures to herbicides, chemicals, and radiation ◯ Traumatic brain injuries ◯ Spinal cord injuries ◯ Traumatic amputations ◯ Cold injury ◯ Military sexual trauma ◯ Hearing impairments ◯ Visual impairments
Culturally aware nurses are:
◯ More likely to explore cultural variations among clients. ◯ Better able to understand how personal beliefs impact client care. ◯ Able to recognize the meaning of health differs with each culture.
Issues in Migrant Health
◯ Poor and unsanitary working and housing conditions ◯ Exposure to environmental pesticides ◯ Less access to dental, mental health, and pharmacy services ◯ Inability to afford care ◯ Availability of services (distance, transportation, hours of service, health record tracking) ◯ Language barriers and cultural aspects of health care
Case management nursing includes the following:
◯ Promoting interprofessional services and increased client/family involvement. ◯ Decreasing cost by improving client outcomes. ◯ Providing education to optimize health participation. ◯ Advocating for services and client rights.
National health goals:
◯ Reduction in per capita domestic water usage ◯ Reduction in blood lead levels in children ◯ Reduction in indoor allergens ◯ Reduction in the number of new schools near highways ◯ Increase in schools with policies/practices to promote health and safety
Recognizing Actual or Potential Child Abuse/Neglect
◯ Unexplained injury ◯ Unusual fear of the nurse and others ◯ Injuries/wounds not mentioned in history ◯ Fractures, including older healed fractures ◯ Presence of injuries/wounds/fractures in various stages of healing ◯ Subdural hematomas ◯ Trauma to genitalia ◯ Malnourishment or dehydration ◯ General poor hygiene or inappropriate dress for weather conditions ◯ Considered to be a "bad child"
Community Assessment: Social and Community Factors Influencing Violence
◯ Work stress ◯ Unemployment ◯ Media exposure to violence ◯ Crowded living conditions ◯ Poverty ◯ Feelings of powerlessness ◯ Social isolation ◯ Lack of community resources (playgrounds, parks, theaters)
What are some characteristics of homeless populations?
◯◯ Adults who are unemployed, earn low wages, or are migrant workers ◯◯ Female heads of household ◯◯ Families with children (fastest growing segment) ◯◯ People who are mentally ill (large segment) Care of Special Populations RN Community Health nursing 73 ◯◯ People who abuse alcohol or other substances ◯◯ Abandoned children ◯◯ Adolescent runaways ◯◯ Older adults with no one to care for them
What steps must the nurse take when caring for clients who experience violence?
◯◯ Build trust and confidence with a client. ◯◯ Focus on the client rather than the situation. ◯◯ Assess for immediate danger. ◯◯ Provide emergency care as needed. ◯◯ Develop a plan for safety. ◯◯ Make needed referrals for community services and legal options. ◯◯ If abuse has occurred, complete mandatory reporting, following agency guidelines.
What are common health problems of migrant workers?
◯◯ Dental disease ◯◯ Tuberculosis ◯◯ HIV ◯◯ Depression and other mental health problems ◯◯ Domestic violence ◯◯ Lack of prenatal care ◯◯ Higher infant mortality rates
What are some barriers to health care in rural areas?
◯◯ Distance from services ◯◯ Lack of personal/public transportation ◯◯ Unpredictable weather and/or travel conditions ◯◯ Inability to pay for care/underinsured/uninsured ◯◯ Shortage of rural hospitals/health care providers
What are some health status considerations of rural residents?
◯◯ Higher infant and maternal morbidity rates ◯◯ Higher rates of chronic illnesses (heart, lung, hypertension, cancer, diabetes mellitus) and motor vehicle crash-related injuries ◯◯ Higher health occupational risks (machinery accidents, skin cancer, respiratory problems due to chemical exposure) ◯◯ Higher rates of suicide ◯◯ High risk of trauma and injuries (falls, amputations, crush injuries, pesticide exposure) ◯◯ Less likely to seek medical care
What health problems can be included with ETOH, tobacco and other drug use?
◯◯ Low birth weight ◯◯ Congenital abnormalities ◯◯ Accidents ◯◯ Homicides ◯◯ Suicides ◯◯ Chronic diseases ◯◯ Violence
What are some migrant health issues?
◯◯ Poor and unsanitary working and housing conditions ◯◯ Less access to dental, mental health, and pharmacy services ◯◯ Inability to afford care ◯◯ Availability of services (distance, transportation, hours of service, health record tracking) ◯◯ Language (majority speak Spanish) and cultural aspects of health care
What factors affect individuals in vulnerable populations?
◯◯ Poverty ◯◯ Poor self esteem ◯◯ Young or advanced age ◯◯ Chronic stress ◯◯ Emotional instability ◯◯ Environmental factors
What are signs and symptoms of potential child abuse?
◯◯ Unexplained injury ◯◯ Unusual fear of the nurse and others ◯◯ Evidence of injuries not mentioned in history (old burns, scars, ecchymosis, human bite marks) ◯◯ Fractures, including older healed fractures ◯◯ Subdural hematomas ◯◯ Trauma to genitalia ◯◯ Malnourishment or dehydration ◯◯ General poor hygiene or inappropriate dress for weather conditions ◯◯ Considered to be a "bad child"
What are signs and symptoms of potential elder abuse?
◯◯ Unexplained or repeated physical injuries ◯◯ Physical neglect and unmet basic needs ◯◯ Rejection of assistance by caregiver ◯◯ Financial mismanagement ◯◯ Withdrawal and passivity ◯◯ Depression
What are common health conditions of homeless persons?
◯◯ Upper respiratory disorders ◯◯ Tuberculosis ◯◯ Skin disorders (athlete's foot) and infestations (scabies, lice) ◯◯ Alcoholism/drug abuse ◯◯ HIV/AIDS ◯◯ Assault and rape ◯◯ Mental illness ◯◯ Dental caries ◯◯ Hypothermia and heat-related illnesses ◯◯ Malnutrition
What are some social and community factors that influence violence?
◯◯ Work stress ◯◯ Unemployment ◯◯ Media exposure to violence ◯◯ Crowded living conditions ◯◯ Poverty ◯◯ Feelings of powerlessness ◯◯ Social isolation ◯◯ Lack of community resources (playgrounds, parks, theaters)
Ethambutol (Myambutol)
☐ Obtain baseline visual acuity tests. ☐ Determine color discrimination ability. ☐ This medication should not be given to children younger than 13 years of age. ☐ Instruct the client to report changes in vision immediately.
leading causes of death in children
☐ Perinatal conditions/congenital anomalies ☐ Sudden Infant Death Syndrome (SIDS) ☐ Motor vehicle/other unintentional injuries
Neglect includes the failure to provide:
☐ Physical care, such as food, shelter, and hygiene ☐ Emotional care and/or stimulation necessary to achieve developmental milestones, such as speaking and interacting with a child ☐ Education for a child ☐ Needed health or dental care
Nitroglycerin (Nitrostat) considerations
☐ Used to treat angina and help control blood pressure. ☐ Used cautiously with other antihypertensive medications. ☐ Vasodilators can cause orthostatic hypotension .Remind the client that a headache is a common side effect of this medication. ☐ Encourage the client to sit and lie down slowly.
What is economic maltreatment?
☐☐ Failure to provide the needs of a victim when adequate funds are available ☐☐ Unpaid bills when another person is managing the finances, resulting in disconnection of heat or electricity
What are ETOH withdrawal s/sx?
☐☐ Irritability ☐☐ Tremors ☐☐ Nausea ☐☐ Vomiting ☐☐ Headaches ☐☐ Diaphoresis ☐☐ Anxiety ☐☐ Sleep disturbances
