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CH Final exam study answers and rationales
community health (nurs 450)
Denver College of Nursing
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Denver College of Nursing Focused Review Study Areas 1-define and contrast
community- BASED nursing practice : The nurse focuses on "illness care" of INDIVIDUALS AND FAMILIES across the lifespan. HOSPICE or the individual screen one nurse :one patient,/child. Community health home of Ms Brown, hospice, One school nurse:to little Jimmy and his family for referral for a problem/asthma, teach a family how to change a dressing, in occupational one nurse one worker
Individual-focused practice (community-based) Case Management (direct care), client education, individual and family advocacy, Diagnoses, interventions, and treatments are carried out at individual client level. Continuity of care providers
community- ORIENTED nursing practice POPULATION FOCUSED. -PREVENTION- PUBLIC HEALTH NURSING a nurse to entire community. a nurse for after school one nurse:wellness class of new moms, vaccination clinic for
Direct care of AT RISK/ primary, secondary, tertiary
community oriented nurses provide health care to promote quality of life. Has its primary focus on health care either of the entire community or populations as in public health nursing families, and groups in a community. - To preserve, protect, promote, or maintain health.
Goal is to prevent disease, preserve, restore, and protect health for the community and the population within it Prevent: disease, disability; TO: promote, protect, and maintain health.
Focus is on “health care” of groups in community. Provide health care to promote quality of life. Community diagnosis, health surveillance, monitoring, and evaluation of community and population
Population -focused practice (community-oriented) Diagnoses, interventions, and treatments for population or subpopulation. Population-level decision making is different.
- Know the three PUBLIC HEALTH CORE FUNCTIONS / services. Be able to identify these. Be able to provide examples of each. See Fig. 1.
Assessment 1) monitor health status to identify community health problems 2) Diagnose and investigate health problems and health hazards in the community Systematic data collection on the population, monitoring the population’s health status, and making information available about the health of the community asking questions/ getting data
Policy development 1- inform, educate and empower people about health issues, 2- mobilize community partnership to identify and solve health problems 3- develop policies and plans that support individual and community health efforts Policy development- community garden Efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions a change in policy to better benefit populations
Assurance : 1- enforce laws and regulations that protect health and ensure safety 2- link people to needed personal health services and assure the provision of health care when other unavailable 3- assure a competent public health and personal healthcare workforce
4- evaluate effectiveness, accessibility and quality of personal and population- based health sciences------ resources making sure you have staff and time Assurance -Making sure that essential community-oriented health services are available Makes sure the policy is being followed/ services are available Eg: Do I have enough staff to oversee pts.? Do I have enough money to run this program? Am I able to provide the services the community needs? -Includes providing essential personal health services for individuals as well as a competent PH workforce.
What is public health? A scientific discipline that includes the study of epidemiology, statistics, and assessment Aggregate = population. Share something in common... something about them makes them a population. EDUCATE public to clean water, STI’s and reporting
Disparity -different health outcomes... take care of all communities
- Be able to describe and identify examples of P< S<T for all areas studied in this class. ALL PREVENTION
PRIMARY: , trying to keep healthy people healthy. Promote health, prevent occurrence of disease, injury, or disability.
VACCINATIONS, EDUCATION, NUTRITION, Fluoride, counseling Inc. Physical fitness In the Community: nice parks, keep healthy, fluoridation of water, car seat for new baby keep you healthy, education to wear a seat belt/helmets
SECONDARY health screenings/testing individuals w health problems “Who Are At Risk For” developing complications..... diagnose and prompt treatment, -return person to health. We don’t know if there is a problem or not. So we test, screening Nothing bad as happened In the community we identify vulnerable populations. At risk but we don’t know if we think we know but we are testing..... symptomatic... don’t know if you are sick or NOT. May have it or NOT. Referrals if you are screening care in place.
TERTIARY PREVENTION: TREATMENT bad thing has happened. prevent complication diabetics, stroke, get them back to a higher level of function. Community: bad thing RESCUE people- get them electricity, minimize damage, repair roads,
- Review and be able to describe some of the “Forces Stimulating Change in the Demand for Health Care” on pages 34 through 37
1-socioeconomic Social and economic trends-healthier lifestyles, less ppl smoke, appreciate quality of life more, financially less not as much now, shift from financial success, rising household incomes/ per person is income increasing., rich got richer/ poor got poorer; gap is widening. Family composition is changing. Affordable care act (insurance) we insured more people.
2-Demographic : increased fertility, baby boom, how many pple died, number of babies, aging society, POPULATION is growing... leading minority, white 50% in 2050, mortality for all genders declines.
Under 18 or over 65. More elderly later,
- Factors that make a child at higher risk for lead poisoning. Poor, children of color, lack of access to healthcare, living in a house built before 1970’s, buying painted toys from china, children at risk bc of their size and immaturity of systems, B-Brain Barrier not well developed, their height/size bc they are closer to the ground,
Primary: use only no lead based paint-. Secondary prevention: good surveillance-will help with early detection, remove the paint and replace. Tertiary prevention: take steps to reduce blood lead levels, drink water,
The THREE R’s for Reducing Environmental Pollution are 1-REDUCE consumption reduces waste and unnecessary packaging and nonessentials. 2- REUSE choosing reusable rather than disposable products creates less water (glass instead of paper) 3-RECYCLE Recycle paper, glass, cans, and plastic decreases pollution.
- Know the 4 key pediatric outcomes for t he Environmental Influences on Child Health Outcomes: ECHO program and how you would assess for each, page 96 1- Upper and Lower airway, 2-obesity, 3- pre-peri-post natal outcomes 4- neurodevelopment
Environmental NURSE : IPREPARE assessment : Investigate potential exposures, Present work, Residence, Environmental concerns, Past work, Activities, Referrals and resources, and Educate
Chapter 9
- Be very familiar with the epidemiologic triangle.
AGENT: Infectious bacteria, viruses, fungi, parasites /chemical - heavy metals, toxic chemicals, pesticides / physical agents – radiation, heat, cold, machinery, animate or inanimate object. (salmonella or food, tractor) cigarettes, radon gas,
HOST: immunizations make you less likely to get it. genetic susceptibility, Immutable characteristics (age, sex) , Acquired characteristics (immunological status) Lifestyle factors (diet, exercise) Living being (Kids/children who ate the bad food) person who does or doesn’t get sick, diabetes, all autoimmune, very young very old, cancer, lymphoma, HIV-aids, steroid use, fatigue, stress, low socio economic status (allostatic load). Cortisol, adrenalin, stress.
ENVIRONMENT: The setting or surrounding that sustains the host. Hand hygiene, PPE things you can do on the outside. Climate (temperature, rainfall) Plant and animal life (agents, reservoirs, habitats for agents) Human Population ( crowding, social support) Socioeconomic factors (education, resources, access to care) Working Conditions (levels of stress, noise satisfaction) The food that may have not been cooked all the way, or cross contamination of utensils
Virulence how contagious how infective and how sick it makes you
Web of Causality. Type 2 diabetes, age, lack of exercise, family genetics, Know all aspects of the triangle and what affects them (is host factors, environmental factors) several factors collectively web of casualty. Need a web
Descriptive: what’s the basics?
Who: is the affected (person)? Race, sex, age, education, occupation, income, and marital status What: is the source of the outbreak. Where: it happened (place)? examine geographic patterns When: did this occur? (Time). Ong term patterns, rapid or uncommon peak, cyclical time patterns - seasonal
Analytic: distribution causative factors is the HOW and WHY are some more affected than others
(determining factors, data records & previous patterns) X statistics- no numbers.
- INCIDENCE: New cases # of ppl who developed new diagnoses/di sease in 2021. Number or %. Usually a shorter term illness. Important to know NEW cases. Researcher determines the time, which parameters
PREVALENC E : # of New and Existing ALL people w Alzheimers in Colorado in 2019 -specified time. Usually for long standing disease... diabetic CHRONIC or longer term illnesses. ... grows because more New cases, and people are living longer w disease, and /not dying as much.
Cite the factors that influence the prevalence rate- deaths people that die they are no longer counted in prevalence
Validity : is the measurement really measuring what your measure- multiple people measuring isn’t valid-
Attack rate : food born illness. 29 went to picnic, 8 became ill, of the 29 19 ate potato salad. and the attack rate is 8/19=42%
22 kids in daycare, 19 ate turkey dressing and 11 became ill. What is the attack rate? 11/19 = 57%
- Be able to distinguish the difference between screening tests: Sensitivity- quantifies how accurately true positives – this test is needed when early TX , contagious, and ABX are needed for every case. Mammography, pregnancy test, strep, wont miss any ____, HIV – to protect others or get tx., cancer True POSITIVES and false POSITIVES closer to 100% better predictor
Specificity- indicates how accurately the test identifies those without the condition or trait -true negatives. This test is needed when rescreening is impractical and when it is important to reduce false- positive results. How accurately true negative-but may miss some. Influenza- doesn’t have long term effects and treat all the same anyway. True negatives and false negatives closer to 100% better predictor
Chapter 11 pg 193
- Know the 6 components of the Health Belief Model, What motivates an individual to do something?
1- Perceived susceptibility Will something happen to me?/ I wont get it at 16yo
2- Perceived severity: If something does happen to me will it be a problem? They will find a cure by then
MASS CASUALTY EXERCISES IS ALWAYS PREPAREDNESS. Hands on Personal checklist, stock piled water and snacks, family plan Emergency supplies kit and plan for where to meet ARC and FEMA
Professional preparedness Disaster medical assistance teams Community preparedness National Health Security Strategy (NHSS) Communication protocol Disaster and Mass Casualty Exercises Response save lives use MAASLOWS SAVE LIVES
Assessment – think Maslow. Do they have fresh water and food and elimination and then we think of SAFETY Soon as they are safe we start recovery.- rebuilding Emergency support functions – DHS, ARC, FEMA, CDC, Office Emergency Management National incident management system Response to bioterrorism International relief efforts
4 stages preparedness planning. , RESPONSE. Immediate emergency response , recovery , mitigation. -planning preparedness how can you do better the next time
Psychological stress of disaster worke
B e able to identify patients tagged using the START triage method. Quick assessment include: perfusion, respirations, mental status
Green : walking wounded Yellow : person sitting/lying following commands, lacerations/broken bones Red : needs attention /critical respirations over 35: , Black : no respirations after a head tilt , dead/leave for dead
Chapter 15
- Endemic, hyperendemic, epidemic, and pandemic
Endemic– persistent usual presence with low to moderate number of cases Botulism in Alaska/ food bourne Influenza cases/hand mouth foot /chicken pox in a day care Hyperendemic – persistently high number Cholera in Pacific Islanders/Nigeria ( bacteria of the small intestine) diarrhea tx with oral fluids/ and tetracycline- wash your hands after you poop and don’t poop in water, cover your poop w dirt Epidemic – outbreak/ occurrence within in an area is clearly in excess of expected levels (endemic) Acute Flaccid Myelitis Measles Pandemic – epidemic spread over several countries or continents COVID, SARS
Chapter 19
- Describe ways to assess family health and function, such as: genogram: health/illness patterns in families. Need interview!! for 3 generations. -Risk assessment more intensive. “My Family Health Portrait” at CDC website., ecomap: represents the families interactions with other groups and organizations- how much energy goes to work, church, extended families, friends, and recreation home assessment: Healthy people targets areas in Health Promotion, Health Protection, Preventative Services, And Surveillance And Data Systems to describe objectives. Assessment of family health risk requires many approaches As in any assessment, the first and most important task is to get to know the family, their strength and their needs.
Chapter 21
- Social Determinants Of Health. OUTSIDE THE SKIN / THE OUTSIDE WORLD Remember
these can be positive or negative. page 360! Determinants of Health are part of vulnerability.
- Higher economic status/income= better health, 2) low education= linked with poor health, more stress, lower sef confidence, 3) Physical environment safer water/air/ homes/ communities bike path, all contribute good health. 4) social support networks, family friends, community, beliefs of health 5) Genetics- coping skills, 6) Health services -access available healthy food, 7) Gender men v women suffer dif diseases at dif ages. that lead to resource constraints, poor health and health risk;
Healthy People 2020 say: DOH: 1) social and economic environment, 2) physical environment, and 3) the person’s individual characteristics and behaviors.
Chapter 19 and 23
- Overcrowding
- Work expectations (read page 385 re: ages)
- May not attend school or Head Start
Housing – often substandard and crowed diseases spread rapidly TB Issues in migrant health Migrant Health Act (1962) Primary and supplemental health services Migrant Health Centers issues lack of knowledge (don’t know where to go), unable to afford, availability (need to be working), hours, transportation (no cars get dropped off to farm), language, discrimination, documentation
Cultural aspects – folk medicine - Dental disease – compounded problems leads to heart problems - TB Incidence – higher disease & death rates - Incidence of HIV/AIDS – sex, needles, tattoo - Higher incidence of type 2 diabetes - Depression & anxiety-related disorders - Poverty, isolation, uncertainty - Domestic violence - Very common - Difficulty reporting
Chapter 23
- Prevention For Community Mental Health issues
Levels of Prevention. Prevention page 410
Primary prevention services include affordable housing, housing subsidies, effective job-training programs, employer incentives, preventive health care services, multisystem case management, birth control services, safe-sex education, needle-exchange programs, parent education, and counseling programs.
Secondary prevention activities are aimed at reducing the prevalence of pathologic nature of a condition (screening for need for emergency housing, screening for depression). Early DX, and prompt tx
Tertiary Prevention attempts to restore and enhance functioning (i., support of affordable housing, promotion of psychosocial rehabilitation programs, mental health services after crisis occurs). Comprehensive case management, physical and mental health services, emergency shelter housing
- State some of the factors that make people at risk for homelessness.
Pregnant women – poorer outcomes, STIs, substance abuse, nutritional deficits Children – high anxiety, depression, delayed development Adolescents – risky behaviors, runaways, trafficking, sexual abuse Older adults – fewer supports Average life expectancy in U. – 78 years in 2019 Life expectancy of homeless - 43-47 years
- Identify requirements for home care and hospice care under the Medicare guidelines.
Medicare Hospice Program Req:
- Medicare beneficiary
- 6 month life expectancy
- Home bound
- Need for skilled care
Medicare Home Care Program Req
Medicare beneficiary
City policy scooter’s
- Describe why home health care and home hospice are challenging and potential areas for legal and ethical issues
Legal and ethical issues
- -At risk for malpractice claims
- -Complexity of care needed
- -Actual or alleged negligence - rushed visits or failure to adhere to standards of practice
- -No witnesses
- -Family perceptions
- Be able to cite benefits of case management and describe which patients benefit most
Additional areas to study:
Patients who might need case management:
- Chronic diseases
- High Risk for complications
- Cost containment
- Coordination & Administration
- Disease management
- EBP & Outcomes Measurement
- Be sure you understand herd immunity and how it works. What does the R0 factor mean?
Herd Immunity Immunity of a group or community immunizing the 99% of the populations so those who cannot be immunized are not at risk. Based on resistance of high proportion of individual members of a group to infection If a high enough proportion of individuals in a population are immune, the majority will protect the few susceptible people because the pathogen is less likely to find a susceptible person. We want to vaccinate as many people as possible
- MEASLES : Know everything covered in the lecture and video – caused by the Ruebella Vius (herd immunity- need 94% to be vaccinated) Acute highly contagious respiratory
o airborne isolation Highly contagious, fever, runny nose, cough, rash, Koplik spots on cheek, Healthy People
Benefits of Case Management Handel cost containment High patient satisfaction Recourse management and knowledge Patient/ legal compliance Advocacy for the patients needs Coordinate cares and appointments
- Be able to distinguish between all 4 types of acquired immunity
Natura l Immunity : ACTIVE: immunization: You got sick and formed antibodies- came naturally. Measles, Covid Got immunization for a certain amount of time PASSIVE: mom to baby (placenta/milk)
Artificial Immunity : ACTIVE: got stuck with a needle and got immunized
PASSIVE: giving gabba globulin (anti-venom, rabies shot)- only for a certain time. passive rabies tx, get bit by a fox, passive last for this episode
Artificially acquired passive using something from the immune system.
- Really look at the Charts With All Three Types Of Hepatitis. Know transmission, long term prognosis, treatment, vaccination, etc.
Hepatitis Hepatitis A virus- Most often fecal-oral route; or may be water, food that has been contaminated, or sexual contact; often silent in children. Abrupt onset May be endemic in some countries (???) VACCINE available (Box 27) Mild to severe symptoms once you get it you have life long immunity Fever, nausea, lack of appetite, malaise, abdominal discomfort Jaundice occurs later Prevention-
Hepatitis B virus. BLOOD
- Know late effects of all types of hepatitis, STD’s, HIV/AIDS and tuberculosis.
Example – liver failure with hepatitis B, certain cancers with HPV, infectivity with chronic Hep C, etc.
Know prevalence of infectious disease world wide. How do we screen for international disease spread?
Describe how social determinants of health affect whether a patient gets tuberculosis, such as poverty, overcrowding, etc. Also know primary, secondary and tertiary in relation to TB.
Social determinants of health: o Food insecurity o Poor housing o Environmental conditions o Malnutrition o Financial status o Cultural barriers Primary prevention: o If people are known to be living in an area of high TB infection rate give the BCG vaccine Secondary prevention: o Screening for TB such as IGRA blood test or PPD skin test Tertiary prevention: o Treating those who have been infected with TB through antibiotics
- Know about salmonellosis in general, how it is transmitted, signs and symptoms and seriousness of outbreaks.
Salmonellosi
- Bacteria onset within 48 hours
- Headache, abdominal pain, diarrhea, N&V, fever
- Most susceptible infants, elderly, disabled
- Meat, poultry, eggs, lettuce, peanut butter
- Animal to person, person to person Salmonellosis is a bacterial disease characterized by a sudden onset of headache, abdominal pain, diarrhea, nausea, sometimes vomiting, and fever. Also, can see lack of appetite Transmission is through ingestion of food from an infected animal or food containing feces of an animal or person, usually at restaurants, hospitals, nursing homes, and institutions for children. Death is uncommon except among infants, older adults, and the debilitated; it is estimated only a small percent (1%) of cases are recognized clinically and reported
- Be able to identify the usual bioterrorism agents, such as anthrax, ........ (look these up in the Red Book)
Agents of Bioterrorism High mortality & easily distributed Anthrax ( Bacillus anthracis ) Plague ( Yersinia pestis ) Smallpox (variola major) look at case study
Botulism ( Clostridium botulinum ) – neuro! Tularemia ( Francisella tularensis ) Selected hemorrhagic viruses (Filoviridae and Arenaviridae) Anthrax ( Bacillus anthracis ) In soil / handling infected animals (not human to human) Incubation – usually 1 - 7 days Can be up to 60 days (spores) Cutaneous, GI, respiratory (fever, cough, shortness of breath) Antibiotics (60 days if infected) High fatality rates – 80% inhalation Aerosol
CONTACT – MRS. WEE M – Multidrug resistant organism* R – Respiratory infection S – Skin infections* W – Wound infection* E – Enteric infection – clostridium difficile* E – Eye infection - conjunctivitis What Is Protective Isolation and When Do We Use It? No plants or flowers Protect the pt. from us they are susceptible to sickness (immune-compromised)
- Know and be able to cite examples of
Vector-borne : transmitted by a carrier/vector mosquito, tick or fly. Biologic a mosquitos carry malaria. Mechanical transmission occurs when an insect contacts the infectious agent with its leg or mouthparts and carries it to the host. Flies contaminate food.
Rocky Mountain Spotted Fever, Lyme Disease, Zika Virus
Point source: all persons exposed become ill at the same time during one incubation period o Example: smokestacks
zoonoses: vector typically involve – ticks lyme disease BITES inhalation, ingestion, Infection transmitted from vertebrate animal to human Can be viruses, bacteria, parasites, fungi Vectors, bites (rabies), dead carcasses, ingestion, inhalation of excrement Many diseases begin as zoonoses started with animals Read page 472
Bloodborne illnesses: infectious microorganisms in human blood that can cause diseases in humans o Example: Hep C, HIV, Hep B
food borne illnesses, food poisoning. Samonellas (sudden onset of headache, abd pain, diarrhea, nausea, and fever), hep A, trichononis , botulism, mercury, paralytic
Look at the current COVID 19 pandemic and how it relates to all areas of Community/Public Health. Be able to relate this to disasters, surveillance, epidemics and pandemics, ethical issues related to this. Pandemic, Herd immunity, principalism, utilitarianism, consequentialism,
Define the ethical principles of
19
Autonomy: individual autonomy of individual right to do what self wants; refers to self governance
distributive justice: or social justice refers to the allocation of benefits and burdens to members of society
veracity: telling truth, conformity to facts, accuracy
beneficence: doing good
nonmaleficence: doing no harm non-infliction of harm
deontology: adhering to moral rules or duty rather than to consequences or actions. The action is right or wrong in itself -regardless of the amount of good that might come from it.
principalism: relies on ethical principles to guide decision making
utilitarianism: the doctrine that actions are right if they are useful or for the benefit of a majority; the moral value of an action is determined by its overall benefit
Consequentialism: the right action is the one that leads to the most good/least harm
- Identify the steps involved in an ETHICAL DECISION-MAKING FRAMEWORK and be able to apply them.
1-Identify the ethical issues and dilemmas.
2-Place ^^ w/i a meaningful context
3- Obtain all relevant facts
4 - Reformulate ethical I/D if needed
5-Consider approached to actions or options
6- Make the decision and take action
7-Evaluate the decision and the action
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CH Final exam study answers and rationales
Course: community health (nurs 450)
University: Denver College of Nursing
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