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ATI Community Health Nursing Review
Personal and Community Health (KIN 235)
University of Miami
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ATI CMS Community Health Nursing Review
Chapter 1; Overview of Community Health Nursing
Community Health Nursing Theories à Systems thinking; studies how individual or unit interacts w/ other organizations or systems; useful in examining cause& effect relationships à Upstream thinking; used to focus on interventions that promote health or prevent illness
- Nightingales Environmental Theory; highlights relationship between environment and health; depicts health as continuum; emphasizes preventative care
- Health Belief Model (HBM); predict or explain health behaviors; assumes preventive actions are
taken to avoid disease; emphasizes change at individual level ; describes likelihood of taking an
action to avoid disease based on
- Perceived susceptibility, seriousness, and threat of a disease
- Modifying factors (demographics, knowledge level)
- Cues to action (media campaigns, disease effect on family/friends, recommendations from health care professionals)
- Perceived benefits minus perceived barriers to acting
- Milios Framework for Preventions; complements HBM ; emphasizes change at community level; identifies relationship between health deficits and availability of health promoting resources; theorizes that behavior changes w/in a large number of people can lead to social change
- Penders Health promotion Model (HPM); similar to HBM; does not consider health risk as factor
that provokes change; examines factors that affects individual actions to promote and protect health
- Personal factors (biological, psychological, sociocultural), behaviors, abilities, self-efficacy
- Feelings, benefits, barriers, and characteristics associated with the action
- Attitudes of others, and competing demands and preferences
- Transtheoretical (TTM) of Stages of Change (SOC) Model; theorizes that change occurs over time and in 6 stages 1. Precontemplation, where the individual is unaware of the need to change 2. Contemplation, where the individual considers change, and weighs the benefits with costs 3. Preparation, where the individual plans to take action 4. Action 5. Maintenance, where the individual implements actions to continue the behavior 6. Termination, when conscious efforts to continue the health behavior are no longer needed because the individual is consistent. Most clients never reach this point.
- The Precaution Adoption Process Model; similar to TTM & SOC; includes stage of being unengaged regarding issue between stages of being unaware & contemplating; does not include termination stage
Essentials of Community Nursing
Determinants of Health; client of environmental factors that influence health (nutrition, social support, stress, education, finances, transportation, housing, biology, genetics, personal health practices)
Health Indicators; describe health status of a community & serves as targets for improvement (mortality rates, disease prevalence, levels of physical activity, obesity, tobacco, or other substance use)
Nurses; determine community heaths by examining the degree to which the communities collective health needs are identified and met
Community; group of people and institutions that share geographic, civic, &/or social parameters
Community health nursing involves synthesis of nursing & public health theory
Goals; promote, preserve, & maintain health of populations
Client is the community or a population (an aggregate that shares 1+ personal characteristics w/in community)
Public Health Nursing; population focused, involves combo of nursing knowledge w/ social & public health sciences; GOAL à promote health & prevent disease
- ASSESSMENT; systematic methods used to monitor health of population; monitor health status to identify problems; diagnose & investigate health problems & hazards w/in community
- POLICY DEVELOPMENT; developing laws & practices to promote health of a population based on scientific evidence; inform, educate & empower about health issues; mobilize community partnerships to identify & solve health problems; develop policies & plans that support individual & community health efforts
- ASSURANCE; ensuring adequate health care personnel and services are accessible; enforce laws & regulations; link people to needed health services & ensure the provision of health care; ensure competent public & personal healthcare workforce; evaluate effectiveness, accessibility, and quality of personal & population based health services
Population- Focused Nursing; includes assessing to determine needs, intervening to protect & promote health, and preventing disease w/in specific populations ( those at risk for HTN, w/o health insurance, w/ specific knowledge deficits)
- Key Principles of Public Health Nursing; emphasize primary prevention; work to achieve greatest good for the most people; recognize that the client is a partner in health, use resources wisely to promote the best outcomes
Principles Guiding Community Health Nursing - Ethics; 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. - Apply ethical principles through core functions as they collect and manage information (assessment), develop policies that are in the best interest of the people in an area (policy development), and create interventions that promote healthcare equality across population groups (assurance).
Chapter 2; Factors Influencing Community Health
- Social determinants of health are factors within a community or defined location that affect individual health. These are divided into five categories: neighborhood and built environment, social and community context, economic stability, health and healthcare, and education. Culture
- Cultural competence: Cultural competence is a skill the nurse develops in learning to respect individual dignity and preferences, as well as acknowledging cultural differences; Culturally competent care is guided by four dimensions.
- Cultural preservation: Assisting the client to maintain traditional values and practices
- Cultural accommodation: Supporting & facilitating use of cultural practices that are beneficial to health
- Cultural repatterning: Assisting client to modify cultural practices that are not beneficial to health
- Cultural brokering: Advocating, mediating, negotiating, & intervening between client’s culture &health care culture on behalf of the client
- Cultural Assessment à Steps of Data Collection; 1. Collection of self-identifying data about client’s ethnic background, religious preference, family structure, food patterns, and health practices. 2. Nurse should pose questions that address the client’s perceptions of their health needs. 3. Identification of how cultural factors can affect the effectiveness of nursing interventions.
- Environmental Control; the belief in how the environment affects the individual
- Time Orientation; describes whether focus is more on past, present, or future
- Social Organization; describes significance of individual family members of family as a whole
- Health Beliefs & Practices; - Biomedical beliefs about illness focus on identifying a cause for every effect on body, body functions like a machine; basis for the way the majority of medical facilities in the U. function & based on identifying a biophysical cause and treatment for health problems. - Naturalistic beliefs about illness relate individual as a part of nature or creation; imbalance in nature is believed to cause disease. This is the basis of Eastern or Chinese medicine. Several other cultures, such as the Mexican culture, follow the hot-cold theory of balance in relation to health and illness that accompanies this belief framework. - Magico-religious beliefs about illness link health to supernatural forces, or good and evil. This includes belief in faith healing used by some Christian religions, or voodoo and witchcraft practices used in Caribbean nations.
- Biological Variations in Health; can be linked to genetic ties
Environmental Health; relates to the quality of the air, land, water & other surroundings - Environmental Risks - Toxins: lead, pesticides, mercury, solvents, asbestos, and radon - Air pollution: carbon monoxide, particulate matter, ozone, lead, aerosols, nitrogen dioxide, sulfur dioxide, and tobacco smoke - Water pollution: wastes, erosion after mining or timbering, & run-off from chemicals added to soil - Contamination: food & food products w/ bacteria, pesticides, radiation, and medication (growth hormones or antibiotics)
Assessment; use I PREPARE” to determine current & past environmental exposures
I: Investigate: potential exposures
P: Present work: exposures, use of personal protective equipment, location of safety data sheets (SDSs), hazardous materials brought home from work on clothing, trends
R: Residence: age of home, heating, recent remodeling, chemical storage, water
E: Environmental concerns: air, water, soil, industries in the neighborhood, waste site or landfill nearby
P: Past work: exposures, farm work, military, volunteer, seasonal, length of work
A: Activities: hobbies, activities, gardening, fishing, hunting, soldering, melting, burning, eating, pesticides, alternative healing/medicines
R: Referrals and resources: Environmental Protection Agency, Agency for Toxic Substances & Disease Registry, Association of Occupational and Environmental Clinics, SDS, OSHA, local health department, environmental agency, poison control
E: Educate: risk reduction, prevention, follow-up
à National Health Care Goals
REDUCE
- Toxic air emissions, Waterborne disease outbreaks, Per capita domestic water use, Blood lead levels in children, Pesticide exposures requiring visits to a health care facility, Indoor allergen levels, U. homes with lead-based paint or related hazards, Exposure to chemicals and pollutants, Risks posed by hazardous sites, Number of new schools near highways, Global burden of disease due to environmental concerns
INCREASE
Use of alternative modes of transportation for work, Number of days that beaches are open and safe for swimming, Recycling of municipal solid waste, Testing for presence of lead-based paint in pre-1978 housing, Monitoring for diseases or conditions caused by environmental hazards, Homes with radon mitigation (those at-risk) and radon-reducing features, Schools with policies/practices to promote health and safety, Presence/use of information systems related to environmental health
à Nursing Interventions
Primary Prevention
INDIVIDUAL; educate to reduce environmental hazards
COMMUNITY; educate groups; advocate for safe air & water; support programs for waste reduction; advocate for waste reduction & management
Secondary Prevention
INDIVIDUAL; survey for health conditions that can be r/t environmental & occupational exposures; obtain environmental health histories; monitor workers for levels of chemical exposure at job sites; screen children 6mo-5yr for blood lead levels
COMMUNITY; survey for health conditions r/t environmental and occupational exposure; assess neighborhoods, schools, work sites, & community for hazards
Tertiary Prevention
INDIVIDUAL; refer homeowners to lead abatement resources; educate clients w/ asthma about triggers
COMMUNITY; Become active in consumer & health-related orgs & legislation r/t environmental health issues; Support cleanup of toxic waste sites & removal of other hazards.
Private Funding; - Health maintenance organizations (HMOs): Comprehensive care is provided to members by a set of designated providers. - Preferred provider organizations (PPOs): Predetermined rates set for services; financial incentives are in place to promote use of PPO providers. - Medical savings accounts: Untaxed money put in an account for use for medical expenses.
Self-Pay
Chapter 3; Epidemiology & Communicable Diseases
Epidemiology; study of health related trends in populations for purpose of disease prevention, health maintenance & health protection
Epidemiological triangle ; Epidemiology involves the study of the relationships among an agent, host, and environment, interaction determines the development and cessation of communicable diseases, as they form a web of causality, which increases or decreases the risk for disease.
- The agent is the physical, infectious, or chemical factor that causes the disease.
- The host is the living being that an agent or the environment influences
- The environment is the setting or surrounding that sustains the host.
Epidemiological calculations; provide numerical info about impact of disease & death on populations & aggregates
- Incidence & Prevalence Rates; used to measure the existence of a particular disease and allow the nurse to compare the rate of disease in one population to another
- Mortality Rates; Provide information about cause of death; overall death rates ( crude mortality rate ), deaths from specific causes ( cause‐specific rate , case fatality rate ), deaths at specific times across the lifespan ( infant mortality ratio , age‐specific rate ).
- Attack Rates; A disease or condition is endemic when there is a moderate, ongoing occurrence in a given location; # of exposed that develop disease ÷ total number of exposed people - Epidemic: rate of disease exceeds usual (endemic) level of the condition in a defined population. - Pandemic: Condition occurs when an epidemic occurs in multiple countries or continents.
Communicable Diseases - Leading causes of communicable disease deaths; acute respiratory infections (including pneumonia and influenza), HIV/AIDS, diarrheal diseases, tuberculosis, malaria, and measles. - Populations at risk; young children, older adults, immunocompromised, high risk lifestyle, international travelers, healthcare workers
Modes of Transmission; Vertical (parent-child) or Horizontal (person/object -person)
Airborne: particles transmitted by air via droplets or particles; (Measles [airborne isolation precautions], Chickenpox [airborne isolation precautions], Tuberculosis (pulmonary or laryngeal) [airborne isolation precautions], Pertussis [droplet isolation precautions], Influenza [droplet isolation precautions], Severe acute respiratory syndrome (SARS) [droplet isolation precautions])
Foodborne
- Food infection (bacterial, viral, parasitic infection of food); (Norovirus, 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)
Waterborne: fecal contamination of water; Cholera, Typhoid fever, Bacillary dysentery, Giardia lamblia
Vector-borne: via a carrier, i., mosquito or tick; (West Nile virus, Lyme disease, Rocky Mountain spotted fever, Malaria) - Direct contact: Sexually transmitted infections: (HIV/AIDS, chlamydia, gonorrhea, syphilis, human papilloma virus (HPV), genital herpes, hepatitis B, C, D), Infectious mononucleosis, Enterobiasis (pinworms), Impetigo, Lice, scabies
Defense Mechanisms
Herd immunity: Protection due to the immunity of most community members making exposure unlikely
Natural immunity: Natural defense mechanisms of the body to resist specific antigens or toxins
Acquired immunity: Develops through actual exposure to the infectious agent
Active: Production of antibodies by the body in response to infection or immunization with a specific antigen
Passive: Transfer of antibodies to the host either transplacentally from mother to newborn or through transfusions of immunoglobulins, plasma proteins, antitoxins
Nationally Notifiable Diseases
Anthrax
Botulism
Cholera
Congenital rubella syndrome (CRS)
Diphtheria
Giardiasis
Gonorrhea
Hepatitis A, B, C
HIV infection
Influenza-associated pediatric mortality
Legionellosis/Legionnaires’ disease
Lyme disease
Malaria
Meningococcal disease
Mumps
Pertussis (whooping cough)
Poliomyelitis, paralytic
Poliovirus infection, nonparalytic
Rabies (human or animal)
Rubella (German measles)
Salmonellosis
Severe acute respiratory syndrome- associated coronavirus disease (SARS-CoV)
Shigellosis
Smallpox
Syphilis
Tetanus/C. tetani
Toxic shock syndrome (TSS) (other than Streptococcal)
Tuberculosis (TB)
Typhoid fever
Vancomycin-intermediate and vancomycin-resistant
Viral hemorrhagic fever
Staphylococcus aureus (VISA/VRSA)
Data Collection - Informant Interviews; direct discussion w/ community members - Strengths; minimal cost, participants serve as future supporters, insight into beliefs/attitudes members, reading/writing not req, personal interaction - Limits; built in bias, meeting time & place - Community Forum; open public meeting - Strengths; opportunity for community input, minimal cost - Limits; difficult finding time/place, potential to drift from issue, challenge to get adequate participation, less vocal may be reluctant to speak - Secondary Data; use of existing data to assess a problem - Strengths; database of prior concerns/needs, ability to trend health issues over time - Limits; data may not represent current situation, time consuming - Participant Observation; observation of formal/informal community activities - Strengths; indication of community priorities, environmental profile, identification of power structures - Limits; bias, time consuming, inability to ask participants questions - Focus Groups; directed talk w/ representative sample - Strengths; participants potential supporters, insight into community support, participant reading/ writing not req - Limits; discussion of irrelevant issues, challenging to get participants, req. strong facilitator, difficult to ensure sample represents community, time consuming to transcribe - Surveys; specific questions asked in written format - Strengths; data collected on population & problems, random sampling, written or online, contact not req - Limits; low response rate, expensive, time consuming, possible collection of superficial data, req. reading/wring of participants - Windshield Survey; assesses several community components by driving through a community - Strengths; descriptive overview of community - Limits; need for driver, time consuming, results based only on visualization - Survey Components; People, Places, Housing, Social Systems
Community Health Diagnoses
Community Health Education - Learning Theories - 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 - Critical theory: Use of ongoing discussion and inquiry to increase learners’ depth of knowledge, thereby changing thinking and behaviors - Developmental theory: Use of techniques specific to learners’ developmental stages to determine readiness to learn, and to impart knowledge - 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 - Social learning theory: Links info to beliefs and values to change or shift learners’ expectations - Domains of Learning - Cognitive domain: Involves knowledge and the development of intellectual skills; for example, a client discusses how sodium intake will affect blood pressure. - Affective domain: Involves a change in attitude and development of values; for example, a client expresses acceptance of having a colostomy and maintains self- esteem. - Psychomotor domain: Involves the performance of a skill; for example, the community nurse teaches a client how to self-administer insulin.
Chapter 5; Practice Setting & Nursing Roles in the Community
Practice Settings - Public Health; employed at federal, state & local levels - Purpose; impact health of population through disease prevention, health promotion, & actions that protect health - Home Health; provide health care services to where client lives, includes assisted living & nursing homes - Omaha System Model; used under home health & hospice to implement the nursing process - Collect & assess data - State problem - Identify admission problem rating using problem classification scheme - Planning & intervening - Rerating problems during care & at discharge - Evaluate end problem outcome - Hospice; focuses on enhancing quality of life through provision of palliative care, supporting client & family through dying process & providing bereavement support following death - Comprehensive care for the terminally ill; no curative treatment given; control of s/s of problem & dying process is priority; nurse may work w/ family up to 1 year following pt. death - Occupational Health; healthcare in the workplace seeks to promote health and prevent occupational illness & injury - Assess risks for work related illness & injury, Plan & deliver health & safety services in workplace, Collab w/ community health providers, facilitate health promotion activities - Nursing Responsibilities - Primary Prevention; Teaching good nutrition and knowledge of health hazards, and providing information on immunizations and use of protective equipment - Secondary Prevention; Identifying workplace hazards, early detection through health surveillance and screening, prompt treatment, counseling and referral, and prevention of further limitations - Tertiary Prevention; Restoration of health through rehabilitation strategies and limited-duty programs
- Screening & Prevention CHILDREN; height & weight, vision & hearing, dental health, immunization status, lead exposure, cholesterol & triglyceride levels
ADOLESCENTS; height & weight, vision & hearing, dental health, Rubella serology & immunization hx, substance use disorders, mental health screenings, cholesterol & triglyceride levels
- National Health Goals CHILDREN ADOLESCENTS ̄ dental caries, obesity, infant mortality, ̄ violent crimes, use of substances, secondhand smoke deaths r/t MVA newborn blood spot screening & follow up, schools w/ breakfast program, access to medical home, schools that require participation of extracurriculars, health education, childhood immunizations, wellness checkups, physical activity use of child safety restraints, physical activity, number of breastfed infants
Adults - Health Concerns & Leading Causes of Death - Heart disease, DM, mental health, STI, Colorectal Cancer MEN; unintentional injury, ED, WOMEN: Reproductive (childbearing, Malignant neoplasm (testes, prostate) menopause, preconception counseling Malignant neoplasm (breast, cervix, ovaries) - Screening & preventative - BP, Cholesterol (45-65), Fecal occult blood test/sigmoidoscopy (50+), DM, HIV, Skin cancer MEN; DRE, PSAT WOMEN: Pap, mammogram, breast exam, rubella serology & vax hx (childbearing years) - National Health Goals ̄ bone disease, cancer death, sexual violence, HIV/AIDS, fatal & nonfatal injury, unplanned pregnancy, xs alcohol/tobacco use contraception, early & adequate care for pregnant clients, ability to identify warning signs of heart attack & stroke, abstinence from alcohol, nicotine, & substance among pregnant clients
Older Adults
- Fastest growing aggregate in US; 1/3 of prescribed medications; Most have at least 1 chronic health condition
- National Health Goals ̄ number w/ mod-severe functional limitations, hospitalizations r/t HF, inappropriate medicine use, hospitalization r/t pressure injuries, ED visits r/t falls use of preventive services, use of “welcome to Medicare benefit”, info to public r/t elder abuse, neglect & exploitation, physical activity among reduce physical or cognitive fxn, access to DM self- management benefits, professionals w/ geriatric certifications
Families - Approaches; Family as a... - Component of society; monitors how family’s interact w/ other institutions (schools, medical facilities); used to study & implement population focused interventions - System; studies how interactions among family members affect entire family; used to promote family health by directing intervention towards how family member interact
- Client; examines family unit functioning first then individual needs; used to determine how family health s impacted by each members reaction to health event
- Context; focuses on individual first then family; used to promote health & recovery of a member using family as a resource for service & support
- Crisis & 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.
- Family Health Risk Appraisal
- Biological Health Risk Assessment; Genograms used to gather basic info, relationships w/in family, & health and illness patters, enhanced family tree
- Environmental Risk; Ecomaps used to identify family interactions with other groups and organizations; provides info about families support groups
- Behavioral Risk; info gathered about families health behavior, including health values, health habits, & health risk perceptions
- National Health Goals ̄ barriers to access, allergens w/I home, families unable to have child or maintain pregnancy, passive smoke exposure, hunger, intimate partner violence positive parenting, Health education, home testing for radon, health insurance coverage, individuals w/ PCP
Chapter 7; Care of Specific Populations
Violence - Types - Homicide; often r/t substance abuse; most often committed by someone the victim knows or during argument; often preceded by violence inn families; rates among adolescents - Assault; males more likely than females to be assaulted; youths at slight increased risk - Rape; often unreported; most often spousal (marital) or acquaintance (date); females more at risk than males, risk in cities, between 8pm-2am, on the weekend, and in the summer - Suicide; highest rates among 45-64 yrs., females more likely to attempt & males more likely to succeed; whites most likely than other ethnic groups - Violence; physical violence occurs when pain or harm results; sexual violence occurs when sexual contact occurs w/o consent; emotional violence includes behavior that minimizes feelings of self-worth or humiliates threatens or intimidates a family member; Neglect- failure to provide physical care, emotional care, education, &/or needed health or dental care - Economic Maltreatment; failure to provide for the needs of a vulnerable person when adequate funds are available; theft or misuse of money or property - Individual Risk Factors for Violence; hx of abuse of exposure to violence, low self-esteem, fear & distrust of others, poor self-control, inadequate social skills, minimal social support/isolation, immature motivation for marriage or childbearing, weak coping skills - Recognizing Potential Child Abuse/Neglect; unexplained injury, unusual fear of nurse or others, injuries/wounds not mentioned in hx, fractures, injuries in various stages of healing, subdural hematomas, genital trauma, malnourishment or dehydration, poor hygiene or inappropriate dress, parents consider “bad child” - Recognizing Potential Older Adult Abuse; unexplained or repeated physical injuries, physical neglect and unmet basic needs, rejection of assistance by caregiver, financial mismanagement, w/drawl & passivity, depression
- Health issues; upper resp disorders, TB, skin disorders (athletes foot, scabies, lice), substance use disorders, HIV/AIDs, trauma, mental health disorders, dental caries, hypothermia & heat related illness, malnutrition à Strategies for Prevention & Assisting
- Prevent from becoming homeless; assist in eliminating contributing factors – refer for mental health therapy & counseling, enhance parenting skills to prevent runaways
- Alleviate existing homelessness; refer for financial assistance, food, & health services
- Prevent recurrence of poverty, homelessness & health problems; advocate & provide effort toward political activity to provide needed services for mental health & homeless
Rural Residency; typically, have < 20k residents; frontier areas < 6 persons/sq mile
- Urban areas 20k-49, 999 w/ larger central cities having 1 mill +
- ̄ population densities linked to ̄ access to care, ̄ health status, & ̄ health seeking behaviors
- Health Status of Rural Residents
- ; infant & maternal morbidity, DM & obesity rates, suicide rates, trauma/injuries from lightening; farm machinery; drowning & boating; snowmobile, ATV, & motorcycle crashes; occupational ass. risks (fishing, mining, construction, agriculture); skin cancer; rates of resp complications from exposures to pesticides & chemicals; risk of stress related health problems * poor mental health
- ̄; likely to seek preventative care, meet physical activity recommendation
- Barriers
- Distance, lack of transportation, unpredictable weather, under/uninsured, shortage of rural hospitals/health care providers
- Priority Needs
- Cancer prevention, mental health care, substance use prevention & treatment, immunization programs, & family planning àNURSING: Assist w/ identifying & applying assistance programs, use cultural competence w/ interventions; establish trusting partnerships w/ key individuals; teach prevention & protection measures for exposure
Migrant Employment; seasonal n& migrant workers often employed in farming; make temp home during employment & may be paying for family to live elsewhere - Agriculture workers NOT covered under common labor laws; Minors ( 12+) NOT covered under child labor act & can work alongside family members even under hazardous conditions - Migrant Health Act; provides funding for migrant health centers which serve 1/5th population
- Health Problems
- Dental disease, TB, chronic conditions, stress/anxiety/mental health, leukemia, iron deficiency anemia, stomach/uterine & cervical cancers, lack of prenatal care, infant mortality rates, STIs, HIV/AIDS
- Issues in Migrant Health
- Food insecurity, inconsistent income w/ yearly cycles of unemployment, poor & unsanitary working & housing, pesticide exposure, less access to dental/mental/pharmacy, unable to afford care, ̄ availability of services, language barriers, discrimination, immigrant status
- Pesticide Exposure
- S/S; headache, dizziness, dyspnea, N/V, abdominal cramping, poor concentration, eye irritation; confusion, irritability, muscle weakness & twitching, nasopharyngeal irritation, rash
- Complications; cancer, reproductive problems, Parkinson’s, liver damage, behavioral issues; Impaired fetal development w/ pregnancy (even from secondary exposure)
Veterans; Veterans Health Admin (w/in VA) responsible for purchasing coverage & delivering healthcare; Nation’s largest integrated health care system - Health Issues - Mental health, substance use, suicide, infectious disease, exposure to herbicides/chemicals/radiation, TBI, SCI, traumatic amputations, cold injury, military sexual trauma, hearing & visual impairments - Strategies for Veteran Health Care - Coordinate referral to resources; Advocate for strengthening health care system; Assist w/ transition; Ensure continuity of care between acute & outpatient; Develop partnerships w/ local agencies
Disability; factor in body, senses, or mind that affects interaction w/ daily environment
- ADA initial legislation to promote rights for disabled
- Individuals w/ Disabilities Education Act (IDEA); promoted rights of disabled children & their parents; ensures free public education & accommodations to prepare for independent living, assists w/ funding of education, & evaluates effectiveness of education
- Effects of Disability
- Cost of chronic management, poverty, isolation & self-image issues, altered family roles, risk of abuse
- ̄ employment rates, household income, opportunity for physical activity, ability to live independent àNURSING: primary prevention to prevent disability; identify disability & chronic diseases early; connect clients w/ resources to promote maximum self-care ability connect families w/ respite care & counseling; advocate; ensure public buildings are accessible; implement programs to QOL
Other At Risk Populations - Immigrant; often have waiting period for financial assistance for medical care; unauthorized only eligible for vaccines, school lunch, tx for communicable disease, & emergency care - Refugees; eligible for Temporary Assistance for Needy Families, Medicaid & SSI - Pregnant Adolescents; limited education & job opportunities; risk of poverty, homelessness, school problems, violence, malnutrition, low birth weight & premature babies - Incarcerated; risk of mental health disorders, rape/assault, rates of chronic disease - Sexual or Gender Minorites; face barriers to adequate healthcare; risk of psychosocial distress & substance use disorders; health disparities include poorer mental health, risk for disability - National Health Goals; survey & monitoring systems, health insurance coverage, amount of people w/ routine health care providers; ̄ bullying, amount of people who experience major depressive episodes, adult tabaco & illicit drug use
- Disaster RECOVERY; begins when danger no longer exists & needed representatives & agencies
are available to assist w/ rebuilding; last until economic & civil life of community restored (may take
days- years)
- Communicable disease and sanitation controls are important aspect of recovery
- PTSD & delayed stress reaction (DSRR) common during aftermath à Phases of Emotional Reaction During a Disaster
- Heroic; intense excitement & concern for survival; often rush of assistance from outside area
- Honeymoon; affected individuals begin to bond & relive experience
- Disillusionment; responders can experience depression & exhaustion; contains unexpected delays in receiving aids
- Reconstruction; adjusting to new reality & continued rebuilding of area; counseling may be needed; affected begin looking ahead àNURSING; DISATSER RECOVERY; make home visits & reassess health care needs, provide & coordinate care in shelters, provide stress counseling & assess for PTSD or DSR & make referrals
Bioterrorism - Agents of Bioterrorism - Category A; Highest priority agents; pose risk to national security; easily transmitted w/ high mortality rates i., smallpox, botulism, anthrax, tularemia, viral hemorrhagic fevers (Ebola), plague - Category B; Second highest priority; moderately easy to disseminate; high morbidity rate & low mortality rates i., typhus fever, ricin toxin, diarrheagenic E coli, west Nile virus - Category C; Third highest priority; emerging pathogens that can be engineered for mass dissemination as they are easy to produce &/or have potential for high morbidity & mortality rates i., hantavirus, influenza, TB, rabies
Bioterrorism Incidents - Inhalation anthrax - S/S; headache, fever, chills, muscle aches, chest discomfort, severe dyspnea, shock - Prevent; vaccine for high risk; Cipro & Doxycycline following exposure - TX; Antitoxin & IV ABX w/ 2+ antimicrobial agents - Botulism - S/S; double/blurred vision, slurred speech, difficulty swallowing, progressive muscle weakness, difficulty breathing - Prevent; NONE, no approved vaccine - TX; airway management, mechanical vent, antitoxin; Eliminate toxin (vomiting, enemas, sx excision of wound tissue); Support (nutrition, fluids, prevent complications) - Smallpox - S/S; sudden onset, high fever, fatigue, head & body ache; rash (2-4 days after fever)begins on face & tongue then quickly spreads to trunk/arms/legs then hands/feet then turns to pus filled lesions that are all in same stage of development and do not collapse when punctured - Prevent; vaccine for high risk (10 yrs. immunity), can be given w/in 3 days exposure; contact & airborne precautions - TX; No cure; Support (hydration, pain, antipyretics, ABX for secondary infections) - Ebola; transmitted via contaminated body fluid of those exhibiting s/s of infection - S/S; fever, severe HA, joint & muscle weakness, fatigue & weakness, hemorrhage, V/D, shock
- Prevent; No vaccine; droplet & contact precautions; prevent contact w/ semen of previously infected client for up to 3 months following recovery
- TX; Support (IV fluids, dialysis, airway, counseling); minimize invasive procedures
- Plague
- S/S; forms can occur separate or in combo Pneumonic plague; fever, HA, weakness, PNA w/ SOB, chest pain, cough, bloody or watery sputum Bubonic plague; swollen tender lymph nodes, fever, HA, chills, weakness Septicemic plague; fever, chills, weakness, prostration, abdominal pain, shock, DIC, gangrene of nose & digits
- Prevent; vaccine no longer available in US; contact precautions until decontaminated if exposed to bubonic plague; droplet precaution until 72 hr. after ABX if exposed to pneumonic
- TX; Gentamicin & fluroquinolones
- Tularemia
- S/S; sudden fever, chills, HA< dizziness, diarrhea, muscle aches, joint pain, dry cough, progressive weakness; if airborne life threatening PNA & systemic infection
- Prevent; vaccine under review by FDA not currently available
- TX; Streptomycin or gentamycin; in mass casualty doxycycline or cipro
à NURSING; participate in planning & prep for immediate erespine; identify potential biological agents; survey for and report bioterrorism activityType equation here. - Assess Threat; is the population at risk for sudden high disease rates? Is the normal vector for disease available in the affected area? Is there a potential delivery system w/in community? - Recognize Bioterrorism Event; Is there a rapidly increasing disease rate w/in normally healthy population? Is disease occurring that is unusual for area? Is endemic occurring that is unusual for time? Large number of people dying w/ same s/s? Unusual number of dead/dying animals? - Levels of Prevention - Primary; Bioterrorism planning - Secondary; Early recognition - Tertiary; Rehab of survivors
Chapter 9; Continuity of Care
- Transition from acute to outpatient setting; CHN use technology to maintain continuity of care
- CHN should facilitate the development of partnerships w/in the community as they are important to attaining collaborate health out comes
- Examples of Partnering Entities; individuals, families, community agencies, civic orgs, citizen groups, educational setting, political offices, employment bureaus
- Characteristics of Successful Partnerships; Shared power & goals, integrity, flexibility, negotiation
Referrals, Discharge Planning, & Case Management - Consultations; consultants have specialized knowledge and provide expert advice, services, or info àNURSING; serve as expert witness in legal proceeding, serve as consultant r/t healthcare needs of individuals families, & groups w/in community, coordinate recommendation from multiple consultants to ensure client safety, incorporate recommendation from a consultant into clients plan of care, request expert opinions of community members & agency leader, - Referrals - Steps; engage in working relationship; establish criteria for referral, explore resources; accept clients decision to use given resource; make referral; facilitate referral; evaluate outcome
ATI Community Health Nursing Review
Course: Personal and Community Health (KIN 235)
University: University of Miami
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