Environmental and Global Health; End of Life Care Flashcards

Question

Emerging and Reemerging Diseases

Answer 1

Influenza Ebola Hepatitis C West Nile Severe Acute Respiratory Syndrome (SARS) HIV/AIDS

Answer 2

No longer being trained for one setting Nurses are mobile, and change is daily Global health approach teaches nurses to: - View things from many angles - Work collaboratively - View health globally Worldviews are: - Full of contradiction - Diverse - Open to opportunities to make a difference Key role of nurses now is education on a global basis Assessment for health literacy - Implementation - Intervention - Prevention - Evaluation

Answer 3

Infectious Respiratory Disease - Bacterial or viral - Many preventable through vaccination Malaria - Preventable - Primarily results from exposure that occurred during travel abroad HIV and AIDS - Higher among persons 25 to 44 - African American - Hispanic - Men - On the rise in older adults Diarrheal Disease - Leading cause of death among children below the age of five - Fecal-oral route most common route for transmission - Transmission is usually waterborne, foodborne, or through person-to-person contact

Answer 4

Emerging Disease - One that has appeared in the population for the first time or that may have existed previously but is rapidly increasing in incidence or geographic range - Some have been eradicated or close to eradication - New diseases emerging at a rate of one per year - Severe ARS, West Nile, Ebola, Zika, COVID Reemerging diseases - Malaria, TB, bacterial pneumonia, polio in Alabama

Answer 5

Three key components are needed in the transmission cycle - Agent - Host - Environment Other parts of transmission include: - Reservoir: where agent resides - Mode of Transmission: the method through which the agent leaves its reservoir and enters its host. - Life Cycle of an Infectious Agent Agent -> Reservoir -> Portal of Exit -> Mode of Transmission -> Portal of Entry -> Susceptible Host

Answer 6

Passive Immunity - Short-term resistance - May be acquired naturally (maternal antibody transfer) Active Immunity - Long-term - Occurs naturally when a person contracts a disease - Artificial: vaccine

Answer 7

Involves conducting a systematic epidemiological investigation into the sudden increase in the incidence of communicable disease Public health’s goal is to gather enough information so that measures can be put in place to halt the spread of disease

Answer 8

- Point Source: the source of the exposure happened at one point in time - Continuous source: the exposure is ongoing - Intermittent source: exposure comes and goes

Answer 9

Not all diseases caused by an infection are communicable The communicability of an agent is based on the transmission of the infection from one person to another Breaking the cycle: - Prevention - Immunization - Surveillance - Outbreak Investigation: An outbreak investigation, related to CDs, involves conducting a systematic epidemiological investigation into the sudden increase in the incidence of a CD.

Answer 10

Care Team Member - Majority inpatient care setting - Can be facilitated at home or at LTACs Goals of Care - Importance to patient Quality of Life Focus - Physical, Social, Spiritual, and Psychological *Palliative care focuses on expert assessment and management of pain and other symptoms, assessment and support of caregiver needs, and coordination of care. *Palliative care attends to the physical, functional, psychological, practice, and spiritual consequences of a serious illness. *It is a person- and family-centered approach to care, providing people with serious illness relief from the symptoms and stress of an illness. *Through early integration into the care plan for the seriously ill, palliative care improves QOL for the patient and the family. *Can pursue curative treatment *Any age at any stage of serious illness

Answer 11

Care Team Member - All different care settings - Home assisted living, LTACs, inpatient or hospice house Goals of Care: - Maintain at what state they are - Support patient and family through dying process/bereavement process Comprehensive Care Principles - “Normal” part of life *Less than 6 months, terminally ill *Hospice is a specific type of palliative care provided to patients with a life expectancy measured in months not years *Hospice teams provide patients and their families with expert medical care, emotional, and spiritual support, focusing on improving patient and family QOL *Supports the patient & family through the dying process and the surviving family through the bereavement process *Provides comprehensive medical and supportive services across a variety of settings *Based on the idea that dying is a part of the normal life cycle *Must forgo curative treatment Requires medical prognosis of 6 months of less

Answer 12

Improve quality of life for patient with serious illnesses Provide emotional, spiritual, physical, and social support to effectively manage symptoms

Answer 13

Traumatic, sudden, usually in ER, hard to handle Ex: Heart attack, MVA

Answer 14

Get diagnosis, then steadily decline over weeks/months Ex: Pancreatic cancer

Answer 15

Lives for years with a chronic disease, then a flare occurs and makes having that chronic illness hard to live with Ex: COPD

Answer 16

Starts out mild, then progresses Ex: Alzheimer’s Disease

Answer 17

- Decline in socialization - Altered mental status - Decreased PO intake - Fatigue - Bedbound - Unable to complete some ADLs

Answer 18

- Oliguria/Anuria - Little to no responsiveness - Terminal Secretions: “death rattle” - “Rally” day or “surge” - Temperature instability - Tachycardia - Near-death awareness

Answer 19

Cool extremities Bradycardia Mottling Terminal secretions: “death rattle” can hear secretions in lungs Apnea/Cyanosis Obtundation: can not wake them up, unresponsive

Answer 20

- Knowledge deficit (don’t know that people that are dying are in pain when they can’t express it) - Pain scales not utilized - Lack of continuity of care - Poor communication within interdisciplinary team - Regulation of controlled substances - Potential of addiction

Answer 21

- Accountability of staff - Length of stay - EMR - Insurance companies - Pharmacy concerns - Limited access to PCPs

Answer 22

- Reluctance to speak up - Cultural concerns - Sensory or cognitive impairment - Perception of complaining and not being a “good” patient - Fear of addiction - Older adults assume it is normal to feel this way

Answer 23

*Team approach *S/S of increasing pain - Look at VS, grimacing, moaning *Medications - Opioids (morphine) and Nonopioids (Acetaminophen) *Side effects - Opioids: Constipation, N/V, pruritus, over-sedating *Effectiveness - IV med: reassess in 15-30 min - Oral: reassess in 1 hour *Can try nonpharm methods

Answer 24

*Infants and children are often undertreated r/t misguided fears of... - Addiction - Belief they do not feel pain due to having underdeveloped nervous systems - Inappropriate knowledge of pham interventions *Physiological indicators (change in HR, BP, O2 sat) may not give accurate picture of pain *Facial grimacing and crying may not be reliable *Withdrawn, irritability, or not engaging with family/healthcare team are more reliable cues *Talk to parents/caregivers!!!

Answer 25

DNR/DNI: Do not resuscitate, do not intubate (don’t have to be together) *Facility Policy - Patient comes with it, it has to be followed by the facility *Legal Guardians - Who can sign it? Patient or legal guardian *Reversal - Legalities, can be done at hospital *Limitations of the order - Varies by state - Varies in whether pt wants resuscitation but not intubation, etc *Family Education/Support - Talk to the family

Answer 26

* Community environmental health assessment: - It is a means by which public health and environmental health professionals and agencies partner with community members, organizations, and each other to identify, prioritize, and address environmental health issues. * One of the most widely used community assessment methodologies is the Protocol for Assessing Community Excellence in Environmental Health (PACE EH) * Communities that have implemented PACE EH consider it to be a successful tool for expanding the capacity of health agencies in essential environmental health services; engaging the community in problem-solving; and implementing action plans that use community resources to reduce health risks. * PACE EH draws on community collaboration and environmental justice principles to involve the public and other stakeholders in: - Identifying local environmental health issues - Setting priorities for action - Targeting populations most at risk - Addressing identified issues

Answer 27

(1) Knowledge of the role environment plays in the health of individuals, families, and populations (2) Ability to assess for environmental health hazards and make appropriate referrals (3) Advocacy (4) Utilization of appropriate risk communication strategies; (5) Understanding of policies and legislation related to environmental health. ANA’s Principles of Environmental Health for Nursing Practice With Implementation Strategies. * Knowledge of environmental health concepts * The Precautionary Principle: use products and practices that do not harm human health or the environment and to take preventive action in the face of uncertainty. * Nurses have a right to work in an environment that is safe and healthy. * Healthy environments are sustained through multidisciplinary collaboration. * Choices of materials, products, technology, and practices in the environment that impact nursing practice are based on the best evidence available. * Approaches to promoting a healthy environment respect the diverse values, beliefs, cultures, and circumstances of patients and their families. * Nurses participate in assessing the quality of the environment in which they practice and live. * Nurses, other health care workers, patients, and communities have the right to know relevant and timely information about the potentially harmful products, chemicals, pollutants, and hazards to which they are exposed. * Nurses participate in research of best practices that promote a safe and healthy environment. * Nurses must be supported in advocating for and implementing environmental health principles in nursing practice.

Answer 28

Epidemiological triangle which describes the relationship between an agent (exposure), host (human), and environment (the complex setting in which agent and host come together) * Environment—that brings agent and host together in the places we live, that is, housing, schools, workplaces, recreational spaces, communities, and, ultimately, the world * Interaction between agent and environment: Environmental assessment determines “Why was the agent present in the environment in such a way that the host could be exposed?” * Interaction between host and environment: Epidemiology determines: “Who was exposed? When? Where? How?” * Interaction between host and agent: Epidemiology determines “What disease?”; Lab identifies/confirms agent

Answer 29

* Built environment: Human-made surroundings created for the daily activities of humans, reflects the range of physical and social elements that make up a community * Poor communities often have a built environment with limited resources, higher pollution, poorer maintenance of buildings, fewer options for outside activities, a smaller selection of goods (including groceries), and limited transportation, all leading to poorer health (e.g., lead poisoning, asthma, cancer)

Answer 30

* The probability that individuals will be adversely affected by a hazardous substance depends on: (1) Its inherent toxicity, that is, ability to cause harm to humans (2) Whether it enters the body and reaches susceptible organs (3) The amount that is present. * Three pathways or routes of entry—ingestion, inhalation, and dermal absorption * Time lags, known as latency periods, can interfere with our ability to identify cause-and-effect links and hamper our ability to anticipate and prevent negative health effects (Cancer develops many years after exposure)

Answer 31

(1) Hazard identification (2) Dose-response assessment: based on experiments that look for a correlation between an increase in harmful effects and an increase in quantity of a substance (3) Exposure assessment: consideration of the level, timing, and extent of the exposure (4) Risk characterization: brings together the information from the first three steps to guide a judgment about the risk of health problems to those who are exposed.

Answer 32

* Carbon monoxide is produced by combustion and is typically encountered in automobile exhaust and home-heating emissions. * Specific metals and pesticides affect many body systems, sometimes accumulating in the body and, because they release over time, perpetuating their effects over a long period of duration. * Lead is stored in the bone, where it can slowly release over time to cause deleterious health effects long after the actual exposure has occurred. - Blood Lead Level: screen for amount of lead in blood * Environmental cigarette smoke contains thousands of chemicals, some of which are associated with cancer.

Answer 33

* Reduce lead in drinking water in homes built before 1986 and other places children frequent. * Remove lead paint hazards from low-income housing built before 1960 and other places children spend time. * Increase enforcement of the federal Renovation, Repair, and Painting (RRP) rule. * Reduce lead in food and consumer products. * Reduce air lead emissions * Clean up contaminated soil * Improve blood lead testing among children at high risk of exposure, and find and remediate the sources of their exposure. * Ensure access to developmental and neuropsychological assessments and appropriate high-quality programs for children with elevated blood lead levels. * Improve public access to local data Fill gaps in research to better target state and local prevention and response efforts.

Answer 34

* Infectious agents such as bacteria, viruses, and other organisms such as rickettsia. * Some molds are known to have effects on the respiratory system and possibly other more systemic outcomes. * Many documented hazards associated with plant and animal contact * Toxic plants and fungi such as poisonous mushrooms and inedible plants * Allergens such as dust mites, cockroaches, and pet dander

Answer 35

* Injurious exchange of energy * Heat and cold, all forms of radiation, noise, and vibration * Physical forms of environmental risk for bodily injury include events such as falls, vehicle crashes, and crush injuries, as well as hazards associated with violence, such as knife or gunshot wounds

Answer 36

Communities and individuals that live in fear or experience stress, panic, and anxiety associated with real or perceived threats are subject to psychosocial conditions that affect not only health and safety but also overall well-being

Answer 37

* Almost all scenarios that pose environmental risks to health combine more than one threat, and these combinations often act synergistically to raise the level of danger. * Noise in the presence of some chemicals may result in what is called ototoxicity. Ototoxicity is damage to the inner ear that results due to exposure to pharmaceuticals, chemicals, and/or ionizing radiation. * Mixing cleaning agents that contain ammonia with others containing chlorine leads to the production of chloramines, which are much more toxic than ammonia or chlorine alone.

Answer 38

* The amount of exposure to an environmental risk varies based on the proximity to the exposure * This reflects two key components of environmental exposure to hazardous substances: time and location. * At the individual level, an environmental exposure assessment begins with time and place. * An assessment should include three components: an exposure survey, a work history, and an environmental history * The exposure survey reviews any exposures past and present as well as exposures for members of the household. * The work history asks about presence of hazardous substances in the workplace, and the environmental history includes potential exposure within the community. * Warm handoff: This is used in health care as a means for transferring care between two members of the health-care team

Answer 39

* Children playing on the ground and floor may spend their time in the most contaminated areas. - Outdoor soil is often contaminated with heavy metals and pesticides, and hand-to-mouth behavior promotes ingestion of both seen and unseen agents. * Children near parents who are washing work clothes may be playing amid toxins that have been carried home as particles from the workplace. * Even toys may pose a risk for exposure to toxins including lead and cadmium. * Children have ingested substances from unlabeled food containers that have been repurposed to hold chemicals or were stored in an easily accessible place such as under the sink. * Children have faster rates of absorption of most toxic substances: the toxic action can be deadlier because children have a higher metabolic rate, a faster rate of cell growth, and less developed immune and neurological systems. * Fetuses affected when a pregnant woman is exposed to toxins (alcohol, environmental tobacco smoke, carbon monoxide) * Breast milk can constitute an ongoing source of ingested toxins because some toxins will transfer from the mother to her milk * In agricultural settings, children and adolescents are at risk of injuries from farm equipment and vehicles with an agriculture-related fatality of someone under the age of 18 * In urban settings, there are often limited spaces where children can play, and available play spaces may have faulty playground equipment, as well as exposure to chemical and biological waste or threats of violence (playgrounds: potential for ingestion of canine roundworms, genus Toxocara, found in the intestines of cats and dogs that are shed in the feces)

Answer 40

* Changes in physical and mental functioning associated with age: Hearing and vision loss, respiratory disease, increased fragility of skin, decreased rates of metabolism, and disorders such as osteoporosis and heart disease. * Older adults experience increased rates of chronic health conditions, accounting for increased vulnerability to environmental health issues * Older adults also have higher body burdens of chemicals that have been absorbed over their lifetimes. Some substances accumulate over time in the body, a process known as bioaccumulation. * These toxic substances are commonly retained in tissues such as bone or adipose (fat) tissue and can become a long-term cause of poor health outcomes including cancer, organ damage (in particular, to the kidneys, heart, and liver), cardiac disease, increased chance of stroke, and neurological, immunological, and hematopoietic disorders. * Lead is stored in the bone with a half-life (time over which only half of the amount is excreted) of more than 20 years. Its slow release over time is reflected by high BLLs that reach and damage target organs * Older adults are more vulnerable with the anticipated increase in extreme weather due to climate change * One of the contributing environmental factors that increases the vulnerability of older adults is a diminished ability to regulate body temperature - Heat wave: adequate cooling, adequate availability of water for hydration, and an effective method of communication are needed - In addition to cold injuries and death that can result from lack of heat, many people use space heaters that use fuel such as kerosene (fire hazard), charcoal or wood burning indoors -> carbon monoxide hazard - Housing codes dictate a minimum temperature that must be achievable if the space is to be legally rented. - City social services, home visiting care, warning systems and emergency cooling centers, monitoring of older adults and isolated persons during an extreme heat or cold event, and improving communication and awareness among city officials and emergency medical services.

Answer 41

* Industry and the need for energy have resulted in the emission of toxic chemicals into the air. * Cities with high dependence on motor vehicles for transport, such as Los Angeles and London, have struggled with severe smog due to emissions from automobiles. * In the 21st century, the continued emission of CO2 has resulted not only in the warming of the climate but a reduction in the quality of the air

Answer 42

* Ambient air is the air surrounding a place or structure and is also referred to as outdoor air. * Poor ambient air quality is associated with increased mortality rates from pulmonary and cardiovascular disease. * Scientists devised a mechanism to evaluate the current air quality called the ambient air standard: refers to the highest level of a pollutant in a specific place over a specific period of time that is not hazardous to humans. * Many outdoor air contaminants originate from major stationary sources, known as point sources: chemical plants, power plants, refineries, and incinerators. * Pollutants may be generated by transportation sources such as buses, trucks, and cars (on-road) and ships, planes, and construction equipment (off-road), all referred to as mobile sources. * Area sources include smaller sources of emission such as gas stations, dry cleaners, commercial heating and cooling systems, railways, and waste disposal facilities such as landfills and wastewater treatment operations. * Clean Air Act (1970): specifies allowable limits, known as the National Ambient Air Quality Standards, for industrial emission of a set of major air pollutants called the criteria air pollutants * These are carbon monoxide, nitrogen dioxide, ozone, particulate matter, lead, and sulfur dioxide.Ground-level ozone and particulate matter are the greatest threats to human health. * One way to evaluate the degree of air pollution in a specific area is the Air Quality Index (AQI). The AQI is computed by the EPA based on measures of the five criteria for air pollutants. Good, moderate, unhealthy for sensitive groups, unhealthy, very unhealthy, and hazardous

Answer 43

* Environmental tobacco smoke, animal dander, cockroaches, and the spores of molds that grow in damp environments. * Many pollutants exist in the home in the form of house dust, which may also be composed of heavy metals, pesticides, gram-negative bacteria, and chemicals such as phthalates. * Chemicals associated with the materials used to build homes, such as formaldehyde, are another concern. * Buildings that are well insulated, tightly sealed for efficient climate control, and lack windows that can be opened by occupants are more likely to retain indoor air pollutants.

Answer 44

* The quality of water is a major determinant of the health of a population. Both organic and inorganic contaminants are associated with adverse outcomes. * Inorganic Water Contaminants - Lead contaminants (Flint) * Globally, a major issue related to potable water is organic contaminants that increase the risk for communicable diseases * The main barriers to the provision of safe drinking water include setting it as a priority, financial capacity, sustainability of the water supply, sanitation, and hygiene behaviors.

Answer 45

* The term epidemic is used when there is a significant increase in the number of cases than would normally occur. * Endemic refers to the usual number of cases of a disease that occur within a population. * Pandemic describes epidemics occurring across the globe.

Answer 46

* Nurses provide care to patients with a CD and also must incorporate preventive measures in their practice, such as the use of personal protective equipment (PPE) and proper cleaning of patient areas to prevent transmission of these diseases. * Understanding of CDs at both an individual level and a population level is essential. * The key is to understand the infectious agents that cause disease, the environment relevant to the transmission of disease from one person to another, and who is at risk for becoming infected

Answer 47

* These diseases are either bacterial or viral. * Many of these diseases can be prevented through vaccination (required for children in public school) such as vaccines for prevention of chickenpox, diphtheria, and rubella. * Some of these diseases are seasonal, for example, influenza (flu) * Flu is seasonal, with a peak in early December and a peak in February. * Because of the higher mortality rate in vulnerable populations such as children, older adults, and those who are already ill, many hospitals require that all employees receive a flu vaccination.

Answer 48

* Malaria is a subtropical disease caused by a parasite transmitted through the bite of an infected female mosquito, often referred to as the “malaria vector” * Malarial infections in the United States are primarily the result of exposure that occurred during travel abroad. In addition, these travelers had not adhered to recommended malaria prophylaxis.

Answer 49

* A person infected with HIV may not develop AIDS until 10 to 15 years after the initial infection. * A negative HIV test within 6 months of the first HIV infection diagnosis is stage 0 and remains 0 until 6 months after diagnosis. * If a stage-3-defining opportunistic illness has been diagnosed, the stage is 3 * Otherwise, the stage is determined by the CD4 test immunologic criteria based on the CDC case definition guidelines. * In the U.S., the prevalence of HIV and AIDS is higher among persons in the 25- to 44-year-old age group, those who are African American and Hispanic, and in men. * Racial disparity is especially apparent in children, with 80% of all pediatric cases being African American or Hispanic * HIV infection is also on the rise among older adults because of increased longevity of those living with HIV as well as an increase in risky behaviors in this age group * Certain behaviors increase the risk for transmission of HIV, including men having sex with men, those engaging in injection drug use, and those engaging in unprotected sex. * UNAIDS 909090: An ambitious treatment target to help end the AIDS epidemic. The three main goals by 2020 were: - 90% of all people living with HIV will know their HIV status. - 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. - 90% of all people receiving antiretroviral therapy will have viral suppression.

Answer 50

* In low-income countries, it is a leading cause of death among children under 5. * The most common route for transmission of diarrheal disease is the fecal-oral route. * Good hand hygiene, especially hand washing, and soap alone can reduce the incidence of diarrheal disease * Efficient sanitary systems and safe drinking water also play a huge role in preventing diarrheal diseases. * Pathogens that cause diarrheal disease include viruses, bacteria, and protozoa. Transmission is usually waterborne (e.g., cholera), foodborne (e.g., Escherichia coli [E. coli]), or through person-to-person contact * Worldwide, rotavirus is the most common cause of diarrheal disease among children. There are now two vaccines available for use with infants.

Answer 51

* In 1889, the National Tuberculosis Association (now the National Lung Association) realized that TB was preventable and not inherited. Since that time, prevention efforts have resulted in a steady downward trend in the incidence and prevalence of TB * Between 1988 and 1992, five clusters of TB cases appeared in six hospitals. What stood out about these cases was that the agent M. tuberculosis had mutated (changed) and was now resistant to drugs used to treat active TB (MDRTB). * With HIV, TB does not always present in a classic manner, and diagnosis was delayed in these cases * The case fatality rate (CFR) was high. A CFR is determined by taking the number of fatal cases and dividing it by the total number of cases. * Through careful surveillance of TB, the CDC can determine who is at greatest risk based on numerous factors including race, age, geographical location, and place of birth. * Index case: first case identified in a particular outbreak. * Secondary cases: patients who were diagnosed with active TB and who had contact with the index patient.

Answer 52

* The term agent or pathogen refers to the infectious organism that causes the disease such as a virus or bacteria * Bacteria: Bacterial meningitis, Anthrax Bubonic plague, Tuberculosis, Streptococcal infections * Rickettsia (bacteria): Typhus, Rocky Mountain spotted fever * Viruses: HIV, common cold Influenza * Mycoses (fungi): Candida, Histoplasmosis, Fungal meningitis * Protozoa: Malaria, Giardia, Toxoplasmosis, Trichomoniasis * Helminths (parasitic worms): Hookworm, Pinworm, Trichinosis * Arthropods (ticks, fleas, mosquitoes, lice): Malaria, Dengue fever, Lyme disease, Bubonic plague * Infectivity: reflects the capacity of an agent to enter and multiply in the host. * Pathogenicity: which is the capacity of the agent to cause disease in the human host * Toxigenicity: reflects the pathogen’s ability to release toxins that contribute to disease within the human host * Virulence: the ability of the pathogen to cause disease * Antigenicity: the ability of the agent to produce antibodies in the human host

Answer 53

The environment refers to the conditions external to the host and the agent associated with the transmission of the agent. * The first of these is the reservoir, or where the agent resides: Animals, humans, water (waterborne diseases), food (foodborne diseases), and the air (airborne diseases). * Carrier: human who is infected but who has no outward signs of disease. * Incubating carrier: someone who has been infected but has not yet shown signs of the disease * Inapparent carrier: someone who is infected but does not develop the disease, yet continues to shed the agent * Convalescent carrier: a person who is infected but who no longer shows signs of acute disease * Chronic carrier: remains infected with the agent with no sign of disease for a long period of time.

Answer 54

The method through which the agent leaves its reservoir and enters its host. * Transmission can occur through water, food, air, vectors, fomites, unprotected sexual contact, or penetrating trauma * Vectors: usually insects that carry the disease from the reservoir to humans without becoming ill themselves * Fomite: an inanimate object. An infected host touches the object and sheds the agent onto the object. The agent is then transmitted to the next person who touches the object. * Aerosol or airborne transmission: The agent is contained in aerosol droplets and is transferred from one human to another or animal to human. * Oral transmission: The agent is transferred through food or water. * Zoonotic transmission: The agent is transmitted directly from animals to humans. * Person-to-person transmission: The agent is transmitted through direct contact between persons, usually through contact with mucous membranes, blood, or saliva.

Answer 55

* The life cycle of the agent or the vector provides added information on the transmission of an infectious agent, including how the agent exits its reservoir (portal of exit), the mode of transmission (water, vector, fomite, etc.), and how the agent enters the host (the portal of entry). * The agent that causes TB primarily infects the lungs; the portal of exit is coughing. The action of coughing expels the agent from the reservoir (human) into the air. The agent has now left its reservoir and is contained in the droplets expelled from the lungs. The mode of transmission is through the air, so TB is considered an airborne disease. The portal of entry for TB is almost always through the host’s respiratory system.

Answer 56

* The host is the human who is at risk for disease due to exposure to the agent. * The main characteristic is the susceptibility of the host, that is, the likelihood of becoming infected with the agent. * This is expressed in terms of the host’s immunity, or resistance to the disease. Humoral immunity means that the host carries antibodies to the agent in the blood, and cellular immunity is specific to each type of cell. * When a person has passive immunity, immunity is transferred from one individual to another. - Lasts a short time. - Natural: mother to infant. - Artificial: transfer of antibodies * Active immunity is acquired through exposure to the agent. - It is long-lasting and can last for life, as when a person who had mumps as a child remains immune for the rest of his life. - Artificial: vaccine * Inherent resistance. This is the ability of the host to resist the disease independent of antibodies * Colonization: a person is infected with the agent but has no signs of infection. Colonized hosts are able to spread the disease despite not being apparently ill.

Answer 57

Interventions can be aimed at any point in the cycle of transmission * Eradicating the vector: pesticides * Blocking mode of transmission: mosquito nets * Reduce susceptibility of host: vaccination

Answer 58

* An outbreak investigation, related to CDs, involves conducting a systematic epidemiological investigation into the sudden increase in the incidence of a CD. * Investigators seek to identify who got sick, what made them sick, when they got sick, and at what point it happened. * The public health team’s goal is to gather enough information so that measures can be put in place to halt the spread of disease. * These facts are essential to determine what is the best action to take to break the chain of transmission and prevent further spread of the disease to uninfected members of the population. * An epidemic curve is constructed by plotting on a graph the number of cases (y-axis) based on the date of onset (x-axis) * Point source: the source of the exposure happened at one point in time * Continuous source: the exposure is ongoing * Intermittent source: exposure comes and goes

Answer 59

* Transmission can occur from the reservoir directly or indirectly. * Person-to-person contact is an example of direct transmission and occurs with sexually transmitted infections (STIs) * Indirect transmission occurs when the agent leaves the reservoir and is transferred to the human host through an indirect means such as a vector or in the case of fomite transmission. * Generation time: the interval between infection with the agent and the maximum time that the host is infectious, that is, the communicability of the host. * Community or herd immunity: refers to the immunity of a population to an agent. If a large portion of the population is immune (by vaccine or past infection), that can prevent the spread of the disease to persons in the population who do not have immunity. * Attack rate: a type of incidence rate; it is calculated using the number of persons who are ill divided by the total number of the population. This is multiplied by a constant (usually 100) and expressed over a certain time period. * Secondary attack: dividing the number of new cases in a particular group minus the initial case(s) by the number of susceptible persons in the group minus the initial case(s). This is multiplied by a constant (usually 100).

Answer 60

The main focus is to control the spread of disease * (1) Changing the environment - Can involve altering or eliminating the reservoir, controlling the vector, applying personal measures of hygiene, and using aseptic technique. * (2) Inactivating the agent - Includes the use of physical and chemical agents (heat, refrigeration) * (3) Increasing host resistance - Vaccine refers to the immunizing agent used to increase the host’s resistance to viral, rickettsial, and bacterial diseases. - In the United States, children routinely receive a series of vaccines that protect against measles, mumps, diphtheria, poliomyelitis, and rubella

Answer 61

* A noncommunicable disease (NCD) is a disease that is not passed from one person to the next through direct or indirect means and is not associated with an infectious agent. * Chronic disease: refers to either communicable diseases such as AIDS, or NCDs such as diabetes that have a long duration and usually slow progression, require medical attention over time, and/or limit the ability to perform activities of daily living (ADLs) * According to the WHO there are four main categories of NCDs: cardiovascular diseases (CVD), cancers, chronic respiratory diseases (CRD), and diabetes. * Nurses in all settings play an important role in prevention of NCDs across the continuum of prevention through primary-, secondary-, and tertiary-level interventions.

Answer 62

* The majority of NCDs cannot be prevented or cured through vaccination or medication; rather, they require maintaining a healthy lifestyle, early diagnosis and treatment, and long-term management. * The care of NCDs is moving away from an acute care model to a chronic care model in which the disease is managed over time and the focus is decreasing morbidity and mortality associated with NCDs * Care of an existing NCD should be provided within a secondary and tertiary prevention framework that focuses on early detection and treatment as well as a long-term plan of care aimed at reducing morbidity and mortality

Answer 63

* Mortality rates are used to estimate the life expectancy of a group of people. * Life expectancy is defined as the number of years a person could be expected to live based on the current mortality rates in a specific setting, usually a country. * Health-adjusted life expectancy (HALE) reflects the average number of years that a person can expect to live in good health by adjusting for disease and/or injury. * The WHO uses HALEs to measure the average level of health in countries and regions by evaluating population-specific prevalence of disease and injury as well as severity distribution of health states.

Answer 64

* NCDs often lead to premature death, that is, a death that occurs earlier than the standard life expectancy. * Therefore, premature death reflects the number of potential life years lost. * Premature death is usually expressed as the years of potential life lost (YPLL). * YPLL is calculated by subtracting the age at which a person dies from their expected life expectancy * From a population perspective, premature death is calculated based on the number of potential life years lost prior to the life expectancy of the population per 100,000 persons

Answer 65

* In addition to premature death, most NCDs lead to disability that can affect an individual’s quality of life and productivity. * A method for quantifying the burden of disease that takes into account both premature death and disability is called the disability-adjusted life year (DALY). * This is defined as measurement of the gap that exists between the ideal health status of a disease- and disability-free population that lives to an advanced age * DALY = YLL (Years of Life Lost) + YLD (Years of Life Disabled)

Answer 66

(1) nutrition, (2) physical activity, (3) tobacco use, and (4) alcohol use.

Answer 67

* CVD and stroke are the first and fifth leading causes of death. * Large regional variations in the burden associated with CVD exist across the U.S. with dietary risk exposures being the largest attributable risk factor related to CVD burden of disease * Other risk factors include high blood pressure, obesity, tobacco use, high cholesterol, and low levels of physical activity.

Answer 68

* Second leading cause of death * Public health efforts to promote increased screening for breast and colorectal cancer have resulted in a decrease in deaths because of early detection and screening, and the length of cancer survival has increased * Tobacco use is the leading risk factor for cancer with Lung cancer the leading cause of cancer death in both men and women * Family history, diet, exercise, reproductive history, and alcohol use have all been associated with increased risk for breast cancer

Answer 69

* Includes chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases, and pulmonary hypertension * Major risk factor for COPD and other CRDs is tobacco use; others include exposure to air pollutants, chemical fumes, and dust from the environment or workplace.

Answer 70

* Two underlying factors that have contributed to the increase in the incidence of type 2 diabetes are changes in lifestyle, especially exercising and diet * The prevention or delay of the onset of type 2 diabetes can happen through a healthy lifestyle that includes making healthful changes to diet, increasing the level of physical activity, and maintaining a healthy weight.

Answer 71

Nutrition, Exercise, and Obesity: The main risk factors associated with obesity are poor nutrition and lack of exercise. These two risk factors are linked to numerous other factors at the population level, including changes in population behaviors, environmental factors, and socioeconomic factors.

Answer 72

* Pollutants in the environment increase the risk for asthma, cardiovascular health problems, and cancer * Tobacco Use: strongly associated with increased risk for adverse health outcomes including cancer, pulmonary disease, and CVD. The single most preventable cause of morbidity and mortality is the use of tobacco. * Alcohol use: it has the potential to adversely affect health across the life span, including but not limited to injury, breast cancer, hypertension, stroke, liver disease, and brain damage

Answer 73

* Income and social status: Higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health. * Education: Low education levels are linked with poor health, more stress, and lower self-confidence. * Physical environment: Safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. * Employment and working conditions: People in employment are healthier, particularly those who have more control over their working conditions * Social support networks: Greater support from families, friends, and communities is linked to better health. * Culture: Customs and traditions, and the beliefs of the family and community all affect health. * Genetics: Inheritance plays a part in determining lifespan, healthiness, and the likelihood of developing certain illnesses. * Personal behavior and coping skills: Balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health. * Health services: Access and use of services that prevent and treat disease influences health. * Gender: Men and women suffer from different types of diseases at different ages

Answer 74

* Primary prevention focuses on behavioral change with a strong emphasis on healthy eating and exercise. - Population-level primary prevention programs help to change barriers to a healthy lifestyle. - For example, obtaining an adequate level of exercise in an urban setting requires safe streets for walking and/or access to recreational activities. * Secondary prevention efforts are also associated with reduced morbidity and mortality related to NCD, especially screening - Examples of screening programs recommended by the CDC for the prevention of NCDs include mammograms and screening for colorectal cancer * Tertiary prevention efforts aimed at reducing the adverse consequences experienced by a person who has already been diagnosed with a disease. - The goal is to reduce the morbidity and disability associated with the disease and to prevent premature death

Answer 75

* Health-related quality of life (HRQoL) is a multidimensional construct related to the desired physical and psychological health outcomes for most of the interventions that nurses provide to individuals and families. * An evidence-based approach to improving HRQoL for persons with NCD is chronic disease self-management (CDSM). * CDSM is an ongoing process by which individuals with a chronic illness or condition engage in self-management of medications, symptoms, and promotion of their own health, and can be applied to both noncommunicable and communicable chronic disease. * CDSM requires implementation of health-promotion and health protection strategies * Extensive research exists related to the efficacy of patient education programs for specific chronic diseases such as asthma and diabetes

Environmental and Global Health; End of Life Care Flashcards

(99 cards)